Trends in alcohol services utilization from 1991-1992 to 2001-2002: ethnic group differences in the U.S. population

Background: During the early 1990s in the United States, changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10‐year period from 1991–1992 to 2001–2002 among U.S. whites, blacks, and Hispanics. Methods: Data come from 2 household surveys of the U.S. adult population. The 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions conducted face‐to‐face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUDs). Results: From 1991–1992 to 2001–2002, drinking‐related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, blacks and Hispanics were less likely than whites to use private health professional care. Hispanics with AUDs were less likely than whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, blacks and Hispanics were less likely than whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for blacks with AUDs, and mutual aid for Hispanics with AUDs). Conclusions: Our findings showed increases from 1991–1992 to 2001–2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to whites. These utilization trends for blacks and Hispanics may reflect underlying disparities in healthcare access for minority groups, and language and logistical barriers to utilizing services.     

Drinking,Alcohol Use Disorder,and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol‐related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries’ cultural norms around consumption still have on immigrants’ alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals’ sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.     

Racial and ethnic disparities in mobility device use in late life

OBJECTIVE: Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference. METHODS: The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care. RESULT: Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites. DISCUSSION: Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it.     

Racial differences in diabetes self-management and quality of care in Texas

AimTo assess racial/ethnic differences in diabetes self-management behaviors and quality of care in Texas.MethodsThis cross-sectional study assessed self-management behaviors and quality of care in 1720 adults with diabetes in the 2002–2004 Texas Behavioral Risk Factor Surveillance Survey. Multiple logistic regression models were used for assessing the independent association between race/ethnicity, self-management behaviors, and quality of care variables controlling for covariates. SAS (SAS Institute Inc, 2002-2003) was used for statistical analysis.ResultsEighteen percent of Hispanics, 14% of Blacks, and 10% of Whites reported never performing home glucose testing. Seventeen percent of Hispanics, 11% of Blacks, and 10% of Whites reported never doing home foot exam. Thirty-two percent of Hispanics, 21% of Blacks, and 16% of Whites did not have an A1C test in the prior 12 months. Twelve percent of Hispanics, 10% of Blacks, and 6% of Whites did not have a dilated eye exam in the prior 12 months. Fifty-four percent of Whites, 42% of Blacks, and 40% of Hispanics received a flu shot. Forty-nine percent of Whites, 30% of Blacks, and 26% of Hispanics received a pneumonia shot. In adjusted models, Hispanics were more likely to be sedentary (OR, 1.64; 95% CI, 1.08–2.49) compared to Whites. Blacks did not differ significantly from Whites (OR, 1.46; 95% CI, 0.92–2.34). Hispanics (OR, 1.61; 95% CI, 1.01–2.57) and Blacks (OR, 1.83; 95% CI, 1.10–3.03) were more likely to get an annual foot exam by a provider compared to Whites. Hispanics (OR, 0.54; 95% CI, 0.34–0.85) and Blacks (OR, 0.58; 95% CI, 0.35–0.98) were less likely to get a pneumonia shot compared to Whites.ConclusionsHispanics have poorer access to care and poorer health status compared to Whites or Blacks. Controlling for socioeconomic and access to care variables eliminated disparities in self-management but did not eliminate disparities in quality of diabetes care.     

Sociodemographic Predictors of Pattern and Volume of Alcohol Consumption Across Hispanics,Blacks, and Whites: 10‐Year Trend (1992–2002)

