Improving Decision Making to Prevent Substance Misuse among Adolescents from Traditionally Underserved Communities

改善决策，防止传统服务不足社区的青少年滥用药物

基本信息

批准号：
10708017
负责人：
JULIA W FELTON
金额：
$ 23.49万
依托单位：
HENRY FORD HEALTH SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-30 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10708017
关键词：
Adolescence Adolescent Adult Aftercare Age Alcohol abuse Alcohol consumption Behavioral Mechanisms Case Series Childhood Choice Behavior Clinical Computers Data Decision Making Development Disadvantaged Disparity Drug usage E-learning Effectiveness Effectiveness of Interventions Enrollment Environment Etiology Event Exposure to Future Goals Health behavior Impulsivity Individual Intervention Intervention Studies Interview Investigational Therapies Leadership Life Link Literature Longevity Low income Measures Methods Michigan Modeling Morbidity - disease rate National Institute of Drug Abuse Neighborhoods Neurocognitive Neurologic Outcome Parents Pathway interactions Population Poverty Prediction of Response to Therapy Prevention Prevention Research Prevention approach Process Public Health Randomized Randomized, Controlled Trials Research Research Personnel Resource-limited setting Resources Rewards Risk Schools Services Short-Term Memory Surveys System Taxes Testing Time Tobacco use Training Training Programs Vulnerable Populations Youth active method adolescent substance use adverse childhood events childhood adversity community setting computerized cost critical period design discounting dosage drinking early adolescence early life adversity early-life disadvantage effectiveness evaluation ethnic minority evidence base executive function feasibility trial follow-up high school implementation trial improved informant insight marijuana use meetings middle age mortality neighborhood disadvantage pilot trial post intervention preference prevent preventive intervention racial minority recruit reduced substance use sobriety socioeconomic disparity socioeconomics substance misuse substance misuse prevention substance use substance use prevention therapy development underserved area underserved community

项目摘要

Early childhood adversity is associated with significant risk for engaging in problematic substance use across the lifespan. Adolescents living in low-income neighborhoods are both more likely to experience adverse childhood events and less likely to have access to evidence-based preventative substance use interventions. Thus, there is a critical need to identify interventions that can effectively prevent the escalation of substance use in vulnerable youth and be feasibly disseminated in low-resource, traditionally underserved communities. Delay discounting has emerged in the literature as a critical etiological marker of substance use risk and a potential pathway from early life disadvantage to problematic alcohol and drug use. Elevated delay discounting is characterized by an exaggerated tendency to select rewards that are immediately available. Higher (more problematic) rates of delay discounting during adolescence are associated with more severe and frequent substance use and are predictive of steeper escalations in alcohol, marijuana and tobacco use. Working memory, the capacity to store and manipulate information utilized in decision making, is closely linked to delay discounting and a plausible neurocognitive mechanism linking early adverse environments to problematic discounting tendencies and subsequent substance use. Guided by an experimental therapeutics framework, recent findings from our own research team and others suggests the efficacy of utilizing a computer-based working memory training program to improve discounting among mid-life adults. Computer-based training programs may be particularly suitable to implement in low-resource communities for at-risk adolescents. Specifically, adolescence is a critical period for the development of both working memory and delay discounting, and interventions targeting working memory during this life stage have evidenced favorable clinical results. Further, computerized interventions require limited staff and space resources, making them both feasible and scalable in traditionally underserved communities. Building on promising findings from the investigator team’s formative research, this application proposes to pilot a computer-based working memory intervention among adolescents exposed to early life adversity in the low-resource community of Detroit, Michigan. Primary aims include establishing the preliminary feasibility, acceptability and appropriateness of delivering a computerized working memory intervention in a community setting serving low-income adolescents as well as conducting a small-scale Stage I randomized control trial to examine the effectiveness of this intervention in reducing rates of delay discounting. The subsequent impact of this intervention on changes in adolescent substance use over a three-month follow-up period will also be examined as an exploratory aim. The proposed research will provide valuable insight into the utility of targeting a specific pathway from early adversity to later substance use during adolescence and will establish a model for disseminating interventions in low-resource communities. Results of this study will also set the stage for future large-scale (R01) prevention research.

儿童早期的逆境与跨界使用有问题的药物的重大风险相关。生活在低收入社区的青少年更有可能经历不利的生活。儿童事件，并且不太可能获得基于证据的预防性药物使用干预措施。因此，迫切需要确定能够有效防止物质使用升级的干预措施并在资源匮乏、传统上服务不足的社区进行可行的传播。折扣已在文献中出现作为药物使用风险的关键病因学标志和潜在的从早期生活不利到有问题的酗酒和吸毒的途径是。其特点是倾向于选择立即可用的奖励。有问题的）青春期延迟贴现率与更严重和更频繁的物质使用，并预示着酒精、大麻和烟草的使用会急剧增加。记忆是存储和处理决策中使用的信息的能力，与延迟密切相关折扣和合理的神经认知机制将早期不利环境与有问题的问题联系起来在实验治疗框架的指导下，折扣倾向和随后的物质使用。我们自己的研究团队和其他人的最新研究结果表明，利用基于计算机的工作记忆训练计划，以改善中年成年人的折扣。这些方案可能特别适合在资源匮乏的社区针对高危青少年实施。具体来说，青春期是工作记忆和延迟贴现发展的关键时期，针对这一生命阶段工作记忆的干预措施已证明具有良好的临床效果。此外，计算机化干预措施需要有限的人员和空间资源，这使得它们既可行又可行。基于研究团队的有希望的发现，可在传统上服务不足的社区进行扩展。形成性研究，该应用程序建议试点基于计算机的工作记忆干预密歇根州底特律市资源匮乏的社区中遭受早期生活逆境的青少年主要目标。包括确定交付的初步可行性、可接受性和适当性社区环境中的计算机化工作记忆干预也为低收入青少年提供服务进行小规模第一阶段随机对照试验以检验该干预措施的有效性降低延迟贴现率的后续影响。三个月后续期内的物质使用情况也将作为探索性目标进行审查。研究将为针对从早期逆境到后期逆境的特定途径的效用提供有价值的见解青春期物质使用，并将建立一个在资源匮乏地区传播干预措施的模型这项研究的结果也将为未来大规模（R01）预防研究奠定基础。