Mediators and Moderators of a Neighborhood Experiment on Alcohol Use

 描述（由申请人提供）：青少年过度饮酒会破坏健康发育，并导致日后生活中不利的社会，经济和健康后果。虽然现有的研究主要集中在个人层面的原因，邻里环境越来越多地被认为是上游的决定因素，酒精使用。然而，由于大多数以前的社区健康研究不是实验性的，它可能是有偏见的，并削弱了政策翻译的基础。我们的研究提出了一个新的可用数据的二次分析，从一个社会实验的自愿邻里搬迁使用住房券在5个城市（移动到机会，MTO，研究），以测试是否，如何，以及为什么随机分配的报价移动到一个低贫困社区超过15年的时间影响了青少年和他们的母亲的酒精使用，过量饮酒和酒精依赖。我们将补充现有的数据与额外的邻里水平的数据，以丰富数据集和测试多层次的假设。MTO是唯一一项随机分配家庭接受不同社区住房环境的大规模研究，以支持早期生活社区环境如何影响酒精使用的强有力因果推论。在推出时，MTO是扭转社区贫困对少数民族家庭的破坏性影响的最有希望的政策之一。但健康研究人员对MTO数据的访问有限，这影响了7000多万美元投资的科学回报。由于像MTO这样的住宅流动性实验是罕见的，昂贵的，而且由于MTO深刻地影响了物质的使用，因此探索其影响至关重要。我们提出了新的次要数据分析与新提供的15年随访数据，从这个随机对照试验，使用新的方法来测试调解和适度，适用于酒精的结果措施，以前没有检查。我们采用创新的方法来评估调解（即，基于权重的因果方法）和效果修正（即，机器学习技术）。除了对早期生活邻里变化如何影响过度饮酒进行强因果推理的RCT设计外，我们还利用为数不多的纵向干预设计之一，对母亲及其子女进行抽样，以阐明青春期出现的饮酒的家庭传播。我们的R21项目建立在一个富有成效的跨学科团队的基础上，具有MTO研究经验，并提出了3个目标：测试在MTO实验中搬到低贫困社区如何影响过度饮酒和酒精依赖;检查MTO实验对过度饮酒和酒精依赖的影响是否对更脆弱的家庭不利;测试是否移动到一个低贫困社区的MTO过度饮酒和酒精依赖的影响是由个人层面的压力介导;家庭层面的背景;或邻里层面的压力，酒精供应，或酒精规范。研究结果将丰富我们对社区和家庭环境作为青少年和成年人过度饮酒和饮酒原因的理解，并为下一代的酒精预防政策提供信息。

 DESCRIPTION (provided by applicant): Excessive drinking in adolescence disrupts healthy development and leads to adverse social, economic and health consequences later in life. Although existing research focuses primarily on individual-level causes, neighborhood context is increasingly recognized as an upstream determinant of alcohol use. Yet since most prior neighborhood research on health has not been experimental, it is potentially biased, and weakens the foundation for policy translation. Our study proposes a secondary analysis of newly-available data from a social experiment of voluntary neighborhood relocation using housing vouchers in 5 cities (the Moving to Opportunity, MTO, Study), to test whether, how, and why random assignment of an offer to move to a low- poverty neighborhood over a 15 year period influenced the alcohol use, excessive drinking, and alcohol dependence of adolescents and their mothers. We will complement existing data with additional neighborhood- level data to enrich the dataset and test multilevel hypotheses. MTO is the only available large-scale study that has randomly assigned families to receive different neighborhood housing contexts, to support strong causal inferences of how early-life neighborhood context shapes alcohol use. When launched, MTO was one of the most promising policies to reverse the damaging effects of neighborhood poverty for minority families. But health researchers have had limited access to MTO data, compromising the scientific payoff of the $70+ million investment. Since residential mobility experiments like MTO are rare, expensive, and since MTO profoundly affected substance use, it is crucial to probe its effects. We propose new secondary data analyses with newly available 15 year follow-up data from this RCT, using novel methods to test mediation and moderation, applied to alcohol outcome measures that have not been examined prior. We apply innovative methods for assessing mediation (i.e., weight-based causal methods) and effect modification (i.e., machine learning techniques). Aside from the RCT design for strong causal inference of how early-life neighborhood changes influence excessive drinking, we also leverage one of the few longitudinal intervention designs sampling both mothers and their children, to illuminate familial transmission of drinking as it emerges in adolescence. Our R21 project builds on a productive, interdisciplinary team, experienced with the MTO study, and proposes 3 aims: to test how moving to a low-poverty neighborhood in the MTO experiment influenced excessive drinking and alcohol dependence; to examine if the MTO experimental effect on excessive drinking and alcohol dependence was less beneficial for more vulnerable families; to test whether effects of moving to a low-poverty neighborhood in MTO for excessive drinking and alcohol dependence were mediated by individual-level stress; family-level context; or neighborhood-level stress, alcohol availability, or alcohol norms. The results will enrich our understanding of neighborhood and family context as a cause of excessive drinking and alcohol use in adolescents and adults, and inform the next generation of alcohol prevention policy.