This article was downloaded by: [TOBB Ekonomi Ve Teknoloji] On: 23 December 2014, At: 20:17 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Ethnicity in Substance Abuse Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wesa20
Drinking Severity and Its Association With Nutrition Risk Among African American Women a
b
Dionna O. Roberts , Katelin B. Nickel , Mildred Mattfeldt-Beman d
c
, Noelle Fearn , Lori Jones & Linda B. Cottler
c
e
a
Vanderbilt University Medical Center , Nashville , Tennessee
b
Washington University School of Medicine , St. Louis , Missouri
c
Saint Louis University Doisy College of Health Sciences , St. Louis , Missouri d
Click for updates
Saint Louis University , St. Louis , Missouri
e
University of Florida , Gainesville , Florida Published online: 22 May 2014.
To cite this article: Dionna O. Roberts , Katelin B. Nickel , Mildred Mattfeldt-Beman , Noelle Fearn , Lori Jones & Linda B. Cottler (2014) Drinking Severity and Its Association With Nutrition Risk Among African American Women, Journal of Ethnicity in Substance Abuse, 13:2, 93-103, DOI: 10.1080/15332640.2013.847395 To link to this article: http://dx.doi.org/10.1080/15332640.2013.847395
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Ethnicity in Substance Abuse, 13:93–103, 2014 Copyright # Taylor & Francis Group, LLC ISSN: 1533-2640 print=1533-2659 online DOI: 10.1080/15332640.2013.847395
Drinking Severity and Its Association With Nutrition Risk Among African American Women Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
DIONNA O. ROBERTS Vanderbilt University Medical Center, Nashville, Tennessee
KATELIN B. NICKEL Washington University School of Medicine, St. Louis, Missouri
MILDRED MATTFELDT-BEMAN Saint Louis University Doisy College of Health Sciences, St. Louis, Missouri
NOELLE FEARN Saint Louis University, St. Louis, Missouri
LORI JONES Saint Louis University Doisy College of Health Sciences, St. Louis, Missouri
LINDA B. COTTLER University of Florida, Gainesville, Florida
This analysis examined the association between drinking severity, food insecurity, and drinking related health comorbidities among 258 African American women who drank heavily from the ‘‘Sister to Sister’’ study. Women were stratified by drinking status: 23% were heavy drinkers (women who drank 30 to 52 weeks in the 12 months prior to study participation and consumed the equivalent of at least 20 alcoholic beverages at one sitting) and 77% were less heavy drinkers (women with all other combinations of drinking habits who drank less than 30 weeks in the 12 months prior to study participation). Heavy drinkers were more likely to not check
This work was supported by NIAA, AA 12111, PI Linda B. Cottler, PhD, MPH Address correspondence to Linda B. Cottler, PhD, MPH, Associate Dean for Research and Planning, College of Public Health and Health Professions, Dean’s Professor and Chair Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, Florida, 32611. E-mail: [email protected] 93
94
D. O. Roberts et al.
nutrition labels, skip meals to buy drugs=alcohol, and report a history of stomach disease, diabetes, memory, weight, and kidney problems compared with less heavy drinkers. The heavy drinkers were at increased nutrition risk due to food insecurities and were more susceptible to drinking related health comorbidities compared with less heavy drinkers.
