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How universal are social influences to drink and problem behaviors for alcohol use?
Addictive Behaviors 27 (2002) 75 – 86
How universal are social influences to drink and problem behaviors for alcohol use? A test comparing urban African-American and Caribbean-American adolescents Jennifer A. Epstein*, Christopher Williams, Gilbert J. Botvin Institute for Prevention Research, Cornell University, Weill Medical College, 411 East 69th Street, KB 201, New York, NY 10021, USA
Abstract The purpose of this study is to test specifically which social influences and which problem behaviors predict drinking among a sample of African-American and Caribbean-American black adolescents residing in New York City. A total of 3212 African-American or Caribbean-American seventh graders completed questionnaires assessing their alcohol use, demographic characteristics, social influences to drink, and other behavioral measures. Logistic regression analyses examined predictors for the overall black sample and separately for each of the two black groups. The predictors of alcohol initiation were virtually identical for both groups (father’s drinking, siblings’ drinking, friends’ drinking, peer drinking, and smoking) with the exception of marijuana use. Although there were some common predictors of alcohol consumption for the two groups (siblings’ drinking, friends’ drinking, and smoking), some factors only influenced alcohol consumption for African-Americans (father’s drinking and marijuana use) and others only did so for Caribbean-Americans (deviance and absenteeism). These findings highlight the importance of examining the etiology of alcohol use for different black groups. D 2001 Elsevier Science Ltd. All rights reserved. Keywords: Adolescents; Alcohol use; African-American; Caribbean-American
* Corresponding author. Tel.: +1-212-746-1270; fax: +1-212-746-8390. E-mail address: [email protected] (J.A. Epstein). 0306-4603/02/$ – see front matter D 2001 Elsevier Science Ltd. All rights reserved. PII: S 0 3 0 6 - 4 6 0 3 ( 0 0 ) 0 0 1 6 5 - 9
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1. Introduction Alcohol abuse is a leading health and safety problem in Black America. Marketers are advertising alcohol much more heavily in black neighborhoods than in white ones (Hackbarth, Silvestri, & Cosper, 1995; McMahon & Taylor, 1990; Moore, Williams, & Qualls, 1996). Black men residing in impoverished neighborhoods reported greater alcohol-related problems than comparable white men (Jones-Webb, Snowden, Herd, Short, & Hannan, 1997). According to nationwide samples, rates of frequent heavy drinking and alcohol-related problems were especially high among black men (Caetano & Clark, 1998). Ethnic subgroup differences in alcohol use tend to be ignored (Collins, 1992). Black Americans comprise individuals of varied primary languages, countries of origin, and cultural perspectives (Hopp & Herring, 1999). Limited research compares drinking prevalence for African-American youth vs. Caribbean-American youth. A large-scale, multi-ethnic study of alcohol use among 7th to 12th grade students residing in New York State found that both African-Americans and Caribbean-Americans were lower in per capita alcohol use, percentage of heavy drinkers, and times drunk per month than whites (Barnes & Welte, 1986). Caribbean-American adolescents had similar drinking patterns to African-American adolescents. Despite this apparent similarity, this survey is over a decade old. More recent research indicates that Caribbean-American 7th graders drank more frequently, became drunk more often, consumed more per drinking occasion, and planned to drink more in the future relative to African-American youth (Epstein, Botvin, Baker, & Diaz, 1998). However, these studies did not examine predictors of alcohol use for each black group. In recent work concentrating on predictors of alcohol among black adolescents, some studies compared blacks to whites (Higgins, Albrecht, & Albrecht, 1997; Poulin, 1991) and others focused solely on blacks (Brook, Whiteman, Balka, & Cohen, 1997; Maton & Zimmerman, 1992). But none of them explored the etiology for separate black groups, such as African-Americans and Caribbean-Americans. Consequently, researchers seem to presume that the etiology of adolescent alcohol use is the same regardless of different black ethnic groups. Without research demonstrating that this is true, this is an untested assumption. Clearly, the black community is not a monolithic group. In contrast to this state of affairs for research of adolescent drinking among black youth, some progress has been made in research with Hispanic youth. Specifically, one study examined demographic factors and social influences to drink for current drinking (at least once a month) among different Hispanic groups (Dusenbury, Epstein, Botvin, & Diaz, 1994). The same needs to be done for black adolescents using a fuller array of social influences to drink and also other problem behaviors. Now some groundwork ought to be established to provide a framework for potential predictors to test the etiology of alcohol use among different groups of black youth. Based on social learning theory (Bandura, 1986), when individuals often observe their friends, family members, or other significant others engaging in a particular behavior, such as drinking, they may then imitate this drinking behavior themselves. Once they begin drinking, the original drinking models then reinforce the behavior. This social learning process of behavior through observation, modeling, imitation, and reinforcement
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appears to influence alcohol use in adolescence among black adolescents. Many studies have found parental alcohol use to be a strong predictor of adolescent alcohol use among black (Brook et al., 1997; Feigelman, Li, & Stanton, 1995) and white samples (Foxcroft & Lowe, 1991; Pang, Wells-Parker, & McMillen, 1989; Wilks, Callan, & Austin, 1989). Past research conducted with predominantly white samples indicated that peers and friends play a major role in influencing adolescents to drink (USDHHS, 1997; Wilks et al., 1989). Siblings’ alcohol use is often neglected in studies of alcohol use. Older and same-aged sibling alcohol use may legitimize and encourage alcohol use (Conger & Rueter, 1996; Duncan, Duncan, & Hops, 1998). Although it can be argued that in general the social learning process would be universal, the specific social influences to drink may depend on ethnicity or culture. To evaluate which social influences to drink apply to which groups, it is necessary to include a full array of social influences among different groups of black adolescents. According to problem behavior theory, alcohol use results from an interaction of personal, physiological, genetic, and environmental factors (Jessor, 1991). The theory posits that some adolescents find deviant behaviors (such as drinking and smoking) functional because the acts help them achieve personal goals. Mischief, delinquency, and acting-out behaviors appear to provide a way of achieving social status for poorly adjusted adolescents. Smoking, drinking, marijuana use, and other deviant behavior have been found to all be part of a problem behavior syndrome. In prior research, cigarette and marijuana use were associated with alcohol use with predominantly white samples. (Ellickson, Hays, & Bell, 1992; Fleming, Leventhal, Glynn, & Ersler, 1989). Yet, little work explored these relationships for black youth. As with social learning, it would be expected that problem behaviors inter-relationship ought to be universal in adolescence. However, cultural factors may exert a role over which particular problem behaviors associate with one another. The purpose of this study is to identify which demographic, social influences to drink, and problem behaviors predict alcohol use among black inner-city adolescents. This study also focuses on testing these factors separately for two black groups: African-Americans and Caribbean-Americans. Understanding the risk factors associated with early stage drinking, whether they be vastly different or similar, among African-Americans and CaribbeanAmericans would help in the development and refinement of appropriate prevention approaches. The inclusion of two alcohol measures (alcohol initiation and alcohol consumption) ensures that specific pathways to patterns of drinking are explored (Epstein, Botvin, Diaz, & Schinke, 1995).
