The reviewed studies most commonly assessed mortality at the county level (37 studies) or the state level (31 studies). Despite the importance of community-level SDOH,8,9 only three studies used smaller areas of aggregation such as Census tracts or zip codes. This shortcoming of the literature limits understanding of how local factors influence alcohol-related mortality. Accordingly, there is an opportunity for future research to explore associations at smaller scales, such as census tracts or neighborhoods, to inform more targeted interventions and local policy solutions. Varying estimates of alcohol dependence also have been observed among Asian-American national groups and American Indian tribes. Chae et al. (2008), based on data from the 2002–2003 NLAAS, reported a 3.6 percent lifetime estimate of alcohol disorders among Asian Americans.
Cancers
- It is hypothesized that the ability to establish and maintain social networks in both cultures improves a person’s capacity to cope with the demands of living in a bicultural context (LaFromboise et al., 1993).
- Four studies found a nonsignificant relationship between urbanicity/metropolitan status and DUI fatalities40,47 and deaths of despair.72,75 The heterogeneity in these results suggests there may be important effect modifiers for further consideration.
- One type of adaptation in this framework is sociocultural adaptation, operationalized as a person’s “fit” within their new receiving culture and ability to respond to the demands of the social environment.
- For cancer of the larynx, both incidence and mortality rates are higher among Black men than among White men (incidence, 9.8 and 6.0; mortality, 4.4 and 2.0) (National Cancer Institute 2011c).
One factor that may impact acculturation among Hispanics living in the U.S. is the community of settlement—the reason being that respective communities of settlement have diverse characteristics such as attitudes toward Hispanics, sociopolitical history, ethnic density, public policies, and available resources (Cano et al., 2015). In addition, respective communities of settlement may also have a distinct context of reception—the social expectations of how immigrants and racial/ethnic minorities should interact with and acculturate toward the receiving culture (Schwartz et al., 2010; Schwartz, Unger, et al., 2014). Learn up-to-date facts and statistics on alcohol consumption and its impact in the United States and globally. Explore topics related to alcohol misuse and treatment, underage drinking, the effects of alcohol on the human body, and more.
Acculturation and Alcohol: What Did We Learn?
Native Americans of both genders have the highest prevalence of weekly heavy drinking, whereas Hispanic men have the highest prevalence of daily heavy drinking. Rates of weekly heavy drinking are lowest for Asian-American and Hispanic women, and rates of daily heavy drinking are lowest among Asian-American and Black women. Dawson et al. (2004) reported few changes in the percentages of U.S. adults who exceed recommended drinking limits from 1991–1992 to 2001–2002. Among Whites, there was an increase in the proportion of adults exceeding weekly drinking limits and a decrease in proportion exceeding daily drinking limits. The research reviewed focuses on Whites, Blacks, Hispanics, Asians, and Native Americans (i.e., American Indians and Alaska Natives) in the United States as general ethnic groups, although significant subgroup differences within populations also are evident.
Blacks and Native Americans are at greater risk than Whites for FAS and fetal alcohol spectrum disorders (Russo et al. 2004). From 1995 to 1997, FAS rates averaged 0.4 per 1,000 live births across data-collection sites for the Fetal Alcohol Syndrome Surveillance Network and were highest for Black (1.1 percent) and Native American (3.2 percent) populations (CDC 2002). Liver cirrhosis is one alcohol-attributed disease that has more severe consequences for some ethnic groups. Hispanics and Blacks have greater risk for developing liver disease compared with Whites (Flores et al. 2008), and Hispanic men have the highest rate of liver cirrhosis mortality (Stinson et al. 2001; Yoon and Yi 2008). Additionally, rates of alcohol-related esophageal cancer and pancreatic disease are higher for Black men than White men (Polednak 2007; Yang et al. 2008), whereas fetal alcohol syndrome and fetal alcohol spectrum disorders are more prevalent in Blacks and Native Americans (Russo et al. 2004).
