Asian American Problem Drinking Trajectories During the Transition to Adulthood: Ethnic Drinking Cultures and Neighborhood Contexts

Objectives. We aimed to identify problem drinking trajectories and their predictors among Asian Americans transitioning from adolescence to adulthood. We considered cultural and socioeconomic contextual factors, specifically ethnic drinking cultures, neighborhood socioeconomic status, and neighborhood coethnic density, to identify subgroups at high risk for developing problematic drinking trajectories.Methods. We used a sample of 1333 Asian Americans from 4 waves of the National Longitudinal Study of Adolescent to Adult Health (1994–2008) in growth mixture models to identify trajectory classes of frequent heavy episodic drinking and drunkenness. We fitted multinomial logistic regression models to identify predictors of trajectory class membership.Results. Two dimensions of ethnic drinking culture—drinking prevalence and detrimental drinking pattern in the country of origin—were predictive of problematic heavy episodic drinking and drunkenness trajectories. Higher neighborhood socioeconomic status in adolescence was predictive of the trajectory class indicating increasing frequency of drunkenness. Neighborhood coethnic density was not predictive of trajectory class membership.Conclusions. Drinking cultures in the country of origin may have enduring effects on drinking among Asian Americans. Further research on ethnic drinking cultures in the United States is warranted for prevention and intervention.Alcohol use disorders among Asian American young adults are important public health concerns. Although drinking prevalence is low for Asian Americans overall,1 Asian American young adults, particularly those in some ethnic groups such as Korean and Japanese, have higher rates of alcohol abuse and dependence than most other racial groups and other Asian ethnic groups such as Chinese.1–6 Asian Americans, including adolescents and young adults, are an underinvestigated population in alcohol research. Much of the small body of alcohol research, with college samples of mostly Korean and Chinese descent, has focused on genes involved in alcohol metabolism2,3,5,7,8 and the psychosocial moderators or mediators of their effects.2,9,10 Longitudinal studies on developmental trajectories of Asian American drinking are particularly rare.Past research indicates that alcohol consumption tends to escalate after high school in emerging adulthood (ages 18–25 years)11 and then begins to decline.12–14 Although problem drinking during emerging adulthood in itself is an important public health concern,15,16 continued or escalating problem drinking beyond this period is of even greater concern because of potential long-term health and social consequences. We aimed to identify developmental trajectories of problem drinking among Asian Americans transitioning from adolescence to adulthood that will help distinguish normative and problematic long-term drinking patterns. We also identified predictors of problematic drinking trajectories, with special attention to contextual factors concerning the broader cultural and socioeconomic environments of drinking, as these have received little research attention in this understudied population.Our investigation of ethnic drinking cultures addressed some of the documented limitations of acculturation research, including the common presumption that alcohol consumption and other risky health behaviors following an immigrant’s arrival in the United States are largely attributable to the influence of US culture,17 little understanding of ethnic cultures that may influence these behaviors,18 and the use of acculturation measures without clear bearings on the specific health issue at hand,19 which makes it difficult to elucidate the specific mechanisms through which acculturation influences health behaviors.20 In our view, the lack of understanding of the conditions within immigrant communities, along with preoccupation with how immigrant communities respond to US culture outside their communities, is critical.21 The approach we take here puts the focus squarely back on the cultural conditions within immigrant communities that specifically concern drinking—namely, ethnic drinking cultures, defined as cultural norms and behavioral practices of drinking in an immigrant’s country of origin.22 Our approach was informed by transnationalism theories, which suggest that immigrants often maintain socioeconomic ties with their homelands and retain elements of their cultural heritage, some of which may also appeal to their US-born descendants.23,24 In the context of drinking, transnationalism theories suggest that ethnic drinking culture from the country of origin may have enduring influence on immigrants and their children.A focus on ethnic drinking cultures has other significance in current research on immigrant health. Heterogeneity in drinking and other health outcomes across ethnic or national groups has been highlighted in recent research,25–27 which has used ethnicity as an implicit proxy of underlying yet undefined cultural or socioeconomic conditions that are assumed to vary across ethnic groups. Yet efforts to clarify the underlying conditions that may lead to diverse outcomes have been lacking.22 The 2 dimensions of ethnic drinking cultures used in this study, drinking prevalence and detrimental drinking pattern, express in quantifiable terms drinking-related cultural conditions that may explain the diverse drinking outcomes across Asian American subgroups. In our pioneering cross-sectional studies, we found robust associations of these dimensions with alcohol consumption among Asian American adults28 and young adults.22 Building on this research, in this longitudinal study, we examined the influence of ethnic drinking cultures on developmental trajectories of problem drinking among Asian Americans transitioning to adulthood in an effort to demonstrate their effects more conclusively.We also considered 2 neighborhood contextual factors as predictors of drinking trajectories, socioeconomic status (SES) and coethnic density. Neighborhood socioeconomic disadvantage may lead to problem drinking through several mechanisms including stress associated with a high level of poverty and often-accompanying social disorganization,29,30 a lack of social control on deviant behaviors associated with weaker community ties in disadvantaged neighborhoods,31,32 and increased density of bars and liquor stores in lower-income areas.33,34 Studies of effects of neighborhood disadvantage on substance use outcomes are decidedly mixed, as studies show less of an effect, or even an inverse association, of neighborhood disadvantage with adolescent substance use compared with adult substance use.35 Most adolescent substance users are in an experimental stage, and problematic trajectories of use are not evident until early adulthood, which is one impetus for the current study. Neighborhood coethnic density has been found to have protective buffering effects on health and health behaviors, including drinking,36 attributed to enhanced social cohesion, mutual social support, and a stronger sense of community and belongingness.37–41 Little research has been reported on the influence of these contextual factors on alcohol use over time among Asian American adolescents and young adults.Summarily stated, we addressed the following specific research question in this study: do ethnic drinking cultures, neighborhood SES, and neighborhood coethnic density predict problematic drinking trajectories for Asian Americans transitioning from adolescence to adulthood? We controlled for several key individual-level predictors of alcohol use during adolescence in our multivariate models—namely, US nativity, individual-level SES, age of drinking initiation, attachment to mother, and peer drinking in adolescence. This research helps identify specific profiles of subgroups at high risk for developing problematic, long-term patterns of drinking to guide prevention and intervention efforts targeted at the subgroups most likely to benefit. This is of great practical significance given the wide diversity among Asian Americans, both cultural42 and socioeconomic.43,44