Subgroup differences in drinking patterns among black and white men: results from a national survey

Adult low-risk drinkers and abstainers are not the same

Background

Alcohol consumption, even at low-levels, can not be guaranteed as safe or risk free. Specifically, the 2009 Australian National Health and Medical Research Council drinking guidelines recommend that adults should not drink more than two standard drinks on any day on average, and no more than four drinks on a single occasion. Nearly 40% of Australians aged 12 years and older drink alcohol but don’t exceed these recommended limits, yet adult low-risk drinkers have been largely overlooked in Australian alcohol survey research, where they are usually grouped with abstainers. This paper examines the socio-demographic profile of low-risk drinking adults (18+ years old), compared to those who abstain.

Methods

Data from the 2013 National Drug Strategy Household Survey were used. In the past 12 months, 4796 Australians had not consumed alcohol and 8734 had consumed alcohol at low-risk levels, accounting for both average volume and episodic drinking (hereafter low-risk).

Results

Multivariate logistic regression results indicated that low-risk drinkers were more likely to be older, married, Australian-born, and reside in a less disadvantaged neighbourhood compared with abstainers. There was no significant difference by sex between low-risk drinkers and abstainers.

Conclusions

The socio-demographic profile of low-risk drinkers differed from that of abstainers. Combining low-risk drinkers and abstainers into a single group, which is often the practice in survey research, may mask important differences. The study may support improved targeting of health promotion initiatives that encourage low-risk drinkers not to increase consumption or, in view of increasing evidence that low-risk drinking is not risk free, to move towards abstinence.

Trends in Alcohol Intake and the Association between Socio-Demographic Factors and Volume of Alcohol Intake amongst Adult Male Drinkers in China

Background: The volume of alcohol intake and type of alcohol affect Chinese men’s health. This study investigated changes of alcohol type between 2004 and 2011, explored the trend of change in alcohol type with age and determined the social demographic factors influencing the alcohol intake of Chinese men. Methods: Research data originated from the public database, China Health and Nutrition Survey (CHNS). Three chi-square tests were used to determine the prevalence of different alcohol types (beer, wine and liqueur) and the trend with age among male drinkers from 2004 to 2011. An ordered logistic regression model was established with alcohol intake as the dependent variable and social demography as the independent variable to analyze the influence of these factors on male alcohol intake. Results: This study confirmed that from 2004 to 2011, 70.1% of Chinese men consumed alcohol less than 168 g/w. The popularity of beer was on the rise, while the liqueur alcohol consumption decreased from 2004 to 2011 and the consumption of wine began to rise rapidly after 2006 (p < 0.05 for all). The prevalence of liqueur drinking increased with age and the prevalence of beer drinking decreased with age among Chinese male drinkers (p < 0.05 for all). From 2004 to 2011, a positive correlation appeared between age and male alcohol intake (p < 0.05 for all). In 2004 (OR = 1.22, 95% CI: 1.03–1.44), 2006 (OR = 1.21, 95% CI: 1.02–1.42) and 2011 (OR = 1.51, 95% CI: 1.31–1.75), Chinese men living in rural areas had a high volume of alcohol intake. From 2004 to 2011, the participants had married consumed more alcohol (p < 0.05 for all). In 2004 (OR = 0.61, 95% CI: 0.43–0.88) and 2011 (OR = 0.80, 95% CI: 0.68–0.94), higher education levels were negatively correlated with male alcohol intake. In 2006 (OR = 1.29, 95% CI: 1.07–1.56), 2009 (OR = 1.76, 95% CI: 1.45–2.14) and 2011 (OR = 1.35, 95% CI: 1.13–1.61), male drinkers who were working consumed more alcohol. From 2004 to 2011, a significant positive correlation appeared between tobacco consumption and alcohol intake (p < 0.05 for all). Conclusion: Consumption of three types of alcohol (beer, wine and liqueur) varies with the year. Beer consumption decreases with age, whereas liqueur consumption increases with age. Social demographic factors, such as residence, age, highest education level, working status and tobacco consumption, are related to alcohol intake. Our study affirms the effect of age on the choice of different types of alcohol.

Changing Racial/Ethnic Disparities in Heavy Drinking Trajectories Through Young Adulthood: A Comparative Cohort Study

BACKGROUND

There is evidence of racial/ethnic differences in the age at which young adults age out of heavy drinking. Some studies have found Black and Hispanic drinkers engage in more frequent heavy drinking than White people beyond adulthood. Yet, the alcohol-related disparities literature has produced contradictory findings on whether an age-crossover effect is evident among racial/ethnic groups; that is, whether racial/ethnic minorities' drinking levels or trajectories are lower than White people at young ages but later exceed (or crossover) those of White people. This study extends this scant literature by assessing whether racial/ethnic differences in heavy drinking have changed over time (possibly accounting for mixed findings from prior research); and tests for an age-crossover effect in heavy drinking using longitudinal data from 2 cohorts born 20 years apart.

