Identifying Modifiable Influences on Alcohol Problems in High-Risk Neighborhoods

描述（由申请人提供）：邻里环境可能会对酒精结果产生负面影响，但很少有研究探讨邻里，社交网络和个人因素之间的协同纵向相互关系如何与酒精问题的复发和恢复有关。随着时间的推移，对这些相互关系缺乏了解限制了我们设计全面预防和治疗以解决酒精问题的能力。为了解决现存文献中的重大空白，并为服务规划提供信息，本研究将描述抑制复发和支持恢复的健康社区。该研究还将确定适合干预的缓冲因素，这些因素可以帮助预防高风险社区居民的复发。我们建议开发和测试酒精问题复发和恢复的社会生态模型，以描述邻里，社会网络和个人因素如何独立和交互地预测酒精问题和依赖的复发和恢复。研究目的是：（1）描述全县范围内的治疗设施，自助资源和酒精出口相对于社区社会经济资源的分布，随着时间的推移，稳定和混乱;（2）检查这些社区特征对复发，恢复，治疗利用和自助参与的纵向影响;（3）确定随着时间的推移缓冲或加剧社区影响的社会网络和个人因素;以及（4）测试随着时间的推移，问题饮酒者是否会“向下漂移”到高风险社区。这项研究使用了11年来收集的数据，这些数据来自一个人口统计学上多样化的城市和农村县的治疗中心（N=926）和社区（N=672）。现有的采访数据将通过每次采访时的地理编码地址与社区指标（包括药物滥用治疗、自助资源和酒精店的位置和特征;社会经济资源;混乱和犯罪）联系起来。分析包括邻近映射和空间随机效应模型，以及多层次纵向分析，例如潜在增长曲线建模和潜在转变分析。该研究对预防复发、提供正式的药物滥用治疗和自助以及与酒精出口有关的政策有几个实际意义。这项创新的研究将有助于通过确定特定的邻里触发，可以在治疗过程中解决，以防止复发。它还将确定可改变的因素，例如社交网络对清醒的支持或参与自助，以减少生活在高风险社区的问题和依赖性饮酒者所经历的负面影响，这可以由治疗和预防专家解决。还可以制定辅助计划，以促进经济资源有限的客户改变住房，帮助他们在治疗后从高风险社区转移。调查结果还将说明酒精出口特别有害的地方，并强调需要新的治疗方案和自助团体。 公共卫生相关性：该项目使用的数据从现有的纵向研究的问题和依赖饮酒者补充信息的社区参与者居住在11年的时间。这项研究将确定一些问题饮酒者康复的原因（例如生活在促进支持清醒的社交网络的社区），以及其他饮酒者在康复一段时间后继续经历酒精问题或复发的原因（例如生活在有许多酒吧或酒类商店的社区）。研究结果将为预防规划、治疗和善后规划以及酒精供应政策提供信息。

DESCRIPTION (provided by applicant): Neighborhood contexts can negatively impact alcohol outcomes, but few studies have examined how synergistic longitudinal interrelationships between neighborhoods, social networks and individual factors relate to relapse and recovery from alcohol problems. Lack of knowledge about these interrelationships over time limits our ability to design comprehensive prevention and treatment to address alcohol problems. To address significant gaps in the extant literature and inform service planning, this study will characterize healthy neighborhoods that inhibit relapse and support recovery. The study will also identify buffering factors amenable to intervention that can help prevent relapse by residents of high-risk neighborhoods. We propose to develop and test a socioecological model of relapse and recovery from alcohol problems to describe how neighborhood, social network and individual factors independently and interactively predict relapse and recovery from alcohol problems and dependence over time. The research aims are: (1) Describe county-wide distribution of treatment facilities, self-help resources and alcohol outlets relative to neighborhood socioeconomic resources, stability and disorder over time; (2) Examine longitudinal effects of these neighborhood characteristics on relapse, recovery, treatment utilization and self-help involvement; (3) Identify social network and individual factors that buffer or exacerbate neighborhood effects over time; and (4) Test whether there is a "downward drift" of problem drinkers into high-risk neighborhoods over time. The study uses data collected over 11 years from problem and dependent drinkers recruited from treatment centers (N=926) and the community (N=672) in a demographically diverse urban and rural county. Existing interview data will be linked with neighborhood indicators (including locations and characteristics of substance abuse treatment, self-help resources and alcohol outlets; socioeconomic resources; disorder and crime) via geocoded addresses at each interview. Analyses include neighborhood mapping and spatial random effects models, as well as multilevel longitudinal analysis, such as latent growth curve modeling and latent transition analysis. The study has several practical implications for relapse prevention, provision of formal substance abuse treatment and self-help, and policy pertaining to alcohol outlets. This innovative study will help prevent relapse by identifying specific neighborhood triggers that can be addressed during treatment. It also will identify modifiable factors, such as social network support for sobriety or participation in self-help that reduce negative consequences experienced by problem and dependent drinkers who live in high-risk neighborhoods, which could be addressed by treatment and prevention specialists. Ancillary programs also could be developed to facilitate housing changes by clients with limited financial resources to help them move from high-risk neighborhoods after treatment. Findings also will illustrate where alcohol outlets are especially detrimental and highlight where new treatment programs and self-help groups are needed. PUBLIC HEALTH RELEVANCE: This project uses data from an existing longitudinal study of problem and dependent drinkers supplemented with information on the neighborhoods where participants lived over an 11-year period. The study will identify reasons some problem drinkers recover (such as living in neighborhoods that promote social networks that support sobriety), as well as reasons other drinkers continue to experience alcohol problems or relapse after a period of recovery (such as living in neighborhoods with many bars or liquor stores). Results will inform prevention programming, treatment and aftercare planning, and alcohol availability policy.