# Risk and resilience pathways linking community adversity, decision making, and alcohol misuse: A prospective study of Appalachian adolescents

> **NIH NIH R01** · WEST VIRGINIA UNIVERSITY · 2020 · $550,869

## Abstract

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.

## Key facts

- **NIH application ID:** 10013108
- **Project number:** 5R01AA027241-02
- **Recipient organization:** WEST VIRGINIA UNIVERSITY
- **Principal Investigator:** Alfgeir Kristjansson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $550,869
- **Award type:** 5
- **Project period:** 2019-09-10 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10013108

## Citation

> US National Institutes of Health, RePORTER application 10013108, Risk and resilience pathways linking community adversity, decision making, and alcohol misuse: A prospective study of Appalachian adolescents (5R01AA027241-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10013108. Licensed CC0.

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