The Alcohol Policy Environment and Leading Causes of Alcohol Related Mortality

酒精政策环境和酒精相关死亡率的主要原因

• 批准号: 8926816
• 负责人: Timothy Simonds Naimi
• 金额: $ 42.13万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8926816
• 关键词: AODR mortality; Accounting; Adult; Affect; Age; Alcohol consumption; Alcohol dependence; Alcoholic Liver Cirrhosis; Alcoholism; Alcohols; Automobile Driving; Cessation of life; Chronic; Cirrhosis; Complex; Consumption; Data; Data Analyses; Data Set; Disease remission; District of Columbia; Environment; General Population; Geographic state; Grant; Health; Heavy Drinking; Homicide; Individual; Intervention; Life; Measures; Mediating; Methods; Minority; Modeling; Outcome; Patient Self-Report; Pattern; Persons; Policies; Policy Analysis; Policy Developments; Population; Prevention; Prevention strategy; Price; Public Health; Race; Reporting; Research; Source; Subgroup; Suicide; System; Taxes; Testing; United States; Vehicle crash; Violence; Vital Statistics; Work; Youth; accomplished suicide; alcohol policy information system; attributable mortality; binge drinking; drinking; evidence base; high risk; impaired driving performance; improved; innovation; male; mortality; population based; public policy on alcohol; sex; social; suicidal morbidity; underage drinking; years of life lost; young adult

DESCRIPTION (provided by applicant): Although individual alcohol policies can reduce alcohol-related harms, the policy environment in states is highly variable. Previously, our research team characterized the U.S. state policy environment, conceptualized as the effect of multiple concurrent policies and operationalized as Alcohol Policy Scale (APS) measures. We found that stronger state alcohol policy environments were associated with fewer binges drinking, less youth drinking, less impaired driving, and increased remission from alcoholism. We now propose to assess the relationships between the alcohol policy environment and leading causes of alcohol-related mortality. ARCF: Although ARCF has declined due in part to the enactment of driving-oriented policies, the proportion of fatal crashes that are alcohol-relate remains unchanged since 1995, a period when several effective drinking-oriented policies have eroded. Our current works finds that drinking-oriented policies have a strong association with adult impaired driving, independent of driving-oriented policies. Aim 1 is to: a) determine the relationship between the alcohol policy environment and AIDF; b) assess independent associations and interactions between drinking-oriented versus driving-oriented policy subgroups and AIDF, and determine if the relationship between drinking-oriented policies and AIDF is mediated by binge drinking; c) assess independent associations of drinking-oriented policy subgroups targeting alcohol prices versus physical availability with AIDF. Violent Deaths: Suicide and homicide mortality differs by age, sex and race. We hypothesize that differential effects of the state policy environment may partly explain these disparities, and that some groups of related policies are more protective for violent deaths than others. Aim 2 is to: a) determine the relationship between the alcohol policy environment and suicide, overall and by age, sex and race; b) assess independent associations and interactions between population-oriented versus youth-oriented policies and suicide among youth and young adults; c) assess independent associations between policy subgroups targeting alcohol prices versus physical availability and suicide among males and racial minorities. Aim 3 will assess homicide mortality using identical aims and analogous models as for Aim 2. Alcoholic Cirrhosis: Few studies have examined the associations between alcohol policies and cirrhosis, or whether consumption patterns mediate that relationship. We hypothesize that stronger state alcohol policy environments are associated with reduced cirrhosis mortality through reductions in both average consumption and binge drinking. Aim 4 is to: a) determine the relationship between the alcohol policy environment and alcoholic cirrhosis mortality by sex; b) assess whether this relationship is mediated by binge drinking, after accounting for average consumption. Using our previously developed methods, we will collect three additional years of policy data and utilize population-based data sets in state- and individual-level analyses of data from 1999-2014 to improve the understanding of how state alcohol policy environments may influence alcohol-related mortality and to assist with prevention strategies.

描述（由申请人提供）：虽然个人酒精政策可以减少与酒精相关的危害，但各州的政策环境差异很大。此前，我们的研究团队对美国国家政策环境进行了描述，将其概念化为多项并行政策的影响，并将其具体化为酒精政策量表 (APS) 措施。我们发现，更强有力的州酒精政策环境与酗酒现象的减少、青少年饮酒的减少、驾驶障碍的减少以及酗酒症状缓解的增加有关。我们现在建议评估酒精政策环境与酒精相关死亡主要原因之间的关系。 ARCF：虽然 ARCF 有所下降，部分原因是颁布了以驾驶为导向的政策，但自 1995 年以来，与酒精相关的致命事故的比例保持不变，而在这一时期，一些有效的以饮酒为导向的政策已经受到侵蚀。我们目前的研究发现，以饮酒为导向的政策与成人酒后驾驶有很强的相关性，独立于以驾驶为导向的政策。目标 1 是： a) 确定酒精政策环境与 AIDF 之间的关系； b) 评估饮酒导向政策与驾驶导向政策亚组与 AIDF 之间的独立关联和相互作用，并确定饮酒导向政策与 AIDF 之间的关系是否由酗酒调节； c) 与 AIDF 评估针对酒精价格与实际供应情况的饮酒导向政策小组的独立关联。暴力死亡：自杀和他杀死亡率因年龄、性别和种族而异。我们假设国家政策环境的差异效应可能部分解释了这些差异，并且某些相关政策比其他政策对暴力死亡具有更强的保护作用。目标 2 是： a) 确定酒精政策环境与自杀之间的总体关系以及按年龄、性别和种族划分的关系； b) 评估以人口为导向与以青年为导向的政策与青少年自杀之间的独立关联和相互作用； c) 评估针对酒精价格的政策分组与男性和少数族裔的实际供应和自杀之间的独立关联。目标 3 将使用与目标 2 相同的目标和类似模型来评估他杀死亡率。 酒精性肝硬化：很少有研究探讨酒精政策与肝硬化之间的关联，或者消费模式是否介导这种关系。我们假设，更强有力的国家酒精政策环境与通过减少平均消费和酗酒来降低肝硬化死亡率相关。目标 4 是： a) 确定酒精政策环境与按性别划分的酒精性肝硬化死亡率之间的关系； b) 在考虑平均消费量后，评估这种关系是否是由酗酒介导的。使用我们之前开发的方法，我们将收集另外三年的政策数据，并利用基于人口的数据集对 1999 年至 2014 年的州和个人层面的数据进行分析，以加深对州酒精政策环境如何影响酒精的理解。相关死亡率并协助制定预防策略。