Dataset Information

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking.

ABSTRACT: BACKGROUND:African Americans are generally known to have lower heavy drinking prevalence than Whites despite often greater individual and community risk factors. While it is supposed that their protective resources explain this "paradox," studies have not explicitly examined this. OBJECTIVE:Assess the contribution of protective resources to Black-White differences in heavy drinking, and (secondarily) whether protective resources operate by reducing heavy drinking and/or increasing abstinence. METHODS:Using data from the 2009-2010 U.S. National Alcohol Survey (N = 3,133 Whites and 1,040 Blacks ages 18+), we applied propensity score (PS) weighting to estimate racial differences in heavy drinking and abstinence under hypothetical conditions in which Whites are similar to Blacks in: (1) age and marital status; (2) socioeconomic position and unfair treatment; (3) neighborhood socioeconomic conditions and alcohol outlet density; and (4) protective resources (proscriptive religiosity, area-level religiosity, "drier" network drinking norms and patterns, and family social support). RESULTS:The Black-White gap in male and female drinkers' baseline heavy drinking increased after weighting adjustments for demographics. In women, this gap was reduced after weighting on disadvantage and eliminated after adjusting for protective resources. In men, adjustment for disadvantage increased the racial gap, and protective resources reduced it. Protective resources had a stronger effect on Black-White differences in men's abstinence than heavy drinking, but similar effects on these outcomes in women. CONCLUSION:Protective resources help explain Black-White differences in men's and particularly women's heavy drinking. Future research is needed to elucidate mechanisms of action and additional factors underlying racial differences in men's heavy drinking.

SUBMITTER: Mulia N

PROVIDER: S-EPMC6173315 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking.

Mulia Nina N Ye Yu Y Karriker-Jaffe Katherine J KJ Zemore Sarah E SE Jones-Webb Rhonda R

Substance use & misuse 20180402 12

<h4>Background</h4>African Americans are generally known to have lower heavy drinking prevalence than Whites despite often greater individual and community risk factors. While it is supposed that their protective resources explain this "paradox," studies have not explicitly examined this.<h4>Objective</h4>Assess the contribution of protective resources to Black-White differences in heavy drinking, and (secondarily) whether protective resources operate by reducing heavy drinking and/or increasing ...[more]

PMID: 29608112

Similar Datasets

Project description:BACKGROUND & AIMS:Previous studies reported that black vs white disparities in survival among elderly patients with colorectal cancer (CRC) were because of differences in tumor characteristics (tumor stage, grade, nodal status, and comorbidity) rather than differences in treatment. We sought to determine the contribution of differences in insurance, comorbidities, tumor characteristics, and treatment receipt to disparities in black vs white patients with CRC 18-64 years old. METHODS:We used data from the National Cancer Database, a hospital-based cancer registry database sponsored by the American College of Surgeons and the American Cancer Society, on non-Hispanic black (black) and non-Hispanic white (white) patients, 18-64 years old, diagnosed from 2004 through 2012 with single or first primary invasive stage I-IV CRC. Each black patient was matched, based on demographic, insurance, comorbidity, tumor, and treatment features, with 5 white patients, from partially overlapping subgroups, using propensity score and greedy matching algorithms. We used the Kaplan-Meier method to estimate 5-year survival and Cox proportional hazards models to generate hazard ratios. RESULTS:The absolute 5-year survival difference between black and white unmatched patients with CRC was 9.2% (57.3% for black patients vs 66.5% for white patients; P < .0001). The absolute difference in survival did not change after patient groups were matched for demographics, but decreased to 4.9% (47% relative decrease [4.3% of 9.2%]) when they were matched for insurance and to 2.3% when they were matched for tumor characteristics (26% relative decrease [2.4% of 9.2%]). Further matching by treatment did not reduce the difference in 5-year survival between black and white patients. In proportional hazards model, insurance and tumor characteristics matching accounted for the 54% and 27% excess risk of death in black patients, respectively. CONCLUSIONS:In an analysis of data from the National Cancer Database, we found that insurance coverage differences accounted for approximately one half of the disparity in survival rate of black vs white patients with CRC, 18-64 years old; tumor characteristics accounted for a quarter of the disparity. Affordable health insurance coverage for all populations could substantially reduce differences in survival times of black vs white patients with CRC.

