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October 2003, Vol 93, No. 10 | American Journal of Public Health 1683-1685
© 2003 American Public Health Association

RESEARCH AND PRACTICE

Racial Disparities in Alcohol Use: Comparison of 2 American Indian Reservation Populations With National Data

Janette Beals, PhD, Paul Spicer, PhD, Christina M. Mitchell, PhD, Douglas K. Novins, MD, Spero M. Manson, PhD and the AI-SUPERPFP Team (Cecelia K. Big Crow, Dedra Buchwald, Buck Chambers, Michelle L. Christensen, Denise A. Dillard, Karen DuBray, Paula A. Espinoza, Candace M. Fleming, Ann Wilson Frederick, Diana Gurley, Lori L. Jervis, Shirlene M. Jim, Carol E. Kaufman, Ellen M. Keane, Suzell A. Klein, Denise Lee, Monica C. McNulty, Denise L. Middlebrook, Laurie A. Moore, Tilda D. Nez, Ilena M. Norton, Heather D. Orton, Carlette J. Randall, Angela Sam, James H. Shore, Sylvia G. Simpson, and L. L. Yazzie.)

The authors are with the American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Aurora.

Correspondence: Requests for reprints should be sent to Janette Beals, PhD, AIANP, Nighthorse Campbell Native Health Building, F800, PO Box 6508, Aurora, CO 80045-0508 (e-mail: jan.beals{at}uchsc.edu).


   INTRODUCTION
TOP
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
American Indian alcohol use has received scrutiny in recent decades,1 but data derived from samples that permit direct comparisons to other US epidemiological studies have been less commonly reported.2–4 This brief places rates of the quantity and frequency of alcohol use in 2 tribally defined reservation samples in such a comparative epidemiological context.


   METHODS
TOP
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) methods are described in greater detail elsewhere5 as well as on our Web site (http://www.uchsc.edu/ai/ncaianmhr/presentresearch/superprj.htm). The 2 populations of inference were legally enrolled members of the Northern Plains or Southwest tribes who were aged 15 to 54 when the sample frame was developed (1997) and who lived on or within 20 miles of their reservations. (Maintenance of American Indian community confidentiality is as important as that of individual confidentiality; therefore, general cultural descriptors are used.6) Data were collected between 1997 and 1999. Once located and determined eligible, 76.8% of the Northern Plains group and 73.7% of the Southwest group agreed to participate.

Two published reports provide points of comparison. One, the National Longitudinal Alcohol Epidemiologic Study,4,7 interviewed a total of 42 682 adults aged 18 years and older in 1992; 92% of the households and 97% of the selected individuals within those households agreed to participate. Dawson and colleagues4 developed a 3-level drinking status variable. Current drinkers were those respondents who had consumed at least 12 drinks in the preceding year. Former drinkers had consumed at least 12 drinks in some 1-year period of their lives but drank fewer than 12 drinks in the past year. Lifetime abstainers were respondents who had never consumed more than 12 drinks in any year. AI-SUPERPFP was able to replicate this drinking status variable almost exactly; however, former drinkers were restricted to those reporting no drinks in the past year. The National Longitudinal Alcohol Epidemiologic Study data were reported for the US population, men and women aged 18 years and older, as well as for the following age groups: 18–29, 30–44, 45–64, and 65 years or older. The AI-SUPERPFP was able to replicate the 18–29 and 30–44 age groups but also included respondents aged 45–57 as a third group.

A second published report that provided us with information for comparison is the Collaborative Alcohol-Related Longitudinal Project,8,9 which provided meta-analytic estimates of quantity (typical number of drinks per occasion) and frequency (number of days alcohol was used per month).9 AI-SUPERPFP was able to replicate these variables identically. The data reported here reflect the following published age groupings: 15–19, 20–24, 25–29, 30–34, 35–39, 40–49, and 50–59 years. AI-SUPERPFP comparisons of quantity and frequency data are presented with the same age groupings (except for the last one, which was restricted to 50–57 years).

Variable construction was completed with standard statistical packages: SAS10 and SPSS.11 All inferential analyses were conducted in Stata12 using sample and nonresponse weights.13 Standard errors and confidence intervals are reported for each estimated parameter.


