Predicting drinking problems among black and white men: results from a national survey

Sleep-Related Predictors of Risk for Alcohol Use and Related Problems in Adolescents and Young Adults

PURPOSE

Growing evidence supports sleep and circadian rhythms as influencing alcohol use and the course of alcohol use disorder (AUD). Studying sleep/circadian-alcohol associations during adolescence and young adulthood may be valuable for identifying sleep/circadian-related approaches to preventing and/or treating AUD. This paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood with an emphasis on the effects of sleep/circadian factors on alcohol use.

SEARCH METHODS

The authors conducted a literature search in PsycInfo, PubMed, and Web of Science using the search terms "sleep" and "alcohol" paired with "adolescent" or "adolescence" or "young adult" or "emerging adult," focusing on the title/abstract fields, and restricting to English-language articles. Next, the search was narrowed to articles with a prospective/longitudinal or experimental design, a sleep-related measure as a predictor, an alcohol-related measure as an outcome, and confirming a primarily adolescent and/or young adult sample. This step was completed by a joint review of candidate article abstracts by two of the authors.

SEARCH RESULTS

The initial search resulted in 720 articles. After review of the abstracts, the list was narrowed to 27 articles reporting on observational longitudinal studies and three articles reporting on intervention trials. Noted for potential inclusion were 35 additional articles that reported on studies with alcohol-related predictors and sleep-related outcomes, and/or reported on candidate moderators or mediators of sleep-alcohol associations. Additional articles were identified via review of relevant article reference lists and prior exposure based on the authors' previous work in this area.

DISCUSSION AND CONCLUSIONS

Overall, the review supports a range of sleep/circadian characteristics during adolescence and young adulthood predicting the development of alcohol use and/or alcohol-related problems. Although sleep treatment studies in adolescents and young adults engaging in regular and/or heavy drinking show that sleep can be improved in those individuals, as well as potentially reducing alcohol craving and alcohol-related consequences, no studies in any age group have yet demonstrated that improving sleep reduces drinking behavior. Notable limitations include relatively few longitudinal studies and only two experimental studies, insufficient consideration of different assessment timescales (e.g., day-to-day vs. years), insufficient consideration of the multidimensional nature of sleep, a paucity of objective measures of sleep and circadian rhythms, and insufficient consideration of how demographic variables may influence sleep/circadian-alcohol associations. Examining such moderators, particularly those related to minoritized identities, as well as further investigation of putative mechanistic pathways linking sleep/circadian characteristics to alcohol outcomes, are important next steps.

Substance use disparities by age, race, sex, and sexual orientation among persons living with HIV in the Southern U.S

BACKGROUND

Alcohol and drug use is overrepresented among individuals living with Human Immunodeficiency Virus (HIV) and is associated with poor health outcomes. Determining the extent to which substance use differs between demographic profiles of people living with HIV (PLWH) would determine at-risk groups that would benefit from intervention.

METHODS

Cross-sectional screening data (N = 1307, M_age = 42.7 years, 66% male, 86% African American, 39% sexual minority) was examined from an HIV clinic in the southern U.S. largely treating underserved and low-income patients. Age, gender, race/ethnicity, sexual orientation, and their interactions were entered as predictors of substance use and related impairment in a series of zero-inflated negative binomial regressions.

RESULTS

African Americans reported more drug use (p = 0.004) and drug-related negative consequences (p = 0.003). Notably, alcohol-related negative consequences of African American heterosexuals were much higher at younger ages, compared to sexual minorities (regardless of race) and White heterosexuals of all age groups (p = 0.04).

CONCLUSIONS

Among PLWH in the U.S. South, African Americans may be uniquely at-risk with for problems related to drug-related functional impairment. Specifically, young heterosexual African Americans are at high risk for alcohol-related impairment. Implications are discussed.

Momentary associations between stress and alcohol craving in the naturalistic environment: differential associations for Black and White young adults

BACKGROUND AND AIMS

Black drinkers compared with White drinkers experience more alcohol-related problems. Examination of social determinants of inequities in alcohol problems is needed. The current study measured (1) associations between acute stress and alcohol craving in the naturalistic environment for self-identified Black and White individuals who drink alcohol and (2) whether a history of attention deficit hyperactivity disorder (ADHD) moderated these associations.

DESIGN AND SETTING

Observational study using ecological momentary assessment (EMA) to collect data from participants at six semi-random time-points throughout the day during a 10-day period. A series of three-level multi-level models examined between- and within-person associations for stress and alcohol and tested if these associations differed for Black and White adults.

PARTICIPANTS

Participants were 229 adult drinkers (aged 21-35 years) who completed a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD.

MEASUREMENTS

Momentary stress and alcohol craving, ADHD history and socio-demographic characteristics (i.e. racial identity, sex, age, current education level, household income) were assessed. Participants were required to self-identify as either 'African American or Black' or 'European American or White'.

FINDINGS

Significant racial identity × stress interactions indicated that associations between stress and craving were stronger for Black compared with White adults across the 10-day period (between-person: B = 0.14, P = 0.007), concurrently within a given EMA time-point (within-person: B = 0.04, P = 0.001) and prospectively from time-point to time-point (within-person: B = 0.05, P = 0.001). Results remained while accounting for income × stress interactions.

CONCLUSIONS

Acute stress appears to be more strongly related to alcohol craving in self-identified Black compared with self-identified White individuals. This provides support for policy changes to eliminate structural inequities that increase stress exposure and the development of just-in-time culturally responsive interventions focused on coping with acute stress for Black individuals.