Project description:BackgroundBlack-white differences in smoking abstinence are not well understood. This trial sought to confirm previously reported differences in quitting between blacks and whites and to identify factors underlying this difference.MethodsDuring enrollment, 224 black and 225 white low-income smokers were stratified on race and within race on age and sex to ensure balance on these factors known to impact abstinence. The intervention included varenicline for 12 weeks and six guideline-based smoking cessation counseling sessions. The primary endpoint was cotinine-verified 7-day point prevalence smoking abstinence at week 26. A priori socioeconomic, smoking, treatment process (eg, treatment utilization, side effects, withdrawal relief), psychosocial, and biological factors were assessed to investigate race differences in abstinence. Unadjusted odds ratios (OR) were used to compare abstinence between blacks and whites. Adjusted odds ratios from logistic regression models were used to examine predictors of abstinence. All statistical tests were two-sided.ResultsBlacks were less likely to achieve abstinence at week 26 (14.3% vs 24.4%, OR = 0.51, 95% confidence interval [CI] = 0.32 to 0.83, P = .007). Utilizing best subsets logistic regression, five factors associated with race jointly predicted abstinence: home ownership (yes/no, OR = 3.03, 95% CI = 1.72 to 5.35, P < .001), study visits completed (range = 0-6, OR = 2.81, 95% CI = 1.88 to 4.20, P < .001), income (household member/$1000, OR = 1.03, 95% CI = 1.01 to 1.06, P = .02), plasma cotinine (per 1 ng/mL, OR = 0.997, 95% CI = 0.994 to 0.999, P = .002), and neighborhood problems (range = 10-30, OR = 0.88, 95% CI = 0.81 to 0.96, P = .003).ConclusionsThe race difference in abstinence was fully explained by lack of home ownership, lower income, greater neighborhood problems, higher baseline cotinine, and higher visit completion, which were disproportionately represented among blacks. Findings illuminate factors that make it harder for blacks in the United States to quit smoking relative to whites and provide important areas for future studies to reduce tobacco-related health disparities.

Project description:BackgroundThe amount of alcohol consumed during an occasion can be influenced by physical and social attributes of the setting, characteristics and state of individuals, and the interactions of these components. This systematic review identifies and describes the specific combinations and sequences of context-related factors that are associated with heavy drinking occasions.Materials and methodsWe conducted a systematic literature search of MEDLINE, Embase and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Eligible articles were event-level and event-based studies that quantitatively analysed associations of sequences or combinations of context-related factors with event-level alcohol consumption. We extracted information on study design, sample, variables, effect estimates and analytical methods. We compiled a list of combinations and sequences associated with heavier drinking (i.e., 'risky contexts') and with lighter drinking ('protective contexts'). The review protocol was registered with PROSPERO (registration number: CRD42018089500).ResultsWe screened 1902 retrieved records and identified a final sample of 65 eligible studies. Daily mood, day of week, location and drinking group characteristics are important drivers of whether an individual engages in a heavy drinking occasion. The direction and magnitude of some associations differed by gender, age, personality and motives, such that in particular social or physical contexts, some people may feel compelled to drink more while others are compelled to drink less. Very few sequences of factors were reported as being associated with event-level alcohol consumption.ConclusionsContexts or factors are experienced in specific sequences that shape the broader drinking context and influence drinking behaviours and consequences but are under-studied. Event-level studies such as those using ecological momentary assessment can harness new technologies for data collection and analysis to improve understandings of why people engage in heavy drinking. Continued event-level research will facilitate public health interventions and policies that reduce heavy drinking and alcohol-related harms.