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
KEYWORDS African nutrition risk
American
women,
drinking
severity,
INTRODUCTION Heavy drinking directly increases nutrition risk through metabolic processes related to alcohol metabolism. It also increases nutrition risk by displacing nutrients with an energy dense (7 kcal=gm), low nutrient quality source (Nelms, Sucher, & Long, 2007), which can contribute to the undernourishment of heavy drinkers (Breslow, Guenther, & Smothers, 2006; Santolaria et al., 2000). Many studies have looked at the impact of heavy drinking on nutrition risk, but most of these studies were done among Caucasians (Breslow, et al., 2006; Chen et al., 2009; Gramenzi et al., 2006; Liangpunsakul, Qi, Crabb, & Witzmann, 2010; Okosun, Seale, Daniel, & Eriksen, 2005; Santolaria et al., 2000). It is possible that nutrition outcomes related to heavy drinking may differ for other populations, specifically African American women, who are heavy drinkers. Food insecurity is defined as a lack of access at all times to enough food (Chilton & Booth, 2007; Nord & Kantor, 2006), the limited availability of safe and nutritionally adequate foods (Karnik et al., 2011), or the inability to acquire enough food for all members of the household due to insufficient money or other resources for food (Freedman & Bell, 2009; Nord & Kantor, 2006). Households that are food insecure are at an increased risk for decreased nutrition status and poor health outcomes (Nord & Kantor, 2006). Food insecurity is also linked to income (Nord & Kantor, 2006), and among the poor in the United States, food insecurity disproportionately affects households with an income below the federal poverty line, households with children that are headed by single women, and minorities (Chilton & Booth, 2007; Freedman & Bell, 2009; Tarasuk, 2001). Food insecurity is higher in African American households; in fact, 22.4% to 26.4% are food insecure (Champagne et al., 2007; Chilton & Booth, 2007; Feinberg, Kavanagh, Young, & Prudent, 2008) compared with 8.2% of Caucasian households (Chilton & Booth, 2007). Contributors to food insecurity include not having enough food to eat and skipping meals (Cha´vez, Telleen, & Kim, 2007; Nelson, Brown, & Lurie, 1998). Women who experience household food insecurity report lower energy intake, which can be associated with
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
Drinking Severity & Nutrition Risk in Women
95
economic and behavioral influences (Tarasuk, 2001), such as heavy alcohol consumption. Low-income African American populations tend to have poor diet quality (Auslander, Haire-Joshu, Houston, Rhee, & Williams, 2002). Reading the nutrition facts label is associated with improved dietary factors (Ollberding, Wolf, & Contento, 2010); however, few studies have been conducted on nutrition label use among African Americans. Satia, Galanko, and Neuhouser (2005) conducted a study examining nutrition label use among African Americans living in North Carolina. This study found that 25.3% of African Americans usually read nutrition labels. The study participants who were most likely to read nutrition labels were older women with post high school education (Satia et al., 2005). To our knowledge, no nutrition label studies have been conducted on low-income African American women who are heavy drinkers. African American women have a higher disease burden and poorer health outcomes when compared with other groups in the United States (Champagne et al., 2007; Chilton & Booth, 2007). Specifically, African American women are at an increased risk of developing chronic diseases and have a higher rate of morbidity and mortality (Auslander et al., 2002) due to lack of access to care, under-treatment, and low health knowledge (Movahed, John, Hashemzadeh, & Jamal, 2009). Little is known about the impact of heavy drinking in relation to drinking related health comorbidities and nutrition risk among African American women of low socioeconomic status (SES). The purpose of this analysis was to examine nutrition risk in the form of food insecurity by drinking severity in an underserved sample of African American women participating in a human immunodeficiency virus (HIV) prevention intervention.
METHODS Data were collected from the Sister to Sister (STS) study, which was funded by the National Institute on Alcohol Abuse and Alcoholism, and were approved by the Institutional Review Board at Washington University School of Medicine in St. Louis, Missouri. Assessments were made to evaluate the impact of peer-delivered, alcohol-related, HIV prevention interventions for high-risk female heavy drinkers 18 to 64 years of age who were sexually active in the 12 months prior to study enrollment and who met a threshold for heavy drinking as determined by the Alcohol Use Disorders Identification Test (AUDIT) screening criteria (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001). The AUDIT, developed by the World Health Organization, screens for excessive drinking and correlates with alcohol dependence across gender, age, and cultures (Babor et al., 2001). Women with an AUDIT score of four or higher were eligible to participate in the STS study. Women who tested positive for heroin or cocaine and women who lived more than 50 miles outside of
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
96
D. O. Roberts et al.
the Metropolitan St. Louis area for six months were excluded. After completion of the initial interview session, all candidates received HIV testing; if they tested positive for HIV they were excluded because the purpose of the STS study was to evaluate participants who became seropositive in the 12-month period after baseline. Community health workers reached 5,551 women in parks, grocery stores and bus stops and by other outreach methods. Of these women, 2,420 were initially screen-positive for the STS study; however, after excluding 2,072 women for the following reasons: low AUDIT scores, drug positive urine, inability to be located for follow-up, rejection of recruitment efforts, positive HIV tests, receiving treatment, and relocation; 348 women met study criteria and completed the interview. Of those women, 258 classified themselves as black or African American and are the focus of the current analysis. In this analysis, food insecurity was operationalized by reporting a positive response to the following: (a) not having enough food to eat over a 30-day period, (b) not reading nutrition labels while at the store in the 30 days prior to study participation, and (c) skipping meals in the 30 days prior to study participation for various reasons. The following eight reasons for skipping meals were examined: having no money, being on a diet, skipping meals so someone else could eat, spending food money on alcohol or drugs, spending food money on cigarettes, having no transportation to get food, having the utilities shut off, or not having a working stove or microwave to cook food. Drinking severity was based on drinking habits in the 12 months prior to study participation, including drinking frequency and extreme consumption of alcohol. These habits were captured by reports of how many weeks in the past year the participant drank and whether she had at least one instance of consuming the equivalent of no less than 20 alcoholic beverages in one sitting in the past year. Using a combination of these two variables, two groups of drinkers were established; a heavy drinker was a woman who drank 30 to 52 weeks in the 12 months prior to study participation and consumed the equivalent of at least 20 alcoholic beverages at one sitting (n ¼ 60). Women with all other combinations of drinking habits were classified as less heavy drinkers (n ¼ 198). This analysis also included information on participant history of physical health problems related to drinking, including liver disease, stomach disease, and memory problems. Additional health comorbidities that have been found to be associated with high-risk drinking included being told by a health professional they had high blood pressure, kidney problems, diabetes, or a weight problem.