METHODS

Data are from the 1979 (n = 10,963) and 1997 (n = 8,852) cohorts of the National Longitudinal Survey of Youth (NLSY). Generalized estimating equations were used to model trajectories of heavy drinking frequency from ages 17 to 31. Racial/ethnic differences were determined using sex-stratified models and 3-way interactions of race/ethnicity with age, age-squared, and cohort.

RESULTS

Racial/ethnic differences in heavy drinking trajectories have changed over time in men and women. In the older NLSY cohort, Hispanic men and Black women surpassed White men's and women's heavy drinking frequency by age 31. This crossover was absent in the younger cohort, where trajectories of all racial-sex groups converged by age 31. Normative trajectories have changed in Hispanics and White people of both sexes, with a delay in age of peak frequency, and greater levels of heavy drinking in the younger cohort of women.

CONCLUSIONS

Changes in heavy drinking trajectories over time suggest the need for targeted interventions during young adulthood. While disparities in young adult heavy drinking were no longer apparent in the more recent birth cohort, continued monitoring is important.

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 Influence of Current and Past Alcohol Use on Earnings: Three Approaches to Estimation

This article examines alcohol consumption and wages of males, aged 21 through 28, from three different perspectives. First, a four-equation model employs the National Longitudinal Survey of Youth to estimate a wage equation and an hours-of-work-equation for heavy drinkers and contrasts these estimates with wage and hours equations for moderate drinkers. Using a variety of drinking thresholds to distinguish "heavy" drinkers from "moderate" ones, the association between current levels of drinking, wages, and hours of work is measured. The longitudinal nature of the data is then used to study the relation between a profile of drinking over the 1982-1985 period and earnings. Last, a wage-change model investigates how the profile of drinking over the period 1982-1984 is related to the wage change between 1982 and 1985. The results from the static single-period model differ markedly from the wage-change model. Cross-sectional data show that higher drinking levels are correlated with higher wages and hours of work. Over time, however, increased drinking is associated with lower wages.

Revising and Improving the African American Acculturation Scale

The African American Acculturation Scale (AAAS) was revised and improved with a sample of 520 African American adults. Items that some participants in prior studies found objectionable were dropped, and a new version of the scale was created by factor analyzing the remaining items. The revised AAAS (AAAS-R) consists of 47 items that no participant has objected to; these comprise eight new, empirically derived subscales (i.e., factors) that have high reliability and validity and correlate r = .97 with the original 74-item version of the scale. It is strongly recommended that researchers interested in studying acculturation among African Americans use this new version of the scale.

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.

Epidemiology of drinking, alcohol use disorders, and related problems in US ethnic minority groups

This chapter reviews selected epidemiologic studies on drinking and associated problems among US ethnic minorities. Ethnic minorities and the White majority group exhibit important differences in alcohol use and related problems, including alcohol use disorders. Studies show a higher rate of binge drinking, drinking above guidelines, alcohol abuse, and dependence for major ethnic and racial groups, notably, Blacks, Hispanics, and American Indians/Alaskan Natives. Other problems with a higher prevalence in certain minority groups are, for example, cancer (Blacks), cirrhosis (Hispanics), fetal alcohol syndrome (Blacks and American Indians/Alaskan Natives), drinking and driving (Hispanics, American Indians/Alaskan Natives). There are also considerable differences in rates of drinking and problems within certain ethnic groups such as Hispanics, Asian Americans, and American Indians/Alaskan Natives. For instance, among Hispanics, Puerto Ricans and Mexican Americans drink more and have higher rates of disorders such as alcohol abuse and dependence than Cuban Americans. Disparities also affect the trajectory of heavy drinking and the course of alcohol dependence among minorities. Theoretic accounts of these disparities generally attribute them to the historic experience of discrimination and to minority socioeconomic disadvantages at individual and environmental levels.

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

Researchers have found that, compared to European Americans, African Americans report later initiation of drinking, lower rates of use, and lower levels of use across almost all age groups. Nevertheless, African Americans also have higher levels of alcohol problems than European Americans. After reviewing current data regarding these trends, we provide a theory to understand this apparent paradox as well as to understand variability in risk among African Americans. Certain factors appear to operate as both protective factors against heavy use and risk factors for negative consequences from use. For example, African American culture is characterized by norms against heavy alcohol use or intoxication, which protects against heavy use but also provides within-group social disapproval when use does occur. African Americans are more likely to encounter legal problems from drinking than European Americans, even at the same levels of consumption, perhaps thus resulting in reduced consumption but more problems from consumption. There appears to be one particular group of African Americans, low-income African American men, who are at the highest risk for alcoholism and related problems. We theorize that this effect is due to the complex interaction of residential discrimination, racism, age of drinking, and lack of available standard life reinforcers (e.g., stable employment and financial stability). Further empirical research will be needed to test our theories and otherwise move this important field forward. A focus on within-group variation in drinking patterns and problems is necessary. We suggest several new avenues of inquiry.