2. Method 2.1. Overview A total of 37 junior high schools in New York City participated in an investigation of the etiology and prevention of adolescent alcohol and other drug use. Districts and schools were recruited based on the composition of black and Hispanic students, as well as the
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socio-economic status of the population. The reason for this is because the focus of the larger investigation was on black and Hispanic economically disadvantaged inner-city students. Moreover, these two ethnic groups have the largest representation in New York City schools. Consequently, this sample represents economically disadvantaged inner-city youth. Prior to any exposure to drug abuse prevention programs, seventh graders from these schools completed questionnaires in which they reported their patterns of drug use and other relevant measures. A passive consent procedure was used to obtain parental consent and less than 1% refused participation. More than 90% of the potential participants took part in the baseline survey. 2.2. Sample The present study focuses on the 3212 adolescents who identified themselves as either African-American (71%) or Caribbean/West Indian (29%). The mean age of participants in the current study was 12.9 years old (S.D. = 0.58). This sample was 52% female. The majority of students reported receiving free or subsidized lunch at school (61%). Less than half of the sample lived in two-parent households (45%). 2.3. Procedure All seventh graders in participating schools completed a questionnaire in class. A team of three to five data collectors who were members of the same ethnic groups as the participating students administered the questionnaire following a standardized protocol. Teachers were not involved in data collection. Students were assured that their answers would remain confidential and would not be shown to teachers, parents, or other students. Stressing the confidential nature of the students’ responses helped ensure the quality (validity and higher response rate) of self-report data. Carbon monoxide (CO) breath samples were collected using a procedure that enhances validity of substance use self-report data (Botvin, Botvin, Renick, Filazzola, & Allegrante, 1984). Data collectors returned at least once to survey students who had been absent at the first data collection. 2.4. Measures Students completed one of two randomly distributed questionnaire forms containing the same items with the order reversed for the measures on the last half of the questionnaire. Half the sample completed each form minimizing data loss due to fatigue, boredom, or inadequate time. All data were self-report. The questionnaire consisted of items concerning ethnic group, gender, and age; items assessing the alcohol use behavior of respondents and their friends; and items assessing other factors relevant to alcohol use. All of the items/scales used were derived from psychometrically valid instruments used widely in previous research. Past research has indicated these items were suitable for the target minority population by demonstrating that the measures had high validity (construct, discriminant, and criterion) with predominantly Hispanic and black samples (Botvin et al.,
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1992; Botvin, Dusenbury, Baker, James-Ortiz, & Kerner, 1989). Furthermore, the measures have been cross-validated by their use in other studies with predominantly Hispanic and/or black adolescents (Botvin et al., 1993; Botvin, Schinke, Epstein, & Diaz, 1994; Botvin, Schinke, Epstein, Diaz, & Botvin, 1995). 2.4.1. Alcohol measures Students indicated their frequency of drinking with a nine-point-scale for ‘‘How often (if ever) they drank alcohol’’: (1) never, (2) a few times but not in the past year, (3) a few times a year, (4) once a month, (5) a few times a month, (6) once a week, (7) a few times a week, (8) once a day, or (9) more than once a day. Another item measured alcohol consumption by asking, ‘‘If you drink alcohol, how much do you usually drink each time you drink?’’ Students responded on a six-point scale: (1) I don’t drink, (2) 1 drink, (3) 2 drinks, (4) 3 or 4 drinks, (5) 5 or 6 drinks, or (6) more than six drinks. 2.4.2. Background variables Students self-reported their gender, family structure (two-parent family, not two-parent family), age, ethnicity, and socio-economic status (receive free or subsidized lunch in school or not). 2.4.3. Social influences to drink alcohol Normative expectations related to alcohol use were assessed: (1) perceived prevalence of alcohol use among peers (peer norms), and (2) perceived prevalence of alcohol use among adults (adult norms). By asking how many friends drink beer, wine, or liquor, friends’ use was determined. Friends’ use, peer norms, and adult norms were measured on five-point scales: (1) none, (2) less than half, (3) about half, (4) more than half or (5) all or almost all. Perceived use by mother or stepmother, father or stepfather, and older sibling(s) were measured on four-point scales, with response categories of ‘‘no,’’ ‘‘used to but quit,’’ ‘‘yes,’’ or ‘‘not sure.’’ Availability was assessed with an item derived from Newcomb and Felix-Ortiz (1992) about how hard or easy it would be to obtain beer, wine, or liquor on a four-point scale: (1) very hard, (2) hard, (3) easy, or (4) very easy. 2.4.4. Behavioral measures Students also indicated how often (if ever) they smoked cigarettes and smoked marijuana on the same nine-point scale as the frequency of drinking alcohol measure. Respondents rated how often they got into trouble (in school, at home, and with police) on three fivepoint scales: (1) never, (2) once, (3) twice, (4) three or four times or (5) more than four times. Students indicated how often they attended religious services on an eight-point scale: (1) never, (2) hardly ever, (3) once or twice a year, (4) about every other month, (5) once a month, (6) two or three times a month, (7) once a week, or (8) more than once a week. They also indicated about how many days they had been absent from school in the last year on a five-point scale: (1) none, (2) 1–2 days, (3) 3–6 days, (4) 7–15 days, or (5) 16 or more days.
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3. Results 3.1. Data analysis plan By running a series of logistic regressions, the most important predictors of patterns of alcohol use were identified among this large sample of black inner-city adolescents. Logistic regressions represented the best strategy because of the low level of alcohol use and intentions at this age and to correspond with the dichotomous alcohol measures used in national surveys (Johnston, O’Malley, & Bachman, 1999) and past etiologic research (e.g., Epstein et al., 1995). A criterion variable of lifetime drinking status was derived from the drinking index: the alcohol initiation measure was dichotomized into two categories to identify students who never drank alcohol or students who had tried alcohol. Alcohol consumption per drinking occasion was recoded to contrast students who drank one or no drinks vs. those who had two or more drinks. The independent variables were recoded to create less skewed and more meaningful categories. For age, students were split into those that were under 13 years old and those 13 years old and older. Perceived family drinking (mother, father, and siblings) was construed as either the family members did not drink or the family members had engaged in any lifetime use (i.e., used to but quit or current drinker). Both peer drinking and friends’ drinking were divided into categories of none vs. less than half to all. Adult drinking was categorized into students perceiving that none to less than half of the adults drink vs. those perceiving that about half to all adults drink. Perceived availability of alcohol was split into students believing that it is easy vs. those believing it is hard to obtain alcohol. Religious attendance was divided into groups of those who attended more than once a month and those who attended once a month or less. In terms of absenteeism, students were categorized as being absent 6 days or less vs. 7 days or more. The trouble scale was dichotomized based on a median split. Both cigarette and marijuana smoking were construed as lifetime use measures comparing students who never smoked to students who had tried smoking. Logistic regressions were computed for each alcohol outcome measure (alcohol initiation and alcohol consumption). Specifically, three separate logistic regressions consisting of (1) background variables, (2) behavioral measures, and (3) social influence to drink variables were run for the three alcohol outcome measures. Then the significant predictors from each of the three logistic regressions were included in a final logistic regression model for each of the alcohol outcome measures. Individuals for whom any of the variables in the equation was missing were omitted from the analysis. The number of respondents included in each analysis is indicated below. This procedure was followed for the overall black sample and then again for African-American students only and Caribbean-American students only. 3.2. Alcohol initiation Table 1 shows the final logistic regression model for alcohol initiation. For the overall sample, significant predictors in the final model (n = 1878) included: ethnic group (AfricanAmerican vs. Caribbean-American), a variety of social influences (father’s drinking, siblings’
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Table 1 Predictors of alcohol initiation Variables Ethnicity (African-American) Caribbean-American Age (under 13) 13 and over Gender (female) male Socio-economic status (not free or subsidized lunch) free or subsidized lunch Mother’s drinking (none) ever drink Father’s drinking (none) ever drink Sibling’s drinking (none) ever drink Friends’ alcohol use (none) < half to all Peer drinking norms (none) < half to all Trouble in past month (low) high Smoking (never) ever Marijuana use (never) ever
Overall
African-American
Caribbean-American
OR
OR
OR
95% CI
95% CI
95% CI
1.51 1.18 – 1.95 not applicable not applicable not applicable not applicable 1.19 0.94 – 1.51 –
–
–
–
–
0.92 – 1.60
–
–
1.05 0.82 – 1.33 –
–
0.75
0.49 – 1.13
1.32 0.98 – 1.77 –
–
–
–
1.79 1.37 – 2.35 1.94
1.46 – 2.56
2.00
1.33 – 3.01
1.80 1.29 – 2.50 1.62
1.12 – 2.35
2.71
1.50 – 4.87
3.41 2.63 – 4.42 3.63
2.66 – 4.95
3.60
2.32 – 5.59
2.36 1.68 – 3.30 2.57
1.73 – 3.82
2.29
1.24 – 4.20
1.11 0.88 – 1.41 1.28
0.96 – 1.69
1.03
0.68 – 1.54
3.72 2.72 – 5.09 3.76
2.65 – 5.34
2.99
1.75 – 5.09
1.40 0.83 – 2.35 1.90
1.07 – 3.37
–
–
–
1.21
Reference group in parentheses. – Variable not included in final model.