Statistical Methods Data were analyzed using PASW Statistics version 18 and SAS version 9.2 software (Cary, NC). Chi-square tests were used to examine the association
Drinking Severity & Nutrition Risk in Women
97
between drinking severity among African American women and food insecurity and drinking related health comorbidities. Fisher exact test was used when 25% of cells had an expected count that was less than 5. P values less than 0.05 were considered to be statistically significant. Logistic regression was used to examine the association between drinking severity and measures that were significant in bivariate analyses. Women with missing data for one or more of the statistically significant variables were excluded from the logistic regression model.
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
RESULTS Descriptive Results Among the population of African American women who met the AUDIT threshold, 23% were classified as heavy drinkers and 77% were classified as less heavy drinkers. Sixty-nine percent of women were between ages 18 to 39; 59% reported having less than a high school education and most (91%) were unemployed. Seventy percent of women had never married, but 58% lived in a household with three or more children. In terms of government assistance, 76% reported receiving food stamps, 35% had children in their household who received free or reduced school meals, 24% lived in a household with someone who received Women, Infants and Children (WIC) services, 17% received energy assistance, and 14% were currently living in public or subsidized housing. Eighty-two percent of women had taken their first drink prior to age 19. None of these factors differentiated women by drinking severity.
The Relationship Between Drinking Severity, Food Insecurity, and Health Comorbidities As shown in Table 1, compared with less heavy drinkers, heavy drinkers were more likely to forego checking the nutrition labels of food at the store and to skip meals to buy alcohol or drugs. Specifically, 88% of heavy drinkers did not check the nutrition label compared with 69% of less heavy drinkers (p ¼ .004); 17% of heavy drinkers versus 2% of less heavy drinkers reported skipping meals to buy alcohol or drugs (p < .001). Further, regarding underlying drinking related health comorbidities, drinking severity was significantly associated with memory problems (p < .001), stomach disease (p ¼ .004), and other health comorbidities, including weight problems (p ¼ .008), kidney problems (p ¼ .005), and diabetes (p ¼ .03). The variables significant in bivariate analyses were added to a logistic regression model (Table 1). After controlling for these variables, only two were significantly related to heavy drinking among African American women. Specifically, women who were heavy drinkers were three times (odds ratio [OR] ¼ 2.96; 95% confidence interval [CI] ¼ 1.21, 7.24) as likely than women who were less heavy drinkers to report not checking nutrition labels at
98
D. O. Roberts et al.
TABLE 1 The Relationship Between Drinker Severity, Food Insecurity, and Health Comorbidities in Bivariate Analysis and Adjusted Binary Logistic Regression Modeling (N ¼ 258)
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
Variable Food insecurity Did not checked nutrition label at the store Did not have enough food to eat in past 30 days Reasons skipped meals in past 30 days: Did not have enough money or food stamps to buy food On a diet So another family member could eat Spent money on alcohol or drugs Spent money on cigarettes Didn’t have transportation to the store Utilities were shut off Stove=microwave not working Drinking-related health comorbidities Memory problems Stomach disease Liver disease Other health comorbidities High blood pressure Weight problem Kidney problem Diabetes
Less heavy Heavy Chidrinker drinker Total (N ¼ 258), (n ¼ 60), (n ¼ 198), squared p-value % % %
OR (95% CI)a (N ¼ 250)
73
88
69
.004a
29
25
30
.50
14
17
13
.52b
12 9
10 8
13 10
.60 .79
5
17
2
Journal of Ethnicity in Substance Abuse Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wesa20
Drinking Severity and Its Association With Nutrition Risk Among African American Women a
b
Dionna O. Roberts , Katelin B. Nickel , Mildred Mattfeldt-Beman d
c
, Noelle Fearn , Lori Jones & Linda B. Cottler
c
e
a
Vanderbilt University Medical Center , Nashville , Tennessee
b
Washington University School of Medicine , St. Louis , Missouri
c
Saint Louis University Doisy College of Health Sciences , St. Louis , Missouri d
Click for updates
Saint Louis University , St. Louis , Missouri
e
University of Florida , Gainesville , Florida Published online: 22 May 2014.
