Title: Can Religion and Socioeconomic Status Explain Black-White Differences in Alcohol Abuse?
Description: Backgroud: Drinking to a level that causes harm to oneself or others is characterized by several terms in the alcohol literature. These include: alcohol abuse, alcoholism, excessive drinking, heavy drinking, and problem drinking. The latter is the term used throughout the dissertation. Findings across various alcohol measures and across time show that Blacks have lower prevalence rates of problem drinking than Whites. These results appear paradoxical. First Blacks have poorer health status than Whites for many health outcomes such as diabetes, hypertension, and cirrhosis of the liver--a chronic condition attributed to heavy alcohol use. Blacks lower problem drinking than Whites seem contrary to the way social determinants and tension-reduction theories are thought to influence health. According those theories and frameworks, exposure to poor economic and social circumstances are considered socioeconomic status-related stressors, which are risk factors for problem drinking. Blacks therefore would be expected to have higher prevalence rates of problem drinking because they are exposed to a greater number and frequency of poor socioeconomic status conditions, and greater frequency of stressors relative to Whites.

Quite often, the typical investigation of Black-White differences in health aims to understand why Blacks have poorer health than Whites. I investigated problem drinking for my dissertation because I thought it was equally important to understand health and behavioral outcomes for which Blacks do better than Whites and to learn about what contributes to that better health. Levels of religious involvement, the salience of religion among groups, and the potential strength of religion to regulate the lives of individuals differ across social statuses such as race/ethnicity and socioeconomic status. That rationale is discussed through historical evolution of religion among Blacks, beginning slavery, through theories attributed to Max Weber and Karl Marx, and through analysis of a passage within the Holy Bible. Given that measures of religion differ across social status, it is plausible then that religion's protective effect on health too is expected to be different across social statuses. My second hypothesis is that the protective benefits of religion on problem drinking will be stronger among Blacks than Whites.

My third hypothesis is that lower socioeconomic status is associated with higher levels of religious involvement. My fourth hypothesis is that the protective benefits of religion on problem drinking are stronger among persons with low compared to high socioeconomic status. Finally, I argue that the dual social location of low socioeconomic status and Black race creates an opportunity where the protective effects of religious involvement on problem drinking become compounded. My fifth hypothesis is that the protective effects of religious involvement on problem drinking among Black low socioeconomic status would explain their lower prevalence rates of drinking compared to Whites. Methods: A secondary data analysis was conducted using Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) among a sample of Non-Hispanic Blacks (n=6, 587) and Non-Hispanic Whites (n=20,161). The main dependent variable was DSM-IV alcohol abuse. A second variable, heavy drinking, which was used for sensitivity analyses, was derived from two variables (1) frequency of consuming 5+ drinks in a single day and (2) largest number of drinks in a single day.

The exposure variables were four measures of religious involvement: (1) currently attending religious services, (2) frequency of religious service attendance, (3) count of the number of religious members one interacted with on a social basis, and (4) importance of spirituality in one's daily life. Education and income were the socioeconomic status (SES) variables. Race/ethnicity was a binary variable indicating Non-Hispanic Blacks versus Non-Hispanic Whites. Results: Detailed results of this analysis are presented in this dissertation. Conclusions: Overall, religion measures had a protective effect on problem drinking, but service attendance had the most robust association. It appears that religion and socioeconomic status are not competing factors that potentially explain race-differences, in fact, they work together. There appears to be some support for the perspective that Black-White differences are explained, or at least better understood, when socioeconomic status and religion operate in an interaction model framework.

The lack of finding of Black-White differences across all combinations of religion and socioeconomic status, and those differences being dependent on the type of problem drinking measure used limits the ability to generalize to an overall hypothesis. There are some noteworthy contributions this dissertation that advances the state of knowledge on this topic. It appears that the effect of religion on DSM-IV alcohol abuse for Blacks operates under different model assumptions than for Whites. Therefore, statistical comparisons may not tell the full story of Black-White differences and I recommend a renewed focus on race-specific analyses. Two main theoretical contributions emerge from this study. First, these findings suggest that individual religiosity plays an important protective role on problem drinking for equally for Blacks and Whites. The study adds more evidence as to which dimensions of religiosity most salient for protecting against problem are drinking, which is lacking in the research literature.

Second, sensitivity analyses showed that the type of alcohol measure one uses to characterize problem drinking has potential implications racial disparities in alcohol research.