By Yan Wang, Ph.D.
Despite being 900 million strong, rural residents in China remain an extremely understudied and underserved population in many aspects including alcohol use and alcoholism prevention.
Alcohol use in the country has increased dramatically since the 1980s along with the country’s rapid economic growth. Rural residents are disproportionately represented among the ranks of those affected by high-risk drinking and alcohol use disorders. For example, one survey of a large sample of the Chinese population (n = 512,891, 56 percent rural residents) showed that rural residents had much higher rates of heavy drinking for both genders (46 percent versus 39 percent for male, 31.1 percent vs. 21 percent for female). Rural residents are twice as likely to develop alcohol abuse and dependence disorders than their urban counterparts.
Stress, anxiety, depression and alcohol dependence form mediation pathway linking stress to alcohol use among rural Chinese
Psychosocial stress has long been recognized as an important predictor for alcohol use and dependence. In today’s China, rural residents face high level of stress due to a number of social factors, including low income, little access to social welfare and health care, and separation from key family members who have migrated to the urban areas to work.
Alcohol, being brewed and used by Chinese people for thousands of years, now is also employed as a maladaptive coping strategy for stress. But not all people who are stressed use alcohol as remedy, and the missing piece here suggests a potential mediation mechanism. Using longitudinal data, researchers have recently identified negative emotions, including anxiety and depression, as mediators in the relationship between stress and alcohol use.
Resilience buffers the impact of stress on negative emotions, which in turn reduces alcohol use
Resilience, as the ability to adapt to stressful circumstances, has received much attention as a buffering mechanism for substance use and mental wellbeing. Researchers found that resilience is negatively associated with substance use including alcohol, but the underlying mechanism has rarely been examined. Considering the fact that resilience plays a critical role in buffering stress ranging from daily stress to traumatic events, we hypothesize that resilience reduces alcohol use through its moderation effect on the link from stress to negative emotions. In other words, those who have higher levels of resilience may be less likely to develop negative emotions as a result of high stress, therefore are less likely to have alcohol use problems.
We tested this “moderated mediation” model using survey data collected with audio computer-assisted self-interview (ACASI) from a random sample of 1,145 adult rural residents enrolled in the Migrant Health and Behavior Study, a study of rural-to-urban migrants, rural residents, and urban residents in Wuhan, China. We found a high prevalence of stress (47 percent) and alcohol dependence (10.7 percent) in our sample, which once again highlighted the importance of etiological research focusing on stress and alcohol use in rural populations. Results showed that negative emotions, both anxiety and depression, fully mediated the link between perceived stress and alcohol dependence. Meanwhile, resilience significantly buffered the effect of stress on negative emotions, subsequently reducing alcohol dependence.
Resilience training may provide a cost-effective preventive intervention for alcohol use among rural Chinese residents
One unique contribution of our study is identifying the moderator that can help break the mediation pathway from stress to alcohol use, which suggests a new way to intervene and reduce alcohol dependence—resilience training. Stress in life is inevitable, but how “resilient” each individual is holds the key to explain the individual differences in psychological and behavioral outcomes under stress.
Another study of ours conceptualized three components of resilience considered essential: anticipation, flexibility, and bounce-back. We propose that highly resilient individuals—
- Can anticipate adverse or stressful events before they occur and be well prepared to deal with them;
- Are more flexible and have the ability to buffer the impact of adverse or stressful events without significant maladjustment; and
- Can recover (bounce back) quickly and adequately from the adverse or stressful impact.
Resilience enhancement programs are available for health promotion, but few have been used for alcohol intervention purposes. Our findings provide empirical evidence supporting the potential to adapt existing resilience training programs or devise new programs for alcohol intervention purposes. Currently, there is a lack of evidence-based alcohol intervention programs in China. The significant barriers not only include the dearth of empirical data supporting the development of such intervention programs, but also the low availability of rural residents’ access to public healthcare resources. Our study suggests the potential success of resilience training as a cost-effective intervention for alcohol use and dependence in rural China.
Funding Acknowledgement: This study was supported by NIH grant (R01 MH086322, Principle Investigator: Xinguang Chen).
References:
Wang, Y., Chen, X. (2015). Stress and Alcohol Use in Rural Chinese Residents: A Moderated Mediation Model Examining the Roles of Resilience and Negative Emotions. Drug and Alcohol Dependence, 155, 76-82.
Chen, X., Wang, Y., Yan, Y. (2015). The Essential Resilience Scale: Instrument Development and Prediction of Perceived Health and Behavior. Stress and Health, DOI: 10.1002/smi.2659
About the Author
Yan Wang, Ph.D., is a research assistant professor of epidemiology at University of Florida. She has training and expertise in both psychology and epidemiology. Dr. Wang received her Ph.D. in child and family studies from Syracuse University in 2013. With an interdisciplinary perspective, her research focuses on using advanced methodology to investigate the complex etiological processes involved in risk behaviors, especially alcohol/tobacco use and sexual risk behaviors among youth and vulnerable populations such as rural residents and persons living with HIV/AIDS. She has worked on a number of NIH funded projects, including those on mental health and risk behaviors among urban, rural-to-urban migrant, and rural residents in China; alcohol use among persons living with HIV/AIDS in Florida; and advanced quantum modeling on sexual risk behaviors. More information on her research can be found here: http://epidemiology.phhp.ufl.edu/yan-wang-phd/
