Castillo Mezzich A, Tarter R E, Giancola P R, Lu S, Kirisci L, Parks S
Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, PA 15213, USA.
Drug Alcohol Depend. 1997 Mar 14;44(2-3):157-66. doi: 10.1016/s0376-8716(96)01333-6.
The purpose of this study was to elucidate the etiological pathways towards substance use and risky sexual behavior in female adolescent substance abusers. The study had three aims: (1) to determine the relations between behavioral dysregulation, negative affectivity, and childhood victimization with substance use and risky sexual behavior, (2) to determine whether these relations are mediated by internalizing symptomatology, antisocial behavior, and affiliating with an adult boyfriend; and (3) to determine whether age of menarche moderates the relation between the mediating variables and substance use and risky sexual behavior. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, childhood victimization, internalizing symptomatology, antisocial behavior, affiliation with adult boyfriends, substance use, and risky sexual behavior in 125 substance abusing female adolescents and 78 controls between the ages of 14-18 years. Structural equation modeling was used to determine the etiological pathways. Results indicated that behavioral dysregulation, negative affectivity, and childhood victimization were related to substance use and risky sexual behavior. Age of menarche was significantly correlated with affiliation with an older boyfriend and risky sexual behavior. Antisocial behavior mediated the associations between behavioral dysregulation, negative affectivity and childhood victimization with substance use and risky sexual behavior. Affiliation with an adult boyfriend was directly associated with substance use involvement and accounted for the relationship between chronological age and risky sexual behavior. Finally, late menarche enhanced the association between internalizing symptomatology and substance use involvement. The results highlight the importance of behavioral dysregulation, negative affectivity, and childhood victimization in predicting substance use and risky sexual behavior, as well as the finding that antisocial behavior and affiliation with an adult boyfriend may be etiologically important in predicting these outcomes. Therefore, from a prevention and treatment standpoint, behavioral and affective dysregulation, childhood victimization as well as antisocial behavior may serve as clinical 'gateways' for altering the developmental trajectory toward substance use and risky sexual behavior in high risk and substance abusing youth. For example, reducing dysregulation through behavior modification procedures that have been developed for conduct disordered children would appear to be a heuristic avenue of investigation emanating from the results obtained in this study.
本研究的目的是阐明女性青少年药物滥用者出现药物使用及危险性性行为的病因路径。该研究有三个目标：（1）确定行为失调、消极情感性和童年期受侵害经历与药物使用及危险性性行为之间的关系；（2）确定这些关系是否通过内化症状、反社会行为以及与成年男友交往来介导；（3）确定初潮年龄是否调节中介变量与药物使用及危险性性行为之间的关系。采用多种行为、精神病学访谈和自我报告测量方法，对125名年龄在14至18岁的药物滥用女性青少年和78名对照者的行为失调、消极情感性、童年期受侵害经历、内化症状、反社会行为、与成年男友交往、药物使用及危险性性行为进行指标化。使用结构方程模型来确定病因路径。结果表明，行为失调、消极情感性和童年期受侵害经历与药物使用及危险性性行为有关。初潮年龄与与年长男友交往及危险性性行为显著相关。反社会行为介导了行为失调、消极情感性和童年期受侵害经历与药物使用及危险性性行为之间的关联。与成年男友交往与药物使用直接相关，并解释了实际年龄与危险性性行为之间的关系。最后，初潮较晚增强了内化症状与药物使用之间的关联。研究结果突出了行为失调、消极情感性和童年期受侵害经历在预测药物使用及危险性性行为方面的重要性，以及反社会行为和与成年男友交往在预测这些结果方面可能具有病因学重要性这一发现。因此，从预防和治疗的角度来看，行为和情感失调、童年期受侵害经历以及反社会行为可能是改变高危和药物滥用青少年走向药物使用及危险性性行为发展轨迹的临床“通道”。例如，通过为品行障碍儿童开发的行为矫正程序来减少失调，似乎是基于本研究结果的一条具有启发性的研究途径。
