Effects of Disadvantage and Protective Resources on Alcohol-related Disparities

在美国，酗酒是可预防死亡的主要原因。鉴于与白人相比，黑人和西班牙裔与酒精相关的发病率和死亡率较高，减少酗酒和酒精问题的种族差异是一项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异的理解存在重大差距。先前的研究已经证实，黑人和西班牙裔饮酒者（与白人相比）重度饮酒和酒精问题的发生率更高；此外，有证据表明，即使在饮酒水平相似的情况下，黑人和西班牙裔人的酒精问题发生率也相对较高。然而，据我们所知，还没有研究正式评估这些差异的中介因素。此外，只有很少的研究在控制消费的情况下调查了酒精问题的种族差异，而且这些研究是有限的。因此，本研究的主要目的是描述和解释在相同消费水平下重度饮酒和酒精问题的种族差异。我们的概念方法认识到美国的种族/民族群体在经济、社会和社区劣势方面存在差异，并借鉴了最近的理论工作，表明累积的劣势暴露可能在理解健康差异方面发挥重要作用。我们的研究还考虑了与酒精相关的因素，如饮酒量、饮酒环境和酗酒年龄的差异，这些因素都可能导致同等消费水平下问题的差异。该研究调查了美国三个最大的种族/族裔群体——白人（作为参照）、黑人和西班牙裔之间的酒精相关差异，并分析了2005年和2010年美国国家酒精调查（NAS）的数据；总N = 11839。NAS提供了广泛的细粒度酒精消费和问题措施；经济、社会和心理变量；以及与社区社会经济地位、酒类出口密度和种族/民族构成相关的人口普查数据。先进的统计技术，如结构方程模型、有调节的中介测试和倾向得分匹配将被用于解决以下具体目标：1)描述重度饮酒和酒精问题（即负面饮酒后果和依赖症状）中的种族差异；2)评估不利条件和酒精相关因素在多大程度上造成了这些种族差异；3)确定保护性资源（如社会支持、饮酒规范和网络、宗教信仰），以减轻弱势群体对重度饮酒的影响。通过确定不同风险因素对种族差异的相对贡献，本研究将有助于确定政策制定和预防工作的优先顺序，并将为寻求解决风险因素的干预措施提供信息，并建立在每个种族/族裔群体的保护资源基础上。

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.