Family Intervention for Children and Crack-Using Mothers

描述（由申请人提供）： 这项发展（R21）研究将解决未满足的需求之间的青春期前的青年和他们的非洲裔美国母亲滥用快克可卡因。青少年药物使用和高风险性行为之间的密切联系使非洲裔美国人药物滥用者的青少年儿童成为药物滥用和艾滋病毒的最高风险群体之一。母亲吸毒的社会背景及其与潜在的疏忽和侵略性养育的关联可能会通过对家庭动态的负面影响导致不良的儿童结局。研究表明，家庭因素影响物质使用、艾滋病毒相关风险和长期保护因素。由于缺乏家庭或父母的参与，药物使用和减少艾滋病毒风险干预措施对青年的短期影响可能会随着时间的推移而减弱。针对吸毒母亲、其青春期前子女及其二元互动的选择性家庭技能干预措施可能是预防青少年吸毒和艾滋病毒风险因素贯穿青春期和成年期的更持久的方法。为了打破孕产妇吸毒家庭中潜在的代际吸毒模式和艾滋病毒风险，迫切需要查明这些家庭的儿童面临的风险和保护机制，并调整和测试针对青春期前特别脆弱阶段青年人中这些因素的家庭技能干预措施。由于目标母亲和儿童很难接触和保留在干预措施中，拟议的研究将分两个阶段进行：形成和实验。形成阶段将调整和完善招募和保留战略以及社区投入的干预措施;实验阶段将审查以多成分形式（孕产妇、青年和母婴会议）提供的经调整的家庭技能干预措施的成果，以防止滥用快克且未接受治疗的非裔美国母亲的儿童（10至14岁）滥用药物和艾滋病毒。建议的发展研究的具体目标如下：具体目标：形成阶段。目标1）制定和完善有效的战略，以达到，招募和留住使用快克的非洲裔美国母亲及其子女（10至14岁），进行多方面的家庭技能干预，以防止青少年吸毒和艾滋病毒。目标2）修订，调整和定制相关的家庭干预措施，以减少药物滥用的风险因素，并在使用快克且未接受治疗的非裔美国母亲的目标青春期前儿童（10至14岁）中预防艾滋病毒。具体目标：实验阶段。目的3）描述使用快克且未接受治疗的非裔美国母亲的儿童（10至14岁）的个体、母亲和家族风险和保护因素。目的4）在3个月和6个月的随访中，检查在使用快克的非裔美国母亲及其子女中进行的适用于药物滥用和艾滋病毒预防的家庭技能干预的结果（家庭环境，青年社交技能和问题行为，物质使用和性风险）。目的5）探索中介（例如，母亲和青少年的自我效能，感知风险，和母亲的药物使用）和调节因素（青年年龄，性别，学校表现，宗教信仰）的干预效果的物质使用，性意图和风险行为的儿童的非裔美国人的母亲谁使用快克和没有在治疗。

DESCRIPTION (provided by applicant): This developmental (R21) study will address an unmet need among preteen youths and their African-American mothers who abuse crack cocaine. The strong link between adolescent substance use and high-risk sexual behaviors makes adolescent children of African-American drug abusers one of the highest risk groups for substance abuse and HIV. The social contexts of maternal drug use and its associations with potentially neglectful and aggressive parenting may lead to poor child outcomes through negative influence on family dynamics. Research shows that family factors influence substance use, HIV-related risk, and protective factors in the long term. Short-term effects of substance use and HIV risk-reduction interventions with youth may diminish over time because of the lack of family or parent involvement. Selective family-skills interventions that target drug-using mothers, their preadolescent children, and their dyadic interactions may be a more-durable approach to prevent youth drug abuse and HIV risk factors through adolescence and adulthood. To break potential intergenerational patterns of drug use and HIV risk among families with maternal drug use, there is a critical need to identify risks and protective mechanisms operating for the children of these families, and to adapt and test a family-skills intervention that targets these factors among youths at an especially vulnerable stage of pre-adolescence. Because target mothers and children are hard to reach and retain in interventions, the proposed study will be conducted in two phases: formative and experimental. The formative phase will adapt and refine recruitment and retention strategies and the intervention with community input; the experimental phase will examine the outcomes of the adapted family-skills intervention delivered in a multicomponent format (maternal, youth, and mother-child sessions) to prevent drug abuse and HIV among children (aged 10 to 14 years) of African-American mothers who abuse crack and are not in treatment. The specific aims of the proposed developmental study are as follows: Specific Aims: Formative Phase. Aim 1) To develop and refine effective strategies to reach, recruit, and retain African-American mothers who use crack and their children (aged 10 to 14 years) in a multicomponent family-skills intervention to prevent youth drug abuse and HIV. Aim 2) To revise, adapt, and tailor relevant family interventions to reduce risk factors for substance abuse and prevent HIV among the targeted preteen children (aged 10 to 14 years) of African-American mothers who use crack and are not in treatment. Specific Aims: Experimental Phase. Aim 3) To describe individual, maternal, and familial risk and protective factors in children (aged 10 to 14 years) of African-American mothers who use crack and are not in treatment. Aim 4) To examine the outcomes (family environment, youth social skills and problem behaviors, substance use, and sexual risk) of a family-skills intervention adapted for drug abuse and HIV prevention among African-American mothers who use crack and their children relative to a no-intervention control group at 3- and 6-month follow-ups. Aim 5) To explore mediating (e.g., maternal and adolescent self-efficacy, perceived risk, and maternal drug use) and moderating factors (youth age, gender, school performance, religiosity) of intervention effectiveness on substance use, sexual intentions and risk behaviors among children of African-American mothers who use crack and are not in treatment.