Examining Key Assumptions: Prevention of Alcohol Use

描述（由申请人提供）：拟议的试点研究项目将检验关于青少年酒精使用流行病学的关键假设的经验有效性，这些假设是当前联邦和州针对社区预防酒精使用和其他问题行为的政策的基础。社区面临着各种各样的风险因素，以及一系列令人困惑的酒精和其他药物（ATOD）预防计划。为了帮助提供协调和有计划的以社区为基础的方法，政策制定者已经转向了一种新兴的最佳实践模式，我们称之为“社区诊断”（C-Dx）。在这个模型中，社区系统地评估和识别与国家和州标准相比升高的风险因素，然后选择针对这些升高的风险因素的预防性干预措施。通过州和联邦政府的政策以及基金会的倡议，C-Dx方法正在社区中得到实例化。C-Dx模型所依据的研究表明，大量风险/保护因素与青少年酒精和其他物质使用和滥用有关。然而，到目前为止，在大多数情况下，这种联系只是在个人层面，而不是在社区层面。这样的研究为干预提供了一个理论基础，以加强个别家庭的养育，以减少青少年过早饮酒。然而，尚未证明的是，这些同样的关系在社区一级也适用，在社区一级就行动作出决定。很可能仅凭个人流行病学并不能为社区预防决策提供充分的依据；有必要深入探讨“社区层面的青少年社会流行病学风险和结果”。在从个人研究转向社区预防的过程中，至少有五个假设没有得到充分的检验，可能是无效的。将通过对几个大型数据集的定量分析来检验这五个假设，这些数据集包含了各社区青少年风险和ATOD使用情况的数据。这些分析的结果可能使我们能够建议改变C-Dx模型；然而，这一试点项目很可能将为开展更密集的工作奠定基础，以审查社区酒精和其他物质使用的流行病学。

DESCRIPTION (provided by applicant): The proposed pilot research project will examine the empirical validity of key assumptions regarding the epidemiology of adolescent alcohol use that underlie current federal and state policies toward community- based prevention of alcohol use and other problem behaviors. Communities are faced with a diverse array of dozens of identified risk factors and a confusing array of alcohol and other drug (ATOD) prevention programs. To help provide a coordinated and planful community-based approach, policymakers have moved toward an emerging best practices model we term "Community Diagnosis" (C-Dx). In this model, communities systematically assess and identify risk factors that are elevated compared to national and state norms, and then select preventive interventions targeting those elevated risk factors. The C-Dx approach is being instantiated in communities through the policies of state and federal governments, as well as foundation initiatives. The C-Dx model is based on research showing that a large number of risk/protective factors are linked to adolescent alcohol and other substance use and abuse. However, in most cases to date, this linkage has only been made at the level of individuals, not communities. Such research provides a rationale for intervening to enhance parenting in individual families to reduce early- onset adolescent alcohol use. However, what has not yet been demonstrated is that these same relationships hold at the level of community, where decisions on actions are made. It is likely that individual-level epidemiology alone does not provide a sufficient basis for community prevention decisions; there is a need for in-depth exploration of "community level social epidemiology of youth risk and outcomes." There are at least five assumptions in the move from individual research to community prevention that have not been adequately examined and may not be valid. The five assumptions will be examined through quantitative analyses of several large datasets that contain data on youth risk and ATOD use across communities. The results of these analyses may enable us to recommend changes to the C-Dx model; however, it is likely that this pilot project will set the stage for a more intensive line of work examining the community epidemiology of alcohol and other substance use. PUBLIC HEALTH RELEVANCE: This project seeks to test five key assumptions in the application of individual epidemiology concerning adolescent alcohol use to community-level decision-making. The validity of these assumptions has not been demonstrated previously. If these assumptions are not valid, then the leading model for applying science to community-based prevention of alcohol and other problem behaviors may need to be reformulated to maximize the effectiveness of prevention resources. Increasing the efficiency of the application of prevention resources would have substantial public health benefits for youth, families, and society.