Abstract
Alcohol dependence is prevalent among Mexican Americans, as 15% of men meet the threshold for dependency. Drinking in a bar increases the odds of binge drinking; however, research is not clear regarding whether drinking companions within the bar setting further increases risk. Therefore, we examine whether drinking place (bars) and companion (friends) have direct or synergistic effects on binge drinking. Data included two samples of Mexican American drinkers, one group who resides along the U.S.-Mexico border (N = 691) and a similar group living in large cities that are not proximal to the border (N = 660). Among border residents, drinking with friends was significantly associated with binge drinking on the maximum drinking occasion. Drinking at bars was associated with increased drinking among non-border residents only. These findings suggest that drinking context and choosing friends as drinking companions are related to one’s propensity to binge drink on a single heavy drinking occasion, and these risk factors differ across context.
Hispanics are currently the largest ethnic minority group in the United States (U.S. Census Bureau, 2012), and Mexican Americans comprise the greatest proportion of Hispanics living in the United States (63%; Ennis, Rios-Vargas, & Albert, 2011). The prevalence of alcohol dependence is relatively high among Mexican Americans, with prevalence rates around 10%, with 15% of Mexican American men (2% of women) meeting the criteria for alcohol dependence (Caetano, Ramisetty-Mikler, & Rodriguez, 2008; Grant et al., 2004). Comparatively, 15.3% of Puerto Rican men (6.4% of women), 9.0% of South/Central American men (0.8% of women), and 5.3% of Cuban men (1.6% of women) meet the criteria for alcohol dependence (Caetano et al., 2008). Although Hispanics in general are less likely to drink compared with non-Hispanic Whites, Hispanics tend to drink a larger quantity of alcohol during drinking episodes (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2013). This is problematic in that alcohol is related to several high-risk behaviors, as Mexican Americans are at elevated risk for alcohol-impaired driving citations, alcohol-impaired driving mortality, as well as diabetes, cirrhosis, and liver disease (Chartier & Caetano, 2010; NIAAA, 2013), compared with other Hispanic national groups.
Residence along the U.S.-Mexico border has been identified as a risk factor for alcohol-related risk behavior. Mexican Americans are exposed to the added risk associated with alcohol consumption in Mexico, which has been associated with binge drinking and other alcohol-related problems (Caetano, Mills, & Vaeth, 2013). Overall, Caetano and colleagues attribute a large proportion of the well-documented alcohol-related problems observed among young Mexican Americans to differences in alcohol consumption patterns, rather than the environment (e.g., living on the border; Caetano et al., 2013; Caetano et al., 2008).
Among Mexican Americans, a great deal of this high-riskalcohol consumption takes place in bars (Mills & Caetano, 2012). In this same sample of Mexican Americans, bar attendance has been associated with acute alcohol problems (Mills, Caetano, & Vaeth, 2013). It is clear that drinking in a bar has detrimental effects on drinking behavior (e.g., drinking in bars predicts increased binge drinking; Curran, Harford, & Muthen, 1996), and this effect can occur independently of known social-cognitive antecedents of alcohol consumption (Mills & Caetano, 2012; Mills et al., 2013). However, it is not clear whether or not one’s drinking companions (e.g., friends) have an independent effect or a moderated effect on binge drinking.
Very little research has focused on the event-specific role of the peer group during drinking episodes. Theoretically, there is a reason to believe that a social learning relationship applies to alcohol consumption within bars(Kandel & Andrews, 1987), as friends have a direct influence on teaching someone how to behave in a particular context, such as a bar. However, it also seems that the environmental context that often characterizes drinking in bars can directly affect individual behavior, independently of social cognition (Graham, Bernards, Osgood, & Wells, 2006). Because previous research has not examined the independent and/or synergistic effect of drinking context and drinking companion on binge drinking (independent of alcohol-related cognitions), we aim to examine the direct effects of drinking context and companion in a sample of U.S.-Mexico border and non-border Mexican Americans. The purpose of this study is to examine whether the drinking companion, specifically friends, positively influences the quantity of alcohol use on the maximum drinking occasion in the past year, independent of context and cognitions. We hypothesize that Mexican Americans who drink with their friends (compared with family, sexual partners, colleagues, etc.) are more likely to binge drink during the maximum drinking occasion. Because previous research using these data suggests that alcohol use is more common among the U.S.-Mexico border due to increased availability of drinking outlets, we also expect that bar attendance will emerge as a more robust predictor of binge drinking among Mexican Americans residing near the border compared with those living in non-border cities.
