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BACKGROUND: Alcohol use is an established yet modifiable risk factor for breast cancer. However, recent research indicates that the vast majority of U.S. women are unaware that alcohol use is a risk factor for breast cancer. There is limited information about the sociodemographic characteristics and alcohol use correlates of awareness of the alcohol use and breast cancer link, and this is critically important for health promotion and intervention efforts. In this study, we assessed prevalence of the awareness of alcohol use as a risk factor for breast cancer among U.S. women and examined sociodemographic and alcohol use correlates of awareness of this link. METHODS: We conducted a 20-minute online cross-sectional survey, called the ABLE (Alcohol and Breast Cancer Link Awareness) survey, among U.S. women aged 18 years and older (N = 5,027) in the fall of 2021. Survey questions assessed awareness that alcohol use increases breast cancer risk (yes, no, don't know/unsure); past-year alcohol use and harmful drinking via the Alcohol Use Disorders Identification Test (AUDIT); and family, health, and sociodemographic characteristics. We conducted multivariate multinomial regression analysis to identify correlates of awareness that alcohol use increases breast cancer risk. RESULTS: Overall, 24.4% reported that alcohol use increased breast cancer risk, 40.2% reported they were unsure, and 35.4% reported that there was no link between alcohol use and breast cancer. In adjusted analysis, awareness of alcohol use as a breast cancer risk factor, compared to not being aware or unsure, was associated with being younger (18-25 years old), having a college degree, and having alcohol use disorder symptoms. Black women were less likely than white women to report awareness of the alcohol use and breast cancer link. CONCLUSIONS: Overall, only a quarter of U.S. women were aware that alcohol use increases breast cancer risk, although 40% expressed uncertainty. Differences in awareness by age, level of education, race and ethnicity and level of alcohol use offer opportunities for tailored prevention interventions, while the overall low level of awareness calls for widespread efforts to increase awareness of the breast cancer risk from alcohol use among U.S. women.
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Alcoolismo , Neoplasias da Mama , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , DemografiaRESUMO
Wide-ranging effects of the COVID-19 pandemic have led to increased psychological distress and alcohol consumption, and disproportionate hardship for disadvantaged groups. Early in the pandemic, telehealth services were expanded to maintain healthcare access amidst lockdowns, medical office closures, and fear of infection. This study examines general and behavioral healthcare access and disparities during the first year of the pandemic. Data are from the 2019-2020 US National Alcohol Survey (collected February 2019 to April 2020) and its COVID follow-up survey conducted January 30 to March 28, 2021 (N = 1819). General and behavioral healthcare-related outcomes were assessed at follow-up, and included perceived need for and receipt of care, delayed care, and use of telehealth since April 1, 2020. Results indicate that the majority of respondents with perceived need for healthcare received some behavioral healthcare (reported by 63%) and particularly general healthcare (88%), but nearly half (48%) delayed needed care. Delays were mostly due to COVID-related reasons, but cost barriers also were common and significantly impeded care-seeking by uninsured persons, young adults, rural residents, and persons whose employment was reduced by the pandemic. Disparities in the receipt of healthcare were pronounced for Hispanic/Latinx (vs. White) and lower-income (vs. higher-income) groups (AORs <0.37, p's < 0.05). Notably, telehealth was commonly used by Hispanic/Latinx and lower-income groups for general and particularly behavioral healthcare. Results suggest that telehealth has provided an important bridge to healthcare for certain medically underserved groups during the pandemic, and may be vital to future efforts to increase equity in healthcare access.
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COVID-19 , Telemedicina , Adulto Jovem , Humanos , Pandemias , Controle de Doenças Transmissíveis , Acessibilidade aos Serviços de SaúdeRESUMO
Most research on cultural stressors and alcohol has focused on intercultural stressors. Continuing to exclude intracultural stressors (e.g., intragroup marginalization) from alcohol research will yield a biased understanding of the experiences of Hispanics living in a bicultural society. As we amass more studies on intracultural stressors, research will be needed to identify mutable sociocultural factors that may mitigate the association between intracultural stressors and alcohol. To address these limitations, we examined the association between intragroup marginalization and alcohol use severity and the extent to which gender and bicultural self-efficacy may moderate this association. A convenience sample of 200 Hispanic emerging adults ages 18-25 (men = 101, women = 99) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Higher intragroup marginalization was associated with higher alcohol use severity. Gender functioned as a moderator whereby intragroup marginalization was associated with higher alcohol use severity among men, but not women. Also, higher social groundedness functioned as a moderator that weakened the association between intragroup marginalization and alcohol use severity. Role repertoire did not function as a moderator. Our findings are significant because they enhance the reliability of the association between intragroup marginalization and alcohol use severity, and the moderating effect of gender in this respective association. This emerging line of research suggests that alcohol interventions targeting Hispanics may have a significant limitation by not accounting for intracultural stressors.
