Asian American problem drinking trajectories during the transition to adulthood: ethnic drinking cultures and neighborhood contexts

Profiles of negative and positive risk-taking behavior among Asian and non-Asian American emerging adults

Risk-taking includes both negative and positive risky behaviors, but little is known about how negative and positive risk-taking occur simultaneously. This study examined negative and positive risk-taking profiles of Asian American and Non-Asian American emerging adults (N = 401; Mage = 20.68; 68.30% women) and their demographic and cultural factor correlates. Three profiles emerged: Moderate Negative and Positive, Low Negative and Positive, and High Negative/Average Positive. Asian Americans were most likely to belong in the Low Negative and Positive. The High Negative/Average Positive profile was associated with stronger emotion control values, whereas the Low Negative and Positive profile was higher in humility values. These findings underscore the role of cultural beliefs in shaping distinct risk-taking patterns among emerging adults.

Exploring patterns of alcohol use and alcohol use disorder among Asian Americans with a finer lens

BACKGROUND

National survey data suggest Asian Americans (AA) are less likely to consume alcohol and develop AUD than Americans in other groups. However, it is common for AA to be born outside of the US and carry gene variants that alter alcohol metabolism, both of which can lead to lower levels of alcohol involvement. The current study examined differences in alcohol use and AUD between AA and other groups before and after controlling for birth location and gene variants.

DESIGN

Past year alcohol measures were examined from adults 18+ (N=22,848) in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III before and after controlling for birth location (inside or outside of the US) and gene variants (ALDH2*2 and ADH1B*2/ADH1B*3). Gender gaps in alcohol measures also were assessed.

RESULTS

Before adjustments, AA were less likely than White Americans to drink in the previous year (OR=0.50, 95% CI 0.41-0.62), binge (OR=0.68, 95% CI 0.52-0.88), engage in frequent heavy drinking (OR=0.55, 95% CI 0.42-0.73), and reach criteria for AUD (OR=0.71, 95% CI 0.53-0.94). After controlling for birth location and gene variants, AA remained less likely to drink in the past year (OR=0.54, 95% CI 0.41-0.70) but all other differences disappeared. Gender gaps were only observed for AA born outside of the US, highlighting the importance of experience rather than racial category per se.

CONCLUSIONS

Findings indicate that heterogeneity among AA leads to spurious generalizations regarding alcohol use and AUD and challenge the model minority myth.

Examination of the "model minority" stereotype through ethnicity and sexual orientation heterogeneity among Asian American youth

INTRODUCTION

The "model minority" stereotype disguises heterogeneity among Asian American youth, many of whom are harmed by policies and attitudes that assume this population to be uniformly high achieving and "problem free." The current study uses an intersectional lens to disaggregate this population by ethnicity and sexual orientation subgroups to demonstrate differences in academic performance and substance use behavior among Asian American youth. This study also investigates the extent to which racial/ethnicity and sexual orientation-based bullying may explain such links.

METHODS

Participants included 65,091 Asian American youth (46.41% Southeast Asian; 37.01% East Asian; 16.58% South Asian) in grades 6-12, who were part of the California Healthy Kids Survey (2015-2017). Participants were 49.4% female and about a third each were in grades 6-8, grades 9-10, and grades 11-12. School-based surveys were administered. Youth reported on substance use, grades, and bias-based bullying experiences in the past 12 months.

RESULTS

Generalized linear mixed-effects model results showed that outcomes varied widely across youth ethnicity and sexual orientation subgroups. Inclusion of racial/ethnic and sexual orientation bullying in these models attenuated the direct effects between ethnic and sexual identities and academic performance and substance use outcomes.

CONCLUSIONS

Implications of this work suggest that research and policy should not treat Asian American students as uniformly high-performing and low-risk, because the experiences of those who deviate from these assumptions will be left undetected. Interventions targeting bias-based bullying may be able to reduce disparities in academic and substance use outcomes among Asian American youth.

An Illustrative Review of Substance Use-Specific Insights From the National Longitudinal Study of Adolescent to Adult Health

PURPOSE

The purpose of this illustrative, thematic review was to demonstrate the utility of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) for substance use research and to describe substance use-specific insights gained from Add Health research over the past 2 decades.

