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Try out PMC Labs and tell us Beer man seeking beer Elliott Mississippi woman you think. Learn More. Findings have indicated that people with higher SES may consume similar or greater amounts of alcohol compared with people with lower SES, although the latter group seems to bear a disproportionate burden of negative alcohol-related consequences.
These associations are further complicated by a variety of moderating factors, such as race, ethnicity, and gender. Thus, among individuals with lower SES, members of further marginalized communities, such as racial and ethnic minorities and homeless individuals, experience greater alcohol-related consequences. Future studies are needed to more fully explore the underlying mechanisms of the relationship between SES and alcohol outcomes. This knowledge should be applied toward the development of multilevel interventions that address not only individual-level risks but also economic disparities that have precipitated and maintained a disproportionate level of alcohol-related consequences among more marginalized and vulnerable populations.
According to the World Health Organizationalcohol consumption is responsible for approximately 5. The alcohol-related disease burden is precipitated in part by acute intoxication, which decreases reaction time, perception and motor skills, and inhibitions and is thereby associated with an increased risk for traffic accidents, self-inflicted injuries, suicide, falls, drownings, alcohol poisoning, and interpersonal violence. Longer-term effects of alcohol consumption also contribute to the disease burden by way of various medical conditions e.
Given the strong positive association between alcohol use and negative alcohol-related consequences, it is important to understand social determinants of these alcohol outcomes. These factors, which operate within various systems and levels, interact and transact over time to determine alcohol-related outcomes, such as drinking patterns and negative alcohol-related consequences Gruenewald et al. It synthesizes data primarily obtained from English-language systematic reviews and meta-analyses that were based on studies conducted in the past decade involving adult populations for a summary of these reviews and meta-analyses, see table 1.
In some cases, these analyses were limited to studies from only one country, whereas other analyses were cross-national. In any case, caution must be used when interpreting these findings, because the cultural and political contexts in which these phenomena occur can differ widely. In addition, this article reviews some larger, population-based studies see table 2particularly those that were not addressed within the included reviews and which directly assess the association between SES and alcohol consumption and related outcomes.
Although most of the studies only included adults, a few also involved adolescents when meta-analyses and reviews did not exclude such studies. Findings were inconclusive for associations between alcohol use and deprivation, poverty, income, unemployment, social disorder, and crime. Social-capital characteristics e. The most common psychiatric disorders were alcohol dependence prevalence 8. Lower educational attainment was associated with more reported alcohol-related consequences at comparable drinking levels in both men and women.
The association between area-level disadvantage and substance use seemed to vary according to age, ethnicity, size of area examined, type of SES measure, specific outcome analyzed, and analysis techniques. For both men and women, lower SES was associated with 1. Alcohol consumption and SES interacted to lead to greater harm in people with lower SES even at comparable levels of alcohol consumption. Most studies found that more debt is related to worse health i. Evidence indicated only weak and inconsistent associations between lower childhood SES and later alcohol use and abuse.
Among Finnish men, those with a steady high or increasing drinking trajectory had an increased risk of experiencing health and economic disadvantage. Among Finnish women, those with a steady high drinking trajectory had an increased risk of almost all health and economic disadvantages. Individual-level socioeconomic and cultural factors were protective against alcohol-related mortality. Some, but not all, area-level factors were protective against alcohol-related mortality. Overall prevalence of HED was Time spent in low-barrier, non—abstinence-based, permanent, supportive housing Housing First model was associated with declining alcohol use.
Greater of months spent in housing predicted additional decreases in alcohol use. Marked increases in unemployment rates during the recent recession did not moderate these associations. Neighborhoods with both the highest income and the highest income maldistribution had the highest prevalence of alcohol use.
On an individual level, both high neighborhood income and income maldistribution were associated with greater likelihood of alcohol use as well as with greater frequency of alcohol use. Neighborhood disadvantage was inversely associated with heavy drinking for White drinkers but positively associated with heavy drinking for African-American drinkers. Neighborhood disadvantage was marginally associated with elevated alcohol-related consequences among those who do drink, particularly among African-American men and White women.
Higher Black—White poverty ratios were associated with higher levels of light and heavy drinking among Whites and Blacks. Higher Black—White poverty ratios were associated with increased alcohol-related consequences and dependence for Blacks.
