ABSTRACT: National Alcohol Surveys: Advancing Epidemiologic Analyses of 21st Century Drinking Hazardous alcohol use remains one of the most common preventable causes of morbidity and mortality in the US and it manifests major racial/ethnic and other disparities. Nationally representative surveys repeated over time provide a means to advance survey methods, monitor trends in alcohol use overall and in sub-groups, and investigate timely health topics related to alcohol use. The Alcohol Research Group and its Center have conducted a series of National Alcohol Surveys (NAS) for forty years, and are proposing in this Project to conduct the 15th edition of the NAS in 2023-2024 (termed N15). Through the implementation of the N15 we will respond to challenges to modern-day survey research by employing a multi-mode, adaptive survey design. This will include a fully web-based survey using address-based sampling, and probability and non-probability web panels. Further, this will be the first NAS to include biosample collection using dried blood spots (DBS). Including an additional NAS in the series will expand the trend data available for framing recent changes in alcohol consumption patterns, which is also essential for age-period-cohort models for understanding components of these trends. With NAS series data from 2000-2020 we propose to evaluate racial/ethnic and socioeconomic disparities in alcohol use and alcohol problems, and risk relationships between alcohol use patterns and problems using causal inference methods including instrumental variables based on alcohol tax estimates and other policy measures. Such methods have yet to be applied to the study of disparities in alcohol-related problems. Capitalizing on the expanded trends data, we propose to examine trends for total and beverage- specific alcohol volume, alcohol use disorder, and co-use of alcohol with marijuana and other drugs from 1979 or 1984, dependent on the availability of measures, to 2024 with age-period-cohort decompositions. Alcohol and drug co-use, particularly cannabis, is especially timely given the legalization of recreational marijuana use in many states and the ongoing opioid crisis. Psychological distress (PD) is a likely driver of the opioid crisis and “deaths of despair”. Recent NAS editions have included measures of PD, a common problem for which alcohol use is a known risk factor. However, less well understood are the individual- and environmental-level moderators and biological mediators of this relationship. Collecting DBS samples will enable the study of inflammation as a biological mediator of the relationship between alcohol use and PD, which could inform future research and prevention interventions. Further, a better understanding of the moderators of the relationship between alcohol use and PD, from individual- to community-level characteristics, could help to prioritize groups to receive prevention interventions. In summary, this project proposes data collection and analyses that can advance both methodological issues and substantive research questions with the aim of better understanding and addressing 21st century drinking and its trends, correlates and consequences.

PUBLIC HEALTH RELEVANCE The implementation of the 2024 National Alcohol Survey will deepen our knowledge of how to collect high quality survey data and biological samples, responding to contemporary survey research challenges. Expanding the NAS series to 45 years will provide us with new data to develop and examine up-to-date trends in alcohol use and problems, and potential disparities in the risk for alcohol-related problems across gender, socioeconomic and racial/ethnic groups. We will also learn whether inflammation partially explains alcohol's effect on psychological distress, and address disparities in these effects among racial/ethnic groups, level of education, and neighborhood status.