Developmental trajectories of alcohol use among monoracial and biracial Black adolescents and adults

OBJECTIVE

The present study investigates developmental trajectories of alcohol use from early adolescence to adulthood by age and race/ethnicity among White, Black, Black-American Indian, Black-Hispanic, and Black-White individuals and associated sociodemograhphic correlates.

METHOD

We used a subsample of nationally representative data obtained from the National Longitudinal Study of Adolescent Health (Add Health). The analytic sample consisted of 15,278 individuals in Wave 1 (ages 11 to 21 years). The sample consists of adolescents who were in Grades 7-12 at wave one and who were followed across four waves of data collection into adulthood. Respondents could report more than one race/ethnicity.

RESULTS

We find distinct alcohol trajectories among monoracial and biracial/ethnic Blacks with all groups showing a cross-over or catch-up effect. Black-White adults demonstrated a cross-over effect by surpassing the alcohol drinking rates of Whites in adulthood, Black-American Indians showed a within-group catch-up effect by surpassing the alcohol drinking rates of monoracial and biracial/ethnic Blacks in adulthood, and monoracial Blacks were most likely to be non-drinkers in adulthood. We also show gender, socioeconomic status, and household structure differences in impact on alcohol use among monoracial and biracial/ethnic Blacks.

CONCLUSIONS

Significant heterogeneity is observed regarding alcohol trajectories between monoracial and biracial/ethnic Blacks.

Longitudinal relationships between college education and patterns of heavy drinking: a comparison between Caucasians and African-Americans

PURPOSE

The current study compared longitudinal relationships between college education and patterns of heavy drinking from early adolescence to adulthood for Caucasians and African-Americans.

METHODS

We analyzed data from 9,988 non-Hispanic Caucasian and African-American participants from all four waves of the National Longitudinal Study of Adolescent Health. Growth curve modeling tested differences in rates of change and levels of heavy drinking from ages 13 to 31 years among non-college youth, college withdrawers, 2-year college graduates, and 4-year college graduates, and compared these differences for Caucasians and African-Americans.

RESULTS

There were significant racial differences in relationships between college education with both changes in and levels of heavy drinking. Rates of change of heavy drinking differed significantly across the college education groups examined for Caucasians but not for African-Americans. In addition, Caucasians who graduated from 4-year colleges showed the highest levels of heavy drinking after age 20 years, although differences among the four groups diminished by the early 30s. In contrast, for African-Americans, graduates from 2- or 4-year colleges did not show higher levels of heavy drinking from ages 20 to 31 years than the non-college group. Instead, African-American participants who withdrew from college without an associate's, bachelor's, or professional degree consistently exhibited the highest levels of heavy drinking from ages 26 to 31 years.

CONCLUSIONS

The relationship between college education and increased levels of heavy drinking in young adulthood is significant for Caucasians but not African-Americans. Conversely, African-Americans are likely to be more adversely affected than are Caucasians by college withdrawal.

Acculturation stress, anxiety disorders, and alcohol dependence in a select population of young adult Mexican Americans

OBJECTIVES

Mexican Americans comprise one of the most rapidly growing populations in the U.S. and within this population the process of acculturation has been suggested to be associated with some mental health problems. This study sought to ascertain quantitative information indexing acculturation stress and its association with mental health disorders in a select community sample of Mexican Americans.

METHODS

Demographic information, DSM-III-R diagnoses, and information on cultural identity and acculturation stress were obtained from 240 Mexican American young adults that were recruited by fliers and were residing in selected areas of San Diego.

RESULTS

No associations were found between measures of cultural identification and lifetime diagnoses of drug or alcohol dependence, major depressive disorder, anxiety disorders or antisocial personality disorder/conduct disorder in this sample of Mexican American young adults. However, lifetime diagnoses of alcohol dependence, substance dependence, and anxiety disorders were associated with elevations in acculturation stress.

CONCLUSION

Quantitative measures of acculturation stress, but not cultural identity per se, were found to be significantly associated with substance dependence and anxiety disorders in this select population of Mexican American young adults. These data may be helpful in designing prevention and intervention programs for this high risk population.

Acculturation Style and Alcohol Use Among African American College Students

This study examined whether a relationship exists between acculturation and alcohol use among African American college students and if the relationship varies by religiosity and gender. Most researchers use unidimensional African American acculturation measures that cannot capture the construct’s complexity; this study is the first to use a bidimensional measure. Results revealed a relationship between acculturation and alcohol use. Less frequent drinking occurred among marginalists (those who reject both African and Eurocentric U.S. culture), while assimilationists (those who reject African culture in favor of Eurocentric U.S. culture) drank more frequently. Religiosity and gender also significantly influenced the nature of the relationship.