drinking, friends’ drinking, and peer drinking norms) and cigarette smoking. According to the final logistic regression model for African-Americans, the significant predictors of alcohol initiation included those found for the overall sample with the addition of marijuana use (n = 1425). All the same social influences predicted ever trying alcohol among CaribbeanAmericans: siblings’ drinking, fathers’ drinking, friends’ drinking, and peers’ drinking (n = 583). Cigarette smoking, but not marijuana use, increased the odds of ever drinking among Caribbean-Americans. 3.3. Alcohol consumption per drinking occasion Table 2 shows the final logistic regression models for alcohol consumption. In the overall sample, significant predictors were siblings’ drinking, friends’ drinking, peer drinking norms, getting in trouble in the past month, ever smoking, and ever use of marijuana (n = 2093). Based on the final logistic regression model, significant predictors of amount consumed per drinking occasion for African-American students included: father’s drinking, siblings’
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Table 2 Predictors of alcohol consumption Overall Variables Age (under 13) 13 and over Family structure (two-parent) not two parent Socio-economic status (not free or subsidized lunch) free or subsidized lunch Father’s drinking (none) ever drink Sibling’s drinking (none) ever drink Friends’ alcohol use (none) < half to all Peer drinking norms (none) < half to all Ease of obtaining alcohol (hard) easy Trouble in past month (low) high Absenteeism (less than 7 days) seven or more days Smoking (never) ever Marijuana use (never) ever
African-American
Caribbean-American OR
OR
95% CI
OR
95% CI
95% CI
1.35
0.91 – 1.99
–
–
1.95
0.99 – 3.85
1.27
0.85 – 1.88
–
–
–
–
0.94
0.64 – 1.38
0.90
0.55 – 1.47
–
–
–
–
2.40
1.43 – 4.02
–
–
2.13
1.40 – 3.23
1.96
1.14 – 3.39
2.39
1.19 – 4.82
7.70
3.62 – 16.36
5.73
2.48 – 13.22
12.87
3.00 – 55.14
2.38
1.05 – 5.41
1.54
0.65 – 3.64
–
–
1.48
0.95 – 2.32
1.73
0.97 – 3.07
–
–
1.64
1.06 – 2.55
1.57
0.91 – 2.71
2.72
1.23 – 6.04
–
–
–
–
2.38
1.15 – 4.95
3.34
2.19 – 5.09
3.42
2.01 – 5.82
2.80
1.41 – 5.54
2.09
1.21 – 3.61
3.12
1.61 – 6.06
–
–
Reference group in parentheses. – Variable not included in final model.
drinking, friends’ drinking, cigarette smoking, and marijuana use (n = 1385). According to the final logistic regression model for Caribbean-American students, significant predictors of alcohol consumption per drinking occasion were siblings’ drinking, friends’ drinking, getting into trouble, absenteeism, and cigarette smoking (n = 640).
4. Discussion In this sample of inner-city black adolescents, family members and the peer group influenced drinking as expected according to social learning theory (Bandura, 1986). Friends’ alcohol use was consistently related to both alcohol initiation and alcohol consumption for the entire black sample and each of the two black subgroups. Siblings’ alcohol use had the same association with the two drinking measures. Peer drinking was related to both alcohol measures for the entire black sample but not with alcohol consumption for each of the subgroups. Father’s drinking influenced alcohol initiation across black adolescents, as well as within each black subgroup. Consequently, similarly aged adolescents appeared to exert the
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most social impact on the respondents’ drinking. Cigarette smoking was positively linked with the alcohol measures. Marijuana use predicted alcohol initiation and alcohol consumption for the African-American subgroup but not the Caribbean-American subgroup. Deviant behavior predicted alcohol consumption for the entire black sample and Caribbean-Americans supporting problem behavior theory (Jessor, 1991). Examining differences in etiology of drinking is important as the number of immigrant blacks in the United States continues to rise (US Bureau of Census, 1990). For instance, 31% of blacks living in New York State are foreign-born (US Bureau of Census, 1990). Past research and national surveys homogenize the different black subgroups. In the present study, it was possible to examine black subgroup differences in alcohol use. Of course, only the overall sample analysis included the ethnic comparison between the two black subgroups. Caribbean-American adolescents were more likely to have started drinking relative to African-American adolescents congruent with an earlier finding from a study of continuous measures of drinking behavior and prevalence rates (Epstein et al., 1998). Unlike the earlier investigation, the current study found this difference even controlling for a variety of other factors in an etiologic model of alcohol initiation. By examining the predictors for each alcohol measure, some patterns become apparent. The determinants of alcohol initiation were virtually identical whether focusing on the overall sample or either of the two black subgroups. Specifically, the drinking behavior of family members (father and older siblings), as well as friends and peers, increased the probability of alcohol initiation for both groups. One problem behavior, cigarette smoking, was associated with alcohol initiation across and within both black subgroups. Based on the factors tested in this study, it appears the relevant social influences to drink and early cigarette smoking transcended culture in predicting alcohol initiation. The only exception was that initiation of marijuana use had a relationship with alcohol initiation only among African-American adolescents. Since African-Americans were less likely to have started drinking alcohol relative to Caribbean-Americans, it appears that the most precocious African-American youth were trying both substances while Caribbean-American youth who tried alcohol were not necessarily as precocious. As stated earlier, there was consistency for the two ethnic groups (African-American and Caribbean-American) whereby friends’ drinking was associated with alcohol consumption among both. Earlier research identified alcohol-using friends as a critical social influence to drink among white adolescents (Byram & Fly, 1984; Harford, 1985; Kandel, 1986; Kandel & Andrews, 1987; McLaughlin, Baer, Burnside, & Pokorny, 1985) and Hispanic adolescents (Dusenbury et al., 1994; Epstein, Dusenbury, Botvin, & Diaz, 1996). Therefore, the social influence to drink from friends is apparently a common experience shared by all ethnic groups that affects adolescent drinking behavior. In addition to friends’ alcohol use, siblings’ drinking exerted an influence on their brothers’ and sisters’ heavier drinking in both cultures. Similarly, those adolescents who tried cigarette smoking engaged in heavier alcohol consumption whether these adolescents were African-American or Caribbean-American. Yet there were differences in the determinants of alcohol for African-Americans compared to Caribbean-American adolescents. As with alcohol initiation, marijuana use was associated with heavier alcohol consumption only for African-American adolescents. Most likely, these were the more precocious African-American youth. Fathers’ drinking was only related to