Background: There have been limited trend studies examining variations on the patterns of alcohol consumption among Whites, Blacks, and Hispanics in the United States. The current paper reports national trends in drinking patterns, volume of drinking (number of drinks per month), binge drinking, and drinking to intoxication among Blacks, Whites, and Hispanics over a period of 10 years and identifies sociodemographic predictors of these behaviors across the 3 ethnic groups. Methods: Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population. Results: Trends varied across different dimensions of drinking and ethnic groups. There were no statistically significant differences in the mean number of drinks consumed per month among men and women in any of the 3 ethnic groups between 1992 and 2002, but there was a significant rise in the proportion of current drinkers in both genders and in all 3 ethnic groups. Multivariate analysis indicated that, compared to Whites in 1992, Blacks and Hispanics did not increase their volume of drinking, but Whites did. Drinking 5 or more drinks in day at all did not increase between 1992 and 2002, but drinking 5 or more drinks at least once a month was more likely for all groups in 2002 compared to Whites in 1992. Drinking to intoxication at all was more likely among Whites in 2002 than 1992, but drinking to intoxication at least once a month was more likely among Whites and Blacks in 2002 than 1992. Conclusion: The only common trend between 1992 and 2002 across both genders and 3 ethnic groups was a rise in the proportion of drinkers. There was also a rise in drinking 5 or more drinks in a day (Whites, Blacks, and Hispanics) and drinking to intoxication (Whites and Blacks), but this was limited to those reporting such drinking at least once a month. The reasons for these changes are many and may involve complex sociodemographic changes in the population. It is important for the field to closely monitor these cross‐ethnic trends in alcohol consumption.     

Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries

OBJECTIVES: Numerous studies have documented disparities in health care utilization between non-Hispanic White and minority elders. We investigated differences in anti-dementia medication use between non-Hispanic White and minority community-dwelling Medicare beneficiaries with dementia. METHODS: Using multivariate analysis with generalized estimating equations, we estimated prevalence ratios (PRs) for anti-dementia medication use by race/ethnicity for 1,120 beneficiaries with dementia from years 2001 through 2003 of the Medicare Current Beneficiary Survey. RESULTS: After adjusting for demographics, socioeconomics, health care access and utilization, comorbidities, and service year, we found that anti-dementia medication use was approximately 30% higher among non-Hispanic Whites compared to other racial/ethnic groups (PR=0.73, 95% confidence interval [CI]=0.59, 0.91). As for individual racial/ethnic groups, prevalence disparities remained significant for non-Hispanic Blacks (PR=0.75, 95% CI=0.57, 0.99) and non-Hispanic others (PR=0.50, 95% CI=0.26, 0.96) but were attenuated for Hispanics (PR=0.84, 95% CI=0.59, 1.20). DISCUSSION: Results provide evidence that racial/ethnic disparities in utilization of drugs used to treat dementia exist and are not accounted for by differences in demographic, economic, health status, or health utilization factors. Findings provide a foundation for further research that should use larger numbers of minority patients and consider dementia type and severity, access to specialty dementia care, and cultural factors.     

Racial and Ethnic Disparities in Genetic Testing at a Hereditary Breast and Ovarian Cancer Center

BackgroundPrior studies suggest that referral to genetic counseling and completion of genetic testing vary by race/ethnicity; however, the data are limited.ObjectiveWe sought to evaluate patterns of genetic testing and clinical outcomes across race/ethnicity at a hereditary breast and ovarian cancer center.DesignThe medical records for all patients undergoing genetic assessment at a hereditary breast and ovarian cancer center were reviewed and stratified by self-reported race/ethnicity (non-Hispanic White, Hispanic, non-Hispanic Black, and Asian).ParticipantsA total of 1666 patients met inclusion criteria (non-Hispanic Whites, 1367; Hispanics, 85, non-Hispanic Blacks, 101; Asians, 113).Main MeasuresDemographics, patient characteristics, and referral patterns for patients who underwent genetic testing were analyzed using Kruskal-Wallis tests, chi-square test, or Fisher’s exact tests, stratifying by self-reported race/ethnicity. Pathogenic mutations and variants of unknown significance (VUS) were reviewed. Outcomes of patients with genetic mutations and personal history of breast and/or gynecologic malignancies were compared.Key ResultsNon-Hispanic Whites were more likely to be referred due to family cancer history compared to all other ethnicities while Non-Hispanic Blacks, Hispanics, and Asians were more likely to be referred due to personal history of cancer (p < 0.001). Non-Hispanic Blacks and Hispanics were more likely to have advanced-stage cancer at the time of genetic testing (p < 0.02). Rates of mutations did not differ by race/ethnicity when Ashkenazi Jewish patients were excluded (p = 0.08). Among patients found to have a BRCA1/2 mutation, Non-Hispanic Whites were more likely to undergo cancer screening and risk-reducing surgery compared with all other ethnicities (p = 0.04).ConclusionsMinority patients were more likely to utilize genetic services following a cancer diagnosis and less likely due to family cancer history, suggesting a missed opportunity for mutation detection and cancer prevention in this population. Efforts to eradicate racial/ethnic disparities in early access to genetic testing and guided cancer prevention strategies are essential.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-06064-x) contains supplementary material, which is available to authorized users.     

