Comorbidity of addictive and mental disorders has been shown to be pervasive, with more than half (54%) of those aged 15-54 in the National Comorbidity Survey who had one diagnosable disorder having at least one co-occurring disorder. Less is known about comorbidity in youth or the degree to which it is affected by environmental factors. This proposal describes a two-year, multi-level investigation of the roles that mental disorders and adverse family, school, and community environments play in increasing risk of children and adolescents' misuse of alcohol and other drugs. The primary objective is to identify preventable antecedents of youth substance use disorders, using a developmental psychopathology approach. These investigations will be accomplished through secondary analyses of a multi-level study of 3000 youth and their communities, gathered by the Project on Human Development in Chicago Neighborhoods (PHDCN) from 1995-2001. Comorbidity between mental and addictive disorders among the youth will be described; additionally, the developmental risk processes that gave rise to the disorders themselves on the pathway to subsequent substance problems will be investigated. This proposal is being submitted by a new investigator, trained in social/psychiatric epidemiology. Youth, 9-18 years of age at baseline, and a caregiver were interviewed at home three times. Community characteristics were measured in 1995 and 2001 from independent samples and from videotapes of subjects' neighborhoods. Multilevel statistical methods will be used including discrete time survival analysis, hierarchical linear modeling, and individual growth modeling. This sample is uniquely suited to address the proposed aims, given (1) the longitudinal nature of the study; (2) the ability to compare neighborhoods and schools using an ecological framework and measurement of contextual features; and (3) comprehensive assessments of individual mental health and substance use behaviors. The use of existing data sets represents an opportunity to address these questions in a cost-effective manner. In his 1999 report on mental health, former U.S. Surgeon General Satcher asserted that little is known about the role of mental disorders in increasing the risk of misuse of alcohol and other drugs by youth. By addressing this research silence in a scientifically sound, multi-level study design, the products of the proposed research will be important contributions toward improving the planning and efficacy of health promotion and substance abuse prevention programs at the individual and local community level.
