Effects of Disadvantage and Protective Resources on Alcohol-related Disparities

描述(由申请人提供)：在美国，大量饮酒是可预防的死亡的主要原因。鉴于黑人和西班牙裔与白人相比，与酒精相关的发病率和死亡率更高，减少酗酒和酒精问题中的种族差异是一个重要的公共卫生目标。然而，目前，我们对与种族有关的酒精差距的理解存在严重差距。先前的研究已经证实，黑人和西班牙裔(与白人)饮酒者中酗酒和酒精问题的比例更高；此外，有一些证据表明，即使在酒精消费水平相似的情况下，黑人和西班牙裔的酒精问题发生率也相对更高。然而，据我们所知，还没有研究正式评估这些差异的调停者。此外，只有极少数研究在控制饮酒时考察了酒精问题中的种族差异，而且这些研究都是有限的。因此，这项研究的主要目的是描述和解释同等消费水平的酗酒和酗酒问题中的种族差异。我们的概念性方法认识到，美国的种族/民族群体在经济、社会和社区方面受到不同程度的不利影响，并借鉴了最近的理论工作，这些工作表明，累积受到不利影响可能在理解健康差距方面发挥重要作用。我们的研究还认为与酒精相关的因素--如饮酒量、饮酒环境和酗酒年龄的差异--是导致同等消费水平问题差异的潜在因素。这项研究考察了美国最大的三个种族/民族白人(作为参照物)、黑人和西班牙裔之间与酒精有关的差异，并分析了2005年和2010年美国国家酒精调查(NAS)的数据；总N=11,839。NAS提供了广泛的细粒度酒精消费和问题测量；经济、社会和心理变量；以及关于社区SES、酒精销售点密度和种族/民族构成的地理链接人口普查数据。将使用结构方程建模、缓和调解测试和倾向得分匹配等高级统计技术来解决以下具体目标：1)描述大量饮酒和酒精问题(即负面饮酒后果和依赖症状)中的种族差异；2)评估劣势和酒精相关因素在多大程度上导致这些种族差异；3)确定保护资源(例如社会支持、饮酒规范和网络、宗教信仰)，以减轻劣势对大量饮酒的影响。通过确定不同风险因素对种族差异的相对贡献，这项研究将有助于确定决策和预防工作的优先次序，并将为寻求解决风险因素和加强每个种族/族裔群体的保护资源的干预措施提供信息。

DESCRIPTION (provided by applicant): Project Summary Heavy alcohol use is a leading cause of preventable death in the U.S. Given that rates of alcohol-related morbidity and mortality are elevated among Blacks and Hispanics compared to Whites, reducing racial disparities in heavy drinking and alcohol problems is an important public health goal. At present, however, there is a critical gap in our understanding of alcohol disparities related to race. Prior research has already established higher rates of heavy drinking and alcohol problems among Black and Hispanic (vs. White) drinkers; further, there is some evidence of relatively higher rates of alcohol problems among Blacks and Hispanics even at similar levels of alcohol consumption. Yet, no studies to our knowledge have formally evaluated mediators of these disparities. Further, only a very few studies have examined racial disparities in alcohol problems when controlling for consumption, and those have been limited. The primary objective of this study is thus to describe and explain racial disparities in both heavy drinking and alcohol problems at equivalent levels of consumption. Our conceptual approach recognizes that racial/ethnic groups in the U.S. are differentially exposed to economic, social, and neighborhood disadvantages, and draws upon recent theoretical work suggesting that cumulative exposure to disadvantage may play a significant role in understanding health disparities. Our study also considers alcohol-related factors-such as differences in drink size, drinking contexts, and age at heavy drinking-as potential contributors to disparities in problems at equivalent levels of consumption. The study examines alcohol-related disparities among Whites (as the referent), Blacks, and Hispanics, the three largest racial/ethnic groups in the U.S., and analyzes data from the 2005 and 2010 U.S. National Alcohol Survey (NAS); total N=11,839. The NAS provides a wide array of fine- grained alcohol consumption and problem measures; economic, social and psychological variables; and geolinked Census data on neighborhood SES, alcohol outlet density, and racial/ethnic composition. Advanced statistical techniques such as structural equation modeling, moderated mediation tests, and propensity score matching will be employed in addressing the following Specific Aims: 1) to describe racial disparities in heavy drinking and alcohol problems (i.e., negative drinking consequences and dependence symptoms); 2) to assess the extent to which disadvantage and alcohol-related factors account for these racial disparities; and 3) to identify protective resources (e.g., social support, drinking norms and networks, religiosity) that mitigate the impact of disadvantage on heavy drinking. By identifying the relative contribution of distinct risk factors to racial disparities, this study will help in prioritizing policymaking and prevention efforts, and will inform interventions seeking to address risk factors and build upon the protective resources of each racial/ethnic group.