Minority Health Research Gains Momentum at NIAAA

America’s demographics are changing faster than ever before. This past December, the U.S. Census Bureau released a report predicting that ethnic minorities in the United States will increase dramatically, from 37 to 57 percent of the population between now and 2060.

This rapid growth heightens the need for more research on minority health issues, including epidemiologic studies and investigations to learn more about effective alcohol prevention and treatment approaches. NIAAA’s Health Disparities Research Program addresses the unique alcohol-related issues facing racial and ethnic minorities.

Challenges

Racial and ethnic minorities experience higher alcohol-related morbidity and mortality rates than non-Hispanic Whites. For example, research shows that Hispanics and Blacks experience liver cirrhosis at higher rates than non-Hispanic Whites (Flores, 2008). White Hispanic men have the highest death rates from liver cirrhosis, about 1.8 times the rates for White and Black non-Hispanic males (Yoon and Yi, 2008). Black men are more likely than White men to suffer alcohol-related esophageal cancer and pancreatic disease, and also have higher mortality rates from alcohol-related car crashes.

Blacks and Hispanics in particular are also less likely than Whites to get professional treatment for alcohol problems (Chartier, 2011, and Schmidt, 2007), possibly because they have less access to health care generally. A recent analysis showed that 35 percent of non-Hispanic Whites who are at-risk drinkers visited a primary care physician compared with 21 percent of Blacks, 24.6 percent of English-speaking Hispanics, and 3.6 percent of Spanish-speaking Hispanics (Mulia and Schmidt, 2011). As a result, members of minority groups may not receive the screening and intervention necessary to prevent additional problems.

Reluctance to enter treatment may stem from concerns about finding and paying for services (Schmidt, 2007). Also, Hispanics in particular worry that providers will not understand their language, background, and culture, and believe treatment will not work (Zemore, 2009).

The impact of these health issues may intensify as these segments of the population grow.

NIAAA Initiatives

The NIAAA Minority Health and Health Disparities Initiatives, coordinated by Judith Arroyo, Ph.D., is addressing these issues through enhanced research efforts and collaborations across the National Institutes of Health (NIH) and with outside organizations.

Top research priorities include increasing minority representation in research populations, developing a better understanding of minority subgroups, broadening the knowledge base, especially of Asian American and American Indian/Alaska Native (AI/AN) communities, and identifying the genetic contribution to problems.

The 2004–2005 National Epidemiologic Survey on Alcohol Related Conditions (NESARC) oversampled both Blacks and Hispanics. Future NESARC surveys will continue oversampling these groups, and there are also plans to oversample Asian Americans. In addition, NIAAA hopes to expand funding opportunity announcements, so researchers can conduct secondary analysis on a variety of existing data sets, including NESARC, to yield more information on alcohol-related problems among minorities.

Another key issue is why minority subgroups experience alcohol problems differently. “Hispanics from Mexico have different issues than those from Puerto Rico and Cuba. Black Americans have different issues depending on whether they are African American, Afro Caribbean, or Haitian, or have lived here for generations,” Dr. Arroyo said. “We need to understand these differences better.” In addition, she said, “We are trying to engage with Asian American communities to better understand their needs.”

NIAAA grantees are making great strides in a variety of critical research areas. James Allen, Ph.D., at the University of Alaska, studies how Alaska Native culture protects young people from the allure of alcohol. “We discovered that these communities have a wealth of strengths to draw on that help individuals quit drinking and that can protect them from drinking in the first place,” said Dr. Allen.

Cindy Ehlers, Ph.D., at the Scripps Research Institute, investigates factors affecting how different minority groups react to alcohol. She explains that ethnic groups can differ in certain enzymes that metabolize alcohol. About 40 percent of Asians and 15 percent of African Americans have differences in these enzymes, which serve as a protective factor against the development of alcohol use disorders.

Psychosocial factors, which vary across ethnic groups, also can play a role. “For Hispanics, acculturation stress can influence drinking patterns and risk for problems. For Native Americans, historical trauma can make a difference,” said Dr. Ehlers. Understanding these influences can help researchers develop effective prevention and treatment approaches.

In addition to these efforts, the NIAAA program is joining several other NIH Institutes on funding opportunity announcements to increase the number of grants studying minority health issues. The NIAAA program also is working with the National Institute on Drug Abuse on a joint portfolio review and will establish an expert panel to determine what areas need more attention.

Outside NIH, the program cooperates with a variety of groups to promote minority health research. For the past 10 years, NIAAA has supported the National Hispanic Science Network’s alcohol-related research symposia and sponsored junior investigators so they could attend and present their work at these conferences.

NIAAA also hosted two symposia on minority health issues at the Research Society on Alcoholism’s (RSA) 2012 conference. Plans for events at the upcoming RSA annual conference are underway.

All of these efforts promise to enhance understanding of minority health issues. Said Dr. Arroyo, “I am excited about harnessing the power of research to support the needs of racial and ethnic minority groups.”

Sources:

Chartier K, Caetano R. Trends in alcohol services utilization from 1991-1992 to 2001-2002: Ethnic group differences in the U.S. population. Alcoholism: Clinical and Experimental Research. 2011 August;35(8):1485-97.

Flores YN, Yee HF, Leng M, Escarce JJ, Bastani R, et al. Risk factors for chronic liver disease in Blacks, Mexican Americans, and Whites in the United States: Results from NHANES IV, 1999–2004. American Journal of Gastroenterology. 2008 Sep;103(9):2231-38.

Mulia N, Schmidt LA, Ye Y, Greenfield TK. Preventing disparities in alcohol screening and brief intervention: The need to move beyond primary care. Alcoholism: Clinical and Experimental Research. 2011 Sep;35(9):1557-60.

Schmidt LA, Ye Y, Greenfield TK, Bond J. Ethnic disparities in clinical severity and services for alcohol problems: Results from the National Alcohol Survey. Alcoholism: Clinical and Experimental Research, 2007 Jan;31(1):48-56.

Yoon Y, Yi H. Surveillance Report No. 83—Liver cirrhosis mortality in the United States, 1970-2005.

Zemore SE, Mulia N, Yu Y, Borges G, Greenfield TK. Gender, acculturation, and other barriers to alcohol treatment utilization among Latinos in three National Alcohol Surveys. Journal of Substance Abuse Treatment. 2009 Jun;36(4):446–56.