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greater alcohol consumption among African-American adolescents. The reason for this might be due to the higher proportion of boys in the African-American group vs. the CaribbeanAmerican group combined with the tendency for adolescents to imitate the drinking behavior of the same-sex parent as has been found in past research (Harburg, Davis, & Caplan, 1982). A greater propensity to engage in deviant behavior (i.e., being in trouble and absenteeism) predicted alcohol consumption only for Caribbean-American students. In Caribbean culture parents value a punitive, restrictive approach to discipline and child rearing such that obedience and docility are valued (Brown, 1984; Payne, 1989). This harsh and punitive parenting style has long been associated with aggressive, defiant, and acting-out behavior among adolescents (Wasserman, Miller, Pinner, & Jaramillo, 1996). As a result, these adolescents can be said to exhibit a more general problem behavior syndrome because deviant behavior was associated with excessive drinking. This study focused on social influences and problem behaviors as predictors of alcohol use for a black sample as well as separately for African-American and Caribbean-American adolescents. Further research needs to test other potential predictors of alcohol use for these two groups. As the data from this study were cross-sectional, future work must address testing variables longitudinally. The findings from this study might not generalize to other black adolescents living in other regions of the country or in non-urban areas. Since this study supports a theoretical framework in which social learning and problem behaviors are implicated in alcohol use among different groups of black adolescents, these findings also advocate for skills-based approaches to alcohol and other drug use prevention shown to be effective among inner-city minority youth (Botvin, 1995). Such skills-based approaches teach social resistance skills within the context of a broader intervention promoting general personal and social competence and target multiple drugs. Consequently, these approaches improve the adolescents’ ability to resist the social influences to drink and the larger problem behavior syndrome by not simply focusing on alcohol prevention. Although skills-based drug prevention approaches target the three gateway drugs, an even broader focus on problem behaviors including other forms of deviance should help prevent alcohol use, as well as other problem behaviors.
Acknowledgments This study was supported by a grant from the Alcoholic Beverage Medical Research Foundation to Dr. Epstein. Funds from the National Institute for Drug Abuse to Dr. Botvin (P50DA7656) also partially supported this research.
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Botvin, E. M., Botvin, G. J., Renick, N. L., Filazzola, A. D., & Allegrante, J. P. (1984). Adolescents’ self-reports of tobacco, alcohol, and marijuana use: examining the comparability of videotape, cartoon, and verbal boguspipeline procedures. Psychological Reports, 55, 379 – 386. Botvin, G. J. (1995). School-based drug abuse prevention. In: G. J. Botvin, S. Schinke, & M. Orlandi (Eds.), Drug abuse prevention with multi-ethnic youth ( pp. 169 – 192). Newbury Park, CA: Sage Publications. Botvin, G. J., Baker, E., Botvin, E. M., Dusenbury, L., Cardwell, J., & Diaz, T. (1993). Factors promoting cigarette smoking among black youth: a causal modeling approach. Addictive Behaviors, 18, 397 – 405. Botvin, G. J., Dusenbury, L., Baker, E., James-Ortiz, S., Botvin, E. M., & Kerner, J. (1992). Smoking prevention among urban minority youth: assessing effects on outcome and mediating variables. Health Psychology, 11, 290 – 299. Botvin, G. J., Dusenbury, L., Baker, E., James-Ortiz, S., & Kerner, J. (1989). Skills training approach to smoking prevention among Hispanic youth. Journal of Behavioral Medicine, 12, 279 – 296. Botvin, G. J., Schinke, S. P., Epstein, J. A., & Diaz, T. (1994). Effectiveness of culturally focused and generic skills training approaches to alcohol and drug abuse among minority youths. Psychology of Addictive Behaviors, 8, 116 – 127. Botvin, G. J., Schinke, S. P., Epstein, J. A., Diaz, T., & Botvin, E. M. (1995). Effectiveness of culturally focused and generic skills training approaches to alcohol and drug abuse prevention among minority adolescents: twoyear follow-up results. Psychology of Addictive Behaviors, 9, 183 – 194. Brook, J. S., Whiteman, M., Balka, E. B., & Cohen, P. (1997). Drug use and delinquency: shared and unshared risk factors in African American and Puerto Rican adolescents. Journal of Genetic Psychology, 158 (1), 25 – 39. Brown, J. A. (1984). Group work with low-income Black youths. Social Work with Groups, 73, 111 – 124. Byram, O. W., & Fly, J. W. (1984). Family structure, race and adolescent’s alcohol use: a research note. American Journal on Drug and Alcohol Abuse, 10 (3), 467 – 478. Caetano, R., & Clark, C. L. (1998). Trends in alcohol consumption patterns among whites, blacks, and Hispanics: 1984 and 1995. Journal of Studies on Alcohol, 59 (6), 659 – 668. Collins, R. L. (1992). Methodological issues in conducting substance abuse research on ethnic minority populations. Drugs and Society, 6, 59 – 77. Conger, R. D., & Rueter, M. A. (1996). Siblings, parents and peers: a longitudinal study of social influences in adolescents at risk for alcohol use and abuse. In: G. H. Brody (Ed.), Sibling relationships: their causes and consequences. Advances in applied developmental psychology, (vol. 10, pp. 1 – 30). Norwood, NJ: Alexa Publishing. Duncan, T. E., Duncan, S. C., & Hops, H. (1998). Latent variable modeling of longitudinal and multilevel alcohol use data. Journal of Studies on Alcohol, 59 (4), 399 – 408. Dusenbury, L., Epstein, J. A., Botvin, G. J., & Diaz, T. (1994). Social influence predictors of alcohol use among New York Latino youth. Addictive Behaviors, 19, 363 – 373. Ellickson, P. L., Hays, R. D., & Bell, R. M. (1992). Stepping through the drug use sequence: longitudinal and scalogram analysis at initiation and regular use. Journal of Abnormal Psychology, 10, 441 – 451. Epstein, J. A., Botvin, G. J., Baker, E., & Diaz, T. (1998). Patterns of alcohol use among ethnically-diverse black and Hispanic urban youth. Journal of Gender, Culture, and Health, 3, 29 – 39. Epstein, J. A., Botvin, G. J., Diaz, T., & Schinke, S. P. (1995). The role of social factors and individual characteristics in promoting alcohol use among inner-city minority youth. Journal of Studies on Alcohol, 56, 39 – 46. Epstein, J. A., Dusenbury, L., Botvin, G. J., & Diaz, T. (1996). Language use and initiation of alcohol use among New York City Hispanic adolescents. Journal of Child and Adolescent Substance Abuse, 5, 63 – 79. Feigelman, S., Li, X., & Stanton, B. (1995). Perceived risks and benefits of alcohol, cigarette, and drug use among urban low-income African-American early adolescents. Bulletin of the New York Academy of Medicine, 72 (1), 57 – 75. Fleming, R., Leventhal, H., Glynn, K., & Ershler, J. (1989). The role of cigarettes in the initiation and progression of early substance use. Addictive Behaviors, 143, 261 – 272. Foxcroft, D. R., & Lowe, G. (1991). Adolescent drinking behavior and family socialization factors: a metaanalysis. Journal of Adolescence, 14 (3), 255 – 273. Hackbarth, D. P., Silvestri, B., & Cosper, W. (1995). Tobacco and alcohol billboards in 50 Chicago neighbor-
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hoods: market segmentation to sell dangerous products to the poor. Journal of Public Health Policy, 16 (2), 213 – 230. Harburg, E., Davis, D. R., & Caplan, R. (1982). Parent and offspring alcohol use, imitative and aversive transmission. Journal of Studies on Alcohol, 43 (5), 497 – 503. Harford, T. C. (1985). Drinking patterns among black and non-black adolescents: results of a national survey. In: R. Wright, & T. D. Watts (Eds.), Prevention of black alcoholism: issues and strategies ( pp. 276 – 291). Springfield, IL: Charles C. Thomas. Higgins, P. C., Albrecht, G. L., & Albrecht, M. H. (1997). Black – white adolescent drinking: the myth and the reality. Social Problems, 25, 215 – 224. Hopp, J. W., & Herring, P. (1999). Promoting health among black American populations: an overview. In: R. M. Huff, & M. V. Kline (Eds.), Promoting health in multicultural populations: a handbook for practitioners ( pp. 201 – 221). Thousand Oaks, CA: Sage Publications. Jessor, R. (1991). Risk behavior in adolescence: a psychosocial framework for understanding and action. Journal of Adolescent Health, 12, 597 – 605. Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (1999). National survey results on drug use from the Monitoring the Future study, 1975 – 1998, volume I secondary school students. Rockville, MD: National Institute of Drug Abuse. Jones-Webb, R., Snowden, L., Herd, D., Short, B., & Hannan, P. (1997). Alcohol-related problems among black, Hispanic and white men: the contribution of neighborhood poverty. Journal of Studies on Alcohol, 58 (5), 539 – 545. Kandel, D. B. (1986). Processes of peer influence in adolescence. In: R. Silberstein (Ed.), Development as action in context: problem behavior and normal youth development ( pp. 203 – 228). New York, NY: Springer-Verlag. Kandel, D. B., & Andrews, K. (1987). Processes of adolescent socialization by parents and peers. International Journal of Addictions, 22, 319 – 342. Maton, K. I., & Zimmerman, M. A. (1992). Psychosocial predictors of substance use among urban black male adolescents. Drugs and Society, 6 (1 – 2), 79 – 113. McLaughlin, R. J., Baer, P. E., Burnside, M. A., & Pokorny, A. D. (1985). Psychosocial correlates of alcohol use at two age levels during adolescence. Journal of Studies on Alcohol, 46 (3), 212 – 218. McMahon, E. T., & Taylor, P. A. (1990). Citizens’ action handbook on alcohol and tobacco billboard advertising. Washington, DC: Center for Science in the Public Interest. Moore, D. J., Williams, J. D., & Qualls, W. J. (1996). Target marketing of tobacco and alcohol-related products to ethnic minority groups in the United States. Ethnicity and Disease, 6 (1 – 2), 83 – 98. Newcomb, M. D., & Felix-Ortiz, M. (1992). Multiple protective and risk factors for drug use and abuse: crosssectional and prospective findings. Journal of Consulting and Clinical Psychology, 63 (2), 280 – 296. Pang, M. G., Wells-Parker, E., & McMillen, D. L. (1989). Drinking reasons, drinking locations, and automobile accident involvement among collegians. International Journal of the Addictions, 24, 215 – 227. Payne, M. A. (1989). Use and abuse of corporal punishment: a Caribbean view. Child Abuse and Neglect, 13 (3), 389 – 401. Poulin, J. E. (1991). Racial differences in the use of drugs and alcohol among low income youth and young adults. Journal of Society and Social Welfare, 18 (3), 159 – 166. U.S. Bureau of the Census. (1990). Census of population. Washington: U.S. Government Printing Office. U.S. Department of Health and Human Services. (1997). Ninth special report to U.S. Congress on alcohol and health. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Wasserman, G. A., Miller, L. S., Pinner, E., & Jaramillo, B. (1996). Parenting predictors of early conduct problems in urban, high-risk boys. Journal of the American Academy of Child and Adolescent Psychiatry, 35 (9), 1227 – 1236. Wilks, J., Callan, V. J., & Austin, D. A. (1989). Parent, peer, and personal determinants of adolescent drinking. British Journal of Addictions, 84, 619 – 630.
How universal are social influences to drink and problem behaviors for alcohol use? A test comparing urban African-American and Caribbean-American adolescents Jennifer A. Epstein*, Christopher Williams, Gilbert J. Botvin Institute for Prevention Research, Cornell University, Weill Medical College, 411 East 69th Street, KB 201, New York, NY 10021, USA
Abstract The purpose of this study is to test specifically which social influences and which problem behaviors predict drinking among a sample of African-American and Caribbean-American black adolescents residing in New York City. A total of 3212 African-American or Caribbean-American seventh graders completed questionnaires assessing their alcohol use, demographic characteristics, social influences to drink, and other behavioral measures. Logistic regression analyses examined predictors for the overall black sample and separately for each of the two black groups. The predictors of alcohol initiation were virtually identical for both groups (father’s drinking, siblings’ drinking, friends’ drinking, peer drinking, and smoking) with the exception of marijuana use. Although there were some common predictors of alcohol consumption for the two groups (siblings’ drinking, friends’ drinking, and smoking), some factors only influenced alcohol consumption for African-Americans (father’s drinking and marijuana use) and others only did so for Caribbean-Americans (deviance and absenteeism). These findings highlight the importance of examining the etiology of alcohol use for different black groups. D 2001 Elsevier Science Ltd. All rights reserved. Keywords: Adolescents; Alcohol use; African-American; Caribbean-American
* Corresponding author. Tel.: +1-212-746-1270; fax: +1-212-746-8390. E-mail address: [email protected] (J.A. Epstein). 0306-4603/02/$ – see front matter D 2001 Elsevier Science Ltd. All rights reserved. PII: S 0 3 0 6 - 4 6 0 3 ( 0 0 ) 0 0 1 6 5 - 9
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1. Introduction Alcohol abuse is a leading health and safety problem in Black America. Marketers are advertising alcohol much more heavily in black neighborhoods than in white ones (Hackbarth, Silvestri, & Cosper, 1995; McMahon & Taylor, 1990; Moore, Williams, & Qualls, 1996). Black men residing in impoverished neighborhoods reported greater alcohol-related problems than comparable white men (Jones-Webb, Snowden, Herd, Short, & Hannan, 1997). According to nationwide samples, rates of frequent heavy drinking and alcohol-related problems were especially high among black men (Caetano & Clark, 1998). Ethnic subgroup differences in alcohol use tend to be ignored (Collins, 1992). Black Americans comprise individuals of varied primary languages, countries of origin, and cultural perspectives (Hopp & Herring, 1999). Limited research compares drinking prevalence for African-American youth vs. Caribbean-American youth. A large-scale, multi-ethnic study of alcohol use among 7th to 12th grade students residing in New York State found that both African-Americans and Caribbean-Americans were lower in per capita alcohol use, percentage of heavy drinkers, and times drunk per month than whites (Barnes & Welte, 1986). Caribbean-American adolescents had similar drinking patterns to African-American adolescents. Despite this apparent similarity, this survey is over a decade old. More recent research indicates that Caribbean-American 7th graders drank more frequently, became drunk more often, consumed more per drinking occasion, and planned to drink more in the future relative to African-American youth (Epstein, Botvin, Baker, & Diaz, 1998). However, these studies did not examine predictors of alcohol use for each black group. In recent work concentrating on predictors of alcohol among black adolescents, some studies compared blacks to whites (Higgins, Albrecht, & Albrecht, 1997; Poulin, 1991) and others focused solely on blacks (Brook, Whiteman, Balka, & Cohen, 1997; Maton & Zimmerman, 1992). But none of them explored the etiology for separate black groups, such as African-Americans and Caribbean-Americans. Consequently, researchers seem to presume that the etiology of adolescent alcohol use is the same regardless of different black ethnic groups. Without research demonstrating that this is true, this is an untested assumption. Clearly, the black community is not a monolithic group. In contrast to this state of affairs for research of adolescent drinking among black youth, some progress has been made in research with Hispanic youth. Specifically, one study examined demographic factors and social influences to drink for current drinking (at least once a month) among different Hispanic groups (Dusenbury, Epstein, Botvin, & Diaz, 1994). The same needs to be done for black adolescents using a fuller array of social influences to drink and also other problem behaviors. Now some groundwork ought to be established to provide a framework for potential predictors to test the etiology of alcohol use among different groups of black youth. Based on social learning theory (Bandura, 1986), when individuals often observe their friends, family members, or other significant others engaging in a particular behavior, such as drinking, they may then imitate this drinking behavior themselves. Once they begin drinking, the original drinking models then reinforce the behavior. This social learning process of behavior through observation, modeling, imitation, and reinforcement
