Heavy drinking during periods of high unemployment: 15-year trend study of the role of race/ethnicity

"Deaths of despair" over the business cycle: New estimates from a shift-share instrumental variables approach

This study presents new evidence of the effects of short-term economic fluctuations on suicide, fatal drug overdose, and alcohol-related mortality among working-age adults in the United States from 2003-2017. Using a shift-share instrumental variables approach, I find that a one percentage point increase in the aggregate employment rate decreases current-year non-drug suicides by 1.7 percent. These protective effects are concentrated among working-age men and likely reflect a combination of individual labor market experiences as well as the indirect effects of local economic growth. I find no consistent evidence that short-term business cycle changes affect drug or alcohol-related mortality. While the estimated protective effects are small relative to secular increases in suicide in recent decades, these findings are suggestive of important, short-term economic factors affecting specific causes of death and should be considered alongside the longer-term and multifaceted social, economic, and cultural determinants of America's "despair" epidemic.

Gender and Childhood Victimization: A Longitudinal Study of Heavy Drinking in Young Adulthood

The present longitudinal study, for 12 years, followed a group of young adults, examining (1) whether/how victimization in childhood increased the likelihood of heavy drinking; (2) whether depression mediated the strain-heavy drinking relationship; and (3) whether/how relationships among strain, depression, and heavy drinking differed across two gender groups. Data came from the National Longitudinal Survey of Youth 1997 cohort, dating 2004-2015 (5 interview waves and 22,549 person-wave measurements total). We linked consumption of 5+ drinks (during the month prior) to four discrete measures of violent victimization, to one measure of stressful events, and to depression. We needed to consider repeat measures of the same variables over time, so we used generalized estimating equations (GEE) to analyze data. Depression was found to increase heavy drinking uniformly. Empirical evidence confirmed that in the strain-heavy drinking relationship, depression plays a minor mediating role. Gender moderated heavy drinking's associations. Specifically, bullying in childhood raised risk for female respondents. The current strain was associated with a higher risk of heavy drinking among male respondents. Childhood victimization, as well as current life stress, play an important role in depression and heavy drinking. Future research should focus on the development of specific, targeted care to reduce heavy drinking's harm and promote equity among Americans.

Does a Crossover Age Effect Exist for African American and Hispanic Binge Drinkers? Findings from the 2010 to 2013 National Study on Drug Use and Health

BACKGROUND

Among general population studies, lower rates of binge drinking tend to be found among African Americans and Hispanics compared to Whites. However, among older adult populations, minority groups have been shown to be at higher risk for binge drinking, suggesting the presence of a crossover effect from low to high risk as a function of age. To date, limited research has examined the crossover effect among African American and Hispanic populations compared to non-Hispanic Whites across large developmental time frames or explored variation in risk based on income or gender. This study aimed to fill these gaps in the literature.

METHODS

Data were compiled from the 2010 to 2013 National Survey on Drug Use and Health surveys, which provide annual, nationally representative data on substance use behaviors among individuals aged 12 and older. Hispanic, non-Hispanic African American, and non-Hispanic White respondents were included (N = 205,198) in the analyses.

RESULTS

A crossover effect was found for African American males and females among the lowest income level (i.e., incomes less than $20,000). Specifically, after controlling for education and marital status, compared to Whites, risk for binge drinking was lower for African American males at ages 18 to 24 and for females at ages 18 to 34, but higher for both African American males and females at ages 50 to 64. No crossover effect was found for Hispanic respondents.

CONCLUSIONS

Although African Americans are generally at lower risk for binge drinking, risk appears to increase disproportionately with age among those who are impoverished. Explanatory factors, such as social determinants of health prevalent within low-income African American communities (e.g., lower education, violence exposure, housing insecurity) and potential areas for intervention programming are discussed.

The Effects of the Global Economic Recession and a Reduced Alcohol Tax on Hospitalizations Due to Alcohol-Attributed Diseases in Taiwan

This study is to assess the effects of the 2008 economic crisis and a 2009 alcohol tax reduction on alcohol-related morbidity for men of different socioeconomic statuses in Taiwan. Admissions data for the period from 2007 to 2012 for men aged 24–59 years in 2007 was retrieved from the National Health Insurance Research Database. With stratification over three income levels, an interrupted time-series analysis examining the effects of the crisis and taxation reduction on incidence rates of hospitalization for alcohol-attributed diseases (AADs) was employed. The low income group showed a significant (p < 0.05) change in the rate of AAD-related hospitalizations in July 2008; specifically, an abrupt 7.11% increase that was then sustained for several months thereafter. In contrast, while the middle income group exhibited a significant 22.9% decline in the rate of AAD-related hospitalizations over the course of the crisis, that downward trend was gradual. The reduction of the alcohol tax resulted in increased rates of AADs among both the low and high income groups. The economic recession and the reduction of the alcohol tax resulted in an increased rate of AAD among low income men.

Effects of the Global Financial Crisis on Health in High-Income Oecd Countries

A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups.