Inner-city substance abuse patterns: a study of psychiatric inpatients

Multiple studies have reported about substance abuse in Blacks and Hispanics. However, little is known about substance-abusing psychiatric patients of these ethnic groups. This study reports the prevalence and patterns of substance abuse among 171 consecutive patients (90 Blacks and 81 Hispanics) admitted to the acute psychiatric unit of an inner-city general hospital. The lifetime prevalence was 63%. Within the month prior to admission, 48% had used the following substances: cannabis, 40%; alcohol, 37%; amphetamines, 20%; cocaine, 12%; phencyclidine (PCP), 12%; barbiturates and/or sedative-hypnotics, 10%; opioids, 9%; inhalants, 1%; hallucinogens, 1%. Those who abused alcohol were more likely to abuse barbiturates and/or sedative-hypnotics, and opioids. Logistic regression analysis showed that major depression, ethnicity, and schizophrenia each were significant predictors of particular types of abuse. Patients with major depression were less likely to use PCP, Blacks were more likely than Hispanics to use hallucinogens, and schizophrenics were less likely to use opioids. In all cases in which sex, age, and personality disorder were significant, males, the young adult group, and those with personality disorder were more likely to be abusers. These three variables were all strong predictors of both multiple and extensive substance abuse. Overall, our findings suggest that in the inner-city, a substantial number of young adult psychiatric inpatients are a high risk group for multiple substance abuse. The coexistence of substance abuse and other psychiatric disorders has clinical and treatment implications, and calls attention for changes within the conventional psychiatric milieu.     

Differences in functional status of Hispanic versus non-Hispanic White elders: data from the Medical Expenditure Panel Survey

OBJECTIVES. Few national studies have focused specifically on the functional status of Hispanic elders. We examined the prevalence of functional limitations and disabilities among Hispanic and Black elders compared to non-Hispanic Whites. METHODS. We analyzed seven measures of functional limitations, disabilities, and dependencies. Logistic regression was used to examine racial and ethnic group differences adjusting for age, gender, and education. RESULTS. Compared to non-Hispanic Whites, Hispanics tended to report greater instrumental activities of daily living (IADL) dependencies and cognitive disabilities. Blacks were more likely to have activities of daily living (ADL) and IADL dependencies and require use of assistive devices compared to non-Hispanic Whites. Further adjustment for respondent status reduced differences between groups, but these models may overadjust for functional status differences. DISCUSSION. Given the projected growth of minority elders, policymakers and planners will need to consider race and ethnic differentials in functional status in determining future medical and social service needs.     

Race/ethnicity and asthma management among adults presenting to the emergency department

We investigated whether racial/ethnic disparities exist in asthma management among 1785 adults requiring emergency department (ED) treatment. In this multicentre study, non‐Hispanic blacks with increased chronic asthma severity were only as likely (P > 0.05) as non‐Hispanic whites or Hispanics to utilize controller medications or see asthma specialists before ED presentation and to be prescribed recommended inhaled corticosteroids at ED discharge. Improved ED education on evidence‐based chronic disease management is needed to address continuing race/ethnicity‐based asthma disparities.     