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appears to influence alcohol use in adolescence among black adolescents. Many studies have found parental alcohol use to be a strong predictor of adolescent alcohol use among black (Brook et al., 1997; Feigelman, Li, & Stanton, 1995) and white samples (Foxcroft & Lowe, 1991; Pang, Wells-Parker, & McMillen, 1989; Wilks, Callan, & Austin, 1989). Past research conducted with predominantly white samples indicated that peers and friends play a major role in influencing adolescents to drink (USDHHS, 1997; Wilks et al., 1989). Siblings’ alcohol use is often neglected in studies of alcohol use. Older and same-aged sibling alcohol use may legitimize and encourage alcohol use (Conger & Rueter, 1996; Duncan, Duncan, & Hops, 1998). Although it can be argued that in general the social learning process would be universal, the specific social influences to drink may depend on ethnicity or culture. To evaluate which social influences to drink apply to which groups, it is necessary to include a full array of social influences among different groups of black adolescents. According to problem behavior theory, alcohol use results from an interaction of personal, physiological, genetic, and environmental factors (Jessor, 1991). The theory posits that some adolescents find deviant behaviors (such as drinking and smoking) functional because the acts help them achieve personal goals. Mischief, delinquency, and acting-out behaviors appear to provide a way of achieving social status for poorly adjusted adolescents. Smoking, drinking, marijuana use, and other deviant behavior have been found to all be part of a problem behavior syndrome. In prior research, cigarette and marijuana use were associated with alcohol use with predominantly white samples. (Ellickson, Hays, & Bell, 1992; Fleming, Leventhal, Glynn, & Ersler, 1989). Yet, little work explored these relationships for black youth. As with social learning, it would be expected that problem behaviors inter-relationship ought to be universal in adolescence. However, cultural factors may exert a role over which particular problem behaviors associate with one another. The purpose of this study is to identify which demographic, social influences to drink, and problem behaviors predict alcohol use among black inner-city adolescents. This study also focuses on testing these factors separately for two black groups: African-Americans and Caribbean-Americans. Understanding the risk factors associated with early stage drinking, whether they be vastly different or similar, among African-Americans and CaribbeanAmericans would help in the development and refinement of appropriate prevention approaches. The inclusion of two alcohol measures (alcohol initiation and alcohol consumption) ensures that specific pathways to patterns of drinking are explored (Epstein, Botvin, Diaz, & Schinke, 1995).
2. Method 2.1. Overview A total of 37 junior high schools in New York City participated in an investigation of the etiology and prevention of adolescent alcohol and other drug use. Districts and schools were recruited based on the composition of black and Hispanic students, as well as the
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socio-economic status of the population. The reason for this is because the focus of the larger investigation was on black and Hispanic economically disadvantaged inner-city students. Moreover, these two ethnic groups have the largest representation in New York City schools. Consequently, this sample represents economically disadvantaged inner-city youth. Prior to any exposure to drug abuse prevention programs, seventh graders from these schools completed questionnaires in which they reported their patterns of drug use and other relevant measures. A passive consent procedure was used to obtain parental consent and less than 1% refused participation. More than 90% of the potential participants took part in the baseline survey. 2.2. Sample The present study focuses on the 3212 adolescents who identified themselves as either African-American (71%) or Caribbean/West Indian (29%). The mean age of participants in the current study was 12.9 years old (S.D. = 0.58). This sample was 52% female. The majority of students reported receiving free or subsidized lunch at school (61%). Less than half of the sample lived in two-parent households (45%). 2.3. Procedure All seventh graders in participating schools completed a questionnaire in class. A team of three to five data collectors who were members of the same ethnic groups as the participating students administered the questionnaire following a standardized protocol. Teachers were not involved in data collection. Students were assured that their answers would remain confidential and would not be shown to teachers, parents, or other students. Stressing the confidential nature of the students’ responses helped ensure the quality (validity and higher response rate) of self-report data. Carbon monoxide (CO) breath samples were collected using a procedure that enhances validity of substance use self-report data (Botvin, Botvin, Renick, Filazzola, & Allegrante, 1984). Data collectors returned at least once to survey students who had been absent at the first data collection. 2.4. Measures Students completed one of two randomly distributed questionnaire forms containing the same items with the order reversed for the measures on the last half of the questionnaire. Half the sample completed each form minimizing data loss due to fatigue, boredom, or inadequate time. All data were self-report. The questionnaire consisted of items concerning ethnic group, gender, and age; items assessing the alcohol use behavior of respondents and their friends; and items assessing other factors relevant to alcohol use. All of the items/scales used were derived from psychometrically valid instruments used widely in previous research. Past research has indicated these items were suitable for the target minority population by demonstrating that the measures had high validity (construct, discriminant, and criterion) with predominantly Hispanic and black samples (Botvin et al.,
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1992; Botvin, Dusenbury, Baker, James-Ortiz, & Kerner, 1989). Furthermore, the measures have been cross-validated by their use in other studies with predominantly Hispanic and/or black adolescents (Botvin et al., 1993; Botvin, Schinke, Epstein, & Diaz, 1994; Botvin, Schinke, Epstein, Diaz, & Botvin, 1995). 2.4.1. Alcohol measures Students indicated their frequency of drinking with a nine-point-scale for ‘‘How often (if ever) they drank alcohol’’: (1) never, (2) a few times but not in the past year, (3) a few times a year, (4) once a month, (5) a few times a month, (6) once a week, (7) a few times a week, (8) once a day, or (9) more than once a day. Another item measured alcohol consumption by asking, ‘‘If you drink alcohol, how much do you usually drink each time you drink?’’ Students responded on a six-point scale: (1) I don’t drink, (2) 1 drink, (3) 2 drinks, (4) 3 or 4 drinks, (5) 5 or 6 drinks, or (6) more than six drinks. 2.4.2. Background variables Students self-reported their gender, family structure (two-parent family, not two-parent family), age, ethnicity, and socio-economic status (receive free or subsidized lunch in school or not). 2.4.3. Social influences to drink alcohol Normative expectations related to alcohol use were assessed: (1) perceived prevalence of alcohol use among peers (peer norms), and (2) perceived prevalence of alcohol use among adults (adult norms). By asking how many friends drink beer, wine, or liquor, friends’ use was determined. Friends’ use, peer norms, and adult norms were measured on five-point scales: (1) none, (2) less than half, (3) about half, (4) more than half or (5) all or almost all. Perceived use by mother or stepmother, father or stepfather, and older sibling(s) were measured on four-point scales, with response categories of ‘‘no,’’ ‘‘used to but quit,’’ ‘‘yes,’’ or ‘‘not sure.’’ Availability was assessed with an item derived from Newcomb and Felix-Ortiz (1992) about how hard or easy it would be to obtain beer, wine, or liquor on a four-point scale: (1) very hard, (2) hard, (3) easy, or (4) very easy. 2.4.4. Behavioral measures Students also indicated how often (if ever) they smoked cigarettes and smoked marijuana on the same nine-point scale as the frequency of drinking alcohol measure. Respondents rated how often they got into trouble (in school, at home, and with police) on three fivepoint scales: (1) never, (2) once, (3) twice, (4) three or four times or (5) more than four times. Students indicated how often they attended religious services on an eight-point scale: (1) never, (2) hardly ever, (3) once or twice a year, (4) about every other month, (5) once a month, (6) two or three times a month, (7) once a week, or (8) more than once a week. They also indicated about how many days they had been absent from school in the last year on a five-point scale: (1) none, (2) 1–2 days, (3) 3–6 days, (4) 7–15 days, or (5) 16 or more days.
