Subjective Social Status and Financial Hardship: Associations of Alternative Indicators of Socioeconomic Status with Problem Drinking in Asian Americans and Latinos

Financial strain measures and associations with adult health: A systematic literature review

Despite growing attention to other social needs like food and housing insecurity, financial strain, defined as having difficulty making ends meet or lacking money for basic needs, is under-recognized. Inconsistent labels and measures have made the literature difficult to unify. We used many synonyms for financial strain to systematically identify 199 U.S. studies (316 papers) that used financial strain measures that were operationally consistent with our definition as predictors of health among adults. We thematically coded financial strain measures for content and synthesized evidence based on measure and methods. Financial strain was measured by self-reported lacking money for basic needs (119 studies) and/or difficulty making ends meet (n = 132), and less commonly additionally based on coping strategies (n = 23), satisfaction with finances (n = 14), worry about finances (n = 22), the anticipation of strain (n = 14), and/or lacking money for leisure (n = 29). Regardless of measure, financial strain was associated with poorer mental, physical, biological, and functional health, worse health behaviors and more social needs. Associations were found across diverse and population-based samples and when accounting for other socioeconomic factors and even intermediating health factors. Results demonstrate predictive validity for two different one-item screening tools. Furthermore, the vast evidence linking financial strain to health highlights an urgent need for policy action addressing financial strain to advance health equity.

Global trends and differences in the burden of alcohol use disorders attributable to childhood sexual abuse by sex, age, and socio-demographic index: Findings from the Global Burden of Disease Study 2019

BACKGROUND

Childhood sexual abuse (CSA) is a severe global problem associated with alcohol use disorder (AUD). Previous studies have confirmed this relationship; however, there is a lack of research on the disease burden of AUD attributable to CSA.

OBJECTIVE

To analyze global spatiotemporal trends and differences in the disease burden of AUD attributable to CSA and its relationship with age, sex, and the sociodemographic index (SDI).

PARTICIPANTS AND SETTING

Data from the Global Burden of Disease 2019 Public Database.

METHODS

Summary exposure value (SEV) was used to evaluate CSA. Disability-adjusted life year (DALY), years lived with disability (YLD), years of life lost (YLL), and their annual rates of change were used to evaluate disease burden. Cluster analysis based on Ward's method was used to examine the global burden associated with age, sex, and SDI. A 95 % uncertainty intervals (UI), excluding 0, was considered statistically significant.

RESULTS

In 2019, 1.63 million (95 % UI 0.23-3.90 million) DALYs of AUD were caused by CSA and the age-standardized rates (ASRs) of DALY was 19.77 (95 % UI 2.78-47.46) globally. Annual rates of change in DALY of people over 65 years of age increased from 1990 to 2019 in all regions except the High-middle SDI regions. The ASRs of DALY of females in High SDI regions, were always at a much higher level than other SDI regions, and showed an upward trend from 1990 to 2019 (DALY 1990: 20.38 [95 % UI 2.87-47.77], 2019: 23.61 [95 % UI 3.55-54.94]).

CONCLUSIONS

Substantial geographical differences were observed in the burden of AUD attributable to CSA. The level of CSA exposure was inconsistent with the related burden of AUD in different regions according to the sociodemographic index. The burden of disease increased in the elderly population and in females in high sociodemographic index regions.

A scoping review of health inequities in alcohol use disorder

Background: Alcohol Use Disorder (AUD) poses a significant health burden on individuals. The burden occurs more frequently in the medically underserved, as well as racial and sexual minority populations. Ameliorating health inequities is vital to improving patient-centered care.Objectives: The objective of this scoping review is to chart the existing evidence on health inequities related to AUD and identify existing knowledge gaps to guide future equity-centered research.Methods: We performed a literature search using the Ovid (Embase) and MEDLINE (PubMed) databases for articles on AUD that were published in the 5-year period spanning from 2017 to 2021 and written in English. The frequencies of each health inequity examined were analyzed, and findings from each included study were summarized.Results: Our sample consisted of 55 studies for analysis. The most common inequity examined was by race/ethnicity followed by sex or gender. The least reported inequities examined were rural under-resourced areas and occupational status. Our findings indicate that significant research gaps exist in education, rural under-resourced populations, and LGBTQ+ communities with AUD.Conclusions: This scoping review highlights the gaps in research on inequities in AUD. To bridge the current gaps, we recommend research on the following: 1) triage screening tools and the use of telemedicine for rural, under-resourced populations; 2) interventions to increase treatment engagement and retention for women; and 3) community-based participatory methodologies for the LGBTQ+ communities.

The association between student loan debt and perceived socioeconomic status and problematic drinking and mental health symptoms: A preliminary investigation

U.S. young adults face the largest student loan burden in history, rising income inequality, and economic uncertainty. Personal debt and other financial stressors have been associated with problematic drinking and mental health symptoms. In this paper, we investigated whether student loan debt was more strongly linked to problem drinking and mental health symptoms among those in lower positions of socioeconomic status (SES) and those who perceived greater [in]stability in their SES (SES-instability). Using data from a larger study of college graduates, we investigated SES, SES-instability, student debt, and their 2-way interactions on problematic drinking and mental health symptoms. College graduates (N = 331), who were two years post-graduation, completed measures assessing student debt, perceived SES, SES-instability, problematic drinking, and mental health symptoms (depression, anxiety, and stress). The hypotheses and data analysis plan were registered prior to conducting analyses. The expected unique, positive associations of SES-instability with problematic drinking and mental health symptoms were supported. SES was uniquely linked with problematic drinking only and in the opposite direction as predicted. Student debt was uniquely and positively linked to stress only. The expected interactions were largely supported for SES-instability and student debt-i.e., the associations of student debt with problematic drinking, anxiety, and stress were stronger (more positive) for those with greater SES-instability. The expected interactions for SES and student debt were null. Though data are cross-sectional and come from an educationally-privileged group, study findings provide preliminary evidence of links between young adult student loan debt, greater SES-instability, and their drinking/mental health.

Subjective Family Socioeconomic Status and Peer Relationships: Mediating Roles of Self-Esteem and Perceived Stress

This study explored the relationships between subjective family socioeconomic status (FSES), self-esteem, perceived stress, and perceived peer relationships among Chinese adolescents. A total of 1,353 adolescents (age range: 15-19 years) were asked to complete a questionnaire. Mediation analysis revealed that subjective FSES influenced perceived peer relationships in three ways: first, through the mediating effect of perceived stress; second, through the mediating effect of self-esteem; and third, through the serial mediating effects of perceived stress and self-esteem. The results remained significant after controlling for parental education. In addition, a contrast analysis showed no significant differences in the mediating effects of self-esteem and perceived stress. Thus, we suggest that steps should be taken to improve adolescents' self-esteem and reduce their stress through training interventions and preventive measures, to help them improve their perceived peer relationships and reduce adverse effects associated with low subjective FSES.