Full length articleThe association between racial and socioeconomic discrimination and two stages of alcohol use in blacks
Introduction
Although Blacks have higher abstention rates and delayed onset of alcohol use relative to other ethnic groups (Anthony et al., 1994; Hasin et al., 2007; McKinney and Caetano, 2014), Black drinkers experience among the highest rates of alcohol-related problems at the same level of exposure (Caetano, 1997; Caetano and Kaskutas, 1996; Galvan and Caetano, 2003; Jones-Webb, 1998; Mulia et al., 2009; Witbrodt et al., 2014). This disparity in alcohol-related consequences is suggestive of risk pathways for developing alcohol problems among Blacks that are not well represented in current etiological models of problem drinking, which have been developed primarily on samples of Whites. Psychosocial factors of particular relevance to Blacks - such as racial discrimination - need to be considered to better understand alcohol-related risk pathways.
This study draws on the Transactional Model of Stress and Coping (Lazarus and Folkman, 1987), which identifies drinking alcohol as one approach to cope with stress, and Minority Stress Models (Clark et al., 1999; Harrell, 2000), which posit that disadvantaged individuals experience additional stress related to their disadvantaged status (e.g., discrimination). We further draw from the Stress Process Model (Pearlin and Schooler, 1978), which suggests that effective coping is not evenly distributed in society, with disadvantaged groups being less likely to use efficacious approaches (e.g., drinking alcohol).
Extensive evidence suggests experiences of racial discrimination are associated with increased alcohol involvement among Blacks (Zapolski et al., 2014). For example, racial discrimination has been linked to increased binge and heavy drinking (e.g., Hurd et al., 2014; Kwate et al., 2010; Terrell et al., 2006) and alcohol-related problems (e.g., Boynton et al., 2014; Broman, 2007; Hunte and Barry, 2012). However, the findings are mixed, with several studies finding no relation between racial discrimination and alcohol outcomes (e.g., Chavez et al., 2015; Grekin, 2012; Tobler et al., 2013). These inconsistencies suggest further investigation of the link between racial discrimination and alcohol use and misuse among Blacks is needed.
Racial discrimination is the most common form of discrimination studied (Gilbert and Zemore, 2016). However, Blacks’ experiences of discrimination are not limited to racial discrimination. Socioeconomic discrimination (being thwarted, harassed, or made to feel subordinate because of one’s social class or economic standing; Krieger, 2005), may also be commonly experienced by Blacks, given their overrepresentation among those with low socioeconomic status (SES; Williams, 1999; Williams et al., 2010; Zemore et al., 2018). Socioeconomic discrimination has been linked to depression (Belle and Doucet, 2003; Canady et al., 2008) and sleep outcomes (Van Dyke et al., 2016); however, no study has investigated the association between socioeconomic discrimination and alcohol outcomes.
When examining the impact of discrimination on alcohol use risk among Black youth, we can also gain a broader perspective by considering other factors that might impact this relation, such as parental experiences of discrimination, religious involvement, and social support. Parental experiences of discrimination may be an indicator of offspring racial socialization (the process of preparing children for racism; Anderson and Stevenson, 2019; Spencer, 1983; Hughes et al., 2006). Prior research suggests that racial socialization may buffer the effects of racial discrimination on alcohol use (Neblett et al., 2010). Although prior research suggests a link between parental experiences of discrimination and offspring internalizing and externalizing symptoms (Tran, 2014) and suicidality (Arshanapally et al., 2017), no study has investigated the impact of parental experiences of discrimination on offspring alcohol use. Religious involvement is also a known protective factor against problem drinking (e.g., Heath et al., 1999; Meyers et al., 2017; Zapolski et al., 2014), and has been found to moderate the relation between discrimination experiences and alcohol outcomes (Henderson, 2017). Similarly, there is evidence that social support reduces the impact of discrimination experiences on alcohol use (Gerrard et al., 2017; Pascoe and Richman, 2009). Thus, religious involvement and social support were included as potential moderators in this study.
The research to-date on racial discrimination and alcohol outcomes has not considered the association of discrimination with the timing of drinking behaviors or progression through stages of alcohol use. Breaking down the multi-stage risk-pathway from alcohol initiation to the development of problem drinking (Sartor et al., 2007) can inform targeted interventions. Identifying the points in drinking course where discrimination may be most impactful can guide intervention efforts toward those critical periods where they may be most effective. The goal of the present study was to characterize the association of experiences of racial and socioeconomic discrimination with the timing of two stages of alcohol use: initiation and the progression from first use to problem drinking in Black youth, in the context of known risk factors and potential protective factors.
Section snippets
Participants
Participants were drawn from the Missouri Family Study, a high-risk study of alcohol use disorder (AUD)-related conditions, conducted from 2003−2009. Two ascertainment strategies were used to identify high-risk AUD families. First, eligible families with one index child aged 13, 15, 17, or 19 years and one or more full siblings were identified through Missouri birth records. Biological mothers completed a brief phone screen assessing family risk for AUD. If the mother reported the biological
Results
Prevalence of discrimination experiences, alcohol outcomes, and timing of alcohol stages are reported in Table 2. Sixty-two percent of offspring reported experiencing racial discrimination and 26% reported experiencing socioeconomic discrimination. Endorsement of socioeconomic discrimination was higher in males (χ2 = 5.03, p = 0.02) than females. Thirty-four percent of mothers endorsed both racial and socioeconomic discrimination; 34% endorsed one of the two. Most offspring reported consuming
Discussion
The present study expanded on existing research on the link between discrimination and drinking behaviors among Black youth by examining socioeconomic as well as racial discrimination and considering maternal discrimination experiences in relation to the progression through two stages of alcohol use. These findings inform etiologic models of problem drinking among Black youth by highlighting the relevance of socioeconomic in addition to racial discrimination, potential sex differences in their
Contributors
All six authors were personally and actively involved in substantive work leading to the report and will hold themselves jointly and individually responsible for its content. Each author has approved the final manuscript.
Role of funding sources
Funding for this study was provided by the National Institute on Alcohol Abuse and Alcoholism (R01 AA012640, R01 AA023549) and the National Institute on Drug Abuse (T32 DA15035, T32 DA019426). The National Institutes of Health did not play a role in the study design, collection, analysis, interpretation of the data, writing the manuscript, or the decision to submit the manuscript for publication.
Conflicts of interest
No conflict declared.
Acknowledgements
We thank all the research participants and their families for the time they dedicated to this study.
References (60)
- et al.
Discrimination and symptoms of depression in pregnancy among African American and White women
Womens Health Issues
(2008) - et al.
Racial/ethnic workplace discrimination: association with tobacco and alcohol use
Am. J. Prev. Med.
(2015) - et al.
Upward social mobility and identity
Curr. Opin. Psychol.
(2017) - et al.
Discrimination and drinking: a systematic review of the evidence
Soc. Sci. Med.
(2016) Children’s cultural values and parental child rearing strategies
Dev. Rev.
(1983)- et al.
Socioeconomic status discrimination is associated with poor sleep in African-Americans, but not Whites
Soc. Sci. Med.
(2016) - et al.
Childhood maltreatment and substance use disorders among men and women in a nationally representative sample
Can. J. Psychiatry
(2012) Diagnostic and Statistical Manual of Mental Disorders, Text Revision
(1994)Diagnostic and Statistical Manual of Mental Disorders
(2013)- et al.
RECASTing racial stress and trauma: theorizing the healing potential of racial socialization in families
Am. Psychol.
(2019)