The broad, long-term objective of the proposed study is to empirically establish a theoretically grounded stress process model of the social epidemiology of excess alcohol use, abuse and dependence by analyzing data from the National Co-morbidity Survey. This same model will also control for the presence of other co-morbid disorders and their association with alcohol-related problems.
The specific aims are to (1) explore the association between socioeconomic status (SES) and excess alcohol use, abuse, and dependence (herein referred to as alcohol """"""""misuse"""""""") by modeling mediators of the relationship conceptualized as stressors and resources;(2) assess the relationship between stressors and resources wherein one may moderate, or interactively erode or enhance, the effect of the other;(3) study the feedback effects of alcohol use over time on exposure to stressors and access to resources, which may in turn reinforce healthy alcohol consumption or exacerbate problematic alcohol behaviors;and (4) include both dimensional and categorical assessments of alcohol use and misuse. This project is related to the mission of NIH to conduct medical research that will inform efforts to prevent disease such as alcohol-related disorders by explaining their complex etiology.
The specific aims will be met by statistical analysis of national-level epidemiological data on psychiatric disorders including alcohol-related disorders. Measurement models of all the major components of the stress process model will be estimated with confirmatory factor analysis (CFA). Causal models of the stress process will be estimated with structural equation modeling (SEM). Mplus software will be employed to (1) correctly estimate standard errors to adjust for complex sampling, (2) estimate models that take into account differential probabilities of selection, (3) weight the analyses to correct for non-response and to post-stratify, (4) construct measurement models with CFA, (5) estimate causal models with mediators and moderators and longitudinal data, and (6) conduct SEM with continuous or categorical outcomes. The results will be interpreted with reference to the stress process model wherein the confluence of stressors and resources will explain the process through which low socioeconomic status results in relatively higher rates of alcohol problems. The results will have implications for specific stressors and resources that may be targeted at a population level to reduce the risk for alcohol abuse and dependence.

Public Health Relevance

The purpose of this project is to explain the causes of alcohol misuse, including abuse and dependence, by examining socially structured patterns of exposure to stressors and access to resources over time. The misuse of alcohol is understood to occur via a process that begins with a person's position in society's social structure and flows through his or her proximate life experiences including stressors like unemployment and resources like social support which in turn affect alcohol misuse. The feedback effects of alcohol misuse on stressors and resources and continued alcohol misuse over time are also examined.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Small Research Grants (R03)
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Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Breslow, Rosalind
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University of Nevada Reno
Social Sciences
Schools of Arts and Sciences
United States
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Elliott, Marta; Lowman, Jennifer (2015) Education, income and alcohol misuse: a stress process model. Soc Psychiatry Psychiatr Epidemiol 50:19-26