Heavy alcohol use is a leading cause of preventable death in the U.S. Given that rates of alcohol-related morbidity and mortality are elevated among Blacks and Hispanics compared to Whites, reducing racial disparities in heavy drinking and alcohol problems is an important public health goal. At present, however, there is a critical gap in our understanding of alcohol disparities related to race. Prior research has already established higher rates of heavy drinking and alcohol problems among Black and Hispanic (vs. White) drinkers;further, there is some evidence of relatively higher rates of alcohol problems among Blacks and Hispanics even at similar levels of alcohol consumption. Yet, no studies to our knowledge have formally evaluated mediators of these disparities. Further, only a very few studies have examined racial disparities in alcohol problems when controlling for consumption, and those have been limited. The primary objective of this study is thus to describe and explain racial disparities in both heavy drinking and alcohol problems at equivalent levels of consumption. Our conceptual approach recognizes that racial/ethnic groups in the U.S. are differentially exposed to economic, social, and neighborhood disadvantages, and draws upon recent theoretical work suggesting that cumulative exposure to disadvantage may play a significant role in understanding health disparities. Our study also considers alcohol-related factors-such as differences in drink size, drinking contexts, and age at heavy drinking-as potential contributors to disparities in problems at equivalent levels of consumption. The study examines alcohol-related disparities among Whites (as the referent), Blacks, and Hispanics, the three largest racial/ethnic groups in the U.S., and analyzes data from the 2005 and 2010 U.S. National Alcohol Survey (NAS);total N=11,839. The NAS provides a wide array of fine- grained alcohol consumption and problem measures;economic, social and psychological variables;and geolinked Census data on neighborhood SES, alcohol outlet density, and racial/ethnic composition. Advanced statistical techniques such as structural equation modeling, moderated mediation tests, and propensity score matching will be employed in addressing the following Specific Aims: 1) to describe racial disparities in heavy drinking and alcohol problems (i.e., negative drinking consequences and dependence symptoms);2) to assess the extent to which disadvantage and alcohol-related factors account for these racial disparities;and 3) to identify protective resources (e.g., social support, drinking norms and networks, religiosity) that mitigate the impact of disadvantage on heavy drinking. By identifying the relative contribution of distinct risk factors to racial disparities, this study will help in prioritizing policymaking and prevention efforts, and will inform interventions seeking to address risk factors and build upon the protective resources of each racial/ethnic group.
Public Health Relevance Statement This study describes and explains racial disparities in heavy drinking and alcohol problems, specifically assessing the contribution of economic, social and neighborhood disadvantage and alcohol-related factors. It also examines race-specific protective resources that may buffer the effects of disadvantage on heavy drinking and alcohol problems. Findings will help to prioritize policymaking and inform prevention efforts to reduce racial disparities in heavy drinking and alcohol problems, a leading cause of death among Americans.
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