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Adaptação Psicológica , Consumo de Bebidas Alcoólicas , Hispânico ou Latino , Autoeficácia , Estresse Psicológico , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/psicologia , Estudos Transversais , Cultura , Papel de Gênero , Hispânico ou Latino/psicologia , Gravidade do Paciente , Reprodutibilidade dos Testes , Fatores Sexuais , Marginalização Social/psicologia , Estresse Psicológico/etnologia , Estresse Psicológico/psicologiaRESUMO
BACKGROUND: Surveys of changes in drinking during the COVID-19 pandemic have primarily relied on retrospective self-report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage-specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use. METHODS: Data from 1819 completed interviews from the N14C follow-up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage-specific quantity and frequency, and DSM-5 AUD items were asked in both surveys and used to estimate changes from pre-pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age. RESULTS: Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits. CONCLUSIONS: Results confirm prior findings of overall increases and subgroup-specific changes, and importantly, provide detailed information on the patterns of change across major socio-demographic subgroups. Substantial increases in the prevalence of DSM-5 moderate to severe AUDs are a novel finding that is of particular concern.
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Alcoolismo , COVID-19 , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , COVID-19/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pandemias , Estudos RetrospectivosRESUMO
Objectives: The misuse of prescription drugs in the U.S. is an alarming public health crisis. Prior research at the U.S.-Mexico border has found high rates of prescription drug misuse, but with rates varying significantly across border communities. We aimed to examine a model of permissive climate measures and stress exposures as potential mediators of community differences in prescription drug misuse at the U.S.-Mexico border.Design: We analyzed data from the U.S.-Mexico Study of Alcohol and Related Conditions (UMSARC). Household, in-person interviews were conducted with Mexican-origin residents of the Texas border cities Laredo (n = 751) and Brownsville/McAllen (n = 814). Interviews assessed past-year misuse of any and pain-reliever prescription drugs. Drug availability, neighborhood safety, exposure to violence/crime, and social support were examined as potential mediators. Analyses were stratified by gender and employed regressions and mediation analysis with Mplus.Results: The past-year prevalence of any prescription drug misuse in Laredo was 26.3% among women and 24.4% among men, and in Brownsville/McAllen was 12.4% among men, and 6.7% among women. Mediation analysis revealed site effects via some of the hypothesized risk factors for men, but not for women. Specifically, for men, site effects on any and pain reliever prescription drug misuse were partially mediated via high drug availability and low family support.Conclusions: Past-year prescription drug misuse was over 3 times the 2015 national prevalence among both men and women in Laredo and calls for immediate attention. Findings regarding the model suggest drug availability and social support may be relevant to understanding community differences in prescription drug misuse among men living at the border, and that additional factors should be investigated to understand misuse among women living at the border.
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Transtornos Relacionados ao Uso de Álcool , Uso Indevido de Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Emigração e Imigração , Feminino , Humanos , Masculino , Americanos Mexicanos , México/epidemiologia , Texas/epidemiologiaRESUMO
BACKGROUND: Valid measurement of alcohol use can be difficult in surveys, which are subject to biases like underreporting and differential nonresponse. Still, monitoring trends, policy impacts, disparities, and related issues all require valid individual- and state-level drinking data collected over time. Here, we propose a double-adjustment approach for improving the validity of the Behavioral Risk Factor Surveillance System (BRFSS) alcohol measures. METHODS: Validity analyses of the 1999 to 2016 BRFSS, a general population survey of U.S. adults. Measures are aggregated to state level for N = 918 observations, single-adjusted for BRFSS methodologic changes, and double-adjusted by per capita consumption. Fixed-effects models: (i) assess predictive validity using adjusted BRFSS drink volume to predict mortality outcomes and (ii) assess outcome validity using state-level alcohol taxes to predict adjusted BRFSS volume. RESULTS: Neither the raw nor the single-adjusted BRFSS drinking measures were related to mortality in the expected direction, while double-adjusted BRFSS volume and 5+ days were significantly positively related to mortality, as expected. Spirits and beer taxes were not related to single-adjusted BRFSS drinking in the expected direction. However, spirits and beer taxes were both significantly related to double-adjusted BRFSS volume in the expected directions. CONCLUSIONS: Future studies should consider using the double-adjusted BRFSS measures to ensure the validity of drinking survey data in analyses where variation over time is considered.
