Less drinking, yet more problems: understanding African American drinking and related problems

Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

IMPORTANCE

Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information.

OBJECTIVE

To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013.

DESIGN, SETTING, AND PARTICIPANTS

The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016.

MAIN OUTCOMES AND MEASURES

Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD.

RESULTS

The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%).

CONCLUSIONS AND RELEVANCE

Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.

Pathways linking marijuana use to substance use problems among emerging adults: A prospective analysis of young Black men

OBJECTIVES

Marijuana use rates peak during emerging adulthood (ages 18 to 25years). Although marijuana use quantity reliably predicts substance-related problems, considerable individual differences characterize this association. The aims of the present study were to examine the influence of community disadvantage in amplifying the effects of marijuana use on downstream substance use problems, as well as the mediating influence of social disengagement in the path linking marijuana use frequency to related problems.

METHOD

We conducted a 3-year longitudinal study with 505 Black men from rural communities in Georgia, age 20.3years at baseline. Three waves of data were collected at 18-month intervals in participants' homes or convenient community settings. Men completed audio computer-assisted self-interviews concerning their substance use, engagement in conventional roles and relationships, community characteristics, and substance use problems.

RESULTS

Community disadvantage moderated the association of marijuana use with changes in substance use problems across time. In disadvantaged communities, a robust effect emerged between marijuana use frequency and related problems, whereas in less disadvantaged communities, marijuana use quantity and problems were not significantly associated. Increases in social disengagement mediated the influence of marijuana use on substance use problems in the context of community disadvantage.

CONCLUSIONS

For young Black men, residence in a disadvantaged neighborhood appears to amplify the impact of marijuana use on substance use problems. This effect appears to be a consequence of increases in social disengagement.

A GABRA2 polymorphism improves a model for prediction of drinking initiation

BACKGROUND

Survival analysis was used to explore the addition of a single nucleotide polymorphism (SNP) and covariates (sex, interview age, and ancestry) on a previously published model's ability to predict onset of drinking. A SNP variant of rs279871, in the chromosome 4 gene encoding gamma-aminobutyric acid receptor (GABRA2), was selected due to its associations with alcoholism in young adults and with behaviors that increased risk for early drinking.

METHODS

A subsample of 674 adolescents (ages 14-17) participating in the Collaborative Study on the Genetics of Alcoholism (COGA) was examined using a previously derived Cox proportional hazards model containing: 1) number of non-drinking related conduct disorder (CD) symptoms, 2) membership in a high-risk alcohol-dependent (AD) family, 3) most best friends drank (MBFD), 4) Achenbach Youth Self Report (YSR) externalizing score, and 5) YSR social problems score. The above covariates along with the SNP variant of GABRA2, rs279871, were added to this model. Five new prototype models were examined. The most parsimonious model was chosen based on likelihood ratio tests and model fit statistics.

RESULTS

The final model contained four of the five original predictors (YSR social problems score was no longer significant and hence dropped from subsequent models), the three covariates, and a recessive GABRA2 rs279871 TT genotype (two copies of the high-risk allele containing thymine). The model indicated that adolescents with the high-risk TT genotype were more likely to begin drinking than those without this genotype.

CONCLUSIONS

The joint effect of the gene (rs279871 TT genotype) and environment (MBFD) on adolescent alcohol initiation is additive, but not interactive, after controlling for behavior problems (CD and YSR externalizing score). This suggests that the impact of the high-risk TT genotype on the onset of drinking is affected by controlling for peer drinking and does not include genotype-by-environment interactions.

Race and socioeconomic status in substance use progression and treatment entry

This study examined trajectories of progression from early substance use to treatment entry as a function of race, among inpatient treatment seekers (N = 945). Following primary race-contingent analyses of use progression, secondary analyses were conducted to investigate the effects of socioeconomic status (SES) on the observed differences. African Americans reported significant delays in treatment entry relative to Caucasians. Racial differences in alcohol, marijuana, and cocaine use trajectories were observed. Accounting for SES rendered observations of accelerated use among African Americans nonsignificant. However, inclusion of SES failed to mitigate the marked racial disparity in treatment entry.

The Role of Religious Involvement in Black-White Differences in Alcohol Use Disorders

OBJECTIVE

To date, a paradox in the social epidemiology of alcohol use disorders (AUDs) remains unresolved: non-Hispanic Blacks experience higher socioeconomic disadvantage, stressor exposures, and individual stress-prominent AUD risk factors, yet have lower than expected AUD risk compared with non-Hispanic Whites. Religious involvement is associated with lower AUD risk. Non-Hispanic Blacks are highly religiously involved. Together, those facts may account for Black-White differences in AUD risk.

METHOD

We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N = 26,784) to examine whether (a) religious involvement accounts for Black-White differences in AUD risk, and (b) race moderates the association between religious involvement and AUD. Religious involvement indicators were service attendance, social interaction, and subjective religiosity and spirituality. Twelve-month AUD prevalence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was the outcome. Covariates were age, education, income, marital status, and U.S.-born versus foreign-born nativity.

RESULTS

Blacks were significantly less likely than Whites to have an AUD (adjusted odds ratio [aOR] for men = 0.70, 95% CI [0.59, 0.83]; aOR for women = 0.71, 95% CI [0.57, 0.89]). An adjusted model with all three religious involvement indicators explained 17% of race differences among men (OR = 0.82) and 45% among women (OR = 1.03). There was no evidence that the association between religious involvement and AUD differed between Blacks and Whites.

CONCLUSIONS

Religious service attendance, subjective religiosity, and spirituality account for a meaningful share of the Black-White differences in AUD. Future research is needed to conduct more fine-grained analyses of the aspects of religious involvement that are potentially protective against AUD, ideally differentiating between social norms associated with religious involvement, social support offered by religious participation, and deeply personal aspects of spirituality.

Examining the Protective Effect of Ethnic Identity on Drug Attitudes and Use Among a Diverse Youth Population

Ethnic identity is an important buffer against drug use among minority youth. However, limited work has examined pathways through which ethnic identity mitigates risk. School-aged youth (N = 34,708; 52 % female) of diverse backgrounds (i.e., African American (n = 5333), Asian (n = 392), Hispanic (n = 662), Multiracial (n = 2129), Native American (n = 474), and White (n = 25718) in grades 4-12 provided data on ethnic identity, drug attitudes, and drug use. After controlling for gender and grade, higher ethnic identity was associated with lower past month drug use for African American, Hispanic, and Multiracial youth. Conversely, high ethnic identity was associated with increased risk for White youth. An indirect pathway between ethnic identity, drug attitudes, and drug use was also found for African American, Hispanic, and Asian youth. Among White youth the path model was also significant, but in the opposite direction. These findings confirm the importance of ethnic identity for most minority youth. Further research is needed to better understand the association between ethnic identity and drug use for Multiracial and Hispanic youth, best ways to facilitate healthy ethnic identity development for minority youth, and how to moderate the risk of identity development for White youth.