Race/Ethnicity Differences between Alcohol, Marijuana, and Co-occurring Alcohol and Marijuana Use Disorders and Their Association with Public Health and Social Problems Using a National Sample

Background: Alcohol and marijuana are commonly used and misused in the United States, both singly and together. Despite this, few studies examine their co-occurring use and the corresponding association with public health and other problems. Moreover, there is a lack of investigation into differences in these associations on the basis of race/ethnicity. Methods: The present study estimated the frequency of alcohol use disorder, marijuana use disorder, and co-occurring alcohol and marijuana use disorder and their associated public health and social problems in Whites, African Americans, and Hispanics. This cross-sectional study included 13,872 individuals and used data from the 2005-2007 National Survey on Drug Use and Health. Frequency was calculated and multinomial regression was used to assess associations between substance use disorder and psychosocial, adverse consequences such as history of being arrested, substance use treatment, and sexually transmitted infection. Results: Alcohol use disorder was comparable between, and most prevalent among, Whites and Hispanics compared to African Americans, whereas marijuana use disorder was greatest among African Americans compared to other race/ethnicities. Co-occurring alcohol and marijuana use disorders were most prevalent for African Americans versus Whites and Hispanics, and similar in Whites and Hispanics. In general, major depressive episode was more prevalent for respondents with co-occurring use disorders or single marijuana use disorders. However, race/ethnicity differences in associations between substance use disorder and psychosocial correlates and adverse consequences were observed. Conclusions: Findings have implications for race/ethnicity appropriate integrated prevention and treatment of single and co-occurring use disorders and psychiatric comorbidities. (Am J Addict 2012;21:435-444).     

Alcohol-related and viral hepatitis C-related cirrhosis mortality among Hispanic subgroups in the United States, 2000-2004

Background: Hispanics have much higher cirrhosis mortality rates than non‐Hispanic Blacks and Whites. Although heavy alcohol use and hepatitis C virus (HCV) infection are two major risk factors for cirrhosis, no studies have systematically assessed the contribution of alcohol‐ and HCV‐related cirrhosis deaths to the total cirrhosis mortality for Hispanics as a whole and its variations across Hispanic subgroups. To fill this gap, this study presents the latest data on total cirrhosis mortality as well as its component alcohol‐ and HCV‐related cirrhosis mortality for all Hispanics and for Hispanic subgroups. Methods: The multiple‐cause approach was used to analyze data from the U.S. Multiple Cause of Death Data Files for 28,432 Hispanics and 168,856 non‐Hispanic Whites (as a comparison group) who died from cirrhosis as the underlying or a contributing cause during 2000–2004. Four major Hispanic subgroups were defined by national origin or ancestry, including Mexicans, Puerto Ricans, Cubans, and Other Hispanics. The cirrhosis deaths were divided into four distinctive cause‐of‐death categories: alcohol‐related, HCV‐related, both alcohol‐ and HCV‐related, and neither alcohol‐ nor HCV‐related. Age‐adjusted total cirrhosis death rates and percentage shares of the cause‐specific categories were compared across Hispanic subgroups and non‐Hispanic Whites. Results: Compared with non‐Hispanic Whites, all Hispanic subgroups except Cubans had much higher cirrhosis mortality. The age‐adjusted total cirrhosis death rates were twice as high for Puerto Ricans and Mexicans as for non‐Hispanic Whites. Alcohol‐related and HCV‐related cirrhosis death rates also were higher for most Hispanic subgroups than for non‐Hispanic Whites. Conclusions: Heavy alcohol use and hepatitis C viral infection are two important factors contributing to the high cirrhosis mortality among Hispanics. However, their relative contributions to total cirrhosis mortality varied by gender and Hispanic subgroup. This information is useful for targeted prevention and intervention efforts to address the excessive cirrhosis mortality in the Hispanic population.     

