Disentangling contributions of bar attendance, drinking, and other factors to elevated acute alcohol problems on the U.S.-Mexico border

Abstract

Background: Levels of drinking are unusually elevated among young adults on the U.S.-Mexico border, and this elevation can be largely explained by young border residents' unusually high frequency of bar attendance. However, this explanation complicates interpretation of high alcohol problem rates that have also been observed in this group. Because bar environments can lower the threshold for many types of problems, the extent to which elevated alcohol problems among young border residents can be attributed to drinking per se-versus this common drinking context-is not clear.

Methods: Data were collected from multistage cluster samples of adult Mexican Americans on and off the U.S.-Mexico border (current drinker N = 1,351). After developing structural models of acute alcohol problems, estimates were subjected to path decompositions to disentangle the common and distinct contributions of drinking and bar attendance to problem disparities on and off the border. Additionally, models were estimated under varying degrees of adjustment to gauge the sensitivity of the results to sociodemographic, social-cognitive, and environmental sources of confounding.

Results: Consistent with previous findings for both drinking and other problem measures, acute alcohol problems were particularly elevated among young adults on the border. This elevation was entirely explained by a single common pathway involving bar attendance frequency and drinking. Bar attendance did not predict acute alcohol problems independently of drinking, and its effect was not moderated by border proximity or age. The common indirect effect and its component effects (of border youth on bar attendance, of bar attendance on drinking, and of drinking on problems) were surprisingly robust to adjustment for confounding in all parts of the model (e.g., fully adjusted indirect effect: b = 0.11, SE = 0.04, p < 0.01).

Conclusions: Bar attendance and associated increases in drinking play a key, unique role in the high levels of acute alcohol problems among the border's young adult population that cannot be entirely explained by sociodemographic or social-cognitive characteristics of young border residents, by contextual effects of bars on problems, or by broader neighborhood factors. Bar attendance in particular may represent an early modifiable risk factor that can be targeted to reduce alcohol problem disparities in the region.

Keywords: Alcohol Problems; Bars; Mexican Americans; Social Cognitions; U.S.-Mexico Border.

Figure 1

Four pathways that could explain an association between border youth and acute alcohol problems. For simplicity, not all exogenous covariates are shown. If border youth attend bars more often than other groups, higher rates of problems might reflect associated increases in drinking (an indirect pathway involving parameters P1, P2, and P3), and/or effects of bar attendance on problems that cannot be attributed to drinking (an indirect pathway involving parameters P1 and P5). Border youth may also exhibit drinking-related increases in problems even after adjusting for differences in rates of bar attendance (an indirect pathway involving parameters P4 and P3). Finally, border youth may report higher levels of acute problems independently of both bar attendance and drinking (a direct effect captured by parameter P6).

Figure 2

Unadjusted and adjusted differences in mean acute problem severity by location and age. Error bars show standard errors. Unadjusted estimates (a) were derived from the simple regression of acute alcohol problem severity on location, age, and their interaction. Means in the middle graph (b) were derived from models that additionally adjusted for the effect of bar attendance on acute alcohol problem severity. The final graph (c) shows means implied by the baseline mediation model, which adjusted for effects of both bar attendance and drinking on acute alcohol problem severity. In the unadjusted model, border young adults reported significantly higher acute alcohol problem severity than older border residents (b = .41, SE=.18, p<.05); other comparisons were nonsignificant. Acute alcohol problems is a latent variable scaled in a standard deviation metric, where the reference group (non-border residents aged 30+) intercept/mean is defined as zero.