Alcohol-Related Disparities Among Women: Evidence and Potential Explanations

Although research on alcohol-related disparities among women is a highly understudied area, evidence shows that racial/ethnic minority women, sexual minority women, and women of low socioeconomic status (based on education, income, or residence in disadvantaged neighborhoods) are more likely to experience alcohol-related problems. These problems include alcohol use disorder, particularly after young adulthood, and certain alcohol-related health, morbidity, and mortality outcomes. In some cases, disparities may reflect differences in alcohol consumption, but in other cases such disparities appear to occur despite similar and possibly lower levels of consumption among the affected groups. To understand alcohol-related disparities among women, several factors should be considered. These include age; the duration of heavy drinking over the life course; the widening disparity in cumulative socioeconomic disadvantage and health in middle adulthood; social status; sociocultural context; genetic factors that affect alcohol metabolism; and access to and quality of alcohol treatment services and health care. To inform the development of interventions that might mitigate disparities among women, research is needed to identify the factors and mechanisms that contribute most to a group's elevated risk for a given alcohol-related problem.

Racial discrimination, binge drinking, and negative drinking consequences among black college students: serial mediation by depressive symptoms and coping motives

Objectives: Experiences of racial discrimination have been associated with diverse negative health outcomes among racial minorities. However, extant findings of the association between racial discrimination and alcohol behaviors among Black college students are mixed. The current study examined mediating roles of depressive symptoms and coping drinking motives in the association of perceived racial discrimination with binge drinking and negative drinking consequences. Design: Data were obtained from a cross-sectional study of Black college students attending a predominantly White institution in the northeastern US (N = 251, 66% female, mean age = 20 years). Results: Results from path analysis showed that, when potential mediators were not considered, perceived racial discrimination was positively associated with negative drinking consequences but not frequency of binge drinking. Serial multiple mediation analysis showed that depressive symptoms and in turn coping drinking motives partially mediated the associations of perceived racial discrimination with both binge drinking frequency and negative drinking consequences (after controlling for sex, age, and negative life events). Conclusions: Perceived racial discrimination is directly associated with experiences of alcohol-related problems, but not binge drinking behaviors among Black college students. Affective responses to perceived racial discrimination experiences and drinking to cope may serve as risk mechanisms for alcohol-related problems in this population. Implications for prevention and intervention efforts are discussed.

In-the-Moment Drinking Characteristics: An Examination Across Attention-Deficit/Hyperactivity Disorder History and Race

BACKGROUND

Adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and Black drinkers are at elevated risk for alcohol problems and alcohol use disorder. Processes that increase risk for these distinct populations have not focused on in-the-moment behaviors that occur while drinking. The present study examined in-the-moment drinking characteristics (i.e., location, social context, day, time, drink type, speed of consumption) that may differ for individuals with and without ADHD histories or for Black and White drinkers. We also examined the interplay among these in-the-moment drinking characteristics to further understanding of contexts when risk may be momentarily increased.

METHODS

As part of a larger study, 135 individuals (M_age  = 27.81, 69.6% male, 45.9% ADHD, 69.6% White) completed a 10-day ecological momentary assessment protocol that included self-initiated reports following consumption of an alcoholic drink. Hypotheses were tested using multilevel modeling.

RESULTS

Controlling for multiple demographic covariates, Black drinkers drank significantly more quickly than White drinkers and were more likely to consume hard liquor-containing beverages. Differences in drinking speed remained significant when adjusting for Black drinkers' greater likelihood to consume liquor-containing beverages and momentary experience of discrimination; however, Black drinkers' increased likelihood to consume liquor-containing beverages was no longer significant when adjusting for momentary experience of discrimination. Individuals with ADHD histories did not differ from those without ADHD histories in any in-the-moment drinking characteristics. ADHD and race did not interact to predict any drinking characteristic.

CONCLUSIONS

Differences in speed of alcohol consumption and propensity to consume liquor-containing beverages may contribute to increased risk for alcohol problems experienced by Black drinkers compared to White drinkers.

The association between racial and socioeconomic discrimination and two stages of alcohol use in blacks

BACKGROUND

This study aimed to characterize the associations of racial and socioeconomic discrimination with timing of alcohol initiation and progression from initiation to problem drinking in Black youth.

METHODS

Data were drawn from a high-risk family study of alcohol use disorder. Mothers and their offspring (N = 806; M_age = 17.87, SD_age = 3.91; 50% female) were assessed via telephone interview. Cox proportional hazards regression analyses were used to examine associations between discrimination and timing of first drink and progression from first drink to problem drinking in two separate models. Predictor variables were considered in a step-wise fashion, starting with offspring racial and socioeconomic discrimination, then adding (2) maternal racial and/or socioeconomic discrimination experiences; (3) religious service attendance and social support as potential moderators; and (4) psychiatric and psychosocial risk factors and other substance use.

RESULTS

Offspring racial discrimination (HR: 2.01, CI: 1.17-3.46 ≤ age 13) and maternal experiences of discrimination (HR: 0.79, CI: 0.67-0.93) were associated with timing of initiation in the unadjusted model only; offspring socioeconomic discrimination predicted timing of initiation among female offspring, even after adjusting for all covariates (HR: 1.49, CI: 1.14-1.93). Socioeconomic discrimination predicted a quicker transition from first use to problem drinking exclusively in the unadjusted model (HR: 1.70, CI: 1.12-2.58 ≤ age 18). No moderating effects of religious service attendance or social support were observed for either alcohol outcome.

CONCLUSIONS

Findings suggest socioeconomic discrimination is a robust risk factor for initiating alcohol use in young Black female youth and should be considered in the development of targeted prevention programs.

Alcohol use and coping in a cross-sectional study of African American homicide survivors

The loss of a loved one to homicide is associated with considerable distress, often in the form of posttraumatic stress disorder (PTSD) and complicated grief (CG), and alcohol misuse. Yet alcohol-related problems and loss from a homicide are issues that disproportionally affect African Americans. The present study investigated alcohol use in a sample of 54 African American homicide survivors. Although there was a low prevalence of hazardous drinking, alcohol use was associated with higher levels of PTSD, complicated grief, and depression severity. In addition, scores on the Alcohol Use Disorders Identification Test (AUDIT) were correlated with active emotional coping and avoidant emotional coping. In analyses of PTSD symptom clusters, emotional numbing and hyperarousal symptoms were significantly correlated with AUDIT total score.

