Conversely, indicators of social capital (such as community engagement and social cohesion) may serve to buffer against social isolation and depression, resulting in lower drug- and alcohol-related mortality. The higher level of risky drinking for Native Americans and Hispanic men and the increased occurrence of alcohol consequences for Native Americans, Hispanics, and Blacks may indicate a greater need for alcohol treatment in these populations. For Native American men, Beals et al. (2005) reported more help seeking from specialty alcohol or drug treatment providers relative to the U.S. population, but there were no differences for women. Comparatively, Alaska Natives report less use of psychiatrists, medical doctors, and psychologists for alcohol problems than Whites, Blacks, and Hispanics (Hesselbrock et al. 2003). However, the differences in alcohol services for Alaska Natives may represent a lower availability of some professionals in Alaska.
Ethnicity and Alcohol-Attributed Harms
This review focuses on area-level SDOH likely to be linked to mortality resulting from either acute or chronic alcohol-related causes. Alcohol availability and alcohol control policies, along with health care availability, also are germane for deaths attributable to alcohol misuse or AUD. Adequate health care is crucial for treating chronic physical health conditions caused or exacerbated by alcohol use and behavioral health conditions such as AUD, depression, and anxiety. As described by Monnat,10 socioeconomic disadvantages are likely determinants of higher drug-related (and alcohol-related) mortality through effects of economic stressors on family relationships, social connections, hopelessness, and social disorder.
Multivariate analyses
Some studies included measures of health care and social services, which are important determinants of mortality.95 Six studies reported associations between area-level health care factors and alcohol-related mortality outcomes. The fields of developmental psychology and epidemiology indicate that emerging adulthood (ages 18–25 years) is a period in which people tend to drink most heavily in comparison to adolescents and older adults (Sussman & Arnett, 2014; Substance Abuse and Mental Health Services Administration SAMHSA, 2018). For instance, in the United States (U.S.), emerging adults report the highest prevalence of all age groups in terms of current alcohol use (56.3%), binge drinking (36.9%), heavy drinking (9.6%), and alcohol use disorder (10.7%; SAMHSA, 2018). Compared to other racial/ethnic groups, Hispanic (inclusive of Latinos, Latinas, and Latinx) emerging adults had the second-highest prevalence of current alcohol use (50.1%), binge drinking (32.9%), and heavy drinking (8.0%), and the third-highest prevalence of alcohol use disorder (10.7%; SAMHSA, 2018).
From 2001 to 2005, alcohol-attributed deaths accounted for 11.7 percent of all Native American deaths, more than twice the rates of the general U.S. population (CDC 2008). Likewise, Native Americans are over-represented in national estimates of alcohol-related motor vehicle deaths and alcohol-involved suicides (CDC 2009a, b). Furthermore, alcohol consumption may be more detrimental at all levels of drinking (i.e., abstinence, moderate, and heavy drinking) for Blacks in terms of mortality. Sempos et al. (2003) found no protective health effect for moderate drinking in Blacks, as previously reported in Whites. Men regardless of their birthplace were likely to drink more per week as well as engage more in binge drinking than foreign-born females.
Procedure and Participants
This change was partly attributed to a sharper decrease in the age of drinking onset for women compared with men born 1954 to 1983 and was most pronounced for White women but less so for Hispanic women (Grucza et al. 2008b). This study also aimed to (2) examine potential moderating factors of respective associations among acculturation orientations and bicultural self-efficacy with what drug causes foaming at the mouth alcohol use severity. Several studies assessed the relationships of mortality outcomes with area-level demographic correlates, yielding mixed results.
Furthermore, the consequences of drinking appear to be more profound for Native Americans, Hispanics, and Blacks. Explanations for these differences are complex, likely affected by risky drinking behaviors, immigration experiences, racial/ethnic discrimination, economic and neighborhood disadvantage, and variations in alcohol-metabolizing genes. A more complete understanding of these effects for ethnic minority groups is needed to enable researchers to face the challenges of reducing and ultimately eliminating health disparities in the alcohol field. Research has shown differential social and health effects from alcohol use across U.S. ethnic groups, including Whites, Blacks, Hispanics, Asians, and Native Americans. The relationship of ethnicity to alcohol-related social and health harms partially is attributed to the different rates and patterns of drinking across ethnicities.
