Social, Familial, Neighborhood Factors and Drinking in Puerto Rico

描述(由申请人提供)：与酒精有关的问题、滥用和依赖是波多黎各的一个重要公共卫生问题。不幸的是，岛上的公共卫生当局缺乏应对这些问题所必需的关于饮酒及其后果的流行病学数据。为了弥补这一知识差距，本申请建议对波多黎各圣胡安18岁及以上成年人的饮酒情况进行深入的家庭流行病学调查(样本N=1,500)。提出了一套四个创新的目标，这些目标将共同审查与饮酒相关的社会、家庭和邻里因素及其对岛上的影响。拟议的具体目标是：1)检查对饮酒的态度和期望以及家庭凝聚力和支持对饮酒和与酒精有关的问题以及DSM-IV滥用和依赖之间的联系的影响；2)通过检查失业与就业不足、压力、抑郁、饮酒、与酒精有关的问题、滥用和依赖之间的联系，检查当前经济衰退对饮酒行为及其相关后果的影响；3)扩展目标1和目标2，以审查社区集体效能(社会凝聚力和社会控制)、社区劣势(由人口普查变量贫困、受教育程度和失业所代表)、饮酒量、酗酒和酗酒和依赖之间的联系；4)鉴于波多黎各的具体文化环境，其中一些已在上文目标1、2和3中描述，测试其跨文化适用性 新提出的DSM-V物质使用障碍标准的维度，并检查诊断“孤儿”的比例和特征。这项研究的结果将大大提高治疗提供者和预防专业人员更多地了解波多黎各酒精问题的能力。这项研究将收集关于饮酒、与酒精相关的问题、虐待和依赖的个人和社区层面预测因素的详细流行病学数据。这些数据将与波多黎各的公共卫生专业人员共享，这将使这些专业人员能够规划有效的治疗对策以及预防战略，以解决岛上的酒精问题。考虑到这一点，研究团队由美国本土和波多黎各的研究人员组成，以加强这项研究的翻译应用。最后，所产生的知识也将适用于在波多黎各人以及美国本土的其他拉美裔群体中理解饮酒及其后果。 公共卫生相关性：在波多黎各，酗酒和与酒精有关的问题是一个严重的健康和社会问题；然而，关于决定饮酒及其在岛上的后果的社会、家庭和邻里因素，缺乏最新的流行病学数据。对这些因素的了解对于在个人和社区层面实施预防干预非常重要。该项目将对圣胡安大都市区波多黎各成年人的随机家庭样本中的这一复杂因素进行研究。

DESCRIPTION (provided by applicant): Alcohol-related problems, abuse and dependence are an important public health problem in Puerto Rico. Unfortunately, public health authorities on the island lack the epidemiological data on drinking and its consequences that are necessary to respond to these problems. To cover this gap in knowledge, this application proposes an in-depth household epidemiological survey of drinking among adults 18 years of age and older in San Juan, Puerto Rico (sample N=1,500). A set of four innovative aims is proposed, which together will examine social, familial and neighborhood factors associated with drinking and its consequences on the island. The proposed specific aims are: 1) To examine the influence of attitudes and expectancies about drinking and of family cohesion and support on the association between drinking and alcohol-related problems, and DSM-IV abuse and dependence; 2) To examine the impact of the present economic recession on drinking behavior and associated consequences by examining the association between unemployment and underemployment, stress, depression, drinking, alcohol-related problems, abuse and dependence; 3) Expanding aims 1 and 2 to examine the association between neighborhood collective efficacy (social cohesion and social control), neighborhood disadvantage (as represented by the census-level variables poverty, under education and unemployment), volume of drinking, binge drinking, and alcohol abuse and dependence; 4) Given the specific cultural circumstances of Puerto Rico, some of which are described in aims 1, 2 and 3, above, test the cross-cultural applicability of the dimensionality of the newly proposed DSM-V substance use disorder criteria and examine the proportion and characteristics of diagnostic "orphans". Results from this study will greatly enhance the ability of treatment providers and prevention professionals to understand more about alcohol problems in Puerto Rico. The study will collect detailed epidemiological data on individual- and neighborhood-level predictors of drinking, alcohol-related problems, abuse and dependence. These data will be shared with public health professionals in Puerto Rico, which will enable these professionals to plan effective treatment responses as well as prevention strategies to address alcohol problems on the island. With this in mind, the research team is composed of researchers on the U.S. mainland and in Puerto Rico so that translational application of this research is enhanced. Finally, the knowledge produced will also be applicable to understanding drinking and its consequences among Puerto Ricans as well as other Hispanic groups on the U.S. mainland. PUBLIC HEALTH RELEVANCE: Heavy drinking and alcohol-related problems are a serious health and social problem in Puerto Rico; yet, there is a dearth of up-to-date epidemiological data on the social, familial and neighborhood factors that determine drinking and its consequences on the island. Knowledge about these factors is important for implementing prevention interventions at the individual and neighborhood level. This project will study this complex array of factors in a random household sample of Puerto Rican adults in the San Juan metropolitan area.