Substance abuse and its sequelae, particularly AIDS and interpersonal violence, constitute a contemporary public health crisis of ever-widening impact. The increasing risk of substance abuse in youth, particularly among urban minorities, reveals the need for prevention and early intervention measures. Elucidation of the role of specific familial and sociocultural factors in the development of drug use and abuse would yield targets for primary and secondary prevention of substance abuse and its complications. This application proposes to integrate family and migrant study methodology in a five-year prospective epidemiologic study of adolescent offspring of native migrant Puerto Rican substance abusers and controls. The wave of migration of Puerto Ricans to Connecticut over several decades provides an exceptional opportunity to differentiate cultural, familial, and individual risk and protective factors for adolescent drug use and abuse. Puerto Ricans are an important yet understudied ethnic subgroup characterized by an apparently low prevalence of substance use and abuse on the island of Puerto Rico, yet by a prevalence of AIDS that is among the greatest in the world. Migrant study methodology permits identification of environmental risk factors for substance use/abuse by comparing the disease experience of biologically similar subgroups in their native and adopted environments. The family study method enables the identification of transmissible components of a condition by comparing the rates and risk factors for diseases in relatives of cases with those of controls. Combining these two approaches in a single study to investigate risk factors for substance abuse allows us to: a) identify the relative contribution of family history of substance abuse and psychopathology on drug use and abuse in Puerto Rican adolescents while taking into account the influence of cultural environment, and b) identify the relative contribution of cultural factors on the risk of adolescent substance use and abuse, while taking into account background familial factors. The main aims of the study are: (1) to elucidate familial patterns of substance use and abuse and comorbid psychopathology among island and mainland Puerto Ricans; (2) to investigate the role of specific sociocultural factors in the development of adolescent substance use and abuse; (3) to identify and model the dynamics of the salient risk and protective factors at the individual, familial, and environment levels for Puerto Rican adolescents at high and low risk for the development of substance abuse by virtue of parental substance abuse, and; (4) To conduct a longitudinal follow-up of the offspring to examine transitions in substance use status, and the association between the early patterns of substance use and comorbid psychopathology (including course and outcomes), as well as examine the stability of the assessments.
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