Alcohol, Gender, and Religion: Factors Associated with Alcohol-Related Problems Among Karen Refugees

Background: Past epidemiological studies on alcohol-related problems among refugees suggest relatively low risk among refugee populations in comparison with non-refugee immigrants (Salas-Wright & Vaughn, 2014). However, results from community-based studies indicated that harmful alcohol use exists among resettled refugee communities awhile largely undetected (Clements-Green, 2012; Ezard, 2012). Underdiagnosed alcohol-related problems among this population may pose a significant challenge to their successful integration in the United State and compromise their overall well-being. Given high exposure to war- and conflict-related trauma among the refugee population, it is vital to identify unique factors associated with alcohol-related problems and use that understanding to develop interventions to improve the well-being of the individuals and the quality of lives in their communities. Hence, the purpose of this study is to examine the factors associated with alcohol-related symptoms among Karen refugees from Burma.

Method: Karen refugees living in a mid-size city in a Northeastern State were recruited using a convenience sampling method. Using translated survey materials, we completed 201 individual interviews, conducted in Karen language by interviewers who were native speakers. The alcohol-related problem was measured using the Alcohol Use Disorders Identification Test (AUDIT; M=1.4, range=0-19). We conducted a linear regression analysis to model alcohol- related problems using the following set of variables: Sociodemographic factors included age (M=40.6, range=18-83), sex (female=63.7%), marital status (married=81.1%), years of education (M=5.1, range=0-16), and Burmese language proficiency (M=2.1; 1=poor, 5=excellent); immigrant-related factors included years in the U.S. (M=8.2, range=1-15) and English language proficiency (M=1.6; 1=poor, 5=excellent); Health factors included the level of trauma (RHS; M=10.9, range=0-43), depression (K-10; M=15.2, range=0-43), the number of chronic health conditions (M=1.4, range=0-6), and self- rated physical health (SRPH; M=3.0, 1=excellent, 5=poor); and Social Integration factors included social support (LSNS-6; M=2.3, range=0-5), employment (employed=53.2%), and religious participation (M=3.1; 0=none, 6=daily).

Results: Descriptive analysis showed that the average AUDIT score for male and female were 3.74 and 0.12, respectively. The results of the linear regression showed that alcohol-related problem (AUDIT) was associated with being male (b=-3.68; p<0.001), being married (b=1.6; p<0.05), lower religious participation (b=-0.69; p<0.001), greater trauma (b=0.08; p<0.05), and lower depression symptoms (b=-0.11, p<0.05). The final regression model explained approximately 30 percent of the variance in the sample. In addition, post-hoc interaction analyses revealed that gender significantly intersected with the individual (marital status), community (religious participation), and societal (trauma) factors.

Conclusion and Implication: The study results confirmed a general trend about the gendered pattern of alcohol-related problems in the Karen participants. The post-hoc interaction analyses further indicated that married men, men with lower religious participation, and men with higher trauma scores were associated with higher AUDIT scores in comparison with their female counterparts. The findings of this study highlight the critical need for paying attention to this specific group of Karen men and a need for a culturally appropriate intervention approach that may involve family, encourage social interactions, and/or focus on trauma when addressing the alcohol- related problems among the Karen refugee population.