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BACKGROUND: Drinking patterns among young adult men and women in the United States have been understudied, especially among racial and ethnic groups such as Asian Americans and Hispanics. Because alcohol-related racial and ethnic health disparities persist or increase in midlife, identifying peak ages of hazardous drinking could help to reduce disparities. METHODS: We used the National Longitudinal Study of Adolescent to Adult Health to examine: (1) past 12-month heavy episodic drinking (HED) and total alcohol volume consumption among non-Hispanic White (NHW), Black, Hispanic, and Asian men and women from ages 12 through 41, and (2) age-varying associations of race and ethnicity with drinking. Hispanic and Asian ethnic groups were disaggregated by historical drinking patterns. Time-varying effect models accounted for major demographic confounders. RESULTS: NHW men and women experienced elevated drinking rates in their early 20s, with a second elevation in their 30s. Black men and women did not have elevated drinking until their 30s. Among Hispanic men and women, peak drinking periods varied by gender and subgroup drinking pattern. Peak HED and total consumption emerged in the early 30s for Asian men, while peak HED occurred in the early 20s for Asian women. Drinking at certain ages for some racial and ethnic minoritized men and women did not differ from that in their NHW counterparts. CONCLUSIONS: Age periods during which subgroups in the U.S. population experience elevated alcohol consumption vary by ethnicity and gender. Recognition of these group differences could enhance our understanding of intervention timing.
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AIMS: High-intensity drinking (HID), extreme drinking considerably above the level of heavy episodic drinking (HED), is associated with long-term health and social consequences. There is limited understanding of HID beyond young adulthood. This study aims to identify concurrent risk factors for HID, comparing age differences among all adults. METHODS: Multinomial logistic and linear regression modeling was performed using a nationally-representative sample of adults (analytic n = 7956) from the 2015 and 2020 National Alcohol Surveys. The outcomes were any HID of 8-11 drinks and 12+ drinks for men, and 8+ drinks for women, and corresponding frequencies. Concurrent risk factors included coping motive, sensation seeking, simultaneous use of alcohol and cannabis (SAC), and drinking at a bar or party. Analyses were stratified by age (18-29 vs. older) and sex. RESULTS: For younger men, sensation-seeking was significantly associated with HID (vs. no HED) at both levels and frequency of HID 8-11 drinks, while drinking to cope was only significant for 12+ drinks. For older men, drinking to cope was a consistent predictor for both HID level and its frequency, but sensation-seeking was not significant. Both coping and sensation-seeking were significantly associated with any HID for all women, while coping was significant for HID frequency for younger women. Frequent drinking at bars and parties were associated with greater odds of HID for all adults. With HED as referent, similar patterns of (though fewer significant) associations were observed. CONCLUSIONS: Younger and older adults share similar risk factors for HID, with coping more consistent for older men.
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Adaptação Psicológica , Motivação , Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Estados Unidos/epidemiologia , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Fatores de Risco , Uso da Maconha/epidemiologia , Uso da Maconha/psicologia , Pessoa de Meia-Idade , Fatores Etários , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Fatores SexuaisRESUMO
BACKGROUND: In California, all four-year public colleges have adopted 100% smoke-/tobacco-free policies (TFP) whereas community colleges (CCs), particularly rural CCs, are less likely to have tobacco-free environments. This raises concerns about health equity, particularly because smoking prevalence is higher in rural areas compared to urban. We examined policy adoption barriers and facilitators for rural California CCs with the aim of providing lessons learned to support TFP adoption by rural CCs and improve conditions for student health and well-being. METHODS: A multiple case study of four CCs in California with (n = 2) and without (n = 2) TFPs was conducted. Semi-structured interviews with 12 campus and community stakeholders, school administrative data, and policy-relevant documents were analyzed at the case level with comparison across cases to identify key barriers, facilitators and campus-specific experiences. RESULTS: All four CCs shared similar barriers to policy adoption including concerns about wildfires, individual rights, and fear of marginalizing people who smoke on campus. These CCs have experienced serious wildfires in the last ten years, have high community smoking prevalence, and fewer school resources for student health. For the two tobacco-free CCs, long-term wildfire mitigation efforts along with leadership support, campus/community partnerships and a collective approach involving diverse campus sectors were essential facilitators in successful TFP adoption. CONCLUSION: Study results underscore contextual pressures and campus dynamics that impact tobacco control efforts at colleges in rural communities. Strategies to advance college TFP adoption and implementation should recognize rural cultural and community priorities.