METHODS

We searched multiple electronic databases (PubMed, PsycInfo, and Web of Science) and selected an illustrative sample of 40 articles that used Add Health data and longitudinally examined a measure of alcohol, marijuana, or illicit drug use or prescription drug misuse as the exposure or outcome in association with diverse domains of additional factors assessed (social, emotional, behavioral, contextual, biological, and genetic).

RESULTS

Included articles identified several key associations between substance use behaviors and additional factors from a wide range of domains. For example, results from several studies indicated that experiences of sexual violence, adolescent dating violence, and intimate partner violence are associated with an increased likelihood of later prescription opioid misuse, heavy drinking, and marijuana use, with some differences by biological gender and race/ethnicity. Results from other studies showed that bidirectional associations between substance use and mental health differ by specific type of substance and mental health condition.

DISCUSSION

Existing research using Add Health data has provided valuable insights regarding substance use by leveraging the study's longitudinal design, the prospective nature of data collection, the breadth and depth of substance use questions assessed from adolescence to adulthood, the size and diversity of the cohort, and the wide range of additional factors measured over time.

COVID-19 Racism, Depressive Symptoms, Drinking to Cope Motives, and Alcohol Use Severity Among Asian American Emerging Adults

The COVID-19 pandemic has incited widespread anti-Asian racism, which is linked to numerous behavioral health consequences including depressive symptoms. As racism-induced depressive symptoms are linked to coping-related alcohol use and because alcohol-related problems represent a significant public health concern in this population, we investigated whether COVID-19 racism predicted alcohol use severity through depressive symptoms and drinking to cope motives among Asian American emerging adults (N = 139; Mage = 23.04; 50% women, 50% men). We conducted a serial mediation wherein COVID-19 racism predicted alcohol use severity sequentially through depressive symptoms and drinking to cope motives. COVID-19 racism directly and significantly predicted alcohol use severity. The indirect effect via depressive symptoms and drinking to cope motives was also significant, suggesting that COVID-19 racism is likely a risk factor for alcohol-related problems. Results inform intervention science and highlight the need for policy and behavioral health services to curb COVID-19 racism.

Ethnic density effect on alcohol-related hospitalizations among Chinese enclaves and ethnoburbs in California, 2007-2011

INTRODUCTION

Research suggests there is an 'ethnic density effect' whereby racial/ethnic minority populations appear healthier when they reside in neighborhoods with greater numbers of people from the same ethnic group. The purpose of this study is to test whether this effect is observed for residents in Chinese enclaves (immigrant neighborhoods in urban areas) and ethnoburbs (immigrant neighborhoods in suburban areas) for measures on alcohol abuse and dependence.

METHODS

ZIP code areas of California that represented Chinese enclaves and ethnoburbs were identified and mapped. Spatial regression models were used to compare neighborhood-level effects, including the ethnic density of Chinese enclaves and ethnoburbs on observed rates of alcohol-related hospitalizations compared to the rest of California. Analyses used Bayesian Space-Time Misalignment Poisson models on the annual number of alcohol-related hospitalizations per ZIP code for the years 2007-2011 (n = 8488 space-by-time units).

RESULTS

Ethnic density effect appeared for residents of ZIP code areas with greater proportions of Chinese Americans (RR=0.986, 95% CI: 0.982, 0.990). After controlling for sociodemographic characteristics, residents of ZIP code areas representing Chinese enclaves had lower risks for alcohol-related hospitalizations (RR=0.766, 95% CI: 0.630, 0.927); hospitalizations among residents of Chinese ethnoburbs no longer differed from the rest of the state. Compared to Chinese enclaves, Chinese ethnoburbs had a lower poverty rate (p < .001), a greater English fluency rate (p = .002), and similar proportions of residents who were Chinese and foreign-born.

CONCLUSION

Despite the socioeconomic advantages of living in Chinese ethnoburbs, populations living in these neighborhoods experience more problems related to alcohol abuse and dependence.

Adolescent Development in Context: A Decade Review of Neighborhood and Activity Space Research

Over the last decade, two lines of inquiry have emerged from earlier investigations of adolescent neighborhood effects. First, researchers began incorporating space-time geography to study adolescent development within activity spaces or routine activity locations and settings. Second, cultural-developmental researchers implicated neighborhood settings in cultural development, to capture neighborhood effects on competencies and processes that are salient or normative for minoritized youth. We review the decade's studies on adolescent externalizing, internalizing, academic achievement, health, and cultural development within neighborhoods and activity spaces. We offer recommendations supporting decompartmentalization of cultural-developmental and activity space scholarship to advance the science of adolescent development in context.

