Neighborhood Contexts and Alcohol Use Disorder Among Mexican Americans Living in the US-Mexico Border Region.

AIMS: This study assessed contributions of exposure to neighborhood stressors (violent victimization, witnessing crime, greater alcohol and drug availability) to variation in alcohol use disorder (AUD) symptoms among drinkers in three cities in Texas, USA. METHODS: We used data from interviews conducted from 2011 to 2013 with Mexican-origin adults (ages 16-65) in the US-Mexico Study of Alcohol and Related Conditions who were past-year drinkers (N = 1960; 55% male) living in two cities in the Texas-Mexico border region (Laredo, n = 751 and Brownsville/McAllen, n = 814) and one interior comparison site (San Antonio, n = 771). Analyses (conducted in 2018 and 2019) examined overall and gender-stratified multilevel mediated effects of each border site (versus San Antonio) on AUD symptoms through the neighborhood-level factors, adjusting for individual- and neighborhood-level covariates. RESULTS: Overall, drinkers in Laredo reported more AUD symptoms than drinkers in the other cities, and their neighborhoods had more witnessing of crime and greater perceived drug availability, as well as higher levels of disadvantage and a lower proportion non-Hispanic White residents, than neighborhoods in San Antonio. Witnessing neighborhood crime was associated with increased AUD symptoms, while neighborhood disadvantage and proportion non-Hispanic White residents each were negatively associated with AUD symptoms. Perceived neighborhood insecurity, crime victimization, perceived neighborhood drug availability and neighborhood alcohol availability (off- and on-premise) were not significantly associated with AUD symptoms. Stratified models suggested possible gender differences in indirect effects through witnessing neighborhood crime. CONCLUSION: Reducing witnessing of neighborhood crime may help reduce AUD symptoms among adults living in the US border region.

Black-White differences in barriers to specialty alcohol and drug treatment: findings from a qualitative study.

The objective of this study was to explore, in-depth, differences in barriers to specialty alcohol and drug treatment services between Black and White participants with recent substance use disorders (SUD). We recruited 34 participants with a recent SUD of White and Black racial/ethnic descent for qualitative interviews. Interviews were coded to identify barriers to specialty treatment. We found that barriers related to stigma and lack of social support were more pervasive in the narratives of Blacks as compared to Whites. Results suggest that stigma and lack of perceived social support may impact Blacks more than Whites in seeking SUD treatment.

Understanding differences in prescription drug misuse between two Texas border communities.

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.

The Downward Spiral: Socioeconomic Causes and Consequences of Alcohol Dependence among Men in Late Young Adulthood, and Relations to Racial/Ethnic Disparities.

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.

Gender Differences in Use of Alcohol Treatment Services and Reasons for Nonuse in a National Sample.

BACKGROUND: The majority of adults with alcohol use disorders do not obtain help, and women are less likely to utilize alcohol services than men. We sought to quantify gender differences in alcohol services utilization, overall and by type, using national longitudinal data and to explore potential gender differences in perceived need for help and reasons for not seeking help. METHODS: We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions from White, African American, and Hispanic adults (n = 2,592) who met DSM-IV criteria for alcohol abuse or dependence at Wave 1 (2000 to 2001). We tested gender differences in Wave 2 (2004 to 2005) services utilization, perceived need for help, and treatment barriers using Rao-Scott chi-square tests and assessed predictors of outcomes in multivariable logistic regression, adjusting for problem severity, co-occurring disorders, and demographics. RESULTS: Women had much lower odds than men of utilizing any alcohol service (adjusted odds ratio [aOR] 0.53; 95% confidence interval [95% CI]: 0.33, 0.86), specialty services (aOR 0.41; 95% CI 0.19, 0.87), and 12-step groups (aOR 0.39; 95% CI 0.21, 0.71). Perceived need for help among those who had not used any services was very low (5%), with no gender difference. Further, men and women reported equivalent numbers of treatment barriers and the same rank order for the most frequently endorsed barriers. However, women were twice as likely as men to think a problem would get better by itself-the most frequent reason for not seeking help (47% vs. 24%, p < 0.001), and men were more likely than women to report unsuccessful past help-seeking and not thinking anyone could help (19% vs. 3%, p < 0.001 and 17% vs. 5%, p = 0.001, respectively). CONCLUSIONS: Consistent with previous studies, women were less likely to utilize alcohol services than men. Future interventions should address low problem recognition, and tailoring to gender-specific barriers may help close the disparity in services utilization.