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BACKGROUND: Despite substantial declines in underage drinking and binge drinking, alcohol consumption has increased in the past 30 years. This study examined how beverage-specific drinking patterns varied by sex, age, and race and ethnicity from 1979 to 2020. METHODS: Secondary data analysis was conducted on pooled data from the National Alcohol Survey series from 1979 to 2020 of a sample of U.S. adults ages 18 years or older. Total and beverage-specific volume were calculated from graduated frequency questions on reported beverage type, which included beer, wine, and spirits. Sex-stratified analyses focused on descriptive trends of each alcohol measure over time and by age and race and ethnicity. Time-varying effect models were also conducted to identify subgroups at higher risk for increased consumption over time. RESULTS: Women's drinking increased, with alcohol volume rising substantially from 2000 to 2020; the largest increase was among women 30 and older. Men's alcohol volume also rose over this period but remained below the levels of 1979 and 1984, with older adults increasing their consumption those 18-29 decreased their drinking. Beverage-specific trends showed some similarities by gender: in 2020, wine volume was at its highest level for both women and men, while spirits volume also was at its highest level for men and in women was tied with the 1979 peak in spirits consumption. Increases were also found among Black men and women and Latina women from 2000 to 2020. CONCLUSIONS: Given the increases in alcohol volume, particularly among women and older age groups, alcohol policy, interventions, and education should consider ways to reduce harms associated with alcohol use among these groups. Continued monitoring of beverage-specific drinking patterns is needed to track policy-relevant changes.
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Introduction: Tobacco use remains a serious problem for young adults. Given the large number of young adults attending college, a tobacco-free campus is one strategy to reduce tobacco use. Young adult engagement is recognized as a common strategic practice in tobacco control policy efforts, especially in changing social norms around tobacco use. Community colleges can leverage and engage students in adoption of campus 100% tobacco-free policies. This qualitative study examines the importance of student engagement in advancing 100% tobacco-free policies in community colleges and identifies strategies for campuses to involve students in such efforts. Methods: We selected 12 community colleges and conducted key informant interviews with campus and community-based organizations that were involved in campus policy adoption efforts. We conducted 33 semistructured interviews and transcribed, coded, and analyzed them by using a thematic analytic framework with inductive and deductive approaches to examine student engagement processes. Results: Community colleges represented campuses with (n = 6) and without (n = 6) tobacco-free policy and varied by geography (urban vs rural) and student population size. Three main themes emerged: 1) no "wrong door" for students to engage in tobacco control work, 2) a myriad of ways for students to be involved in policy adoption, and 3) benefits of student engagement. Conclusion: We found that students are doers, allies, and champions in adoption of 100% campus tobacco-free policy. Colleges should leverage their campuses' most important assets - students - to be agents of change and to involve them in the full spectrum of interventions and advocacy.
