Race, alcohol consumption and vehicle crashes: an epidemiologic paradox

描述(由申请人提供)：尽管高危饮酒和酒精使用障碍的风险因素积累更多，但国家流行病学调查一直报告，美国黑人和西班牙裔狂饮和酒精使用障碍的患病率与非拉美裔白人相当或更低。然而，死亡率数据表明，他们因酒精导致的机动车撞车死亡率(MVCF)较高。这些看似不同的模式表明了一种流行病学悖论，其后果对公共卫生很重要：MVCFs是年轻人死亡的主要原因，与非西班牙裔白人相比，黑人和西班牙裔MVCFs经历了严重的不平等，所有MVCFs中约30%与酒精有关。在目前的导师研究科学家发展奖(K01)的申请中，我建议在四个领域发展专门知识，使我能够发展一系列与酒精相关的健康中的种族/民族悖论的研究：1)已建立的环境对与酒精相关的健康的影响；2)关于酒精使用的文化和社会规范的概念化和衡量；3)重复测量数据的分析；以及4)流行病学数据收集的实地方法。我将利用在这些培训领域获得的技能，开始通过三个研究项目来填补我们在了解与酒精相关的健康方面的种族/民族差异方面的突出空白， 为此，K01将允许我保护研究时间，否则作为新的助理教授是不可能的。首先，我将探讨种族/民族悖论本身的有效性。我将探讨少数族裔中较低的问题饮酒率是否仅限于青少年和年轻人，以及与非西班牙裔白人相比，黑人和西班牙裔老年人的问题饮酒率是否更高。这项工作将利用国家纵向数据集，并纳入关于黑人和拉丁裔亚群内轨迹的信息，这些亚群从未被描述过。其次，我将确定与酒精相关的社会规范是否会调节酒精使用和MVC风险的总体差异，从而增加我们对这一悖论是如何产生的了解。我将使用纽约社会环境调查的数据，这是纽约市的一项流行病学研究，具有丰富的种族和民族多样性，也是仅有的以社区为基础的样本之一，用来衡量酒精标准。第三，我将测试一种潜在的机制来解释种族/民族悖论：黑人和西班牙裔个人经历更多由酒精引起的MVCF，因为他们饮酒的建筑环境更危险(例如，更糟糕的路况)。为了验证这一假设，我提出了一项新的研究，将国家层面的死亡分析报告系统的记录与人口普查和土地使用信息联系起来。除了这些研究目标外，我的K01奖励期间将专注于准备一项R01拨款提案，以收集与酒精相关的健康方面的种族/民族差异的原始数据，该数据建立在这里提出的研究的基础上并加以扩展。只有当我有足够的时间进行新的培训和研究时，这些项目才是可行的，K01基金将提供这些时间。

DESCRIPTION (provided by applicant): Despite a greater accumulation of risk factors for at-risk drinking and alcohol use disorders, national epidemiological surveys consistently report that Blacks and Hispanics in the United States (US) have an comparable or lower prevalence of binge drinking and alcohol disorders compared to non-Hispanic Whites. However, mortality data indicate that they have higher rates of alcohol-attributable motor vehicle crash fatality (MVCF). These seemingly divergent patterns indicate an epidemiologic paradox, the consequences of which are important for public health: MVCF is a leading cause of death among young adults, Blacks and Hispanics experience substantial inequities in MVCF compared to non-Hispanic Whites, and approximately 30% of all MVCFs are alcohol-related. In the present application for a Mentored Research Scientist Development Award (K01), I propose to develop expertise in four areas that will allow me to develop a line of research into the racial/ethnic paradox in alcohol-related health: 1) Built environment effects on alcohol-related health; 2) Conceptualization and measurement of cultural and social norms regarding alcohol use; 3) Analysis of repeated measures data; and 4) Field methods in epidemiologic data collection. I will use the skills obtained in these training areas to begin to fill outstanding gaps in our understanding of racial/ethnic differences in alcohol- related health with three research projects, for which the K01 will allow me protected research time that would otherwise not be possible as a new assistant professor. First, I will probe the validity of the racial/ethnic paradox itself. I ill explore whether lower rates of problem drinking among racial/ethnic minorities are limited to adolescents and young adults, and whether rates of problem drinking among older adults are higher among Blacks and Hispanics compared to non-Hispanic Whites. This work will utilize a national longitudinal dataset and incorporate information on trajectories within Blacks and Latino subgroups, which have never been characterized. Second, I will determine if alcohol-related social norms mediate overall differences in alcohol use and MVC risk, adding to our knowledge of how the paradox arises. I will use data from the New York Social Environment Survey, an epidemiologic study in New York City with rich racial and ethnic diversity and one of the only community-based samples to measure alcohol norms. Third, I will test a potential mechanism to explain the racial/ethnic paradox: that Black and Hispanic individuals experience more alcohol-attributable MVCF because the built environment in which they consume alcohol is more dangerous (e.g., worse road conditions). To test this hypothesis I propose a novel study linking records from the Fatality Analysis Reporting System on a national level with census and land usage information. In addition to these research aims, my K01 award period will focus on preparation of an R01 grant proposal to collect original data on racial/ethnic differences in alcohol-related health that builds on and extends the research proposed here. These projects are feasible only if I have protected time for new training and research, which K01 funding will provide.