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking

BACKGROUND

African Americans are generally known to have lower heavy drinking prevalence than Whites despite often greater individual and community risk factors. While it is supposed that their protective resources explain this "paradox," studies have not explicitly examined this.

OBJECTIVE

Assess the contribution of protective resources to Black-White differences in heavy drinking, and (secondarily) whether protective resources operate by reducing heavy drinking and/or increasing abstinence.

METHODS

Using data from the 2009-2010 U.S. National Alcohol Survey (N = 3,133 Whites and 1,040 Blacks ages 18+), we applied propensity score (PS) weighting to estimate racial differences in heavy drinking and abstinence under hypothetical conditions in which Whites are similar to Blacks in: (1) age and marital status; (2) socioeconomic position and unfair treatment; (3) neighborhood socioeconomic conditions and alcohol outlet density; and (4) protective resources (proscriptive religiosity, area-level religiosity, "drier" network drinking norms and patterns, and family social support).

RESULTS

The Black-White gap in male and female drinkers' baseline heavy drinking increased after weighting adjustments for demographics. In women, this gap was reduced after weighting on disadvantage and eliminated after adjusting for protective resources. In men, adjustment for disadvantage increased the racial gap, and protective resources reduced it. Protective resources had a stronger effect on Black-White differences in men's abstinence than heavy drinking, but similar effects on these outcomes in women.

CONCLUSION

Protective resources help explain Black-White differences in men's and particularly women's heavy drinking. Future research is needed to elucidate mechanisms of action and additional factors underlying racial differences in men's heavy drinking.

The Effects of Mothers' Protective Parenting and Alcohol Use on Emerging Adults' Alcohol Use: Testing Indirect Effects Through Prototype Favorability Among African American Youth

BACKGROUND

We examined how mothers' protective parenting and alcohol use influenced changes in offspring's heavy drinking among a sample of African American youth. The conceptual model also tested indirect effects of mothers' behaviors, through changes in the youths' social images (i.e., prototypes) of heavy drinkers, derived from the prototype willingness (PW) model.

METHODS

Participants were 686 emerging adults (55% female) from the Family and Community Health Study (FACHS), an ongoing prospective study of African American families. Three waves of FACHS data were used as follows: T3 during 10th grade (M age = 16.3 years), T4 shortly after high school (M age = 19.4 years), and T5 3 years later (M age = 22.1 years). Mothers' self-reports of protective parenting and alcohol use were assessed at T4. Two separate path models tested the study hypotheses. The first model specified direct and indirect effects of mothers' protective parenting and alcohol use. The second model added interaction terms between the protective parenting behaviors and mothers' alcohol use. The analyses were first conducted using the full sample and then repeated separately for female and male participants.

RESULTS

Maternal alcohol use had a positive and direct effect on offspring's alcohol use. Mothers' endorsement of alcohol-related rules inhibited normative increases in the favorability of the offspring's social image of heavy drinkers (prototype) while her warmth was positively related to these increases. Maternal alcohol use amplified the positive association between mothers' warmth and the daughters' increased drinking. For sons, maternal alcohol use increased the positive association between alcohol-related rules and increased prototype favorability.

CONCLUSIONS

Results indicated clear gender differences in how mothers' behaviors influence her offspring's alcohol use during the transition to emerging adulthood. Interventions that target culturally specific risk and protective factors within the family environment are needed to reduce health disparities among this vulnerable population of youth.

Ten-Year Trend in Women's Reasons for Abstaining or Limiting Drinking: The 2000 and 2010 United States National Alcohol Surveys

BACKGROUND

Data on individual and cultural factors contributing to drinking can inform screening and brief intervention in clinical practice. Our aims were to examine 10-year trends in women's reasons for abstaining/limiting drinking and to document changes in associations with drinking status for population subgroups defined by race/ethnicity and age.

MATERIALS AND METHODS

Using repeated cross-sectional data from White, Black and Hispanic women in the 2000 and 2010 United States National Alcohol Surveys (combined N = 5501), population-weighted multiple linear and multinomial logistic regression models assessed changes in three reasons for abstaining or limiting drinking (health concerns, religious prohibition, and upsetting family or friends) and drinking status (past-year abstainer, low-risk drinker, or at-risk drinker), and their associations over time.

RESULTS

Adjusting for key demographics, reasons for limiting alcohol consumption declined in importance over time, with reductions in both health concerns and religious prohibition particularly noteworthy for older women of all three racial/ethnic backgrounds. Despite these reductions in importance, both health concerns and religious prohibition were most consistently associated with increased abstinence relative to low-risk drinking; these reasons were not strongly associated with at-risk drinking, however.

CONCLUSIONS

It is essential for healthcare providers and others to disseminate accurate information about the risks of drinking to counter cultural shifts that suggest greater acceptance of moderate-to-heavy drinking by women aged 40 and older.

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.

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.

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).

Intersections of poverty, race/ethnicity, and sex: alcohol consumption and adverse outcomes in the United States

We examine whether intersectionality theory-which formalizes the notion that adverse health outcomes owing to having a marginalized social status, identity, or characteristic, may be magnified for individuals with an additional marginalized social status, identity, or characteristic-can be applied using quantitative methods to describe the differential effects of poverty on alcohol consumption across sex and race/ethnicity. Using the National Epidemiologic Survey on Alcohol and Related Conditions, we analyze longitudinal data from Black, Hispanic, and White drinkers (n = 21,140) to assess multiplicative interactions between poverty, as defined by the US Census Bureau, sex, and race/ethnicity, on adverse alcohol outcomes. Findings indicated that the effect of poverty on the past-year incidence of heavy episodic drinking was stronger among Black men and Black women in comparison to men and women of other racial/ethnic groups. Poverty reduction programs that are culturally informed may help reduce racial/ethnic disparities in the adverse outcomes of alcohol consumption.