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Política Antifumo , Adulto Jovem , Humanos , Controle do Tabagismo , Uso de Tabaco/prevenção & controle , California , Estudantes , UniversidadesRESUMO
BACKGROUND: Childhood adversity is strongly associated with adolescent substance use, but few epidemiologic studies have investigated early childhood adversity (ECA) before age 5. This study investigated pathways by which ECA is associated with adolescent alcohol and cannabis use and high school completion through childhood behavioral and academic mediators and their reciprocal effects. METHODS: Data were from the National Longitudinal Survey of Youth 1979-Child/Young Adult Cohort which surveyed children born 1984-1999 and followed through 2016 (n = 5521). Outcomes included alcohol and cannabis use frequency at ages 15-18, and high school completion by age 19. ECA at ages 0-4 was a cumulative score of maternal heavy drinking/drug use, low emotional support, low cognitive stimulation, and household poverty. Multilevel path models were conducted with ECA, childhood mediators (behavioral (externalizing and internalizing problems) and academics (reading and math scores), accounting for demographics and confounders. RESULTS: ECA was indirectly associated with adolescent cannabis frequency through mediators of externalizing/internalizing problems, low academics, and early cannabis onset before age 14. ECA was also indirectly associated with alcohol frequency via the same mediators, but not early alcohol onset. Greater behavioral problems elevated substance use risk; whereas, low academics reduced risk. Reciprocal effects were evident between childhood behavioral problems and cannabis frequency to high school completion. CONCLUSION: Adversity from birth to age 4 is associated with childhood behavioral problems and lower academics, which increased adolescent alcohol and cannabis use and lowered high school completion. Early childhood interventions with parents and preschools/daycare may reduce early onset and adolescent substance use.
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Experiências Adversas da Infância , Cannabis , Transtornos do Comportamento Infantil , Transtornos Relacionados ao Uso de Substâncias , Adulto Jovem , Humanos , Adolescente , Pré-Escolar , Recém-Nascido , Lactente , Adulto , Criança , Estudos LongitudinaisRESUMO
Adjusting for demographics and standard drinking measures, High Intensity Drinking (HID), indexed by the maximum quantity consumed in a single day in the past 12 months, may be valuable in predicting alcohol dependence other harms across high and low income societies. The data consisted of 17 surveys of adult (15,460 current drinkers; 71% of total surveyed) in Europe (3), the Americas (8), Africa (2), and Asia/Australia (4). Gender-disaggregated country analyses used Poison regression to investigate whether HID (8-11, 12-23, 24+ drinks) was incrementally influential, beyond log drinking volume and HED (Heavy Episodic Drinking, or 5+ days), in predicting drinking problems, adjusting for age and marital status. In adjusted models predicting AUDIT-5 for men, adding HID improved the overall model fit for 11 of 15 countries. For women, 12 of 14 countries with available data showed an improved fit with HID included. The results for the five Life-Area Harms were similar for men. Considering the results by gender, each country showing improvements in model fit by adding HID had larger values of the average difference between high intensity and usual consumption, implying variations in amounts consumed on any given day. The amount consumed/day often greatly exceeded HED levels. In many societies of varying income levels, as hypothesized, HID provided important added information on drinking patterns for predicting harms, beyond the standard volume and binging indicators.
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Transtornos Relacionados ao Uso de Álcool , Alcoolismo , Adulto , Masculino , Humanos , Feminino , Consumo de Bebidas Alcoólicas , Pobreza , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Community college students engage in more risky sexual behavior compared to their four-year counterparts, yet have access to fewer reproductive health services. The study's purpose was to examine whether California Community College student health centers' participation in Family PACT, a state publicly-funded family planning program, increased reproductive health services to community colleges students. PARTICIPANTS: California community college student health centers. METHODS: Bivariate analyses of student health centers with and without Family PACT participation and qualitative analysis of five participating campuses. RESULTS: Among the 60 colleges in the study, 25 student health centers participated in the Family PACT program. Family PACT campuses reported greater provision of sexual and reproductive health services and higher levels of staffing and revenue. CONCLUSIONS: Key benefits of Family PACT participation among community colleges include expansion of sexual and reproductive health services to an underserved population and increased student health centers' financial sustainability.
