Social Adversity, Stress, and Alcohol Problems: Are Racial/Ethnic Minorities and the Poor More Vulnerable?

Abstract

ABSTRACT. Objective: Experiences of racial/ethnic bias and unfair treatment are risk factors for alcohol problems, and population differences in exposure to these social adversities (i.e., differential exposure) may contribute to alcohol-related disparities. Differential vulnerability is another plausible mechanism underlying health disparities, yet few studies have examined whether populations differ in their vulnerability to the effects of social adversity on psychological stress and the effects of psychological stress on alcohol problems. Method: Data from the 2005 U.S. National Alcohol Survey (N = 4,080 adult drinkers) were analyzed using structural equation modeling to assess an overall model of pathways linking social adversity, depressive symptoms, heavy drinking, and alcohol dependence. Multiple group analyses were conducted to assess differences in the model's relationships among Blacks versus Whites, Hispanics versus Whites, and the poor (income below the federal poverty line) versus non-poor (income above the poverty line). Results:The overall model explained 48% of the variance in alcohol dependence and revealed signifi cant pathways between social adversity and alcohol dependence involving depressive symptoms and heavy drinking. The effects of social adversity and depressive symptoms were no different among Blacks and Hispanics compared with Whites. However, the poor (vs. non-poor) showed stronger associations between unfair treatment and depressive symptoms and between depressive symptoms and heavy drinking. Conclusions: Contrary to some prior studies, these fi ndings suggest that racial disparities in alcohol problems may be more a function of racial/ethnic minorities' greater exposure, rather than vulnerability, to chronic stressors such as social adversity. However, observed differences between the poor and non-poor imply that differential vulnerability contributes to socioeconomic disparities in alcohol problems. Efforts to reduce both differential exposure and vulnerability might help to mitigate these disparities. (J. Stud. Alcohol Drugs, 73, 570-580, 2012)

Vulnerabilidades clínicas e sociais em usuários de crack de acordo com a situação de moradia: um estudo multicêntrico de seis capitais brasileiras

“…A exposição a doenças e a situações adversas da vida acontece de forma diferenciada de acordo com cada indivíduo, regiões e grupos sociais, e ela está intimamente relacionada às condições socioeconômicas, ao nível educacional e a outros indicadores sociais, como status de moradia, situação legal e doenças associadas 2,8,9 .…”

Effects of Economic Disruptions on Alcohol Use and Problems: Why Do African Americans Fare Worse?

“…To date, no studies have examined the role of racial stigma in explaining the effects of job loss on alcohol outcomes in a large and racially/ethnically diverse sample as we do in the current analysis. Previous studies have largely focused on the role of racial stigma in explaining alcohol outcomes (Mulia & Zemore, 2012;Zemore et al, 2011).…”

Does early socio-economic disadvantage predict comorbid alcohol and mental health disorders?

“…Cross-sectionally, SES has been associated separately with alcohol disorders (Windle and Davies, 1999;Caldwell et al, 2008;Rush and Koegl, 2008;Swendsen et al, 2009;Adler and Stewart, 2010;Melotti et al, 2011;Young-Wolff et al, 2011;Green et al, 2012;Karriker-Jaffe, 2013) and with depression and anxiety (de Graaf et al, 2002;Gilman et A c c e p t e d M a n u s c r i p t 5 al., Melchior et al, 2007;Cerda et al, 2010). A number of studies have linked socioeconomic factors and comorbid alcohol and mental health disorders (Ross, 1995;Costello et al, 1997;Windle and Davies, 1999;Armstrong and Costello, 2002;de Graaf et al, 2002;Rush and Koegl, 2008;Cerda et al, 2010;Green et al, 2012;Mulia and Zemore, 2012;Pulkki-Raback et al, 2012), but whether these associations differs from the single disorders is unclear: the use of varying measures makes comparisons challenging (Cerda et al, 2010).…”

“…Aspects such as low personal income (Ross, 1995;Pulkki-Raback et al, 2012) and lower family social support (Windle and Davies, 1999) have been cross-sectionally associated with comorbid alcohol and mental health problems in large national studies (Mulia and Zemore, 2012). Other studies however have found this to hold only for Caucasian groups (Costello et al, 1997).…”

“…Some comparisons have found that low income is more strongly associated than is education (Ross, 1995;Pulkki-Raback et al, 2012), while others suggest that lower education is more strongly associated with common mental disorders (Araya et al, 2003) or comorbid disorders (de Graaf et al, 2002). Generalisation of these seemingly inconsistent associations is complicated by heterogeneity of study designs (Ross, 1995;Costello et al, 1997;de Graaf et al, 2002;Araya et al, 2003;Mulia and Zemore, 2012) and diversity in sample characteristics (Costello et al, 1997;Rush and Koegl, 2008;Green et al, 2012). The cumulative effect of multiple dimensions of socioeconomic disadvantage has been argued Page 6 of 35 A c c e p t e d M a n u s c r i p t 6 to impact on health problems later in life (Turrell et al, 2003;Marmot, 2005;Chartier et al, 2010;Marie-Mitchell and O'Connor, 2013), but it is unknown whether cumulative disadvantage affects comorbid alcohol and mental health disorders.…”