Heavy drinking is the third leading cause of preventable death among Americans and strongly associated with alcohol-related morbidity and problems, including negative drinking consequences and alcohol dependence. While racial/ethnic minorities bear a disproportionate burden of alcohol-related problems in the U.S., it is unknown whether this reflects more harmful, long-term patterns of heavy drinking. While some studies suggest that minorities have longer heavy drinking "careers", these have been based on short-term follow-up data, retrospective data, and age-specific prevalence data. Rigorous, prospective cohort studies have rarely examined racial/ethnic differences in heavy drinking trajectories, and those few studies that have shown contradictory findings for racial differences by the mid-to-late 20s, the age when these studies typically end. However, there are important theoretical and empirical reasons to expect that racial/ethnic groups diverge in their heavy drinking patterns as they transition out of early adulthood into middle age. Our central hypothesis is that racial/ethnic minority groups'greater accumulation of disadvantage over the life course will contribute to prolonged heavy drinking beyond the 20s, which could help to explain recent findings of more recurring and persistent alcohol problems among minorities (vs. whites) in mid-life. Responding to PA-11-308 "Secondary Analysis of Existing Alcohol Epidemiology Data", we propose to investigate this in the first, in-depth, prospective analysis of racial/ethnic disparities in heavy drinking trajectories from adolescence to middle age in a nationally-representative U.S. sample (National Longitudinal Surveys of Youth).
Our Specific Aims are to: 1) Describe racial/ethnic differences in heavy drinking trajectories from the late teens to middle age, and their association with persistent alcohol problems;2) Identify predictors of membership in heavy drinking trajectories, and mediators through which they operate to create alcohol problems;and 3) Assess the extent to which lifecourse socioeconomic factors explain racial disparities in prolonged heavy drinking and alcohol problems, and the mechanisms (differential exposure and differential consequences) contributing to these disparities. Our study draws on a social determinants perspective, thus departing somewhat from the dominant approach of developmental psychopathology. Heeding recent, federal calls for multisectoral efforts to address health inequities, we give special attention to the ways in which disparities related to education (parental and personal educational attainment, quality of education, and returns on education) may contribute to racial disparities in prolonged heavy drinking and problems. Our highly multidisciplinary team will utilize growth mixture models, structural equation models, and propensity scoring, and capitalize on data from both the 1979 and 1997 NLSY to examine cohort effects and differences by gender and Hispanic subgroup. This research will identify a range of far-reaching and interim policy targets to address racial disparities in lifecourse heavy drinking which are amenable to intervention in the education, social welfare and labor sectors.

Public Health Relevance

This study will describe racial disparities in prolonged heavy drinking and persistent alcohol problems in a nationally representative sample of Americans followed from adolescence to middle age. The study will identify lifecourse socioeconomic factors that increase risk for these adverse alcohol outcomes, and assess the extent to which racial disparities in these outcomes are explained by differential exposure to, and consequences of, these risk factors. Study results will help to inform interventions targeted to different perios of the life course, which can help to reduce racial alcohol-related disparities.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Godette, Dionne
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Public Health Institute
United States
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