Exploring second generation Korean American alcohol use through church-based participatory research: A rapid ethnographic assessment in Los Angeles, California, United States

The prevalence of heavy drinking is high among Korean Americans (KAs), but alcohol treatment utilisation is low. Korean American drinking behaviours may be attributable to the Korean drinking culture. However, relatively little research has been conducted to explore this narrative. The aim of this paper was to examine the social and cultural contexts of drinking and help-seeking behaviours among second generation KAs. In 2016, we conducted a rapid ethnographic assessment (REA) in partnership with a Korean American church in Los Angeles. The REA involved participant observation and ten unstructured interviews. We used constructivist grounded theory to analyse the themes emerging from field notes and interview transcripts. Respondents perceived the existence of a Korean drinking culture in the United States that has been passed down from prior generations and preserved in ethnic enclaves. This Korean drinking culture was marked by festive occasions with heavy drinking, but the extent to which respondents adopted this drinking culture may have depended on their ethnic identities and connections to the community. For many second generation KAs, identity and community were tied to religious life. We found that KAs perceived professional treatment and recovery resources to be underutilised. We offer insights about church-based participatory research as an approach to studying drinking among KAs.

Drinking cultures and socioeconomic risk factors for alcohol and drug use disorders among first- and second-generation immigrants: A longitudinal analysis of Swedish population data

BACKGROUND

Few longitudinal studies investigate predictors of substance use incidence among immigrants. The current study describes substance use disorders in immigrants to Sweden, focusing on drinking culture in the country of origin and socioeconomic status (SES), and how these intersect with generational status to influence risk.

METHODS

Using pseudonymized Swedish population registry data, we track onset of alcohol use disorder and drug use disorder in a longitudinal study of 815,778 first-generation immigrants and 674,757 second-generation immigrants from 64 countries over a 6-year period. Cox regression analysis estimated risks of alcohol and drug use disorders in second-generation immigrants compared to first-generation, and moderation analyses assessed interactions of generational status with country-of-origin per capita alcohol consumption and SES.

RESULTS

Immigrants and second-generation immigrants originating from countries with high levels of alcohol consumption had higher risks for alcohol and drug use disorders. Immigrants with high SES had lower risks for alcohol and drug use disorders. The interaction between generational status and country-of-origin alcohol consumption was significant for drug use disorder (not for alcohol use disorder), with drug use disorder risk for second-generation immigrants being highest for those from countries with the lowest level of country-of-origin per capita alcohol consumption. The interaction between generational status and SES was significant for alcohol use disorder, with low-SES second-generation immigrants showing markedly higher risk than first-generation immigrants with comparable SES.

CONCLUSIONS

Among immigrants in Sweden, second-generation immigrants are at increased risk of developing alcohol and drug use disorders, particularly if they have lower SES. Policy and community attention to these high-risk subgroups in immigrant communities is warranted.

Longitudinal Change in Alcohol Use and Motivations for Drinking Among Asian American College Students

BACKGROUND

Asian Americans are understudied in the literature on alcohol, due to data limitations and the perception that they are at low risk for alcohol misuse. Yet, certain subpopulations-such as college students-may be at higher risk. The current study examined longitudinal change in alcohol use and motivations for drinking among Asian American students. We tested for differences by nativity status, ethnic origin, and gender and examined whether motivations covaried with alcohol use.

METHODS

Asian American first-year college students (N = 199, 45.7% female, 37.7% foreign-born) attending a US university were identified through stratified random sampling using registrar information. For 7 consecutive semesters, students completed online surveys about their behaviors and beliefs.

RESULTS

Multilevel models demonstrated that alcohol use and alcohol-related motivations increased over time. US-born students consistently consumed more alcoholic drinks, reached higher peak drinking levels, and drank more frequently than foreign-born students; however, motivations did not differ by nativity status. Chinese American students consumed less alcohol, drank less, and were more motivated to avoid alcohol-related consequences than students of other/multiple heritage ethnic origins. Each motivation subscale was associated with alcohol use at the between-person level. Likewise, within-person variability in motivations was linked to variability in drinking across semesters. Controlling for other motivations, drinking for fun emerged as the strongest correlate of alcohol use variability.

