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In national statistics for the United States, it is common to see information about different segments of the population. For example, data from the U.S. Census and many national surveys on drug use often are subdivided in relation to four racial groups: (1) white, (2) black, (3) Asian or Pacific Islander, (4) American Indian or Alaska native. In concept, "racial heritage" refers to biologically inherited origins, but most people appreciate that these categories of race are determined more by social ideas and customs than by sharp genetic distinctions among these four groups. Some people even change their racial affiliation as they change their social perceptions.

In some national statistics and survey data, it also is common to see subdivisions in relation to "ethnic heritage," which sometimes refers to a person's country of origin but more generally refers to shared social and cultural characteristics. For example, people with recent or distant family origins in Spain or Portugal, or former colonies of Spain and Portugal (e.g., Mexico, Brazil), are called Iberian, Hispanic, or Latino; in North American statistics, it has been typical to subdivide the racial groups in relation to ethnicity as well: (1) White-not Hispanic, (2) Black-not Hispanic, (3) White-Hispanic, (4) Black-Hispanic, and so on. Here, too, the designation of Hispanic or Latino refers more to a social characteristic than to a specific family-genetic background. For example, American Indians from Mexico may be classified as Hispanic-American on the basis of their Mexican ancestry or as Native American on the basis of their North American Indian ancestry. The utility of these classifications of ethnicity and ethnic heritage depends on the degree to which they reflect sameness of social customs and learned behavior. People who are being compared within different ethnic groups ought to exhibit similarities in social customs and learned behaviors, and sometimes a shared sense of affiliation with that particular group. People across different ethnic groups ought to demonstrate more variation in social customs and learned behaviors than are to be seen among people within these groups.

There are many reasons for national reports to present statistical data on the population classified in relation to racial and ethnic heritage. Anyone reading historical documents for the period during and preceding the nineteenth century will find it difficult to escape a conclusion that these classifications were motivated in part by prejudice and racist thinking. Since the nineteenth century—from the earliest days of the U.S. Census—government officials have been interested in knowing the ethnic origins, as well as the size, of different racial and ethnic groups within the population for various policy and planning purposes.

Despite their somewhat questionable origins and uses, racial and ethnic classifications are important measures of social and historical phenomena in the United States. For example, in the area of public health, when national statistics on liver cirrhosis are examined, it can be seen that Americans who describe themselves as African-American are more likely to develop liver cirrhosis compared with Americans of predominantly European heritage. This type of information can guide public health action directed at preventing and treating liver cirrhosis. It is a help in targeting early detection and intervention efforts intended to reduce the suffering associated with liver cirrhosis. It may help identify specific environmental conditions such as poor nutrition or infectious diseases that might account for the higher risk of liver cirrhosis in the African-American segment of the population.

National statistics on alcohol and other drug use in relation to racial and ethnic heritage also have helped the nation's policymakers to see that some segments of the population have a greater need than others for alcohol and drug treatment and prevention services. Through block grants and other funding mechanisms, the federal, state, and local governments can provide support for services that target the special population groups with more needs for these services.

Although statistics on ALCOHOL and other drug use in relation to race and ethnic heritage can be used for the benefit of the population, it must be said that this topic has been understudied and the evidence often misrepresented. On the one hand, the topic is understudied in the sense that differences can be observed in alcohol and other drug use across racial and ethnic subgroups of the population, but it is not known whether they are due to differences in inherited predispositions or to other differences. On the other hand, the evidence of racial and ethnic differences in alcohol and drug use can be misrepresented and interpreted prejudicially as data showing one group to be inferior to another.

The complicated nature of this topic can be illustrated by considering liver cirrhosis among African Americans in the United States. In part, the occurrence of liver cirrhosis is determined by long-term heavy drinking of alcoholic beverages, but liver cirrhosis is also caused by prior infections or by auto-immune reactions, and vulnerability to alcohol-related liver cirrhosis is also influenced by cofactors such as poor nutrition. In the United States, African Americans historically have been at great social disadvantage. On average, they are not as wealthy as other Americans, and, in addition, they more often live in poverty, with associated poor nutrition, underutilization of health care services, and compromised health status. Hence, it might be these socioeconomically related conditions that account for the excess occurrence of liver cirrhosis among African Americans rather than any inherited characteristics or personal characteristics related to drinking.

Within the United States, many other racial and ethnic minority groups also live with social disadvantages similar to those endured by African Americans. For this reason, it is easy to misinterpret national statistics on alcohol and drug use among racial and ethnic minority groups if they are taken strictly at face value. Instead, one must look beneath the surface and ask whether social or economic conditions might account for the statistics.

While studying racial and ethnic differences in CRACK smoking and other COCAINE use, some public health scientists have attempted to hold constant the social and neighborhood conditions that also could explain these differences. Once social and neighborhood characteristics had been taken into account, these studies found very little evidence to support the idea that African Americans or Hispanics were more likely to smoke crack or to take cocaine.

