Date of Award

1-1-2020

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

School of Social Welfare

Content Description

1 online resource (ix, 118 pages) : illustrations (some color)

Dissertation/Thesis Chair

Carmen Morano

Committee Members

Jiang Yu, Barry Martin Loneck, Tomoko Udo

Keywords

Alcohol Use Disorder, Asian American, Chronic Medical Conditions, Social Inequalities in Health, Asian Americans, Pacific Islander Americans, Discrimination in medical care, Chronic diseases

Subject Categories

Social Work

Abstract

Objectives: To determine latent subgroups of Asian Americans and Pacific Islanders (AAPIs) and examine the associations between the subgroups, alcohol use disorder (AUD), and chronic medical conditions among AAPIs and whether risks for chronic medical conditions differ by a history of lifetime AUD. Method: The National Survey of Alcohol and Related Conditions III (N = 36,309) provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was utilized. Latent Class Analysis was used to examines the heterogeneity within response patterns to items that describe social inequality among AAPIs. Multinomial logistic regression and multiple logistic regressions were performed by adding the class membership into models to examine the link between class membership, the severity of AUD, and each chronic medical condition. Results: Four classes identified; Class 1 labeled SES inequality (38%), Class 2 labeled High ACEs (17%), Class 3 labeled High Discrimination (9%), and Class 4 labeled Low inequality (37%). Results from the analyses of the multinomial logistic regression model identified that the class membership was associated with the severity of lifetime AUD. Specifically, people in Class 2 (with high ACEs) had significantly greater risks for lifetime AUD across all severity levels, compared with people in low inequality. When conducting three logistic regression models, class membership was still associated with a stomach ulcer, arthritis, sleep problems, and osteoporosis after adjusting for health-related covariates. When adjusted for lifetime AUD additionally, Class 1 was associated with arthritis, sleep problems, and osteoporosis, Class 2 was associated with high cholesterol, arthritis, and sleep problems, and Class 3 was associated with nerve problems. When conducting multiple logistic regressions to explore further associations between class membership and chronic medical conditions by lifetime AUD, people in Class 1 with lifetime AUD were showed significantly greater odds of diagnosis for high cholesterol (AOR = 5.29, CI = 1.18–23.58). People in Class 2 reported significantly greater odds of diagnosis for hypertension (AOR = 2.49, CI = 1.03–6.05), and Class 3 without lifetime AUD showed significantly greater odds of nerve problems (AOR = 3.08, CI = 1.04–9.09). Conclusions: This study examined associations between social inequality, AUD, and chronic medical conditions, based on ecosocial theory. Latent class models demonstrate how unequal power is distributed across classes. Social inequality and AUD may be key factors in predicting chronic medical conditions. In closing, this dissertation suggested social work practice and policies to address AUD issues and health outcomes.

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