Estimating the Impact of Out-of-Home Placement on Health Risk Behavior in Adolescents Exposed to Maltreatment: An Advanced Causal Inference Approach

估计户外安置对遭受虐待的青少年健康风险行为的影响：一种高级因果推理方法

• 批准号: 10678772
• 负责人: Austin Blake
• 金额: $ 4.77万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-08 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10678772
• 关键词: Address; Adolescence; Adolescent; Adult; Age; Behavior; Biological; Caregivers; Caring; Child; Child Abuse and Neglect; Child Welfare; Childhood; Development; Environment; Event; Exposure to; Family; Fellowship; Financial cost; Foundations; Health; Health Status; Home; Individual; Intervention; Long-Term Effects; Mediating; Mediator; Mentors; Methods; Modeling; Modernization; Nature; Outcome; Parents; Personal Satisfaction; Policies; Population; Prevention; Probability; Psychopathology; Research; Risk; Risk Behaviors; Risk Factors; Safety; Sampling; Schools; Scientist; Scoring Method; Selection Bias; Services; Sex Behavior; Substance Addiction; Surveys; Symptoms; Testing; Time; Training; Unsafe Sex; Youth; career; experience; foster care; high risk; maltreatment; multidisciplinary; patient home care; preventive intervention; sexual risk behavior; societal costs; substance use; systems research; therapy design; young adult

ABSTRACT Child maltreatment is associated with health risk behaviors carrying high personal and societal costs, such as substance use and sexual risk behavior.1–4 Placement of children into out-of-home care aims to mitigate these negative effects.5 Findings about rates of health risk behavior among youth in out-of-home care are mixed,6–16 although studies show that young adults formerly in care have heightened levels of health risk behavior.17–20 These mixed findings may be due to the fact that most studies test effects of placement across childhood on later health risk behaviors. However, placement during adolescence may be a turning point that redirects trajectories of health risk behavior. Adolescence is a period of rapid change and a typical period for initiation of these behaviors,21 and adolescents have more difficulties adjusting to placement than do younger children.22 To test whether adolescent placement acts as a turning point, it is important to know whether placement initiates long-term changes in trajectories, short-term (time-specific) changes, or both. To design interventions, it is also necessary to understand the mechanisms underlying placement effects. However, because placement may occur at various points across time, identifying its direct and mediated effects requires modeling out-of-home placement, mediators, confounders, and outcomes as time-varying variables. Importantly, out-of-home placement is a nonrandom event, and many pre-placement variables likely predict both placement and subsequent health risk behavior. To deal with this threat to causal inference, recent research has utilized propensity score methods.23–27 However, these methods cannot accommodate time- varying variables, precluding tests of placement as a turning point or tests of its time-specific mediators. Accordingly, the proposed study uses two modern methods for causal inference, inverse probability of treatment weighting (IPTW) and g-estimation, to test direct and mediated effects of placement on health risk behaviors across time. These methods can account for biases from observed confounders and accommodate time-varying variables.28,29 Aim 1 tests whether adolescents with out-of-home placement since the prior wave show short-term, time-specific increases in substance use and initiation of unprotected sex, compared to those who remain in-home. Aim 2 tests whether adolescent placement predicts longer-term elevations in adult health risk behavior. Aim 3 tests time-varying mediators of the effect of placement on adult health risk behavior. These aims will be tested in a national sample of 738 maltreated youth (age 11-14 at baseline) studied across four waves to adulthood. The training plan brings together a distinguished mentoring team to provide multidisciplinary training in child welfare system research, modern quantitative methods for causal inference, developmental psychopathology of health risk behaviors, implications for intervention and policy, and professional development. This will provide the applicant with the foundation to launch a research career studying the effects of placement and child welfare involvement on adolescents' developmental outcomes.

抽象的 儿童虐待与承担高个人和社会成本的健康风险行为有关， 例如使用物质和性风险行为。1-4儿童将儿童放置在户外护理中的目的是 减轻这些负面影响。5关于户外护理中青年人健康风险行为率的发现 混合了6-16 行为。17–20这些混合发现可能是由于大多数研究测试跨越位置的效果 以后的健康风险行为的童年。但是，青少年期间的安置可能是一个转折点 重定向健康风险行为的轨迹。青少年是一个快速变化的时期，也是一个典型的时期 这些行为的启动，21和青少年比年轻人更适合适应安置的困难 22测试青少年放置是否充当转折点，重要的是要知道是否知道是否 放置启动轨迹，短期（特定时间）变化或两者兼而有之的长期变化。设计 干预措施，还必须了解放置效果的机制。然而， 由于位置可能会在整个时间的各个点发生，因此确定其直接和中介作用需要 将室外安置，调解人，混杂因素和结果建模为时变变量。 重要的是，户外放置是一个非随机事件，许多预位变量可能 预测安置和随后的健康风险行为。为了应对因果推论的这种威胁，最近 研究采用了倾向得分方法。23–27但是，这些方法无法适应时间 - 变化的变量，排除位置作为转折点的测试或特定时间特定的介体的测试。 根据每项研究，都使用两种现代方法来进行因果推断，相反的可能性 治疗加权（IPTW）和G估计，以测试放置对健康风险的直接和中介作用 跨时间的行为。这些方法可以解释观察到的混杂因子的偏见并适应 时变变量。28,29AIM 1测试自先前的波浪以来是否有户外放置的青少年是否存在 与那些相比 谁仍然在家。 AIM 2测试青少年放置预测是否长期升高成人健康 风险行为。 AIM 3测试安置对成人健康风险行为的影响时变化的调解人。 这些目标将在全国738名虐待青年（基线为11-14岁）的全国样本中进行测试。 四波到成年。培训计划汇集了一个杰出的心理团队，以提供 儿童福利系统研究中的多学科培训，因果推断的现代定量方法， 健康风险行为的发展心理病理学，对干预和政策的影响以及 专业发展。这将为申请人提供基金会启动研究职业 研究安置和儿童福利参与对青少年发展结果的影响。

项目成果

Intergenerational patterns of attachment in custodial grandfamilies.

监护祖父家庭的代际依恋模式。

• DOI: 10.1037/fam0001150
• 发表时间: 2023
• 期刊: Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43)
• 作者: Blake,AustinJ;Infurna,FrankJ;Castro,SaulA;Webster,BritneyA;Dolbin-MacNab,MeganL;Smith,GregoryC;Crowley,DMax;Musil,Carol
• 通讯作者: Musil,Carol

Grandparent alcohol use disorder and grandparent-grandchild relationships.

祖父母酒精使用障碍和祖孙关系。

• DOI: 10.1037/fam0001116
• 发表时间: 2023
• 期刊: Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43)
• 作者: Blake,Austin;Chassin,Laurie
• 通讯作者: Chassin,Laurie