Hitting Close to Home: A Mixed-Methods Examination of Multilevel Socioecological Influences on Alcohol Outcomes Among Black Adults

Abstract

Background: Despite lower levels of alcohol use, Black people bear a disproportionately greater burden of alcohol-related health problems when compared to other racial/ethnic groups, representing a significant public health concern. Although existing research has made progress in understanding broad contributors to health inequities, existing models of substance use fail to adequately explain disparities in alcohol-related consequences experienced by Black adults. Guided by the socioecological model, this dissertation examines individual, interpersonal, community, and macrosystem factors contributing to alcohol-related health disparities among Black adults, and the role of drinking motives in these associations. Method: An exploratory sequential mixed-method design was used across two phases. In Phase I, qualitative interviews were conducted with Black adults (N = 20) to explore perceptions of neighborhood environments and drinking experiences. Thematic analysis identified individual, interpersonal, community, and macrosystem risk and protective factors for alcohol use and consequences. In Phase II, Black adults (N = 123) across 13 metropolitan cities completed surveys assessing alcohol outcomes and self-reported neighborhood and macrolevel measures. Participant addresses were geocoded to obtain spatial measures of neighborhood characteristics. Stepwise mediation models, including linear and negative binomial regression, examined associations between community- and macro-level and alcohol outcomes, and the mediating role of drinking motives. Results: Qualitative findings identified individual (life transitions, personal stress), interpersonal (family drinking history, peer influences, community stressors), community (build environment, structural conditions, alcohol availability), and macrosystem factors (discrimination, alcohol policies, media representation, stereotypes and cultural narratives) as salient influences on drinking experiences. Quantitative findings revealed significant associations between neighborhood factors and alcohol use and consequences, with drinking motives mediating some of these relationships. Implications: Findings highlight the importance of socioecological approaches in informing culturally tailored public health interventions and policies aimed at reducing alcohol-related disparities in Black communities.