CONCLUSIONS

Alcohol misuse was highest among US-born students and those with higher motivations for drinking. Furthermore, alcohol use varied in tandem with motivations, suggesting that motivations may be a useful intervention target among this population.

"What's a normal weight?" - Origin and receiving country influences on weight-status assessment among 1.5 and 2nd generation immigrant adolescents in Europe

Many adolescents struggle with adequately assessing their weight-status, often leading to unnecessary weight-related interventions or preventing necessary ones. The prevalence of weight-status over- and underestimation differs considerably cross-nationally, suggesting that individual weight-status assessment is informed by cross-nationally differing standards of evaluation. For adolescents with a migration background, this brings up the possibility of a simultaneous influence of origin- and receiving country standards. The current study examines the magnitude of both influences using data from the 2014 Health Behaviour in School-Aged Children study. The cross-national design of the study enabled us to aggregate weight-evaluation standards for 41, primarily European, countries. Subsequently, we identified a sample of 8 124 adolescents with a migration background whose origin as well as receiving country participated in the study. Among those adolescents, we assessed the effects of origin and receiving country weight-evaluation standards using cross-classified multilevel regression analyses. Descriptive analyses revealed considerable differences in weight-evaluation standards between the countries. Regression analyses showed that both origin- and receiving country weight-evaluation standards were significantly associated cross-sectionally with weight-status assessment among the immigrant adolescents, with a stronger impact of receiving country standards. Results illustrate the context-sensitivity of adolescent weight-status assessment and reinforce the theoretical notion that immigrant adolescent development is not only informed by factors pertaining to their receiving country but also, albeit to a lesser extent, by those pertaining to their origin country.

School-Class Co-Ethnic and Immigrant Density and Current Smoking among Immigrant Adolescents

Although the school-class is known to be an important setting for adolescent risk behavior, little is known about how the ethnic composition of a school-class impacts substance use among pupils with a migration background. Moreover, the few existing studies do not distinguish between co-ethnic density (i.e., the share of immigrants belonging to one’s own ethnic group) and immigrant density (the share of all immigrants). This is all the more surprising since a high co-ethnic density can be expected to protect against substance use by increasing levels of social support and decreasing acculturative stress, whereas a high immigrant density can be expected to do the opposite by facilitating inter-ethnic conflict and identity threat. This study analyses how co-ethnic density and immigrant density are correlated with smoking among pupils of Portuguese origin in Luxembourg. A multi-level analysis is used to analyze data from the Luxembourg Health Behavior in School-Aged Children study (N = 4268 pupils from 283 classes). High levels of co-ethnic density reduced current smoking. In contrast, high levels of immigrant density increased it. Thus, in research on the health of migrants, the distinction between co-ethnic density and immigrant density should be taken into account, as both may have opposite effects.

Space and Place in Alcohol Research

PURPOSE OF REVIEW

To summarize the recent literature on social and physical environments and their links to alcohol use and identify empirical research strategies that will lead to a better understanding of alcohol use in contexts.

RECENT FINDINGS

Recent research has continued to describe the importance of neighborhood and regional contexts on alcohol use, while a smaller emerging scientific literature assesses the impacts of contexts on drinking.

SUMMARY

The dynamic, longitudinal, and multiscale processes by which social and physical structures affect social interactions and substance use have not yet been uncovered or quantified. In order to understand and quantify these processes, assessments of exposures (e.g., how individuals use space) and risks within specific locations are essential. Methods to better assess these exposures and risks include model-based survey approaches, ecological momentary assessment (EMA) and other forms of ecologically- and temporally-specific analyses, affiliation network analyses, simulation models, and qualitative/multi-methods studies.

Trajectories of change after a health-education program in Japan: decay of impact in anxiety, depression, and patient-physician communication

Background

Health education can benefit people with chronic diseases. However, in previous research those benefits were small, and reinforcement to maintain them was not effective. A possible explanation is that the benefits appeared to be small and reinforcement appeared to be ineffective because those analyses mixed data from two latent groups: one group of people who needed reinforcement and one group of people who did not. The hypothesis is that mixing the data from those two different groups caused the true effects to be “diluted.”

