Academic journal article Alcohol Research

Associations between Socioeconomic Factors and Alcohol Outcomes

Academic journal article Alcohol Research

Associations between Socioeconomic Factors and Alcohol Outcomes

Article excerpt

According to the World Health Organization (2014), alcohol consumption is responsible for approximately 5.9 percent of deaths worldwide and a global loss of 139 million disabilityadjusted life-years. 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.g., cancer, cardiovascular disease, and liver cirrhosis) and psychiatric disorders (e.g., depression and alcohol use disorder [AUD]). Given the strong positive association between alcohol use and negative alcohol-related consequences, it is important to understand social determinants of these alcohol outcomes.

The quantity and frequency of a person's alcohol use, the resulting negative alcohol-related consequences (also known as alcohol-related problems), and his or her risk of AUD are determined by a variety of influences. These include higher-level chrono- and macrolevel factors, such as historical time and geopolitical context, as well as meso-, micro-, and individual-level factors, such as community context, family/peer influences, biological predisposition, effects of prenatal alcohol exposure, psychological factors, and sociodemographic features (e.g., gender, age, race, ethnicity, culture, religious affiliation, and socioeconomic status [SES]) (Edwards 2000; Gately 2008). 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 alcoholrelated consequences (Gruenewald et al. 2014; Holder 1998).

This article focuses on one particular aspect of this complex set of systems, namely the relationship between SES- including income/economic factors, educational level, employment status, and housing status-and alcoholrelated outcomes. It synthesizes data primarily obtained from Englishlanguage 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 2), particularly 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.

Across the studies discussed in this article, SES has been operationalized on various levels (e.g., individual, area/neighborhood, and national levels) using a variety of parameters, such as personal income and debt, family or household income, educational level, employment status, and housing status; neighborhood or area disadvantage; and gross national income. 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.g., by quantity and/or frequency of alcohol use or heavy episodic drinking [HED],1 defined as consuming four or more drinks per episode for women and five or more drinks per episode for men), or dichotomously by alcohol-use status (e. …

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