Academic journal article Alcohol Research

Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework

Academic journal article Alcohol Research

Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework

Article excerpt

The alcohol research literature is overwhelmingly focused on risk factors, from the societal level down to the individual. Worldwide, 3.3 million deaths were attributed to alcohol misuse in 2012 (World Health Organization 2014). Excessive alcohol use is the third leading cause of death in the United States, accounting for 88,000 deaths per year (Centers for Disease Control and Prevention 2014). Globally, alcohol-attributable disease and injury are responsible for an estimated 4 percent of mortality and 4 to 5 percent of disability-adjusted life-years (DALYs) (Rehm et al. 2009). The harmful effects of alcohol misuse are far reaching and range from accidents and injuries to disease and death, as well as consequences for family, friends, and the larger society. Economic costs attributed to excessive alcohol consumption are considerable. In the United States alone, the costs of excessive alcohol use were estimated at $223.5 billion in 2006, or $746 per person (Bouchery et al. 2011). Much of these costs result from a loss in workplace productivity as well as health care expenses, criminal justice involvement, and motor vehicle crashes (Rehm et al. 2009).

This article reviews some of the cultural and social influences on alcohol use and places individual alcohol use within the contexts and environments where people live and interact. This is not an exhaustive review but aims to show the wide range of contexts that may shape alcohol use.

Disparities in and Influences on Alcohol Use: A Social-Ecological Framework

Alcohol consumption varies across gender and race/ethnicity. Across the world, men consume more alcohol than women, and women in more developed countries drink more than women in developing countries (Rehm et al. 2009). American men are much more likely than women to use alcohol (56.5 percent vs. 47.9 percent, respectively), to binge drink (30.4 percent vs. 16 percent, respectively), and to report heavy drinking (9.9 percent vs. 3.4 percent, respectively) (Substance Abuse and Mental Health Services Administration [SAMSHA] 2013). (Binge drinking is defined here as the number of instances in the past 12 months that women drank 4 or more drinks and men drank 5 or more drinks within a 2-hour period.) Among racial and ethnic groups, Whites report the highest overall alcohol use among persons age 12 and over (57.4 percent). American Indian/Alaska Natives report the highest levels of binge drinking (30.2 percent), followed by Whites (23.9 percent), Hispanic/Latinos (23.2 percent), African Americans (20.6 percent), and Asians (12.7 percent) (SAMHSA 2013). Alarmingly, according to two nationally representative samples, trends in alcohol misuse increased among both men and women and African-American and Hispanic youth over the decade between 1991- 1992 and 2001-2002. Rates of dependence also increased among men, young Black women, and Asian men during the same time period (Grant et al. 2004).

Given these trends, it is clear that a better understanding of the underlying social and cultural factors contributing to these disparities is needed. For example, socioeconomic status (SES) indicators (i.e., education, income, and occupation) usually are strong predictors of health behaviors and outcomes and tend to be positively associated with health. People with higher SES tend to drink more frequently than others (Huckle et al. 2010). Among drinkers, low-SES groups tend to drink larger quantities of alcohol (Huckle et al. 2010).

Like other health issues, alcohol use can be linked to a complex array of factors ranging from individual-level (i.e., genetics) to population-level (i.e., cultural and societal factors) characteristics (Berkman et al. 2000; Krieger 2001; Link and Phelan 1995). On a population level, emerging research has documented the relationship between social determinants and health (Berkman and Kawachi 2000; Berkman et al. 2000) and, specifically, the social epidemiology of alcohol use (Bernstein et al. …

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