Mechanisms Underlying Differential Effects of Neighborhood Poverty on Problematic Adolescent Drug Use

项目摘要/摘要 一个孩子在哪里长大，他或她可能会有使用有问题的药物的风险。令人惊讶的是，政策和 旨在改善社区条件的计划已经产生了令人满意的结果，在这些项目中，一些儿童 Benefit，但其他人受到了伤害。了解社区影响问题的机制- ATIC药物使用以及这些机制在不同子组和城市之间的差异-即了解在哪里和 --机制适用于谁--对于优化未来邻里干预的有效性至关重要。 涉及学校环境各方面的调解机制尚未得到审查，但可能会证明 有望理解社区对有问题的药物使用的不同影响。这样做的目的是 K99/R00是确定以学校为基础的机制，调解社区贫困之间的关系 和有问题的药物使用，并开发统计方法来了解调解效果在 小组和地点。这一目标有助于实现提高干预实效的长期目标-- 通过调整干预措施来处理最相关的机制，以防止药物滥用和依赖 根据地点和个人特点，为每个目标人口制定行动计划。K99阶段fi使 遵循对实现研究目标和长期目标至关重要的培训差距：1)方法学 关于因果调解分析的培训；2)关于药物滥用和预防依赖的主题培训 禁止人口；以及3)参与以学校为基础的真实世界干预措施，以制定切实可行的方法 实用程序。拟议研究的目标1确定了调节这一关系的学校环境机制(fi 在社区贫困和青少年问题药物使用之间，以及这些机制的莫迪fierers。目标2 扩展了拟议的研究团队最近开发的统计方法，用于概括干预效果 从一个城市到另一个城市，以推广调解效果。最后，AIM 3使用在AIM中开发的方法 2确定学校环境机制如何协调邻里贫困和有问题的药物使用 美国各大城市的情况有所不同。这项拟议的研究预计将确定以学校为基础的机制- 邻里贫困对青少年问题药物使用的不同影响 关于随机邻里居住的唯一研究。此外，预计它将贡献一种新的统计 一种方法，结合了尖端的机器学习技术来识别哪些中介机制可以 跨地区推广，推进翻译研究。成功的干预被认为在不同的情况下有效- 输入设置，但实际情况并非如此。拟议的研究将使我们能够预测干预效果 同时考虑到人口构成和调解机制的Modifier的差异。这将是 通过为未来社区的设计和目标提供信息，为改善健康做出重大贡献 对青少年和在预防有问题的药物使用方面可能受影响最大的地方进行干预。

PROJECT SUMMARY/ABSTRACT Where a child grows up can influence his or her risk of problematic drug use. Surprisingly, policies and programs designed to improve neighborhood conditions have yielded conflicting results in which some children benefit but others are harmed. Understanding the mechanisms by which neighborhoods act to affect problem- atic drug use and how these mechanisms differ across subgroups and cities—that is, understanding where and for whom mechanisms apply—is essential to optimize the effectiveness of future neighborhood interventions. Mechanisms involving mediation by aspects of the school environment have been unexamined, but could prove promising for understanding differential effects of neighborhood on problematic drug use. The objective of this K99/R00 is to identify school-based mechanisms that mediate the relationship between neighborhood poverty and problematic drug use and to develop statistical methods to understand how mediation effects differ across subgroup and place. This objective contributes to the long-term goal of improving the effectiveness of interven- tions to prevent drug abuse and dependence by tailoring interventions to address the most relevant mechanisms of action for each target population based on place and individual-level characteristics. The K99 phase fills the following training gaps that are critical to achieving the research objective and long-term goal: 1) methodologic training in causal mediation analysis; 2) subject-matter training in drug abuse and dependence prevention in ur- ban populations; and 3) involvement in real-world school-based interventions to develop methods with practical utility. Aim 1 of the proposed research identifies the school environment mechanisms that mediate the relationship between neighborhood poverty and adolescent problematic drug use and modifiers of those mechanisms. Aim 2 extends a statistical method recently developed by the proposed research team for generalizing intervention ef- fects from one city to another to generalizing mediation effects. Finally, Aim 3 uses the method developed in Aim 2 to identify how the school environment mechanisms mediating neighborhood poverty and problematic drug use differ across major U.S. cities. The proposed research is expected to identify school-based mechanisms underly- ing differential effects of neighborhood poverty on adolescent problematic drug use by subgroup and place using the only study of randomized neighborhood residence. In addition, it is expected to contribute a novel statistical method that incorporates cutting-edge machine learning techniques to identify which mediation mechanisms can generalize across place, advancing translational research. Successful interventions are assumed to work in differ- ent settings, but that is not the case in practice. The proposed research will allow us to predict intervention effects while accounting for differences in population composition and modifiers of the mediation mechanism. This will make a significant contribution to improving health by informing the design and targeting of future neighborhood interventions to adolescents and places that may be most impacted in terms of problematic drug use prevention.