Drinking norms and alcohol-related problems in the United States

Gender Differences in the Association between Positive Drinking Attitudes and Alcohol-Related Problems. The WIRUS Study

Background: Alcohol consumption is deeply integrated in people's social- and work lives and, thus, constitutes a serious public health challenge. Attitudes toward drinking stand out as important predictors of drinking, but have to date been sparsely studied in employee populations. This study explores the association of employees' attitudes toward drinking with their alcohol-related problems, and whether this association is moderated by gender and employment sector. Methods: Cross-sectional data were collected from a heterogeneous sample of employees (N = 4094) at 19 Norwegian companies. Drinking attitudes were assessed using the Drinking Norms Scale. The AUDIT (Alcohol Use Disorders Identification Test) scale was then used to assess any alcohol-related problems. Data were analyzed using chi-square tests, analysis of covariance (ANCOVA), and multiple logistic regression. Results: Employees with predominantly positive drinking attitudes were almost three times as likely to report alcohol-related problems compared to employees with more negative drinking attitudes (OR = 2.75; 95% CI: 2.00-3.76). Gender moderated the association between positive drinking attitudes and alcohol-related problems (OR = 3.30; 95% CI: 2.10-5.21). The association was stronger in women (OR = 5.21; 95% CI: 3.34-8.15) than in men (OR = 3.10; 95% CI: 2.11-4.55). Employment sector did not moderate the association between drinking attitudes and alcohol-related problems. Conclusions: Employee attitudes toward alcohol should be monitored to better enable early workplace health promotion interventions targeting alcohol problems. These interventions might need to be gender-specific.

Education inequality and use of cigarettes, alcohol, and marijuana

Education inequality at the neighborhood-level may influence population health and health behavior. We assessed the relations between education inequality and substance use in 59 New York City (NYC) neighborhoods. We used Gini coefficients of education to describe neighborhood education inequality and data from a random-digit-dial phone survey of adult residents of NYC to assess use of substances. Among 1355 respondents (female=56.2%; white=35.7%; mean age=40.4), 23.9% (95% confidence interval [CI]=20.3-27.5) reported smoking, 39.4% (95% CI=35.3-43.4) drinking, and 5.4% (95% CI=3.6-7.3) using marijuana in the previous 30 days. In multilevel models controlling for neighborhood education, neighborhood income inequality, and individual covariates, living in a neighborhood with high education inequality was associated with a greater prevalence of drinking (p=0.02) and of smoking marijuana (p=0.004) but among current drinkers it was associated (p=0.03) with having fewer drinks. The odds of alcohol use (OR=1.70) and marijuana use (OR=3.49) were greater in neighborhoods in the 75th percentile of education Gini compared to neighborhoods in the 25th percentile of education Gini. Statisical interactions suggest that there may be a stronger relation between education inequality and marijuana use in neighborhoods with low mean education than in neighborhoods with higher mean levels of education. These findings, taken together, suggest a complex relation between education inequality and substance use; likelihood of the use of alcohol and marijuana was higher in areas with higher education inequality suggesting potential roles for substance use norms and availability, whereas quantity used among drinkers was higher in areas with low education inequality, suggesting potential roles for both disadvantage and norms.

Neighborhood income and income distribution and the use of cigarettes, alcohol, and marijuana

Evidence about the relationship between contextual variables and substance use is conflicting. Relationships between neighborhood income and income distribution and the prevalence and frequency of substance use in 59 New York City (NYC) neighborhoods were assessed while accounting for individual income and other socio-demographic variables. Measures of current substance use (in the 30 days prior to the survey) were obtained from a random-digit-dial phone survey of adult residents of NYC and data from the 2000 U.S. Census to calculate median neighborhood income and income distribution (assessed using the Gini coefficient). Among 1355 respondents analyzed (female=56.2%, mean age=40.4), 23.9% reported cigarette, 40.0% alcohol, and 5.4% marijuana use in the previous 30 days. In ecologic assessment, neighborhoods with both the highest income and the highest income maldistribution had the highest prevalence of drinking alcohol (69.0%) and of smoking marijuana (10.5%) but not of cigarette use; there was no clear ecologic association between neighborhood income, income distribution, and cigarette use. In multilevel multivariable models adjusting for individual income, age, race, sex, and education, high neighborhood median income and maldistributed neighborhood income were both significantly associated with a greater likelihood of alcohol and marijuana use but not of cigarette use. Both high neighborhood income and maldistributed income also were associated with greater frequency of alcohol use among current alcohol drinkers. These observations suggest that neighborhood income and income distribution may play more important roles in determining population use of alcohol and marijuana than individual income, and that determinants of substance use may vary by potential for drug dependence. Further research should investigate specific pathways that may explain the relationship between neighborhood characteristics and use of different substances.

