Neighborhood socioeconomic status and substance use by U.S. adults
Introduction
The importance of the neighborhood context for successful child and adolescent development has long been acknowledged (Bronfenbrenner, 1979), and studies of neighborhood effects on youth have proliferated over the past two decades (Leventhal and Brooks-Gunn, 2000). Neighborhood effects persist into adulthood, as the place one lives provides a context for both work and leisure, and many people develop important social relationships with neighbors. In the best cases, neighborhoods provide infrastructure and social structures that are positive resources for residents both young and old (Browning and Cagney, 2003, Robert, 1999, Wen et al., 2003); however, neighborhoods also can cause stress and tension (Cohen et al., 2003, Ewart and Suchday, 2002, Fitzpatrick and LaGory, 2000) or provide contextual cues and social norms promoting health risk behaviors such as alcohol or drug use (Ahern et al., 2008). For some, the combination of neighborhood stress and permissive social norms may result in tobacco, alcohol or other drug use to cope with increased anxiety and tension (Greeley and Oei, 1999, Moos et al., 1989). Neighborhood effects vary quite widely according to individual attributes, including the amount of time spent near home (Inagami et al., 2007). The current study examines effects of neighborhood socioeconomic status (SES) on substance use in a national sample of U.S. adults and examines variation by gender and age.
Studies of neighborhood effects on adult health outcomes suggest neighborhood SES is an important marker of a variety of contextual factors that impact health and behavior. Disadvantaged neighborhoods often suffer from illicit drug sales and proliferation of alcohol outlets including bars and liquor stores (Bluthenthal et al., 2008), as well as erosion of social controls of behaviors considered to be risky, antisocial or unconventional (Sampson and Groves, 1989, Wilson, 1987). Visible drug sales (Bradizza and Stasiewicz, 2003, Kadushin et al., 1998, Lambert et al., 2004), high alcohol outlet density (Bryden et al., 2012, Livingston et al., 2007, Theall et al., 2009) and social disorganization (Duncan et al., 2000, Esbensen and Huizinga, 1990, Hill and Angel, 2005, Lambert et al., 2004, Wilson et al., 2005) each contribute to substance use and associated problems. At the other end of the socioeconomic spectrum are more affluent areas. Residents of these areas often embrace health-related lifestyles (Cockerham et al., 1997, Ross, 2000). In contrast with neighborhood disadvantage, neighborhood affluence may be associated with certain types of light, recreational substance use patterns that are compatible with a sub-culture of health, such as moderate alcohol use.
Some studies show strong associations between neighborhood disadvantage and increased use of tobacco, alcohol or drugs (Boardman et al., 2001, Datta et al., 2006, Diez Roux et al., 2003, Giggs et al., 1989, Stimpson et al., 2007, Waitzman and Smith, 1998, Williams and Latkin, 2007). A recent review found that neighborhood SES was associated with both adult and adolescent substance use outcomes, with effects of neighborhood disadvantage noted more consistently in samples of adults (Karriker-Jaffe, 2011). There have only been a few studies conducted in the U.S. with national samples, as in the current study. Those suggest that neighborhood disadvantage is associated with recreational and illicit drug use (Ford and Beveridge, 2006, Hoffmann, 2002), heavy drinking (Karriker-Jaffe et al., 2012, Stimpson et al., 2007), and alcohol-related problems (Jones-Webb et al., 1997, Karriker-Jaffe et al., 2012). However, these national studies of neighborhood effects on drug outcomes often find differing results depending on the specific neighborhood measure employed. This was the case in the study by Hoffmann (2002), which documented a positive association between male joblessness in the neighborhood and adolescent drug use, as well as a negative association of the same outcome with neighborhood poverty. Findings also tend to vary by the particular outcome considered, such as in the study by Ford and Beveridge (2006), which showed neighborhood disadvantage was associated with increased use of barbiturates and amphetamines, but not greater use of marijuana, cocaine, LSD or tranquilizers. The current study contributes to the extant literature by considering separate substance use outcomes in addition to alcohol, while using a Census-based composite measure of neighborhood socioeconomic status (SES) that allows differentiation of effects of affluent and disadvantaged (compared to middle-class) neighborhoods in a national sample of U.S. adults.