Method
Data Collection
Data included two samples of Mexican American adults, one group who resided along the U.S.-Mexico border, and a group of Mexican Americans who reside in large cities that are not proximal to the border. During March 2009 through July 2010, 1,307 Mexican Americans residing along the border in California (Imperial County, n = 365), Arizona (Cochise, Santa Cruz, and Yuma Counties, n = 173), New Mexico (Dona Ana County, n = 65), and Texas (Cameron, El Paso, Hidalgo and Webb Counties, n = 704) were interviewed. Mexican Americans in the non-border group (N = 1,288) were interviewed as part of the 2006 Hispanic Americans Baseline Alcohol Survey (HABLAS), a study of more than 5,000 Puerto Rican, Mexican American, Cuban American, and South/Central Americans in five metropolitan areas of the United States. Most of the 1,288 non-border respondents were interviewed in Los Angeles (n = 609) and Houston (n = 513); additional interviews were conducted in New York (n = 86), Philadelphia (n = 59), and Miami (n = 21). The present analyses are restricted to respondents who consumed at least one drink of alcohol during the 12 months prior to the interview (N = 1,351).
The sampling methodology and survey instrument used in both studies were virtually identical, allowing us to pool both samples. Both studies involved a multistage clustered random sample of self-reported Mexican Americans of age 18 or older from areas described above. Trained bilingual interviewers obtained formal informed consent and conducted in-person, at-home computer assisted personal interviews that lasted approximately 1 hour. All respondents received a $25 (USD) incentive for participating. The only methodological difference between the two samples was that the border study was stratified by county to include primary sampling units from urban areas only. This ensured that the border and metropolitan non-border groups were comparable.
The survey instrument used in both studies was piloted in English, translated into Spanish, and then translated back into English. Weighted response rates for the border and non-border samples were 67% and 76%, respectively. Both surveys were approved by the Committee for the Protection of Human Subjects at the University of Texas Health Science Center at Houston. The demographic distribution of the sample is provided in Table 1.
Sample Description, Mexican American Adults, N = 1,351.
Note. The drinking companion measures are not mutually exclusive; therefore, the proportions exceed 100%.
p< .05. **p< .01. ***p< .001.
Measures
We elected to use three measures that corresponded to one particular time frame: the maximum drinking occasion. We believe that this restriction allows us to understand how these three influences (companion, place, and binge drinking) are associated during one temporal instance.
Binge drinking during the heaviest drinking occasion
To measure binge drinking on the maximum drinking occasion in the past 12 months, we used the following item: “When you had the most to drink in the last 12 months, how many drinks did you have at that time (in the last 12 months)? (By ‘drink,’ we mean one can or bottle of beer, one bottle of wine cooler, one four-ounce glass of wine or a drink with a shot of hard liquor.)” This number was dichotomized using the 5/4 guidelines according to self-identified sex (males who reported drinking five or more alcoholic beverages in one sitting, and females who reported four or more, were coded as “binge drinkers”), providing an indicator of whether the respondent binge drank on that occasion (NIAAA, 2004). This item was dichotomized due to the skewed distribution of the “maximum number of drinks” in these data.
Bar attendance during the maximum drinking occasion
Bar attendance was measured using the item, “Think about the occasion in the last 12 months that you had the most to drink. Where were you when you had the most to drink (in the last 12 months)?” Those who responded, “bar/tavern/club” were coded as “1,” and all other locations (at home, at a friend’s house, a party or wedding, relative’s home, or “other location”) were included as the reference category. This was dichotomized because bar attendance has been linked to high-riskalcohol consumption in previous studies using these data (Mills et al., 2012; Mills et al., 2013).