Alcohol Outcomes by Sexual Orientation and Race/Ethnicity: Few Findings of Higher Risk

OBJECTIVE

This study sought to confirm a previously identified race by sexual orientation interaction and to clarify men's alcohol-related risk by using an expanded classification of sexual orientation.

METHOD

We collapsed three waves of National Alcohol Survey data, restricting the analytic sample to White (n = 5,689), Black (n = 1,237), and Latino (n = 1,549) men with complete information on sexual orientation and alcohol use. Using self-reported sexual identity and behavior, respondents were categorized as exclusively heterosexual (referent), behaviorally discordant heterosexuals (i.e., heterosexual identity and same-sex partners), or gay/bisexually identified men. We used multivariable logistic regression to model lifetime alcohol dependence symptoms, lifetime drinking-related consequences, and past-year hazardous drinking, controlling for age, education, employment, and relationship status and accounting for the complex survey design.

RESULTS

There was no difference in risk of past-year hazardous drinking and lifetime drinking-related consequences between heterosexual, behaviorally discordant heterosexual, and gay/bisexual men, independent of race/ ethnicity. Among Black men, behaviorally discordant heterosexuals had three-fold higher odds of lifetime alcohol dependence symptoms than exclusively heterosexual peers (aOR = 3.30, 95% CI [1.19, 9.18], p = .02). Gay/bisexual Latino men had marginally significantly lower odds of lifetime alcohol dependence symptoms (aOR = 0.36, 95% CI [0.12, 1.03], p = .06).

CONCLUSIONS

There is little support for broad statements of greater alcohol risk among gay/bisexual men; however, for some subgroups and outcomes the direction and degree of risk depend on race/ ethnicity. Thus, this study underscores the importance of considering the potential interaction of sexual orientation and race/ethnicity, which may exacerbate or attenuate.

Religious involvement and marijuana use among a sample of African American young adults

Is religiosity associated with African American drug use? Despite the increased research attention that has been devoted to the topic, findings to date have been inconclusive. To address this issue, we analyze data from a sample of 434 young adults residing in Miami-Dade County Florida. We find that, of the four dimensions of religiosity considered here, only religious attendance is inversely related to marijuana use for men and women. The implications of these findings are discussed.

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.

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.

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.

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.

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.

Taking a life course approach to studying substance use treatment among a community cohort of African American substance users

BACKGROUND

Life course theory emphasizes the need to examine a wide variety of distal factors along with proximal factors, longitudinally. Yet research on who obtains substance use treatment is generally cross-sectional and limited to examining developmentally proximal factors (e.g., substance use severity) and demographic factors.

METHODS

To investigate treatment within a life-course framework, we studied 522 drug and/or alcohol users from a community cohort of African Americans followed prospectively from age 6. Developmentally distal factors of childhood and adolescent social behavior, family environment, academic achievement, mental health, and substance use along with the key proximal factors of substance use severity and socioeconomic status were examined using regression analyses to assess their impact on obtaining adult substance use treatment.

RESULTS

One-fifth of the study population obtained treatment for substance use by age 32 (20.5%). Although adult socioeconomic status was not associated with substance use treatment in adulthood in the multivariable model, the proximal factor of substance use severity was a strong predictor of obtaining substance use treatment, as expected. After including several developmentally distal factors in the model, childhood aggression also had an independent effect on adult substance use treatment, above and beyond substance use severity.

CONCLUSIONS

These findings emphasize the importance of using a life course framework when exploring predictors of treatment; early life characteristics are important influences beyond the more proximal factors in adulthood. Research should continue to take a life course approach to better understand pathways to substance use treatment.

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.

Associations between alcohol use and alcohol-related negative consequences among black and white college men and women

OBJECTIVE

The gender gap in alcohol use has been narrowing among young adults, while race differences in alcohol problems change throughout the life course, with Whites experiencing more problems before middle adulthood and Blacks experiencing more after. Yet, there is a paucity of research on the intricate relationship among gender, race, alcohol use, and alcohol problems in emerging adults. The present study addressed this gap in the literature.

METHOD

The sample included White (n = 14,772) and Black (n = 458) college students from multiple colleges across the United States (59% female; 51% freshmen; Mage = 20 years).

RESULTS

With alcohol use levels adjusted for, women were more likely to report consequences related to damage to self and dependence-like symptoms than men. There were no significant race differences in either the type or the number of alcohol problems. Further, there was no Race × Alcohol Use interaction in relation to alcohol problems. We found a statistically significant interaction between gender and alcohol use in predicting alcohol problems, suggesting that, at higher levels of drinking, the risk for women to experience alcohol problems was significantly greater than that for men.

CONCLUSIONS

The reverse race gap in alcohol use and problems may not surface until young adulthood or may not be relevant for those who attend college. College interventions should help both Black and White students reduce problems associated with drinking and focus on limiting harm among female students.

The relative risk of involvement in fatal crashes as a function of race/ethnicity and blood alcohol concentration

INTRODUCTION

The literature presents a puzzling picture of Latinos being overrepresented in alcohol-related crashes, but not in noncrash drinking and driving. This report examines if, like other demographic variables in which some groups are at a higher crash risk than others (e.g., young drivers), different racial/ethnic groups face different crash risks.

METHOD

This study compares blood-alcohol information from the 2006-2007 U.S. Fatality Analysis Reporting System (FARS) with control data from the 2007 U.S. National Roadside Survey. Logistic regression, including a dual interaction between BAC and race/ethnicity, was used to estimate crash risk at different BAC levels.

RESULTS

It was found that, although Hispanic and African-American drivers were less likely to be involved in single-vehicle crashes than their White counterparts, all drivers face similar BAC relative crash risk regardless of their group membership. The overrepresentation of Latino drivers in alcohol-related crashes could be explained by differences in patterns of consumption, driving exposure, lack of awareness of driving rules, and/or socioeconomics.

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.

