Michael P. Marshal, Ph.D. - US grants

The central goal of the proposed project is to test the mediating role of marital functioning on the relation between parental alcoholism and adolescent/young adult offspring drug use/abuse. Research shows that spouses of alcoholics are at increased risk for marital problems, and that children of dysfunctional marriages are at increased risk for drug use/abuse; however, this mediator model has not been tested. Two secondary goals of this project are to test: (a) the longitudinal and reciprocal relations between trajectories of spouses' alcohol use/abuse and marital functioning; and (b) the family and parenting processes that account for the relation between parents' marital functioning and offspring drug use/abuse. These goals will make important contributions to drug use/abuse theory and help to identify appropriate family variables for substance use prevention and intervention programs. These goals will be accomplished using five waves of data from an ongoing study of substance use and abuse in children of alcoholics and nonalcoholic controls that began in 1988, and will be tested using advanced statistical techniques including latent curve and hierarchical linear modeling. Families were recruited from community sources, and DSM-111 alcoholism diagnoses were obtained via face-to-face interviews with the parents. The mean age of these children at Wave 1 was 12.5 years, 24% were Hispanic, and 46% were female.

DESCRIPTION (provided by applicant): This K01 award will provide specialized training in the skills necessary to conduct longitudinal research and to identify risk and protective factors in the development of alcohol use disorders in high-risk youth populations. The training plan will include an intensive study of alcohol use disorders (AUDs), longitudinal research and quantitative methods, and Attention-Deficit/Hyperactivity Disorder (ADHD), which will be accomplished via four primary training mechanisms: 1) guided readings in each content area designed by mentors and consultants; 2) regular meetings with each consultant to discuss professional development, grantsmanship, training/career goals, and ongoing data analysis and manuscripts; and 3) a series of workshops and courses led by leading experts in the field and designed to address the training goals. The training plan will also be facilitated by a series of complimentary research aims, which will include a systematic evaluation of the concurrent, longitudinal, and bidirectional relationships between two central risk factors for the development of alcohol use disorders (AUDs): parent alcoholism and childhood ADHD. Moreover the proposed study will evaluate the role of offspring ADHD and family functioning in the intergenerational transmission of AUDs. These aims will be examined using an original data collection project designed to examine the role of family functioning in ADHD families with alcoholic parents, and data from two ongoing longitudinal studies: the Pittsburgh ADHD Longitudinal Study (PALS) conducted by Drs. Brooke Molina (AA11873) and William Pelham (DA12414), and the Berkeley study of preadolescent ADHD girls, conducted by Dr. Hinshaw (MH45064). Both of these studies are the largest of their kind, and include comprehensive, state-of-the-art assessment batteries administered in face-to-face interviews with the target and at least one custodial parent. Moreover, they both include extensive longitudinal follow-up assessments in adolescence and young adulthood. The results of the proposed research and the skills obtained via the proposed training plan will serve as a springboard for future R01 studies that will examine the role of parent and offspring psychopathology in family functioning and the intergenerational transmission of AUDs, with the ultimate purpose of identifying targets for AUD prevention and intervention programs.

Abstract Over 25 million people have died of AIDS, making it one of the largest public health crises in history. There are over 33 million people with HIV world-wide. The majority of new HIV cases occur before age 25, and within marginalized populations. Syndemics theory postulates that multiple emerging and converging psychosocial epidemics are the driving mechanisms that cause HIV transmission. We are proposing that a developmental interpretation and application of syndemics theory is needed in order to explain HIV risk. Sexual minority youth (youth who endorse some level of same-sex attraction, behavior, and/or identity) are an ideal population to use as a model for testing the longitudinal development of syndemic processes. Sexual minority youth are highly marginalized, poorly understood, and severely underserved. They experience multiple psychosocial problems of epidemic proportions that are considered the core components of the syndemic effect. Compared with heterosexual youth, sexual minority youth are up to 5 times more likely to use drugs, 7 times more likely to be victimized, 6 times more likely to have mental health problems, and 5 times more likely to engage in HIV risk behavior. Yet longitudinal studies with sexual minority youth have rarely been conducted due to a host of cultural and methodological barriers. The overarching goal of this research project is to examine substance use and HIV risk behaviors in a longitudinal study of sexual minority youth and a matched comparison group of heterosexual youth. Due to the many important features of the proposed methodology and theory, this will be the first youth study of its kind. These features include the: (A) longitudinal, quasi-experimental design, (B) evaluation of individual growth or change in adolescent substance use and risky sexual behaviors over time, (C) examination of mediators and moderators of risk for substance use and risky sexual behavior, and (D) identification of risk and protective factors associated with the convergence of these multiple emerging epidemics and how they lead to HIV/AIDS. Results from this project will generate a wealth of information about the development of health problems among this highly vulnerable and marginalized group. They will provide empirical support for a developmental interpretation and application of the syndemics framework. And they will serve as a model for understanding how syndemic processes unfold in marginalized populations to raise risk for HIV/AIDS.

