Prenatal Cocaine Exposure: Young Adult Follow Up

描述(由申请人提供)：复原力的理论结构，即潜在风险之后的好于预期的结果，为宫内可卡因暴露(IUCE)和宫内物质暴露(IUSE)的纵向研究提供了一个创新的框架。复原力源于人与环境的相互作用，可以缓冲生物和社会风险的影响。我们建议对140-150名年龄在18-24岁(50%患有IUCE)的城市参与者进行隐蔽的多学科纵向随访，自出生以来持续跟踪，以记录多个领域的风险、保护和促进因素。已经收集和建议的数据集的独特特征包括：12个月时的安斯沃思依恋分类，从婴儿期开始重复的前瞻性测量照顾者和儿童的暴力暴露，重复的物质困难测量，以及父母的监禁，在这个周期中增加了歧视，积极的种族认同，以及年轻人亲密关系的质量的测量，在16岁之前通过自我报告或尿液分析开始使用药物的样本的61%。在拟议的研究期间(2010年4月1日至2015年3月31日)，参与者进入发育时期，此时肥胖症的出现、从这种障碍中可能的恢复、承担早期成人角色的能力变得可测量，执行和记忆功能成熟。我们专注于选定的生物背景因素，这些因素可能在决定这些领域的复原力和风险方面至关重要。我们认为潜在的生物因素包括：性别、出生体重、IUCE、评估时的年龄，以及一种新的综合测量宫内物质暴露(IUSE)总水平的方法，包括单一量表中的可卡因、烟草、酒精和大麻水平，以及作为不同变量的个别物质。参与者开始使用精神活性物质的时间和青春期/青年同时使用精神活性物质的水平都是对仍在发育中的中枢神经系统的生物风险的指标，这是一项主要结果。我们将分析从婴儿期到成年期的潜在缓冲背景因素的影响，这些因素有助于：1)远离肥胖症；2)更大的适应角色功能，包括较少的艾滋病毒危险行为，较晚的生育，较少的精神症状，较少的犯罪行为，以及在教育，就业和人际关系中的积极适应；以及3)执行和记忆功能的预期成熟。为了充分利用数据的纵向性质，我们提出了广义混合线性模型，包括用于描绘轨迹的增长曲线模型，用于检验调节变量的分层交互模型，以及用于评估中介的结构方程路径模型。IUSE影响了从婴儿到成年人的所有种族的许多美国人。这个样本代表了这样一个群体，与其他群体相比，他们遭受了更多的物质使用带来的不良生活后果&无论有没有IUSE，他们都面临着不成比例的社区压力。确定在这种健康差距的背景下促进复原力的因素具有特别的科学意义和公共卫生意义。 公共卫生相关性：许多美国人，从婴儿到成年人，都经历过宫内暴露于精神活性物质，这可能会使他们在许多方面面临不利生活轨迹的风险增加。因此，在宫内暴露后，在多个领域(包括免于药物使用障碍)描绘婴儿、儿童、青少年以及可能在青年时期促进或抑制复原力的兼有因素对公共卫生干预具有重要意义。

DESCRIPTION (provided by applicant): The theoretical construct of resilience, better-than-expected outcome following potential risk, provides an innovative framework for the longitudinal study of intrauterine cocaine exposure (IUCE) & intrauterine substance exposure (IUSE). Resilience evolves from person/environment interactions, which may buffer the impact of biologic & social risks. We propose a masked multidisciplinary longitudinal follow-up of 140-150 urban primarily African American/African Caribbean participants aged 18-24 (50% with IUCE), continuously followed since birth to document risks, protective & promotive factors in multiple domains. Unique features of the already collected & proposed data set include: Ainsworth attachment classification at 12 months, repeated prospective measurement since infancy of the caregiver's & child's exposure to violence, repeated measures of material hardship, & parents' incarceration, with the addition in this cycle of measures of discrimination, positive ethnic identity, & quality of young adult intimate relationships 61% of the sample initiated substance use by age 16 by self-report or urine assay. During the proposed period of study (4/1/2010 - 3/31/2015) the participants enter the developmental epoch when the emergence of SUDs, possible recovery from such disorders, & ability to undertake early adult roles become measurable, & executive & memory functions mature. We focus on selected biological contextual factors, which may be crucial in determining resilience & risk in these domains. We consider as potential biologic factors among others: gender, birth weight, IUCE, age at assessment, & a novel composite measurement of overall level of intrauterine substance exposures (IUSE) including levels of cocaine, tobacco, alcohol, & marijuana in a single scale, as well as the individual substances as distinct variables. The participant's timing of initiation & concurrent level of adolescent / young adult use of psychoactive substances are both indicators of biologic risk to the still developing central nervous system & a major outcome. We will analyze the influence of potentially buffering contextual factors from infancy to young adulthood contributing to: 1) Freedom from SUDs; 2) Greater adaptive role function including fewer HIV risk behaviors, later childbearing, fewer psychiatric symptoms, less criminal behavior, & positive adaptation in education, employment & personal relationships; & 3) Expected maturation of executive & memory functions. We propose generalized mixed linear models to utilize fully the longitudinal nature of the data, including growth curve models to delineate trajectories, stratified & interaction models to examine moderators, & structural equation path models to evaluate mediation. IUSE impacts many Americans of all ethnic groups ranging from infants to adults. This sample represents a demographic, which, compared to other groups, suffers more adverse life consequences from substance use & which, with or without IUSE, faces disproportionate levels of community stressors. Identification of factors fostering resilience in this context of health disparities is of particular scientific & public health relevance. PUBLIC HEALTH RELEVANCE: Many Americans, ranging from infants to adults, have experienced intrauterine exposures to psychoactive substances which may put them at increased risk of adverse life trajectories in many dimensions. Therefore, following intrauterine exposures, delineation of infant, childhood, adolescent, and concurrent factors which can promote or inhibit resilience during young adulthood in multiple domains (including freedom from substance use disorders) has important implications for public health interventions.