Structural Stressors, Neurocognition in Reward Related Decision Making and Substance Use Risk

Columbia University Health Sciences, New York NY

Investigators

Abstract

Structural stressors that impact health can include mutually reinforcing systems, such as area-level group differences in income, education and housing that disadvantage individuals, and are increasingly recognized as a fundamental cause of disparities in health. However, the impact of neighborhood-level structural stressors on substance use risk in youth at higher risk for a substance use disorder (SUD) is not known, despite the widespread negative impact that SUDs have on public health. To address this major gap, we plan to characterize the impact of area-level group differences in income, education and exposure to violence, on neurocognitive mechanisms of substance use risk at the brain and behavior levels in two disadvantaged contexts. A Community Advisory Board will refine our approach and maximize impact of findings. Results will inform structural interventions, the primary line of prevention for structural stressors. The buffering effect of area- and family-level protective factors, e.g., percentage of Latine owned businesses, parental monitoring, and individual-level factors, e.g., neurocognition could also inform secondary lines of structural-, family- and individual level-prevention. Mutually reinforcing structural stressors that exclude individuals from access to wealth and other opportunities, e.g. education and safe living environments, can lead to appraising the environment as unjust. We have learned from social psychology that weaker belief in a just world relates to choosing smaller, sooner over larger, later rewards, aka steeper delay discounting, as this is the optimal strategy in an unjust world. However, when the reward is a substance and immediate use is chosen over long-term health, this environmental adaptation could increase the risk of substance use. During adolescence, delay discounting predicts future use and in childhood, neighborhood disadvantage relates to reduced grey matter volume in prefrontal brain regions, possibly indexing environmental shaping. In adulthood, SUDs are associated with steeper delay discounting and decreased task-related brain activity in prefrontal regions. We will work with the Boricua Youth Study (BYS), an intergenerational, representatively sampled cohort of Puerto Rican families living in the South Bronx, New York (SBx) and San Juan, Puerto Rico (PR) that has been followed for 20+ years. We hypothesize that greater neighborhood structural stressors, measured as a latent factor indexed by group differences in income and education, and murder rates, will relate to alterations in adolescent neural structure and delay discounting related function (R61; n=36 in SBx; n=36 in PR), weaker belief in a just world, and thus increase substance use risk in at risk youth (R33; n=80 in SBx; n=80 in PR). Neighborhood- and family-level protective factors will buffer the impact of structural stressors on neural outcomes (R33). Results will reflect the impact of structural stressors on neurocognitive mechanisms of substance use risk in youth at higher risk for SUDs, guiding structural-, family- and individual prevention approaches.