Nina Mulia

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.

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 womens 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.

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.

Economic Loss and Alcohol Consumption and Problems During the 2008 to 2009 U.S. Recession

BACKGROUND There is some evidence that individual-level job loss can lead to greater alcohol consumption and problems. While other forms of economic loss were common during the recent recession, these are rarely investigated in studies of macroeconomic decline. This study examined the relationship between types of economic loss in the 2008 to 2009 recession and alcohol outcomes, and whether this varied by gender and age. METHODS Data are from the 2009 to 2010 U.S. National Alcohol Survey (N = 5,382). We used multivariable regression to estimate associations between economic loss and alcohol volume, monthly drunkenness, negative drinking consequences, and alcohol dependence in the overall sample and within gender and age groups (18 to 29, 30 to 49, 50+), controlling for demographic and alcohol history covariates. RESULTS In the overall sample, severe economic loss (job or housing loss) was positively associated with negative drinking consequences, alcohol dependence, and (marginally) drunkenness, whereas moderate loss (loss of retirement savings, reduced work hours/wages, or trouble paying the rent/mortgage) was unassociated with alcohol outcomes. Important gender and age differences were observed. Women reporting retirement loss, reduced hours/wages, and job loss consumed 41 to 70% more alcohol than women unaffected by the recession, and men who experienced job loss and housing problems had increased risk for drunkenness, drinking consequences, and dependence. Middle-aged Americans affected by partial or complete job loss and housing problems also had greater risk of drunkenness and alcohol-related problems, and older adults who lost retirement savings drank 42% more alcohol than their peers unaffected by the recession. With the exception of negative drinking consequences, young adult alcohol outcomes were largely unrelated to recessionary loss. CONCLUSIONS This study highlights the adverse effects of recession-induced economic losses on alcohol use and problems in demographic subgroups. As men and middle-aged Americans were at risk for multiple, adverse alcohol outcomes, these groups may warrant special alcohol screening and intervention efforts in future macroeconomic crises.

Ethnic drinking cultures and alcohol use among Asian American adults: findings from a national survey.

AIMS To investigate the influence of ethnic drinking cultures on alcohol use by Asian Americans and how this influence may be moderated by their level of integration into Asian ethnic cultures. METHODS A nationally representative sample of 952 Asian American adults extracted from the Wave 2 National Epidemiologic Survey of Alcohol and Related Conditions data was used. Multiple logistic and linear regression models were fitted, some of which were stratified by nativity. RESULTS Controlling for financial stress, discrimination and demographic variables, a hypothesized, positive relationship between ethnic drinking cultures and alcohol outcomes held for most drinking outcomes. A hypothesis on the moderating effect of integration into ethnic cultures indicated by ethnic language use was supported for US-born Asian Americans. CONCLUSION Ethnic drinking cultures may significantly influence alcohol use by Asian Americans. The influence of ethnic drinking cultures may be conditioned by the degree of integration into the ethnic cultures. To inform alcohol interventions for reducing harmful and hazardous alcohol use among immigrants, future research needs to explore the cultural and social processes occurring in immigrant communities that might significantly influence drinking.

U.S. trends in light, moderate, and heavy drinking episodes from 2000 to 2010

BACKGROUND Risks and potential benefits associated with alcohol use vary with the amount of alcohol consumed on a drinking occasion. Over time, changes in the absolute and relative numbers of light or heavy drinking episodes may occur, impacting health and social problems. METHODS Analyses of the 2000, 2005, and 2010 National Alcohol Surveys focus on trends in the volumes of alcohol consumed on days where the drinker had 1 to 2, 3 to 4, or 5 or more drinks separately. These volume measures were obtained from graduated frequency questions with adjustments for estimated drink alcohol content for each drinker based on reported beer brand, spirits drink and pour method, contexts of drinking, and demographic characteristics. Respondents with especially high alcohol content drinks were adjusted up 1 category, and those with especially low alcohol content drinks were adjusted down 1 category. Trend significance was tested with adjusted Wald tests and in negative binomial models with 2000 as the reference year, indicators for race/ethnicity group and interactions between these and survey year, and adjustments for age, educational attainment, income, employment status, and wetness region. Analyses were conducted both in the overall sample including abstainers and in the current drinker sample only. RESULTS Overall trend results indicate an increase in drink alcohol content-adjusted alcohol volume of 25% from 2000 to 2010 with similar changes between 2000 to 2005 and 2005 to 2010. Most of the increase from 2000 to 2005 resulted from increased volume from light drinking (1 to 2 drinks) days for men and women and moderate to heavy drinking (3 to 4 drinks) days for women, while the change from 2005 to 2010 resulted mostly from volume from heavy drinking days (5+ drinks per day) for men. Black and Hispanic women were found not to have participated in the overall trend of increased alcohol volume. CONCLUSIONS Findings highlight shifts in drinking patterns suggesting increased heavy occasion drinking in 2010, particularly among men.