Racial/ethnic differences in adolescent substance use: mediation by individual, family, and school factors

OBJECTIVE

This study examined racial/ethnic differences in alcohol, cigarette, and marijuana use among a diverse sample of approximately 5,500 seventh and eighth graders. We also evaluated the extent to which individual, family, and school factors mediated racial/ ethnic disparities in use.

METHOD

Students (49% male) from 16 participating middle schools in southern California reported on lifetime and past-month substance use, individual factors (expectancies and resistance self-efficacy), family factors (familism, parental respect, and adult and older sibling use), and school factors (school-grade use and perceived peer use). We used generalized estimating equations to examine the odds of consumption for each racial/ethnic group adjusting for sex, grade, and family structure. Path analysis models tested mediation of racial/ethnic differences through individual, family, and school factors.

RESULTS

After adjusting for sex, grade, and family structure, Hispanics reported higher and Asians reported lower lifetime and past-month substance use, compared with non-Hispanic Caucasians. Rates of substance use did not differ between non-Hispanic African Americans and Caucasians. Several individual factors mediated the relationship between Hispanic ethnicity and substance use, including negative expectancies and resistance self-efficacy. Higher use among Hispanics was generally not explained by family or school factors. By contrast, several factors mediated the relationship between Asian race and lower alcohol use, including individual, family (parental respect, adult and older sibling use), and school (perceived peer use, school-grade use) factors.

CONCLUSIONS

Results highlight the importance of targeting specific individual, family, and school factors in tailored intervention efforts to reduce substance use among young minority adolescents.

From Racial Discrimination to Substance Use: The Buffering Effects of Racial Socialization

The experience of race-based discrimination may place African American youth at risk for substance use initiation and substance use disorders. This article examines the potential of parental racial socialization-a process by which parents convey messages to their children about race-to protect against the impact of racial discrimination on substance use outcomes. Focusing on stress as a major precipitating factor in substance use, the article postulates several possible mechanisms by which racial socialization might reduce stress and the subsequent risk for substance use. It discusses future research directions with the goal of realizing the promise of racial socialization as a resilience factor in African American and ethnic minority youth mental health.

Pathways to Adult Alcohol Abuse across Racial/Ethnic Groups: An Application of General Strain and Social Learning Theories

There is considerable variation in the prevalence, etiology and consequences of alcohol and other drug use across racial/ethnic groups, but studies examining these issues among adult populations remain scarce. This is an important oversight as exposure to many of the risk factors associated with substance use and abuse has been shown to vary by race/ethnicity as well as age. This study examines the causes and correlates of adult alcohol abuse across the three largest racial/ethnic groups in the United States—Whites, Blacks and Hispanics—and provides a theoretically grounded examination of substance abuse by applying two general theories of deviance, Agnew's general strain theory and Akers' social learning theory. Results indicate unconditional support for both theories when applied to White alcohol abuse but more conditional support when applied to patterns of adult alcohol abuse among Hispanics and Blacks. These results suggest that these three racial/ethnic groups experience somewhat different pathways to alcohol disorder.

The race/ethnic age crossover effect in drug use and heavy drinking

Existing literature suggests that Blacks and to some extent Hispanics are less likely than Whites to use substances in their youth. However, by age 35 their use rates are higher than those of Whites. This has been referred to as the race/ethnic age crossover effect in substance use. However, more research is needed to clarify whether this is true for Blacks and Hispanics, males and females, and for drugs and alcohol. It is also empirically unclear why this crossover effect occurs. The present study explores these issues. The National Household Survey of Drug Abuse is merged for four years (1999-2002) to study the race/ethnic age crossover effect (n = 208,878). The results suggest that the race/ethnic age crossover effect cannot be used to describe Hispanic relative to White substance use. However, it is applicable to Black substance use, in particular illegal drug use for Black males and heavy drinking for Black females. Additional analyses reveal that the crossover effect for Blacks is eliminated when socio-demographic controls are included. With controls, drug use and heavy drinking for Blacks are lower than that of Whites for all age groups and for both males and females. Process differences are also revealed in the effects of the socio-demographic correlates. More specifically, these analyses of composition and process suggest that drug availability/exposure is a particularly important factor which likely contributes to the crossover effect in substance use and deserves further study.

Ethnicity and adolescent pathways to alcohol use

OBJECTIVE

This study examined the influence of ethnicity on factors affecting alcohol-use behaviors in a community sample of white, black, and Hispanic youth (N = 323). Conduct problems, positive alcohol expectancies, and socioeconomic status were expected to mediate the effect of negative affectivity and a paternal history of substance dependence on the age at onset of regular drinking and the frequency of drinking.

METHOD

Subjects ages 14-21 (57.9% female; 60.7% white) were interviewed along with their fathers at baseline (Time 1), and subjects only were interviewed again 5 years later (Time 2). A structural equation model was used to test a deviance proneness model for predicting drinking behaviors and to evaluate differences on model paths by ethnicity.