Drug use, misuse, and the urban environment

Urbanization is probably the single most important demographic shift world-wide throughout the past and the new century and represents a sentinel change from how most of the world's population has lived for the past several thousand years. As urban living becomes the predominant social context for the majority of the world's population, the very ubiquity of urban living promises to shape health directly and to indirectly affect what we typically consider risk factors or determinants of population health. Although a growing body of research is exploring how characteristics of the urban environment may be associated with health (e.g. depression) and risk behaviours (e.g. exercise patterns), relatively little research has systematically assessed how the urban environment may affect drug use and misuse. In this paper we will propose a conceptual framework for considering how different characteristics of the urban environment (e.g. collective efficacy, the built environment) may be associated with drug use and misuse, summarize the existing empiric literature that substantiates elements of this framework, and identify potential directions for future research.

Gender differences for the risk of alcohol-related problems in multiple national contexts

The primary research question asked is: After holding alcohol consumption constant, will men and women be at equal risk for a variety of alcohol-related problems? Since women are actually at a higher blood alcohol content at the same consumption levels, a physiological argument would suggest that women are at equal or greater risk for alcohol problems than men. However, variation in societal norms surrounding gender roles and/or societal-level stress may mediate the experience of men and women, regardless of the differences in physiology. Ten cross-sectional general population studies are used. Analyses control for individual-level variables (age, quantity, and frequency of drinking) and societal-level variables (proportion of women in the work force and female suicide rate) that might confound these relationships; cross-study homogeneity is examined.

Historical and cultural roots of drinking problems among American Indians

Roots of the epidemic of alcohol-related problems among many Native North Americans are sought in cultural responses to European arrival, the role of alcohol in frontier society, and colonial and postcolonial policies. Evidence from the historical record is considered within the framework of current social science. Initially, Native American's responses to alcohol were heavily influenced by the example of White frontiersmen, who drank immoderately and engaged in otherwise unacceptable behavior while drunk. Whites also deliberately pressed alcohol upon the natives because it was an immensely profitable trade good; in addition, alcohol was used as a tool of "diplomacy" in official dealings between authorities and natives. The authors argue that further research into the origins of modern indigenous people's problems with alcohol would benefit from an interdisciplinary "determinants of health" approach in which biological influences on alcohol problems are investigated in the context of the cultural, social, and economic forces that have shaped individual and group drinking patterns.

Drinking patterns and problems: a comparison of two black primary care samples in two regions

This paper explores the effect of regional ("wet" vs. "dry") variation in drinking patterns and problems on the prevalence of alcohol-related problems among those seeking care in primary care settings. A sample of black primary care patients interviewed in Hinds County, MS (n = 740) and in Contra Costa County, CA (n = 93) are compared on quantity and frequency of usual drinking, drunkenness, consequences of drinking, and alcohol dependence. Controlling for demographic differences in logistic regression analysis, drinkers in Contra Costa, while no more likely to report heavy drinking, were four times more likely to report alcohol-related consequences, more than five times more likely to report alcohol dependence experiences, and more than nine and a half times more likely to report ever having had treatment for an alcohol problem than those in Hinds County. Data suggest that regional variations in drinking patterns may be reflected in alcohol involvement in primary care caseloads, and that the large variation in the prevalence of alcohol-related problems found in primary care settings may, in part, be attributable to this. All primary care settings do not appear to hold equal promise for screening for and intervening with problem drinking, and further research is needed in determining those settings that provide the greatest potential for targeting prevention efforts.