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Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas , Política Pública , Impostos , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto JovemRESUMO
OBJECTIVE: Hispanic immigrants exhibit more positive outcomes than U.S.-born Hispanics across educational, psychological, and physical health indices, a phenomenon called the immigrant paradox. We examined the immigrant paradox in relation to alcohol use severity among Hispanic young adults while considering both positive (optimism) and negative (depressive symptoms) processes. METHOD: Among 200 immigrant and U.S.-born Hispanic young adults (Mage = 21.30; 49% male) in Arizona and Florida, we tested whether optimism and depressive symptoms statistically mediated the relationship between nativity and alcohol use severity. Specifically, we examined whether Hispanic immigrants reported greater optimism than their U.S.-born counterparts, and whether such optimism was, in turn, associated with less depressive symptoms and thus lower alcohol use severity. RESULTS: Indirect effects were significant in hypothesized directions (nativity â optimism â depressive symptoms â alcohol use severity). CONCLUSIONS: Both positive and negative psychological processes are important to consider when accounting for the immigrant paradox vis-à-vis alcohol use severity among Hispanic young adults.
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Consumo de Bebidas Alcoólicas/etnologia , Depressão/etnologia , Emigrantes e Imigrantes/psicologia , Hispânico ou Latino/psicologia , Otimismo/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Modelos Psicológicos , Índice de Gravidade de Doença , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Recent increases in alcohol-related morbidity and mortality have not occurred alongside notable increases in per capita alcohol consumption (PCC). This discrepancy may be partially due to U.S. PCC estimates not including annual estimates of the percentage of alcohol by volume (%ABV) of beer, wine, and spirits, but rather relying on time-invariant %ABV values. METHODS: Building on a prior study covering 1950 to 2002, estimates of the annual mean %ABV of beer, wine, and spirits sold in the United States were calculated using the %ABV of major brands and sales of each beverage type for each state and nationally for the period 2003 to 2016. We applied these estimates to the calculation of annual beverage-specific and total PCC, and made descriptive comparisons between our PCC estimates and those estimates using invariant %ABV values. RESULTS: For all beverage types, our mean %ABV estimates increased nationally and for all but 5 states. The PCC estimates from wine and spirits utilizing variable %ABV values were lower than estimates using invariant %ABV, and consumption from beer was higher. Our total PCC estimates were also lower than %ABV-invariant estimates; however, the percent change for %ABV-invariant estimates was 5.8% compared to a 7.9% change in our %ABV-variant estimates over the 2003 to 2016 period. CONCLUSIONS: Given the application of PCC estimates to understand changes in alcohol-related morbidity and mortality, the inclusion of annual estimates of the %ABV of alcoholic beverages sold in the United States is necessary to ensure the precision of PCC measures such that the conclusions drawn from these applications are accurate and valid.
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Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/tendências , Bebidas Alcoólicas/análise , Interpretação Estatística de Dados , Etanol/análise , Humanos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Policies regarding alcohol use during pregnancy continue to be enacted and debated in the United States. However, no study to date has examined whether these policies are related to birth outcomes-the outcomes they ultimately aim to improve. Here, we assessed whether state-level policies targeting alcohol use during pregnancy are related to birth outcomes, which has not been done comprehensively before. METHODS: The study involved secondary analyses of birth certificate data from 148,048,208 U.S. singleton births between 1972 and 2013. Exposures were indicators of whether the following 8 policies were in effect during gestation: Mandatory Warning Signs (MWS), Priority Treatment for Pregnant Women, Priority Treatment for Pregnant Women/Women with Children, Reporting Requirements for Data and Treatment Purposes, Prohibitions Against Criminal Prosecution, Civil Commitment, Reporting Requirements for Child Protective Services Purposes, and Child Abuse/Child Neglect. Outcomes were low birthweight (<2,500 g), premature birth (<37 weeks), any prenatal care utilization (PCU), late PCU, inadequate PCU, and normal (≥7) APGAR score. Multivariable fixed-effect logistic regressions controlling for both maternal- and state-level covariates were used for statistical analyses. RESULTS: Of the 8 policies, 6 were significantly related to worse outcomes and 2 were not significantly related to any outcomes. The policy requiring MWS was related to the most outcomes: specifically, living in a state with MWS was related to 7% higher odds of low birthweight (p < 0.001); 4% higher odds of premature birth (p < 0.004); 18% lower odds of any PCU (p < 0.001); 12% higher odds of late PCU (p < 0.002); and 10% lower odds of a normal APGAR score (p < 0.001) compared to living in a state without MWS. CONCLUSIONS: Most policies targeting alcohol use during pregnancy do not have their intended effects and are related to worse birth outcomes and less PCU.
