Effects of Socioeconomic Inequalities on ATOD use over the Life-Course from Adolescence to Young Adulthood

Background: Socioeconomic status is one factor used to help explain the pathways to risky alcohol, tobacco, and other drug (ATOD) use, but this factor is often limited to use as a control variable in ATOD research. Using longitudinal data from a representative sample, this study examined the short- and longer-term effects of socioeconomic inequalities on ATOD behaviors.

Methods: Respondents with data from Waves I and III interviews and parent interviews were used from the National Longitudinal Study of Adolescent Heath. Socioeconomic inequalities are measured by household income in adolescence and economic stress in young adulthood. Multivariate regression analyses were conducted with past year ATOD behaviors as the outcomes. Goodness-of-fit tests were used to assess model fit.

Results: Findings indicated different pathways to ATOD use in young adulthood. In separate models, there is a significant positive relationship between family income and alcohol, marijuana and other drug use, controlling for race, gender, age, early smoking onset, risk preference, and peer/family influence. The opposite effect was noted for smoking, where a significant but negative relationship exists with family income. Past year economic stress was a significant factor for all four outcomes with odds ratios ranging from 1.43 (alcohol) to 1.76 (marijuana).

Conclusions: By dissecting the pathways that influence problem ATOD behaviors across the life course, we can identify the optimal times for prevention and intervention efforts to help reduce socioeconomic inequities in health behaviors. Our results also highlight the complex and potentially damaging role of socioeconomic stress in the promotion of substance use.