Higher Hispanic—White poverty ratios were associated with higher levels of light drinking by Whites and Hispanics. Higher Hispanic—White poverty ratios were associated with increased alcohol-related consequences and dependence for Hispanics. For men with low SES, living in a neighborhood with a high SES was associated with increased risk drinking, intoxication, and alcohol-related problems. For women, living in a neighborhood with low SES was associated with increased risk of alcohol problems, but no Beer man seeking beer Elliott Mississippi woman existed with individual SES.
Frequent unfair treatment, high racial stigma, and extreme disadvantage was associated with 2 to 6 times greater experience of alcohol problems. Severe economic loss job, housing was positively associated with negative drinking consequences, alcohol dependence, and, marginally, with intoxication. Both unstable and lost housing were associated with more alcohol problems and alcohol dependence symptoms.
Perceived family support moderated the associations. Greater family support was associated with fewer alcohol problems, irrespective of housing instability. Job loss was not associated with alcohol outcomes if housing instability was included in the analysis. Being in the subpopulation with the lowest SES was associated with increased mortality.
Drinking, smoking, and physical inactivity ed for about two-thirds of the increased mortality risk. Alcohol consumption declined for most adults studied, with substantial variation in the rate of decline; in a minority, alcohol consumption increased. High SES affluence, high educational attainment was associated with increasing alcohol consumption over time. Family income trajectory was associated with past-year alcohol use at age 15 and ever-smoking at age Children of families with declining SES were more likely to drink than were children from the most advantaged and most disadvantaged families.
Job loss during the past year was positively associated with average daily alcohol consumption, frequency of HED, and alcohol abuse or dependence. Recent homelessness and affiliation with alcohol-using friends was associated with increased risk of alcohol abuse. After experiencing severe economic loss, Blacks were more likely to experience alcohol-related problems and alcohol dependence compared with Whites.
Across the studies discussed in this article, SES has been operationalized on various levels e. Although these variables often are interrelated, this article addresses economic, income, and educational factors; employment status; and housing status in separate sections to facilitate interpretation of the overall findings.
Alcohol-related variables evaluated in this article, which were assessed either cross-sectionally or longitudinally, include the following:. Alcohol use, which is operationalized either continuously e. It is important to keep in mind that these are outcomes at the individual level; however, alcohol use and misuse certainly also have consequences at the familial, community, or societal levels. A discussion of these consequences is outside of the scope of this article. The article first summarizes cross-sectional perspectives on the associations of socioeconomic variables such as income, economic factors, and educational level with the quantity and frequency of alcohol use as Beer man seeking beer Elliott Mississippi woman as negative alcohol-related consequences.
In addition, it reviews the findings of longitudinal analyses regarding the associations between SES and alcohol-related outcomes before focusing on studies assessing two specific socioeconomic variables—i. A discussion of the limitations of the existing research and future directions concludes the review. Note that in some of the studies discussed, alcohol-related variables have been collapsed with other drug-related variables e. These studies typically have focused on either individual-level e. The findings indicated that people who did not graduate from high school and had a low income had the lowest prevalence of HED.
However, among those respondents who did engage in HED, those who reported the lowest educational and income levels reported the highest frequency of HED and the highest quantity consumed per occasion CDC Another population-based study conducted in New York City at the neighborhood level yielded similar findings Galea et al. Specifically, the neighborhoods with the highest income and with the greatest income disparities showed the highest prevalence of alcohol use as well as greater frequency of drinking. Similarly, analysis of data from a large, population-based survey called the Panel Study of Income Dynamics demonstrated that three indicators of family-background SES—income, wealth, and parental education—predicted alcohol use in young adults Patrick et al.
Young adults with the highest family-background SES reported greater alcohol use, and those with greater family wealth reported higher monthly HED prevalence. It is conceivable, however, that other factors, such as regional differences or personal characteristics e. Finch and colleagues found that subjective social status was not associated with level of alcohol use; however, consistent with the findings of other studies, personal and household income were positively correlated with alcohol-use quantity and frequency as well as frequency of HED.
Richardson and colleagues conducted a meta-analysis of 65 studies examining the effects of personal, unsecured debt on various health outcomes, including 5 studies that included alcohol-related outcomes. The findings from those studies indicated that personal, unsecured debt was associated with 2. In another review of 41 studies, Karriker-Jaffe examined whether area-level disadvantage i. The studies included in the analysis assessed the impact of a wide range of area-level SES effects. The review concluded that residents in a given area were relatively similar in their AOD use i.