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OBJECTIVE: To compare drug use for cities along the USMexico border. MATERIALS AND METHODS: Data are from the US-Mexico Study on Alcohol and Related Conditions (UMSARC, 2011-2013), a survey of 4 796 randomly selected BMexican and of Mexican origin individuals on both sides of the border. RESULTS: Higher rates of any past-year drug use and symptoms of drug use disorders were found only in the border city of Laredo, when compared to the non-border city of San Antonio. Nuevo Laredo and Reynosa/Matamoros showed higher rates of drug use than the non-border city of Monterrey. Much higher rates (OR's in the range of 4-11) were found in the US cities when compared to their acrossthe-border Mexican counterparts. CONCLUSIONS: Drug use is high on the border for the selected Mexican cities. Misuse of prescription drugs is nevertheless a concern in the south Texas border cities in our study.
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Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Cidades , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos de Amostragem , Fatores Socioeconômicos , Texas/epidemiologia , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: There is a paucity of genetics research examining alcohol use among Latinos. The purpose of this study is to examine Latino perceptions of participation in alcohol studies that collect biological samples, an important precursor to increasing their participation in genetics research. METHODS: A synthesis of the literature addressing participation of racial/ethnic minorities in alcohol genetics research was undertaken. We developed a framework of themes related to barriers and facilitators for participation, which we then used to analyze two focus groups held with 18 Latino participants. RESULTS: From the literature review, we identified nine themes related to facilitators of and barriers to participation. They are, on continua: curiosity to disinterest; trust to mistrust; understanding to confusion; safety to danger; inclusion to exclusion; sense of connection to disconnection; hope to despair; ease to hassle; and benefit to cost. Another theme emerged from the focus groups: previous experience to no previous experience with health research. CONCLUSIONS: Applying the themes from the literature review to Latino perspectives on providing biological samples for alcohol research helps expand their definition and applicability. Consideration of these themes when designing recruitment/retention materials and strategies may encourage Latino participation in alcohol genetics research. SCIENTIFIC SIGNIFICANCE: An understanding of these themes and their significance for Latinos is offered in the form of "guiding questions" for researchers to consider as we strive for more inclusive research. Focus group participants were Mexican American; future research should further explore perspectives of this heterogeneous demographic group by studying other Latino subgroups. (Am J Addict 2017;26:477-485).
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Participação da Comunidade , Pesquisa em Genética , Hispânico ou Latino , Grupos Focais , HumanosRESUMO
BACKGROUND: Alcohol use is a major public health problem with vast implications for poor, war-torn countries. The objective of this study was to describe prevalence of alcohol use and risky drinking across socio-demographic factors in South Sudan, and to determine the association between risky drinking, traumatic events and mental distress. METHODS: This is a randomized, population based, cross-sectional study from the north-western part of South Sudan with nearly 500 participants. We used the Alcohol Use Disorders Identification Test (AUDIT) as main outcome variable, the General Health Questionnaire (GHQ-28) for mental distress and five questions to assess traumatic events. RESULTS: The mean AUDIT score was 2.7 (SD 0.3) with 14,2 % in the high risk problem drinking category. Being male, lack of a regular income and psychological distress were significantly associated with higher AUDIT score. Traumatic events, however, was not associated with higher score on AUDIT. CONCLUSION: Despite decades of civil war and great poverty the alcohol use in this population was at the same level as other countries in Southern Africa. Traumatic events were not related to risk of problem drinking.