DESCRIPTION (provided by applicant): The central goal of this study is to describe and explain longitudinal patterns of adolescent substance use among sexual minority girls. Our meta-analysis of 18 cross-sectional studies showed that the odds of substance use for sexual minority girls were 400% higher than they were for heterosexual girls;However, few if any studies have examined longitudinal patterns of use, significant risk markers, mediators, or moderators of this disparity (Marshal et al., 2008). Only two studies to date have examined trajectories of substance use behavior among young sexual minority youth, and suggest that these disparities are maintained or increase over time as sexual minority youth approach young adulthood (Corliss et al., 2008;Marshal et al., 2009). Furthermore, cross-sectional evidence suggests that substance use among sexual minority girls is associated with other psychosocial health problems such as depression (Fergusson et al., 1999;Garofalo, et al., 1998). However no studies to date have examined the role of psychosocial risk factors in the long term patterns of substance use in this high risk population. We are proposing a developmental interpretation and application of Minority Stress Theory (MST;Hatzenbuehler, 2009;Meyer, 2003). Our new approach combines it with Developmental Psychopathology Theory (Cicchetti &Cohen, 2006) in order to articulate the unique needs and problems faced by sexual minority youth. Our Specific Aims are to: (1) Examine disparities between sexual minority girls and heterosexual girls in the age of onset and longitudinal course of substance use (quantity and frequency of cigarette, alcohol, and illicit drug use);(2) Determine whether the association between sexual minority status and trajectories of substance use is moderated or mediated by other psychosocial risk and protective factors (e.g., mental health, risky sexual behavior, deviant peer affiliation, victimization, social support, self-esteem, parent-child relationship quality);and (3) Explore whether the associations between sexual minority status, psychosocial factors, and substance use vary across demographic subgroups (e.g., age, ethnicity, family structure, SES). This proposal is innovative because: (1) it will be the first to characterize the onset, course, and long-term psychosocial correlates of substance use among sexual minority girls;(2) it will develop a new theoretical approach to describing and explaining risk for substance use among sexual minority youth;and we will (3) fill critical gaps in the health disparities and health services literatures, as well as provide important descriptive and explanatory information about longitudinal pathways of risk among this highly vulnerable group that will help inform future research, prevention, and intervention programs. PUBLIC HEALTH RELEVANCE: The primary goal of this study is to describe and explain longitudinal patterns of adolescent substance use among sexual minority girls. Recent meta-analysis results showed that the odds of adolescent substance use for sexual minority girls were 400% higher than they were for heterosexual girls. However, very few studies have examined longitudinal patterns of use, significant risk markers, mediators, or moderators of this disparity. This longitudinal study will characterize the onset, course, and long-term psychosocial risk and protective factors associated with substance use among sexual minority girls, and in doing so it will fill critical gaps in the health disparities and health services literatures.

DESCRIPTION (provided by applicant): The central goals of this competing renewal grant are to: (1) identify specific mediated pathways of risk for substance use and abuse among sexual minority girls (SMGs; girls who report same-sex sexual orientation) and (2) identify developmentally appropriate protective factors that can inform the development of novel prevention and intervention studies tailored for this high risk group. SMGs are 400% more likely to report substance use than are heterosexual girls. Recent results from grant years 1-3 showed that SMGs reported multiple mental health disparities including risky sexual behavior that were significant across all levels of all demographic covariates. SMG substance use disparities seen in adolescence increased as girls transition to young adulthood and change in binge drinking over time is more closely linked to suicidality in SMGs than it is in boys. In grant years 1-3 we were highly successful in documenting the persistence of SMG substance use disparities and identifying important psychosocial correlates of the disparities. Building on this foundation, we propose a heuristic model that articulates the most probable (empirically-supported, theory-driven) pathways of risk for substance use in SMGs. Dozens of conceptual models have been developed to describe risk for substance use among other at-risk teens; however no one has developed an empirically supported heuristic model that describes risk pathways for sexual minority youth. Preliminary data from grant years 1-3 and our proposed data sets (Add Health and the Pittsburgh Girls Study) show strong preliminary support for our hypothesized mediate pathways (stress-negative affect, social marginalization, and future expectations pathways). This proposal will build upon this foundation, and seeks to move the field forward by proposing and testing several longitudinal mediated pathways of risk and identify modifiable protective factors that will inform the design of a novel prevention and intervention program for SMGs.