RESULTS

Ethnic group membership moderated mediational pathways linked to the onset of regular alcohol use but not to drinking frequency. An increase in the number of childhood conduct problems predicted an earlier age at onset of regular drinking for blacks, whereas more positive alcohol expectancies were associated with an earlier initiation of regular drinking for whites and Hispanics.

CONCLUSIONS

Findings from this study provide evidence that risk factors for alcohol use in adolescents and young adults vary according to ethnic group.

The effects of media exposure on alcohol consumption patterns in African American males

OBJECTIVES

The study examined the role of media exposure, ethnicity, mood/affect, socio-demographic factors and religion on alcohol consumption patterns.

METHODS

Secondary analysis of the General Social Survey (GSS), 1972-2002 cumulative data file was used to provide quantitative estimates of the relationship between media exposure, ethnicity, mood/affect, socio-demographic factors and religion. The sample consisted of (n = 13,742) White subjects and (n = 2,192) African American subjects.

RESULTS

Watching television and reading the newspaper were significant predictors of alcohol use. Watching television had a positive significant effect on alcohol use and abuse; but only in the absence of religiosity. Race did not have a significant effect on alcohol use or abuse. The survey year had significant effects on media use.

CONCLUSION

This research has significant policy implications in explaining predictors of alcohol use and abuse as well as protective factors for this behavior.

Substance Use in Ethnic Minority Youth

As evidenced in the literature, there has been a recent interest in understanding drug and alcohol use in ethnic minority populations, particularly among adolescents. Although epidemiological and treatment outcome research involving substance use and abuse has improved among ethnic minority groups, this information has yet to be sufficiently integrated. This paper provides a comprehensive review of the extent of drug and alcohol use and related problems among ethnic minority youth, including patterns of use and treatment implications and recommendations.

Education and race-ethnicity differences in the lifetime risk of alcohol dependence

OBJECTIVES

While lower socioeconomic status (SES) is related to higher risk for alcohol dependence, minority race-ethnicity is often associated with lower risk. This study attempts to clarify the nature and extent of social inequalities in alcohol dependence by investigating the effects of SES and race-ethnicity on the development of alcohol dependence following first alcohol use.

DESIGN

Cross-sectional analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). Survival analysis was used to model alcohol dependence onset according to education, race-ethnicity and their interaction.

SETTING

United States, 2001-2.

RESULTS

Compared with non-Hispanic white people, age-adjusted and sex-adjusted risks of alcohol dependence were lower among black people (odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.63 to 0.78), Asians (OR = 0.65, CI = 0.49 to 0.86) and Hispanics (OR = 0.68, CI = 0.58 to 0.79) and higher among American Indians (OR = 1.37, CI = 1.09 to 1.73). Individuals without a college degree had higher risks of alcohol dependence than individuals with a college degree or more; however, the magnitude of risk varied significantly by race-ethnicity (chi(2) for the interaction between education and race-ethnicity = 19.7, df = 10, p = 0.03); odds ratios for less than a college degree were 1.12, 1.46, 2.24, 2.35 and 10.99 among Hispanics, white people, black people, Asians, and American Indians, respectively. There was no association between education and alcohol dependence among Hispanics.

CONCLUSIONS

Race-ethnicity differences in the magnitude of the association between education and alcohol dependence suggest that aspects of racial-ethnic group membership mitigate or exacerbate the effects of social adversity.

Alcoholic subtypes: are two sufficient?

AIMS

Guided by the literature on alcohol subtypes, cluster analytical solutions ranging from two to five were evaluated for a large (n = 802), ethnically diverse sample of alcoholic in-patients.

DESIGN

Personal interview data were collected from in-patients regarding their substance abuse and psychiatric disorder status, risk factors for psychopathology and health outcomes.

SETTING

The data were collected at five alcohol in-patient treatment settings in New York; three settings were in New York City, one in Rochester and one in Buffalo.

PARTICIPANTS

The sample included 802 participants (481 males and 321 females) with racial/ethnic group diversity (418 blacks, 180 whites, 187 Hispanics, 17 of other ethnic origin).

MEASUREMENTS

Subjects were assessed with standardized measures of substance abuse and psychiatric disorders, family history of alcoholism, psychopathy, temperament, alcohol expectancies and clinical health variables.

FINDINGS

Based on internal and external criteria and compatibility with the existing literature, four subtypes were identified: mild course, polydrug, negative affect and chronic/antisocial. On external criteria, the polydrug subtype had the highest rate of family criminality, high-risk sexual behavior and intravenous drug use; the negative affect subtype had the highest rate of childhood sexual abuse, attempted suicide and childhood homelessness; the chronic/antisocial personality (ASP) subtype had the most severe pattern of drinking and antisocial behavior.