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Consumo de Bebidas Alcoólicas/epidemiologia , Transtorno Depressivo/psicologia , Apoio Social , Guerra , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Prevalência , Sudão do Sul/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Activation of the kynurenine pathway of tryptophan metabolism results in increased production of potentially depressogenic tryptophan catabolites and a reduction in tryptophan availability for serotonin synthesis. As alcohol consumption affects tryptophan metabolism and disposition, we determined serum levels of tryptophan, kynurenine, and an index of tryptophan degradation (kynurenine/tryptophan ratio) in patients with alcohol-use disorder (AUD) and compared their levels considering abstinence duration, AUD severity, and comorbid depression. METHODS: The study sample included 169 AUD inpatients from 8 alcohol treatment facilities in Kathmandu, Nepal. The Composite International Diagnostic Interview was administered to generate the AUD diagnosis. The Alcohol Use Disorder Identification Test (AUDIT) captured AUD severity and patterns of alcohol use. The Hopkins Symptom Checklist-25 was used to reveal current depressive symptoms. Serum kynurenine and tryptophan levels were determined by high-performance liquid chromatography, and tryptophan degradation was measured by KT ratio (kynurenine/tryptophan × 10(3)). RESULTS: Patients with above average AUDIT scores had higher mean serum levels of kynurenine (2.1 µM ± 0.7 vs. 1.8 µM ± 0.6, p = 0.006) and KT ratios (48.6 ± 17.6 vs. 40.4 ± 14.3, p = 0.002) than those with below average scores. Patients with current depressive symptoms had higher mean tryptophan concentrations (49.9 µM ± 13 vs. 45.7 µM ± 14.1, p = 0.047) and lower KT ratios (41.4 ± 14 vs. 47.5 ± 17.6, p = 0.028) compared to patients whose reported depressive symptoms were below the standard cutoff. Higher tryptophan levels and lower KT ratios in the depressed group were specific to patients with longer abstinence and higher AUD severity. CONCLUSIONS: Depression-related deregulation in tryptophan metabolism was found to depend on length of abstinence and on AUD severity. Together, results suggest that in AUD populations, peripheral tryptophan metabolism is subject to interactions between AUD severity and depressive symptoms.
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Transtornos Relacionados ao Uso de Álcool/sangue , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Depressão/sangue , Depressão/epidemiologia , Triptofano/sangue , Adulto , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Biomarcadores/sangue , Estudos Transversais , Depressão/diagnóstico , Feminino , Humanos , Cinurenina/sangue , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Resultado do Tratamento , Triptofano/metabolismo , Adulto JovemRESUMO
BACKGROUND: Little population-based data among middle-aged adults exists examining the relationships between depressive symptoms, alcohol use, and socio-economic status (SES). This study aimed to describe the relationships between depressive symptoms and alcohol use at different levels of SES and to determine differences across SES levels among a population-based sample of 40 and 45 year old adults in Norway. METHODS: This analysis was based on data from two Norwegian health studies conducted in 2000 and 2001, and included community-dwelling Norwegian men and women aged 40 and 45 years. Self-reported frequency and quantity of alcoholic drinks was used to calculate past-year typical quantity of drinks consumed and frequency of 5+ drinks per occasion, or heavy episodic drinking (HED). Depressive symptoms were assessed with the 10-item Hopkins Symptom Checklist, and SES was measured as education level and employment status. To observe the association between depressive symptoms and alcohol use at each level of SES we fitted multinomial logistic regression models using each alcohol outcome as a dependent variable stratified by level of education and employment. To observe differences across levels of SES, we examined the interaction between depressive symptoms and SES level in multinomial logistic regression models for each alcohol measures. RESULTS: Having depressive symptoms was significantly associated with an increased risk of 5+ typical drinks among people in the lowest (RRR = 1.60, p ≤ 0.05) education level, and not among people in the highest. Conversely, significant associations were observed among all levels of employment. For frequency of HED, depressive symptoms was not significantly associated with frequency of HED at any education level. Depressive symptoms was associated with 13+ past year HED episodes among people with no employment (RRR = 1.97, p ≤ 0.05), and part-time employment (RRR = 2.33, p ≤ 0.01), and no association was observed among people with full-time employment. A significant interaction was observed for depressive symptoms and employment for risk of 13+ past-year HED episodes. CONCLUSIONS: The results show a variety of associations between depressive symptoms and alcohol use among people with lower SES, and suggest type of alcohol use and SES measure may influence the observation of an association between depressive symptoms and alcohol use at different SES levels.
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Consumo de Bebidas Alcoólicas/epidemiologia , Depressão/epidemiologia , Adulto , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Fatores SocioeconômicosRESUMO
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.