Probability and predictors of transition from abuse to dependence on alcohol, cannabis, and cocaine: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND

Little is known about the transition from substance abuse to substance dependence.

OBJECTIVES

This study aims to estimate the cumulative probability of developing dependence and to identify predictors of transition to dependence among individuals with lifetime alcohol, cannabis, or cocaine abuse.

METHODS

Analyses were done for the subsample of individuals with lifetime alcohol abuse (n = 7802), cannabis abuse (n = 2832), or cocaine abuse (n = 815) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Estimated projections of the cumulative probability of transitioning from abuse to dependence were obtained by the standard actuarial method. Discrete-time survival analyses with time-varying covariates were implemented to identify predictors of transition to dependence.

RESULTS

Lifetime cumulative probability estimates indicated that 26.6% of individuals with alcohol abuse, 9.4% of individuals with cannabis abuse, and 15.6% of individuals with cocaine abuse transition from abuse to dependence at some point in their lives. Half of the transitions of alcohol, cannabis, and cocaine dependence occurred approximately 3.16, 1.83, and 1.42 years after abuse onset, respectively. Several sociodemographic, psychopathological, and substance use-related variables predicted transition from abuse to dependence for all of the substances assessed.

CONCLUSION

The majority of individuals with abuse do not transition to dependence. Lifetime cumulative probability of transition from abuse to dependence was highest for alcohol, followed by cocaine and lastly cannabis. Time from onset of abuse to dependence was shorter for cocaine, followed by cannabis and alcohol. Although some predictors of transition were common across substances, other predictors were specific for certain substances.

Temporal Trends and Changing Racial/ethnic Disparities in Alcohol Problems: Results from the 2000 to 2010 National Alcohol Surveys

BACKGROUND

Economic conditions and drinking norms have been in considerable flux over the past 10 years. Accordingly, research is needed to evaluate both overall trends in alcohol problems during this period and whether changes within racial/ethnic groups have affected racial/ethnic disparities.

METHODS

We used 3 cross-sectional waves of National Alcohol Survey data (2000, 2005, and 2010) to examine a) temporal trends in alcohol dependence and consequences overall and by race/ethnicity, and b) the effects of temporal changes on racial/ethnic disparities. Analyses involved bivariate tests and multivariate negative binomial regressions testing the effects of race/ethnicity, survey year, and their interaction on problem measures.

RESULTS

Both women and men overall showed significant increases in dependence symptoms in 2010 (vs. 2000); women also reported increases in alcohol-related consequences in 2010 (vs. 2000). (Problem rates were equivalent across 2005 and 2000.) However, increases in problems were most dramatic among Whites, and dependence symptoms actually decreased among Latinos of both genders in 2010. Consequently, the long-standing disparity in dependence between Latino and White men was substantially reduced in 2010. Post-hoc analyses suggested that changes in drinking norms at least partially drove increased problem rates among Whites.

CONCLUSIONS

Results constitute an important contribution to the literature on racial/ethnic disparities in alcohol problems. Findings are not inconsistent with the macroeconomic literature suggesting increases in alcohol problems during economic recession, but the pattern of effects across race/ethnicity and findings regarding norms together suggest, at the least, a revised understanding of how recessions affect drinking patterns and problems.

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.

Ethnicity and gender comparisons of health consequences in adults with alcohol dependence

The moderating effects of ethnicity and gender on factors associated with physical health consequences in adults manifesting alcohol dependence were examined using data from the 2001-2002 US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Black and white respondents with a lifetime diagnosis of DSM-IV alcohol dependence were selected for the study (n = 3,852). A multiple-group structural equation model tested ethnicity, gender, and intervening variables as predictors of physical health status in alcohol-dependent men and women. Study findings offer implications for clinical practice with alcohol-dependent individuals by identifying likely target groups and problems for intervention.

Alcohol use disorders and perceived drinking norms: ethnic differences in Israeli adults

OBJECTIVE

Individuals' perceptions of drinking acceptability in their society (perceived injunctive drinking norms) are widely assumed to explain ethnic group differences in drinking and alcohol use disorders (AUDs), but this has never been formally tested. Immigrants to Israel from the former Soviet Union (FSU) are more likely to drink and report AUD symptoms than other Israelis. We tested perceived drinking norms as a mediator of differences between FSU immigrants and other Israelis in drinking and AUDs.

METHOD

Adult household residents (N = 1,349) selected from the Israeli population register were assessed with a structured interview measuring drinking, AUD symptoms, and perceived drinking norms. Regression analyses were used to produce odds ratios (OR) and risk ratios (RR) and 95% confidence intervals (CI) to test differences between FSU immigrants and other Israelis on binary and graded outcomes. Mediation of FSU effects by perceived drinking norms was tested with bootstrapping procedures.

RESULTS

FSU immigrants were more likely than other Israelis to be current drinkers (OR = 2.39, CI [1.61, 3.55]), have higher maximum number of drinks per day (RR = 1.88, CI [1.64, 2.16]), have any AUD (OR = 1.75, CI [1.16, 2.64]), score higher on a continuous measure of AUD (RR = 1.44, CI [1.12, 1.84]), and perceive more permissive drinking norms (p < .0001). For all four drinking variables, the FSU group effect was at least partially mediated by perceived drinking norms.

CONCLUSIONS

This is the first demonstration that drinking norms mediate ethnic differences in AUDs. This work contributes to understanding ethnic group differences in drinking and AUDs, potentially informing etiologic research and public policy aimed at reducing alcohol-related harm.

Formal and informal substance use treatment utilization and alcohol abstinence over seven years: is the relationship different for blacks and whites?

BACKGROUND

This study examines whether the effects of formal substance use treatment utilization and Alcoholics Anonymous (AA) on 30-day abstinence vary for black versus white Americans.

METHODS

The current analysis utilizes data from a longitudinal sample of 1013 black and white, dependent and problem drinkers across a 7-year period. Participants were identified through a probability survey in the general population and consecutive intakes in chemical dependency treatment programs in a California County. Generalized Estimating Equations assessing interactions between race and treatment utilization incorporated variables from four post-baseline interviews, controlling for baseline variables.