CONCLUSIONS

Findings are discussed with regard to the etiological and clinical utility of the four-subtype formulation, and consistency with recent studies in molecular genetics and pharmacology.

Culture Change and Ethnic-Minority Health Behavior: An Operant Theory of Acculturation

Data on acculturation and ethnic-minority health indicate that acculturation has opposite effects on the same health behavior among different ethnic groups; opposite effects on different health behaviors within an ethnic group; opposite effects on the same health behavior for the women vs. the men of most ethnic groups; and no effect whatsoever on some health behaviors for some ethnic groups. This evidence is so incoherent that it is unintelligible, and hence it continues to be largely useless to health psychology and behavioral medicine. This paper presents a new theory of acculturation that renders these confusing data coherent by predicting such changes in minority health behavior a priori. By so doing, the operant model of acculturation has the potential to improve health promotion and disease prevention and thereby reduce ethnic health disparities.

Alcohol dependence and the price of alcoholic beverages

This study estimates the impact of the price of alcoholic beverages on latent dimensions of current alcohol dependence and abuse. A three-part econometric model is used to estimate the impact of price on three latent dimensions (factors). For heavier drinking, the estimated price elasticity is -1.325 (P = 0.027); for physical and other consequences of drinking, -1.895 (P = 0.003); for increased salience of drinking, -0.411 (P = 0.339). For a single latent factor characterized simply as dependence/abuse, estimated price elasticity is -1.487 (P = 0.012). These results suggest that higher prices for alcohol reduce important dimensions of current alcohol dependence and abuse.

Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up

PURPOSE

The purpose of this study was to examine the relationship between age at drinking onset and the development of DSM-IV alcohol abuse and dependence in a 12-year prospective study of youth in the United States.

METHODS

Logistic regression analyses were used to quantify the relationship between age at drinking onset and the development of alcohol abuse and dependence controlling for sociodemographic factors and problem indicators.

RESULTS

The odds of alcohol dependence decreased by 5% in 1989 and 9.0% in 1994 for each year drinking onset was delayed. In 1994, the odds of alcohol abuse increased by 7.0% with each decreasing year of age at drinking onset, while age at drinking onset was not related to alcohol abuse in 1989. Several other risk factors were found to be strong and consistent predictors of abuse and dependence in 1989 and 1994, including being male, divorced, separated or never married, younger, and having an early history antisocial behaviors and marijuana use.

IMPLICATIONS

Implications of the results of this study are discussed in terms of other factors that may impact on the onset-abuse and onset-dependence relationship and the need to focus future prevention efforts.

The impact of drinking and drinking consequences on short-term employment outcomes in at-risk drinkers in six southern states

Alcohol use and misuse impose economic burdens, with over half the total costs estimated associated with lost productivity. Research on labor productivity and alcohol abuse has been limited by methodologic differences, making conclusions equivocal. This study employed two waves of data from a community probability sample of 658 at-risk drinkers. It analyzed the prospective impact of several measures of drinking and drinking consequences on the 6-month follow-up probability of not being employed and fewer weeks of employment if employed. Drinking seven drinks or more on an average drinking day significantly increased the likelihood of not working and, for those who were working, reduced weeks of employment. Thus, productivity benefits may accrue from developing treatments for at-risk drinkers, particularly interventions to reduce drinking.

Alcohol use in late life: disability and comorbidity

Alcohol use by older adults is common, yet the risks and/or benefits of drinking, especially moderate drinking, are not well understood. Heavy drinking is a well-established factor in causing disability and excessive mortality among all age groups, including the elderly. However, literature is emerging that suggests that among elders with chronic medical and emotional health disorders, even modest alcohol consumption can lead to excessive disability and poorer perceived health. This article reviews the current literature on alcohol use and the relationship to common health problems in late life and suggests a model for examining the interaction of alcohol use and disability. Implications for intervention development are also discussed.

Risk factor distribution among sociodemographically diverse African American adults

Because African Americans tend to have lower socioeconomic status (SES) than whites and numerous health indicators are related to SES variables, it is important when examining between-group differences in health indices to account for SES differences. This study examined the effects of income and education on several biologic and behavioral risk factors in a sample of sociodemographically diverse African American adults. Approximately 1,000 African American adults (aged 18-87) were recruited from 14 churches with predominantly black membership to participate in a nutrition education intervention. Demographics, height, weight, blood pressure, self-reported cigarette and alcohol use, self-reported diet by food frequency questionnaire, serum carotenoids, serum total cholesterol, and nutrition knowledge were assessed. The association of these risk factors were examined by four levels of education and income. For men, body mass index, blood pressure, total cholesterol, daily intake of fruits and vegetables, serum carotenoids, heavy alcohol use, or exercise were not associated significantly with income or education using analysis of variance (ANOVA). Past month alcohol use and nutrition knowledge were associated positively with education, but not income. For women, body mass index and smoking were associated inversely with income, but not with education. Blood pressure, total cholesterol, intake of fruits and vegetables, heavy alcohol use, and exercise were not associated with either income or education using ANOVA. Serum carotenoids, any 30-day alcohol use, and nutrition knowledge were associated positively with both income and education. Results using linear regression generally were similar for men and women, although a few more variables were associated significantly with SES compared to ANOVA analyses. Several health indicators that have been associated with socioeconomic variables in whites were not associated or only weakly associated in this diverse sample of African Americans. One interpretation of these findings is that SES factors may function differently among blacks and whites.