   RESULTS
TOP
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Table 1Go compares the National Longitudinal Alcohol Epidemiologic Study data with those derived from AI-SUPERPFP. The percentage of lifetime abstainers ranged from less than 20% (Northern Plains men aged 45–57 years, US men aged 30–44 years and 45–64 years) to well over 50% (Southwest women aged 45–57 years). The Southwest population was more likely to have lifetime abstainers than was either the US or the Northern Plains population for most age and gender groups. The rates of abstention for Northern Plains men were generally similar to those for the US men. The percentages of these populations who were former drinkers ranged from less than 10% (Southwest and Northern Plains men aged 18–29 years) to a high of 36% (Northern Plains women aged 45–57 years). Fewer significant differences were found among former drinkers than among lifetime abstainers. The rates of current drinkers ranged from 12% (Southwest women aged 45–57 years) to more than 60% (Northern Plains and US men aged 18–29 years and 30–44 years). Most Southwest samples were less likely to be current drinkers than were either the US or the Northern Plains samples.


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  		TABLE 1—— Drinking Status Comparisons of AI-SUPERPFP Populations to US General Population, by Age and Gender: National Longitudinal Alcohol Epidemiologic Study4
 
The Collaborative Alcohol-Related Longitudinal Project’s8,9 estimates of frequency and quantity for current drinkers are compared with those of AI-SUPERPFP in Table 2Go. Frequency ranged from less than 2 times per month (US men aged 15–19 years) to more than 17 times per month (US men aged 40–49 and 50–59 years). Frequency estimates for US men were generally higher than for American Indian men. Fewer differences were found among women. Quantity patterns were reversed: the American Indian samples typically reported greater quantities than did the US samples.


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  		TABLE 2—— Past-Month Frequency and Quantity Comparisons of AI-SUPERPFP Populations to US Samples, by Age and Gender: Collaborative Alcohol-Related Longitudinal Project9
 

   DISCUSSION
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
These findings support and extend the current literature. Previous investigations with American Indian adolescents and adults have shown that alcohol use varies by gender, age, and tribe.14–20 Here, direct comparisons to published data from other US populations indicate that American Indians in these community samples may be less likely to use alcohol than are others in the United States. Among American Indian drinkers, however, more alcohol was consumed per drinking occasion.


   Acknowledgments
 
The study was supported by National Institutes of Health grants R01 MH48174 (S. M. Manson and J. Beals, Principal Investigators), P01 MH42473 (S. M. Manson, Principal Investigator), R01 DA14817 (J. Beals, Principal Investigator), R01 AA13420 (J. Beals, Principal Investigator), and R01 AA013800 (D. K. Novins, Principal Investigator).

AI-SUPERPFP would not have been possible without the significant contributions of many people. The following interviewers, computer and data management staff, and administrative staff supplied energy and enthusiasm for a project that was often difficult: Anna E. Barón, Amelia T. Begay, Cathy A. E. Bell, Mary Cook, Helen J. Curley, Mary C. Davenport, Rhonda Wiegman Dick, Marvine D. Douville, Geneva Emhoolah, Fay Flame, Roslyn Green, Billie K. Greene, Jack Herman, Tamara Holmes, Shelly Hubing, Cameron R. Joe, Louise F. Joe, Cheryl L. Martin, Jeff Miller, Robert H. Moran Jr, Natalie K. Murphy, Ralph L. Roanhorse, Margo Schwab, Jennifer Settlemire, Donna M. Shangreaux, Matilda J. Shorty, Selena S. S. Simmons, Jennifer Truel, Lori Trullinger, Jennifer M. Warren, Theresa (Dawn) Wright, Jenny J. Yazzie, and Sheila A. Young. We also would like to acknowledge the contributions of the Methods Advisory Group: Margarita Alegria, Evelyn J. Bromet, Dedra Buchwald, Steven G. Heeringa, Ronald Kessler, Peter Guarnaccia, R. Jay Turner, and William A. Vega. Finally, we thank the tribal members who so generously answered all the questions asked of them.

Human Participant Protection
The study was reviewed and approved by the Colorado Multiple Institutional Review Board. Tribal approvals were obtained, as was informed consent from all respondents.


   Footnotes
 
Contributors
J. Beals conceptualized, designed, and implemented the AI-SUPERPFP; analyzed the data; and drafted the brief. P. Spicer conceptualized, designed, and implemented the AI-SUPERPFP and helped draft the brief. C. M. Mitchell conceptualized, designed, and implemented the AI-SUPERPFP; provided statistical expertise; and edited the brief. D. K. Novins conceptualized, designed, and implemented the AI-SUPERPFP and edited the brief. S. M. Manson conceptualized, designed, and implemented the AI-SUPERPFP; acquired funding; and edited the brief. The AI-SUPERPFP team members listed as authors oversaw the conceptualization, design, and implementation of the study.

