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

产品说明：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饮酒者所经历的结果上，因为酒精使用会导致显著的发病率和死亡率。然而，酒精不仅对饮酒者个人产生不利影响，对其他人也会产生不利影响，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。澳大利亚和新西兰的初步研究表明，过量饮酒会伤害家庭，导致虐待或忽视儿童，并使饮酒者以外的人花费时间，金钱和心灵的平静，可能会使饮酒者本身的社会成本直接增加一倍。除了本申请的初步工作使用了国家酒精调查（NAS）中的简要量表之外，完全没有关于酒精对他人的危害的美国人口范围的数据。针对PA-11-016（流行病学与预防），我们建议对美国成年人因他人大量饮酒而造成的危害进行首次全面调查，研究此类危害的类型和来源，以及对健康相关生活质量，心理健康以及时间和经济负担的影响。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（预计NH 1，580），并进行一项平行的，专门的美国范围内的酒精对他人的危害调查（NH 2，250）。这两项调查将包括共同的项目和规模，并使用相同的抽样设计（双帧固定电话/手机RDD CATI调查，过抽样非洲裔美国人和西班牙裔）。这将允许汇集某些分析的数据，以实现更大的功效和精确度。目前的目标包括：（1）全面估计酒精对他人危害的流行程度、来源和严重性，并检验关于这些方面的个体差异的假设;（2）检验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，障碍和酒精出口密度），以了解如何防止这种伤害;（3）估计多层次模型，以检查国家酒精税，酒精供应政策和“湿”到“干”饮酒文化的作用。我们将调查这些影响程度对伤害的发生、来源和严重程度的相互作用。除了研究的新方向（第一次美国成年人口调查酒精对他人的危害），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），同时解决基于地点的排序和选择效应在上下文分析中常见。作为这项工作的一部分，我们将确定与其他饮酒者的严重危害相关的高风险情况，这些情况可能适合预防干预措施，并检查影响途径，目的是帮助制定预防战略，并评估可能有助于减少其他饮酒者危害的酒精政策。

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.