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Serviços de Saúde Reprodutiva , Serviços de Saúde para Estudantes , Humanos , Estudantes , Universidades , Serviços de Planejamento Familiar , CaliforniaRESUMO
Alcohol screening is one of the most cost-effective clinical preventive services and important for intervening in the development of alcohol problems. We examine predictors of the quality of alcohol screening, approximated by alcohol quantity screening, which is a prerequisite for appropriate counseling, and compare conventional regression approach with Classification and Regression Trees (CART). Data come from the 2020 National Alcohol Survey, a population survey of US adults aged 18 years and over. Analyses focus on those reporting any alcohol screening at all (N = 989). The primary outcome was whether a healthcare profession had ever asked how much they drink, which is necessary to identify heavy drinking. We examined 12 potential predictors of alcohol quantity: gender, age, race and ethnicity, education, marital status, having a usual source of primary care, insurance, and health conditions. Analyses were replicated in heavy episodic drinking (HED) and high intensity drinking (HID) subgroups, both warranting alcohol counseling. Logistic regression results show that having diabetes and not having a college degree predict missed alcohol quantity screening in the sample overall, and younger age predicts missed alcohol quantity screening in the HED/HID subgroups. CART identified Black and Hispanic respondents who had not attended college at high risk of missed screening for heavy drinking in the overall sample, and those with public insurance at high risk of missed screening for heavy drinking in the HED/HID subgroups. The quality of alcohol screening needs improvement in general, and to avoid unintended disparities in alcohol-related health services.
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AIMS: To estimate longitudinal pathways from childhood socio-economic position (SEP) to educational attainment and mid-life heavy drinking in black Americans in order to identify potential points of early intervention to reduce risk for alcohol-related problems in adulthood. DESIGN, SETTING AND PARTICIPANTS: Data are from 1299 black Americans in the US National Longitudinal Survey of Youth, followed from 1979 (aged 15-19 years) to 2012. Given gender differences in factors related to education and alcohol outcomes, gender-stratified path models were analyzed. MEASUREMENTS: Youth socio-economic indicators included parental education (approximating childhood SEP) and adolescent poverty duration. Education-related measures included high-poverty school, perceived school safety, academic problems, suspension from school, educational expectations and educational attainment. Adulthood measures included repeated unemployment, poverty duration and mean frequency of heavy drinking (six or more drinks/day) in young adulthood and mid-life. Covariates included age, dual-parent household, marital status, early drinking onset and family history of alcohol problems. FINDINGS: For both genders, two main pathways originating from low childhood SEP flowed to educational attainment through (1) educational expectations and (2) suspension and from educational attainment to mid-life heavy drinking [total indirect effect = 0.131, 95% confidence interval (CI) = 0.072-0.197 for women and 0.080, 95% CI = 0.035-0.139 for men]. For both genders, adolescent poverty (standardized ßs ≥ 0.139), academic problems (ßs ≥ 0.221) and school suspension (ßs ≥ 0.166) were significantly (Ps < 0.05) related to lower educational expectations. In adulthood, educational attainment was indirectly protective against mid-life heavy drinking through its significant effects (Ps < 0.05) on young adult heavy drinking for both genders (ßs ≤ -0.204) and economic hardships for women (ßs ≤ -0.372). CONCLUSIONS: Low childhood socio-economic position among black Americans appears to be associated with subsequent, adverse socio-economic and school experiences that lead to lower educational attainment and, ultimately, greater heavy drinking at mid-life. Interventions that mitigate these earlier, adverse experiences might have indirect effects on mid-life heavy drinking.
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Negro ou Afro-Americano , Pobreza , Adolescente , Adulto , Criança , Estudos de Coortes , Escolaridade , Feminino , Humanos , Estudos Longitudinais , Masculino , Adulto JovemRESUMO
BACKGROUND: Excessive drinking and opioid misuse exact a high toll on U.S. lives and differentially affect U.S. racial/ethnic groups in exposure and resultant harms. Increasing access to specialty treatment is an important policy strategy to mitigate this, particularly for lower-income and racial/ethnic minority persons who face distinctive barriers to care. We examined whether the U.S. Affordable Care Act's Medicaid expansion improved treatment utilization in the overall population and for Black, Latino, and White Americans separately. METHODS: We analyzed total and Medicaid-insured alcohol and opioid treatment admissions per 10,000 adult, state residents using 2010-2016 data from SAMHSA's Treatment Episode Data Set (N = 20 states), with difference-in-difference models accounting for state fixed effects and time-varying state demographic characteristics, treatment need, and treatment supply. RESULTS: Total treatment admission rates in the overall population declined for alcohol and remained roughly flat for opioids in both expansion and non-expansion states from 2010 through 2016. By contrast, estimated Medicaid-insured alcohol and opioid treatment rates rose in expansion states and decreased in non-expansion states following Medicaid expansion in 2014. The latter results were found for alcohol treatment in the total population and in each racial/ethnic group, as well as for Black and White Americans for opioid treatment. CONCLUSIONS: Medicaid expansion was associated with greater specialty treatment entry at a time when alcohol and opioid treatment rates were declining or flat. Findings underscore benefits of expanding Medicaid eligibility to increase treatment utilization for diverse racial/ethnic groups, but also suggest an emerging treatment disparity between lower-income Americans in expansion and non-expansion states.
