Educational Level and Risk for Alcohol Abuse and Dependence: Differences by Race-ethnicity

Objective: Using prospective data, we extend and strengthen prior evidence on the relationship of educational level and the risk of alcohol abuse and dependence among adults. Hypothesizing that risk of alcohol disorders would be greater among individuals who dropped out of high school without getting a diploma, and among those who entered college but then failed to get a degree, relative to those with a college or higher degree, we examined these relationships by race-ethnicity.

Methods: Data are from the total of 18,571 adult participants selected for the Epidemiologic Catchment Area (ECA) program by probability sampling of households and census tracts between 1980 and 1984. To assess occurrence of psychiatric conditions over time, staff administered the Diagnostic Interview Schedule soon after sampling and again at followup approximately one year later. The final sample for this report was stratified: African Americans (N = 2856) and whites (N = 7889).

Results: In multiple logistic regression analyses, we found that dropping out of high school was associated with elevated risk for alcohol disorders, relative to those with an Associate of Arts degree or higher, among both African Americans (estimated relative risk [RR] = 4.0, 95% confidence interval [CI], 1.1-14.3, P = .03), and whites (RR = 4.7, 95% CI, 2.2-10.0, P = .0001). In contrast, entering college but failing to get a degree was associated with a significantly increased risk only for whites; however, African Americans were less numerous in the sample, causing attenuation of power. In order to assess whether this relationship was confounded by macrosocial factors of the neighborhood environment, cases were matched to non-cases by age and census tract, and initial conditional logistic regression analyses also were completed.

Conclusions: If confirmed in other investigations, these findings may help to identify groups that are at higher risk for developing alcohol abuse and alcohol dependence in adulthood, and may aid in the development of prevention or early intervention programs.