However, the studies reviewed provided only limited and conflicting support for the hypothesis that area-level disadvantage was associated with increased AOD use, with some effects supporting the hypothesis and others pointing in the opposite direction i.
A wide range of factors related to the populations studied e. Similarly, in a review of 48 studies, Bryden and colleagues reported inconclusive findings regarding the association between alcohol use and various measures of SES e.
The analyses did, however, offer area-level corroboration of the conclusions from individual-level studies because there was some indication that adults living in higher-income areas reported greater alcohol use. The findings also indicated a protective effect of the level of community participation and involvement on alcohol use. Another population-based study Karriker-Jaffe et al.
Analyses using various models incorporating both individual-level and neighborhood-level measures indicated that individual-level SES had the strongest impact on drinking patterns and consequences. When such individual-level factors were removed from the models, neighborhoods with lower SES were characterized by greater prevalence of alcohol abstinence compared with neighborhoods with higher SES, although among those who did drink, neighborhood disadvantage was associated with heavy drinking and negative alcohol-related consequences.
Thus, African-American and Hispanic men were excluded from the protective effect of neighborhood disadvantage on risk of any drinking. Furthermore, neighborhood disadvantage was associated with reduced heavy drinking for European Americans but with increased heavy drinking for African Americans.
Thus, in a separate analysis of data from the NAS Mulia et al. However, Blacks and Hispanics reported greater exposure to social disadvantage than Whites, which may for higher rates of problem drinking. Additional analyses of data from the U. Census and and NAS Mulia and Karriker-Jaffe further identified interactions between individual-level and neighborhood SES that influenced alcohol consumption and related problems.
Among men, living in a neighborhood with higher SES was associated with higher odds of heavy drinking and intoxication only among those with a low individual SES compared with men with a middle or higher SES living in the same advantaged neighborhoods. In contrast, neighborhood disadvantage was associated with an increased risk for alcohol-related problems in women, and individual-level SES did not seem to influence this association.
Studies have shown a strong association between SES and alcohol-related mortality, the most severe form of alcohol-related harm. In a meta-analysis of 15 studies capturing data on approximately million Beer man seeking beer Elliott Mississippi woman worldwide, Probst and colleagues examined the association between SES operationalized as a pooled measure reflecting occupation, employment status, income, and education and alcohol-related mortality as well as all-cause mortality. The analyses found that lower SES increased the risk of alcohol-related mortality by 66 percent for men and 78 percent for women compared with all-cause mortality.
Additional studies have supported these findings. In a recent study involving data from the U. Mediating factors, including alcohol use, smoking, and physical inactivity, ificantly and collectively ed for 68 percent of this all-cause mortality Nandi et al. Further, a Finnish study of men ages 25—64 showed that individual-level socioeconomic i.
As with the association with alcohol use discussed earlier, these factors typically dwarfed the influence of area-level factors Blomgren et al. Thus, neither area-level median income nor income inequality was associated with alcohol-related mortality.
Nevertheless, some area-level SES variables i. Other investigators have focused on negative alcohol-related consequences beyond mortality. In addition, men from countries with lower gross national incomes reported more societal consequences of drinking compared with men from countries with higher gross national incomes Grittner et al. Again, these effects of SES-related variables on negative alcohol-related consequences may be moderated by other individual-level factors, such as race and ethnicity.
The study identified four groups of participants: those with virtually no symptoms of mental health or substance-use problems, those with symptoms of licit-substance use disorders mostly alcohol and nicotine dependencethose with mental health disorder symptoms, and those with comorbid symptoms of all five mental health and substance-use indicators. The analysis suggested that the relationship between SES and AUD is not simply unidirectional but that effects actually occur in both directions.
Thus, the investigators found that people who did not earn their high school diploma by age 21 were more than twice as likely to belong to the alcohol- and nicotine-dependence group and six times more likely to belong to the comorbid-symptoms group compared with those who had achieved a higher educational attainment. At the same time, people with greater alcohol- and nicotine-dependence symptoms or comorbid symptomatology achieved lower wealth accumulation at age 30 compared with people with low overall symptom experience Lee et al.
Taken together, these findings indicate a strong, bidirectional relationship between SES and alcohol-related harm.Beer man seeking beer Elliott Mississippi woman
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