Alcohol administration methodology 1994-1995: what researchers do and do not report about subjects and dosing procedures

This article reviews which parts of the alcohol administration methodology were reported in 90 alcohol studies on humans published from 1994 to 1995. although several subject characteristics such as gender were regularly reported, other variables that can influence pharmacokinetics and responses to alcohol were not consistently reported. It is suggested that guidelines for reporting human alcohol administration studies be created and that journal editors and funding agencies require submissions to meet minimum standards for describing the study methodology. Potential guidelines are presented.

Nosology and epidemiology of addictive disorders and their comorbidity

Diagnostic classification systems have developed to the point at which the DSM-IV and ICD-10 are nearly identical, so that researchers and clinicians in different parts of the world have a common language for substance-dependence diagnoses. Despite the differences in nosology, the demographic correlates of alcohol and drug dependence are strikingly similar. Lifetime and 12-month prevalences are generally higher in men than in women, whites compared with nonwhites, younger compared with older cohorts, those with lower income levels and lower educational attainment, and those who have not been stably married (including those who have cohabited). NCS data indicated differences in risk factors for stages of drug use, arguing for separation of these in future analyses. Alcoholics are more likely to have another psychiatric disorder compared with their nonalcoholic counterparts, and ASPD, mania, and other drug dependence rank among those disorders most strongly associated with alcohol and drug dependence. Analyses from the NCS examining temporal ordering of diagnoses have focused attention on anxiety disorders in the cause of alcohol dependence. Depression, although not so strongly associated with substance dependence as clinical studies had led researchers to believe, nonetheless seems to be of etiologic interest as well, according to the NCS analyses. The cross-sectional results of the NLAES data on comorbidity between depression and alcohol and drug dependence have uncovered important new associations between gender, age, and depression and may yield further etiologic insights when age-of-onset data are taken into account.

Drinking, binge drinking, and other drug use among southwestern undergraduates: three-year trends

This study examined substance use patterns and consequences in college students over a three year period. Students were surveyed at a large, southwestern university, allowing for a diverse sample that included a large percentage of minority respondents. Students (total N = 2710) in 1994, 1995, and 1996 responded anonymously to the Core Survey of Alcohol and Drugs. Over 80% of students at each time point were current drinkers, and over one-third at each time period reported binge drinking. Binge drinking was associated with greater weekly drinking and with a range of negative consequences. Underage drinking was prevalent at all time points, and underage drinkers reported drinking in a range of on- and off-campus situations. Hispanic students reported higher rates of binge drinking than other ethnic groups. Nonwhite, non-Hispanic students reported greater rates of abstinence than other students. Although other drug use was much less prevalent, drug use in combination with drinking was associated with more problematic patterns of drinking and more negative consequences. Results are discussed in terms of implications for interventions with college students.

Rural and urban problem drinkers in six Southern states

In 1994-1997 we conducted a four-wave longitudinal study of rural and urban problem drinkers in six Southern United States states to examine rural/urban differences in predictors of service use and course of drinking. This report describes early rural/urban differences from a brief interview with over 3,000 community individuals and among 525 identified problem drinkers. Overall, we found rural/urban differences in alcohol consumption at the community level but only demographic differences among problem drinkers. Our newly developed screening interview for alcohol disorders had excellent agreement (kappa = 0.72) for lifetime disorders and good agreement (kappa = 0.53) for recent disorders against structured diagnostic interviews for DSM-IV criteria.

Changes in drinking problems among whites, blacks, and Hispanics: 1984-1992

This paper reports changes in drinking problems among Whites, Blacks, and Hispanics between 1984 and 1992. A probability sample including 1,777 Whites. 1,947 Blacks, and 1,453 Hispanics in the United States adult household population was interviewed in 1984. In 1992 a subsample consisting of 788 Whites, 723 Blacks, and 703 Hispanics was reinterviewed. Results show a decrease in problem prevalence among Whites, stability among Blacks, and an increase among Hispanics. Problem incidence was higher among Hispanics than among Whites and Blacks, put problem remission was higher among Whites. Women had a lower problem incidence but a higher problem remission than men, independent of ethnicity. The two best predictors of problem status in 1992 were reporting a problem in 1984 and reporting a high level of consumption in 1984.