Substance Abuse Treatment Readmission Patterns of Asian Americans: Comparisons with Other Ethnic Groups

Background and significance: According to New York statewide substance abuse treatment and discharge data, Asians are a small minority who differ significantly from other racial–ethnic groups on income, primary language, treatment setting, substance abuse, referral source, and discharge status. Objectives: The present study further compares alcohol and substance abuse service utilization patterns of Asians with those of Whites, Blacks, and Hispanics in New York State. Methods: Cox regressions were employed to examine the differences in treatment admission patterns among Asians and other ethnic groups, while controlling a number of demographic, treatment-related, and non-treatment-related factors. A sample of 408,158 clients was selected from the Client Data System of the New York State Office of Alcoholism and Substance Abuse Services for the analysis. Results: While Asians in general are less likely to use treatment services and to have multiple treatment admissions compared with other groups, those Asians with multiple admissions tend to show utilization patterns – the period of greatest risk for readmission, the rate at which readmissions occur, and the likelihood of readmission – similar to the other groups at each subsequent admission. Conclusion: These findings suggest both similarities and differences in treatment readmission patterns between Asians and other clients of substance abuse treatment services. Future research on the cultural and linguistic factors related to Asians’ recovery and service utilization patterns after the initial treatment experience may be particularly important for systems of care seeking to be responsive to Asians’ needs.     

Ethnic differences in barriers and referral to cardiac rehabilitation among women hospitalized with coronary heart disease

Important gender differences in cardiac rehabilitation utilization are well established, yet few studies have documented whether reported barriers and referrals vary by ethnicity. This is a cross-sectional study to determine whether barriers and referrals to participation in cardiac rehabilitation differed by race/ethnicity in 304 women (52% ethnic minorities) hospitalized with coronary heart disease. Nearly all subjects (92%) strongly agreed that physician referral was important to participation in rehab, but only 22% of subjects reported physician instruction to attend. Whites were more likely than minorities to report instruction to attend cardiac rehabilitation, and minorities were more likely to report financial barriers when compared with whites. These disparities need to be addressed because minority women have a worse prognosis following hospitalization for coronary heart disease, and cardiac rehabilitation has been shown to improve survival.     

Substance use among emergency room patients: an exploratory analysis by ethnicity and acculturation

OBJECTIVE: While substantial literature exists on the role of alcohol in injury occurrence, little is known about other substance use or abuse and injury, or drug use among the alcohol involved at the time of the emergency room (ER) visit. METHOD: A probability sample of 1,429 patients attending the ER at Santa Clara Valley Medical Center (CA) was interviewed and was asked questions pertaining to licit and illicit drug use and alcohol use within 6 hr prior to the event, and drug use within the last year. RESULTS: While drug use within the 6 hr prior to the event was not found to be significantly different between injured and noninjured patients, injured patients were more likely to report drug use during the last year, and those with violence-related injuries were more likely to report drug use during both time periods compared to those with other injuries. Drug use was associated with ethnicity, with whites more likely than blacks or Hispanics to report use. Among Hispanics, acculturation was related to drug use, with those high on acculturation as likely or more likely than whites to report use. Among those reporting alcohol consumption within 6hr prior to the event and those meeting criteria for alcohol dependence, differences across ethnic/acculturation subgroups for drug use in the same 6-hr period were not significant, and a higher prevalence of both 6-hr and 12-month substance use was found compared to those not reporting drinking during the 6 hr and those not alcohol dependent. CONCLUSIONS: Data suggest that ethnic differences in substance use becomes less important among those alcohol involved, and future research should focus on the interaction of alcohol and other substances on injury occurrence. Data also suggest that substance use associated with increasing acculturation among U.S. Hispanics may have a strong impact on health services utilization, and research is needed by gender, ethnicity, and acculturation to determine the burden that substance use places on the ER.     