To cite this article: Dionna O. Roberts , Katelin B. Nickel , Mildred Mattfeldt-Beman , Noelle Fearn , Lori Jones & Linda B. Cottler (2014) Drinking Severity and Its Association With Nutrition Risk Among African American Women, Journal of Ethnicity in Substance Abuse, 13:2, 93-103, DOI: 10.1080/15332640.2013.847395 To link to this article: http://dx.doi.org/10.1080/15332640.2013.847395
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Ethnicity in Substance Abuse, 13:93–103, 2014 Copyright # Taylor & Francis Group, LLC ISSN: 1533-2640 print=1533-2659 online DOI: 10.1080/15332640.2013.847395
Drinking Severity and Its Association With Nutrition Risk Among African American Women Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
DIONNA O. ROBERTS Vanderbilt University Medical Center, Nashville, Tennessee
KATELIN B. NICKEL Washington University School of Medicine, St. Louis, Missouri
MILDRED MATTFELDT-BEMAN Saint Louis University Doisy College of Health Sciences, St. Louis, Missouri
NOELLE FEARN Saint Louis University, St. Louis, Missouri
LORI JONES Saint Louis University Doisy College of Health Sciences, St. Louis, Missouri
LINDA B. COTTLER University of Florida, Gainesville, Florida
This analysis examined the association between drinking severity, food insecurity, and drinking related health comorbidities among 258 African American women who drank heavily from the ‘‘Sister to Sister’’ study. Women were stratified by drinking status: 23% were heavy drinkers (women who drank 30 to 52 weeks in the 12 months prior to study participation and consumed the equivalent of at least 20 alcoholic beverages at one sitting) and 77% were less heavy drinkers (women with all other combinations of drinking habits who drank less than 30 weeks in the 12 months prior to study participation). Heavy drinkers were more likely to not check
This work was supported by NIAA, AA 12111, PI Linda B. Cottler, PhD, MPH Address correspondence to Linda B. Cottler, PhD, MPH, Associate Dean for Research and Planning, College of Public Health and Health Professions, Dean’s Professor and Chair Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, Florida, 32611. E-mail: [email protected] 93
94
D. O. Roberts et al.
nutrition labels, skip meals to buy drugs=alcohol, and report a history of stomach disease, diabetes, memory, weight, and kidney problems compared with less heavy drinkers. The heavy drinkers were at increased nutrition risk due to food insecurities and were more susceptible to drinking related health comorbidities compared with less heavy drinkers.
