Primary Submission Category: Structural factors
Historical Redlining and Binge Drinking in Early Midlife: The Mediating Role of Racial/Ethnic Disparities
Authors: Muntasir Masum,
Presenting Author: Morgan Scarzafava*
Introduction:
Historical neighborhood redlining, driven by racist lending policies and disinvestment, has been associated with ongoing socioeconomic and health inequalities. While research has linked these structural inequities to multiple adverse health behaviors, including binge drinking, few studies have examined how racial/ethnic disparities may mediate the relationship between redlined neighborhood characteristics and binge drinking, particularly in early midlife (ages 33–43). This project aimed to fill this gap by evaluating (1) the direct association between historical redlining and binge drinking, and (2) the mediating role of racial/ethnic disparities in this association.
Methods:
This study used Wave V data (collected from 2016–2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), focusing on participants aged 33–43. HOLC (Home Owners’ Loan Corporation) redlining maps were used to classify respondents’ childhood or adolescent residential locations into graded risk categories (A–D). We linked these data to participants’ self-reported binge drinking frequency (≥5 drinks in a row for men or ≥4 drinks in a row for women within the past 30 days). Bivariate analyses assessed initial correlations between redlining status, binge drinking, and key covariates (e.g., demographic factors, socioeconomic status, smoking behaviors). Multivariable regression models (logistic and Poisson, as appropriate) were then used to evaluate whether living in historically redlined neighborhoods was associated with a higher probability/frequency of binge drinking in early midlife. Racial/ethnic disparities were examined as mediators using a causal mediation framework, adjusting for potential confounders such as sex, educational attainment, and personal/family history of substance use.
Results:
Out of the participants included in the final analytic sample (n ≈ 8,500), those who grew up in historically redlined neighborhoods exhibited a higher prevalence of binge drinking in early midlife (p < 0.001). After adjusting for demographic and socioeconomic factors, individuals from redlined areas had 1.35 times the odds of reporting binge drinking compared to those from non-redlined neighborhoods (95% CI: 1.18–1.55). Racial/ethnic disparities appeared to play a significant mediating role: Black and Hispanic individuals who grew up in redlined neighborhoods experienced a disproportionate burden of structural disadvantage, which partially explained their elevated odds of binge drinking relative to their white counterparts. Mediation analyses indicated that 28% (p < 0.01) of the association between redlining and binge drinking was explained by racial/ethnic disparities in socioeconomic resources, neighborhood investment, and social environment factors (e.g., alcohol outlet density, perceived neighborhood safety).
Conclusion:
These findings suggest a robust association between historical neighborhood redlining and binge drinking in early midlife, shaped in part by racial/ethnic disparities in social and structural determinants of health. By highlighting the mediating role of racial/ethnic differences, this study underscores the need for targeted public health interventions that address the cumulative effects of structural racism and neighborhood disinvestment. Future longitudinal work should investigate the evolution of these disparities over the life course, and public health policies should focus on community-level revitalization efforts to reduce binge drinking and its sequelae in historically marginalized populations.