Methods

To test that hypothesis we used data from the Chronic Disease Self-Management Program in Japan, focusing on anxiety, depression, and patient-physician communication. To identify latent trajectories of change after the program, we used growth-mixture modeling. Then, to find out which baseline factors were associated with trajectory-group membership, we used logistic regression.

Results

Growth-mixture modeling revealed two trajectories—two groups that were defined by distinct patterns of change after the program. One of those patterns was improvement followed by backsliding: decay of impact. On anxiety and depression the decay of impact was large enough to be clinically important, and its prevalence was as high as 50%. Next, logistic regression analysis revealed that being in the decay-of-impact group could be predicted from multimorbidity, low self-efficacy, and high scores on anxiety or depression at baseline. In addition, one unexpected finding was an association between multimorbidity and better patient-physician communication.

Conclusions

These results support the hypothesis that previous findings (i.e., apparently small effect sizes and apparently ineffective reinforcement) actually reflect “dilution” of large effects, which was caused by mixing of data from distinct groups. Specifically, there was one group with decay of impact and one without. Thus, evaluations of health education should include analyses of trajectory-defined groups. These results show how the group of people who are most likely to need reinforcement can be identified even before the educational program begins. Extra attention and reinforcement can then be tailored. They can be focused specifically to benefit the people with the greatest need.

Reconsidering the Relationship between Age at Migration and Health Behaviors among US Immigrants: The Modifying Role of Continued Cross-border Ties

Age-at-migration is commonly utilized as a proxy measure for assimilation. We re-consider this approach by examining the role of continued connection with places of origin on alcohol use. Cross-border connections may diminish the association between earlier age-at-migration and alcohol use by providing an alternative channel of influence for behavioral norms. Alternatively, a stress and coping perspective on cross border ties suggests potentially countervailing impacts of these connections on alcohol use. We use data from the 2002/2003 National Latino and Asian American Study (NLAAS) (n=1641/1630 Asian and Latino origin respondents, respectively). We first estimate the association between age-at-migration (child/adolescent versus adult migrant) and any past-year alcohol use. We subsequently test the interaction between age-at-migration and two measures of cross-border contact. All models are stratified by region of origin and gender. For Latin American-origin women, cross-border ties are associated with increased risk for alcohol use among those who migrated early in life. In contrast, Asian-origin men and women who migrated as adults and have contact with family and friends abroad have the lowest predicted probabilities of past-year alcohol use. The results among Asians support the idea that cross-border ties can be alternative influences on health behavior outcomes, particularly for adult migrants. Overall, we find qualified support for both transnational and assimilationist perspectives on alcohol use behaviors among US immigrants -- as well as the interaction between these two frameworks. The joint influences of cross-border ties and age-at-migration were observed primarily for immigrant women, and not always in expected directions. We nevertheless urge future research to consider both US and country-of-origin influences on a wider range of health and health behavior outcomes for immigrants, as well as the potential intersection between US and cross-border connections.

Ethnic Drinking Culture, Acculturation, and Enculturation in Relation to Alcohol Drinking Behavior Among Marriage-Based Male Immigrants in Taiwan

Drinking behavior among immigrants could be influenced by drinking-related cultural norms in their country of origin and host country. This study examined the association of ethnic drinking culture, acculturation, and enculturation with alcohol drinking among male immigrants in Taiwan. This cross-sectional survey recruited 188 male immigrants. Ethnic drinking culture was divided into dry and wet according to per capita alcohol consumption and abstinent rate in the countries of origin in reference to that in Taiwan. A scale, Bidimensional Acculturation Scale for Marriage-Based Immigrants, was developed to measure acculturation (adaptation to the host culture) and enculturation (maintenance of the original culture). Drinking patterns (abstinent, low-risk drinking, and hazardous drinking) were determined by scores on the Alcohol Use Disorder Identification Test. There was a significant interaction between ethnic drinking culture and enculturation/acculturation on drinking patterns. Multinomial logistic regression models identified that for those from dry ethnic drinking cultures, a high level of acculturation was associated with increased low-risk drinking, while a high level of enculturation was associated with decreased low-risk drinking. For those from wet ethnic drinking cultures, a low level of acculturation and high level of enculturation were associated with increased hazardous drinking. High family socioeconomic status was associated with increased drinking, while perceived insufficient family income was positively associated with hazardous use. To prevent hazardous use of alcohol, health education should be targeted at immigrant men who drink, especially among those who have economic problems, are from wet ethnic drinking cultures, and demonstrate low adaptation to the host culture.