A moderating role for gender in racial/ethnic disparities in alcohol services utilization: results from the 2000 to 2010 national alcohol surveys.

BACKGROUND Few nationally representative studies have examined racial/ethnic disparities in alcohol services utilization. Further, little is known about whether racial/ethnic disparities generalize across genders, and what factors account for these disparities. Thus, we aimed to describe the combined impact of race/ethnicity and gender on alcohol services utilization, and to explore the roles for social influence factors in explaining racial/ethnic and gender disparities. METHODS Data were pooled across the 2000, 2005, and 2010 National Alcohol Surveys. Outcomes included lifetime utilization of any services, specialty alcohol treatment, and Alcoholics Anonymous. Social influence factors were assessed as lifetime social pressures (i.e., pressures from a partner, friends, and/or family), legal consequences, and work-related consequences. Core analyses included only those with a lifetime alcohol use disorder (AUD). RESULTS Analyses revealed a pattern of lower services utilization among Latinos and Blacks (vs. Whites) and women (vs. men); further, race-by-gender interactions revealed that Black-White differences were limited to women, and provided some evidence of stronger Latino-White disparities among women (vs. men). Illustrating these patterns, among women, only 2.5% of Latinas and 3.4% of Blacks with a lifetime AUD accessed specialty treatment, versus 6.7% of Whites; among men, corresponding figures were 6.8% for Latinos, 12.2% for Blacks, and 10.1% for Whites. Racial/ethnic differences were typically robust (or stronger) when controlling for demographics and AUD severity. Evidence did not support a role for measured social influence factors in racial/ethnic disparities, but did suggest that these factors contribute to gender disparities, particularly among Whites and Blacks. CONCLUSIONS Findings for substantial Latino-White and Black-White disparities, especially among women, highlight the need for continuing research on explanatory factors and the development of appropriate interventions. Meanwhile, our evidence for persistent gender disparities and for social influence factors as drivers of these disparities tentatively suggests a need for intensified outreach to female heavy drinkers.

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.

Preventing Disparities in Alcohol Screening and Brief Intervention: The Need to Move Beyond Primary Care

The alcohol treatment field has focused on promoting screening and brief intervention (SBI) in medically based settings, particularly primary care. In this Commentary, we consider the potential unintended consequences for disparities in access to care for alcohol problems. National data show significant racial/ethnic and socioeconomic differences in the rates at which at-risk drinkers and persons with alcohol use disorders come into contact with primary care providers. This suggests that implementing SBI in mostly primary care settings could inadvertently widen the gap in alcohol-related health disparities. To ensure that all populations in need benefit from this evidence-based treatment, SBI should be considered and adapted for a wider range of service venues, including Federally Qualified Health Centers and venues frequented by racial/ethnic minorities and the uninsured.

Housing Instability and Alcohol Problems during the 2007–2009 US Recession: the Moderating Role of Perceived Family Support

The 2007–2009 US economic recession was marked by unprecedented rates of housing instability and relatively little is known about how this instability impacted alcohol problems. While previous studies have linked homelessness to increased rates of alcohol use and abuse, housing instability during a recession impacts a much larger segment of the population and usually does not result in homelessness. Using a nationally representative sample of US adults, this study examines the association between housing instability during the recession and alcohol outcomes. Additionally, we assess whether this association is moderated by perceived family support. In multivariate negative binomial regressions, both trouble paying the rent/mortgage (vs. stable housing) and lost (vs. stable) housing were associated with experiencing more negative drinking consequences and alcohol dependence symptoms. However, these associations were moderated by perceived family support. In contrast to those with low perceived family support, participants with high perceived family support reported relatively few alcohol problems, irrespective of housing instability. Furthermore, while job loss was strongly associated with alcohol problems in univariate models, no significant associations between job loss and alcohol outcomes were observed in multivariate models that included indicators of housing instability. Findings point to the importance of the informal safety net and suggest that alcohol screening and abuse prevention efforts should be intensified during periods of recession, particularly among those who experience housing instability.