Social Ecology of Maternal Substance Use

描述(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问题的关键机会。向孕妇提供戒烟戒酒资源的机会似乎最大的是融入以社区为基础的保健服务，并注意在母亲的家庭和朋友网络中产生支持。到目前为止，母亲物质使用的生态模型倾向于研究一组有限的社会过程或社区结构特征，但不是两者兼而有之，只关注吸烟，关注婴儿结局，而关于社区对生育结果影响的研究可能无法包括母亲物质使用。背景理论的有限发展侧重于将母体物质使用作为结果，这是问题的一部分。这项拟议研究的目的是调查在围产期和儿童早期育儿期间与母亲饮酒和吸烟有关的邻里结构方面和社会过程的作用。具体地说，我们将调查母亲的个人特征(在具有全国代表性的数据集中)与社区社会生态之间的关系，以预测母亲随时间推移的酒精和烟草使用模式。幼儿纵向调查数据集出生队列中丰富的社区社会过程变量的可用性将得到扩大，根据2000年人口普查的数据构建社区社会经济状况和物质匮乏的结构，以及根据当前人口调查--烟草使用补充资料2000年的社区吸烟流行率估计。我们建议的研究将考察邻里结构特征和社会过程如何相互联系，以及个体特征是从先入为主到儿童早期育儿阶段母体物质使用的直接决定因素。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来根据母亲的酒精和烟草使用情况以及个人随时间的使用轨迹来描述母亲的特征。将检查个人和邻里措施与这些模式和轨迹相关的直接影响。随后，我们将应用潜变量通径分析来评估邻里潜变量对个体特征的潜在中介作用，并分析通径分析的结果是否适用于我们样本的不同子组(调节分析)。这些成果将应用于三个方向的进一步研究：针对母亲的政策和干预措施、儿童健康结果的研究，以及在妇女和儿童健康的关键时期加强对社会进程、结构效应和政策投入的研究。

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.