Influence of usual source of care on differences by race/ethnicity in receipt of preventive services

OBJECTIVE: We examined the relation between race/ethnicity and receipt of preventive services and the effect of having a usual source of care (USOC) on receipt of preventive services in different racial and ethnic groups. DESIGN/PARTICIPANTS: We analyzed data from adults, aged 18 to 64 years in the Household Component of the 1996 Medical Expenditure Panel Survey, a nationally representative survey of health care use for the United States. MEASUREMENTS: The proportion of adults who received age-appropriate preventive services. RESULTS: Compared to white respondents, Hispanics were less likely to receive breast exams and blood pressure and cholesterol screening than were white respondents, and blacks were more likely to report receiving a Pap smear. Despite being less likely to report having a USOC, black and Hispanic women were as likely or more likely to report receiving breast and cervical cancer screening, after controlling for having a USOC and other factors. Hispanics reported receiving blood pressure screening less often, and blacks reported receiving more cholesterol screening. For each race/ethnicity group, having a USOC was associated with receiving preventive services. However, controlling for USOC and other confounders attenuated, but did not eliminate, differences by race/ethnicity. CONCLUSION: The differences by race in receipt of preventive services suggest the need for different starting points for devising strategies to address racial differences in disease outcomes. While having a USOC will be important in narrowing the differences by race in receipt of preventive services, attending to other factors that contribute to disparities in health will also be essential.     

Divergent pathways? Racial/ethnic differences in older women's labor force withdrawal

OBJECTIVES: The purpose of this study was to investigate how women's labor force withdrawal behavior varies across race/ethnicity and to identify life course factors that generate these differences. METHODS: Using a sample of 7,235 women from the 1992-2004 Health and Retirement Study, we estimated cross-sectional multinomial logit models to explore racial/ethnic differences in labor force status at first interview. We then examined the prospective risk of exiting the labor force via retirement, work disability, or death using discrete-time hazard models. RESULTS: Black and Hispanic women had twice the odds of Whites of being work-disabled at first interview. Whereas younger minorities had lower odds of being retired at first interview, older minorities had higher odds. The prospective results showed that both Blacks and Hispanics had higher risks of work disability but not of retirement or of dying in the labor force. Overall, racial/ethnic differences in mid- and later life work behavior stemmed primarily from disparities in life course capital. DISCUSSION: This study shows that substantial racial/ethnic disparities in labor force exit behavior have already emerged by midlife. It is important to note that distinguishing between alternative pathways out of the labor force demonstrates that work disability is a more common experience for Black and Hispanic women than for Whites.     

Disparities in Alcohol-Related Problems Among White, Black, and Hispanic Americans

Background: This study assesses racial/ethnic disparities in negative social consequences of drinking and alcohol dependence symptoms among white, black, and Hispanic Americans. We examine whether and how disparities relate to heavy alcohol consumption and pattern, and the extent to which social disadvantage (poverty, unfair treatment, and racial/ethnic stigma) accounts for observed disparities. Methods: We analyzed data from the 2005 U.S. National Alcohol Survey, a nationally representative telephone‐based survey of adults ages 18 and older (N = 6,919). Given large racial/ethnic differences in abstinence rates, core analyses were restricted to current drinkers (N = 4,080). Logistic regression was used to assess disparities in alcohol‐related problems at 3 levels of heavy drinking, measured using a composite variable incorporating frequency of heavy episodic drinking, frequency of drunkenness, and maximum amount consumed in a single day. A mediational approach was used to assess the role of social disadvantage. Results: African American and Hispanic drinkers were significantly more likely than white drinkers to report social consequences of drinking and alcohol dependence symptoms. Even after adjusting for differences in heavy drinking and demographic characteristics, disparities in problems remained. The racial/ethnic gap in alcohol problems was greatest among those reporting little or no heavy drinking, and gradually diminished to nonsignificance at the highest level of heavy drinking. Social disadvantage, particularly in the form of racial/ethnic stigma, appeared to contribute to racial/ethnic differences in problems. Conclusions: These findings suggest that to eliminate racial/ethnic disparities in alcohol‐related problems, public health efforts must do more than reduce heavy drinking. Future research should address the possibility of drink size underestimation, identify the particular types of problems that disproportionately affect racial/ethnic minorities, and investigate social and cultural determinants of such problems.