Review: Environmental influences on alcohol use: Informing research on the joint effects of genes and the environment in diverse U.S. populations

BACKGROUND AND OBJECTIVES

This review aimed to inform the current state of alcohol research on the joint effects of genes and the environment conducted in U.S. racial/ethnic minority populations, focusing on African Americans, Latinos/Hispanics, Asians, and American Indians.

METHODS

A key-word and author-based search was conducted and supplemented with direct contact to researchers in this area to ensure a comprehensive inclusion of published, peer-reviewed studies. These studies were considered in terms of the racial/ethnic population groups, phenotypes, genetic variants, and environmental influences covered. Research findings from alcohol epidemiologic studies were highlighted to introduce some potential environmental variables for future studies of gene and environment (G-E) relationships.

RESULTS

Twenty-six (N = 26) studies were reviewed. They predominantly involved African American and Asian samples and had a very limited focus on Latinos/Hispanics and American Indians. There was a wide range of alcohol-related phenotypes examined, and studies almost exclusively used a candidate gene approach. Environmental influences focused on the most proximate social network relationships with family and peers. There was far less examination of community- and societal-level environmental influences on drinking. Epidemiologic studies informing the selection of potential environmental factors at these higher order levels suggest inclusion of indicators of drinking norms, alcohol availability, socioeconomic disadvantage, and unfair treatment.

CONCLUSIONS

The review of current literature identified a critical gap in the study of environments: There is the need to study exposures at community and societal levels.

SCIENTIFIC SIGNIFICANCE

These initial studies provide an important foundation for evolving the dialogue and generating other investigations of G-E relationships in diverse racial/ethnic groups. (Am J Addict 2017;26:446-460).

Adverse childhood experiences, mental health, and excessive alcohol use: Examination of race/ethnicity and sex differences

Responses from N=60,598 interviews from the 2010 Behavioral Risk Factor Surveillance System (the 10 states and the District of Columbia that included the optional Adverse Childhood Experience (ACE) module) were used to test whether associations between childhood adversity and adult mental health and alcohol behaviors vary by race/ethnicity and sex. ACE items were categorized into two types - household challenges and child abuse. Outcomes were current depression, diagnosed depression, heavy drinking and binge drinking. Logistic regression models found ACEs significantly associated with depression and excessive alcohol use, but sex did not moderate any relationships. Race/ethnicity moderated the relationship between ACEs and heavy drinking. In stratified analyses, compared to those not exposed to ACEs, non-Hispanic blacks who experienced either type of ACE were about 3 times as likely to drink heavily; Non-Hispanic whites who experienced child abuse or both ACE types were 1.5-2 times as likely to drink heavily; and Hispanics who experienced household challenges or both ACE types were 1.2 and 11 times as likely to report heavy drinking. ACEs impact depression and excessive alcohol use similarly across men and women. With the exception of heavy drinking, ACEs appear to have the same association with excessive alcohol use across race/ethnicity. It may be prudent to further investigate why the relationship between ACEs and heavy drinking may differ by race/ethnicity such that prevention strategies can be developed or refined to effectively address the needs of all sub-groups.

Does a Crossover Age Effect Exist for African American and Hispanic Binge Drinkers? Findings from the 2010 to 2013 National Study on Drug Use and Health

BACKGROUND

Among general population studies, lower rates of binge drinking tend to be found among African Americans and Hispanics compared to Whites. However, among older adult populations, minority groups have been shown to be at higher risk for binge drinking, suggesting the presence of a crossover effect from low to high risk as a function of age. To date, limited research has examined the crossover effect among African American and Hispanic populations compared to non-Hispanic Whites across large developmental time frames or explored variation in risk based on income or gender. This study aimed to fill these gaps in the literature.

METHODS

Data were compiled from the 2010 to 2013 National Survey on Drug Use and Health surveys, which provide annual, nationally representative data on substance use behaviors among individuals aged 12 and older. Hispanic, non-Hispanic African American, and non-Hispanic White respondents were included (N = 205,198) in the analyses.

RESULTS

A crossover effect was found for African American males and females among the lowest income level (i.e., incomes less than $20,000). Specifically, after controlling for education and marital status, compared to Whites, risk for binge drinking was lower for African American males at ages 18 to 24 and for females at ages 18 to 34, but higher for both African American males and females at ages 50 to 64. No crossover effect was found for Hispanic respondents.

CONCLUSIONS

Although African Americans are generally at lower risk for binge drinking, risk appears to increase disproportionately with age among those who are impoverished. Explanatory factors, such as social determinants of health prevalent within low-income African American communities (e.g., lower education, violence exposure, housing insecurity) and potential areas for intervention programming are discussed.

The role of anxiety sensitivity in the relation between anxious arousal and cannabis and alcohol use problems among low-income inner city racial/ethnic minorities

The current study explored anxiety sensitivity as a factor accounting for the association between anxious arousal and problems related to use of cannabis and alcohol among a health disparity sample (low income minorities). Specifically, participants were 130 low-income racial/ethnic minorities who reported daily cannabis use (M_age=37.7 SD=10.0; 28.5% female). There were significant indirect associations of anxious arousal via anxiety sensitivity in relation to: cannabis use problems, cannabis withdrawal symptoms, use of cannabis to cope, as well as hazardous drinking, alcohol use problems, and alcohol consumption. These data indicate anxiety sensitivity is a possible mechanism underlying the relation between anxious arousal and substance use problems among low-income racial/ethnic minorities. Future work could evaluate the efficacy of cannabis and alcohol use treatments incorporating anxiety sensitivity reduction techniques to facilitate amelioration of anxiety and substance use and offset mental health inequalities for this population.

The influence of substance use on depressive symptoms among young adult black men: The sensitizing effect of early adversity

BACKGROUND AND OBJECTIVES

Depressive symptoms have been identified as an important consequence of substance use. Both heavy drinking and marijuana use have acute and short-term effects on systems that regulate emotion, increasing the potential for substance use to induce problems with negative affect and irritability. We investigated the effects of alcohol and marijuana use on depressive symptoms among a sample of young Black men. We also tested the stress sensitization hypothesis that exposure to adverse childhood experiences would amplify the influence of substance use on men's depressive symptoms.

METHODS

Hypotheses were tested with 505 rural Black men who, at ages 19-22 years, provided data on their substance use, adverse childhood experiences, and depressive symptoms; they provided data again 18 months later.

RESULTS

Substance use forecasted increases in depressive symptoms; cross-lagged analyses yielded no evidence for the inverse path, depressive symptoms increasing substance use. The impact of substance use on depressive symptoms was amplified among young Black men who were exposed to adverse childhood experiences. Substance use did not significantly predict depressive symptoms when adversity was low.

