Turning great ideas into healthier communities


PHI's Alcohol Research Group Uncovers Disparities Across the Lifecourse

March 24, 2017 | Alcohol Research Group | This post first appeared on the Alcohol Research Group blog.

A recent study from PHI's Alcohol Research Group's Nina Mulia and colleagues assessed long-term heavy drinking patterns of racial/ethnic groups and found some surprising results. Consistent with other studies, their research showed a significant decline in White men and women’s heavy drinking in their 20’s while Black men and women’s drinking increased during the same period. The study team defined heavy drinking as having six or more drinks on one occasion.

What the research team did not expect to find was a crossover in the frequency of heavy drinking between Latino and White men, and Black and White women who ever drank heavily. Both Latino men and Black women drink less in their early twenties than their White counterparts, but that pattern changes when they reach their late twenties.

“Given racial/ethnic disparities in alcohol-related health and social problems, we thought there might be a crossover in heavy drinking with aging, or at least more enduring heavy drinking by racial/ethnic minorities. There’s a small literature on this showing mixed results but several of the studies ended with young adulthood while our study extends to the early 50’s.

“I’d also like to point out that these results from national, prospective longitudinal data are consistent with our recent findings from retrospective analysis of individuals’ heavy drinking from their teens to their forties using the US National Alcohol Survey,” she added. “The prospective study results show that among women who ever drank heavily, Black women exceed White women’s heavy drinking frequency throughout their thirties and into their early forties.

“It raises questions about why this crossover occurs at this point in the life course and what can be done to prevent it. Also, what are the health consequences of sustained heavy drinking and do they vary across population subgroups. Several of us at ARG are investigating the latter questions in projects led by senior scientist Bill Kerr.”

When thinking about why these kinds of patterns emerged, Mulia described social and structural disparities, which may become more acute when people enter adulthood. “Ostensibly it’s a time when you’re supposed to be getting a decent job, starting a career, having and providing for a family, and having a home, and all that is difficult enough without the differential opportunities, barriers and additional stresses certain racial/ethnic groups face,” she explained.

Mulia is very familiar with these barriers and stresses, having studied social inequities while an undergraduate at Johns Hopkins. In graduate school at the University of Michigan, her MPH project was a policy analysis focused on issues of access to obstetrical services for low-income women, and at the University of California, Berkeley her dissertation used qualitative methods to study daily hardships of low-income, drug-using women, including their experiences with service providers.

After obtaining her DrPH, Mulia completed a postdoctoral fellowship at ARG where she worked on several projects. In one of these she examined the trade-offs that welfare clients make to address competing needs related to alcohol, drug and mental health problems. The larger study, led by former ARG scientist Laura Schmidt, now a professor at the University of California, San Francisco, introduced Mulia to the field of alcohol research.

Since then, Mulia’s interest in alcohol-related disparities has deepened and her contribution to the field has grown. Her epidemiologic work has helped extend understanding of disparities in alcohol problems and access to alcohol treatment, and her experience in policy analysis and efforts to understand substance users’ perspectives will help in determining the most effective approaches to enact change.

When asked what the next steps are, Mulia responded with passion and determination: she wants to answer her previous questions, starting with understanding why an age-crossover in heavy drinking occurs and to what extent this does or does not explain alcohol-related health disparities. She also wants this knowledge to inform her policy work.

“Unless we develop real solutions to fundamental issues of social and structural inequities, we’ll keep seeing these kinds of patterns, and the people affected by these differences will continue to find ways to cope with the stress of living in a less than just society,” she said.

“For me, and many of my colleagues, it seems obvious what we need to do. However, enacting that kind of change is difficult. We need to start by showing the mechanisms that link social inequity to health outcomes, what interventions work and don’t work, and pushing for practical solutions that improve the health and well-being of disadvantaged populations, and that’s what I hope my research can do.”

Related ARG Publications

  • Mulia N, Karriker-Jaffe KJ, Witbrodt J, Bond J, Williams E, Zemore SE (2017). Racial/ethnic differences in 30-year trajectories of heavy drinking in a nationally representative U.S. sample. Drug and Alcohol Dependence, 170 133-141 Abstract or Full Text
  • Mulia N, Tam TW, Bond J, Zemore SE, Li L. (Published online: 26 Feb 2017). Racial/ethnic differences in life-course heavy drinking from adolescence to midlife. Journal of Ethnicity in Substance Abuse, 1-20 Abstract or Full Text
  • Mulia N, Tam TW, & Schmidt LA. (2014). Disparities in the use and quality of alcohol treatment services and some proposed solutions. Psychiatric Services, 65 (5) 626-633 Abstract or Full Text
  • Mulia N & Zemore SE. (2012). Social adversity, stress and alcohol problems: are racial/ethnic minorities and the poor more vulnerable? Journal of Studies on Alcohol and Drugs, 73 (4) 570-580 Abstract or Full Text
  • Mulia N, Schmidt LA, Ye Y, & Greenfield TK. (2011). Preventing disparities in alcohol screening and brief intervention: The need to move beyond primary care. Alcoholism: Clinical and Experimental Research, 35 (9) 1557-1560 Abstract or Full Text
  • Mulia N, Ye Y, Greenfield TK, & Zemore SE. (2009). Disparities in alcohol-related problems among white, black, and Hispanic Americans. Alcoholism: Clinical and Experimental Research 33(4): 654-662. Abstract or Full Text
  • Mulia N, Ye Y, Zemore SE, & Greenfield TK. (2008). Social disadvantage, stress and alcohol use among black, Hispanic and white Americans: findings from the 2005 U.S. National Alcohol Survey. Journal of Studies on Alcohol and Drugs 69(6) 824-833. Abstract or Full Text
  • Mulia, N & Schmidt LA. (2003). Conflicts and trade-offs due to alcohol and drugs: clients’ accounts of leaving welfare. The Social Service Review 77(4) 499-522. Abstract or Full Text
  • Mulia N. (2002). Ironies in the pursuit of well-being: the perspectives of low-income, substance-using women on service institutions. Contemporary Drug Problems 29(4) 711-748. Abstract or Full Text