title: Taking a life course approach to studying substance use treatment among a community cohort of African American substance users.
abstract: BACKGROUND
  Life course theory emphasizes the need to examine a wide variety of distal factors along with proximal factors, longitudinally. Yet research on who obtains substance use treatment is generally cross-sectional and limited to examining developmentally proximal factors (e.g., substance use severity) and demographic factors.
  
  
  METHODS
  To investigate treatment within a life-course framework, we studied 522 drug and/or alcohol users from a community cohort of African Americans followed prospectively from age 6. Developmentally distal factors of childhood and adolescent social behavior, family environment, academic achievement, mental health, and substance use along with the key proximal factors of substance use severity and socioeconomic status were examined using regression analyses to assess their impact on obtaining adult substance use treatment.
  
  
  RESULTS
  One-fifth of the study population obtained treatment for substance use by age 32 (20.5%). Although adult socioeconomic status was not associated with substance use treatment in adulthood in the multivariable model, the proximal factor of substance use severity was a strong predictor of obtaining substance use treatment, as expected. After including several developmentally distal factors in the model, childhood aggression also had an independent effect on adult substance use treatment, above and beyond substance use severity.
  
  
  CONCLUSIONS
  These findings emphasize the importance of using a life course framework when exploring predictors of treatment; early life characteristics are important influences beyond the more proximal factors in adulthood. Research should continue to take a life course approach to better understand pathways to substance use treatment.
authors.affiliation: The Methodology Center, The Pennsylvania State University, University Park, State College, PA 16801, USA; The Prevention Research Center, The Pennsylvania State University, University Park, State College, PA 16802, USA. Electronic address: revanspolce@psu.edu.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Evans-Polce
authors.affiliation: Department of Criminology and Criminal Justice, University of Missouri-St. Louis, St. Louis, MO 63121, USA.
authors.forename: Elaine E
authors.initials: EE
authors.lastname: Doherty
authors.affiliation: Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Ensminger
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D002648:Child; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D055815:Young Adult
keywords: Life course; Risk factors; Substance abuse treatment; Substance use