Clustering of underage alcohol use in communities and its contextual influences

说明(申请人提供)：未成年人饮酒仍然处于令人无法接受的高水平，是一个巨大的公共卫生问题，具有一系列严重的身体、社会和心理-社会后果，包括急性和长期的。该应用程序的目标是检查美国社区和城市样本中未成年人酒精使用的地理聚集程度，并阐明这种聚集的可能解释，因为它与个人、社会和社区层面的环境背景有关。尽管改变整个社区的酒精使用环境的努力激增，但对未成年人酒精使用集群的估计很少，背景因素与这种集群相关的方式也没有得到充分的审查。在流行病学调查中，聚类法通常被视为一种“设计效应”，但聚类法可能具有重要的实质性影响。本申请建议对有史以来最大的未成年人酒精使用随机社区试验进行二次数据分析：(1)基于从交替Logistic回归(ALR)统计方法获得的成对优势比，提供对未成年人酒精使用聚集程度的第一次估计，(2)评估个人、社会和社区层面的环境背景对这种聚集的作用，以及(3)开发一种统计方法，用于检查从潜在类别分析得出的未成年饮酒者的亚类聚集。这项拟议的研究将利用在三年(2004年、2006年和2007年)中每年调查的美国68个城市约6800名14-20岁青年的重复横断面样本的数据，这些数据是作为执行未成年人饮酒法随机社区试验(EUDL-CT)的一部分收集的。除了衡量饮酒和与酒精相关的问题外，这些措施还将包括一系列与未成年人饮酒聚集有关的背景因素：社会影响(朋友、同龄人、家庭和学校)、饮酒的社会背景、社区构成、社区一级的执法活动和饮酒渠道密度。在我们可以理解是什么导致未成年人饮酒聚集的程度上，我们可以确定社区内共享的环境方面，这些方面可能有助于解释未成年人饮酒流行率的高低。这些信息将具有重要意义，因为它揭示了在今后的全社会预防和干预工作中应针对哪些背景因素。 本申请建议对有史以来最大的未成年人酒精使用随机社区试验进行二次数据分析：(1)基于从交替Logistic回归(ALR)统计方法获得的成对优势比，提供对未成年人酒精使用聚集程度的第一次估计，(2)评估个人、社会和社区层面的环境背景对这种聚集的作用，以及(3)开发一种统计方法，用于检查从潜在类别分析得出的未成年饮酒者的亚类聚集。这项拟议的研究将利用在三年(2004年、2006年和2007年)中每年调查的美国68个城市约6800名14-20岁青年的重复横断面样本的数据，这些数据是作为执行未成年人饮酒法随机社区试验(EUDL-CT)的一部分收集的。在我们可以理解是什么导致未成年人饮酒聚集的程度上，我们可以确定社区内共享的环境方面，这些方面可能有助于解释未成年人饮酒流行率的高低。这些信息将具有重要意义，因为它揭示了在今后的全社会预防和干预工作中应针对哪些背景因素。

DESCRIPTION (provided by applicant): Underage alcohol use remains at unacceptably high levels and is an enormous public health issue with a wide range of serious physical, social and psycho-social consequences, both acute and long-term. The goal of this application is to examine the extent to which underage alcohol use clusters geographically in a sample of US neighborhoods and cities and to elucidate a possible explanation for this clustering as it relates to individual, social and community-level environmental contexts. Despite the proliferation of efforts to change the community-wide environment surrounding alcohol use, estimates of the clustering of underage alcohol use are sparse and the manner in which contextual factors are related to this clustering have not been adequately examined. Clustering is most often treated as a "design effect" in epidemiologic surveys, but clustering can have important substantive implications. This application proposes secondary data analysis of the largest-ever randomized community trial of underage alcohol use to: (1) provide the first estimates of the magnitude of clustering of underage alcohol use based on pair wise odds ratios obtained from a statistical method called alternating logistic regression (ALR), (2) evaluate the role of individual, social and community-level environmental contexts on this clustering, and (3) develop a statistical approach for examining the clustering of subtypes of underage drinkers derived from latent class analysis. The proposed study will capitalize on data from repeated cross-sectional samples of approximately 6800 youth aged 14-20 from 68 US cities surveyed in each of three years (2004, 2006 and 2007) and collected as part of the Enforcing Underage Drinking Laws Randomized Community Trial (EUDL-CT). In addition to measures of alcohol use and alcohol-related problems, measures will include a wide range of contextual factors expected to relate to the clustering of underage alcohol use: social influences (friends, peers, family, and school), social context of drinking, neighborhood composition, community-level law enforcement activities, and alcohol outlet density. To the extent to which we can understand what causes clustering of underage alcohol use, we may identify aspects of the environment that are shared within communities and that may help to account for the higher or lower prevalence of underage alcohol use. This information will have importance by disclosing what contextual factors should be targeted in future community-wide prevention and intervention efforts. This application proposes secondary data analysis of the largest-ever randomized community trial of underage alcohol use to: (1) provide the first estimates of the magnitude of clustering of underage alcohol use based on pair wise odds ratios obtained from a statistical method called alternating logistic regression (ALR), (2) evaluate the role of individual, social and community-level environmental contexts on this clustering, and (3) develop a statistical approach for examining the clustering of subtypes of underage drinkers derived from latent class analysis. The proposed study will capitalize on data from repeated cross-sectional samples of approximately 6800 youth aged 14-20 from 68 US cities surveyed in each of three years (2004, 2006 and 2007) and collected as part of the Enforcing Underage Drinking Laws Randomized Community Trial (EUDL-CT). To the extent to which we can understand what causes clustering of underage alcohol use, we may identify aspects of the environment that are shared within communities and that may help to account for the higher or lower prevalence of underage alcohol use. This information will have importance by disclosing what contextual factors should be targeted in future community-wide prevention and intervention efforts.