Obesity and substance use: Identifying pathways and processes in adolescence

描述(申请人提供)：近几十年来，儿童肥胖症的流行日益普遍，这引起了人们对身体健康受损、心理社会适应不良和更高的死亡率的严重关切。尽管人们的担忧与日俱增，但物质使用这一严重的健康风险行为，还没有被广泛地与肥胖联系起来进行研究。这项拟议的项目是一项前瞻性的纵向研究，旨在检查青少年肥胖与青年时期物质使用之间的关系，并试图确定肥胖可能增加物质使用风险的潜在途径和过程。从生物心理社会角度看待风险承担，拟议的研究将利用来自国家青少年健康纵向研究(ADD Health)第1-3波的样本。关于体重指数(BMI)和肥胖状况；社会地位(受害、同伴排斥、社会耻辱感)；异常同伴关系；心理社会失调(抑郁症状)和物质使用(酒精、烟草和大麻)的数据在第一波11-19岁到第三波18-26岁之间获得。这项研究的主要目标是确定肥胖青少年中较差的社会地位、偏离同伴关系和/或心理社会适应不良是否会增加青少年在青年期更频繁和更严重地使用药物的风险。此外，肥胖率方面的种族和性别差异，以及体型和社会地位之间的种族和性别关联，可能会影响对药物使用的投入。这项研究的具体目的是：(1)确定肥胖和非肥胖青少年的BMI百分位数是否可以预测青年期使用药物的频率、严重程度和类型；(2)评估肥胖青少年的社会地位异质性、不正常的同伴关系和心理社会适应是否会影响青春期肥胖对更频繁和更严重的药物使用的作用；以及(3)根据上述目的确定种族和性别差异，以确定属于BMI和肥胖率较高的群体是否会降低使用药物的风险。由于肥胖和物质使用都是卫生保健系统的严重负担，确定青少年肥胖与青年时期物质使用有关的途径可能对旨在减轻物质使用频率和严重程度的预防和干预工作具有重要意义。 公共卫生相关性：这项研究将解决两个关键的公共卫生问题，即青少年肥胖和青壮年物质使用，目的是确定青春期肥胖可能增加青壮年更频繁和更严重的物质使用风险的途径和过程，从而为预防和干预工作提供信息，以减少年轻人中有问题的物质使用。利用国家青少年健康纵向研究(Add Health)，该项目将评估青少年社交的效用 地位、不正常的同伴关系和心理社会失调是青春期青少年肥胖和药物使用共同发生的解释机制。找出肥胖和物质使用之间联系的具体途径和过程，将辨别哪个肥胖青少年亚群(S)在青年期更频繁和更严重地使用物质的风险最高，这可能会改进针对最需要物质使用预防和干预服务的个人的努力。

DESCRIPTION (provided by applicant): The increasing prevalence of childhood obesity in recent decades has raised serious concerns over impaired physical health, psychosocial maladjustment, and higher mortality rates. Despite growing concerns, substance use, a serious health-risk behavior, has not been largely studied in conjunction with obesity. The proposed project is a prospective longitudinal study that examines relations between adolescent obesity and substance use in young adulthood, and attempts to identify the underlying pathways and processes by which obesity may increase risk for substance use. Taking a biopsychosocial perspective on risk-taking, the proposed study will utilize the sample derived from Waves 1-3 of The National Longitudinal Study of Adolescent Health (Add Health). Data have been obtained on body mass index (BMI) and obesity status; social standing (victimization, peer rejection, feelings of social stigmatization); deviant peer affiliation; psychosocial maladjustment (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) on 11,083 adolescents between 11- 19 years at Wave 1 and 18-26 years at Wave 3. The overarching goal of this research is to determine whether poor social status, deviant peer affiliation and/or psychosocial maladjustment among obese adolescents increase risk of more frequent and severe substance use in young adulthood. Furthermore, ethnic and gender disparities in obesity prevalence and ethnic- and gender-specific associations between body size and social status may influence engagement in substance use. The study's specific aims are to (1) identify whether BMI percentile of obese and non-obese adolescents predicts frequency, severity, and type of substance use in young adulthood; (2) assess whether heterogeneity in social status, deviant peer affiliation, and psychosocial maladjustment among obese adolescents informs the role of adolescent obesity on more frequent and severe substance use in young adulthood; and (3) identify ethnic and gender differences from the above aims to determine whether belonging to groups with higher BMI and obesity rates decreases risk of substance use engagement. As both obesity and substance use are severe burdens on the health care system, identifying the pathways by which adolescent obesity is related to substance use in young adulthood may have significant implications for prevention and intervention efforts aimed at mitigating frequency and severity of substance use. PUBLIC HEALTH RELEVANCE: This study will address two critical public health problems, adolescent obesity and substance use in young adulthood, with the aim of identifying the pathways and processes by which adolescent obesity may increase risk of more frequent and severe substance use in young adulthood, thus informing prevention and intervention efforts for mitigating problematic substance use among young adults. Using The National Longitudinal Study of Adolescent Health (Add Health), the project will evaluate the utility of adolescent social status, deviant peer affiliation, and psychosocial maladjustment as explanatory mechanisms of co-occurring adolescent obesity and substance use in young adulthood. Identifying specific pathways and processes by which obesity and substance use are linked will discern which subgroup(s) of obese adolescents are at highest risk for more frequent and severe substance use in young adulthood, potentially leading to improved efforts in targeting individuals at most need for substance use prevention and intervention services.