Relationships between depressive symptoms, anxiety, alcohol consumption, and blood pressure: results from the CARDIA Study. Coronary Artery Risk Development in Young Adults Study

OBJECTIVES

We examined cross-sectional relationships among depressive symptoms, anxiety, alcohol intake, and blood pressure. Test hypotheses were that: (1) alcohol intake, depressive symptoms, and anxiety would be positively related to blood pressure; (2) depressive symptoms and anxiety would have a stronger association with alcohol intake in Blacks than in Whites; and (3) adjustment for differences in depressive symptoms, anxiety, and alcohol intake would reduce Black-White blood pressure differences.

METHODS

Study hypotheses were tested in a sample of 4,352 Black and White adults, participating in the CARDIA study. Hypotheses were tested using multiple linear regression.

RESULTS

Alcohol intake was positively related to systolic (p = 0.0001) and diastolic (p = 0.0004) blood pressure in men, but not in women. Depressive symptoms and anxiety were unrelated to blood pressure. The relationship between alcohol intake and depressive symptoms differed by race/ethnicity in men (p = 0.0719) and in women (p = 0.0002). Alcohol intake increased with increasing levels of depressive symptoms, but the increase was greater in Blacks than in Whites. After accounting for alcohol intake, body mass index, and other variables, Black-White blood pressure differences were reduced in men, but not in women; most of the reduction was caused by body mass index.

CONCLUSIONS

Blacks may respond differently than Whites to psychological distress.

Racial effects on the clinical presentation of alcoholics at a psychiatric hospital

Despite the clinical importance of race effects on comorbidity and symptom patterns in recent community studies, little is known about such effects in various treatment facilities. This study evaluated the effect of race on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. The factor that most strongly distinguished the racial groups was socioeconomic status (SES). After controlling for SES and other factors, no significant difference was noted between ethnic groups in the prevalence of major depressive disorder (MDD) or antisocial personality disorder. However, after controlling for SES and other factors, alcohol and drug use were more severe in African-American alcoholics, along with four symptoms associated with alcohol and drug use. In contrast, reversed neurovegetative symptoms, anxiety-related symptoms, and some personality-related symptoms were more severe in white alcoholics.

Race, gender, and the response to stress: autoworkers' vulnerability to long-term unemployment

A three-wave panel study of auto plant closings focused on the mental health effects of unemployment on blue-collar workers. This paper explores how the impact of long-term unemployment varies across race and gender. We also examine whether other demographic factors can themselves modify the impacts of race and gender. Dependent variables include two measures of distress and two drinking measures. Results showed that the effect of long-term unemployment on distress and drinking was more severe among less educated workers, and responses of blacks were especially sensitive to level of education. In addition, men showed a greater association of long-term unemployment with depression (and to some extent anxiety) than did women. Marriage affected the responses of men but not of women, and of whites but not of blacks. Explanatory variables--the worker's experiences of financial hardship, other negative life events, and lack of a confidant--largely accounted for male-female differences. We conclude by discussing theoretical implications of these effects and address the limitations of the traditional term "vulnerability" in describing them.

Relationships between socioeconomic status and drinking problems among black and white men

We sought to examine the relationships between socioeconomic status and drinking problems within the Black and White male populations. A two-way interactions of social class with race/ethnicity, and with drinking consequences and alcohol dependence symptoms was hypothesized among drinkers. Drinking problems were regressed on social class, race/ethnicity, age, alcohol consumption, and drinking settings. Social class was based on a composite of respondent's income, education, and main wage earner's occupation. Two types of drinking problems were analyzed: drinking consequences and alcohol dependence symptoms. Our hypothesis was partially confirmed. Interactions of social class with race/ethnicity and with drinking problems were observed. Less affluent Black men reported greater numbers of drinking consequences and total drinking problems than less affluent White men; the reverse was true for affluent Black and White men. Results suggest that the relationships between socioeconomic status and drinking problems may vary by race/ethnicity.

Work Team Attitudes, Drinking Norms, and Workplace Drinking

This article investigates the relationship between work team attitudes, drinking norms, and workplace drinking in a large assembly line factory in the Midwest. Respondents were asked whether significant persons at work (friends, team members, and supervisors) would approve or disapprove if they engaged in three types of work-related drinking (before work, at work, and at work to intoxication). Respondents were also asked whether they agreed or disagreed with several positive and negative statements about work teams–a new form of assembly line production introduced in the 1980s. Several items probing relations between union employees and supervisors were also included. Separate regression analyses were used to predict workplace drinking norms and workplace drinking. Using exploratory factor analysis and hierarchical regression, positive attitudes toward work teams significantly predicted less permissive drinking norms even when overall drinking and various background variables were controlled. In a second regression analysis, drinking norms significantly predicted workplace drinking. Additionally, it was revealed in the analysis that hourly African-Americans as a group were significantly more likely to have positive team attitudes and less permissive drinking norms than whites. The role of team-based work system in the primary prevention of workplace alcohol misuse is discussed.