Adolescent depression and substance use: Does co-morbidity vary by neighborhood?

The link between depression and substance use has been well substantiated in the mental health literature. But does this association differ by neighborhood? Indeed, communities are often established based on normative standards such as average income and educational attainment thresholds. Does a community, then, influence health status on an aggregate level and shape adolescent health decision making processes on the individual level? Using the National Longitudinal Survey on Youth 1998, 2000 and 2002 Young Adult Cohorts, multilevel modeling will investigate the relationship between socio-economic status and mental health and well-being by examining disparities among neighborhoods. This paper will address how neighborhood characteristics such as appraisal of neighborhood safety, educational attainment, income and psychosocial indexes vary within and between groups of adolescents. Applying hierarchical linear modeling, adolescent mental health measured by the short form of the CESD will elucidate distinctions in self-reported depression and illicit/licit substance use prevalence by locality. These ratings of depression in conjunction with measures of mastery, self-esteem and parent-child quality ratings as well as sociodemographic characteristics at the individual and regional levels will then be used to examine adolescent substance use within neighborhoods and between communities. Urban, suburban, and rural regions within the US will be compared based on mean income, highest grade completed and perceived neighborhood appeal as determined by adolescent survey participants. Implications for targeted interventions such as health education programs promoting adolescent prosocial behavior and encouraging community-wide involvement will be discussed.