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Transtornos Relacionados ao Uso de Álcool/etnologia , Alcoólicos Anônimos , Disparidades em Assistência à Saúde/tendências , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Feminino , Inquéritos Epidemiológicos , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Fatores Sexuais , Controle Social Formal , Controles Informais da Sociedade , Estados Unidos/epidemiologia , Estados Unidos/etnologia , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: The literature from developed countries suggests a relationship between alcohol use and quality of life and social engagement, where harmful drinkers have lower quality of life and less social engagement. Despite the high rates of harmful alcohol use in South Africa, little is known about the association between drinking pattern and quality of life and social engagement in this context. We aimed to determine if quality of life and social engagement varied across different drinking patterns among older South African adults, contributed to drinking pattern when controlling for socio-demographic factors, and varied differentially between genders. METHODS: This is a secondary analysis of data from the Survey on Global Ageing and Adult Health (SAGE). Alcohol use was measured as self-reports of use over the previous seven days, and we constructed gender-specific alcohol variables. The WHO Quality of Life-scale was used to measure quality of life, and social engagement was measured by frequency of participation in social activities. We used ANOVA to observe differences in quality of life and social engagement scores across drinking patterns, and regression models were used to identify factors independently associated with drinking pattern. RESULTS: There were 2572 (84.4%) lifetime abstainers, and 475 (15.6%) persons who had a drink in the last 7 days. In bivariate analysis, quality of life was lowest among at risk drinking men compared to abstainers (OR=0.21, p=0.02), although this association was not significant in adjusted analysis. Social engagement did not vary statistically significantly across the drinking patterns in the total sample or within gender. CONCLUSIONS: Quality of life and social engagement were not independently associated with drinking pattern among older adults in South Africa in this sample. In order to better understand their alcohol use, further exploratory research is warranted to identify other potentially relevant subjective factors of alcohol use among older adults in South Africa.
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Abstinência de Álcool , Consumo de Bebidas Alcoólicas , Relações Interpessoais , Qualidade de Vida , Envelhecimento , Alcoolismo , População Negra , Etanol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , África do SulRESUMO
INTRODUCTION: Multimorbidity, the presence of two or more long-term health conditions in the same individual, is an emerging epidemic associated with increased morbidity and mortality. Continued drinking concurrent with alcohol-related chronic conditions, particularly with multimorbidity, is likely to further elevate health risk. This study aimed to examine the associations of multimorbidity among diabetes, hypertension, heart disease, and cancer with drinking, and moderation of these associations by age. METHODS: Logistic regression modeling was performed in 2023 using a nationally representative sample of U.S. adults from the 2015-19 National Survey on Drug Use and Health. Multimorbidity was assessed using (1) a count of these conditions and (2) disease-specific categories. The outcomes were past month heavy drinking (7+/14+ drinks weekly) and binge drinking (4+/5+ drinks per occasion) for women and men. RESULTS: A pattern of reduced odds for drinking outcomes associated with a greater degree of multimorbidity was found. This pattern was more apparent in models using the continuous measure of multimorbidity than in those using the categorical measure, and more consistent for binge drinking than for heavy drinking and for women than for men. Significant age interactions were found: the log odds of heavy drinking and binge drinking for both men and women decreased as the number of conditions increased, and more steeply for those ages 50+ than the younger. The log odds of heavy drinking varied little among men under age 50 regardless of multimorbidity. CONCLUSIONS: Alcohol interventions to reduce drinking with multimorbidity, particularly among heavy-drinking men under age 50, are warranted.