Individual and regional factors affecting stress and problem alcohol use: A representative nationwide study of China

OBJECTIVES

The objective of this study was to examine the association between individual and environmental stressors and problem alcohol use among Chinese university students.

METHODS

Participants were 11,942 students, who were identified through a multistage survey sampling process that included 50 universities. Individual information, including feelings of stress and perceptions of problem alcohol use, was obtained by self report. Urban and regional variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were considered in the analyses.

RESULTS

Almost one third (32.6%) of the students suffered from some form of severe stress while problem alcohol use prevalence was 7.3%, (95% CI: 4.1-10.4%). The multilevel logistic regression model found that uncertainty stress, gender, father's occupation and monthly expenses were associated with problem alcohol use. Of the contextual factors home region and the university city GDP and unemployment rate were important. When interactions were considered, the relationship between monthly expenses and financial uncertainty and problem drinking was most evident in high level universities. By contrast, the effects of uncertainty stress on problem drinking were most evident in middle and low level universities.

CONCLUSIONS

The findings underscore that efforts to control problem alcohol use among students in China should pay greater attention to environmental determinants of stress and particularly to improvements in stress management in university settings.

Pathways linking intergenerational cultural dissonance and alcohol use among Asian American youth: The role of family conflict, parental involvement, and peer behavior

A difference in degree of acculturation between immigrant parents and children, known as intergenerational cultural dissonance (ICD), is a risk factor for adolescent alcohol use. We used path analysis with 292 Vietnamese and Cambodian adolescents from immigrant families in the United States to measure potential mediators (family conflict, parental involvement/monitoring, association with deviant peers) of the ICD-alcohol use relationship. The hypothesized model was an adequate data fit among both groups. Among Cambodian adolescents, higher ICD levels significantly predicted increased family conflict, which in turn was associated with reduced parental involvement/monitoring, increased association with deviant peers, and a subsequently higher risk of alcohol use (p < .05 for all coefficients). We also found significant indirect effects of ICD on alcohol use among Vietnamese adolescents through family conflict and parental involvement/monitoring (p < .05 for all coefficients) but not through peer behavior. For both groups, there was no direct effect of ICD on alcohol use outside these pathways. Identification of significant mediators provides potential targets for preventing alcohol use among these populations. In addition, differences in path coefficients between Vietnamese and Cambodian adolescents underscore the importance of conducting analyses stratified by Asian ethnic group.

Factores Psicológicos y Relacionales Asociados a Episodios de Embriaguez en Adolescentes Escolares de Guadalajara, México

El objetivo de este estudio fue asociar factores psicológicos y relacionales vinculados a episodios de embriaguez en 1134 adolescentes escolares de Guadalajara, México. Se evaluaron diez factores psicológicos y relacionales. La variable de desenlace fue episodios de embriaguez durante el último mes. Se encontró una prevalencia de embriaguez de 26.5% con mayor consumo en hombres. Después del análisis de regresión logística los factores asociados a embriaguez fueron tabaquismo, alta autoestima, alta impulsividad, bajo locus de control interno, la presencia de estrés cotidiano y relación distante con el padre. La investigación concluye que los factores psicológicos y relacionales asociados a episodios de embriaguez hicieron referencia a un perfil de omnipotencia ltamente influenciable, y al desapego emocional, por lo que el consumo excesivo de alcohol parece perfilarse como una estrategia de seguridad.

The Future of Research on Alcohol-Related Disparities Across U.S. Racial/Ethnic Groups: A Plan of Attack

OBJECTIVE

Research suggests striking disparities in alcohol use, problems, and treatment across racial/ethnic groups in the United States. However, research on alcohol-related disparities affecting racial/ethnic minorities remains in its developmental stages. The current article aims to support future research in this growing field by highlighting some of the most important findings, questions, and approaches, focusing on psychosocial research.

METHOD

This article advances seven research needs (i.e., questions and topics meriting attention) that we believe are of crucial importance to the field. We draw on the existing literature to illuminate under-explored areas that are highly relevant to health intervention and that complement the field's existing focus.

