Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race.

Sarah Griffin,Michael A Trujillo,Paul B Perrin,Erin R Smith,Allison B Williams,Bruce Rybarczyk

doi:10.1155/2020/5916318

Sarah Griffin, Michael A Trujillo + Show 4 more

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https://doi.org/10.1155/2020/5916318

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Abstract

Class-based discrimination may impact problematic drinking in low-income populations, which may be buffered by personal religiosity. However, little is known how race may impact this association. The purpose of this study was to examine racial differences in the effect of class-based discrimination on problematic drinking as moderated by comfort with God and determine if there were conditional direct effects of class-based discrimination on problematic drinking by race. In this cross-sectional study, participants (N = 189) were patients of an urban, safety-net primary care clinic who completed questionnaires assessing experiences of class-based discrimination, attitudes toward God, and alcohol use. Data were collected from 2015 to 2016 and analyzed using the Hayes PROCESS macro. There was a significant main effect for class-based discrimination predicting problematic drinking. Two-way interaction analyses identified a significant comfort with God by race interaction with greater comfort with God associated with less problematic drinking among white but not black respondents. Conditional direct effects showed that experiences of class-based discrimination were associated with problematic drinking at low and moderate but not high levels of comfort with God in black participants, whereas none were observed for white participants. This study provides insight on how personal religiosity, class-based discrimination, and race may intertwine to shape problematic alcohol use in primarily low-income, urban patients. Clinicians' awareness of risk and protective factors, as well as how race tempers the effects of such factors, is vital in providing better care for this population.

Highlights

Socioeconomic status (SES) has long been known to be a principal determinant of health across a range of outcomes
Individualistic attributions for poverty are especially prominent [11, 12], suggesting that individuals living in poverty may be more deserving of their social position and more susceptible to individual acts of discrimination based on their SES
A moderated moderation analysis examined the effect of class-based discrimination on problematic drinking, as moderated by comfort with God and race in a sample of patients from an urban, safety-net primary care clinic

Summary

Introduction

Socioeconomic status (SES) has long been known to be a principal determinant of health across a range of outcomes. Individuals with the lowest income and least education, two commonly used indicators of SES, were consistently the least healthy across numerous outcomes, including having more limited activity because of a chronic disease, coronary heart disease, diabetes, obesity, having a lower life expectancy at age 25 [1], and increased alcohol abuse, according to several national data sets [2]. Researchers have posited that low SES may contribute to overall health outcomes through the social environment, including experiences of classism or racism, as well as through coping health behaviors such as substance use [8, 9]. As a system of oppression, classism aims to keep individuals of low SES powerless, while the wealthy remain powerful [10], which can manifest through overt forms of discrimination. Preliminary work has found that the lowest-income individuals are the most

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