Bright, S. orcid.org/0000-0002-8577-5221, Buckley, C., Holman, D. et al. (3 more authors) (2025) The association between macro-level structural discrimination and alcohol outcomes: A systematic review. Social Science & Medicine. 118596. ISSN: 0277-9536
Abstract
Alcohol consumption is a major risk factor for death and disability, disproportionately harming disadvantaged groups. While a positive association between interpersonal discrimination and alcohol use is established, structural discrimination’s impact remains unclear. We conducted a systematic review of the association between macro-level structural discrimination and alcohol consumption or related health outcomes. We searched four databases and grey literature, identifying 25 eligible studies, which considered racism (n=11), sexism (n=7), heterosexism (n=4), and intersectional discrimination (n=3). Most considered alcohol consumption (n=17); fewer addressed harm (n=4) or both (n=4). The majority were US-based (n=21), with four making cross-country comparisons. Associations varied by discrimination type, exposure measurement, alcohol outcome, and sociodemographic factors, though differential effects by sociodemographic factors remain understudied. Most structural racism studies considered segregation as the exposure, but findings were inconsistent, even when grouped by outcome. Emerging evidence suggests increased race-based poverty ratios and incarceration gaps are associated with higher consumption and harm, especially for Black and Hispanic populations. Studies of structural sexism often used composite measures, like state-level gender inequality indices. Evidence suggests that as gender equality increases, women are more likely to drink, while greater structural sexism may be linked to higher rates of risky drinking and alcohol-related mortality. Findings on heavy episodic drinking and drinking frequency were mixed, while associations with volume and quantity were mostly non-significant. The limited available evidence suggests structural heterosexism may be positively associated with high intensity drinking and alcohol use disorders among sexually minoritized groups. The simultaneous impact of multiple forms of structural discrimination remains underexplored. Advancing this field requires consensus on how to operationalize structural discrimination within alcohol studies and greater adoption of intersectional and longitudinal approaches.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2025 The Authors. Except as otherwise noted, this author-accepted version of a journal article published in Social Science & Medicine is made available via the University of Sheffield Research Publications and Copyright Policy under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ |
Keywords: | Public Health; Health Sciences; Human Society; Minority Health; Behavioral and Social Science; Substance Misuse; Prevention; Social Determinants of Health; Health Disparities; Alcoholism, Alcohol Use and Health; Basic Behavioral and Social Science; Women's Health; 2.3 Psychological, social and economic factors; 3.1 Primary prevention interventions to modify behaviours or promote wellbeing; Cancer; Stroke; Cardiovascular; Oral and gastrointestinal; Good Health and Well Being; Gender Equality; Reduced Inequalities |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Funding Information: | Funder Grant number Wellcome Trust Ltd 218462/Z/19/Z NATIONAL INSTITUTES OF HEALTH - UNITED STATES OF AMERICA 3R01AA028009-03S1 |
Date Deposited: | 26 Sep 2025 11:21 |
Last Modified: | 01 Oct 2025 09:06 |
Status: | Published online |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.socscimed.2025.118596 |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:232268 |
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