RESULTS

Formal treatment utilization was associated with 30-day abstinence (OR:1.6, 95%CI: 1.3, 2.1), yet this relationship did not differ for blacks and whites. In contrast, there was a significant interaction between AA utilization, race and 30-day abstinence. While both whites and blacks who attended AA were more likely to report 30-day abstinence compared to their non-AA attending counterparts (white OR:4.0, 95%CI: 3.2-5.1 and black OR:2.2, 95%CI: 1.5-3.2), the relationship was stronger for whites. Among those who did not attend AA, blacks were more likely than whites to be abstinent. Post hoc analyses suggest that these latter findings may be related to greater religiosity and "drier" social networks among black Americans.

CONCLUSIONS

While utilization of formal treatment may yield similar benefits for blacks and whites, AA utilization may be more important for maintaining abstinence among whites than blacks. Future research should investigate racial differences in social network drinking patterns and religious reinforcement of sobriety, and the role these may play in AA outcomes.

A longitudinal study of substance use and violent victimization in adulthood among a cohort of urban African Americans

AIMS

This paper examines the effects of experiencing violent victimization in young adulthood on pathways of substance use from adolescence to mid-adulthood.

DESIGN

Data come from four assessments of an African American community cohort followed longitudinally from age 6 to 42 years.

SETTING

The cohort lived in the urban, disadvantaged Woodlawn neighborhood of Chicago in 1966.

PARTICIPANTS

All first graders from the public and parochial schools were asked to participate (n = 1242).

MEASUREMENT

Dependent variables-alcohol, marijuana and cocaine use-came from self-reports at age 42. Young adult violent victimization was reported at age 32, as were acts of violence, substance use, social integration and socio-economic resources. First grade risk factors came from mothers' and teachers' reports; adolescent substance use was self-reported.

FINDINGS

Structural equation models indicate a pathway from adolescent substance use to young adult violent victimization for females and those who did not grow up in extreme poverty (betas ranging from 0.15 to 0.20, P < 0.05). In turn, experiencing violent victimization in young adulthood increased alcohol, marijuana and cocaine use, yet results varied by gender and early poverty status (betas ranging from 0.12 to 0.15, P < 0.05).

CONCLUSIONS

Violent victimization appears to play an important role in perpetuating substance use among the African American population. However, within-group variations are evident, identifying those who are not raised in extreme poverty as the most negatively affected by violence.

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.

Ten-year trends (1992 to 2002) in sociodemographic predictors and indicators of alcohol abuse and dependence among whites, blacks, and Hispanics in the United States

BACKGROUND

The objective of this paper is to examine 10-year trends (1992 to 2002) in the number and type of indicators of DSM-IV abuse and dependence among whites, blacks, and Hispanics in the United States.

METHODS

Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population.

RESULTS

Increases in the prevalence of alcohol abuse between 1992 and 2002 seem associated with a rise in the prevalence of the indicator for "hazardous use." which usually means reports of driving after drinking. The decrease in dependence was not associated with changes in a particular indicator. In addition, both in 1992 and 2002, 12.3 to 15.4% of the men and 5.2 to 7.9% of the women were diagnostic "orphans." These respondents reported 1 or 2 indicators of alcohol dependence as present.

CONCLUSIONS

The observed trends in number and types of indicators of DSM-IV alcohol abuse and dependence were probably triggered by a complex interplay between individuals' volume and pattern of drinking and reactions from the drinkers' social environment. The close association between hazardous use of alcohol and the prevalence of abuse deserves further discussion. A medical diagnostic category should not be so dependent on a criterion that may be influenced by social situations. It is necessary to understand more about diagnostic "orphans" to better design interventions to address their problems.

Motivation for reducing substance use among minority adolescents: targets for intervention

Motivation to change substance use is considered to be one of the most important predictors of client readiness for alcohol and other drug treatment and ability to benefit from treatment. Enhancing motivation to change substance use is an important emphasis of many substance use intervention programs. The specific factors predicting motivation to change substance use remain largely unidentified and poorly understood, particularly among racial/ethnic minority youth. This study examines the influence of adolescent and parental factors on motivation to change substance use among 310 alcohol-using and/or drug-using racial/ethnic minority adolescent males. The analytic plan involved the use of structural equation modeling. Adolescents' motivation to change substance use was influenced directly and indirectly by parental factors, as well as by adolescent substance use severity and externalizing disorders. Findings have implications for treatment with racial/ethnic minority youth, as parental factors may be exceptionally useful targets for interventions aimed at enhancing motivation to reduce substance use among these at-risk youth.

Heavy drinking in early adulthood and outcomes at mid life

BACKGROUND

Heavy drinking in early adulthood among Blacks, but not Whites, has been found to be associated with more deleterious health outcomes, lower labor market success and lower educational attainment at mid-life. This study analysed psychosocial pathways underlying racial differences in the impact of early heavy alcohol use on occupational and educational attainment at mid-life.

METHODS

Outcomes in labor market participation, occupational prestige and educational attainment were measured in early and mid-adulthood. A mixture model was used to identify psychosocial classes that explain how race-specific differences in the relationship between drinking in early adulthood and occupational outcomes in mid-life operate. Data came from Coronary Artery Risk Development in Young Adults, a longitudinal epidemiologic study.

RESULTS

Especially for Blacks, heavy drinking in early adulthood was associated with a lower probability of being employed in mid-life. Among employed persons, there was a link between heavy drinking for both Whites and Blacks and decreased occupational attainment at mid-life. We grouped individuals into three distinct distress classes based on external stressors and indicators of internally generated stress. Blacks were more likely to belong to the higher distressed classes as were heavy drinkers in early adulthood. Stratifying the data by distress class, relationships between heavy drinking, race and heavy drinking-race interactions were overall weaker than in the pooled analysis.