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
KEYWORDS African nutrition risk
American
women,
drinking
severity,
INTRODUCTION Heavy drinking directly increases nutrition risk through metabolic processes related to alcohol metabolism. It also increases nutrition risk by displacing nutrients with an energy dense (7 kcal=gm), low nutrient quality source (Nelms, Sucher, & Long, 2007), which can contribute to the undernourishment of heavy drinkers (Breslow, Guenther, & Smothers, 2006; Santolaria et al., 2000). Many studies have looked at the impact of heavy drinking on nutrition risk, but most of these studies were done among Caucasians (Breslow, et al., 2006; Chen et al., 2009; Gramenzi et al., 2006; Liangpunsakul, Qi, Crabb, & Witzmann, 2010; Okosun, Seale, Daniel, & Eriksen, 2005; Santolaria et al., 2000). It is possible that nutrition outcomes related to heavy drinking may differ for other populations, specifically African American women, who are heavy drinkers. Food insecurity is defined as a lack of access at all times to enough food (Chilton & Booth, 2007; Nord & Kantor, 2006), the limited availability of safe and nutritionally adequate foods (Karnik et al., 2011), or the inability to acquire enough food for all members of the household due to insufficient money or other resources for food (Freedman & Bell, 2009; Nord & Kantor, 2006). Households that are food insecure are at an increased risk for decreased nutrition status and poor health outcomes (Nord & Kantor, 2006). Food insecurity is also linked to income (Nord & Kantor, 2006), and among the poor in the United States, food insecurity disproportionately affects households with an income below the federal poverty line, households with children that are headed by single women, and minorities (Chilton & Booth, 2007; Freedman & Bell, 2009; Tarasuk, 2001). Food insecurity is higher in African American households; in fact, 22.4% to 26.4% are food insecure (Champagne et al., 2007; Chilton & Booth, 2007; Feinberg, Kavanagh, Young, & Prudent, 2008) compared with 8.2% of Caucasian households (Chilton & Booth, 2007). Contributors to food insecurity include not having enough food to eat and skipping meals (Cha´vez, Telleen, & Kim, 2007; Nelson, Brown, & Lurie, 1998). Women who experience household food insecurity report lower energy intake, which can be associated with
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
Drinking Severity & Nutrition Risk in Women
95
economic and behavioral influences (Tarasuk, 2001), such as heavy alcohol consumption. Low-income African American populations tend to have poor diet quality (Auslander, Haire-Joshu, Houston, Rhee, & Williams, 2002). Reading the nutrition facts label is associated with improved dietary factors (Ollberding, Wolf, & Contento, 2010); however, few studies have been conducted on nutrition label use among African Americans. Satia, Galanko, and Neuhouser (2005) conducted a study examining nutrition label use among African Americans living in North Carolina. This study found that 25.3% of African Americans usually read nutrition labels. The study participants who were most likely to read nutrition labels were older women with post high school education (Satia et al., 2005). To our knowledge, no nutrition label studies have been conducted on low-income African American women who are heavy drinkers. African American women have a higher disease burden and poorer health outcomes when compared with other groups in the United States (Champagne et al., 2007; Chilton & Booth, 2007). Specifically, African American women are at an increased risk of developing chronic diseases and have a higher rate of morbidity and mortality (Auslander et al., 2002) due to lack of access to care, under-treatment, and low health knowledge (Movahed, John, Hashemzadeh, & Jamal, 2009). Little is known about the impact of heavy drinking in relation to drinking related health comorbidities and nutrition risk among African American women of low socioeconomic status (SES). The purpose of this analysis was to examine nutrition risk in the form of food insecurity by drinking severity in an underserved sample of African American women participating in a human immunodeficiency virus (HIV) prevention intervention.
METHODS Data were collected from the Sister to Sister (STS) study, which was funded by the National Institute on Alcohol Abuse and Alcoholism, and were approved by the Institutional Review Board at Washington University School of Medicine in St. Louis, Missouri. Assessments were made to evaluate the impact of peer-delivered, alcohol-related, HIV prevention interventions for high-risk female heavy drinkers 18 to 64 years of age who were sexually active in the 12 months prior to study enrollment and who met a threshold for heavy drinking as determined by the Alcohol Use Disorders Identification Test (AUDIT) screening criteria (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001). The AUDIT, developed by the World Health Organization, screens for excessive drinking and correlates with alcohol dependence across gender, age, and cultures (Babor et al., 2001). Women with an AUDIT score of four or higher were eligible to participate in the STS study. Women who tested positive for heroin or cocaine and women who lived more than 50 miles outside of
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
96
D. O. Roberts et al.
the Metropolitan St. Louis area for six months were excluded. After completion of the initial interview session, all candidates received HIV testing; if they tested positive for HIV they were excluded because the purpose of the STS study was to evaluate participants who became seropositive in the 12-month period after baseline. Community health workers reached 5,551 women in parks, grocery stores and bus stops and by other outreach methods. Of these women, 2,420 were initially screen-positive for the STS study; however, after excluding 2,072 women for the following reasons: low AUDIT scores, drug positive urine, inability to be located for follow-up, rejection of recruitment efforts, positive HIV tests, receiving treatment, and relocation; 348 women met study criteria and completed the interview. Of those women, 258 classified themselves as black or African American and are the focus of the current analysis. In this analysis, food insecurity was operationalized by reporting a positive response to the following: (a) not having enough food to eat over a 30-day period, (b) not reading nutrition labels while at the store in the 30 days prior to study participation, and (c) skipping meals in the 30 days prior to study participation for various reasons. The following eight reasons for skipping meals were examined: having no money, being on a diet, skipping meals so someone else could eat, spending food money on alcohol or drugs, spending food money on cigarettes, having no transportation to get food, having the utilities shut off, or not having a working stove or microwave to cook food. Drinking severity was based on drinking habits in the 12 months prior to study participation, including drinking frequency and extreme consumption of alcohol. These habits were captured by reports of how many weeks in the past year the participant drank and whether she had at least one instance of consuming the equivalent of no less than 20 alcoholic beverages in one sitting in the past year. Using a combination of these two variables, two groups of drinkers were established; a heavy drinker was a woman who drank 30 to 52 weeks in the 12 months prior to study participation and consumed the equivalent of at least 20 alcoholic beverages at one sitting (n ¼ 60). Women with all other combinations of drinking habits were classified as less heavy drinkers (n ¼ 198). This analysis also included information on participant history of physical health problems related to drinking, including liver disease, stomach disease, and memory problems. Additional health comorbidities that have been found to be associated with high-risk drinking included being told by a health professional they had high blood pressure, kidney problems, diabetes, or a weight problem.