Peer Reviewed

Accepted for publication February 13, 2003.


   References
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Welty TK. The epidemiology of alcohol use and alcohol-related health problems among American Indians and Alaska Natives. In: Mail PD, Heurtin-Roberts S, Martin SE, Howard J, eds. Alcohol Use Among American Indians and Alaska Natives: Multiple Perspectives on a Complex Problem. Vol 37. Bethesda, Md: US Dept of Health and Human Services; 2002:49–70.

2. Caetano R, Clark CL, Tam T. Alcohol consumption among racial/ethnic minorities: theory and research. Alcohol Health Res World. 1998;22:233–238.[ISI][Medline]

3. Caetano R, Clark CL. Trends in alcohol consumption patterns among Whites, Blacks and Hispanics: 1984 and 1995. J Stud Alcohol. 1998;59:659–668.[ISI][Medline]

4. Dawson DA, Grant BF, Chou SP, Pickering RP. Subgroup variation in U.S. drinking patterns: results of the 1992 National Longitudinal Alcohol Epidemiologic Study. J Subst Abuse. 1995;7:331–344.[Medline]

5. Beals J, Manson SM, Mitchell CM, Spicer P, The AI-SUPERPFP Team. Cultural specificity and comparison in psychiatric epidemiology: walking the tightrope in American Indian research. Cult Med Psychiatry. 2003;27:259–289.[ISI][Medline]

6. Norton IM, Manson SM. Research in American Indian and Alaska Native communities: navigating the cultural universe of values and process. J Consult Clin Psychol. 1996;64:856–860.[ISI][Medline]

7. Grant BF. Comorbidity between DSM-IV drug use disorders and major depression: results of a national survey of adults. J Subst Abuse. 1995;7:481–497.[Medline]

8. Johnstone BM, Leino EV, Motoyoshi MM, Temple MT, Fillmore KM, Hartka E. An integrated approach to meta-analysis in alcohol studies. Br J Addict. 1991;86:1211–1220.[Medline]

9. Fillmore KM, Hartka E, Johnstone BM, Leino EV, Motoyoshi M, Temple MT. A meta-analysis of life course variation in drinking. Br J Addict. 1991;86:1221–1267.[ISI][Medline]

10. SAS Language [computer program]. Version 8.2. Cary, NC: SAS Institute Inc; 2001.

11. SPSS 11.5 [computer program]. Chicago, Ill: SPSS Inc; 2000.

12. Stata Statistical Software [computer program]. Version Special Edition 7.0. College Station, Tex: Stata Corp; 2002.

13. Kish L. Survey Sampling. New York, NY: John Wiley and Sons; 1965.

14. Beauvais F. American Indians and alcohol. Alcohol Health Res World. 1998;22:253–259.[ISI][Medline]

15. May PA, Gossage JP. New data on the epidemiology of adult drinking and substance use among American Indians of the northern states: male and female data on prevalence, patterns, and consequences. Am Indian Alsk Native Ment Health Res. 2001;10(2):1–26.

16. Robin RW, Long JC, Rasmussen JK, Albaugh B, Goldman D. Relationship of binge drinking to alcohol dependence, other psychiatric disorders, and behavioral problems in an American Indian tribe. Alcohol Clin Exp Res. 1998;22:518–523.[ISI][Medline]

17. Lowe LP, Long CR, Wallace RB, Welty TK. Epidemiology of alcohol use in a group of older American Indians. Ann Epidemiol. 1997;7:241–248.[Medline]

18. Kunitz SJ, Gabriel KR, Levy JE, et al. Alcohol dependence and conduct disorder among Navajo Indians. J Stud Alcohol. 1999;60:159–167.[ISI][Medline]

19. Christian CM, Dufour M, Bertolucci D. Differential alcohol-related mortality among American Indian tribes in Oklahoma, 1968–1978. Soc Sci Med. 1989;28:275–284.

20. May PA. Overview of alcohol abuse epidemiology for American Indian populations. In: Sandefur GD, Rindfuss RR, Cohen B, eds. Changing Numbers, Changing Needs: American Indian Demography and Public Health. Washington, DC: National Academy Press; 1996:235–261.





This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
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Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
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Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (14)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Beals, J.
Right arrow Articles by the AI-SUPERPFP Team,
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Beals, J.
Right arrow Articles by the AI-SUPERPFP Team,
Related Collections
Right arrow Gender
Right arrow Native Americans
Right arrow Alcohol

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