Understanding Racial Disparities in Heavy Drinking over the Life Course

描述（由申请人提供）：酗酒是美国人可预防死亡的第三大原因，并且与酒精相关的发病率和问题（包括负面饮酒后果和酒精依赖）密切相关。在美国，虽然少数种族/民族在与酒精有关的问题上承担着不成比例的负担，它 目前还不清楚这是否反映了更有害的长期酗酒模式。虽然一些研究表明，少数群体有更长的酗酒“生涯”，但这些研究是基于短期随访数据、回顾性数据和特定年龄段的流行率数据。严格的前瞻性队列研究很少研究酗酒轨迹的种族/民族差异，以及少数几项研究在20多岁中后期（这些研究通常结束的年龄）显示出种族差异的矛盾结果。然而，有重要的理论和经验的理由，预计种族/族裔群体在他们的大量饮酒模式，因为他们过渡到中年早期成年。我们的核心假设是，种族/少数民族群体在生命过程中积累的劣势将导致20多岁以后长期大量饮酒，这可能有助于解释最近的研究结果，即少数民族（与白人相比）在中年时更经常和持久的酒精问题。响应PA-11-308“现有酒精流行病学数据的二次分析”，我们建议在具有全国代表性的美国样本（全国青年纵向调查）中，对从青春期到中年的大量饮酒轨迹的种族/民族差异进行首次深入的前瞻性分析。我们的具体目标是：1）描述从青少年晚期到中年的大量饮酒轨迹的种族/民族差异，以及它们与持续性酒精问题的关联; 2）确定大量饮酒轨迹成员的预测因子，以及它们产生酒精问题的中介; 3）评估生活过程中的社会经济因素在多大程度上解释了长期大量饮酒和酒精问题中的种族差异，以及造成这些差异的机制（不同的暴露和不同的后果）。我们的研究借鉴了社会决定因素的观点，从而偏离了发展精神病理学的主流方法。注意到最近，联邦呼吁多部门努力解决健康不平等问题，我们特别关注与教育有关的差异（父母和个人的教育程度，教育质量和教育回报）可能会导致长期大量饮酒和问题的种族差异。我们高度多学科的团队将利用增长混合模型，结构方程模型和倾向评分，并利用1979年和1997年NLSY的数据来研究性别和西班牙裔亚组的队列效应和差异。这项研究将确定一系列深远的和临时的政策目标，以解决种族差异的生活过程中大量饮酒，这是经得起干预的教育，社会福利和劳动部门。

DESCRIPTION (provided by applicant): Heavy drinking is the third leading cause of preventable death among Americans and strongly associated with alcohol-related morbidity and problems, including negative drinking consequences and alcohol dependence. While racial/ethnic minorities bear a disproportionate burden of alcohol-related problems in the U.S., it is unknown whether this reflects more harmful, long-term patterns of heavy drinking. While some studies suggest that minorities have longer heavy drinking "careers", these have been based on short-term follow-up data, retrospective data, and age-specific prevalence data. Rigorous, prospective cohort studies have rarely examined racial/ethnic differences in heavy drinking trajectories, and those few studies that have shown contradictory findings for racial differences by the mid-to-late 20s, the age when these studies typically end. However, there are important theoretical and empirical reasons to expect that racial/ethnic groups diverge in their heavy drinking patterns as they transition out of early adulthood into middle age. Our central hypothesis is that racial/ethnic minority groups' greater accumulation of disadvantage over the life course will contribute to prolonged heavy drinking beyond the 20s, which could help to explain recent findings of more recurring and persistent alcohol problems among minorities (vs. whites) in mid-life. Responding to PA-11-308 "Secondary Analysis of Existing Alcohol Epidemiology Data", we propose to investigate this in the first, in-depth, prospective analysis of racial/ethnic disparities in heavy drinking trajectories from adolescence to middle age in a nationally-representative U.S. sample (National Longitudinal Surveys of Youth). Our Specific Aims are to: 1) Describe racial/ethnic differences in heavy drinking trajectories from the late teens to middle age, and their association with persistent alcohol problems; 2) Identify predictors of membership in heavy drinking trajectories, and mediators through which they operate to create alcohol problems; and 3) Assess the extent to which lifecourse socioeconomic factors explain racial disparities in prolonged heavy drinking and alcohol problems, and the mechanisms (differential exposure and differential consequences) contributing to these disparities. Our study draws on a social determinants perspective, thus departing somewhat from the dominant approach of developmental psychopathology. Heeding recent, federal calls for multisectoral efforts to address health inequities, we give special attention to the ways in which disparities related to education (parental and personal educational attainment, quality of education, and returns on education) may contribute to racial disparities in prolonged heavy drinking and problems. Our highly multidisciplinary team will utilize growth mixture models, structural equation models, and propensity scoring, and capitalize on data from both the 1979 and 1997 NLSY to examine cohort effects and differences by gender and Hispanic subgroup. This research will identify a range of far-reaching and interim policy targets to address racial disparities in lifecourse heavy drinking which are amenable to intervention in the education, social welfare and labor sectors.