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Analgésicos Opioides , Etnicidade , Adulto , Analgésicos Opioides/uso terapêutico , Acessibilidade aos Serviços de Saúde , Humanos , Medicaid , Grupos Minoritários , Patient Protection and Affordable Care Act , Estados Unidos/epidemiologiaRESUMO
PURPOSE: Smoke- and tobacco-free policy (SFP) is an effective strategy that can reduce tobacco-related health disparities among young adults. DESIGN: Longitudinal design using administrative, survey, policy data sources, and geocoded tobacco outlet and American Community Survey data. SETTING: California community colleges (CC) and cities/communities where colleges are located, 2003-2019. SAMPLE: 114 California CCs. DATA: School-level (i.e., student population and demographics) and community-level data (socio-demographics, local tobacco control policy, tobacco-related norms and availability, and health resources) from 2003 to 2019. MEASURES: Key outcome is the year CC adopted a 100% SFP. ANALYSIS: Bivariate and multivariate Cox survival models were used to analyze timing of SFP adoption. RESULTS: By 2019, 61 out of 114 (53.5%) CCs were 100% SFP. While community smoking prevalence and tobacco availability were not significant, CCs in rural areas were less likely to be smoke-free. CCs located in cities with stronger tobacco policies (hazard ratio (HR) = 1.08, P < .05), which reported higher student health fees (HR = 2.00, P < .05) and received technical assistance for SFP (HR = 4.59, P < .01) were significantly associated with having 100% SFP. CONCLUSION: Findings suggest that key community factors (strong city tobacco policies) and school and community resources (student health fees, SFP technical assistance) are associated with the presence of 100% SFP at CCs. Resources from the community or within a college might support remaining CCs in becoming 100% smoke-free.
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Política Antifumo , Produtos do Tabaco , Poluição por Fumaça de Tabaco , California/epidemiologia , Humanos , Estudantes , Nicotiana , Universidades , Adulto JovemRESUMO
AIM: Kingdon [(2014) Agendas, Alternatives, and Public Policies. Essex. United Kingdom: Pearson Education Limited] argues that windows of opportunity to pass policies emerge when problems, solutions and policy support co-occur. This study aims to identify a set of alcohol policies with the potential to reduce alcohol-related disparities given high levels of support from marginalized groups, such as racial/ethnic minorities and lower-income groups. METHODS: This study used data from five US National Alcohol Surveys, which were based on household probability samples of adults in 1995 (n = 4243), 2000 (n = 5736), 2005 (n = 1445), 2010 (n = 4164) and 2015 (n = 4041). We used multiple logistic regression to determine the odds of policy support by racial/ethnic group and income level, considering price, place and marketing policies as well as individual-level interventions. RESULTS: Overall a majority of Americans supported banning alcohol sales in corner stores (59.4%), banning alcohol advertisements on television (55.5%), and establishing universal health coverage for alcohol treatment (80.0%). Support was particularly high among Blacks, Hispanics/Latinos and lower-income persons. Multivariate models showed that compared with White people, foreign-born Hispanics/Latinos had the most robust levels of support, including raising alcohol taxes (aOR = 2.40, 95% CI: 2.00, 2.88, P < 0.0001), banning alcohol sales in corner stores (aOR = 2.85, 95% CI: 2.22, 3.65, P < 0.0001) and reducing retail sales hours (aOR = 2.91, 95% CI: 2.38, 3.55, P < 0.0001). CONCLUSION: Of the policies examined, banning alcohol sales at corner stores is most likely to be in a "window of opportunity" for reducing alcohol-related disparities. By simultaneously reducing population-level consumption and harms from others' drinking, place-based policies have the potential to reduce harms experienced by marginalized groups.
