Prospective Associations of Exposure to Discrimination and Alcohol Use: A National Longitudinal Study.

Introduction: This study examined prospective associations of perceived discrimination experience and past-week alcohol use among U.S. adults.

Methods: This longitudinal study analyzed 22 biweekly surveys from the Understanding America Study (UAS) during June 2020-July 2021, a nationally representative U.S. adult panel. Multivariable regressions were conducted to examine prospective associations of perceived discrimination experiences (any vs. none) or mean levels of discrimination (never[0] to almost every day [4]) and past-week alcohol use frequency [days: 0-7]) or binge drinking (yes/no) 2 weeks later, after disaggregating within-person and between-person effects of discrimination regressor and adjusting for covariates. Analyses were conducted in 2024.

Results: Among 8,026 participants, 18.9% reported perceived discrimination experiences. The mean of past-week alcohol drinking was 1.27 days and 9.3% reported past-week binge drinking. Within-person discrimination prevalence and levels of discrimination were associated with higher drinking frequency (IRR[95% CI]=1.05[1.02-1.08], p=.0003 and IRR[95% CI]=1.06[1.02-1.10], p=.002, respectively), and between-person discrimination prevalence was associated with higher drinking frequency (IRR[95% CI]=1.16[1.05-1.30], p=.005) and higher likelihood of binge drinking (AOR[95% CI]=1.90[1.49-2.42], p<.0001). The associations of discrimination prevalence and drinking frequency differed by sex (interaction effect, p-value=.02) and race/ethnicity (interaction effect of Whites vs. Blacks, p-value=.006), with significantly higher numbers of past-week drinking among females (AOR[95% CI]=1.10[1.05-1.15] and Black adults (AOR[95% CI]=1.17[1.07-1.28]), but not among males and Hispanic/other race adults.

Conclusions: Discrimination experiences were prospectively associated with an increased risk of alcohol-drinking outcomes, and the effect was more pronounced among certain demographic groups. Efforts to mitigate the adverse effects of recurrent exposure to discrimination are critical to advance health equity.