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

描述：在美国和全世界，绝大多数关于酒精危害的研究都集中在饮酒者所经历的后果上，因为酒精使用会导致严重的发病率和死亡率。然而，酒精不仅对饮酒者个人有不利影响，而且对其他人也有不利影响，包括家庭成员、朋友、同事和陌生人。除了少数几个领域(如酒后驾车和胎儿酒精影响)，酒精对其他领域的危害(或外部性)在很大程度上没有得到充分的研究，特别是在美国。澳大利亚和新西兰的初步研究表明，过度饮酒会伤害家庭，导致虐待或忽视儿童，并耗费除饮酒者以外的其他人的时间、金钱和内心的平静，潜在地使直接与饮酒者自身伤害相关的社会成本翻一番。除了本申请的前期工作在全国酒精调查(NAS)中使用了一个简单的标尺之外，美国完全没有关于酒精对他人危害的全美人口范围的数据。响应PA-11-016(流行病学与预防)，我们建议首次对美国成年人经历的其他人大量饮酒造成的危害进行全面调查，研究此类危害的类型和来源，以及对与健康相关的生活质量、心理健康和时间和经济负担的影响。为了利用已经得到资助的2014-15年度NAS(预计NH5,270)，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(预计为NH1,580)，并进行一项平行的、专门的全美酒精对他人的危害调查(NH2,250)。这两项调查将包括共同的项目和量表，并使用相同的抽样设计(双框固定电话/手机RDD CATI调查，对非裔美国人和西班牙裔美国人进行过度抽样)。这将允许为某些分析汇集数据，以实现更大的能力和精度。目前的目标包括(1)全面估计酒精对他人的危害的流行率、来源和严重性，并检验关于这些方面的个体差异的假设；(2)测试关于环境影响的假设(饮酒环境和邻里环境，例如城市化、社会经济劣势、无序和酒精出口密度)，以深入了解如何预防这种伤害；(3)评估多层次模型，以检查国家酒税、酒精供应政策以及“湿”到“干”的饮酒文化的作用。我们将调查这些影响程度对危害的发生、来源和严重程度的相互影响。除了这项研究的新方向(这是美国首个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分数匹配技术来对比结果(如对心理健康的影响)，同时解决上下文分析中常见的基于地点的排序和选择效应。作为这项工作的一部分，我们将确定与他人饮酒造成的严重伤害相关的高危情况，这些情况可能适合预防干预，并审查影响的途径，目的是帮助为预防战略提供信息，并评估可能有助于减少其他饮酒者伤害的酒精政策。

DESCRIPTION: 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 ew 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., urbanity, 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.