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Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Comércio/legislação & jurisprudência , Etnicidade/estatística & dados numéricos , Opinião Pública , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
AIMS: Greater neighborhood co-ethnic density (living in proximity with people sharing an ethnicity) and being foreign-born each can protect against risky drinking, but little is known about whether these two factors interact. Using a representative sample of Latinos and Asians from California, USA, we investigate main and interactive effects of neighborhood co-ethnic density and nativity status in relation to heavy episodic drinking (HED). METHODS: This study uses the California Health Interview Survey (N = 30,203) linked with neighborhood data to investigate associations of co-ethnic density and nativity status with HED. Co-ethnic density was based on matching each respondent's ethnicity to the proportion of residents of the corresponding group in their Census tract. Using weighted logistic regression, we first examined main effects of neighborhood co-ethnic density and respondent nativity status on HED. Next, we assessed the interaction of co-ethnic density and nativity status. Finally, we estimated nativity-stratified models to investigate variation in effects of co-ethnic density. RESULTS: Co-ethnic density was not associated with HED for the full sample, but US-born nativity status was associated with increased odds of past-year HED. The interaction model showed co-ethnic density and nativity had synergistic effects, whereby greater levels of neighborhood co-ethnic density buffered risk associated with being US-born. Further, greater neighborhood co-ethnic density was associated with reduced odds of HED for US-born respondents, but it was not associated with HED for foreign-born respondents. CONCLUSIONS: Protective effects of high neighborhood co-ethnic density on HED are stronger for US-born than for foreign-born Latinos and Asians in California.
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Asiático/estatística & dados numéricos , Consumo Excessivo de Bebidas Alcoólicas/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Alcoolismo/epidemiologia , Alcoolismo/etnologia , Ásia/etnologia , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Etnicidade , Humanos , América Latina/etnologia , Modelos LogísticosRESUMO
BACKGROUND: Little is known about the relationships between alcohol consumption and cardiovascular disease (CVD) and related chronic conditions in Asian Americans and how such risk relationships vary among their subgroups. We examine these relationships in Asian Americans and their moderation by ethnic prevalence of a variant the aldehyde dehydrogenase gene: ALDH2*2. METHODS: Multiple logistic regression modeling was performed using a nationally representative sample of Asian-American adults aged 30 to 70 (n = 1,720) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 2 (2004 to 2005) and 3 (2012 to 2013). Outcomes considered were diabetes, hypertension, high cholesterol, CVD, any of the 3 conditions (i.e., diabetes, high cholesterol, and CVD) documented to have a J-shaped relationship with drinking (CVDRC3), and any of the CVD-related conditions (ANYCVD). Demographic and socioeconomic characteristics, health insurance coverage, and other lifestyle risk factors (smoking and obesity/overweight) were adjusted. Analyses were stratified by gender. RESULTS: Alcohol consumption level was positively associated only with hypertension in Asian males, with consuming 7 to 14 drinks per week associated with more than double the risk of lifetime abstinence. For females, alcohol consumption had a dose-response relationship with high cholesterol and CVDRC3. Membership in the higher ALDH2*2 ethnic group overall was associated with lower risk of CVD-related conditions. However, compared to abstainers in lower ALDH2*2 group, females in the higher ALDH2*2 group who consumed more than 7 drinks per week had a higher risk of diabetes, hypertension, CVDRC3, and ANYCVD. CONCLUSIONS: Asian Americans may have increased risk of CVD-related conditions at relatively low alcohol consumption levels. Among Asian-American females, in particular, any amount of drinking may increase risk for high cholesterol or any of the CVD-related conditions previously documented to have a curvilinear relationship with drinking. These risks may be particularly elevated for those in ethnic groups with a high prevalence of ALDH2*2.
