Risk and resilience pathways linking community adversity, decision making, and alcohol misuse: A prospective study of Appalachian adolescents - Abstract: Early adolescent alcohol use impairs psychosocial and neurocognitive development and increases vulnerabilities to drug abuse, academic failure, and mental health problems. The proposed research focuses on youth alcohol use in rural areas of West Virginia (WV), within the Appalachian region. Marginalized in American society, many Appalachian communities suffer chronic poverty and epidemic levels of opioid abuse. Emerging neurocognitive research stresses the maturation and integration of reward-salience and cognitive control systems asso- ciated with adolescent emotion regulation and healthy decision-making abilities. Development in decision making systems forecasts alcohol misuse, however, the factors that contribute to differ- ences in decision making trajectories are poorly understood. Also, accumulating research by our team and others links widespread use of caffeinated beverages by rural youth to alcohol use vulnerabilities. A psychostimulant possessing arousal, motor activation, and reinforcing proper- ties, even moderate doses of caffeine produce symptoms in children and adolescents, including headache, nausea, drowsiness, fatigue, mood disturbances, and sleeplessness. Despite these dangers, prospective investigations of routine caffeine use and the mechanisms through which it confers alcohol use vulnerability are virtually non-existent. We propose to investigate contextual protective factors hypothesized to attenuate the influence of community disadvantage on nega- tive emotionality, maladaptive health behavior, and decision-making trajectories. These factors include regulated, affectively positive family environments, health promoting classroom and school environments, and collective efficacy in local communities. We propose to address these issues in a prospective study of ~2,400 middle school youth from a range of rural, small town, and small city (< 30k) public schools in WV. Our specific aims are: 1. To test pathways linking community disadvantage to alcohol misuse. We expect community disadvantage to forecast slower growth in decision making processes directly and indirectly via negative emotionality which is reinforced by use of caffeine and attendant problems with sleep. In turn, we expect negative emotionality and decision making trajectories to forecast alcohol misuse via proximal vulnerability factors (affiliation with risky peers, academic disengagement). 2. To test hypotheses of contextual factors that protect youth from community disadvantage. We expect contextual protective factors to attenuate the influence of community disadvantage on (a) negative emotionality, (b) caffeine use, sleep problems, and (c) decision making. 3. To explore these alcohol antecedents in the onset of nicotine, marijuana, and other drug use.
