Differential Effects of Alcohol-related Policy across US Population Subgroups

翻译后摘要：不同的影响，酒精相关的政策在美国人口亚组 最近人们认识到，并非所有群体都能受益于基础广泛的公共卫生干预措施。 在某些情况下，弱势群体受益较少，这产生了意想不到的后果， 造成或加剧卫生不平等。酒精政策干预是解决过度饮酒问题的重要工具 人口中的饮酒和酒精问题，但并不经常被用于减轻 与酒精有关的差异为了开始考虑如何以这种方式使用酒精政策，政策制定者 首先需要知道酒精政策是否以及在多大程度上改善了人口健康和健康 股权本部分旨在通过确定哪些酒精政策可能产生 与酒精相关的差异减少最多。我们的研究将集中在酒精税，可用性 限制和治疗机会，减少艾滋病毒/艾滋病的三个最有效和最突出的政策办法， 酒精消费和问题。我们会评估个别政策对一般市民的影响 以及按种族/民族、社会经济地位、性别和年龄定义的亚组，并将确定最 和影响力最小的政策。我们还将估计假设的政策变化对 种族/民族和社会经济差异，并确定税收和可用性政策的最佳组合， 减少酒精消费、问题和死亡率方面的差距。我们的研究将利用政策数据， 多个来源，特别是NIAAA的酒精政策信息系统，并将使用几个国家的数据 分析政策相关的结果。其中包括个人层面的、基于调查的酒精消费量 行为危险因素监测系统（BRFSS）和全国酒精调查 (NAS)，以及国家酒精中心的州级酒精相关死亡率和治疗利用率。 健康统计和治疗事件数据集（TEDS）。分析将侧重于2000-2015年期间 并涉及具有固定和随机效应的混合横截面时间序列模型，差异中的差异 模型和中断的时间序列分析。我们的具体目标是：1）调查饮料的影响- 对饮酒模式、酒精相关问题和酒精所致死亡率征收特定税; 2） 酒精供应政策的影响（政府零售控制，销售的时间和天数，销售点的类型， 和酒精出口密度）对酒精使用模式、问题和死亡率的影响; 3）评估治疗的影响 关于使用药物的准入政策（《精神健康平等和成瘾公平法》和《平价医疗法》） 专业和初级保健为基础的酒精服务;和4）确定政策（和政策组合）的目标1 第二个假设的全国范围内的实施将对减少酒精产生最大的影响 人口中的消费、问题和相关死亡率，以及这些方面的差距。研究结果将有助于 公共卫生决策者权衡和优先考虑改善人口健康的各项政策战略 健康公平。

Abstract: Differential Effects of Alcohol-related Policy across U.S. Population Subgroups It has recently been recognized that not all groups may benefit from broad-based public health interventions. In some cases, disadvantaged groups have benefited less and this has had the unintended consequence of creating or increasing health inequities. Alcohol policy interventions are a vital tool for addressing excessive drinking and alcohol problems in the population but have not often been employed for the purpose of mitigating alcohol-related disparities. To begin to consider how alcohol policy might be used in this way, policymakers first need to know whether and to what extent alcohol policies improve both population health and health equity. This Component aims to address this question by determining which alcohol policies are likely to yield the largest reduction in alcohol-related disparities. Our study will focus on alcohol taxation, availability restrictions and treatment access, three of the most effective and prominent policy approaches for reducing alcohol consumption and problems. We will assess the effects of individual policies on the general population and on subgroups defined by race/ethnicity, socioeconomic status, gender and age, and will identify the most and least impactful policies for each group. We will also estimate the effects of hypothetical policy changes on racial/ethnic and socioeconomic disparities, and ascertain the optimal mix of tax and availability policies for mitigating disparities in alcohol consumption, problems and mortality. Our study will draw on policy data from multiple sources, particularly the NIAAA's Alcohol Policy Information System, and will use several national data sets to analyze policy-relevant outcomes. These include individual-level, survey-based alcohol consumption and problems from the Behavioral Risk Factor Surveillance System (BRFSS) and National Alcohol Survey (NAS), and state-level alcohol-related mortality and treatment utilization rates from the National Center for Health Statistics and Treatment Episode Data Set (TEDS). Analyses will focus on the period from 2000-2015 and involve pooled cross-sectional time-series models with fixed and random effects, difference-in-differences models, and interrupted time-series analyses. Our Specific Aims are to: 1) Investigate the impact of beverage- specific taxes on drinking patterns, alcohol-related problems and alcohol-attributable mortality; 2) Examine the effects of alcohol availability policies (government retail control, hours and days of sale, types of sales outlets, and alcohol outlet density) on alcohol use patterns, problems and mortality; 3) Assess the impact of treatment access policies (the Mental Health Parity and Addiction Equity Act and Affordable Care Act) on the use of specialty and primary care-based alcohol services; and 4) Identify the policies (and policy mix) from Aims 1 and 2 whose hypothetical, nationwide implementation will have the largest impact on reducing alcohol consumption, problems and related mortality in the population, and disparities in these. Study results will help public health decision makers to weigh and prioritize individual policy strategies for improving population health and health equity.