How the social context can explain racial disparities in alcohol use

Background: National estimates of race differences in alcohol use suggest that non-Hispanic whites are more likely to be current drinkers; however, African Americans suffer a greater burden of alcohol-related problems. Findings from national studies fail to account for the social and environmental risk exposures resulting from residential segregation. Thus, little is known about race disparities in alcohol use among individuals who share similar social and environmental conditions. Methods: We compared race disparities in 1,408 individuals from the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) study with 29,372 individuals from the 2003 National Health Interview Survey (NHIS 2003) to determine if race disparities in alcohol use were attenuated in EHDIC-SWB, a racially integrated urban community without race differences in socioeconomic status. Results: In the NHIS 2003 sample, compared to non-Hispanic whites, African Americans had a lower odds of being a current drinker (OR=0.56, 95% CI=0.49-0.64); former drinker (OR=0.84, 95% CI=0.72-0.99); or binge drinker (OR=0.68, 95% CI= 0.58-0.79) independent of covariates. However, in the EHDIC-SWB sample, African Americans had similar odds of being a current drinker (OR=0.95, 95% CI=0.67-1.34); former drinker (OR=0.71; 95% CI=0.50-1.01); or binge drinker (OR=1.02, 95% CI=0.77-1.35) compared to non-Hispanic whites after adjusting for covariates. Conclusions: Among individuals living in a low-income urban racially integrated community with similar exposure to social and environmental risk, race disparities in alcohol use were eliminated. These results suggest that research, policy, and intervention efforts need to account for influential characteristics of the social environment.