RESULTS

Identified research needs include research that (a) better describes disparities in alcohol-related health conditions and their drivers, (b) identifies appropriate screening and brief intervention methods for racial/ethnic minorities, (c) investigates disparities in access to and use of alcohol treatment and support services, (d) examines the comparative efficacy of existing alcohol interventions and develops tailored interventions, (e) explores the impacts of specific alcohol policies across and within racial/ethnic groups, and (f) describes the full spectrum of alcohol-related harms and how and why these may vary across racial/ethnic groups. We also call for (g) continuing research to monitor disparities over time.

CONCLUSIONS

This article points to specific strategies for describing, explaining, intervening on, and monitoring some of the most substantial alcohol-related disparities. Conclusions outline methods and processes that may be advantageous in addressing these priorities, including the use of longitudinal designs; consideration of life course changes; attention to nontraditional intervention settings; and inclusion of disadvantaged populations in all aspects of research.

Ethnic-group socioeconomic status as an indicator of community-level disadvantage: A study of overweight/obesity in Asian American adolescents

Asian American children and adolescents are an under-investigated subpopulation in obesity research. Informed by a wide socioeconomic diversity among Asian American ethnic groups, this study explored ethnic-group socioeconomic status (SES) as an indicator of community-level disadvantage that may influence overweight/obesity in Asian American adolescents. We hypothesized that ethnic-group SES was inversely associated with overweight/obesity in Asian American adolescents. Multiple logistic regression models were fitted using a sample of 1525 Asian American adolescents ages 12-17 from pooled 2007-2012 California Health Interview Survey (CHIS) data. Age, gender, nativity, individual-level SES (income and education), and two lifestyle variables (fast food consumption and physical activity) were controlled for. We found that adolescents in high- or middle-level SES ethnic groups were far less likely to be overweight/obese than those in low-SES ethnic groups. Further, these relationships were more pronounced for foreign-born adolescents but not significant for U.S.-born adolescents. Ethnic-group SES may be a meaningful indicator of community-level socioeconomic disparities that influence the health of Asian Americans and, potentially, other populations with high proportions of immigrants of diverse socioeconomic and ethnic backgrounds.

Asian American and Pacific Islander substance use treatment admission trends

BACKGROUND

A national analysis of Asian Americans and Pacific Islanders (AAPI) substance use treatment admissions has yet to be studied. We sought to explore admission trends for AAPI, demographic and treatment variable change, and individual state admission change over time.

METHODS

We used retrospective time-series logistic regression treating year as a predictor of yearly treatment admission trends, between-state test for heterogeneity of treatment effects among states' AAPI admissions, and percent-changes of AAPI demographic and treatment characteristics. Participants included AAPI (n=135,356) and comparison non-AAPI (n=8,938,982) treatment groups' first-time admissions (N=9,074,338) in United States treatment centers receiving public funding from 2000 to 2012.

RESULTS

AAPI demonstrated a greater increase in admissions than non-AAPI from 2000 to 2012 (p<0.0001; OR=1.02, 95% CI=1.019-1.022). Large percent increases were demonstrated in multiple demographic and treatment characteristic, most notably in prescription opioids as a problem substance, age of first use for the oldest and youngest groups, and homelessness. In addition, trends are provided for individual states to help prioritize resource need.

CONCLUSIONS

The present demographic and treatment characteristics revealed specific variables that may help to improve a culturally competent understanding of increasing risk factors among AAPI clients. The present findings may help to demonstrate which states may need to increase AAPI-specific resources and interventions.

Association of environmental indicators with teen alcohol use and problem behavior: Teens' observations vs. objectively-measured indicators

Most prior studies use objectively measured data (e.g., census-based indicators) to assess contextual risks. However, teens' observations might be more important for their risk behavior.

OBJECTIVES

1) determine relationships between observed and objective indicators of contextual risks 2) determine relations of observed and objective indicators with teen alcohol use and problem behavior. Teens aged 14-16 (N=170) carried GPS-enabled smartphones for one month, with locations documented. Ecological momentary assessment (EMA) measured teens' observations via texts regarding risk behaviors and environmental observations. Objective indicators of alcohol outlets and disorganization were spatially joined to EMAs based on teens' location at the time of the texts. Observed and objective disorganization, and objective indicators of alcohol outlets were related to alcohol use. Observed disorganization was related to problem behavior, while objective indicators were unrelated. Findings suggest the importance of considering teens' observations of contextual risk for understanding influences on risk behavior and suggest future directions for research and prevention strategies.

