Protective Factors as an Explanation for the “Paradox” of Black–White Differences in Heavy Drinking

ABSTRACT

Background: African Americans are generally known to have lower heavy drinking prevalence than Whites despite often greater individual and community risk factors. While it is supposed that their protective resources explain this “paradox,” studies have not explicitly examined this. Objective: Assess the contribution of protective resources to Black–White differences in heavy drinking, and (secondarily) whether protective resources operate by reducing heavy drinking and/or increasing abstinence. Methods: Using data from the 2009–2010 U.S. National Alcohol Survey (N = 3,133 Whites and 1,040 Blacks ages 18+), we applied propensity score (PS) weighting to estimate racial differences in heavy drinking and abstinence under hypothetical conditions in which Whites are similar to Blacks in: (1) age and marital status; (2) socioeconomic position and unfair treatment; (3) neighborhood socioeconomic conditions and alcohol outlet density; and (4) protective resources (proscriptive religiosity, area-level religiosity, “drier” network drinking norms and patterns, and family social support). Results: The Black–White gap in male and female drinkers' baseline heavy drinking increased after weighting adjustments for demographics. In women, this gap was reduced after weighting on disadvantage and eliminated after adjusting for protective resources. In men, adjustment for disadvantage increased the racial gap, and protective resources reduced it. Protective resources had a stronger effect on Black–White differences in men's abstinence than heavy drinking, but similar effects on these outcomes in women. Conclusion: Protective resources help explain Black–White differences in men's and particularly women's heavy drinking. Future research is needed to elucidate mechanisms of action and additional factors underlying racial differences in men's heavy drinking.

KEYWORDS:

• Racial/ethnic disparities
• alcohol use
• heavy drinking
• protective factors
• African American
• stress
• health paradox

Acknowledgments

The authors would like to thank the anonymous reviewers for their thoughtful comments.

Declaration of interest

The authors declare that they have no conflicts of interest.

Additional information

Funding

This work was supported by the U.S. National Institute on Alcohol Abuse and Alcoholism (R01AA020474, R01AA022668, and P50AA005595).