DESCRIPTION (provided by applicant): The central goal of this study is to examine physiological and emotional reactivity to social and gay- related stressors among sexual minority girls (SMGs; girls who report same-sex attraction, same-sex sexual behavior, and/or a bisexual or lesbian identity), and their prospective associations with substance use and abuse. Minority Stress Theory (MST; Meyer, 2003) asserts that discrimination, violence, and victimization are the primary driving mechanisms of substance use and other mental health disparities among SMGs. Several recent studies published by the proposed PI support this hypothesis. Meta-analysis results showed that compared with heterosexual girls, SMGs were 400% more likely to have used drugs and alcohol (Marshal et al 2008), and trajectory analyses show that this disparity is likely to increase as SMGs transition to young adulthood (Marshal et al 2009, 2012). Two other studies showed that compared with heterosexual girls, SMGs were almost 300% more likely to experience suicidality and over 300% more likely to report being assaulted at school (Friedman, Marshal, et al., 2011; Marshal et al, 2011). This study will recruit 120 adolescent girls ages 14-18 (50% SMGs, 50% African-American) to address the proposed aims. We are proposing a modified minority stress model, asserting that physiological and emotional stress reactivity are important components of the minority stress process, and mediators of the pathway to substance use and other mental health outcomes among SMGs. Our specific aims are to: (1) use ecological momentary assessment (EMA) to document the daily social and gay-related stressors examine the real time links between these stressors and substance use, depression, and HIV risk behavior; (2) determine whether SMGs exhibit altered physiological and subjective responses to lab-based social and gay-related stress tasks; and (3) determine whether chronic stress exposure and biomarkers of stress reactivity predict long-term substance use, HIV risk behaviors, and other mental health outcomes. This will be the first study to assess, document, and describe stress reactivity processes among SMGs using lab-based and ecologically valid EMA methodologies. There are no empirically supported substance use interventions for sexual minority youth. Results from this study will accelerate progress towards the development of much needed prevention and intervention programs for SMGs at risk.

Abstract Over 25 million people have died of AIDS, making it one of the largest public health crises in history. There are over 33 million people with HIV world-wide. The majority of new HIV cases occur before age 25, and within marginalized populations. Syndemics theory postulates that multiple emerging and converging psychosocial epidemics are the driving mechanisms that cause HIV transmission. We are proposing that a developmental interpretation and application of syndemics theory is needed in order to explain HIV risk. Sexual minority youth (youth who endorse some level of same-sex attraction, behavior, and/or identity) are an ideal population to use as a model for testing the longitudinal development of syndemic processes. Sexual minority youth are highly marginalized, poorly understood, and severely underserved. They experience multiple psychosocial problems of epidemic proportions that are considered the core components of the syndemic effect. Compared with heterosexual youth, sexual minority youth are up to 5 times more likely to use drugs, 7 times more likely to be victimized, 6 times more likely to have mental health problems, and 5 times more likely to engage in HIV risk behavior. Yet longitudinal studies with sexual minority youth have rarely been conducted due to a host of cultural and methodological barriers. The overarching goal of this research project is to examine substance use and HIV risk behaviors in a longitudinal study of sexual minority youth and a matched comparison group of heterosexual youth. Due to the many important features of the proposed methodology and theory, this will be the first youth study of its kind. These features include the: (A) longitudinal, quasi-experimental design, (B) evaluation of individual growth or change in adolescent substance use and risky sexual behaviors over time, (C) examination of mediators and moderators of risk for substance use and risky sexual behavior, and (D) identification of risk and protective factors associated with the convergence of these multiple emerging epidemics and how they lead to HIV/AIDS. Results from this project will generate a wealth of information about the development of health problems among this highly vulnerable and marginalized group. They will provide empirical support for a developmental interpretation and application of the syndemics framework. And they will serve as a model for understanding how syndemic processes unfold in marginalized populations to raise risk for HIV/AIDS.

? DESCRIPTION (provided by applicant): The overarching goal of this study is to recruit transgender youth (TGY; youth who feel that their true gender is different than their biological sex at birth) into a longitudinal study and examine substance use and associated mental health disparities. This is a very nascent field. To date there are only a handful of within- group descriptive studies reporting high rates of substance use and mental health problems among TGY (Garofalo et al., 2006; Grossman & D'Augelli, 2006), and these studies are largely focused on older teenagers and young adults and male-to-female TGY. In addition, there are only two peer-reviewed disparities studies in the literature (comparing TGY to non-TGY) and both were published within the past year (Reisner et al., 2014, Fergusson et al., 2014). Results from these studies showed that compared with non-TGY, TGY are at increased risk for substance use, depression, anxiety, and suicidality. Yet these seminal studies are limited by their cross-sectional design, absence of measures that can describe and understand transgender-related identity and developmental processes, and other important assessment tools such as face-to-face psychiatric diagnostic interviews and information regarding transgender healthcare access. Thus the primary and overarching goal of this study is to begin to explore and fill these gaps in the adolescent literature. Our specific aims are: (1) to identify and describe substance use and associated mental and behavioral health problems (e.g., depression, suicidality, HIV risk behavior) over time among TGY; and (2) to identify and examine explanatory mechanisms (risk and protective factors) of substance use disparities among TGY (e.g., victimization, social isolation, depression, family and friend support). Currently, there are no evidence-based interventions to guide TGY and families through gender transition care. Findings from this study will provide important preliminary data to inform clinicians working with TGY and will guide the development of an intervention for TGY to promote positive outcomes during the process of transitioning.