Differences in alcohol use patterns between adolescent Asian American ethnic groups: Representative estimates from the National Survey on Drug Use and Health 2002-2013

OBJECTIVE

Studies have suggested that alcohol use prevalence is increasing among Asian American adolescents and there may be significant differences between specific adolescent Asian American ethnicities.

METHOD

Data from the National Survey on Drug Use and Health (2002-2013) were used to estimate prevalence of alcohol use (lifetime, past-month, past-year) and problem (binge drinking, alcohol use disorder [AUD], and early initiation of use) outcomes among adolescent Asian American ethnicities.

RESULTS

Filipino Americans had the highest prevalence of lifetime (29.3%) and past-month (10.3%) use; Korean Americans had the highest prevalence of past-year use (22.7%). Asian Indian Americans had the lowest prevalence of all three use indicators: 14.6%, 11.9%, and 4.9% for lifetime, past-year, and past-month, respectively. Korean Americans had the highest prevalence of binge drinking (5.4%), Filipino Americans had the highest prevalence of AUD (3.5%), and Vietnamese Americans had the highest prevalence of early initiation of use (13.5%). Asian Indian Americans had the lowest prevalence for all three alcohol problem indicators: 2.6%, 1.0%, and 4.9% for binge drinking, AUD, and early initiation of use, respectively.

CONCLUSIONS

Prevalence estimates of alcohol outcomes among Korean, Japanese, and Filipino American adolescents were high and similar to other racial groups that are often considered higher risk racial groups. Estimates among large subgroups with low alcohol use prevalence, Chinese and Asian Indian Americans, may mask high rates among other Asian ethnicities when alcohol use estimates are presented among Asians overall. When feasible, researchers should present alcohol use estimates disaggregated by specific Asian American ethnicities and investigate differences in risk factors across groups.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.

Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework

Alcohol use and misuse account for 3.3 million deaths every year, or 6 percent of all deaths worldwide. The harmful effects of alcohol misuse are far reaching and range from individual health risks, morbidity, and mortality to consequences for family, friends, and the larger society. This article reviews a few of the cultural and social influences on alcohol use and places individual alcohol use within the contexts and environments where people live and interact. It includes a discussion of macrolevel factors, such as advertising and marketing, immigration and discrimination factors, and how neighborhoods, families, and peers influence alcohol use. Specifically, the article describes how social and cultural contexts influence alcohol use/misuse and then explores future directions for alcohol research.

Ethnic drinking cultures, gender, and socioeconomic status in Asian American and Latino drinking

BACKGROUND

Heterogeneity in drinking across national groups is well documented, but what explains such heterogeneity is less clear. To improve understanding of the underlying cultural conditions that may lead to diverse drinking outcomes, we investigate whether 3 dimensions of ethnic drinking culture (EDC)-alcohol consumption level, drinking prevalence, and detrimental drinking pattern (DDP) in the country of origin (COO)-are significantly associated with alcohol consumption in Asian Americans and Latina/os, and whether the associations vary by gender and socioeconomic status (SES) as assessed by educational level.

METHODS

A nationally representative sample of 1,012 Asian American and 4,831 Latino adults extracted from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions data was used. A series of multiple logistic and linear regression models were fitted separately for Asian Americans and for Latinos. Analyses were also stratified by gender and educational level.

RESULTS

Overall, the associations between EDC variables and drinking outcomes were more pronounced for all Asian Americans than for all Latina/os, for males than for females among Asian Americans, and for Latinas than for Latinos. In analyses simultaneously stratifying on gender and education level, however, there was a clear pattern of COO DDP associated with heavier drinking and alcohol consumption volume only for Latinos without a college degree.

CONCLUSIONS

Ethnic drinking cultures may influence drinking in Asian American and Latino subgroups, albeit to a varying degree. Low-SES Latinos may be at disproportionate risk of harmful drinking patterns pervasive in their COO. Future research might investigate the complex interplay between socioeconomic disadvantage and cultural conditions to inform targeted interventions for subgroups at high risk of alcohol-related harms.