Neighborhood Socioeconomic Status and Alcohol Outcomes: Moderators and Mediators

描述（由申请人提供）：本资助申请响应现有流行病学数据的二次分析（PA-08-168）和酒精研究中的流行病学和预防研究（PA-07-449）的计划公告，呼吁国家酒精滥用和酒精中毒研究所发布的探索性和发展性研究。该应用程序提出了一个二次分析的数据从2000年和2005年全国酒精调查（由酒精研究小组进行）与数据从2000年美国十年一次的人口普查，以检查是否，为谁和如何邻里社会经济地位与酒精使用和酒精问题。首先，这项研究将调查是否有直接影响的社区SES对酒精使用，高风险饮酒和酒精问题在全国代表性的美国成年人样本。为了确定社区社会经济背景对哪些群体有影响，我们将研究社区社会经济地位与结果之间的关联是否因人口统计学群体而异。使用线性和逻辑回归的分析将检查不同种族/民族和社会经济背景的居民，以及年轻人，中年人和老年人的邻里环境的相关性。针对高风险饮酒和酒精问题的其他分析将研究早期生活风险因素是否会减轻生活后期暴露于社区风险的影响。这种创新的方法是由发展心理病理学和生命历程的角度来看，在检查酒精使用和酒精问题之间的一般人口样本的成年人。最后的分析将解决如何邻里社会经济背景可能会影响行为，通过确定是否心理社会中介因素有助于解释邻里社会经济地位对酒精结果的影响。中介分析将涉及初步的线性和逻辑回归，以告知整体路径分析模型。 该项目的目标与NIH的使命直接相关，即解释和减少与酒精有关的健康差异。这项探索性的流行病学研究将通过识别重度饮酒和酒精问题风险增加的社区居民群体来为预防科学提供信息。该研究还将通过探索社区对酒精结果的贡献途径来扩展先前的研究。正如方案公告中所指出的，多层次的预防举措非常重要。本研究确定了个人，家庭和邻里水平的风险和保护因素，并探讨了它们之间的相互关系，使用社会生态学的角度。未来的项目将旨在帮助将研究结果转化为以社区为中心的多层次预防干预措施，针对生活在高风险社区的高危人群，包括为最需要帮助的人提供心理健康支持服务，在富裕和弱势社区开展有针对性的公共教育活动，以及改变环境以减轻弱势社区的酒精问题负担。 公共卫生相关性：我们的健康和行为受到我们居住地的影响。这项研究探讨了社区是否与酒精使用和酒精问题有关。它侧重于社区的社会经济地位（富裕和劣势），以及一些群体（如少数民族群体成员，低收入者，年轻人或以前的酗酒者）如果生活在弱势社区，是否会面临更大的风险。该研究还研究了社区如何与酒精问题的表达相关，例如酗酒，抑郁或饮酒的原因。这项研究的结果将有助于为有风险的人和社区制定预防计划。

DESCRIPTION (provided by applicant): This grant application responds to the program announcements for the Secondary Analysis of Existing Epidemiology Data (PA-08-168) and for studies of Epidemiology and Prevention in Alcohol Research (PA-07-449) calling for exploratory and developmental research issued by the National Institute on Alcohol Abuse and Alcoholism. The application proposes a secondary analysis of data from the 2000 and 2005 National Alcohol Surveys (conducted by the Alcohol Research Group) linked with data from the 2000 US Decennial Census to examine whether, for whom and how neighborhood socioeconomic status is associated with alcohol use and alcohol problems. First, the study will investigate whether there are direct effects of neighborhood SES on alcohol use, high-risk drinking and alcohol problems in a nationally-representative sample of US adults. To determine the groups for whom the neighborhood socioeconomic context matters, we will examine whether the associations between neighborhood SES and the outcomes vary by demographic group. Analyses using linear and logistic regression will examine the relevance of the neighborhood environment for residents of different races/ethnicities and socioeconomic backgrounds, as well as for young, midlife and senior adults. Additional analyses focusing on high-risk drinking and alcohol problems will examine whether early-life risk factors moderate the effects of exposure to neighborhood risk later in life. This innovative approach is informed by developmental psychopathology and a life-course perspective in examining alcohol use and alcohol problems among a general population sample of adults. The final analyses will address how the neighborhood socioeconomic context may impact behavior by ascertaining whether psychosocial mediating factors help explain the influence of neighborhood SES on the alcohol outcomes. The mediation analysis will involve preliminary linear and logistic regression to inform overall path analysis models. The objectives of this project are directly relevant to the mission of the NIH to explain and reduce health disparities related to alcohol. This exploratory epidemiologic study will inform prevention science by permitting the identification of groups of neighborhood residents at increased risk for heavy alcohol use and alcohol problems. The study also will extend prior research by exploring the pathways through which neighborhoods contribute to alcohol outcomes. As noted in the program announcements, multi-level prevention initiatives are of great interest. This study identifies risk and protective factors at the individual, familial, and neighborhood levels and explores their interrelationships using a socioecological perspective. Future projects will be designed to help translate the study findings into community-focused, multi-level prevention interventions for at-risk individuals living in high-risk neighborhoods, including mental health support services for people most in need, targeted public education campaigns in affluent and disadvantaged neighborhoods, and environmental change to reduce the burden of alcohol problems in disadvantaged communities. PUBLIC HEALTH RELEVANCE: Our health and behavior are influenced by where we live. This study explores whether neighborhoods are related to alcohol use and alcohol problems. It focuses on neighborhood socioeconomic status (both affluence and disadvantage) and whether some groups (such as racial minority group members, people with low incomes, young adults, or formerly heavy drinkers) are more at risk if they live in disadvantaged neighborhoods. The study also examines how neighborhoods are related to expression of alcohol problems, such as by heavier drinking, depression or reasons for drinking. The results from this study will help develop prevention programs for people and neighborhoods at risk.