DISCUSSION AND CONCLUSIONS

Our findings suggest that, during young adulthood, substance use increases depressive symptoms among Black men who were exposed to childhood adversity. Because childhood adversity disproportionately affects Black men, these findings inform future cross-group research designed to investigate racial disparities in the consequences of substance use.

SCIENTIFIC SIGNIFICANCE

Depressive symptoms may be understood as an effect as well as a cause of substance use, particularly among vulnerable young Black men. (Am J Addict 2017;26:400-406).

Racial/ethnic differences in life-course heavy drinking from adolescence to midlife

Information on heavy drinking over the life course might help to explain racial/ethnic disparities in alcohol-related problems, morbidity, and mortality. Using data from the 2009-2010 U.S. National Alcohol Survey (n = 3,026), we analyzed retrospective decades-based measures of heavy drinking during respondents' teens, 20s, 30s, and 40s. Results indicate that Latino men and African American women have greater risk for persistent-high (vs. declining) heavy-drinking trajectories than Caucasian men and women, and that socioeconomic disadvantage partly accounts for this disparity in women. Prospective longitudinal studies are needed to confirm these results and to elucidate the relationship of life-course heavy-drinking patterns with health-related outcomes, and disparities in these.

Racial Disparities in the Association between Alcohol Use Disorders and Health in Black and White Women

Adverse health attributed to alcohol use disorders (AUD) is more pronounced among black than white women. We investigated whether socioeconomic status (education and income), health care factors (insurance, alcoholism treatment), or psychosocial stressors (stressful life events, racial discrimination, alcoholism stigma) could account for black-white differences in the association between AUD and physical and functional health among current women drinkers 25 years and older (N = 8,877) in the National Epidemiological Survey on Alcohol and Related Conditions. Generalized linear regression tested how race interacted with the association between 12-month DSM-IV AUD in Wave 1 (2001-2002) and health in Wave 2 (2004-2005), adjusted for covariates (age group, alcohol consumption, smoking, body mass index, physical activity, diabetes, cardiovascular disease, and arthritis). Black women with AUD had poorer health than white women with AUD (β = -3.18, SE = 1.28, p < .05). This association was partially attenuated after adjusting for socioeconomic status, health care, and psychosocial factors (β = -2.64, SE = 1.27, p < .05). In race-specific analyses, AUD was associated with poorer health for black but not white women. Accounting for black-white differences in AUD and physical and functional health among women requires investigation beyond traditional explanatory mechanisms.

Racial/ethnic differences in 30-year trajectories of heavy drinking in a nationally representative U.S. sample

BACKGROUND

Racial/ethnic minorities bear a disproportionate burden of alcohol-related problems in the U.S. It is unknown whether this reflects harmful patterns of lifecourse heavy drinking. Prior research shows little support for the latter but has been limited to young samples. We examine racial/ethnic differences in heavy drinking trajectories from ages 21 to 51.

METHODS

Data on heavy drinking (6+ drinks/occasion) are from the 1979 National Longitudinal Survey of Youth (N=9468), collected between 1982 and 2012. Sex-stratified, generalized estimating equations (GEE) were used to model heavy drinking frequency trajectories as a function of age with a cubic curve, and interactions of race with age terms were tested to assess racial/ethnic differences. Models adjusted for time-varying socioeconomic status and marital and parenting status; predictors of trajectories were examined in race- and sex-specific models.

RESULTS

White men and women had similarly steep declines in heavy drinking frequency throughout the 20s, contrasting with slower declines (and lower peaks) in Black and Hispanic men and women. During the 30s there was a Hispanic-White crossover in men's heavy drinking curves, and a Black-White female crossover among lifetime heavy drinkers; by age 51, racial/ethnic group trajectories converged in both sexes. Greater education was protective for all groups.

CONCLUSION

Observed racial/ethnic crossovers in heavy drinking frequency following young adulthood might contribute to disparities in alcohol-related problems in middle adulthood, and suggest a need for targeted interventions during this period. Additionally, interventions that increase educational attainment may constitute an important strategy for reducing heavy drinking in all groups.

Religiosity, race/ethnicity, and alcohol use behaviors in the United States

BACKGROUND

Religiosity is a protective factor against many health problems, including alcohol use disorders (AUD). Studies suggest that religiosity has greater buffering effects on mental health problems among US Blacks and Hispanics than Whites. However, whether race/ethnic differences exist in the associations of religiosity, alcohol consumption and AUD is unclear.

METHOD

Using 2004-2005 NESARC data (analytic n = 21 965), we examined the relationship of public religiosity (i.e. frequency of service attendance, religious social group size), and intrinsic religiosity (i.e. importance of religious/spiritual beliefs) to frequency of alcohol use and DSM-IV AUD in non-Hispanic (NH) Blacks, Hispanics and NH Whites, and whether associations differed by self-identified race/ethnicity.

RESULTS

Only public religiosity was related to AUD. Frequency of religious service attendance was inversely associated with AUD (NH Whites β: -0.103, p 0.05) or Hispanics (β: -0.002, p > 0.05).

CONCLUSIONS

US adults reporting greater public religiosity were at lower risk for AUD. Public religiosity may be particularly important among NH Blacks, while intrinsic religiosity may be particularly important among NH Whites, and among Hispanics who frequently attend religious services. Findings may be explained by variation in drinking-related norms observed among these groups generally, and in the context of specific religious institutions.

Risk and Protective Processes Predicting Rural African American Young Men's Substance Abuse

Informed by a life course perspective, this study tested a cascade model linking harsh, unresponsive parenting during childhood to young African American men's substance abuse via precocious transitions, economic instability, and future orientation. The moderating influence of community disadvantage and romantic partner support on the hypothesized pathways was also examined. At the baseline, the sample included 505 African American men between ages 19 and 22 years from high-poverty rural communities. Follow-up data were collected 18 months after baseline. Using structural equation modeling, we identified harsh, unresponsive parenting influenced precocious transitions in adolescence, which in turn increased economic instability during young adulthood. Economic instability was associated with a reduction in future orientation, a proximal influence on increases in substance abuse. Also, residence in a disadvantaged community amplified the influence of precocious transitions on economic instability and the influence of economic instability on future orientation. Involvement with supportive romantic partnership evinced a protective effect, attenuating the influence of precocious transitions on economic instability and the influence of economic instability on a future orientation. This study expands understanding of young adults' substance abuse by demonstrating the risk and protective processes linking substance abuse to developmental factors across childhood, adolescence, and young adulthood.

Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women

AIMS AND OBJECTIVES

To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual).

BACKGROUND

Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity.

DESIGN

Cross-sectional analysis of existing data.

METHODS

Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment.

RESULTS

Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment.

CONCLUSIONS

Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed.