However, further research is needed to identify the mechanisms that give rise to and sustain these disparities in order to develop prevention strategies. The contributing factors include the higher rates of consumption found in Native Americans and Hispanics, but more broadly range from biological factors to the social environment. More research on the relationship of alcohol to some cancers, diabetes, and HIV/AIDs across ethnic groups is also needed. There is limited evidence for how drinking differentially affects ethnic differences in breast and colorectal cancers and in diabetes and HIV/AIDS onset and care, and few findings for how alcohol-attributed harms vary across ethnic subgroups.
Epidemiological studies show that these high-risk patterns of drinking and drinking volume vary by U.S. ethnic group. Ethnicities with greater drinking volume and higher rates of daily and weekly heavy drinking could be at greater risk for experiencing alcohol-attributed harms. Among adult drinkers in the United States, based on the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Chen et al. 2006), Native Americans and Hispanics have greater alcohol consumption than other ethnic minority groups. Rates of daily heavy drinking were higher among Hispanics (33.9 percent), Native Americans (28.4 percent), and Whites (27.3 percent) compared with Blacks (22.5 percent) and Asians (19.2 percent).
Alcohol Treatment Utilization
Arroyo et al. (2003) reported that Whites in 12-step facilitation (TSF) therapy had better drinking outcomes than did Whites in other types of treatment or Hispanics in TSF therapy. Hispanics show less AA attendance both during and after treatment (Arroyo et al. 1998; Tonigan et al. 2002), as well as improved drinking outcomes in a brief intervention with ethnic matching how to smoke moonrocks between patient and provider (Field and Caetano 2010). Based on preliminary data, American Indians also report better drinking outcomes in motivational enhancement therapy compared with other treatments (Villanueva et al. 2007). Together, these and other studies suggest that culturally tailored alcohol treatment programs are likely solutions for addressing disparities in alcohol treatment for ethnic minority groups (Schmidt et al. 2006).
Ethnicity and Health Disparities in Alcohol Research
Different rates of health insurance coverage across ethnic groups may serve as a barrier to utilization for some treatment services (e.g., care provided by a private physician). However, government funding for alcohol treatment programs also may lessen the affect of insurance coverage on ethnic group differences in treatment utilization. Weisner et al. (2002) showed that Blacks were more likely than Whites to be in a specialty alcohol treatment program regardless of insurance status, whereas Hispanics with health insurance were less likely to enter a treatment program. Several epidemiological studies have examined within-ethnic group differences in rates of alcohol use disorders.
In particular, Native American violent crime victims were more likely (62 percent) than other violent crime victims to report alcohol use by their offender, including Whites (43 percent), Blacks (35 percent), and Asians (33 percent). The strengths of the study include large sample size drawn randomly from the household population, which makes the findings generalizable to the respective national groups in the area from which the sample was drawn. Participants were interviewed in their preferred language with a questionnaire that underwent a detailed Spanish translation and back-translation process. Alcohol consumption measures are based on self-report, which may result in underreporting of alcohol consumption. Although this is acceptable for survey research with general population, it is possible that nonrespondents are different from respondents regarding their level of alcohol consumption.
Cotti and Walker41 found that casino openings were related to more DUI fatalities both in the county in which the casino was located and in neighboring counties. Zemore and colleagues86 found that alcohol- and other drug-related mortality was highest in off- versus on-border counties in the four U.S.-Mexico border states, despite off-border counties having higher proportions of college-educated residents and a lower likelihood of being designated as a high-intensity drug trafficking area. Binge drinking rates vary considerably across women with Puerto Rican women reporting rates nearly twice as high as the other groups. Although no clear pattern was found, these rates decrease significantly after age 50 except among D/SC American women. The weekly alcohol consumption pattern by age is somewhat different across women in each of the four national groups, but all show some decrease in drinking with age. Among Mexican American women, the pattern of consumption by age is U-shaped, with drinking decreasing until the 40–49 age group and then increasing among women 50 years of age and older.