Clustering of underage alcohol use in communities and its contextual influences

描述（由申请人提供）：未成年人饮酒仍然处于不可接受的高水平，是一个巨大的公共卫生问题，具有广泛的严重的身体，社会和心理社会后果，包括急性和长期。这个应用程序的目标是研究在何种程度上未成年人酒精使用集群的地理样本中的美国社区和城市，并阐明这种集群的可能解释，因为它涉及到个人，社会和社区层面的环境背景。尽管扩散的努力，以改变周围的酒精使用的社区范围内的环境，估计未成年人饮酒的集群是稀疏的，并在其中的上下文因素与这种集群的方式没有得到充分的审查。在流行病学调查中，聚类通常被视为一种“设计效应”，但聚类可能具有重要的实质性影响。该申请提出了有史以来最大的未成年人饮酒随机社区试验的次要数据分析，以：（1）根据从称为交替逻辑回归（ALR）的统计方法获得的成对比值比，提供未成年人饮酒聚集程度的第一次估计，（2）评估个人，社会和社区环境背景对这种聚集的作用，及（3）发展一种统计学方法，用于检验从潜在类别分析得出的未成年饮酒者亚型的聚类。这项拟议的研究将利用来自美国68个城市的大约6800名14-20岁青年的重复横断面样本的数据，这些样本在三年（2004年，2006年和2007年）中每年进行调查，并作为执行未成年人饮酒法随机社区试验（EUDL-CT）的一部分收集。除了酒精使用和酒精相关问题的措施，措施将包括广泛的背景因素，预计与未成年人酒精用途：社会影响（朋友，同龄人，家庭和学校），饮酒的社会背景，邻里组成，社区一级的执法活动，和酒精出口密度。在某种程度上，我们可以理解是什么原因导致未成年人饮酒的聚集，我们可以确定社区内共享的环境方面，这可能有助于解释未成年人饮酒的较高或较低流行率。这一信息将具有重要意义，因为它揭示了在未来全社区的预防和干预工作中应针对哪些背景因素。 该申请提出了有史以来最大的未成年人饮酒随机社区试验的次要数据分析，以：（1）根据从称为交替逻辑回归（ALR）的统计方法获得的成对比值比，提供未成年人饮酒聚集程度的第一次估计，（2）评估个人，社会和社区环境背景对这种聚集的作用，及（3）发展一种统计学方法，用于检验从潜在类别分析得出的未成年饮酒者亚型的聚类。这项拟议的研究将利用来自美国68个城市的大约6800名14-20岁青年的重复横断面样本的数据，这些样本在三年（2004年，2006年和2007年）中每年进行调查，并作为执行未成年人饮酒法随机社区试验（EUDL-CT）的一部分收集。在某种程度上，我们可以理解是什么原因导致未成年人饮酒的聚集，我们可以确定社区内共享的环境方面，这可能有助于解释未成年人饮酒的较高或较低流行率。这一信息将具有重要意义，因为它揭示了在未来全社区的预防和干预工作中应针对哪些背景因素。

DESCRIPTION (provided by applicant): Underage alcohol use remains at unacceptably high levels and is an enormous public health issue with a wide range of serious physical, social and psycho-social consequences, both acute and long-term. The goal of this application is to examine the extent to which underage alcohol use clusters geographically in a sample of US neighborhoods and cities and to elucidate a possible explanation for this clustering as it relates to individual, social and community-level environmental contexts. Despite the proliferation of efforts to change the community-wide environment surrounding alcohol use, estimates of the clustering of underage alcohol use are sparse and the manner in which contextual factors are related to this clustering have not been adequately examined. Clustering is most often treated as a "design effect" in epidemiologic surveys, but clustering can have important substantive implications. This application proposes secondary data analysis of the largest-ever randomized community trial of underage alcohol use to: (1) provide the first estimates of the magnitude of clustering of underage alcohol use based on pair wise odds ratios obtained from a statistical method called alternating logistic regression (ALR), (2) evaluate the role of individual, social and community-level environmental contexts on this clustering, and (3) develop a statistical approach for examining the clustering of subtypes of underage drinkers derived from latent class analysis. The proposed study will capitalize on data from repeated cross-sectional samples of approximately 6800 youth aged 14-20 from 68 US cities surveyed in each of three years (2004, 2006 and 2007) and collected as part of the Enforcing Underage Drinking Laws Randomized Community Trial (EUDL-CT). In addition to measures of alcohol use and alcohol-related problems, measures will include a wide range of contextual factors expected to relate to the clustering of underage alcohol use: social influences (friends, peers, family, and school), social context of drinking, neighborhood composition, community-level law enforcement activities, and alcohol outlet density. To the extent to which we can understand what causes clustering of underage alcohol use, we may identify aspects of the environment that are shared within communities and that may help to account for the higher or lower prevalence of underage alcohol use. This information will have importance by disclosing what contextual factors should be targeted in future community-wide prevention and intervention efforts. This application proposes secondary data analysis of the largest-ever randomized community trial of underage alcohol use to: (1) provide the first estimates of the magnitude of clustering of underage alcohol use based on pair wise odds ratios obtained from a statistical method called alternating logistic regression (ALR), (2) evaluate the role of individual, social and community-level environmental contexts on this clustering, and (3) develop a statistical approach for examining the clustering of subtypes of underage drinkers derived from latent class analysis. The proposed study will capitalize on data from repeated cross-sectional samples of approximately 6800 youth aged 14-20 from 68 US cities surveyed in each of three years (2004, 2006 and 2007) and collected as part of the Enforcing Underage Drinking Laws Randomized Community Trial (EUDL-CT). To the extent to which we can understand what causes clustering of underage alcohol use, we may identify aspects of the environment that are shared within communities and that may help to account for the higher or lower prevalence of underage alcohol use. This information will have importance by disclosing what contextual factors should be targeted in future community-wide prevention and intervention efforts.