Racial/ethnic differences in initiation of and engagement with addictions treatment among patients with alcohol use disorders in the veterans health administration

OBJECTIVE

Specialty addictions treatment can improve outcomes for patients with alcohol use disorders (AUD). Thus, initiation of and engagement with specialty addictions treatment are considered quality care for patients with AUD. Previous studies have demonstrated racial/ethnic differences in alcohol-related care but whether differences exist in initiation of and engagement with specialty addictions treatment among patients with clinically recognized alcohol use disorders is unknown. We investigated racial/ethnic variation in initiation of and engagement with specialty addictions treatment in a national sample of Black, Hispanic, and White patients with clinically recognized alcohol use disorders (AUD) from the US Veterans Health Administration (VA).

METHODS

National VA data were extracted for all Black, Hispanic, and White patients with a diagnosed AUD during fiscal year 2012. Mixed effects regression models estimated the odds of two measures of initiation (an initial visit within 180days of diagnosis; and initiation defined consistent with Healthcare Effectiveness Data and Information Set (HEDIS) as a documented visit ≤14days after index visit or inpatient admission), and three established measures of treatment engagement (≥3 visits within first month after initiation; ≥2 visits in each of the first 3months after initiation; and ≥2 visits within 30days of HEDIS initiation) for Black and Hispanic relative to White patients after adjustment for facility- and patient-level characteristics.

RESULTS

Among 302,406 patients with AUD, 30% (90,879) initiated treatment within 180days of diagnosis (38% Black, 32% Hispanic, and 27% White). Black patients were more likely to initiate treatment than Whites for both measures of initiation [odds ratio (OR) for initiation: 1.4, 95% confidence interval (CI) 1.4-1.4; OR for HEDIS initiation: 1.1, 95% CI: 1.1-1.1]. Hispanic patients were more likely than White patients to initiate treatment within 180days (OR: 1.2, 95% CI 1.2-1.3) but HEDIS initiation did not differ between Hispanic and White patients. Engagement results varied depending on the measure but was more likely for Black patients relative to White for all measures (OR for engagement in first month: 1.1, 95% CI: 1.0-1.1; OR for engagement in first three months: 1.2, 95% CI: 1.1-1.2; OR for HEDIS measure: 1.1, 95% CI: 1.0-1.1), and did not differ between Hispanic and White patients.

CONCLUSIONS

After accounting for facility- and patient-level characteristics, Black and Hispanic patients with AUD were more likely than Whites to initiate specialty addictions treatment, and Black patients were more likely than Whites to engage. Research is needed to understand underlying mechanisms and whether differences in initiation of and engagement with care influence health outcomes.

Substance use among persons with homeless experience in primary care

BACKGROUND

Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams.

METHODS

The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use.

RESULTS

Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced.

CONCLUSIONS

Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.

Past racial discrimination exacerbates the effects of racial exclusion on negative affect, perceived control, and alcohol-risk cognitions among Black young adults

Racial discrimination is associated with alcohol use and risky sex cognitions and behaviors, which are risk factors for negative health outcomes, including human immunodeficiency virus infection. The current study investigated the causal impact of racial discrimination on alcohol and sexual-risk cognitions while exploring potential mediators that might help explain this relation: negative affect, perceived control, and meaningful existence. We also examined if past discrimination impacts the strength of (moderates) these effects. Participants were 287 Black/African American young adults aged 18-25. They were randomly assigned to be excluded or included by White peers via the game Cyberball. Racial exclusion (vs. inclusion) predicted greater: perceived racial discrimination, negative affect, alcohol use willingness, and reduced perceived control and meaningful existence. Furthermore, excluded participants who experienced more past racial discrimination reported the lowest perceived control, and greatest negative affect and alcohol-risk cognitions. The findings suggest that past racial discrimination exacerbates the harmful health effects of immediate experiences of discrimination.

The Effects of Alcohol and Cigarette Consumption on Dehydroepiandrosterone (DHEA) in Rural African Americans

Objective: Rurally situated African Americans suffer from stress and drug-related health disparities. Unfortunately, research on potential mechanisms that underlie this public health problem have received limited focus in the scientific literature. This study investigated the physiological impact of nicotine and alcohol use on dehydroepiandrosterone (DHEA) functioning, a biomarker previously linked to hypothalamic-pituitary-adrenal functioning. Method: A rural sample of African American emerging adults ( n = 84) completed a battery of assessments and provided six samples of salivary DHEA at wakeup, 30 minutes postwakeup, 90 minutes postwakeup, 3:00 p.m., 3:30 p.m., and 4:30 p.m. Results: Participants had more DHEA on waking as a function of smoking greater number of cigarettes throughout the day. Although this effect was not replicated with increased levels of alcohol consumption, the interaction between cigarette and alcohol use was associated with increased levels of DHEA on waking. Conclusion: While use of a single substance (i.e., cigarettes) was related to higher DHEA and greater hypothalamic-pituitary-adrenal activation, the addition of a second substance (i.e., alcohol) shifted the individual toward the hyperactive arousal profile common within chronically stressed or challenged populations. These findings support the need to further investigate the relationship between polysubstance use and physiological functioning that may be linked to known health disparities in the African American community.

Relationship of Usual Volume and Heavy Consumption to Risk of Alcohol-Related Injury: Racial/Ethnic Disparities in Four U.S. National Alcohol Surveys

OBJECTIVE

National population data on racial/ethnic disparities and risk of alcohol-related injury are scarce. Alcohol-related injury and drinking patterns are examined in a sample of respondents from four (1995, 2000, 2005, 2010) U.S. National Alcohol Surveys using risk function analysis.

METHOD

Self-reported consumption of 15,476 current drinkers was assessed as the average number of drinks consumed monthly and, separately, the frequency of consuming five or more drinks in a day (5+ days) in the last year. Alcohol-related injury was defined as drinking within 6 hours before the event. Risk curves were defined, separately for Whites, Blacks, and Hispanics, using fractional polynomial regression.

RESULTS

Risk was greatest for Hispanics to 110 drinks per month (3-4 drinks per day) and above 240 drinks per month, whereas risk was greatest for Whites between these levels. Blacks were at lower risk at all monthly volume levels when demographic and socioeconomic status characteristics were controlled for. Whites had the highest risk of an alcohol-related injury based on 5+ drinking days at all levels up to nearly daily 5+ drinking, whereas Blacks had the lowest risk at all levels of 5+ drinking.

CONCLUSIONS

A disparity in alcohol-related injury was found for Hispanics compared with Whites at the same average monthly volume of consumption at lower and higher volume levels, but not at the same number of 5+ drinking days, and a lower risk of alcohol-related injury was found for Blacks for both consumption measures when demographic and socioeconomic status characteristics were taken into account. Although exposure to hazards other than alcohol, which could account for some of the racial/ethnic disparity observed, was not taken into account, these mixed findings suggest this is an important area deserving future research attention.

Viral challenge reveals further evidence of skin-deep resilience in African Americans from disadvantaged backgrounds

OBJECTIVE

Studies have revealed a phenomenon called skin-deep resilience, which develops in upwardly mobile African American youth. They perform well in school, maintain good mental health, and avoid legal problems. Despite outward indications of success, they also show evidence of worse health in biomarker studies. Here we extend this research, asking whether it manifests in differential susceptibility to upper respiratory infection, and if it emerges in European Americans as well.

