Multiple socio-economic contexts during adolescence and health - PDF document

Multiple socio-economic contexts during adolescence and health behaviors in early adulthood Nicoletta Balbo Dondena Centre, Bocconi University, Milan, Italy Nicola Barban Nuffield College, Oxford University, Oxford, UK Frank F. Furstenberg University of Pennsylvania, Pennsylvania, U.S. Abstract This study aims to investigate whether health behaviors of young adults are influenced by different socio-economic contexts, namely family, friends and school, in which they grow up during adolescence. Existing literature has shown no consensus on how socio-economic status may influence adolescent health behaviors. Moreover, most of these studies have looked at only one environment of an adolescent’s socio-economic context at time (e.g., either the family, school, or neighborhood). While focusing on health behaviors during the transition to adulthood, we extend existing literature by adopting an ecological, developmental approach. We take into account that the socio- economic context in which an adolescent grows up is composed by different environments that jointly influence an individual’s development and behaviors. Therefore, we examine how the socio- economic status of family, friends and school community during adolescence may simultaneously affect smoking, drinking and marijuana use from adolescence to early adulthood. 1

Using the National Longitudinal Study of Adolescent Health in the United States, we find that the socio-economic status of an adolescent’s family, friends and school are not highly correlated. This implies that these three contexts may be differently associated with specific health behaviors. Our multilevel analyses show that adolescents are more likely to smoke and drink if they come from more disadvantaged families, although this effect does not seem to last when the individual becomes an adult. Conversely, marijuana use in young adulthood is positively associated with the socio-economic status of the family of origin and the school. We also find that those individuals who come from higher educated families but did not reach the same educational level of their parents are those more likely to smoke and make use of marijuana. 2

Introduction There is an extensive literature on socioeconomic disparities and health behaviors coming from different fields of research, such as sociology, psychology and medical sciences (e.g., Maralani, 2013; Pampel et al., 2010; Siahpush et al., 2006; Sobal and Stunkard, 1989). The importance of uncovering socioeconomic differences in health behaviors stems from the fact that poor health behaviors are associated with increased morbidity and mortality. It has been estimated that such behaviors account for around one-quarter of health disparities, that is differences in health outcomes by socioeconomic groups (Pampel et al., 2010). Existing literature mostly focuses on the association between socio-economic status (SES) and diverse health behaviors, both (i.e., SES and health behaviors) measured either during childhood, adolescence or adulthood. The association between SES and health behaviors is shown not to be equally clear across the lifespan (Chen et al., 2002; West et al., 1990; West, 1988). While, for instance, it seems to be well-recognized that low SES adults are more likely to engage in unhealthy behaviors (Adler et al., 1994; Cutler and Lleras-Muney, 2010), there is no consensus on the relationship between SES and healthy behaviors among adolescents. Sometimes a positive relationship is found, some other studies show a negative or null effect, also depending on the health behavior under study (Hanson and Chen, 2007; Luthar, 2003). Moreover, Daw et al. (2016) have shown that young adults with low parental education are not significantly more likely to engage in unhealthy behaviors than those with high parental education. Some recent research suggests that childhood and adolescence socio-economic circumstances may be important determinant for health outcomes later in life (Cohen et al., 2010; Galobardes et al., 2008; Hayward and Gorman 2004; Luo and Waite 2005; Zimmer et al., 2016). There are several theoretical frameworks explaining the link between early-life advantages or disadvantages and later-life health, the majority of which claims that the effect of early-life SES can be reversible over time (see Cohen et al., 2010 and Pudrovska and Anikputa, 2014 for a review on the topic). Building 3

on and extending this literature that mainly look at health outcomes only, we adopt a life-course, developmental approach (Brandt et al., 2012; Di Gessa et al., 2016) focusing on health behaviors. We aim at uncovering whether and how the socio-economic status of family, friends and school community during adolescence may affect substance use, and more specifically smoking, drinking and marijuana use, from adolescence to early adulthood, when individuals are 15, around 20 and around 30 years-old. Most of existing research on social class gradient and health behaviors during adolescence has looked at only one dimension of an adolescent’s socio-economic context at time (e.g., either the family, school, friends, or neighborhood. Hanson and Chen, 2007). However, some developmental theories claim that the socio-economic context in which a child and then an adolescent grows up is composed by different environments that jointly work on an individual’s development (Bronfenbrenner, 1979; Cook et al., 2002). The ecological approach to child development (Bronfenbrenner, 1979) specifically maintains that an individual’s development is influenced not only by the family system but also by other interconnected environments, that are nested one within the other. In this way, there of course are more proximal and distal systems, with the former ones (such as family, peers and school) more influential than the latter ones (such as cities, regions and nations). Inspired by such ecological, developmental prospective (Bronfenbrenner, 1979; Cook, 2003), we aim at analyzing the relationship between SES during adolescent and health behaviors in young adulthood while taking into account that young people are part of a multi-level social context. More specifically, we focus on the link between the SES of the most proximal - and thereby most influential – environments in which an adolescent is embedded, namely family, friends and school, and his or her smoking, drinking and marijuana use behaviors in early adulthood. Some studies focusing on physical and psychological health outcomes, such as blood pressure or self-esteem, have shown the importance of adopting an ecological approach that takes into 4

account the fact that SES is a multidimensional construct, measurable at multiple levels (Chen and Miller 2013; Chen and Paterson, 2006; Cohen et al., 2010; Schreier and Chen 2013). This stream of research aims at understanding which specific level of SES indicator is significantly associated with a given health outcomes, while taking into account that each context may interact one with another. Findings show that not only family SES but also neighborhood SES is relevant for psychological and physical health outcomes (Chen and Paterson, 2006; Chuang et al., 2005; Warner, 2016). Following this literature, the present paper aims at testing the relative role of different socio- economic contexts (i.e. family, friends and school) as a way to better understand the link between SES and health behaviors. We focus on health behaviors in young adulthood and not on health outcomes, because we are particularly interested in shedding further light on the risk and protective factors associated with the well-documented phenomenon of the peak in substance use in the twenties (Chassin et al., 2009; Johnston et al., 2011). Previous studies have shown that substance use can lead to several problems for young adults, such as difficulties in school, in the labor market, and problems with the criminal justice system (Humensky, 2010). We are aware that the social psychology literature (Chen and Miller 2013; Cook et al., 2002; Schreier and Chen 2013) suggests that the SES in each social context works via specific mechanisms and pathways that should be measured using specific indicators, such as social capital or violence indicators at the neighborhood/school level or parenting indicators at the family level. However, measuring all of the theoretical mechanisms that have been theorized as potential pathways to health would make our models too complex and not readable. Moreover, such an analysis would require a very big sample size as well as very specific and effective measures for each mechanism, and not all of them are available in secondary data. Therefore, we decided to use a unique, synthetic SES measure computed at each of the three levels under study. We believe that such a strategy may help clarifying the relative importance of each socio-economic environment for a specific health behavior. We use parental education as the SES indicator for each of the social 5