ABSTRACT: Health Disparities in Alcohol Use and Other Risk Behaviors after the Onset of Cancers and Cardiovascular Disease-Related Condition The proposed Health Disparities in Alcohol Use and Other Risk Behaviors after the Onset of Cancers and Cardiovascular Disease-Related Condition is a continuation of the 2016-2020 Health Disparities Project focusing on alcohol's role in health outcomes. We shift our attention to patterns of drinking and other health risk behaviors among individuals with diagnosed health conditions focusing on diabetes, hypertension, heart/coronary problem, and cancer as well as multimorbidity among these conditions. As continued heavy drinking with these conditions carries risks for increased morbidity and mortality, which are likely to be further elevated when combined with other health risk behaviors (such as obesity, physical inactivity and tobacco and other drug use), there is a critical need for multifaceted interventions to address these. However, few studies investigating health behaviors following diagnosis or treatment for specific health conditions have focused on alcohol use or the clustering of risky drinking with other risk behaviors. Furthermore, little has been documented regarding population knowledge of alcohol's role in disease risk, which may also influence decisions about drinking. To increase the knowledge base for improved interventions, the proposed research will address three specific aims. First, analyses of drinking patterns after diagnosis of cancers, hypertension, diabetes, heart problems, and alcohol-attributed health harms using the 2015, 2020 and 2024 NAS will evaluate the impacts of condition onset on drinking patterns and the correlates of continued risky drinking. Second, examination of current drinking patterns, other lifestyle risk factors (physical activity and overweight/obesity), and substance use (tobacco, marijuana, and illicit drugs) in individuals with above- stated conditions and multi-morbidity among them will identify the clustering among these behaviors with attention to differences across gender, age, race/ethnicity and socioeconomic status defined groups. These analyses will utilize the 2010-2020 NAS and 2015-2020 National Surveys on Drug Use and Health. Third, evaluation of the predictors of knowledge regarding alcohol's role in cancers and other health conditions and disparities in these, utilizing the 2020 NAS and the National Cancer Institute's 2017 Health Information National Trends Survey, will identify groups and characteristics associated with accurate knowledge of alcohol as a risk factor for each condition and the sources of information associated with accurate knowledge. Each Aim will evaluate racial/ethnic and socioeconomic status disparities as well as gender and age-related differences. Advanced epidemiologic models including generalized estimating equation modeling, propensity score weighting, and latent class analysis will be utilized as appropriate. .

PUBLIC HEALTH RELEVANCE A large segment of the US population lives with chronic conditions adversely affected by drinking. Given our integrative approach, study findings will uniquely contribute to the knowledge base for multi-faceted interventions that can simultaneously address harmful drinking and other risk behaviors to help improve disease management, treatment adherence and overall health of individuals with alcohol-related health problems. Our results concerning disparities in knowledge and behaviors across demographic subgroups will help identify those at high risk for continued drinking with health conditions and inform contextually-relevant interventions targeted at them. .