METHODS

The sample included 514 adults in good health, as judged by physician examination and laboratory testing. Participants completed questionnaires about lifecourse socioeconomic conditions, conscientiousness, psychosocial adjustment, and lifestyle factors. They were subsequently inoculated with a rhinovirus that causes upper respiratory infection, and monitored in quarantine for 5 days the development of illness.

RESULTS

Consistent with past work, African Americans from disadvantaged backgrounds displayed indications of skin-deep resilience. To the extent these participants were high in conscientiousness, they fared better across multiple domains of psychosocial functioning, as reflected in educational attainment, symptoms of depression, and close relationship quality (p values = .01-.04). But analyses of these participants' susceptibility to infection revealed the opposite pattern; higher conscientiousness was associated with a greater likelihood of becoming ill following inoculation (p value = .03). In European Americans, there was no evidence of skin-deep resilience; conscientiousness was associated with better psychosocial outcomes, but not infection risk.

CONCLUSIONS

These observations suggest that resilience may be a double-edged sword for African Americans from disadvantaged backgrounds. The same characteristics associated with academic success and psychological adjustment forecast increased vulnerability to health problems. (PsycINFO Database Record

Overview on Prevalence and Recent Trends in Adolescent Substance Use and Abuse

Substance use and consequent disorders have burdened US health care, criminal justice, and society at large for centuries. Pathological substance use almost invariably begins before 25 years of age, demonstrating how critical adolescence is within the etiology, prevention, and treatment of substance use disorder. This article provides a high-level overview of the prevalence of substance use disorders to provide a context within which the remaining issue provides in-depth descriptions of the evidence on specific topics. Described herein are trends in substance use, substance use disorder, and demographic comparisons.

Progression from First Drink, First Intoxication, and Regular Drinking to Alcohol Use Disorder: A Comparison of African American and European American Youth

BACKGROUND

Differences between African Americans (AAs) and European Americans (EAs) in the prevalence and age at onset of alcohol use and alcohol use disorder (AUD) have been documented, but distinctions in the timing of early stage transitions and contribution of various psychiatric and psychosocial risk factors to the progression from initiation to AUD have yet to be investigated. The current study characterized progression from alcohol use initiation-defined alternatively as first drink, first intoxication, and regular drinking onset-to AUD in AA and EA youth.

METHODS

Psychiatric interviews were administered via telephone to 1,461 participants (56% AA, 44% EA) in a high-risk family study (50.3% female, mean age = 17.6 [SD = 3.8]). Cox proportional hazards regression analyses were conducted separately for the AA and EA subsamples to predict DSM-5 AUD as a function of age at alcohol use initiation, with age at first drink, age at first intoxication, and age at regular drinking onset as the point of origin in separate models.

RESULTS

Across race/ethnicity, regardless of how it was measured, early alcohol use initiation predicted AUD, but hazard ratios (HRs) were lowest for first drink. Regular smoking and social anxiety disorder were significant predictors in both racial/ethnic groups, but associations with conduct disorder (all 3 models: HR range = 2.07 to 4.15) and major depressive disorder (regular drinking: HR = 4.51, confidence interval [CI]: 1.60 to 12.69 for AUD onset ≥ age 20) were specific to AAs. Posttraumatic stress disorder (HR = 5.38, CI: 1.44 to 20.08) and generalized anxiety disorder (HR = 7.35, CI: 2.31 to 23.34 for AUD onset ≤ age 17) were strongly associated with progression from regular drinking to AUD exclusively in EAs.

CONCLUSIONS

Early alcohol use initiation is a marker of risk for AUD in both AA and EA youth, but the contributions of various psychiatric risk factors to the development of AUD are not universal across racial/ethnic groups.

Poor, persecuted, young, and alone: Toward explaining the elevated risk of alcohol problems among Black and Latino men who drink

BACKGROUND

Even given equivalent drinking patterns, Black and Latino men experience substantially more dependence symptoms and other consequences than White men, particularly at low/no heavy drinking. No known studies have identified factors driving these disparities. The current study examines this question.

METHODS

The 2005 and 2010 National Alcohol Surveys were pooled. Surveys are nationally representative, telephone interviews of the U.S. including Black and Latino oversamples; male drinkers were analyzed (N=4182). Preliminary analyses included negative binomial regressions of dependence symptom and consequence counts testing whether effects for race/ethnicity were diminished when entering potential explanatory factors individually. Additional analyses re-examined effects for race/ethnicity when using propensity score weighting to weight Blacks to Whites, and Latinos to Whites, first on heavy drinking alone, and then on heavy drinking and all explanatory factors supported by preliminary analyses.

RESULTS

Preliminary regressions suggested roles for lower individual SES, greater prejudice and unfair treatment, and younger age in the elevated risk of alcohol problems among Black and Latino (vs. White) men at low heavy drinking levels; additional support emerged for single (vs. married) status among Blacks and neighborhood disadvantage among Latinos. When Blacks and Latinos were weighted to Whites on the above variables, effects for race/ethnicity on dependence counts were reduced to nonsignificance, while racial/ethnic disparities in consequence counts were attenuated (by >43% overall).

CONCLUSIONS

Heavy drinking may be especially risky for those who are poor, exposed to prejudice and unfair treatment, young, and unmarried, and these factors may contribute to explaining racial/ethnic disparities in alcohol problems.

Integrating affect and impulsivity: The role of positive and negative urgency in substance use risk

BACKGROUND

The personality traits of positive and negative urgency refer to the tendencies to act rashly when experiencing unusually positive or negative emotions, respectively.

METHODS

The authors review recent empirical work testing urgency theory (Cyders and Smith, 2008a) and consider advances in theory related to these traits.

RESULTS

Empirical findings indicate that (a) the urgency traits are particularly important predictors of the onset of, and increases in, substance use in both children and young adults; (b) they appear to operate in part by biasing psychosocial learning; (c) pubertal onset is associated with increases in negative urgency, which in turn predict increases in adolescent drinking behavior; (d) variation in negative urgency trait levels are associated with variations in the functioning of an identified brain system; and (e) variations in the serotonin transporter gene, known to influence the relevant brain system, relate to variations in the urgency traits.

CONCLUSION

A recent model (Carver et al., 2008) proposes the urgency traits to be markers of a tendency to respond reflexively to emotion, whether through impulsive action or ill-advised inaction (the latter leading to depressive symptoms); this model has received empirical support. The authors discuss new directions for research on the urgency traits.