Effects of Economic Disruptions on Alcohol Use and Problems: Why Do African Americans Fare Worse?

OBJECTIVE

This study tested a model of the effects of recession-related job loss on alcohol use disorder (AUD) and examined why African Americans who lost their jobs during the 2008-2009 recession were at increased risk for AUD relative to Whites. We hypothesized that (a) job loss would be positively associated with psychological distress (i.e., higher levels of depressive symptoms) and increased drunkenness, and (b) low levels of family social support and experiences of racial stigma would exacerbate the effects of job loss on distress, especially among African Americans and Hispanics.

METHOD

Data were drawn from the 2010 U.S. National Alcohol Survey (NAS), a cross-sectional survey of the U.S. general population. Using data from the 2010 NAS (telephone survey of 1,111 African American, 964 Hispanic, and 3,133 White adults), we conducted simultaneous path modeling in Mplus to test mediation and moderation hypotheses. Our key outcome was AUD as measured by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

RESULTS

Recession-related job loss was significantly associated with AUD through its effects on increased drunkenness, and the associations were positive for Whites, stronger for African Americans than Whites, and nonexistent for Hispanics. Job loss was associated with distress in the overall sample, and distress was positively associated with drunkenness among African Americans only, suggesting that distress is another pathway by which job loss affects AUD among African Americans. Higher levels of family social support mitigated the effects of job loss on psychological distress, and this relationship did not differ by race/ethnicity.

CONCLUSIONS

During economic downturns, increased stress and heavy drinking are important pathways through which recession-related job loss can lead to greater AUD among African Americans relative to Whites.

The Great Recession and employee alcohol use: a U.S. population study

This is the first study to examine broadly the overall net change in U.S. population estimates of alcohol use related to a recession--The Great Recession--among individuals who remain employed. The alcohol variables included drinker status, usual frequency and quantity of alcohol use, frequency of heavy drinking and intoxication, as well as contextual assessments of the frequency and quantity of alcohol use during the workday and after work. The moderating influence of gender, race, and age also was explored. Data for this repeated cross-sectional study were obtained from 2 national telephone surveys of U.S. workers. The first survey occurred prior to the Great Recession (2002-2003; N = 2,501), whereas the second survey occurred during and after the official end of the Great Recession (2008-2011; N = 2,581). The results revealed that the recession was related to a higher proportion of drinkers among middle-aged employees, but not among young employees. Gender and race did not moderate the relation of the recession to drinker status. Among drinkers, the recession was not related to usual alcohol use (frequency and quantity), but was positively related to the frequency of heavy drinking and intoxication. Further, the recession had a differential relation to the contextual alcohol measures. It was negatively related to the frequency and quantity of workday alcohol use, but was positively related to the frequency and quantity of afterwork alcohol use. Among drinkers, gender, race, and age did not moderate the relation of the recession to alcohol use.

Race, Employment Disadvantages, and Heavy Drinking: A Multilevel Model

We intended to determine (1) whether stress from employment disadvantages led to increased frequency of heavy drinking and (2) whether race had a role in the relationship between such disadvantages and heavy drinking. Study data came from the National Longitudinal Survey of Youth, a prospective study that has followed a representative sample of youth since 1979. Our study employed data from 11 particular years, during which the survey included items measuring respondents' heavy drinking. Our final sample numbered 10,171 respondents, which generated 75,394 person-waves for data analysis. Both of our hypotheses were supported by results from multilevel mixed-effects linear regression capturing the time-varying nature of three employment disadvantages and of the heavy-drinking outcome. Results show that more-frequent heavy drinking was associated with employment disadvantages, and that disadvantages' effects on drinking were stronger for Blacks and Hispanics than for Whites. That worsening employment disadvantages have worse effects on minority groups' heavy drinking (compared to Whites) probably contributes to the racial health disparities in our nation. Policies and programs addressing such disparities are especially important during economic downturns.

How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review

Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful drinking. Such a different net impact between men and women could potentially contribute to growing gender-related health inequalities during a crisis.

The association between social stressors and drug use/hazardous drinking among former prison inmates

Social stressors are associated with relapse to substance use among people receiving addiction treatment and people with substance use risk behaviors. The relationship between social stressors and drug use/hazardous drinking in former prisoners has not been studied. We interviewed former prisoners at baseline, 1 to 3 weeks post prison release, and follow up, between 2 and 9 months following the baseline interview. Social stressors were characterized by unemployment, homelessness, unstable housing, problems with family, friends, and/or significant others, being single, or major symptoms of depression. Associations between baseline social stressors and follow-up drug use and hazardous drinking were analyzed using multivariable logistic regression. Problems with family, friends, and/or significant others were associated with reported drug use (AOR 3.01, 95% CI 1.18-7.67) and hazardous drinking (AOR 2.69, 95% CI 1.05-6.87) post release. Further research may determine whether interventions and policies targeting social stressors can reduce relapse among former inmates.