Social Ecology of Maternal Substance Use

说明（由申请人提供）：怀孕是影响流行病学和加强减少妇女吸烟和酗酒的关键机会。如果将戒烟和戒酒资源纳入社区保健服务，并注意在母亲的家庭和朋友网络中获得支持，向孕妇提供戒烟和戒酒资源的机会似乎最大。迄今为止，母体物质使用的生态模型倾向于研究一组有限的社会过程或邻里结构特征，而不是两者兼而有，只关注吸烟，并关注婴儿结果，而邻里对出生结果的影响的研究可能没有包括母体物质使用。将母体物质使用作为结果的语境理论的有限发展是问题的一部分。拟议研究的目的是调查邻里结构方面和社会过程在围产期和幼儿养育期间与母亲饮酒和吸烟有关的作用。具体而言，我们将研究母亲的个体特征（在全国代表性数据集中）与社区社会生态之间的关系，作为母亲长期饮酒和吸烟模式的预测因素。基于2000年人口普查数据的社区社会经济地位和物质剥夺的构建，以及来自当前人口调查-烟草使用补充2000年的社区吸烟率估计，将增强早期儿童纵向调查数据集中丰富的社区社会过程变量集的可用性。我们提出的研究将研究社区结构特征和社会过程如何相互关联，以及个体特征如何相互关联，这些特征是从孕前到幼儿养育期母体物质使用的近似决定因素。与迄今为止的大多数研究不同，我们将应用潜在类别分析和生长混合模型，根据母亲的酒精和烟草使用情况以及个人长期使用轨迹来描述母亲的概况。将审查与这些模式和轨迹相关的个人和社区措施的直接影响。随后，我们将应用潜在变量路径分析来评估个体特征对邻域潜在变量的潜在中介作用，并分析路径分析的结果是否适用于我们样本的不同亚组（适度分析）。研究结果将用于以下三个方面的进一步研究：针对母亲的政策和干预措施、儿童健康结果的研究，以及加强对妇女和儿童健康关键时期的社会进程、结构影响和政策投入的研究。

DESCRIPTION (provided by applicant): Pregnancy is a key opportunity to affect the epidemiology and to enhance reduction of women's tobacco and problem alcohol use. The opportunities to provide pregnant women with tobacco and alcohol cessation resources appear to be strongest when integrated into community-based health services, with attention to generating support in mothers' networks of family and friends. Ecological models of maternal substance use to date have tended to examine a limited set of social processes or neighborhood structural characteristics but not both, to focus on smoking only, and to focus on infant outcomes, while studies of neighborhood effects on birth outcomes may fail to include maternal substance use. The limited development of contextual theory focused on maternal substance use as an outcome is part of the problem. The goal of the proposed research is to investigate the role of neighborhood structural aspects and social processes in association with maternal alcohol and tobacco use in the perinatal and early childhood parenting periods. Specifically, we will investigate the relationship between individual characteristics of mothers (in a nationally representative dataset) and the social ecology of neighborhoods as predictors of maternal alcohol and tobacco use patterns over time. The availability of a rich set of neighborhood social process variables in the Birth Cohort of the Early Childhood Longitudinal Survey dataset will be augmented by constructs of neighborhood socioeconomic status and material deprivation based on data from the 2000 Census, and neighborhood smoking prevalence estimates from the Current Population Survey-Tobacco Use Supplement 2000. Our proposed research will examine how neighborhood structural characteristics and social processes relate to each other and to individual characteristics that are the proximate determinants of maternal substance use from preconception through the early childhood parenting period. Diverging from most research to date, we will apply latent class analysis and growth mixture modeling to characterize profiles of mothers according to both their alcohol and tobacco use and individual trajectories of use over time. Individual and neighborhood measures will be examined for direct effects associated with these patterns and trajectories. Subsequently, we will apply latent variable pathway analyses to assess potential mediation of neighborhood latent variables by individual characteristics, and we will analyze whether results of pathway analyses apply to different subgroups of our sample (moderation analyses). The results will be applied toward further research in three directions: policy and interventions for mothers, the study of child health outcomes, and enhanced research in social processes, structural effects, and policy inputs during a critical period for women's and children's health.