Decreasing Substance use Risk among African American Youth: Parent-based Mechanisms of Change

African American couples (N = 139; 67.7 % married; with children between the ages of 9 and 14) were randomly assigned to (a) a culturally sensitive, couple- and parenting-focused program designed to prevent stress-spillover (n = 70) or (b) an information-only control condition in which couples received self-help materials (n = 69). Eight months after baseline, youth whose parents participated in the program, compared with control youth, reported increased parental monitoring, positive racial socialization, and positive self-concept, as well as decreased conduct problems and self-reported substance use. Changes in youth-reported parenting behavior partially mediated the effect of the intervention on conduct problems and fully mediated its impact on positive self-concept, but did not mediate effects on lifetime substance use initiation. Results suggest the potential for a culturally sensitive family-based intervention targeting adults' couple and parenting processes to enhance multiple parenting behaviors as well as decrease youths' substance use onset and vulnerability.

Racial Differences in the Transactional Relationship Between Depression and Alcohol Use From Elementary School to Middle School

OBJECTIVE

The aim of this investigation was to test hypothesized reverse prospective relationships between alcohol consumption and depressive symptomatology as a function of race among youth.

METHOD

In a two-wave prospective study, 328 European American, 328 African American, and 144 Hispanic American youth were studied at the end of fifth grade (last year of elementary school) and the end of sixth grade (first year of middle school).

RESULTS

A positive correlation was observed between alcohol consumption and depressive symptoms among all youth. However, the predictive relationship differed based on race. For European American and Hispanic American youth, depressive symptom levels at the end of elementary school predicted alcohol consumption at the end of the first year of middle school, but the converse relationship was not observed. For African American youth, the opposite pattern was found. Alcohol consumption at the end of elementary school predicted depressive symptom levels at the end of the first year of middle school, and the converse relationship was not observed.

CONCLUSIONS

These findings suggest the possibility that etiological relationships between depression and alcohol use vary by race, thus highlighting the importance of considering race when studying the risk process.

Workplace Discrimination Is Associated With Alcohol Abuse Among Ethnically Diverse Hospital Staff

Research suggests that workplace discrimination plays a role in absenteeism, productivity, and turnover. A link among workplace discrimination, mental health, and health disparities may also exist. The purpose of this study was to determine whether self-reported workplace discrimination is associated with alcohol abuse among hospital workers. Cross-sectional analysis of baseline data collected from a prospective cohort study of workers in two healthcare institutions ( n = 664) was conducted. Workplace discrimination in the previous 12 months was reported by 14% ( n = 91) of participants who were four times more likely to score higher on likely alcohol abuse than their peers. White participants who reported any discrimination were more likely to score higher on likely alcohol abuse than racial/ethnic minority participants who reported any discrimination. Given a diversifying workforce, further research is needed on how workplace discrimination contributes to stress and maladaptive coping, and ultimately health disparities.

Selected State Policies and Associations With Alcohol Use Behaviors and Risky Driving Behaviors Among Youth: Findings from Monitoring the Future Study

BACKGROUND

Effective policies that can reduce alcohol use behaviors and impaired driving among young people at a population level are needed. Graduated driver licensing (GDL) laws increase the driving privileges of young novice drivers as they age and gain more driving experience. In this study, we seek to determine the effects of GDLs on risky driving behaviors of youth and to assess if GDLs have an unintended effect on underage drinking behaviors.

METHODS

We utilized 2000 to 2013 data on 12th grade students from the Monitoring the Future (MTF) study, an ongoing, annual national survey (since 1975) that studies the substance use behaviors of adolescents, as well as data on GDL laws obtained via the Insurance Institute for Highway Safety (IIHS). We conducted a series of regular logistic regression models that included fixed effects for year and state, and adjusted for demographic characteristics, school characteristics, and other state alcohol policies.

RESULTS

Total weighted sample size was 129,289 12th graders. Past month alcohol use and binge drinking (i.e., ≥5 drinks on one occasion) in the past 2 weeks were 45 and 26%, respectively. Seventeen percent of respondents reported riding with a driver who drank alcohol. Nearly 12% reported driving in the past 2 weeks after drinking alcohol, and 7% reported driving after binge drinking. Over half of the students lived in a state with a "good" GDL law. The logistic regression models suggest a link between restrictive GDL policies and a reduction of alcohol use behaviors and risky driving behaviors among youth.

CONCLUSIONS

Our findings indicate that the effects of GDLs extend beyond driving-related risks and into other drinking-related behaviors that pose immediate or delayed health risks for young people. We speculate that GDLs may dictate social norms and expectations for youth risk behaviors, and should be maximized throughout the United States.

Perceived racial discrimination, heavy episodic drinking, and alcohol abstinence among African American and White college students

Previous research has demonstrated that White college students are more likely to drink alcohol at a greater frequency and quantity compared to their African American counterparts. Examining race-related factors that structure alcohol use among college students remains an important area of research. In this study, we specifically examine perceived discrimination and its association with both heavy episodic drinking (HED) and alcohol abstinence among college students. Items that measured perceived racial discrimination in alcohol use contexts and demographic characteristics were used as independent and control variables. African American students were more likely to abstain from alcohol and less likely to engage in HED compared to their White counterparts. Results also suggest that students who believe their drinking will solicit race-based police bias have lower odds of engaging in HED and greater odds of alcohol abstention. We conclude that unsolicited policing, experienced by African Americans generally, and White Americans on campuses, explains effect sizes.

Neighborhood Context and Binge Drinking by Race and Ethnicity in New York City

BACKGROUND

Neighborhood context is associated with binge drinking and has significant health, societal, and economic costs. Both binge drinking and neighborhood context vary by race and ethnicity. We examined the relations between neighborhood characteristics--neighborhood norms that are accepting of drunkenness, collective efficacy, and physical disorder--and binge drinking, with a focus on examining race and ethnic-specific relationships.

METHODS

Respondent data were collected through 2005 random digit-dial-telephone survey for a representative sample of New York City residents; neighborhood data were based on the 2005 New York City Housing and Vacancy Survey. Participants were 1,415 past-year drinkers; Whites (n = 877), Blacks (n = 292), and Hispanics (n = 246). Generalized estimating equations were used to estimate population average models.

RESULTS

For the overall sample, neighborhood norms that were more accepting of drunkenness were associated with greater binge drinking (odds ratio [OR] = 1.22; 95% confidence interval [CI] = 1.09, 1.37); collective efficacy and physical disorder were not significant. However, when examining this by race/ethnicity, greater collective efficacy (OR = 0.75; 95% CI = 0.62, 0.91) and greater physical disorder (OR = 0.76; 95% CI = 0.62, 0.93) were associated with less binge drinking for Whites only. Neighborhood norms that were more accepting of drunkenness were associated with binge drinking among Whites (OR = 1.20; 95% CI = 1.05, 1.38) and, while not significant (perhaps due to power), the associations were similar for Hispanics (OR = 1.18; 95% CI = 0.83, 1.68) and slightly lower for Blacks (OR = 1.11; 95% CI = 0.67, 1.84).

