Elsevier

Addictive Behaviors

Volume 39, Issue 9, September 2014, Pages 1357-1360
Addictive Behaviors

Short Communication
Adult social roles and alcohol use among American Indians

https://doi.org/10.1016/j.addbeh.2014.04.024Get rights and content

Highlights

  • National longitudinal studies of American Indian (AI) substance use are lacking.

  • AI alcohol use was linked to family, work, and school roles during young adulthood.

  • Alcohol use decreased when AI respondents became parents.

  • Alcohol use increased when AI respondents transitioned into full-time employment.

  • AIs who attended college drank less than those who did not attend college.

Abstract

American Indians are disproportionately burdened by alcohol-related problems. Yet, research exploring predictors of alcohol use among American Indians has been limited by cross-sectional designs and reservation-based samples. Guided by a life course developmental perspective, the current study used a subsample of American Indians (n = 927) from the National Longitudinal Study of Adolescent Health (Add Health) to explore alcohol use (current drinking, usual number of drinks, and binge drinking) among this population. We examined whether adult social roles (i.e., cohabitation, marriage, parenthood, college enrollment, and full-time work) were linked to the rise and fall of alcohol use. Multi-level models demonstrated that adult social roles were linked to alcohol use at the within- and between-person levels. Becoming a parent was linked to a lower likelihood of being a current drinker, fewer alcoholic drinks, and less frequent binge drinking. Transitioning to full-time work was associated with a higher likelihood of being a current drinker and more frequent binge drinking. Results point to the importance of exploring within-group trajectories of alcohol use and highlight the protective and risky nature of adult social roles among American Indians.

Introduction

Research demonstrates that American Indians (AIs) experience a disproportionate share of alcohol-related problems. AI adolescents have the highest prevalence of DSM-IV substance use disorders (Wu, Woody, Yang, Pan, & Blazer, 2011) and AI adults are more likely than any other racial or ethnic group to experience alcohol-related injuries (Keyes, Liu, & Cerda, 2011). Furthermore, substance use disorders among AIs escalate during adolescence and young adulthood (Whitbeck et al., 2014), emphasizing the importance of understanding factors that may shape changes in alcohol consumption during this period.

A useful model for understanding changes in AI alcohol consumption is the life course perspective. This perspective points to the myriad of life transitions (e.g., higher education, marriage, and parenthood) clustered during early adulthood that may shape alcohol use. Although the transition to adult social roles has been linked to alcohol use (Bachman et al., 1997, Staff et al., 2014, Staff et al., 2010) associations vary by race (Akins et al., 2013, Paschall et al., 2005), illustrating the importance of examining the impact of adult social roles on changes in alcohol use among AIs. Furthermore, although AIs are a culturally diverse group, they have a shared traumatic history which can cause stress or grief (Walters, Simoni, & Evans-Campbell, 2002) with implications for alcohol consumption. Thus, it is important to explore within-group predictors of alcohol use among this population.

Prior studies suggest that alcohol use among AIs is linked to social roles. Studies have found that married AIs are more likely to stop using alcohol (Stone, Whitbeck, Chen, Johnson, & Olson, 2006) or be in remission from alcohol dependence (Gilder, Lau, Corey, & Ehlers, 2008) than those who are never-married or divorced. However, some studies have found no association between AI marriage and alcohol use (Akins et al., 2013) and others have shown associations only at the bivariate level (Ward & Ridolfo, 2011). Parenthood may also be protective. For instance, Quintero (2000) examined problem drinking among Navajo men and found that parenthood was frequently cited as a primary catalyst for reducing alcohol consumption. Other adult statuses may also influence substance use among AIs. One recent study found that the association of education and employment with substance use differed for AIs and Whites: Among AIs, education and employment were both associated with a lower likelihood of “bender drinking” (Akins et al., 2013).

These studies provide preliminary evidence about the association between adult social roles and alcohol use among AIs, while also revealing important gaps. For instance, most of these studies used cross-sectional designs or focused on community-based reservation samples, despite the fact that only about 22% of AIs live on reservations (Norris, Vines, & Hoeffel, 2012). The current study addresses these gaps in the literature by examining whether transitions into adult social roles (i.e., cohabitation, marriage, parenthood, full-time work, and enrollment in higher education) are associated with changes in alcohol use among AIs included in a nationally representative sample. We utilize a multi-level modeling strategy to disentangle how social roles and substance use are associated at the within- and between-person level. By design, the within-person estimates control for stable individual differences between people (Raudenbush & Bryk, 2002), thus reducing concerns related to selection.

Section snippets

Data and sample

We utilized the restricted-use National Longitudinal Study of Adolescent Health (Add Health) data (Harris, 2009), a nationally representative sample of adolescents (in grades 7–12 at Wave 1) who were initially surveyed in 1994/1995 and re-interviewed in 1996 (W2), 2001–2002 (W3), and 2007–2008 (W4). Data for this study came primarily from the in-home survey, in which information about substance use was collected using a self-administered questionnaire. Our sample was comprised of individuals

Results

Results demonstrated that adult social roles were linked to alcohol use among AIs at the within- and between-person levels. In interpreting these models, it is important to note that between-person associations indicate whether average alcohol use differs for people who ever occupied a particular social role compared to those who never occupied that role. In contrast, within-person associations indicate the extent to which individuals have different alcohol use when they occupy a social role

Discussion

Given the high rates of alcohol misuse and alcohol-related problems among AIs, the current study sought to explore whether family, work, and school roles protected against alcohol use among this population. Although significant associations were documented at the between- and within-person level, we focus our attention on discussing the latter as they are less likely biased due to selection factors. Below, we apply a life course developmental perspective to inform our interpretation of the

Role of funding sources

Financial assistance for this study was provided by NIDA Grant 1R01DA034466-01. The design and content of this study are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Contributors

Author A conceptualized the study, conducted statistical analyses, and wrote the first draft of the manuscript. Authors B and C provided input regarding the conceptualization of the study and made revisions to the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

All authors declare that they have no conflict of interest.

Acknowledgments

This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R. Rindfuss and Barbara Entwisle for their assistance in the original design for the National Longitudinal Study of Adolescent Health.

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