CONCLUSIONS

Disproportionate intensification of life stresses in Blacks renders them more vulnerable to long-term effects of heavy drinking.

Alcohol use, abuse, and treatment in people of African descent

The use and abuse of alcohol is prevalent in many nations across the globe, but few studies have examined within-group differences found in people of African descent in the United States, in Africa, and in the Caribbean. A review of current research about alcohol use, abuse, and treatment in people of African descent is presented, including information about risk factors and contributors to alcohol use. Examples of education and prevention interventions are also described. Finally, conclusions based on the review of the research literature as well as recommendations for future research are explained.

Mental health service utilization and drinking outcomes in a national population sample: are there racial/ethnic differences?

Racial and ethnic disparities in alcohol use and alcohol-related problems have been well-documented. Less information is available about possible disparities in outcomes related to mental health services utilization. The differential effect of mental health services use by race on drinking outcomes was examined. Wave 2 of a national population sample of employed adults who reported having at least one alcoholic drink in the past year (N = 1,058) encompassed measures of the prevalence of mental health services use in response to stress, and alcohol-related outcomes. Non-white participants who reported using any mental health services, four or more mental health visits in the past year, and eight or more mental health visits in the past year reported lower rates of problematic drinking behaviors, including frequency of drinking to intoxication, heavy episodic drinking, and modified Brief MAST scores, than whites who reported similar use of mental health services.

Differences in the measured alcohol content of drinks between black, white and Hispanic men and women in a US national sample

AIMS

To measure and describe drink alcohol content differences between Hispanic, non-Hispanic white and non-Hispanic black men and women in the United States.

DESIGN

A telephone survey re-interview of 397 respondents who participated originally in the 2005 National Alcohol Survey, of whom 306 provided complete information on home drinks.

SETTING

United States.

PARTICIPANTS

Adults aged 18 years and older from across the United States.

MEASUREMENTS

Direct measurement by respondents of simulated drink pours in respondents' own glassware using a provided beaker and reported beverage brands were used to calculate drink alcohol content.

FINDINGS

Black men were found to have the largest overall mean drink alcohol content at 0.79 oz (23 ml) of alcohol. This was significantly larger than the mean for white men or for black women and added 30% to black men's monthly alcohol intake when applied to their reported number of drinks. Spirits drinks were found to be particularly large for men. Multivariate models indicated that drink alcohol content differences are attributable more to income and family structure differences than to unmeasured cultural factors tied to race or ethnicity per se. Models predicting alcohol-related consequences and dependence indicate that adjusting drink alcohol content improves model fit and reduces differences between race/ethnicity defined groups.

CONCLUSIONS

Differences in drink alcohol content by gender, race/ethnicity and beverage type choice should be considered in comparisons of drinking patterns and alcohol-related outcomes. Observed differences can be explained partially by measured characteristics regarding family structure and income.

Racial variations in the incidence of severe alcohol withdrawal

The use of race as a risk assessment tool and pharmacologic target has garnered recent attention and debate. It is currently unclear if a relationship between race and the development of severe alcohol withdrawal exists. We explored this potential relationship using several study groups.

METHODS

A simultaneous prospective enrollment of patients and retrospective chart review of severe alcohol withdrawal in two separate settings was performed comparing both the incidence of withdrawal and alcoholism based on race. These two study groups were then compared to an "at risk" group of alcoholics and the general ED population to determine differences in the distribution of race.

RESULTS

Individuals of white race in both study groups were at increased odds [OR 1.93 (CI 1.11-3.39) and 2.19 (CI 1.41-3.40)] of having severe alcohol withdrawal when compared to non-White "at risk" alcoholics. Blacks in both study groups however, appear to have lower odds [OR 0.23 (CI 0.11-0.47) and 0.11 (CI 0.05-0.23)] of having severe alcohol withdrawal when compared to non-Black "at risk" alcoholics.

CONCLUSIONS

Despite the controversial use of race in medical research and targeting therapies, there appears to be a difference in the odds of severe alcohol withdrawal based on race. The reasons for this finding are currently unclear.

Disparities in alcohol-related problems among white, black, and Hispanic Americans

BACKGROUND

This study assesses racial/ethnic disparities in negative social consequences of drinking and alcohol dependence symptoms among white, black, and Hispanic Americans. We examine whether and how disparities relate to heavy alcohol consumption and pattern, and the extent to which social disadvantage (poverty, unfair treatment, and racial/ethnic stigma) accounts for observed disparities.

METHODS

We analyzed data from the 2005 U.S. National Alcohol Survey, a nationally representative telephone-based survey of adults ages 18 and older (N = 6,919). Given large racial/ethnic differences in abstinence rates, core analyses were restricted to current drinkers (N = 4,080). Logistic regression was used to assess disparities in alcohol-related problems at 3 levels of heavy drinking, measured using a composite variable incorporating frequency of heavy episodic drinking, frequency of drunkenness, and maximum amount consumed in a single day. A mediational approach was used to assess the role of social disadvantage.

RESULTS

African American and Hispanic drinkers were significantly more likely than white drinkers to report social consequences of drinking and alcohol dependence symptoms. Even after adjusting for differences in heavy drinking and demographic characteristics, disparities in problems remained. The racial/ethnic gap in alcohol problems was greatest among those reporting little or no heavy drinking, and gradually diminished to nonsignificance at the highest level of heavy drinking. Social disadvantage, particularly in the form of racial/ethnic stigma, appeared to contribute to racial/ethnic differences in problems.

CONCLUSIONS

These findings suggest that to eliminate racial/ethnic disparities in alcohol-related problems, public health efforts must do more than reduce heavy drinking. Future research should address the possibility of drink size underestimation, identify the particular types of problems that disproportionately affect racial/ethnic minorities, and investigate social and cultural determinants of such problems.