CONCLUSIONS

Overall, results suggest that neighborhood characteristics and binge drinking are shaped, in part, by factors that vary across race/ethnicity. Thus, disaggregating data by race/ethnicity is important in understanding binge drinking behaviors.

Demographic Predictors of Event-Level Associations between Alcohol Consumption and Sexual Behavior

Alcohol consumption is associated with sexual behavior and outcomes, though research indicates a variety of moderating factors, including demographic characteristics. To better target interventions aimed at alcohol-related sexual risk behavior, our analyses simultaneously examine demographic predictors of both day- and event-level associations between alcohol consumption and sexual behavior in a sample of young adults (N = 301) who are sexually active and consume alcohol. Young adults (aged 18-29) recruited using time-space sampling and incentivized snowball sampling completed a survey and a timeline follow-back calendar reporting alcohol consumption and sexual behavior in the past 30 days. On a given day, a greater number of drinks consumed was associated with higher likelihood of sex occurring, particularly for women and single participants. During a given sexual event, number of drinks consumed was not associated with condom use, nor did any demographic predictors predict that association. Findings highlight associations between alcohol and sexual behavior, though not between alcohol and sexual risk behavior, highlighting the need for additional research exploring the complex role of alcohol in sexual risk behavior and the need to develop prevention efforts to minimize the role of alcohol in the initiation of sexual encounters.

Male, But Not Female, Alcohol-Dependent African Americans Discount Delayed Gains More Steeply than Propensity-Score Matched Controls

RATIONALE

Alcohol dependence is known to be associated with steep discounting of delayed rewards, but its relation to the discounting of delayed losses and probabilistic rewards is unclear. Moreover, patterns of alcohol consumption vary considerably between communities, but previous research has not examined the relation between discounting and alcohol dependence in low-income African Americans.

OBJECTIVES

The goal of the present study was to determine whether low-income, alcohol-dependent African Americans differ from controls in the degree to which they discount delayed rewards, delayed losses, or probabilistic rewards.

METHODS

African-American participants, both cases and controls, were recruited from the same low-income neighborhoods, and propensity-score matching was used to further control for demographic differences. Participants performed three tasks that assessed their discounting of hypothetical monetary outcomes: delayed rewards, delayed losses, and probabilistic rewards.

RESULTS

Alcohol-dependent cases discounted delayed gains, but not delayed losses or probabilistic gains, more steeply than their matched controls. The difference in discounting of delayed gains was localized to the male cases, whose discounting was steeper than either the male controls or the female cases; no gender difference was observed between male and female controls.

CONCLUSIONS

The present results extend findings regarding discounting by substance abusers to a previously unstudied group, low-income African Americans, and suggest that in this group at least, alcohol dependence, particularly in males, may be more a reflection of choosing immediate rewards than of ignoring their delayed negative consequences.

Association of exposure to neighborhood drug activity, neurobehavioral traits, and marijuana use among at-risk African American females

INTRODUCTION

Theories of relative deprivation suggest African Americans in disadvantaged communities are at increased risk for drug use. This increased risk may be due, in part, to exposure to drugs and drug subcultures. Given the significance of the prefrontal cortex (PFC) functioning in yielding behavior that is strategically guided rather than reactive to environmental demands, it is important to examine the relationship between PFC functioning, neighborhood drug activity and substance use among African Americans residing in high risk communities.

METHODS

A sample of 120 young adult African American females was recruited from high-risk neighborhoods. Each completed the modified version of the neighborhood environment scale, a neurobehavioral assessment designed to measure apathy, behavioral disinhibition and executive dysfunction, and provided a urine sample that was tested for the presence of psychoactive drugs.

RESULTS

Logistic regression analyses indicated that females with higher scores on behavioral disinhibition were 2.6 times more likely to test positive for marijuana (95%CI = 1.02, 6.57). Neither apathy nor executive dysfunction was related to marijuana use. No relationship emerged between neighborhood drug activity and marijuana use.

CONCLUSIONS

Among the neurobehavioral traits considered only behavioral disinhibition was associated with marijuana use, suggesting that different neurobehavioral domains may be uniquely related to marijuana use. For females living in high risk environments, the extent to which they are able to control impulses may provide some protection against marijuana use. Future studies focused on the moderating effects of behavioral disinhibition on the association of exposure to risk environments and marijuana use may prove beneficial. Further, the study adds to the small base of literature supporting the Frontal Systems Behavior Scale as a brief assessment to evaluate frontally-mediated neurobehavioral traits relevant to substance use. However, future studies aimed at examining the influence of neighborhood drug activity might benefit from more precise measures of exposure to neighborhood drug activity. More research to replicate and expand on the present findings is warranted.

Drinking Patterns and HIV Risk Behaviors Among Black and Latino Men Who Have Sex Within Los Angeles County

Alcohol, the most widely used substance among men who have sex with men (85%), remains an important factor in HIV research among this high-risk population. However, research on alcohol use among Black and Latino men who have sex with men (BLMSM), a population disproportionately affected by HIV in the United States, is limited and inconclusive. This study explored sociodemographic and HIV risk with daily heavy and low-risk drinking patterns among BLMSM. BLMSM (N = 188) aged 18 to 40 years were recruited through social media, local colleges, heteronormative clubs, private men’s groups, gay establishments, and organized events in Los Angeles County. Participants completed self-administered questionnaires. Fisher’s exact tests revealed significant relationships between drinking patterns and condomless insertive anal intercourse (p = .001), race (p < .001), age (p = .02), and perception of alcohol-related HIV risk (p = .007). The Fisher’s exact tests findings for age held true in the multiple regression model (p = .014). Findings suggest that BLMSM who engage in higher risk drinking also engage in alcohol-related HIV risk. Culturally competent interventions should consider including a combined focus to explore the synergy between risky drinking patterns and HIV risk among BLMSM.

Social network and census tract-level influences on substance use among emerging adult males: An activity spaces approach

Social network and area level characteristics have been linked to substance use. We used snowball sampling to recruit 90 predominantly African American emerging adult men who provided typical locations visited (n=510). We used generalized estimating equations to examine social network and area level predictors of substance use. Lower social network quality was associated with days of marijuana use (B=-0.0037, p<0.0001) and problem alcohol use (B=-0.0050, p=0.0181). The influence of area characteristics on substance use differed between risky and non-risky spaces. Peer and area influences are important for substance use among men, and may differ for high and low risk places.

Young adolescents' perceived activity space risk, peer networks, and substance use

Adolescent substance use is a developmentally contingent social practice that is constituted within the routine social-environment of adolescents' lives. Few studies have examined peer networks, perceived activity space risk (risk of substance use at routine locations), and substance use. We examined the moderating influence of peer network characteristics on the relationship between perceived activity space risk and substance use among a sample of 250 urban adolescents. Significant interactions were found between peer networks and perceived activity space risk on tobacco and marijuana use, such that protective peer networks reduced the effect of activity place risk on substance use. A significant 3-way interaction was found on marijuana use indicating that gender moderated peer network's effect on activity space risk. Conditional effect analysis found that boys' peer networks moderated the effect of perceived activity space risk on marijuana use, whereas for girls, the effect of perceived activity space risk on marijuana use was not moderated by their peer networks. These findings could advance theoretical models to inform social-environmental research among adolescents.