Statistical Methods Data were analyzed using PASW Statistics version 18 and SAS version 9.2 software (Cary, NC). Chi-square tests were used to examine the association
Drinking Severity & Nutrition Risk in Women
97
between drinking severity among African American women and food insecurity and drinking related health comorbidities. Fisher exact test was used when 25% of cells had an expected count that was less than 5. P values less than 0.05 were considered to be statistically significant. Logistic regression was used to examine the association between drinking severity and measures that were significant in bivariate analyses. Women with missing data for one or more of the statistically significant variables were excluded from the logistic regression model.
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
RESULTS Descriptive Results Among the population of African American women who met the AUDIT threshold, 23% were classified as heavy drinkers and 77% were classified as less heavy drinkers. Sixty-nine percent of women were between ages 18 to 39; 59% reported having less than a high school education and most (91%) were unemployed. Seventy percent of women had never married, but 58% lived in a household with three or more children. In terms of government assistance, 76% reported receiving food stamps, 35% had children in their household who received free or reduced school meals, 24% lived in a household with someone who received Women, Infants and Children (WIC) services, 17% received energy assistance, and 14% were currently living in public or subsidized housing. Eighty-two percent of women had taken their first drink prior to age 19. None of these factors differentiated women by drinking severity.
The Relationship Between Drinking Severity, Food Insecurity, and Health Comorbidities As shown in Table 1, compared with less heavy drinkers, heavy drinkers were more likely to forego checking the nutrition labels of food at the store and to skip meals to buy alcohol or drugs. Specifically, 88% of heavy drinkers did not check the nutrition label compared with 69% of less heavy drinkers (p ¼ .004); 17% of heavy drinkers versus 2% of less heavy drinkers reported skipping meals to buy alcohol or drugs (p < .001). Further, regarding underlying drinking related health comorbidities, drinking severity was significantly associated with memory problems (p < .001), stomach disease (p ¼ .004), and other health comorbidities, including weight problems (p ¼ .008), kidney problems (p ¼ .005), and diabetes (p ¼ .03). The variables significant in bivariate analyses were added to a logistic regression model (Table 1). After controlling for these variables, only two were significantly related to heavy drinking among African American women. Specifically, women who were heavy drinkers were three times (odds ratio [OR] ¼ 2.96; 95% confidence interval [CI] ¼ 1.21, 7.24) as likely than women who were less heavy drinkers to report not checking nutrition labels at
98
D. O. Roberts et al.
TABLE 1 The Relationship Between Drinker Severity, Food Insecurity, and Health Comorbidities in Bivariate Analysis and Adjusted Binary Logistic Regression Modeling (N ¼ 258)
Downloaded by [TOBB Ekonomi Ve Teknoloji] at 20:17 23 December 2014
Variable Food insecurity Did not checked nutrition label at the store Did not have enough food to eat in past 30 days Reasons skipped meals in past 30 days: Did not have enough money or food stamps to buy food On a diet So another family member could eat Spent money on alcohol or drugs Spent money on cigarettes Didn’t have transportation to the store Utilities were shut off Stove=microwave not working Drinking-related health comorbidities Memory problems Stomach disease Liver disease Other health comorbidities High blood pressure Weight problem Kidney problem Diabetes
Less heavy Heavy Chidrinker drinker Total (N ¼ 258), (n ¼ 60), (n ¼ 198), squared p-value % % %
OR (95% CI)a (N ¼ 250)
73
88
69
.004a
29
25
30
.50
14
17
13
.52b
12 9
10 8
13 10
.60 .79
5
17
2