Although the importance of social and environmental influences in people's use of alcohol and other drugs has been clearly illustrated, it is important to keep in mind that biological factors may also play a role in determining one's preference for alcohol or particular drugs. For example, Asian Americans, as a group, consume less alcohol than any of the other racial or ethnic groups. Their lower drinking rates have been attributed, in part, to the fact that a majority of Asians possess a particular form of an alcohol-metabolizing enzyme whose action results in unpleasant side effects after drinking alcohol.

It also is interesting to find variation within large racial and ethnic groups, because this draws attention to the fact that not all African Americans are alike, nor all Hispanic Americans, Native Americans, Asians, or Pacific Islanders. For example, studying occurrence of alcohol abuse and dependence in different countries of Asia, epidemiologists found that men in South Korea had an extremely high prevalence of these conditions but men in Taiwan an extremely low prevalence. In addition, epidemiologists found more crack smoking among Hispanic Americans whose behavior showed that they had become acculturated to mainstream customs (e.g., by choosing to speak English rather than Spanish) and less crack smoking among other Hispanic Americans (e.g., those who chose to speak Spanish rather than English). This relationship was more pronounced among Hispanic Americans from Mexico than among those from Cuba, however, and this is an additional indication of variation within the large and growing Hispanic segment of the U.S. population.

Studies conducted on alcohol and other drug use by Native Americans provide another example of the variation that can exist within a large racial group. For instance, there is considerable variation in alcohol and other drug experiences from tribe to tribe, from one part of the country to another, and even from one residential location to another (e.g., boarding school students versus other young people). It becomes difficult, therefore, to summarize the alcohol and drug experiences of Native Americans in a few sentences. For many Native-American young people and adults living in urban environments, and sometimes on reservation lands as well, the use of alcoholic beverages and also INHALANT drugs is associated with several social and health problems. Researchers have speculated that the disintegration of Native-American culture has contributed to high rates of STRESS and that this in turn is related to a disproportionately high use of alcohol among this segment of the American population. These statistics alerted the attention of public health workers and government officials, and through their efforts many programs have been initiated to draw Native Americans with alcohol abuse problems into treatment.

Racial and ethnic patterns of alcohol and other drug use and related problems vary by age, gender, and drug. National surveys of high school seniors conducted since the early 1970s, and more recent surveys that included eighth- and tenth-graders, reveal that some minority youth use less alcohol and other drugs than Caucasian youth. Specifically, Caucasians, Native Americans, and Mexican Americans have the highest frequency of reported alcohol use whereas African Americans and Asian Americans have the lowest. Because these surveys include only in-school youth and not children who have dropped out of school, it may be that the true proportions of alcohol and other drug use have been underestimated.

In general, males report using drugs more frequently than females, and this gender difference cuts across racial and ethnic boundaries. For example, African-American males and Caucasian males are more likely than African-American and Caucasian females to use alcohol. It is also true that people in different age groups vary in relation to their reports of using alcohol and other drugs. When researchers carefully divide different racial and ethnic groups by age, some interesting trends in alcohol-use patterns appear. For Caucasian adults, drinking tends to increase until mid to late life, with older people drinking less as a group than younger adults. African Americans, however, tend to be heavier drinkers later in life and to exhibit more alcohol-related health problems (e.g., cirrhosis, esophageal cancer). For some drugs other than alcohol, a similar picture exists. For example, Caucasians and Hispanic Americans report using cocaine earlier in life whereas African Americans report using it later in life. Cigarette SMOKING is more common among young Caucasians (12-17 years old) than it is among Hispanic Americans or African Americans of the same age; however, a higher proportion of the latter groups report smoking later in life.

It is sometimes difficult to interpret findings that point to differences in drug use between minority and nonminority subgroups within the U.S. population. It must be kept in mind that socially shared environmental conditions (e.g., availability of drugs, neighborhood conditions, economic resources) rather than race or ethnic identity may be underlying patterns of drug use. Other factors such as social status and community norms for coping with life stresses may account for reported racial or ethnic differences in drug use.

Continued research is needed to track patterns of alcohol and other drug use in the population and to find out the mechanisms or the reasons that put some groups at higher risk than others for problematic involvement with alcohol and other drugs. Some of the most current information is limited. For instance, minority intravenous drug users are known to have higher rates of exposure to HIV than Caucasian drug users, but no clear explanation for this observation has been determined. Perhaps learning more about barriers to obtaining treatment for intravenous drug use in certain minority populations will contribute to an understanding of this problem.

Researchers, as well as policymakers, need to be culturally sensitive; that is, they must appreciate the social, cultural, and economic conditions that underlie racial and ethnic differences in alcohol and drug use. It is important to realize that racial and ethnic identification can serve as a source of strength to those who design targeted prevention and intervention programs for certain segments of the population.