Racial/Ethnic Disparities in the Risk of Injury Related to the Frequency of Heavy Drinking Occasions

AIMS

To estimate the risk of injury associated with the frequency of heavy drinking days overall and for black, white and Hispanic drinkers in a US sample.

METHODS

Data are from the 2010 National Alcohol Survey and included 6506 respondents comprising the landline sample. Analyses utilize Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking is determined by age of onset and questions on heavy drinking by decade of life. The outcome measure is having had a serious injury at a certain age. Models estimate the risk of injury in relation to heavy drinking in each year controlling for demographics, risk taking and time varying measures of smoking and chronic disease.

RESULTS

Results indicate that the risk of injury increases with the frequency of heavy drinking days to a hazard ratio of 2.14 (1.45-3.14) for daily heavy drinkers. Risks for white respondents were similar to the overall results but different risk relationships were found for black respondents among whom only daily heavy drinkers had increased risk of 4.09 (2.11-7.93), and for Hispanic respondents where elevated risk was seen among yearly heavy drinkers 2.71 (1.29-5.68), with a similar risk estimate for monthly heavy drinkers but lower and non-significant risks found for more frequent heavy drinking categories.

CONCLUSIONS

Different risk relationships were found across race/ethnicity groups suggesting elevated risk with less frequent heavy drinking among Hispanic respondents and very high risk from daily heavy drinking among black respondents.

Drinking behaviors and life course socioeconomic status during the transition from adolescence to adulthood among Whites and Blacks

OBJECTIVE

This study sought to determine how socioeconomic status (SES) changes during the transition from adolescence into adulthood, and to understand the effects of SES on drinking behaviors in early adulthood among U.S. Whites and Blacks.

METHOD

Secondary data analysis was conducted using three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a school-based sample of adolescents (Grades 7-12) followed through adulthood (age range: 25-31 years). Through latent class analysis, SES was operationalized as economic (i.e., income, home ownership) and human capital (i.e., education, occupation). Drinking behavior was categorized into no past-year use, current drinking without weekly heavy episodic drinking (HED), and weekly HED. Models were stratified by race: Whites (n = 5,248) and Blacks (n = 1,875).

RESULTS

For Whites, four economic capital groups (persistently low, upward, downward, and persistently high) and five human capital groups (persistently low, upward with work, upward with school, downward with work, and persistently high) were found. Blacks had roughly similar SES groups as Whites but with lower economic and human capital levels across all groups and without downward groups in either domain. Among both Whites and Blacks, lower economic and human capital groups reported higher abstinence. Persistently low Blacks, however, reported higher HED, whereas persistently low Whites did not. Moreover, economically upward Whites reported lower HED, whereas upwardly mobile Blacks did not.

CONCLUSIONS

Racial disparities were evident by economic and human capital during the transition into adulthood. Although abstinence profiles were similar for Whites and Blacks, both persistently low and upward trajectory groups signified differential HED risks. Future research should examine the mechanisms by which SES trajectories affect drinking behaviors.

Racial/ethnic differences in use of alcohol, tobacco, and marijuana: is there a cross-over from adolescence to adulthood?

Black adolescents in the US are less likely to use alcohol, marijuana, and tobacco compared with non-Hispanic Whites, but little is known about the consistency of these racial/ethnic differences in substance use across the lifecourse. Understanding lifecourse patterning of substance use is critical to inform prevention and intervention efforts. Data were drawn from four waves of the National Longitudinal Study of Adolescent Health (Add Health; Wave 1 (mean age = 16): N = 14,101; Wave 4 (mean age = 29): N = 11,365). Outcomes included alcohol (including at-risk drinking, defined as 5+/4+ drinks per drinking occasion or 14+/7+ drinks per week on average for men and women, respectively), cigarette, and marijuana use in 30-day/past-year. Random effects models stratified by gender tested differences-in-differences for wave by race interactions, controlling for age, parents' highest education/income, public assistance, and urbanicity. Results indicate that for alcohol, Whites were more likely to use alcohol and engage in at-risk alcohol use at all waves. By mean age 29.9, for example, White men were 2.1 times as likely to engage in at-risk alcohol use (95% C.I. 1.48-2.94). For cigarettes, Whites were more likely to use cigarettes and smoked more at Waves 1 through 3; there were no differences by Wave 4 for men and a diminished difference for women, and difference-in-difference models indicated evidence of convergence. For marijuana, there were no racial/ethnic differences in use for men at any wave. For women, by Wave 4 there was convergence in marijuana use and a cross-over in frequency of use among users, with Black women using more than White women. In summary, no convergence or cross-over for racial/ethnic differences through early adulthood in alcohol use; convergence for cigarette as well as marijuana use. Lifecourse patterns of health disparities secondary to heavy substance use by race and ethnicity may be, at least in part, due to age-related variation in cigarette and marijuana use.

Racial/ethnic disparities in alcohol-related problems: differences by gender and level of heavy drinking

BACKGROUND

While prior studies have reported racial/ethnic disparities in alcohol-related problems at a given level of heavy drinking (HD), particularly lower levels, it is unclear whether these occur in both genders and are an artifact of racial/ethnic differences in drink alcohol content. Such information is important to understanding disparities and developing specific, targeted interventions. This study addresses these questions and examines disparities in specific types of alcohol problems across racial-gender groups.

METHODS

Using 2005 and 2010 National Alcohol Survey data (N = 7,249 current drinkers), gender-stratified regression analyses were conducted to assess black-white and Hispanic-white disparities in alcohol dependence and negative drinking consequences at equivalent levels of HD. HD was measured using a gender-specific, composite drinking-patterns variable derived through factor analysis. Analyses were replicated using adjusted-alcohol consumption variables that account for group differences in drink alcohol content based on race/ethnicity, gender, age, and alcoholic beverage.

RESULTS

Compared with white men, black and Hispanic men had higher rates of injuries/accidents/health and social consequences, and marginally greater work/legal consequences (p < 0.10). Hispanic women had marginally higher rates of social consequences. In main effects models controlling for demographics, light drinking and HD, only black women and men had greater odds of alcohol-related problems relative to whites. Interaction models indicated that compared with whites, black women had greater odds of dependence at all levels of HD, while both black and Hispanic men had elevated risk of alcohol problems only at lower levels of HD. Drink alcohol content adjustments did not significantly alter findings for either gender.

CONCLUSIONS

This study highlights the gender-specific nature of racial/ethnic disparities. Interventions focused on reducing HD might not address disparities in alcohol-related problems that exist at low levels of HD. Future research should consider the potential role of environmental and genetic factors in these disparities.