Drinking patterns and problems, drug use and health services utilization: a comparison of two regions in the US general population

While substance abuse has been found to be over-represented in some primary care settings, we do not know under what circumstances this association may vary, and whether it may be linked to differences in attitudes regarding alcohol use as reflected in regional rates of abstention and heavy or problem drinking. Data are reported from the Southern and Western regions of the 1995 National Alcohol Survey. Alcohol consumption variables were not found to be predictive of primary care utilization. Main effects were found for heavier drinking on emergency room (ER) use for an injury, and interactive effects of region were found for consequences of drinking, with those in the South who reported consequences more likely to have used the ER for either an injury or illness than those in the West. These data suggest that ER utilization may be related to regional differences in drinking patterns, while primary care utilization may not be.

Traditionalism in the prevention of substance misuse among Puerto Ricans

Data are presented from a multicluster stratified sample of 1,084 Puerto Rican households in the New York City area. Researchers examined the impact of loss of traditional Hispanic family-oriented gender role values and degree of acculturation upon drug use. Sociodemographic variables are presented. Indices of "traditionalism" and "acculturation" were created, validated, and correlated with drug use. Traditionalism was found to covary negatively with drug use, but more so for women. The positive relationship between acculturation and drug use was found to be influenced by different levels of traditionalism. Implications for treatment and prevention are discussed.

Racial differences in women's drinking norms and drinking patterns: a national study

This study explored whether norms regarding women's drinking were more or less liberal among African American than among Caucasian women, and whether female-specific drinking norms influence drinking rates and drinking problems among the two groups of women. The study is based on data from a 1984 national survey of subsamples of 1,224 African American and 1,034 Caucasian women. Logistic and multiple regression analyses showed that African Americans reported more conservative drinking norms for women than Caucasians even when controlling for general drinking norms and social characteristics. Other findings were that female-specific drinking norms affect the proportion of women drinkers, usual quantity of alcohol consumption, and symptoms of alcohol dependence. African American and Caucasian women were not found to differ in the effect of female-specific drinking norms on alcohol use or on alcohol-related problems. Future research should explore differences in cultural factors that may affect attitudes towards women's drinking as well as more detailed aspects of the relationship between women's drinking norms and problem drinking.

Moderate drinking in women: a concept analysis

This analysis clarifies the concept of moderate drinking in women. The literature reflects a variety of definitions of moderate drinking and refers largely to drinking in men. Several strategies for concept analysis suggested by Walker and Avant (1995) resulted in the formulation of a theoretical definition of moderate drinking in women applicable to practice and research. The defining attributes of women's moderate drinking in contemporary U.S. culture include (1) minimization of risks of alcohol-related problems, (2) a desire for any potential health benefits, (3) deliberate adoption of personal drinking guidelines based on some knowledge of the effects of alcohol, (4) control of when and how much alcohol is consumed, (5) sensitization to special drinking considerations faced by women, and (6) having at least one interpersonal relationship with another moderate drinker.

Alcohol and injuries resulting from violence: a comparison of emergency room samples from two regions of the U.S

Data on representative samples of emergency room patients from a wet region of the U.S. (Contra Costa County, California) and a dry region (Jackson, Mississippi) were analyzed to explore the influence of drinking patterns, rates of abstinence, and per capita consumption with respect to alcohol's role in injuries involving violence. In both samples those with violence-related injuries were more likely to have a positive breathalyzer reading, to report drinking within six hours prior to the event and to report drunkenness and alcohol-related problems compared to those with other injuries. A larger proportion of those with violence-related injuries in the Jackson sample reported consuming more drinks prior to injury and a shorter time lapse between drinking and the event than those in Contra Costa. They were no more likely, however, to report feeling drunk at the time or to attribute a causal association between drinking and the event. The data suggest there may be a closer association of alcohol with violence in the Jackson sample compared to Contra Costa.

Aggregate-level predictors of the prevalence of selected drinking patterns in multiple studies: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project

This paper examines the prevalence of two "at-risk" alcohol drinking patterns (infrequent heavy drinking and frequent heavy drinking) within age/gender groups in multiple general population studies. When heterogeneity in findings across studies is found, we test the hypotheses that suicide, divorce, unemployment rates, and the per capita consumption of alcohol in each country are associated with the prevalence of these drinking patterns. These analyses should inform the literature on the relationships between societal factors and the prevalence of persons in different societies and periods in history that drink at these levels.

Alcohol in fatal and nonfatal injuries: a comparison of coroner and emergency room data from the same county

Although alcohol is thought to be associated with severity of injury, relatively little data are available that compares alcohol's involvement in injury cases treated in the emergency room (ER) with coroner cases of injury fatality, both coming from the same county. Data from a probability sample of casualty patients 18 years and older treated at the University of Mississippi Medical Center ER in Jackson during a 6-month period (n = 275) are compared with data from coroner reports of all fatalities from unnatural causes among those 18 and older in the same county during a 1-year period surrounding the 6 months of data collection in the ER (n = 222). The two samples are compared on demographic characteristics, cause of injury, place of injury, and alcohol use before the event. A significantly larger proportion of the coroner sample was positive for alcohol (57%) and intoxicated (36%), compared with the proportion of those in the ER sample breathalyzed within 6 hr of injury, and reporting no drinking after the event who were positive (15%) and intoxicated (6%). Differences were most pronounced for motor vehicle accidents and fires. Violence-related injuries were more likely in the coroner sample (32%) than in the ER sample (16%), and they were more likely to involve alcohol at levels of intoxication. Those in the coroner sample were also more likely to be alcohol-positive for injuries occurring in all places except the home of another and the workplace. Using logistic regression, gender (male) and site (coroner) were predictive of a positive blood alcohol across all causes of injury combined. Gender (female), being alcohol-positive and site (coroner) were significantly predictive of motor vehicle accidents. Alcohol was not found to be a significant predictor for falls, other accidents, or injuries resulting from violence. Data suggest that alcohol's association with severity of injury varies by cause of injury.

Drinking Contexts, Alcohol Beliefs, and Patterns of Alcohol Consumption: Evidence for a Comprehensive Model of Problem Drinking

The social contexts in which individuals drink and the expected outcomes of that drinking (i.e., individual beliefs about the effects of drinking beverage alcohol) have recently been found to represent conceptually distinct models of alcohol consumption patterns. This paper examines the relationships between contexts, beliefs, and a variety of problem drinking patterns, and reestimates these relationships in a large national probability sample of 2,100 adults (U.S. National Alcohol Survey [National 7], Alcohol Research Group 1984: Berkeley, Calif). Regression analyses indicate that the interrelationship of drinking contexts and drinking beliefs, and their impact on drinking behavior, is more complex than previously described. Consistent with earlier research, when simple frequency of drinking is the focus, social contexts for drinking emerge as the more important independent influences. When several indicators of maladaptive drinking are considered, however, beliefs regarding the effects of drinking, particularly beliefs regarding drinking as a means to modify affect, are found to be more influential. Logic is developed for a comprehensive model of the sources of problem drinking that incorporates both classes of explanatory variables.

Work Team Attitudes, Drinking Norms, and Workplace Drinking

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

Relationships of measures of alcohol consumption with alcohol-related problems in multiple studies: a research synthesis from the collaborative alcohol-related longitudinal project

Two measures of alcohol consumption were used to predict groups of alcohol problems in 21 general population studies from 11 countries to determine (a) if quantity of drinking per occasion or frequency of drinking per month constituted significant "risk" for alcohol problems, having controlled for each as well as individual-level and aggregate-level variables which might confound these relationships and (b) if these associations were homogeneous across studies. A two-tiered analysis assessed these relationships within each study by modeling age, sex, quantity per occasion and frequency per month as predictors of alcohol problems. Meta-analysis combined test statistics to determine if they were homogeneous across studies. The meta-analysis was repeated, blocking for per capita consumption of alcohol (a trait of nations thought to measure drinking norms) and the female rate of suicide (a trait of nations thought to measure societal-level stress). When only individual-level variables were controlled (age and sex), both quantity and frequency were risk factors for each drinking problem. However, except in the case of the association of quantity with alcohol treatment, the magnitude of these risks were heterogeneous across studies. When blocking for the societal-level traits, each had more relevance for some, but not all, of the relationships between consumption and problems. Particularly striking was the well-documented finding that per capita consumption of alcohol significantly distinguished the relationships of frequency of drinking and health problems (while the female suicide rate did not) and the previously undocumented finding that the female suicide rate significantly distinguished the relationships of both quantity and frequency with treatment (while the per capita consumption of alcohol did not). These findings suggest that the impact of norms and the impact of societal stress in groups have different but significant consequences for the relationships of consumption to problems.