Social disadvantage, stress, and alcohol use among black, Hispanic, and white Americans: findings from the 2005 U.S. National Alcohol Survey

OBJECTIVE

Despite growing evidence of the adverse health effects of social disadvantage on minority populations, few studies have investigated whether such effects extend to alcohol problems. This study examines social disadvantage as a source of stress and analyzes its association with alcohol use and problems in the three largest racial/ethnic groups in the United States.

METHOD

Data on white, black, and Hispanic Americans (n = 6,631) were obtained from the 2005 U.S. National Alcohol Survey, a nationally representative telephone-based survey of adults ages 18 and older. Social disadvantage was measured by poverty level, frequency of unfair treatment, racial/ethnic stigma consciousness, and cumulative disadvantage. Outcomes included drinking status, at-risk drinking, and problem drinking.

RESULTS

Blacks and Hispanics reported greater exposure to social disadvantage than whites, including greater poverty, unfair treatment, racial/ethnic stigma, and cumulative disadvantage. In all three racial/ethnic groups, exposure to disadvantage was associated with problem drinking. Frequent unfair treatment, high racial stigma (among minorities), and multiple sources of extreme disadvantage corresponded to a twofold to sixfold greater risk of alcohol problems, partially explained by psychological distress.

CONCLUSIONS

These results are consistent with other studies of stress and adverse health consequences associated with social disadvantage. Although there is a clear disparity in exposure to such hardship, experiences of disadvantage appear to have similar effects on problem drinking among both racial/ethnic minorities and whites. Future research should attempt to assess causal directions in the relationships among social and economic hardship, stress, and alcohol problems.

Gender, acculturation, and other barriers to alcohol treatment utilization among Latinos in three National Alcohol Surveys

This study, using three waves of U.S. National Alcohol Surveys (1995-2005), examines lifetime alcohol treatment utilization and perceived treatment barriers among Latinos. The sample included 4,204 Latinos (2,178 women and 2,024 men); data were weighted. Analyses were linear and logistic regressions. Controlling for survey year, severity, and other covariates, male gender and English language interview predicted higher utilization generally and Alcoholics Anonymous use specifically; English interview was also associated with institutional treatment. (Effects for gender on general utilization were marginal.) Other predictors of utilization included older age, lower education, greater social pressures, greater legal consequences, greater dependence symptoms, and public insurance. Whereas men and women differed little on perceived barriers, analyses showed greater barriers among Spanish (vs. English) interviewees. Latina women's underutilization of alcohol treatment requires further research but may be partially explained by stigma. Associations between language of interview and treatment utilization imply a need for outreach and culturally sensitive programming.

Ethnic differences in alcohol treatment outcomes and the effect of concurrent smoking cessation treatment

The Timing of Alcohol and Smoking Cessation (TASC) Study tested the optimal timing of smoking cessation treatment in an alcohol-dependent population. Previously reported results suggest that providing concurrent smoking cessation treatment adversely affects alcohol outcomes. The purpose of this analysis was to investigate whether there are ethnic differences in alcohol and tobacco outcomes among a diverse sample of alcohol-dependent smokers using data from the TASC trial in which 499 participants were randomized to either concurrent (during alcohol treatment) or delayed (6 months later) smoking intervention. This analysis focused on smokers of Caucasian (n=381) and African American (n=78) ethnicity. Alcohol outcomes included 6 months sustained alcohol abstinence rates and time to first use of alcohol post-treatment. Tobacco outcomes included 7-day point prevalence smoking abstinence. Random effects logistic regression analysis was used to investigate intervention group and ethnic differences in the longitudinally assessed alcohol outcomes. Alcohol abstinence outcomes were consistently worse in the concurrent group than the delayed group among Caucasians, but this was not the case for African Americans. No significant ethnic differences were observed in smoking cessation outcomes. Findings from this analysis suggest that concurrent smoking cessation treatment adversely affects alcohol outcomes for Caucasians but not necessarily for African Americans.

Impact of race and ethnicity on counseling for alcohol consumption: a population-based, cross-sectional survey

BACKGROUND

Counseling for alcohol use is of proven utility, but whether disparities in provision of counseling exist is uncertain.

METHODS

Using the 1999 Behavioral Risk Factor Surveillance System, a population-based telephone survey, we examined participant-reported physician counseling for alcohol use among 15,498 adults in 5 U.S. states. Participants reported their usual alcohol intake, risky drinking (intake of 5 or more drinks on occasion, greater than 60 drinks per month, or driving after drinking), and whether a doctor had spoken with them about alcohol use.

RESULTS

Race and ethnicity were strongly associated with reported receipt of alcohol counseling. Compared with whites, black and Hispanic adults had 2-fold higher odds of reporting receiving counseling among all participants, among problem drinkers, and among abstainers. There were modest differences according to sex, income, self-reported health, and education, but not body mass index. Multivariable adjustment and restriction to participants who reported a recent checkup did not alter these findings. No such disparity was noted for general diet counseling.

CONCLUSIONS

Clear racial and ethnic differences exist in physician counseling for alcohol use, with higher prevalence estimates among racial and ethnic minority populations. Although the cause of these differences is uncertain, systematic application of preventive medical services such as alcohol screening and counseling is needed for all patients.

Windows of opportunity: fundamental concepts for understanding alcohol-related disparities experienced by young Blacks in the United States

This paper presents a theoretical framework for conceptualizing alcohol-related disparities experienced by young Blacks in the United States. The framework highlights areas of risk and opportunity as they relate to the development of alcohol use and alcohol-related problems. In this paper, life course development theory serves as a guide for identifying a critical period in the development of alcohol-related disparities and it serves to guide the identification of opportunities to prevent or attenuate this health outcome. We also highlight concepts from ecosocial theory, resilience theory, and prevention science that advance our understanding of risk and protective factors for the social problems that young Blacks experience related to alcohol use. We conclude with suggestions for designing studies that range from etiology to preventive interventions. We also recommend methodologies that allow for more nuanced understandings of the etiology and prevention of alcohol use and alcohol-related problems experienced by young Blacks than have been available to date.