Electronic Theses and Dissertations

Date

2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Psychology

Committee Chair

James Murphy

Committee Member

Meghan E McDevitt-Murphy

Committee Member

Laura R Marks

Committee Member

Rory A Pfund

Abstract

The alcohol harm paradox (AHP) has been proposed to account for findings that socioeconomically deprived individuals experience disproportionate rates of alcohol-related harm, despite consuming similar or lower amounts of alcohol relative to more advantaged groups. However, the underlying mechanisms responsible are not well understood. Hogarth proposed the existence of three etiological pathways underpinning the AHP. Emerging adults (EAs) ages 21.5 to 25 (N = 466; Mage = 22.6, 57.5% female, 49.4% White, 38.6% Black, 31.1% non-college EAs), who reported consuming 3/4+ alcoholic drinks (for women/men) at least twice in the past month provided information on childhood family poverty, adverse childhood experiences (ACEs), internalizing symptoms, drinking motives, environmental reward, alcohol demand, alcohol-involved and alcohol-free reinforcement, and alcohol problems at baseline, 8, 16, and 24 months. Neighborhood disadvantage data from the American Community Survey and density of on-premise alcohol outlets were linked according to participants’ census tract at baseline. Structural equation modeling was used to validate the proposed conceptual model by simultaneously assessing the three etiological pathways. Results indicated that childhood family poverty was indirectly associated with increases in alcohol-related problems in emerging adulthood via: (1) greater exposure to ACEs, greater levels of internalizing symptoms, increases in drinking to cope motives, and increases in alcohol demand (stress-distress-coping pathway), and via (2) greater neighborhood disadvantage in emerging adulthood, chronic environmental reward deprivation, and increases in relative-reinforcement value (RRV) of alcohol-involved activities (alternative reward pathway). However, results did not support an indirect effect via neighborhood disadvantage, on-premise alcohol outlet density, and increases in alcohol demand (cue exposure/availability pathway) in the current sample. Results highlight the need to address distal, community, neighborhood, and broader policy-level factors that indirectly effect proximal, individual-level determinants that give rise to the AHP.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest.

Notes

Open Access

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