Substance Use Trajectories and Health Outcomes for Monoracial and Biracial Blacks

描述(由申请人提供)：拟议的导师职业发展奖(K01)的总体目标是在成功的NIH资助赞助商的指导下为我提供密集的研究职业发展培训，这将引导我实现研究独立。这项拟议的研究集中在阐明单种族和双族黑人青少年和年轻人使用物质的途径。物质使用研究人员越来越多地提到追赶效应，以解释黑人中一种矛盾的趋势，即青春期物质使用率较低并不意味着成年后物质使用率较低。尽管黑人青少年使用物质的比率比他们的白人同龄人低得多，但到了成年，黑人的物质使用率赶上或超过了白人。这种追赶效应导致黑人的不良社会和健康后果比率很高。将黑人作为一个同质群体对待的规范做法阻碍了对追赶效应的理解。值得注意的是，正如美国人口普查所使用的，“黑人”包括非裔美国人、非洲人、非洲裔加勒比人和混血黑人--但没有考虑可能影响药物使用的不同社会文化经历。因此，这种聚集很可能掩盖了重要的群体间差异。事实上，我的初步研究表明，单一的物质使用轨迹完全不足以描述或预测在单孔和各种混血黑人亚群中发现的物质使用途径。排除我的初步发现，还没有研究在分解的混血黑人青年样本中检验物质使用轨迹的预测因素。因此，拟议的研究试图解决这些知识差距。它将揭示哪些亚群最容易受到追赶效应的影响，以及哪些因素是从青春期向年轻成年期过渡期间单峰和双峰黑人亚群中物质使用的关键决定因素。这项研究建议使用两项具有全国代表性的研究数据：全国青少年健康纵向研究(Add Health)和全国美国生活调查：应对21世纪的压力(NSAL)。本K01旨在1)描述在11至34岁这一开始使用药物的高危时期内，在单一种族群体(黑人、西班牙裔和白人)和两个主要的混血黑人亚群(黑人-西班牙裔、黑人-白人)中吸烟、酒精和大麻使用的发展轨迹。此外，K01将2)评估社会经济地位、种族主义经历、个人/文化、家庭、同伴、学校和邻里因素与物质使用(横截面)和物质使用(纵向)发展轨迹之间的关系。这项拟议的研究是旨在提高我的研究技能的综合培训计划的一个组成部分；我在一个由专家导师组成的跨学科团队的指导下制定了这个计划，他们将在我的K01研究过程中提供指导。这项拟议的研究推进了我的职业目标，即成为一名领先的独立研究员，专注于种族/少数民族，特别是黑人和混血青少年和年轻人之间的健康差距和药物使用和依赖的流行病学、病因学和预防。我在K01的直接职业目标包括在发展科学、文化因素和健康差距方面发展更多的专业知识；获得先进的方法技能；在我初步发现的基础上进行研究；通过同行评议的文章传播我的发现；在国家会议上发表报告；以及准备将我的研究推进到下一阶段的拨款申请。我将利用北卡罗来纳大学和杜克大学异常丰富的研究环境，通过研讨会、定向阅读和课程作业获得知识，并在我的赞助商和顾问的指导下进行研究，从而实现这些目标。这项拟议的研究提供了一个无与伦比的机会，可以让我们了解特定的混血黑人亚群使用物质的途径。此外，这项研究将有助于了解物质使用的病因、追赶效应以及相关的黑人健康差距，并加强预防工作。在K01的最后阶段，我将提交一份R01提案，扩大调查范围，检查所有非聚集的混血群体(例如，美国印第安人白人、亚裔西班牙裔)，以确定是否如一些初步证据所表明的那样，混血是药物使用行为的一般风险因素，或者是否在一些混血群体中发现了高风险，但在其他群体中没有发现。此外，R01研究将检查混血人群中物质使用轨迹的同时和较长期的社会和健康相关性。

DESCRIPTION (provided by applicant): The overall aim of the proposed Mentored Career Development Award (K01) is to provide me with intensive research career development training under the guidance of successful NIH-funded sponsors that will lead me to research independence. The proposed research study centers on elucidating the pathways to substance use among monoracial and biracial Black adolescents and young adults. Increasingly, substance use researchers refer to the catch-up effect to explain a paradoxical trend among Blacks in which lower rates of substance use in adolescence do not predict lower rates of substance use in adulthood. Although Black adolescents use substances at substantially lower rates than their White peers, by young adulthood the rates of substance use among Blacks catch up to or surpass the rates of Whites. This catch-up effect contributes to high rates of adverse social and health outcomes among Blacks. Understanding the catch-up effect is hindered by the normative practice of treating Blacks as a homogeneous group. Notably, as used for the US Census, "Black" includes African Americans, Africans, Afro- Caribbean's, and biracial Blacks-but without regard for different sociocultural experiences that might affect substance use. Thus, such aggregation likely obscures important between-group differences. Indeed, my preliminary research suggests a single substance use trajectory is wholly inadequate for either describing or predicting the pathways to substance use found among monoracial and various biracial Black subgroups. Excluding my preliminary findings, no research has examined predictors of substance use trajectories among de-aggregated samples of biracial Black youth. Hence, the proposed study seeks to address these knowledge gaps. It will reveal which subgroups are most vulnerable to the catch-up effect and which factors are critical determinants of substance use among monoracial and biracial Black subgroups during the transition from adolescence to young adulthood. This study proposes to use data obtained from two nationally representative studies: National Longitudinal Study of Adolescent Health (Add Health) and National Survey of American Life: Coping with Stress in the 21st Century (NSAL). This K01 seeks to 1) describe the developmental trajectories of cigarette, alcohol, and marijuana use among the monoracial groups (Black, Hispanic, and White) and two major biracial Black subgroups (Black-Hispanic, Black-White) during ages 11 to 34 years, which is a high-risk period for onset of substance use. Further, the K01 will 2) assess the relationships among socioeconomic status, experiences of racism, and individual/cultural, family, peer, school, and neighborhood factors and substance use (cross-sectional) and developmental trajectories of substance use (longitudinal) among monoracial and biracial Black adolescents and young adults. The proposed study is an integral component to a comprehensive training program designed to enhance my research skills; I have developed this program with the direction of an interdisciplinary team of expert mentors who will provide guidance throughout my K01 research. The proposed study advances my career goal of becoming a leading independent researcher focused on health disparities and the epidemiology, etiology, and prevention of substance use and dependence among racial/ethnic minorities, especially Black and biracial adolescents and young adults. My immediate career objectives in this K01 include developing greater expertise in developmental science, cultural factors, and health disparities; acquiring advanced methodological skills; conducting research that builds on my preliminary findings; disseminating my findings via peer- reviewed articles; presenting at national meetings; and preparing a grant application that will move my research to its next phase. I will achieve these goals by capitalizing on the exceptionally rich research environments at UNC and Duke University; acquiring knowledge through workshops, directed readings, and coursework; and conducting research under the guidance of my sponsors and advisors. The proposed research represents an unparalleled opportunity to develop an understanding of the pathways to substance use for specific biracial Black subgroups. Further, this research will contribute to the understanding of the etiology of substance use, the catch-up effect, and related health disparities among Blacks, and enhance prevention efforts. In the final stages of this K01, I will submit a R01 proposal that expands the scope of the investigation to examine the full range of de-aggregated biracial groups (e.g., American Indian-White, Asian-Hispanic) to determine whether, as suggested by some preliminary evidence, biracialism is a general risk factor for substance use behaviors or whether high risk for substance use is found among some biracial groups but not in others. In addition, the R01 study will examine concurrent and longer- term social and health correlates of substance use trajectories among biracial groups.