Characterization of neighborhoods in this manner is important, as there may be unique characteristics associated with conditions of advantage that are not captured by a mere absence of disadvantage (Robert, 1999). That is, there may be distinct benefits to residence in the most affluent areas that are not present in other non-poor, middle-class neighborhoods (Browning and Cagney, 2003). Thus, the two extremes in neighborhood socioeconomic conditions (i.e., disadvantage and affluence) may differ in their relationships with substance use outcomes. For example, there is evidence for adults that neighborhood affluence is associated with being an alcohol drinker (Galea et al., 2007a, Galea et al., 2007b) and regularly using alcohol (Chuang et al., 2005, Pollack et al., 2005), while neighborhood disadvantage is associated with abstinence from alcohol (Karriker-Jaffe et al., 2012). It remains unclear whether neighborhood affluence is associated (either positively or negatively) with problem drinking, although analyses using a subset of the data included in the present investigation suggest there may not be a strong association (Mulia and Karriker-Jaffe, 2012). Two analyses of data from New York City suggest higher neighborhood incomes (Galea et al., 2007b) and higher neighborhood education (Galea et al., 2007a) are associated with increased marijuana use, but effects on other drugs were not reported. It is unknown whether findings from prior research will replicate when national data on other drug use by adults is considered.
Thus, this study examines relationships of neighborhood SES with five substance use outcomes using data from two national samples of U.S. adults (analyzed together). The hypotheses are as follows: (1) compared to middle-class neighborhoods, residence in disadvantaged neighborhoods will be positively associated with stress-related and risky substance use patterns (daily tobacco use, monthly drunkenness, monthly use of marijuana and monthly use of other drugs), and (2) compared to middle-class neighborhoods, residence in affluent neighborhoods will be positively associated with “healthy” substance use (drinking within recommended guidelines), but negatively associated with substance use patterns incompatible with a culture of health (particularly daily tobacco use and monthly use of drugs other than marijuana).
Neighborhood effects may be more pronounced for younger adults, as they are more likely to engage in substance use than their older counterparts and they may be more involved in neighborhood-based social networks formed through school activities; however it also is possible that older adults may be more place-bound after retirement from formal employment and thus may be more strongly influenced by their residential environment (Bernard et al., 2007). As such, interactions with age also are assessed. As gender differences in relationships of substance use patterns with neighborhood SES have been suggested by other studies (Karriker-Jaffe et al., 2012, Karvonen and Rimpelä, 1996, Karvonen and Rimpelä, 1997, Matheson et al., 2011), we present gender-stratified models to highlight any differences in associations of these outcomes with neighborhood disadvantage and affluence. Finally, because some studies show neighborhood disadvantage is associated with both increased abstinence and increased heavy drinking and alcohol-related problems among some drinkers (Karriker-Jaffe et al., 2012), we conduct analyses of the alcohol outcomes in the full sample and in a restricted sample of past-year drinkers.
Section snippets
Dataset
Survey data come from the 2000 and 2005 National Alcohol Surveys (NAS). Both cross-sectional surveys utilized computer-assisted telephone interviews with randomly-selected adults ages 18 and older. Each survey included oversamples of African-Americans, Hispanics, and residents from low-population states. For more details on methodology, please see Kerr et al. (2004) and Midanik and Greenfield (2003). The 2000 NAS included 7613 respondents (58% response rate); the 2005 NAS included 6919
Descriptive statistics
Respondents living in the sample's three types of neighborhoods showed important demographic differences. Compared to residents of the middle-class neighborhoods, respondents in disadvantaged neighborhoods were significantly more likely to be under 40 years of age (46.2% disadvantaged vs. 39.5% middle-class vs. 38.6% affluent neighborhoods, F(1.98, 28,573) = 18.20, p < 0.01), less likely to be living with a partner or spouse (53.8% disadvantaged vs. 66.8% middle-class vs. 67.0% affluent
Discussion
The hypotheses were partially supported, with more evidence compatible with the disadvantage hypothesis than the affluence hypothesis. Specifically, compared to middle-class neighborhoods, residence in disadvantaged neighborhoods was positively associated with one of the stress-related behaviors (daily tobacco use by both men and women) and with one of the more risky substance use outcomes (regular use of other drugs by women). There were no significant associations of neighborhood disadvantage
Role of funding source
National Institute on Alcohol Abuse and Alcoholism (NIAAA) provided funding that supported this study. The NIAAA had no further role in study design; in the collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The content is solely the responsibility of the author and does not necessarily represent the official views of the NIAAA or the National Institutes of Health.
Contributors
Dr. Karriker-Jaffe designed the study, undertook the statistical analysis and wrote the manuscript.
Conflict of interest
Dr. Karriker-Jaffe declares she has no conflicts of interest.
Acknowledgements
I would like to thank Drs. Sarah Zemore, Nina Mulia and Jason Bond for their helpful feedback throughout this study. National Institute on Alcohol Abuse and Alcoholism (NIAAA) provided funding for the National Alcohol Surveys (P50 AA05595, T. Greenfield, PI), post-doctoral research fellowship (T32 AA007240, L. Kaskutas, PI) and research grant (R21 AA018175, K.J. Karriker-Jaffe, PI) that supported this study.
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