Kerstin Pahl, Ph.D. - US grants

This is a competing continuation application. This longitudinal study examines the etiologic determinants of changes between adolescence and adulthood in alcohol and drug use and dependence, and the consequences of alcohol and drug use and abuse/dependence on the individual's functioning. The ultimate goal of this research is to investigate developmental pathways to alcohol and drug use and dependence and cessation, and to identify adult protective factors that will offset risks for alcohol and drug use and dependence in adulthood. The sample includes low-income urban African American and Puerto Rican adults who were seen in early/middle adolescence, then in late adolescence, then in their early 20[unreadable]s, and again in their mid 20[unreadable]s. We now propose to study them in their thirties. A fifth data collection is proposed to accomplish the following: (1) examine the interrelations and interactions of risk and protective factors, including personality, family, peers, ecological context, acculturation/cultural values, and African American and Puerto Rican ethnic/racial identity, as they affect the course of alcohol and drug use/abuse/dependence (i.e., onset, stability, cessation) and criminal behavior in these adults;and (2) To study the consequences of early alcohol and drug use and abuse/dependence and other problem behaviors on adult intra- and interpersonal functioning. Interviews with the adult participants will be conducted by trained, interviewers. Scales with adequate psychometric properties measuring the independent variables will be developed from the interview schedules. The primary analytic techniques will be structural equation modeling and other regression-based techniques. This research will enable us to provide further information on (1) suggested specific strategies to prevent increases in alcohol and drug use and dependence, (2) factors promoting the decrease or cessation of drug use, and (3) the timing most adequate to implement these strategies.

DESCRIPTION (provided by applicant): This proposed study of urban Black and Latina women has two major aims. The first is to examine the longitudinal pathways to HIV risk behaviors (unprotected intercourse, multiple/concurrent partners, having a high-risk partner) focusing on the integration of structural/contextual with interpersonal and individual risk factors as predictors. Drug use will be examined as a behavioral risk factor mediating the relationship between structural risks and HIV-risk behaviors. The proposal is informed by Family Interactional Theory and the Theory of Gender and Power, as it applies to HIV-risk behaviors among women of color. The proposed research uses a life-course perspective to examine this critical issue by focusing on both antecedent and concurrent predictors of engagement in HIV-risk behaviors among African American and Puerto Rican women in their thirties. Second, the research will examine the ability of resource factors (i.e., ethnic pride, problem-focused coping, social support) to mitigate structural risk factors (e.g., neighborhood disadvantage) for HIV-risk behaviors. This grant proposal will capitalize on a wealth of data collected at key developmental stages over a period of 20 years as part of the Harlem Longitudinal Development Study (HLDS). Identification of the risk factors for HIV-risk behaviors and the pathways through which they operate will have important implications for public health. Findings from this research can be integrated into prevention and intervention programs aimed at reducing the transmission of HIV and other STIs among women disproportionately at risk. The sample for this study will consist of 450 women who were previously seen in adolescence (T1, T2), emerging adulthood (T3), and young adulthood (T4). At T5, face-to-face interviews will be conducted with the participants. Psychometrically sound scales will be developed from the surveys.

PROJECT SUMMARY/ABSTRACT The proposed research would capitalize on a wealth of longitudinal data previously collected at key developmental stages over a period of 27 years as part of the Harlem Longitudinal Development Study. It has two major aims: The first is to identify the mediators of the relationships between social determinants of health (i.e., socioeconomic disadvantage and ethnicity-based/racial discrimination) and allostatic load in a sample of African Americans and Puerto Ricans entering midlife. The research proposal is guided by a contextual- developmental model based in Phenomenological Variant of Ecological Systems Theory, as well as a pathophysiological theory of stress (allostatic load). Second, the research will identify the differential developmental trajectories of perceived ethnicity-based/racial discrimination from late adolescence to the early forties, examine their associations with allostatic load and mental health in the early forties, and test the ability of resilience resources to mitigate these associations. The sample for this study will consist of 400 male and female African Americans and Puerto Ricans who were previously seen in adolescence (T1, T2), emerging adulthood (T3), young adulthood (T4), and adulthood (T5, T6). Identifying the pathways through which risk and protective factors for allostatic load operate will have important implications for public health by providing targets for intervention and informing policy. Finding moderating constructs that can mitigate the deleterious sequelae of chronic ethnicity-based/racial discrimination will highlight significant areas of resilience. Such a focus on resilience not only moves away from a deficit perspective of people of color, but also has the potential to transform policy and interventions by building on strengths, rather than treating deficits. A move in this direction is an important step towards reaching the goal of eliminating the significant social and ethnic/racial health disparities that plague the U.S. and realizing health equity for all.