Assuntos
Consumo Excessivo de Bebidas Alcoólicas , Multimorbidade , Humanos , Masculino , Feminino , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Pessoa de Meia-Idade , Adulto , Estados Unidos/epidemiologia , Idoso , Adulto Jovem , Diabetes Mellitus/epidemiologia , Inquéritos Epidemiológicos , Hipertensão/epidemiologia , Neoplasias/epidemiologia , Cardiopatias/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Adolescente , Modelos Logísticos , Fatores EtáriosRESUMO
BACKGROUND: Although studies are increasingly adopting online protocols, few such studies in the addiction field have comprehensively described their data review procedures and successes in detecting low-quality/fraudulent data. The current study describes data collection protocols and outcomes of a large, longitudinal study (the PAL Study 2021) that implemented online design elements to study individuals seeking peer support for an alcohol use disorder. METHODS: In 2021, the PAL Study collaborated with mutual-help group (MHG) partners and recovery-related organizations to recruit individuals attending a 12-step group, Women for Sobriety (WFS), LifeRing Secular Recovery, and/or SMART Recovery for an alcohol problem in-person and/or online in the prior 30 days. Participation was solicited both online and in-person. Individuals accessed baseline surveys via an open web link; follow-ups occurred at 6 and 12 months. Analyses included calculating the proportion of surveys eliminated in data quality review; comparing MHG subsamples to internal survey (benchmark) data for Alcoholics Anonymous (AA), WFS, LifeRing, and SMART; and examining response rates and attrition. RESULTS: Although 93% of respondents who opened the baseline survey completed it, 87% of baseline surveys were eliminated in data quality review (final N = 531). Nonetheless, cleaned MHG subsamples were generally similar to benchmark samples on gender, age, race/ethnicity, and education. Follow-up rates for the cleaned sample were 88% (6 months) and 85% (12 months). Analyses revealed some differences in attrition by gender, primary MHG, and lifetime drug problems, but there was no evidence of greater attrition among those in earlier/less stable recovery. CONCLUSIONS: Study methods appear to have produced a valid, largely representative sample of the hard-to-reach target population that was successfully followed across 12 months. However, given the high survey elimination rate and need for extensive data review, we recommend that researchers avoid open-link designs and include comprehensive data review when incorporating online design elements.
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OBJECTIVE: Alcohol involvement is declining among U.S. adolescents, however studies examining population-level trends in alcohol involvement among females and males from diverse racial and ethnic backgrounds are scarce. Therefore, the current study examined alcohol involvement from 2002 to 2019 among Hispanic, Black, and White U.S. adolescent females and males. METHOD: Data were from the National Survey on Drug Use and Health, years 2002-2019. Participants were between 12 to 17 years old and Hispanic, non-Hispanic Black, or non-Hispanic White. Annualized change estimates within each subgroup were analyzed separately for four alcohol variables: 1) lifetime alcohol use; 2) age at alcohol initiation; 3) past-year drinking days; 4) respondent's perceived risk of alcohol misuse. RESULTS: Lifetime alcohol use decreased for all groups, and the decrease was strongest for Hispanic males. Age at alcohol initiation similarly increased for Hispanic and White females and males, with no change in age at alcohol initiation for Black adolescents. Past-year drinking days declined for all groups but was not significant for Black females. Perceiving alcohol misuse as a "great risk" increased only for Hispanic males and females. CONCLUSIONS: Although alcohol involvement is declining among U.S. adolescents, results from this study highlight that engaging with alcohol is normative among many adolescent groups. Also, when considering sex as well as race and ethnicity, there are important distinctions in patterns of decline in alcohol involvement that should be accounted for to inform future research and screening.
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OBJECTIVE: Mutual-help groups (MHGs) like Alcoholics Anonymous (AA) are effective for resolving alcohol use disorders (AUDs), but few studies have examined disparities in MHG participation, particularly recently. We used five waves of National Alcohol Survey data to investigate whether prevalence of AA attendance among those with a lifetime AUD differed by race/ethnicity, age, and sex, directly testing whether these associations varied with time. METHOD: Analyses pooled weighted data from 2000 to 2020, including only participants with a lifetime AUD and identifying as non-Hispanic White, Latinx/Hispanic, or non-Hispanic Black/African American (N = 8,876). Logistic regression models examined associations between lifetime AA attendance and survey year, race/ethnicity, age, and sex; models also tested for differences in demographic effects across survey year using interaction terms. RESULTS: In bivariate models, AA attendance was significantly less prevalent among participants identifying as Latinx/Hispanic (vs. White); ages 18-29 (vs. 30-64); and female (vs. male). Survey year was unrelated to AA attendance, and all interactions involving survey year were nonsignificant. In the final multivariate model (which controlled for severity and other help-seeking), disparities persisted for those identifying as Latinx/Hispanic (vs. White; adjusted odds ratio [aOR] = 0.63) and ages 18-29 (vs. 30-64; aOR = 0.35); AA attendance was also less prevalent among Black/African American (vs. White) participants (aOR = 0.59), but sex became nonsignificant. CONCLUSIONS: Results replicate and extend sparse findings regarding disparities in MHG attendance and suggest a stagnation in AA's growth and reach to underserved populations. Findings highlight the need to more effectively facilitate MHG attendance (and perhaps broader social network change) among racial/ethnic minorities and emerging adults.