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking.

BACKGROUND: African Americans are generally known to have lower heavy drinking prevalence than Whites despite often greater individual and community risk factors. While it is supposed that their protective resources explain this "paradox," studies have not explicitly examined this. OBJECTIVE: Assess the contribution of protective resources to Black-White differences in heavy drinking, and (secondarily) whether protective resources operate by reducing heavy drinking and/or increasing abstinence. METHODS: Using data from the 2009-2010 U.S. National Alcohol Survey (N = 3,133 Whites and 1,040 Blacks ages 18+), we applied propensity score (PS) weighting to estimate racial differences in heavy drinking and abstinence under hypothetical conditions in which Whites are similar to Blacks in: (1) age and marital status; (2) socioeconomic position and unfair treatment; (3) neighborhood socioeconomic conditions and alcohol outlet density; and (4) protective resources (proscriptive religiosity, area-level religiosity, "drier" network drinking norms and patterns, and family social support). RESULTS: The Black-White gap in male and female drinkers' baseline heavy drinking increased after weighting adjustments for demographics. In women, this gap was reduced after weighting on disadvantage and eliminated after adjusting for protective resources. In men, adjustment for disadvantage increased the racial gap, and protective resources reduced it. Protective resources had a stronger effect on Black-White differences in men's abstinence than heavy drinking, but similar effects on these outcomes in women. CONCLUSION: Protective resources help explain Black-White differences in men's and particularly women's heavy drinking. Future research is needed to elucidate mechanisms of action and additional factors underlying racial differences in men's heavy drinking.

Drug use on both sides of the US-Mexico border.

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.

Prevalence and correlates of arrests or stops for drunk driving on both sides of the U.S.-Mexico border.

Risk for driving under the influence of alcohol (DUI) may be higher in U.S. and Mexico border cities as compared to nonborder cities in each country. We examine rates and correlates of self-reported DUI arrests or stops on both sides of the border, drawing on a large-scale survey of 4,796 Mexicans and Mexican Americans in border and nonborder cities of Texas and two states in Mexico. Findings varied by site and country and did not consistently show higher rates on the border. DUI prevention efforts should consider the heterogeneity of local conditions and needs.

Racial/ethnic differences in life-course heavy drinking from adolescence to midlife.

Information on heavy drinking over the life course might help to explain racial/ethnic disparities in alcohol-related problems, morbidity, and mortality. Using data from the 2009-2010 U.S. National Alcohol Survey (n = 3,026), we analyzed retrospective decades-based measures of heavy drinking during respondents' teens, 20s, 30s, and 40s. Results indicate that Latino men and African American women have greater risk for persistent-high (vs. declining) heavy-drinking trajectories than Caucasian men and women, and that socioeconomic disadvantage partly accounts for this disparity in women. Prospective longitudinal studies are needed to confirm these results and to elucidate the relationship of life-course heavy-drinking patterns with health-related outcomes, and disparities in these.

Alcohol Use Patterns and DSM-5 Alcohol Use Disorder on Both Sides of the U.S.-Mexico Border.

BACKGROUND: Alcohol consumption patterns on the U.S.-Mexico border and their relationships with DSM-5 alcohol use disorders (AUD) have been understudied. Yet, the effects of drinking by Mexican-origin individuals may differ between cities on versus off the border both in the United States and in Mexico. We characterize prior 12-month drinking patterns and examine their relationships with AUD, in border and off-border cities of Texas and adjacent Mexican states. METHODS: Data come from the U.S.-Mexico Study of Alcohol and Related Conditions involving 2,336 Mexican Americans in Texas and 2,460 Mexicans in bordering states of Nuevo Leon and Tamaulipas in Mexico. Drinking pattern was defined as an interaction between volume and maximum amount, or intensity (never vs. ever 5+/4+ [men/women], 8+, and 12+ drinks in a day). DSM-5 AUD was assessed using an adaptation of the Alcohol Section of the World Health Organization Composite International Diagnostic Interview core. Separately by gender, 5 logistic regressions models controlling for age were estimated predicting symptoms in 2 or more AUD criteria domains from volume, heavy pattern and, successively, effects of country, and (by country) residing on vs. off the border, or in each of 3 cities/country. RESULTS: A segmentation analysis for Texas males based on rate of experiencing AUD generated several distinct volume groups, each partitioned by an empirically selected maximum, and helped identify a drinking-pattern typology. In gender-stratified models of AUD rates using this typology, adjusting for age, significant volume and intensity effects were seen, more strongly in the United States. Border versus interior differences implied more AUD for given patterns at the border in the United States and the reverse in Mexico, with some city differences also evident. CONCLUSIONS: Drinking-pattern analyses confirm that border proximity may affect drinking problems but in opposite directions in the United States and Mexico, possibly related to economic and psychological stresses specific to respective communities.