Drinking companion during the maximum drinking occasion
Drinking companion was measured using the item, “Who were you drinking with (while drinking on the occasion when you had the most to drink?” Response options included, “alone,” “with friends,” “with a sexual partner,” “with strangers,” “with a family member,” “with a date,” “with co-workers,” and “someone else.” If the respondent reported drinking with friends (regardless of any other selections), they were coded as “1.” If they did not report drinking with friends, they were coded as “0.” Each partner was dummy coded and analyses were conducted separately, as the response options for this item are not mutually exclusive.
Attitudes toward drinking
Respondents provided dichotomous disagree/agree responses to eight positive attitudinal items (e.g., “Having a drink is one of the pleasures of life,” and “It does some people good to get drunk once in a while”) and four negative attitudinal items (e.g., “There is nothing good to be said about drinking” and “Drinking alcohol often brings out the worst in people”; Caetano, 1988; Caetano & Clark, 1999). Negative items were reverse scored and all items were averaged (Cronbach’s α = .72). Higher scores on the final measure reflect more favorable attitudes toward alcohol. These items were included because previous research using this data set indicates that alcohol-related cognitions are strong predictors of bar attendance and heavy drinking (Mills et al., 2013).
Demographic covariates
Demographic covariates were all self-reported, including age, employment status (full time, part-time, temporary illness/unemployed, retired, disabled, or other), marital status, education (less than high school, high school diploma, some college, or greater), income (in thousands), and nativity (immigrant or U.S. born).
Analytical Plan
The logistic regression analyses were conducted using survey methods and sampling weights in accordance with the stratified sampling design. A series of main effects models were tested, evaluating the effects of companion (friend, family, date or sexual partner, co-worker, or no partner) and drinking at a bar or nightclub as risk factors for binge drinking on the maximum drinking occasion. The effect of each companion was evaluated in a separate model, as the companion response options were not mutually exclusive (e.g., a respondent could report drinking with both friends and colleagues during the occasion of interest). To examine the interaction between drinking with a friend at a bar as a risk factor for binge drinking on the maximum drinking occasion, an interaction term was added to the main effects model examining the relationship between friends and binge drinking. To examine border differences, each set of models was stratified by geographic region (e.g., Mexican Americans living along the U.S.-Mexico border, or Mexican Americans not living along the border).
Results
The primary purpose of this study was to test three specific hypotheses:
We found that drinking alcohol with friends was significantly associated with binge drinking on the maximum drinking occasion among adults at the U.S.-Mexico border (odds ratio [OR] = 2.03, 95% confidence interval [CI] = [1.10, 3.73]); however, this association did not hold among non-border adults. As detailed in Table 2, drinking at a bar was strongly associated with binge drinking on the maximum drinking occasion among non-border Mexican Americans (OR = 3.41, 95% CI = [1.35, 8.67]) only. In both the border and non-border samples, alcohol-related attitudes were robust predictors of binge drinking during the maximum drinking occasion. Among non-border adults, males were more likely than females to report binge drinking on the heaviest drinking occasion (OR = 2.45, 95% CI = [1.26, 4.80]). There was no evidence of a multiplicative interaction between drinking location (bar) and companion (friend) as a predictor of binge drinking on the maximum drinking occasion.
Logistic Regression Analysis Evaluating the Influence of Bar Drinking and Drinking With Friends on Binge Drinking, n = 1,251.
Note. OR = odds ratio; CI = confidence interval.
p< .05. **p< .01. ***p< .001.
Further examination of the effects of drinking companions, context, and alcohol-related cognitions are detailed in Table 3. Unexpectedly, the effect of bar attendance during the maximum drinking occasion predicted binge drinking among non-border adults only. Drinking with family, dates or sexual partners, co-workers, or alone did not increase the odds of binge drinking in either sample.
The Influence of Bars and Drinking Companions on Binge Drinking, n = 1,250.
Note. All models control for cognitions and demographic measures. OR = odds ratio; CI = confidence interval.
p< .05. **p< .01. ***p< .001.
