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，酒精不仅会对饮酒者个人产生负面影响，还会对其他人产生负面影响，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效应），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，尤其是在美国。澳大利亚和新西兰的初步研究表明，过度饮酒会伤害家庭，导致儿童虐待或忽视，并花费饮酒者以外的人的时间、金钱和内心的平静，这可能会使饮酒者自身伤害直接相关的社会成本增加一倍。除了在美国国家酒精调查（NAS）中使用了一个简短的量表，为目前的应用程序进行了初步工作外，完全没有关于酒精对他人危害的美国人口数据。根据PA-11-016（流行病学与预防），我们建议对美国成年人所经历的他人酗酒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，以及对与健康相关的生活质量、心理健康、时间和经济负担的影响。为了充分利用已经获得资助的2014-15年度全国饮酒调查（预计nh5270），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nh1580），并在美国范围内开展一项平行的、专门的酒精对他人的危害调查（nh2250）。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（双帧固定电话/手机RDD CATI调查，非裔美国人和西班牙裔美国人过抽样）。这将允许为某些分析汇集数据，以获得更大的权力和精度。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，并检验这些方面的个体差异假设；(2)检验有关环境影响的假设（饮酒环境和邻里环境，如城市化、社会经济劣势、紊乱和酒精出口密度），以深入了解如何预防此类危害；(3)估计多层次模型，以检验国家酒精税、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水平对危害的发生、来源和严重程度的相互作用。除了研究的新方向（第一次美国成年人酒精对他人危害的调查），一项创新是提议使用倾向评分匹配技术来对比结果（如心理健康影响），同时解决背景分析中常见的基于地点的分类和选择效应。作为这项工作的一部分，我们将确定与他人饮酒严重危害相关的高风险情况，这些情况可能适合进行预防性干预，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.