Job loss and alcohol dependence among Blacks and Whites in a National Longitudinal Survey.

We used the 1979 National Longitudinal Survey of Youth to test whether the association between job loss and incidence of alcohol dependence differed across Blacks and Whites. Respondents were interviewed annually from 1979 to 1994; DSM-IV dependence was assessed in 1989 and 1994. Analyses included only those employed in 1989 and involved lagged logistic regressions predicting past-year dependence in 1994 from job loss during 1990-1993. Unexpectedly, results showed stronger and more robust associations between job loss and dependence among Whites (AOR = 1.93, p < .05) than among Blacks (AOR = 0.82, nonsignificant). Findings diverge from prior research, suggesting disparities may differ as a function of age and/or time.

Substance Use and Cumulative Exposure to American Society: Findings From Both Sides of the US-Mexico Border Region.

OBJECTIVES: We investigated whether Mexican immigration to the United States exerts transnational effects on substance use in Mexico and the United States. METHODS: We performed a cross-sectional survey of 2336 Mexican Americans and 2460 Mexicans in 3 Texas border metropolitan areas and their sister cities in Mexico (the US-Mexico Study on Alcohol and Related Conditions, 2011-2013). We collected prevalence and risk factors for alcohol and drug use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol-use disorders; and 2 symptoms (hazardous use and quit or control) of drug use disorder across a continuum of migration experiences in the Mexican and Mexican American populations. RESULTS: Compared with Mexicans with no migrant experience, the adjusted odds ratios for this continuum of migration experiences ranged from 1.10 to 8.85 for 12-month drug use, 1.09 to 5.07 for 12-month alcohol use disorder, and 1.13 to 9.95 for 12-month drug-use disorder. Odds ratios increased with longer exposure to US society. These findings are consistent with those of 3 previous studies. CONCLUSIONS: People of Mexican origin have increased prevalence of substance use and disorders with cumulative exposure to US society.

Factors Explaining Variation in Alcohol Use Disorder Prevalence Across Border and Nonborder Communities in Texas.

BACKGROUND: U.S. border populations have been found to be at high risk for alcohol problems. However, results from the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC) revealed surprisingly large variation in alcohol outcomes even among Texas border sites, with alcohol use disorder (AUD) prevalence ~1.5 to 1.6 times greater in the border city of Laredo compared to both San Antonio and the border site of McAllen/Brownsville. Because a better understanding of this variation is important to identifying environmental influences on AUD, we developed and tested a conceptual model addressing variation in AUD prevalence across Texas UMSARC sites. METHODS: Surveys involved in-person, household interviews with Mexican-origin residents of the Texas border cities Laredo (n = 751) and McAllen/Brownsville (n = 814), with San Antonio as an off-border comparison (n = 771). Interviews assessed past-year DSM-5 AUD; past-year heavy drinking; coping and enhancement motives; and 7 indicators of substance use climate and stress exposure hypothesized to mediate site effects. Analyses, conducted separately by gender, included regressions and structural equation modeling with Mplus. RESULTS: Preliminary analyses revealed that site effects on AUD prevalence were, unexpectedly, exclusive to men, and that Laredan men were similar to McAllen/Brownsville men on demographics, acculturation, and cross-border mobility. However, sites differed dramatically on most of the hypothesized risk factors. Structural equation models confirmed that site effects on AUD were partially mediated via effects of site on indicators of a permissive climate (i.e., permissive drinking norms, high drug availability) and stress exposures (i.e., high exposure to violence/crime, low family support), and via downstream effects on drinking motives and heavy drinking. CONCLUSIONS: Findings of very high rates of past-12-month AUD among Laredan men (35%) suggest the possibility of significant heterogeneity even within demographically similar border areas and underline the need for additional study of the border region. Findings regarding our conceptual model suggest that this model may constitute a useful initial framework for future research on alcohol problems at the border. However, additional research using representative samples is needed to confirm and expand this model to comprehensively address relevant individual and community factors.