Discussion
The purpose of this study was to assess border differences in the effects of drinking alcohol with particular companions (friends) on binge drinking during participants’ maximum drinking occasion within the past year. We hypothesized that drinking with friends would predict binge drinking during the maximum drinking occasion, independent of context (bar) and alcohol-related cognitions. We also expected to find evidence of a stronger effect of drinking with friends and drinking at bars among border adults, and an interaction between context and drinking companion in predicting binge drinking during the maximum drinking occasion. In sum, we found that drinking alcohol with friends and drinking in bars were risk factors for binge drinking on the maximum drinking occasion, independent of individual alcohol-related cognitions. However, there were substantial differences between the border and non-border samples. Specifically, bar drinking was predictive of binge drinking only among non-border adults, while drinking with friends was predictive of binge drinking only among border adults. Friends emerged as the only companions that increased the odds of binge drinking. Alcohol-related cognitions were associated with binge drinking in both samples. We also found that drinking with friends did not modify the effect of drinking at bars on binge drinking during the maximum drinking occasion in either sample.
We found corroborating support for previous studies conducted with this data set regarding the risks associated with drinking in bars (Mills et al., 2012; Mills et al., 2013). Specifically, non-border adults who drank at a bar or nightclub were more than 3 times as likely to binge drink on the maximum drinking occasion than those who drank in other social contexts. This is especially relevant because bar attendance was related to binge drinking independent of alcohol-related cognitions; therefore, it seems that there is something about the environment in bars that appears to encourage heavy alcohol consumption. We did not expect that bar drinking would not predict binge drinking on the maximum drinking occasion, as this is not consistent with the previous research from these data (Mills et al., 2012; Mills et al., 2013). It is possible that this finding is attributable to binge drinking regardless of the context on the maximum drinking occasion on the border, as single drinking event has never been evaluated using these data.
In addition, this study adds to the literature in that were able to examine the direct influence of drinking companion and drinking place, independent of alcohol-related cognitions, on binge drinking during a single time point (each respondents’ maximum drinking occasion). Drinking with friends doubled odds of binge drinking on that occasion among border adults, indicating that the choice of companion when drinking may influence how much alcohol is consumed. The effect of companion; however, was not modified by bar attendance.
These findings should be interpreted in light of several considerations. In measuring binge drinking, companion, and drinking place, we deliberately considered a single drinking occasion. A contrasting approach (referred to as studies of “global associations” by Cooper, 2002) would involve computing associations between variations on these behavioral indices that (a) covered more occasions and (b) ignored temporal co-occurrence (e.g., separate variables covering the number of binge drinking occasions, bars attended, or times one drank with friends in the past 12 months). By “sampling” behavior within a very narrow window (namely, one drinking occasion), our occasion-specific, situational approach necessarily constrains the extent of possible variation that can be observed in each of these behaviors to one of only two values: Either the behavior was present or it was not. Whether such indices are reliable general indicators of the behavior is a sensible a priori concern, but the fact that our results showed significant, theoretically sensible effects substantially bolsters our confidence in this approach. Moreover, by examining temporal co-occurrence of behaviors at a specific point in time, our situational approach speaks more directly to possible theoretical pathways that could underlie observed associations, such as social learning (peer influences), and contextual effects (e.g., the direct influence of the bar environment) on binge drinking.
In conclusion, we found substantial differences in the influence of drinking context and drinking companion between border and non-border adults. Specifically, among border adults, drinking alcohol with friends significantly predicts binge drinking, independent of bar attendance and alcohol-related cognitions. Friends were the only drinking companions that increased the odds of binge drinking. Among non-border adults, alcohol consumption in a bar environment is associated with an elevated risk of binge drinking on the maximum drinking occasion. Alcohol-related cognitions were positively associated with binge drinking on the maximum drinking occasion across both samples of adults. Future research should examine why the bar context and specific drinking companions generate binge drinking, and why these relationships differ geographically.
Footnotes
Authors’ Note
National Institute on Alcohol Abuse and Alcoholism had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the article for publication.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by Grant R01 AA016827 (Caetano, PI) from the National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism (NIH/NIAAA).
