Gender and Developmental Trajectories to Adolescent Substance Use and Sexual Risk Behavior

项目总结/文摘

PROJECT SUMMARY/ABSTRACT This application proposes to conduct a secondary comparative analysis study to examine gender differences and similarities in the developmental trajectories of early behavioral problems and subsequent outcomes of substance use (SU) and sexual risk behaviors (SRBs) in adolescents with prenatal cocaine/poly drug exposure (PCE) vs. a matched group without PCE. Childhood behavioral problems (e.g., aggression, inattention) are well-established precursors to SU and SRBs. Although PCE has been associated with more behavioral problems, little is known about how PCE contributes to childhood developmental trajectories of behavioral problems, which may persist, desist, or escalate over time. Further, developmental trajectories of behavioral problems, SU, and SRBs may differ by gender, yet few studies have compared gender-specific childhood developmental trajectories that lead to SU and/or SRBs. The proposed study will harmonize data from two large, existing community-based birth cohorts (N=1,803): The Cleveland Prenatal Cocaine Exposure Study and the Maternal Lifestyle Study. The aims of the original studies examined long-term effects of in-utero exposure to cocaine on child development. In this proposal, we will examine heterogeneity in developmental trajectories, with specific foci on testing whether PCE and gender interactively contribute to specific trajectories along with the role(s) of life adversities (i.e., violence exposure, childhood maltreatment, sexual victimization), also key etiological factors in SU disorders and SRBs. Specific Aims are to: 1) Identify developmental trajectories of behavioral problems (externalizing, internalizing, inhibitory control/attention) and test for trajectory differences in gender, PCE, and environmental and biological correlates; 2) Examine associations between developmental trajectories of behavioral problems with SU and SRBs for boys and girls; and 3) Explore role(s) of life adversity (i.e., violence exposure, childhood maltreatment, sexual victimization) in trajectories leading to SU and SRBs separately for boys and girls. Caregiver-reported behavior from ages 2/3, 4/5, 6/7, 9, 10, 11, and 12/13 will be used to model trajectories using growth mixture modeling; generalized estimation equations will be used to model the effects of the behavioral trajectory class membership on SU and SRBs at ages 15 and 16/17, controlling for confounders such as parental attachment, monitoring and peer attachment. Findings from the proposed analyses will contribute to advanced early identification of those in greatest need of prevention services and specification of modifiable targets that may be gender-specific, promoting the ongoing development of gender-specific prevention programs, a promising way to address NIDA's strategic priorities in prevention of SU disorders. Further, given that children with PCE tend to be of minority and low socioeconomic status (SES), this study will contribute to reducing health disparities in behavioral health interventions observed in this population, one of the four overarching goals of Healthy People 2020.