Self-efficacy, the perceived confidence to perform a desired action, is a key construct in theories of health behavior and behavior modification—including alcohol use behavior (Bandura, 1982; Kadden & Litt, 2011). Thus, one construct that may be relevant to research on sociocultural determinants of health behavior among Hispanics is bicultural self-efficacy which encompasses multiple domains of functioning such as social groundedness and role repertoire. Social groundedness represents the level of confidence an individual has in establishing social networks in both cultural groups (David et al., 2009).
To obtain correct estimates for the regression coefficients for each combination of these interacting variables, we created a four-level combination variable and used in the models. This is because previous analyses of this data set (Caetano et al., 2008a, 2008b) showed that as a group they drink less, report less binge, and have fewer DUI events and lower rates of alcohol abuse and dependence than the other three groups. Their use as a reference group therefore means that odds ratios comparing other groups with Cuban Americans are higher than 1, which is easier to interpret and understand.
Among women of all national groups, a statistically significant step-wise increase with increasing level of acculturation is seen for binging less than once per month. Further, those at the highest level of acculturation had the highest frequency of drinking 12 or more drinks in a day. Recent advances in alcohol research continue to build our understanding of alcohol consumption and related consequences for U.S. ethnic minority groups. National surveys show variations across ethnicities in drinking, alcohol use disorders, alcohol problems, and treatment use. Higher rates of high-risk drinking among ethnic minorities are reported for Native Americans and Hispanics, although within-ethnic group differences (e.g., gender, age-group, and other subpopulations) also are evident for ethnicities. However, once alcohol dependence occurs, Blacks and Hispanics experience higher rates than Whites of recurrent or persistent dependence.
In particular, prevalence rates of 30-day binge and heavy alcohol use for Pacific Islander groups (ages 18 or older; 26.8 percent and 12.6 percent, respectively), as reported by the 2006 NSDUH, were more than double that of other Asian groups (12.5 percent and 2.6 percent, respectively) (SAMHSA 2008c). Blacks and Hispanics have greater risk for developing liver disease compared with Whites (Flores et al. 2008), and death rates attributed to alcohol-related cirrhosis across populations of Whites, Blacks, and Hispanics are highest for White Hispanic men (Yoon and Yi 2008). Blacks show a greater susceptibility than Whites to alcohol-related liver damage, with risk differences amplified at higher levels of consumption (Stranges et al. 2004). Based on data from the National Center for Health Statistics, 1991–1997, mortality rates for cirrhosis with mention of alcohol were higher in White Hispanics and Black non-Hispanics compared with White non-Hispanics (Stinson et al. 2001).
- Some changes in the prevalence of alcohol abuse and dependence from 1991–1992 to 2001–2002 have been reported for U.S. ethnic groups (Grant et al. 2004).
- Lower rates of treatment completion for Blacks and Hispanics than Whites point to another possible disparity in alcohol treatment (Bluthenthal et al. 2007).
- Role repertoire refers to one’s level of confidence in using or learning culturally appropriate behaviors in relation to both cultural groups (David et al., 2009).
In summary, these findings on volume of drinking and binge drinking by age suggest that older US Hispanic men are at a considerable risk of developing alcohol-related problems because of their continued drinking. Additionally, data from the 2007 NSDUH (SAMHSA 2008a) suggest a greater unmet need for alcohol treatment for some ethnic groups. Asians (0.1 percent) and Hispanics (5.5 percent) with a need for alcohol treatment were less likely to receive specialty alcohol treatment (i.e., alcohol and drug rehabilitation program, hospital or mental health center) compared with Whites (8.0 percent) and Blacks (14.0 percent). Schmidt et al. (2007) also reported less specialty alcohol or drug program use for Hispanics than Whites, whereas Blacks were less likely to use a private physician for alcohol problems and to attend Alcoholics Anonymous (AA). Further, and more alarming, Blacks and Hispanics with higher severity alcohol problems were less likely to use any treatment services compared with Whites who have similar severity of alcohol problems.
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