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 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 versus 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=0.0003 and IRR [95% CI]=1.06 [1.02, 1.10], p=0.002, respectively), and between-person discrimination prevalence was associated with higher drinking frequency (IRR [95% CI]=1.16 [1.05, 1.30], p=0.005) and higher likelihood of binge drinking (AOR [95% CI]=1.90 [1.49, 2.42], p<0.0001). The associations of discrimination prevalence and drinking frequency differed by sex (interaction effect, p=0.02) and race/ethnicity (interaction effect of Whites versus Blacks, p=0.006), 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.