National Alcohol Surveys: Advancing Epidemiologic Analyses of 21st Century Drinking
Co-Directors: Priscilla Martinez and William C. Kerr
Priscilla Martinez, PhD
William C. Kerr, PhD
The implementation of the 2024 National Alcohol Survey will deepen our knowledge of how to collect high quality survey data and biological samples, responding to contemporary survey research challenges. Expanding the NAS series to 45 years will provide us with new data to develop and examine up-to-date trends in alcohol use and problems, and potential disparities in the risk for alcohol-related problems across sex, socioeconomic and racial/ethnic groups. We will also learn whether inflammation partially explains alcohol’s effect on psychological distress, and address disparities in these effects among racial/ethnic groups, level of education, and neighborhood status.
Hazardous alcohol use remains one of the most common preventable causes of morbidity and mortality in the US and it manifests major racial/ethnic and other disparities. Nationally representative surveys repeated over time provide a means to advance survey methods, monitor trends in alcohol use overall and in sub-groups, and investigate timely health topics related to alcohol use. The Alcohol Research Group and its Center have conducted a series of National Alcohol Surveys (NAS) for forty years, and in this project will conduct the 15th edition of the NAS in 2023-2024 (termed N15).
Health Disparities in Alcohol Use and Other Risk Behaviors after the Onset of Cancers and Cardiovascular Disease-Related Conditions
Co-Directors: William C. Kerr and Won Kim Cook
William C. Kerr, PhD
Won Kim Cook, PhD
A large segment of the US population lives with chronic conditions adversely affected by drinking. Given our integrative approach, study findings will uniquely contribute to the knowledge base for multi-faceted interventions that can simultaneously address harmful drinking and other risk behaviors to help improve disease management, treatment adherence and overall health of individuals with alcohol-related health problems. Our results concerning disparities in knowledge and behaviors across demographic subgroups will help identify those at high risk for continued drinking with health conditions and inform contextually-relevant interventions targeted at them.
This project is a continuation of the 2016-2020 Health Disparities Project focusing on alcohol’s role in health outcomes. In this project, we shift our attention to patterns of drinking and other health risk behaviors among individuals with diagnosed health conditions focusing on diabetes, hypertension, heart/coronary problem, and cancer as well as multi-morbidity among these conditions.
Results will inform efforts to reduce health disparities through targeted and general policies and interventions aimed at reducing alcohol use and problems in disadvantaged populations.
Quality of Alcohol-Related Care Received: Missed Opportunities, Disparities and Impacts of Health Reform
Director: Nina Mulia
Nina Mulia, DrPH
Unhealthy drinking and alcohol use disorder (AUD) together affect more than one of every four American adults and are a leading cause of preventable death, with tremendous economic and social costs. This study seeks to increase understanding of gaps in the quality of alcohol-related care received among unhealthy drinkers and persons with AUD, and how this is changing with health reform. Based on analyses of national survey and specialty treatment data, study results may help to stimulate efforts of clinicians, healthcare administrators, treatment providers, and policymakers to improve access to quality alcohol-related care for all.
Nearly 20 years ago it was estimated that Americans with an alcohol use disorder (AUD) receive recommended care only 10% of the time. This was a striking, wake-up call to alcohol services providers and policymakers given the tremendous impact of unchecked harmful drinking in the US. Excessive drinking is a leading cause of preventable death among Americans, with 1 of every 4 US adults exceeding NIAAA’s recommended drinking limits. Moreover, there are disparities in on-going heavy drinking beyond young adulthood, in later onset, persistence and recurrence of AUD, and in alcohol-related morbidity and mortality. The pressing need to address unhealthy drinking has motivated alcohol screening and brief intervention (ASBI) in primary care, and recognition of the chronic, relapsing nature of AUD has focused attention on treatment engagement, retention, and completion and the promise of alcohol pharmacotherapy. Yet new research suggests that the quality of ASBI falls far short of clinical guidelines, and that there may be disparities in access to pharmacotherapy. Now, more than ever, healthcare quality and disparities are key issues for US healthcare providers and policymakers, and targeted by health reform initiatives to improve patient outcomes and reduce medical costs.
This Continuing Center Project aims to shed light on these issues by using national survey and administrative data to investigate alcohol-related care quality and disparities across the alcohol services system, from prevention to treatment.
High-Intensity Drinking over the Life Course
Co-Directors: Camillia K. Lui and Thomas K. Greenfield
Camillia K. Lui, PhD
Thomas K. Greenfield, PhD
This work will broaden our knowledge of both the precursors to and the outcomes of high-intensity drinking (HID) at various points over the life course, also estimating the public health burden attributable to high alcohol intake. This research project is poised to improve HID measurement, track HID trends over time, and enhance theory by contextualizing intensity within an individual’s overall drinking pattern, drinking history, event-level characteristics, and individual and environmental influences. Finally, this research will aid in improving prevention and treatment strategies by better identifying suitable target subgroups and provide information to help shape design of future interventions aimed at reducing harmful drinking intensities among a range of adults, from young adults to middle-aged and older Americans.
Identifying high-risk subgroups through event-based and population-based approaches Binge or heavy episodic drinking (HED) of ≥4/ ≥5 drinks for women/men in a single occasion or day has been a key marker of harmful drinking in general and clinical populations and has been widely used in alcohol epidemiology to capture the public health burden from alcohol use. Yet critics have raised the issue that the HED threshold fails to capture the impact of high-intensity drinking (HID) and implies the same average risks to all heavy drinkers regardless of whether they consume 5 or 15 drinks. Recent studies have raised attention to HID of consuming double (8+/10+ drinks) or even triple (12+/15+ drinks) the HED amount. As amounts per day reach extreme levels, risks for consequences and alcohol use disorders (AUD) increase greatly, even when average intake remains the same.
This project will trace trends in harmful drinking patterns with special attention to HID occurrence and rates over a 40-year period, identify a range of alcohol-related precursors and problems through event-based and population-based approaches, and situate harmful patterns within contexts to inform early screening and interventions for high-risk groups.