Project description:AimsTo estimate longitudinal pathways from childhood socio-economic position (SEP) to educational attainment and mid-life heavy drinking in black Americans in order to identify potential points of early intervention to reduce risk for alcohol-related problems in adulthood.Design, setting and participantsData are from 1299 black Americans in the US National Longitudinal Survey of Youth, followed from 1979 (aged 15-19 years) to 2012. Given gender differences in factors related to education and alcohol outcomes, gender-stratified path models were analyzed.MeasurementsYouth socio-economic indicators included parental education (approximating childhood SEP) and adolescent poverty duration. Education-related measures included high-poverty school, perceived school safety, academic problems, suspension from school, educational expectations and educational attainment. Adulthood measures included repeated unemployment, poverty duration and mean frequency of heavy drinking (six or more drinks/day) in young adulthood and mid-life. Covariates included age, dual-parent household, marital status, early drinking onset and family history of alcohol problems.FindingsFor both genders, two main pathways originating from low childhood SEP flowed to educational attainment through (1) educational expectations and (2) suspension and from educational attainment to mid-life heavy drinking [total indirect effect = 0.131, 95% confidence interval (CI) = 0.072-0.197 for women and 0.080, 95% CI = 0.035-0.139 for men]. For both genders, adolescent poverty (standardized βs ≥ 0.139), academic problems (βs ≥ 0.221) and school suspension (βs ≥ 0.166) were significantly (Ps < 0.05) related to lower educational expectations. In adulthood, educational attainment was indirectly protective against mid-life heavy drinking through its significant effects (Ps < 0.05) on young adult heavy drinking for both genders (βs ≤ -0.204) and economic hardships for women (βs ≤ -0.372).ConclusionsLow childhood socio-economic position among black Americans appears to be associated with subsequent, adverse socio-economic and school experiences that lead to lower educational attainment and, ultimately, greater heavy drinking at mid-life. Interventions that mitigate these earlier, adverse experiences might have indirect effects on mid-life heavy drinking.

Project description:Black-white disparities exist in receipt of recommended medical care, including colorectal cancer treatment. This retrospective cohort study examines the degree to which health systems (e.g., physician, hospital) factors explain black-white disparities in colon cancer care.Data from the Surveillance, Epidemiology, and End Results program; Medicare claims; the American Medical Association Masterfile; and hospital surveys were linked to examine chemotherapy receipt after stage III colon cancer resection among 5294 elderly (> or = 66 years of age) black and white Medicare-insured patients. Logistic regression analysis was used to identify factors associated with black-white differences in chemotherapy use. All statistical tests were two-sided.Black and white patients were equally likely to consult with a medical oncologist, but among patients who had such a consultation, black patients were less likely than white patients (59.3% versus 70.4%, difference = 10.9%, 95% confidence interval [CI] = 5.1% to 16.4%, P < .001) to receive chemotherapy. This black-white disparity was highest among patients aged 66-70 years (black patients 65.7%, white patients 86.3%, difference = 20.6%, 95% CI = 10.7% to 30.4%, P < .001) and decreased with age. The disparity among patients aged 66-70 years also remained statistically significant in the regression analysis. Overall, patient, physician, hospital, and environmental factors accounted for approximately 50% of the disparity in chemotherapy receipt among patients aged 66-70 years; surgical length of stay and neighborhood socioeconomic status accounted for approximately 27% of the disparity in this age group, and health systems factors accounted for 12%.Black and white Medicare-insured colon cancer patients have an equal opportunity to learn about adjuvant chemotherapy from a medical oncologist but do not receive chemotherapy equally. Little disparity was explained by health systems; more was explained by illness severity, social support, and environment. Further qualitative research is needed to understand the factors that influence the lower receipt of chemotherapy by black patients.

Dataset Information

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking.

Publications

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets