Karen G. Chartier

Development and vulnerability factors in adolescent alcohol use.

This article provides an overview of the characteristics of adolescent alcohol use, normative and subgroup variations in drinking behavior, and the important factors associated with an increased risk for developing alcohol problems in later adolescence and young adulthood. Parental or family histories of alcoholism, temperament traits, conduct problems, cognitive functioning, alcohol expectancies, and peer and other social relations are identified as factors influencing an adolescents susceptibility for initiating a variety of alcohol use behaviors. The deviance prone model, proposed by Sher in 1991, is presented as an important tool for testing possible relationships among the various risk factors and their sequencing that leads to early adolescent alcohol use and drug initiation. It is also possible to extend the model to allow for an examination of the complex interplay of risk factors that lead to the development of alcohol use problems in late adolescence and young adults.

Trends in alcohol services utilization from 1991-1992 to 2001-2002: Ethnic group differences in the U.S. population

BACKGROUND During the early 1990s in the United States, changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10-year period from 1991-1992 to 2001-2002 among U.S. whites, blacks, and Hispanics. METHODS Data come from 2 household surveys of the U.S. adult population. The 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions conducted face-to-face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUDs). RESULTS From 1991-1992 to 2001-2002, drinking-related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, blacks and Hispanics were less likely than whites to use private health professional care. Hispanics with AUDs were less likely than whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, blacks and Hispanics were less likely than whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for blacks with AUDs, and mutual aid for Hispanics with AUDs). CONCLUSIONS Our findings showed increases from 1991-1992 to 2001-2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to whites. These utilization trends for blacks and Hispanics may reflect underlying disparities in healthcare access for minority groups, and language and logistical barriers to utilizing services.

On the Pervasiveness of Event-Specific Alcohol Use, General Substance Use, and Mental Health Problems as Risk Factors for Intimate Partner Violence

The aim of this study was to evaluate the role of demographic, mental health, and substance use as risk factors for intimate partner violence (IPV). Data were derived from Wave II of the National Epidemiological Survey on Alcohol and Related Conditions (2004-2005). Eligible participants (N = 25,778) reported having an intimate partner 1 year before the survey. Clustered survey multivariate multinomial regression methods were used to assess risk factors for episodes of IPV. IPV victimization, perpetration, and both victims/perpetrators were assessed. Bivariate analyses indicated that African Americans, Hispanics, and women were more likely to be victims, perpetrators, or victim/perpetrators as compared with men and Whites. Multivariate analyses suggested that having a marijuana use disorder was strongly associated with IPV victimization (odds ratio [OR] = 2.61) and victim/perpetration (OR = 2.65). Post-traumatic stress disorder was consistently associated with all IPV typologies. Depression was associated with victimization (OR = 2.00) and IPV victim/perpetration (OR = 1.74). Antisocial Personality Disorder and Mania were both related to IPV perpetration (ORs = 2.53 and 2.32) and victim/perpetration (ORs = 3.15 and 2.31). Results also indicated that alcohol use during episodes of IPV is common (i.e., 35% of those who reported IPV also reported that alcohol was involved). Results indicate several substance- and mental health–related correlates of IPV. In addition, findings indicate that alcohol use by the victim and/or perpetrator is common during IPV events. Policy implications and directions for future research are discussed.

Alcohol problems in young adults transitioning from adolescence to adulthood: The association with race and gender

Race and gender may be important considerations for recognizing alcohol related problems in Black and White young adults. This study examined the prevalence and age of onset of individual alcohol problems and alcohol problem severity across race and gender subgroups from a longitudinal study of a community sample of adolescents followed into young adulthood (N=166; 23-29 yrs. old who were drinkers). All alcohol problems examined first occurred when subjects were in their late teens and early 20s. Drinking in hazardous situations, blackouts, and tolerance were the most common reported alcohol problems. In race and gender comparisons, more males than females experienced alcohol problems. Blacks generally had a later age of onset of alcohol problems. Multivariate regressions showed greater alcohol problem severity in males compared to females, but no significant differences between Blacks and Whites. Education, family environment and earlier alcohol use behaviors and expectancies were reliable predictors of alcohol problem severity in young adulthood. White males were at particular risk for experiencing more severe alcohol problems. Findings may inform the design of more targeted interventions for alcohol problems in different populations.

Intimate Partner Violence and Alcohol Problems in Interethnic and Intraethnic Couples

Despite the growing number of interethnic marriages in the United States, few studies have examined intimate partner violence (IPV) in interethnic couples. This article examined past-year occurrences of IPV across interethnic and intraethnic couples and tested correlates of IPV specifically in interethnic couples. Data were from a national survey of couples 18 years of age and older from the 48 contiguous states. Interethnic couples (n = 116) included partners from different ethnic backgrounds, including Black–White, Hispanic–White, and Black–Hispanic couples. White (n = 555), Black (n = 358), and Hispanic (n = 527) intraethnic couples included partners with the same ethnicity. Data analyses were prevalence rates and logistic regressions. The analysis showed that interethnic couples were comparatively younger and had shorter relationships than intraethnic White, Black, and Hispanic couples. Male partners in interethnic couples had higher rates of binge drinking and alcohol problems compared with male partners in intraethnic couples. Past-year prevalence rates for any occurrence of IPV and acts of severe IPV were higher for interethnic couples relative to intraethnic couples. Most occurrences of IPV for interethnic couples were mutual. Factors predicting IPV among interethnic couples included marital status, couples’ age, male alcohol problems, and female impulsivity. Mounting evidence points to interethnic couples as a high-risk group for IPV. Interethnic couples may be at greater risk for IPV because of their younger age, binge drinking, and alcohol problems. Future research could build on this study by examining cohort effects and regional differences in IPV for interethnic couples and the risk for IPV across interethnic couples of different ethnic compositions.

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

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

Cardiorespiratory fitness, alcohol intake, and metabolic syndrome incidence in men.

PURPOSE The objective of this study is to prospectively examine the independent and joint effects of alcohol consumption and cardiorespiratory fitness on the incidence of metabolic syndrome (MetS) in a cohort of men. METHODS A prospective examination was done of 3411 apparently healthy men at baseline, who came to the Cooper Clinic (Dallas, TX) for at least two preventive visits (1979-2010). Primary exposure variables were cardiorespiratory fitness and alcohol intake; the outcome measure was MetS and the components thereof. Cox proportional hazards models were computed to assess the relation between the exposure variables and the incidence of MetS while adjusting for confounders. RESULTS For a mean follow-up period of 9 yr (SD = 7.8), 276 men developed MetS. In multivariable analysis, a dose-response relationship was observed between increased levels of fitness and reduced MetS risk (moderate fitness: HR = 0.60; 95% confidence interval (CI), 0.43-0.82; high fitness: HR = 0.49, 95% CI, 0.35-0.69). When examining the independent effects of alcohol, light drinking increased the risk for MetS by 66% (HR = 1.66, 95% CI, 1.11-2.48). No statistically significant interaction effect was observed between alcohol and fitness in relation to MetS (P = 0.32). When assessing the relation between each exposure and the components of MetS, higher fitness consistently reduced the risk of all components, whereas lower alcohol intake reduced the risk of elevated glucose and blood pressure and increased the risk for low HDL cholesterol. CONCLUSIONS Among this cohort of men, higher fitness levels reduced the risk for MetS and its components. The relation between alcohol intake levels and metabolic risk was more complex and not reflected when examining MetS as a whole.

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.

Cardiorespiratory fitness, alcohol, and mortality in men: The Cooper Center Longitudinal Study

BACKGROUND Studies have found that higher levels of cardiorespiratory fitness and light to moderate alcohol intake reduce the risk for premature death. Scant evidence, however, exists assessing the joint effects of both measures on all-cause and cardiovascular disease (CVD) mortality. PURPOSE This study aims to examine the independent and joint effects of alcohol consumption and cardiorespiratory fitness on all-cause and cardiovascular-related mortality in a large cohort of men. METHODS This prospective study included 29,402 men who came to the Cooper Clinic (Dallas, TX) for a preventive medicine visit from 1973 to 2006. Data were analyzed in 2011. The primary exposure variables were tertiles of cardiorespiratory fitness and four categories of alcohol consumption, and the outcomes were all-cause and CVD mortality. Cox proportional hazards regression was used to model the association between alcohol intake, cardiorespiratory fitness, and all-cause and CVD mortality, controlling for potential confounders. RESULTS A total of 1830 (all-cause) and 523 (CVD) deaths occurred in men over an average follow-up period of 17.4 years (SD=9.1). A linear relationship was observed (p<0.001) between increased fitness and reduced all-cause and CVD mortality. Specifically, moderate and high levels of fitness reduced the risk for all-cause mortality (HR=0.67, 95% CI=0.60, 0.74, and HR=0.57, 95% CI=0.49, 0.67, respectively) and CVD mortality in comparison to the low-fitness reference group (HR=0.70, 95% CI=0.57, 0.85; HR=0.54, 95% CI=0.40, 0.75, respectively), while controlling for alcohol intake and other covariates. A significant curvilinear relationship was found (p=0.01) between alcohol intake and all-cause mortality (but not CVD mortality), while controlling for fitness and other covariates. In a categoric examination of alcohol intake and mortality, adjusting for fitness and other confounders, there was no statistically significant effect of light drinking compared to heavy drinking on all-cause mortality or CVD mortality. An examination of the joint effects of fitness and alcohol on all-cause mortality showed that moderate and high fitness levels were protective against mortality irrespective of alcohol consumption levels. Few significant combined effects for CVD mortality reduction were found. CONCLUSIONS Alcohol consumption did not significantly modify the association between fitness and mortality in this large cohort of men.

Strengthening Family Practices for Latino Families

This study examined the effectiveness of a culturally adapted Strengthening Families Program (SFP) for Latinos to reduce risks for alcohol and drug use in children. Latino families, predominantly Puerto Rican, with a 9- to 12-year-old child and a parent(s) with a substance abuse problem participated in the study. Pre- and post-tests were conducted with each family. Parental stress, parent-child dysfunctional relations, and child behavior problems were reduced in the families receiving the intervention; family hardiness and family attachment were improved. Findings contribute to the validation of the SFP with Latinos, and can be used to inform social work practice with Puerto Rican families.