The difference context makes: Americans' views on abstinence and impairment

While it is acknowledged that social norms play a role in determining acceptable drinking levels, there has been little research on the factors that determine approved or prohibited consumption levels in particular social contexts. This paper investigates the factors that influence the choice of abstention or impairment (as compared to 'social drinking') through an analysis of the 1984 survey of American drinking patterns using logistic regression, a method that allows the separate identification of social and demographic factors that encourage abstention or impairment. Results show that although the effects of drinking status variables (such as lifelong abstainer) are contextually neutral, most social and demographic characteristics have differential effects depending on the specific context and the choice of abstention or impairment.

Recent developments in life-event research and their relevance for the study of addictions

The idea that stressful life events can on occasions contribute to the development of addictive disorders is fairly well-accepted within both clinical and research communities. However, little support is available: research is sparse and investigators have generally neglected methodological refinements and innovations in the broader field of life-event research. Some of these developments are discussed, especially as they relate to the measurement of the meaning of life events. Findings from research based on such techniques are summarized, and their relevance for the study of addictions discussed under three headings: specification of life events, vulnerability, and diagnostic specificity.

Judgments of "normal" and "problem" alcohol use as related to reported alcohol consumption

We obtained alcohol use data and judgments of individual ("What do you think?") and cultural ("What do people in general think?") norms for normal and problem quantity and frequency of alcohol use, as well as ratings of whether particular alcohol-related behaviors indicated a drinking problem, from 928 adult respondents who were members of Hawaii's five major racial/ethnic groups [Chinese, European (Caucasian), Filipino, Hawaiian/Part-Hawaiian, and Japanese ancestry]. As compared with older survey data (but consonant with recent survey data), Hawaiians have substantially increased in alcohol use, as have Filipinos (if they drink at all; a high proportion are abstainers), and to a lesser extent, Japanese. Chinese remain very low in alcohol use, while Caucasians have relatively decreased in use. Alcohol use norms (especially of own judged normal use) vary across sexes and ethnic groups and are predictors of consumption both within and across groups. Family resemblances are substantial with regard to alcohol use category (present users, former drinkers, abstainers). Among present users, family resemblances are often significant with regard to amount used; resemblances are more substantial between mothers and offspring than between spouses or between fathers and offspring. There were small but significant ethnic group differences in the number of specific behaviors judged to be indicative of a drinking problem, with the groups reporting the highest mean alcohol consumption (Caucasians and Hawaiians/Part Hawaiians) also indicating more behaviors, particularly pathological as opposed to celebratory behaviors, as being problematic.(ABSTRACT TRUNCATED AT 250 WORDS)

Social stress, normative constraints and alcohol problems in American states

Robert Bales' theory explains rates of alcoholism in populations by the combination of socially induced stress and tension together with a normative system that promotes the use of alcohol for releasing that tension. This paper provides the first systematic test of that theory by combining the variables of social stress and normative approval of alcohol within the same research design. Ecological correlations are used with the 50 states as units of analysis. Stress was measured by a 'state stress index' based on 15 stressful 'life events' aggregated to the state level. Events vary from rates of divorce to community disaster. Normative constraints on drinking were measured by a multi-indicator proscriptive norms index based on religious composition and legal impediments to the purchase and consumption of alcohol. The states were divided into quartiles based on normative constraints surrounding alcohol use from proscriptive to permissive. Alcohol problems were measured by three indicators of heavy drinking and three indicators of alcohol related arrests. All but one of the 24 correlations between the state stress index and the indicators of alcohol problems were highest within the context of strong cultural support for the use of alcohol, thus supporting Bales' original theory. For the arrest variables there was also a clear pattern of curvilinearity, with a second distinct 'peak' in the correlations within the polar opposite quartile of proscriptive states. Competing explanations for the pattern are discussed including the 'social control' hypothesis and the 'ambivalence' hypothesis.