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3. Results 3.1. Data analysis plan By running a series of logistic regressions, the most important predictors of patterns of alcohol use were identified among this large sample of black inner-city adolescents. Logistic regressions represented the best strategy because of the low level of alcohol use and intentions at this age and to correspond with the dichotomous alcohol measures used in national surveys (Johnston, O’Malley, & Bachman, 1999) and past etiologic research (e.g., Epstein et al., 1995). A criterion variable of lifetime drinking status was derived from the drinking index: the alcohol initiation measure was dichotomized into two categories to identify students who never drank alcohol or students who had tried alcohol. Alcohol consumption per drinking occasion was recoded to contrast students who drank one or no drinks vs. those who had two or more drinks. The independent variables were recoded to create less skewed and more meaningful categories. For age, students were split into those that were under 13 years old and those 13 years old and older. Perceived family drinking (mother, father, and siblings) was construed as either the family members did not drink or the family members had engaged in any lifetime use (i.e., used to but quit or current drinker). Both peer drinking and friends’ drinking were divided into categories of none vs. less than half to all. Adult drinking was categorized into students perceiving that none to less than half of the adults drink vs. those perceiving that about half to all adults drink. Perceived availability of alcohol was split into students believing that it is easy vs. those believing it is hard to obtain alcohol. Religious attendance was divided into groups of those who attended more than once a month and those who attended once a month or less. In terms of absenteeism, students were categorized as being absent 6 days or less vs. 7 days or more. The trouble scale was dichotomized based on a median split. Both cigarette and marijuana smoking were construed as lifetime use measures comparing students who never smoked to students who had tried smoking. Logistic regressions were computed for each alcohol outcome measure (alcohol initiation and alcohol consumption). Specifically, three separate logistic regressions consisting of (1) background variables, (2) behavioral measures, and (3) social influence to drink variables were run for the three alcohol outcome measures. Then the significant predictors from each of the three logistic regressions were included in a final logistic regression model for each of the alcohol outcome measures. Individuals for whom any of the variables in the equation was missing were omitted from the analysis. The number of respondents included in each analysis is indicated below. This procedure was followed for the overall black sample and then again for African-American students only and Caribbean-American students only. 3.2. Alcohol initiation Table 1 shows the final logistic regression model for alcohol initiation. For the overall sample, significant predictors in the final model (n = 1878) included: ethnic group (AfricanAmerican vs. Caribbean-American), a variety of social influences (father’s drinking, siblings’
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Table 1 Predictors of alcohol initiation Variables Ethnicity (African-American) Caribbean-American Age (under 13) 13 and over Gender (female) male Socio-economic status (not free or subsidized lunch) free or subsidized lunch Mother’s drinking (none) ever drink Father’s drinking (none) ever drink Sibling’s drinking (none) ever drink Friends’ alcohol use (none) < half to all Peer drinking norms (none) < half to all Trouble in past month (low) high Smoking (never) ever Marijuana use (never) ever
Overall
African-American
Caribbean-American
OR
OR
OR
95% CI
95% CI
95% CI
1.51 1.18 – 1.95 not applicable not applicable not applicable not applicable 1.19 0.94 – 1.51 –
–
–
–
–
0.92 – 1.60
–
–
1.05 0.82 – 1.33 –
–
0.75
0.49 – 1.13
1.32 0.98 – 1.77 –
–
–
–
1.79 1.37 – 2.35 1.94
1.46 – 2.56
2.00
1.33 – 3.01
1.80 1.29 – 2.50 1.62
1.12 – 2.35
2.71
1.50 – 4.87
3.41 2.63 – 4.42 3.63
2.66 – 4.95
3.60
2.32 – 5.59
2.36 1.68 – 3.30 2.57
1.73 – 3.82
2.29
1.24 – 4.20
1.11 0.88 – 1.41 1.28
0.96 – 1.69
1.03
0.68 – 1.54
3.72 2.72 – 5.09 3.76
2.65 – 5.34
2.99
1.75 – 5.09
1.40 0.83 – 2.35 1.90
1.07 – 3.37
–
–
–
1.21
Reference group in parentheses. – Variable not included in final model.
