Alcohol's Harms to Others among US Adults: Individual and Contextual Effects

在美国和世界范围内，绝大多数关于酒精危害的研究都集中在结果上 饮酒者的经验，因为酒精使用会导致严重的发病率和死亡率。然而，酒精 不仅对个人饮酒者产生不利影响，而且对其他人，包括家庭成员，朋友，合作伙伴， 工人和陌生人。除了少数几个领域（如酒后驾驶和胎儿酒精影响）， 酒精对他人的危害（或外部性）在很大程度上没有得到充分研究，特别是在美国。初步研究 澳大利亚和新西兰认为，过量饮酒会伤害家庭，导致虐待或忽视儿童， 花费了饮酒者以外的人的时间、金钱和心灵的平静，可能会直接使社会成本加倍 与饮酒者自身的危害有关。美国全民完全缺席 酒精对他人的危害的数据，除了使用简要量表的本申请的初步工作之外 全国酒精调查（NAS）根据PA-11-016（流行病学和预防），我们建议 第一次全面调查由于其他人大量饮酒造成的危害，正如美国成年人所经历的那样， 研究此类危害的类型和来源，以及对健康相关生活质量、心理健康和健康的影响。 时间和经济负担。为了利用已经资助的2014-15 NAS（预计NH 5，270），我们计划 为报告他人饮酒危害的受访者增加10分钟的详细问题（预期nH 1,580）， 同时也进行了一项平行的、专门的美国范围内的酒精对他人的危害调查（NH 2，250）。两项调查 将包括常见的项目和规模，并使用相同的抽样设计（双框架固定电话/手机RDD CATI调查，对非洲裔美国人和西班牙裔美国人进行过度抽样）。这将允许汇集数据， 分析，以实现更大的功率和精度。目前的目标包括：（1）全面估计 酒精对他人危害的流行程度、来源和严重程度，并检验关于个体的假设。 这些差异;（2）关于环境影响（饮酒环境和 邻近环境，例如，城市化、社会经济劣势、失调和酒精出口密度）， 深入了解如何预防此类伤害;（3）评估多层次模型，以检查 州酒精税，酒精供应政策，以及“湿”到“干”的饮酒文化。我们将调查 这些影响水平对伤害发生、来源和严重度的相互作用。除了有 这项研究的新方向（美国第一次关于酒精对他人危害的成年人口调查），一项创新 是建议使用倾向评分匹配技术来对比结果（如心理健康 影响），同时解决基于位置的排序和选择效果常见的上下文分析。作为 作为这项工作的一部分，我们将确定与他人饮酒造成严重伤害相关的高风险情况， 可能适合预防性干预，并检查影响的途径，目的是帮助 为预防策略提供信息，并评估可能有助于减少其他饮酒者危害的酒精政策。

In the US and worldwide, the vast majority of studies of alcohol's harms have focused on outcomes experienced by the drinker, given that alcohol use causes significant morbidity and mortality. However, alcohol adversely affects not only individual drinkers, but also other people, including family members, friends, co- workers and strangers. With the exception of a few areas (such as drink driving and fetal alcohol effects), alcohol's harms to others (or externalities), are largely understudied, particularly in the US. Initial studies in Australia and New Zealand suggest excessive drinking can harm families, cause child abuse or neglect, and cost people other than the drinker time, money, and peace of mind, potentially doubling the social costs directly associated with harms to drinkers themselves. There has been a complete absence of US population-wide data of alcohol's harms to others, excepting preliminary work for the present application that uses a brief scale in the National Alcohol Survey (NAS). Responding to PA-11-016 (Epidemiology & Prevention), we propose the first comprehensive investigation of harms due to others' heavy drinking, as experienced by US adults, studying types and sources of such harms, as well as impacts on health-related quality of life, mental health and time and financial burdens. To leverage the already-funded 2014-15 NAS (expected NH5,270) we plan to add 10 minutes of detailed questions for respondents reporting harm from others' drinking (expected nH1,580), as well as to field a parallel, specialized US-wide Alcohol's Harms to Others survey (NH2,250). Both surveys will include common items and scales and use the same sampling design (dual-frame landline/cell phone RDD CATI surveys, oversampling African Americans and Hispanics). This will permit pooling data for certain analyses to achieve greater power and precision. Current aims include to (1) comprehensively estimate the prevalence, sources and seriousness of alcohol's harms to others, and test hypotheses about individual differences in these; (2) test hypotheses regarding environmental influences (drinking contexts and neighborhood context, e.g., urbanicity, socioeconomic disadvantage, disorder and alcohol outlet density) to gain insight about how such harms might be prevented; (3) estimate multi-level models to examine the roles of state alcohol taxes, policies on alcohol availability, and 'wet' to 'dry' drinking cultures. We will investigate the interplay of these levels of influence on the occurrence, sources and severity of the harms. In addition to the novel direction of the research (the first US adult population survey of alcohol's harms to others), an innovation is the proposed use of propensity score matching techniques to contrast outcomes (such as mental health impacts) while addressing the place-based sorting and selection effects common in contextual analysis. As part of this work, we will identify high-risk situations associated with severe harms from others' drinking that may be amenable to preventive interventions, and examine pathways of influence, with a goal of helping to inform prevention strategies and evaluate alcohol policies that may help reduce harms from other drinkers.