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Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/genética , Aldeído-Desidrogenase Mitocondrial/genética , Asiático/genética , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/genética , Adulto , Idoso , Estudos Transversais , Etnicidade/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
INTRODUCTION: Understanding the role of alcohol in hypertension and heart problems requires a lifecourse perspective accounting for drinking patterns before onset of health problems that distinguishes between lifetime abstinence and former drinking, prior versus current drinking, and overall alcohol consumption in conjunction with heavy episodic drinking. Using prospective data among U.S. adults aged 21-55 years, this study accounts for these lifecourse factors to investigate the effect of alcohol on hypertension and heart problems. METHODS: Data from the U.S. National Longitudinal Survey of Youth, aged 14-21 years in 1979 and followed through 2012 (n=8,289), were analyzed in 2017-18 to estimate hypertension and heart problems onset from lifecourse drinking patterns. Discrete-time survival models stratified by sex and race/ethnicity, controlling for demographics and time-varying factors of employment, smoking, and obesity. RESULTS: Elevated risks for hypertension were found for women drinking >14 drinks/week regardless of any heavy drinking (AOR=1.57, p=0.023) and for men engaged in risky drinking (15-28 drinks/week) together with monthly heavy drinking (AOR=1.64, p=0.016). Having a history of weekly heavy drinking elevated the risk for women but not for men. No significant relationship was evident for alcohol and heart problems onset. CONCLUSIONS: This study confirms previous findings of increased hypertension risk from higher volume and heavier drinking patterns among women and men but did not find any support for increased heart problems risk, which may be due to the younger age profile of the sample. Further research that incorporates lifecourse drinking patterns is needed to better understand the alcohol-health relationship.
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Consumo de Bebidas Alcoólicas/epidemiologia , Inquéritos Epidemiológicos , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Temperança/tendências , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Feminino , Cardiopatias/etiologia , Humanos , Hipertensão/etiologia , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: While young adults are generally at highest risk for alcohol problems, not all age out of problem drinking. Evidence suggests that Blacks and Latinos age out more slowly than Whites, particularly among men. Targeting men, we investigated whether differences in lifecourse SES might explain racial/ethnic disparities in alcohol dependence in late young adulthood, along with how experiencing alcohol dependence at that life stage relates to subsequent SES. METHODS: We used longitudinal, national data to (i) describe racial/ethnic disparities in late young adult alcohol dependence criteria (LYADC), (ii) examine whether income trajectory in early young adulthood contributes to these racial/ethnic disparities, and (iii) test whether LYADC reciprocally predicts income trajectory in early midlife. Data were from the 1979 National Longitudinal Survey of Youth (N = 3,993), which measured LYADC in 1994 (mean age = 33). Income trajectory classes were derived for early young adulthood (mean ages = 21 to 31) and, separately, early midlife (mean ages = 35 to 45). Analyses included negative binomial regressions and multinomial regressions. RESULTS: Both Black and US-born Latino men reported more LYADC than White men. Further, membership in the persistently low and slow increase (vs. stable middle) early young adult income trajectory classes was associated with more LYADC. Multivariate analyses suggested that Black-White disparities in LYADC were explained by early young adult income trajectories, whereas Latino-White disparities in the same were explained by both early young adult income trajectories and early education. In controlled models, more LYADC predicted a higher likelihood of membership in the persistently low (vs. stable middle) income trajectory class in early midlife. CONCLUSIONS: This study found that poorer SES in early adulthood contributes to alcohol dependence, which reciprocally contributes to poorer SES in early midlife. This cycle appears particularly likely to affect Black and US-born Latino men. Results underline the need to address socioeconomic factors in addressing racial/ethnic disparities in alcohol problems.
