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Edmonds AT, Rhew IC, Jones-Smith J, Chan KCG, De Castro AB, Rubinsky AD, Blosnich JR, Williams EC. Neighborhood Disadvantage, Patterns of Unhealthy Alcohol Use, and Differential Associations by Gender, Race/Ethnicity, and Rurality: A Study of Veterans Health Administration Patients. J Stud Alcohol Drugs 2022; 83:867-878. [PMID: 36484584 PMCID: PMC9756400 DOI: 10.15288/jsad.21-00110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/31/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Stressful conditions within disadvantaged neighborhoods may shape unhealthy alcohol use and related harms. Yet, associations between neighborhood disadvantage and more severe unhealthy alcohol use are underexplored, particularly for subpopulations. Among national Veterans Health Administration (VA) patients (2013-2017), we assessed associations between neighborhood disadvantage and multiple alcohol-related outcomes and examined moderation by sociodemographic factors. METHOD Electronic health record data were extracted for VA patients with a routine Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen. Patient addresses were linked by census block group to the Area Deprivation Index (ADI), dichotomized at the 85th percentile, and examined in quintiles for sensitivity analyses. Using modified Poisson generalized estimating equations models, we estimated associations between neighborhood disadvantage and five outcomes: unhealthy alcohol use (AUDIT-C ≥ 5), any past-year heavy episodic drinking (HED), severe unhealthy alcohol use (AUDIT-C ≥ 8), alcohol use disorder (AUD) diagnosis, and alcohol-specific conditions diagnoses. Moderation by gender, race/ethnicity, and rurality was tested using multiplicative interaction. RESULTS Among 6,381,033 patients, residence in a highly disadvantaged neighborhood (ADI ≥ 85th percentile) was associated with a higher likelihood of unhealthy alcohol use (prevalence ratio [PR] = 1.06, 95% CI [1.05, 1.07]), severe unhealthy alcohol use (PR = 1.14, 95% CI [1.12, 1.15]), HED (PR = 1.04, 95% CI [1.03, 1.05]), AUD (PR = 1.14, 95% CI [1.13, 1.15]), and alcohol-specific conditions (PR = 1.21, 95% CI [1.18, 1.24]). Associations were larger for Black and American Indian/Alaska Native patients compared with White patients and for urban compared with rural patients. There was mixed evidence of moderation by gender. CONCLUSIONS Neighborhood disadvantage may play a role in unhealthy alcohol use in VA patients, particularly those of marginalized racialized groups and those residing in urban areas.
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Affiliation(s)
- Amy T. Edmonds
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
- Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Jessica Jones-Smith
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Kwun C. G. Chan
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - A. B. De Castro
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington
| | - Anna D. Rubinsky
- Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
- Health Services Research & Development, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Emily C. Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
- Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Oliveira LM, Cerezer DM, Casarin M, Moreira CHC, Zanatta FB. Alcohol use disorders are associated with higher prevalence of periodontitis in a rural area of Brazil. J Periodontal Res 2021; 56:940-950. [PMID: 34057233 DOI: 10.1111/jre.12890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of the present cross-sectional study was to determine whether alcohol use disorders (AUD) are independently associated with severe and extent cases of periodontitis in individuals living in a rural area of Brazil. METHODS A representative probability sample (N = 585) was evaluated using six-site full-mouth periodontal examination. AUD was assessed using the alcohol use disorders identification test (AUDIT) and considered in its unidimensional and bidimensional factor structures. The first address hazardous alcohol consumption [HAC (overall scores ≥8)], and the second deals with two distinct constructs, harmful use [HU (items 1-3 scores ≥4 for men or ≥3 for women)], and alcohol-related consequences [ARC (items 4-10 scores ≥1)]. Periodontal outcomes were defined based on the criteria proposed by the CDC-AAP (2012) and an adaptation of the EFP-AAP (2018) definition of generalized stages III or IV periodontitis (GP). Adjusted multilevel multinomial and binary logistic regression analysis were used with a conceptual hierarchical approach to calculate the odds ratios (OR) of periodontal outcomes. RESULTS In the adjusted model, HU (OR = 2.69; 95% CI: 1.29-5.58) and ARC (OR = 3.79; 95% CI: 1.51-9.51) were significantly associated with higher prevalence of severe periodontitis (SP). Higher occurrence of GP was detected in individuals presenting HAC (OR = 1.88; 95% CI: 1.05-3.37) and ARC (OR = 2.90; 95% CI: 1.61-5.24). CONCLUSION AUD was independently associated with higher prevalence of SP and GP in individuals living in a rural area.
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Affiliation(s)
- Leandro Machado Oliveira
- Department of Stomatology, Postgraduate Program in Dentistry, Universidade Federal de Santa Maria (UFSM, Santa Maria, Rio Grande do Sul, Brazil
| | - Débora Martins Cerezer
- Department of Stomatology, Postgraduate Program in Dentistry, Universidade Federal de Santa Maria (UFSM, Santa Maria, Rio Grande do Sul, Brazil
| | - Maísa Casarin
- Department of Semiology and Clinic, Postgraduate Program in Dentistry, Universidade Federal de Pelotas (UFPel, Pelotas, Rio Grande do Sul, Brazil
| | - Carlos Heitor Cunha Moreira
- Department of Stomatology, Postgraduate Program in Dentistry, Universidade Federal de Santa Maria (UFSM, Santa Maria, Rio Grande do Sul, Brazil
| | - Fabrício Batistin Zanatta
- Department of Stomatology, Postgraduate Program in Dentistry, Universidade Federal de Santa Maria (UFSM, Santa Maria, Rio Grande do Sul, Brazil
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