Mediators and Moderators of a Neighborhood Experiment on Alcohol Use

 说明(申请人提供)：青春期过度饮酒会破坏健康发育，并在以后的生活中导致不良的社会、经济和健康后果。尽管现有的研究主要集中在个人层面的原因上，但邻里环境越来越被认为是饮酒的上游决定因素。然而，由于之前大多数关于健康的邻里研究都不是实验性的，它可能存在偏见，并削弱了政策转化的基础。我们的研究建议对5个城市使用住房代金券自愿搬迁社区的社会试验(Moving to Opportunity，MTO，Study)的最新可用数据进行二次分析，以测试15年来随机分配的搬迁到低贫困社区的提议是否、如何以及为什么影响青少年及其母亲的酒精使用、过度饮酒和酒精依赖。我们将用额外的邻域级别数据来补充现有数据，以丰富数据集并测试多级别假设。MTO是唯一一项通过随机分配家庭接受不同社区住房环境的大规模研究，以支持早年社区环境如何影响饮酒行为的强有力的因果推断。在启动时，MTO是扭转邻里贫困对少数族裔家庭的破坏性影响的最有希望的政策之一。但卫生研究人员对MTO数据的获取有限，损害了这项7000多万美元投资的科学回报。由于像MTO这样的住宅流动性实验是罕见的、昂贵的，而且MTO深刻地影响了物质的使用，因此研究其影响至关重要。我们提出了新的二级数据分析，使用来自这项随机对照试验的新的15年随访数据，使用新的方法来测试调节和缓和，适用于以前没有检查过的酒精结果测量。我们采用创新的方法来评估调解(即基于权重的因果方法)和效果修正(即机器学习技术)。除了关于早期社区变化如何影响过度饮酒的RCT设计之外，我们还利用为数不多的对母亲和她们的孩子进行抽样的纵向干预设计之一，来阐明饮酒在青春期出现时的家庭传播。我们的R21项目建立在一个富有成效的跨学科团队的基础上，并在MTO研究中积累了经验，并提出了3个目标：测试在MTO实验中搬到低贫困社区对过度饮酒和酒精依赖的影响；检查MTO对过度饮酒和酒精依赖的实验效应是否对更脆弱的家庭不太有利；测试因过度饮酒和酒精依赖而搬到MTO低贫困社区的影响是否由个人层面的压力、家庭层面的背景、或社区层面的压力、酒精供应或酒精规范所调节。这一结果将丰富我们对邻里和家庭背景作为青少年和成年人过度饮酒和饮酒的原因的理解，并为下一代的酒精预防政策提供参考。

 DESCRIPTION (provided by applicant): Excessive drinking in adolescence disrupts healthy development and leads to adverse social, economic and health consequences later in life. Although existing research focuses primarily on individual-level causes, neighborhood context is increasingly recognized as an upstream determinant of alcohol use. Yet since most prior neighborhood research on health has not been experimental, it is potentially biased, and weakens the foundation for policy translation. Our study proposes a secondary analysis of newly-available data from a social experiment of voluntary neighborhood relocation using housing vouchers in 5 cities (the Moving to Opportunity, MTO, Study), to test whether, how, and why random assignment of an offer to move to a low- poverty neighborhood over a 15 year period influenced the alcohol use, excessive drinking, and alcohol dependence of adolescents and their mothers. We will complement existing data with additional neighborhood- level data to enrich the dataset and test multilevel hypotheses. MTO is the only available large-scale study that has randomly assigned families to receive different neighborhood housing contexts, to support strong causal inferences of how early-life neighborhood context shapes alcohol use. When launched, MTO was one of the most promising policies to reverse the damaging effects of neighborhood poverty for minority families. But health researchers have had limited access to MTO data, compromising the scientific payoff of the $70+ million investment. Since residential mobility experiments like MTO are rare, expensive, and since MTO profoundly affected substance use, it is crucial to probe its effects. We propose new secondary data analyses with newly available 15 year follow-up data from this RCT, using novel methods to test mediation and moderation, applied to alcohol outcome measures that have not been examined prior. We apply innovative methods for assessing mediation (i.e., weight-based causal methods) and effect modification (i.e., machine learning techniques). Aside from the RCT design for strong causal inference of how early-life neighborhood changes influence excessive drinking, we also leverage one of the few longitudinal intervention designs sampling both mothers and their children, to illuminate familial transmission of drinking as it emerges in adolescence. Our R21 project builds on a productive, interdisciplinary team, experienced with the MTO study, and proposes 3 aims: to test how moving to a low-poverty neighborhood in the MTO experiment influenced excessive drinking and alcohol dependence; to examine if the MTO experimental effect on excessive drinking and alcohol dependence was less beneficial for more vulnerable families; to test whether effects of moving to a low-poverty neighborhood in MTO for excessive drinking and alcohol dependence were mediated by individual-level stress; family-level context; or neighborhood-level stress, alcohol availability, or alcohol norms. The results will enrich our understanding of neighborhood and family context as a cause of excessive drinking and alcohol use in adolescents and adults, and inform the next generation of alcohol prevention policy.