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Alcoolismo/epidemiologia , Alcoolismo/etiologia , Disparidades nos Níveis de Saúde , Fatores Raciais , Fatores Socioeconômicos , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: Alcohol misuse, cigarette smoking, poor diet, and physical inactivity, known as the "big four" contributors to chronic conditions and mortality, typically co-occur or cluster together, with their synergistic effect more detrimental to health than their cumulative individual effects. Little research has been reported on race/ethnicity-specific analyses of the clustering of these behaviors in the U.S. This study identified clustered risk behaviors among whites, blacks, and Hispanics and examined whether unhealthy clusters were associated with lower SES (assessed by education level and family income) and poor health status. METHODS: A nationally representative sample of U.S. adults aged 30-69 years (n=9,761) from the 2010 and 2015 National Alcohol Surveys was used to perform latent class analysis and multinomial and logistic regression modeling in 2018-2019. Obesity was used as a proxy for unhealthy diet. RESULTS: Three lifestyle classes were identified in each group. The relatively healthy lifestyle class was identified among whites and Hispanics. The nonsmoking and low risky drinking class among blacks, though showing a healthier lifestyle than the other 2 classes, still had relatively high prevalence of inactivity and obesity. The inactive and obese class was found in all 3 groups. Also identified were the smoking and risky drinking class among whites; the smoking and inactive class among blacks; and the smoking, inactive, and risky drinking class among Hispanics. For all 3 groups, unhealthy lifestyle classes mostly were associated with lower SES. Unhealthy lifestyle classes were also associated with poorer health status. CONCLUSIONS: Multi-behavior interventions are warranted to address inactivity and obesity in all 3 groups and unhealthy clusters involving smoking in each group.
Assuntos
Etnicidade/estatística & dados numéricos , Nível de Saúde , Grupos Raciais/estatística & dados numéricos , Assunção de Riscos , Fatores Socioeconômicos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Comportamento Sedentário/etnologia , Fumar/etnologia , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: The U.S. Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark federal policy aimed at increasing access to substance use treatment, yet studies have found relatively weak impacts on treatment utilization. The present study considers whether there may be moderating effects of pre-existing state parity laws and differential changes in treatment rates across racial/ethnic groups. METHODS: We analyzed data from SAMHSA'S Treatment Episode Data Set (TEDS) from 1999 to 2013, assessing changes in alcohol treatment admission rates across states with heterogeneous, pre-existing parity laws. NIAAA's Alcohol Policy Information System data were used to code states into five groups based on the presence and strength of states' pre-MHPAEA mandates for insurance coverage of alcohol treatment and parity (weak; coverage no parity; partial parity if coverage offered; coverage and partial parity; strong). Regression models included state fixed effects and a cubic time trend adjusting for state- and year-level covariates, and assessed MHPAEA main effects and interactions with state parity laws in the overall sample and racial/ethnic subgroups. RESULTS: While we found no significant main effects of federal parity on alcohol treatment rates, there was a significantly greater increase in treatment rates in states requiring health plans to cover alcohol treatment and having some pre-existing parity. This was seen overall and in all three racial/ethnic groups (increasing by 25% in whites, 26% in blacks, and 42% in Hispanics above the expected treatment rate for these groups). Post-MHPAEA, the alcohol treatment admissions rate in these states rose to the level of states with the strongest pre-existing parity laws. CONCLUSION: The MHPAEA was associated with increased alcohol treatment rates for diverse racial/ethnic groups in states with both alcohol treatment coverage mandates and some prior parity protections. This suggests the importance of the local policy context in understanding early effects of the MHPAEA.
Assuntos
Alcoolismo/reabilitação , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência , Alcoolismo/etnologia , Etnicidade/estatística & dados numéricos , Política de Saúde , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/legislação & jurisprudência , Humanos , Grupos Raciais/estatística & dados numéricos , Estados UnidosRESUMO
BACKGROUND: Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset. METHODS: Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes. RESULTS: T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2-3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (ORadj = 1.14; 95% CI 1.02-1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI). CONCLUSION: ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.