drinking, friends’ drinking, and peer drinking norms) and cigarette smoking. According to the final logistic regression model for African-Americans, the significant predictors of alcohol initiation included those found for the overall sample with the addition of marijuana use (n = 1425). All the same social influences predicted ever trying alcohol among CaribbeanAmericans: siblings’ drinking, fathers’ drinking, friends’ drinking, and peers’ drinking (n = 583). Cigarette smoking, but not marijuana use, increased the odds of ever drinking among Caribbean-Americans. 3.3. Alcohol consumption per drinking occasion Table 2 shows the final logistic regression models for alcohol consumption. In the overall sample, significant predictors were siblings’ drinking, friends’ drinking, peer drinking norms, getting in trouble in the past month, ever smoking, and ever use of marijuana (n = 2093). Based on the final logistic regression model, significant predictors of amount consumed per drinking occasion for African-American students included: father’s drinking, siblings’
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Table 2 Predictors of alcohol consumption Overall Variables Age (under 13) 13 and over Family structure (two-parent) not two parent Socio-economic status (not free or subsidized lunch) free or subsidized lunch Father’s drinking (none) ever drink Sibling’s drinking (none) ever drink Friends’ alcohol use (none) < half to all Peer drinking norms (none) < half to all Ease of obtaining alcohol (hard) easy Trouble in past month (low) high Absenteeism (less than 7 days) seven or more days Smoking (never) ever Marijuana use (never) ever
African-American
Caribbean-American OR
OR
95% CI
OR
95% CI
95% CI
1.35
0.91 – 1.99
–
–
1.95
0.99 – 3.85
1.27
0.85 – 1.88
–
–
–
–
0.94
0.64 – 1.38
0.90
0.55 – 1.47
–
–
–
–
2.40
1.43 – 4.02
–
–
2.13
1.40 – 3.23
1.96
1.14 – 3.39
2.39
1.19 – 4.82
7.70
3.62 – 16.36
5.73
2.48 – 13.22
12.87
3.00 – 55.14
2.38
1.05 – 5.41
1.54
0.65 – 3.64
–
–
1.48
0.95 – 2.32
1.73
0.97 – 3.07
–
–
1.64
1.06 – 2.55
1.57
0.91 – 2.71
2.72
1.23 – 6.04
–
–
–
–
2.38
1.15 – 4.95
3.34
2.19 – 5.09
3.42
2.01 – 5.82
2.80
1.41 – 5.54
2.09
1.21 – 3.61
3.12
1.61 – 6.06
–
–
Reference group in parentheses. – Variable not included in final model.
drinking, friends’ drinking, cigarette smoking, and marijuana use (n = 1385). According to the final logistic regression model for Caribbean-American students, significant predictors of alcohol consumption per drinking occasion were siblings’ drinking, friends’ drinking, getting into trouble, absenteeism, and cigarette smoking (n = 640).
4. Discussion In this sample of inner-city black adolescents, family members and the peer group influenced drinking as expected according to social learning theory (Bandura, 1986). Friends’ alcohol use was consistently related to both alcohol initiation and alcohol consumption for the entire black sample and each of the two black subgroups. Siblings’ alcohol use had the same association with the two drinking measures. Peer drinking was related to both alcohol measures for the entire black sample but not with alcohol consumption for each of the subgroups. Father’s drinking influenced alcohol initiation across black adolescents, as well as within each black subgroup. Consequently, similarly aged adolescents appeared to exert the
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most social impact on the respondents’ drinking. Cigarette smoking was positively linked with the alcohol measures. Marijuana use predicted alcohol initiation and alcohol consumption for the African-American subgroup but not the Caribbean-American subgroup. Deviant behavior predicted alcohol consumption for the entire black sample and Caribbean-Americans supporting problem behavior theory (Jessor, 1991). Examining differences in etiology of drinking is important as the number of immigrant blacks in the United States continues to rise (US Bureau of Census, 1990). For instance, 31% of blacks living in New York State are foreign-born (US Bureau of Census, 1990). Past research and national surveys homogenize the different black subgroups. In the present study, it was possible to examine black subgroup differences in alcohol use. Of course, only the overall sample analysis included the ethnic comparison between the two black subgroups. Caribbean-American adolescents were more likely to have started drinking relative to African-American adolescents congruent with an earlier finding from a study of continuous measures of drinking behavior and prevalence rates (Epstein et al., 1998). Unlike the earlier investigation, the current study found this difference even controlling for a variety of other factors in an etiologic model of alcohol initiation. By examining the predictors for each alcohol measure, some patterns become apparent. The determinants of alcohol initiation were virtually identical whether focusing on the overall sample or either of the two black subgroups. Specifically, the drinking behavior of family members (father and older siblings), as well as friends and peers, increased the probability of alcohol initiation for both groups. One problem behavior, cigarette smoking, was associated with alcohol initiation across and within both black subgroups. Based on the factors tested in this study, it appears the relevant social influences to drink and early cigarette smoking transcended culture in predicting alcohol initiation. The only exception was that initiation of marijuana use had a relationship with alcohol initiation only among African-American adolescents. Since African-Americans were less likely to have started drinking alcohol relative to Caribbean-Americans, it appears that the most precocious African-American youth were trying both substances while Caribbean-American youth who tried alcohol were not necessarily as precocious. As stated earlier, there was consistency for the two ethnic groups (African-American and Caribbean-American) whereby friends’ drinking was associated with alcohol consumption among both. Earlier research identified alcohol-using friends as a critical social influence to drink among white adolescents (Byram & Fly, 1984; Harford, 1985; Kandel, 1986; Kandel & Andrews, 1987; McLaughlin, Baer, Burnside, & Pokorny, 1985) and Hispanic adolescents (Dusenbury et al., 1994; Epstein, Dusenbury, Botvin, & Diaz, 1996). Therefore, the social influence to drink from friends is apparently a common experience shared by all ethnic groups that affects adolescent drinking behavior. In addition to friends’ alcohol use, siblings’ drinking exerted an influence on their brothers’ and sisters’ heavier drinking in both cultures. Similarly, those adolescents who tried cigarette smoking engaged in heavier alcohol consumption whether these adolescents were African-American or Caribbean-American. Yet there were differences in the determinants of alcohol for African-Americans compared to Caribbean-American adolescents. As with alcohol initiation, marijuana use was associated with heavier alcohol consumption only for African-American adolescents. Most likely, these were the more precocious African-American youth. Fathers’ drinking was only related to
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greater alcohol consumption among African-American adolescents. The reason for this might be due to the higher proportion of boys in the African-American group vs. the CaribbeanAmerican group combined with the tendency for adolescents to imitate the drinking behavior of the same-sex parent as has been found in past research (Harburg, Davis, & Caplan, 1982). A greater propensity to engage in deviant behavior (i.e., being in trouble and absenteeism) predicted alcohol consumption only for Caribbean-American students. In Caribbean culture parents value a punitive, restrictive approach to discipline and child rearing such that obedience and docility are valued (Brown, 1984; Payne, 1989). This harsh and punitive parenting style has long been associated with aggressive, defiant, and acting-out behavior among adolescents (Wasserman, Miller, Pinner, & Jaramillo, 1996). As a result, these adolescents can be said to exhibit a more general problem behavior syndrome because deviant behavior was associated with excessive drinking. This study focused on social influences and problem behaviors as predictors of alcohol use for a black sample as well as separately for African-American and Caribbean-American adolescents. Further research needs to test other potential predictors of alcohol use for these two groups. As the data from this study were cross-sectional, future work must address testing variables longitudinally. The findings from this study might not generalize to other black adolescents living in other regions of the country or in non-urban areas. Since this study supports a theoretical framework in which social learning and problem behaviors are implicated in alcohol use among different groups of black adolescents, these findings also advocate for skills-based approaches to alcohol and other drug use prevention shown to be effective among inner-city minority youth (Botvin, 1995). Such skills-based approaches teach social resistance skills within the context of a broader intervention promoting general personal and social competence and target multiple drugs. Consequently, these approaches improve the adolescents’ ability to resist the social influences to drink and the larger problem behavior syndrome by not simply focusing on alcohol prevention. Although skills-based drug prevention approaches target the three gateway drugs, an even broader focus on problem behaviors including other forms of deviance should help prevent alcohol use, as well as other problem behaviors.
Acknowledgments This study was supported by a grant from the Alcoholic Beverage Medical Research Foundation to Dr. Epstein. Funds from the National Institute for Drug Abuse to Dr. Botvin (P50DA7656) also partially supported this research.
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