Substance use in foster care youth: Relations among maltreatment, use, and coping

描述(由申请者提供)：美国青少年药物使用和滥用是一个严重的公共卫生问题，也是青少年发病率和死亡率的风险因素。对药物使用风险的审查发现，儿童时期的虐待是一个相关因素；研究表明，遭受虐待的青少年比其未受虐待的同龄人更有可能出现药物使用问题。在某些情况下，儿童由于虐待或疏忽而被带离家，最近的研究表明，与普通人群中的同龄人相比，居住在户外安置的青年的物质使用障碍的比率更高。虽然认识到儿童期虐待与随后的药物使用之间的关系，但与虐待后的药物使用行为和其他负面后果的风险和保护有关的途径尚未完全确定。在不良生活事件与随后的行为和情绪结果之间的关系中，一个重要的因素，即应对行为，被认为是有影响的。物质使用和应对之间的联系尚不清楚；许多人假设，物质使用实际上可能是适应不良应对的一个指标。此外，在调查虐待与青少年使用药物之间联系的文献中存在重大的方法学缺陷，包括成年人过度使用关于童年虐待和药物使用的回溯性报告，研究人员没有调查其药物使用或虐待措施的心理测量学特性，排除相关协变量，没有包括各种类型的虐待，如忽视和心理虐待，以及使用小样本。以前对文献的回顾强调了需要注意这些方法问题，并对参加家庭外护理的年轻人进行了更多的研究。为了解决这一差距，本研究将在寄养中心的青少年样本中，全面调查虐待作为物质使用和应对行为预测因子的作用。为了实现这一点，本研究将利用结构方程模型框架来评估相互竞争的适度模型：1)以应对行为为调节变量的虐待预测物质使用的模型，以及2)以物质使用为调节变量的虐待预测应对策略的模型。初步分析将审查物质使用测量的测量模型，以及寄养样本中物质使用的潜在协变量，如儿童和安置特征。模型测试将评估每个缓和模型的整体适合性，然后参与者将从NIH资助的一项更大规模的纵向研究中挑选出来，该研究名为“研究儿童适应和韧性的路径”(SPARK)，将包括150名在杰克逊县寄养中心登记的8岁及以上的儿童和青少年。这项研究提高了对这些因素复杂相互作用的科学认识，将为调查寄养青少年虐待儿童、应对行为和物质使用之间的关系提供一个更全面的模型。 公共卫生相关性：为了更好地了解风险和保护因素之间的复杂关系，该项目试图探索寄养青少年遭受虐待后物质使用和应对的交互影响。鉴于虐待后使用药物的风险增加，这一群体已被确定为研究重点。这项拟议的研究旨在测试应对和药物使用的相互竞争的适度模式，以此作为回答与参加户外护理的高危青年干预和预防的重要因素有关的重要问题的手段。

DESCRIPTION (provided by applicant): Youth substance use and abuse in the U.S. is a critical public health issue and a risk factor for morbidity and mortality in adolescents. Examination of risk for substance use has identified that maltreatment in childhood is a relevant factor; research has indicated that youth exposed to maltreatment are more likely than their non- maltreated peers to have substance use problems. In some cases, children are removed from their homes due to maltreatment or neglect, and recent research revealed higher rates of substance use disorders in youth residing in out-of-home placements when compared to peers in the general population. Although the relation between maltreatment in childhood and subsequent substance use is recognized, pathways related to risk and protection for substance use behavior and other negative outcomes following maltreatment have yet to be fully delineated. One important factor, coping behavior, has been implicated in the relation between adverse life events and subsequent behavioral and emotional outcomes. The association between substance use and coping remains unclear; many have hypothesized that substance use may actually be an indicator of maladaptive coping. Further, significant methodological weaknesses exist in the literature investigating the link between maltreatment and substance use in youth including overuse of retrospective reports by adults about childhood maltreatment and substance use, failure of researchers to investigate the psychometric properties of their measures of substance use or maltreatment, exclusion of relevant covariates, failure to include diverse types of abuse such as neglect and psychological maltreatment, and use of small samples. Previous reviews of the literature have highlighted the need for attention to these methodological issues and more research conducted with youth enrolled in out-of-home care. To address this gap, this study will provide a comprehensive investigation into the role of maltreatment as a predictor of substance use and coping behaviors in a sample of youth in foster care. To achieve this, the proposed study will utilize a structural equation modeling framework to assess competing models of moderation: 1) a model with maltreatment predicting substance use with coping behaviors as a moderator and 2) a model with maltreatment predicting coping strategies with substance use as a moderator. Preliminary analyses will examine the measurement model of the substance use measure, as well as potential covariates of substance use in the foster sample such as child and placement characteristics. Model testing will assess overall fit of each moderation model, then Participants will be drawn from a larger, longitudinal study funded by NIH entitled "Studying Pathways to Adjustment and Resilience in Kids" (SPARK) and will include 150 children and adolescents aged 8 years and older who are enrolled in Jackson County foster care. Improved scientific knowledge of the complex interactions of these factors from this study will provide a more comprehensive model for investigating associations between child maltreatment, coping behaviors, and substance use in foster care youth. PUBLIC HEALTH RELEVANCE: To better understand complex relations between risk and protective factors, this project seeks to explore the interactive effects of substance use and coping following exposure to maltreatment in foster care youth. Given the increased risk for substance use following maltreatment, this population has been identified as a research priority. The proposed study aims to test competing moderation models of coping and substance use as a means of answering important questions related to factors important in intervention and prevention for high-risk youth enrolled in out-of-home care.