Co-occurrence of alcohol, drug use, DSM-5 alcohol use disorder, and symptoms of drug use disorder on both sides of the U.S.-Mexico border.

BACKGROUND: The U.S.-Mexico border displays elevated rates of hazardous alcohol and drug use. Whether the co-occurrence of alcohol and drug use and disorders is also high in the border area is unknown. METHODS: Data are from the U.S.-Mexico Study on Alcohol and Related Conditions, a cross-sectional survey of randomly selected respondents interviewed from 2011 to 2013. Participants included 1,690 Mexican Americans from Texas (572 in an off-border city and 1,118 from 3 border cities) and 1,293 Mexicans from Nuevo Leon and Tamaulipas (415 in an off-border city and 878 from 3 Mexican cities bordering Texas) who reported drinking in the last 12 months. Participants were interviewed regarding the prevalence of and risk factors for: (i) co-occurring hazardous alcohol use (5+/4+ at least monthly) and drug use (medical and illicit) and (ii) co-occurring presence of a DSM-5 alcohol use disorder (AUD) and 2 symptoms (hazardous use and quit/control) of drug use disorder (DUD symptoms). RESULTS: Co-occurring hazardous alcohol and drug use was more common in the U.S. border cities (14.7%) than off-border (7.2%), but similar for Mexican border (1.2%) and off-border (1.4%) cities. Co-occurrence of AUD and DUD symptoms was likewise more common at the U.S. border (6.8%) than off-border (3.3%), as well as at the Mexican border (1.3%), compared to off-border (0.6%), but not statistically significant for Mexico. In models adjusting for demographics, mobility factors and exposure to the U.S. culture, border residence in both countries related to a nearly twofold increase in prevalence ratios (PRs) of co-occurring AUD and DUD symptoms (PR = 1.97, 95% CI = 1.36 to 2.85). CONCLUSIONS: Increased rates of co-occurring AUDs and DUDs suggest an added negative impact on already difficult conditions of the border population.

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.

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.

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.

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.

Mode of mutual-help group attendance: Predictors and outcomes in a US national longitudinal survey of adults with lifetime alcohol use disorder.

INTRODUCTION: Although attending substance use-focused mutual-help meetings online may reduce attendance barriers, associations of attendance mode with group participation and outcomes are unknown. Using longitudinal data from mutual-help group attendees, this study, after identifying differences in baseline characteristics by attendance mode, examined associations of attendance mode with mutual-help participation (number of meetings attended, involvement) and outcomes (alcohol abstinence, heavy drinking, alcohol problems). METHODS: The Peer Alternatives for Addiction Study 2021 Cohort sampled attendees of 12-step groups (e.g., Alcoholics Anonymous), Women for Sobriety, LifeRing Secular Recovery, and/or SMART Recovery in-person and/or online within 30 days before baseline. The baseline sample, recruited in fall 2021, was 531 adults with lifetime alcohol use disorder, followed at 6 (88 %) and 12 months (85 %). Differences in baseline characteristics by attendance mode were tested using Chi-squares and ANOVAs. GEE models examined associations of attendance mode, time, and their interactions with mutual-help group participation and alcohol outcomes. The in-person only mode was compared to the online-only, and to the in-person plus online, modes. RESULTS: At baseline, 53.7 % of participants had attended only online meetings in the past 30 days, 33.7 % had attended both in-person and online meetings, and 12.6 % had attended only in-person meetings. Online meeting attendees were less likely to endorse lifetime abstinence as an alcohol recovery goal than in-person-only meeting attendees. In adjusted models (including for recovery goal), those attending online meetings only, or both online and in-person meetings, attended a greater number of meetings compared to those attending only in-person meetings. However, online-only attendance was associated with less involvement than in-person-only attendance. In adjusted models, compared to baseline, involvement increased and outcomes improved at follow-ups. Adjusted models examining alcohol outcomes found that no attendance at mutual-help groups at follow-ups was associated with more heavy drinking compared to in-person-only attendance. CONCLUSIONS: Findings inform efforts to ascertain benefits of mutual-help group participation by suggesting that online attendance is associated with attending more meetings, less involvement, and lower endorsement of abstinence as a recovery goal, and is comparable to in-person attendance on alcohol outcomes. In-person attendance may be more beneficial for less heavy drinking than terminating attendance.