Neighborhood Socioeconomic Status and Alcohol Outcomes: Moderators and Mediators

描述(由申请人提供)：这项资助申请响应了国家酒精滥用和酒精中毒研究所发布的现有流行病学数据二次分析(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。该申请建议对2000年和2005年全国酒精调查(由酒精研究小组进行)的数据进行二次分析，并将其与2000年美国十年一次的人口普查数据联系起来，以检查社区的社会经济状况是否、对谁以及如何与酒精使用和酒精问题有关。首先，这项研究将在具有全国代表性的美国成年人样本中调查邻里SES是否对饮酒、高风险饮酒和酒精问题有直接影响。为了确定邻里社会经济背景对哪些群体很重要，我们将检查邻里社会经济状况和结果之间的关联是否因人口群体而异。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。关注高风险饮酒和酗酒问题的其他分析将检查早期生活风险因素是否会缓解晚年暴露于邻里风险的影响。这一创新的方法是从发展精神病理学和生命过程的角度出发，在成年人的一般人口样本中检查酒精使用和酒精问题。最终的分析将通过确定心理社会中介因素是否有助于解释社区SES对酒精结果的影响来解决社区社会经济环境如何影响行为。中介分析将包括初步的线性回归和Logistic回归，以形成总体路径分析模型。该项目的目标与美国国立卫生研究院解释和减少与酒精有关的健康差距的使命直接相关。这项探索性的流行病学研究将通过允许识别大量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。这项研究还将通过探索社区对酒精结果的影响的途径来扩展先前的研究。正如计划公告中指出的那样，多层次的预防举措非常令人感兴趣。这项研究确定了个人、家庭和社区层面的风险和保护因素，并从社会生态学的角度探讨了它们之间的相互关系。未来的项目将有助于将研究结果转化为针对生活在高危社区的高危个人的以社区为重点的多层次预防干预措施，包括为最有需要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，以及通过环境变化来减轻弱势社区酒精问题的负担。 与公共健康相关：我们的健康和行为受到居住地的影响。这项研究探讨了社区是否与饮酒和酒精问题有关。它关注的是社区的社会经济地位(既有富裕的，也有不利的)，以及某些群体(如少数族裔群体成员、低收入者、年轻人或以前酗酒的人)如果生活在贫困社区，是否面临更大的风险。这项研究还考察了社区与酒精问题的表现之间的关系，例如酗酒、抑郁或饮酒原因。这项研究的结果将有助于为处于危险中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.