An Examination of Neighborhood Contexts and Substance Use Across the Life Course

Abstract

Substance use and abuse takes a substantial toll on the health and well-being of youth and adults in America each year. For the past three decades, prevention scientists have sought to identify and understand the range of malleable factors that place individuals at greater risk for substance use and abuse. Key contextual risk factors across youth and adulthood have been identified in neighborhoods, schools, places of employment, peer groups, and families. Neighborhood socioeconomic contexts, however, have been associated with both increased and decreased risk for substance use and abuse across studies. This dissertation examines three sets of interrelated questions concerning the potential role of neighborhood contexts in substance use and abuse across the life course. The first study considered growth in alcohol use and smoking from grades 5 through 9. Results indicated that youth living in more socioeconomically disadvantaged neighborhoods reported more frequent cigarette smoking and alcohol use over time. After accounting for demographic differences, family factors, and peer factors, a unique association for neighborhood socioeconomics remained for smoking but not for alcohol use. In both cases, affiliations with deviant peers predicted more frequent smoking and alcohol use and mediated the association between neighborhood and substance use. The second study examined cross-sectional associations between a broad range of neighborhood, schools, peer, and family and cigarette smoking, binge drinking, marijuana use, and polysubstance use among 9th grade students. Youth living in more socioeconomically disadvantaged neighborhoods were at greater risk for cigarette smoking, binge drinking, and polysubstance use, but not marijuana use in fully controlled models considering all domains of risk factors, race/ethnicity, gender, multiple indicators of family SES, and initiation of substance use by the 5th grade. The third study considered growth in alcohol use disorder (AUD) symptoms from age 21 to 39. Adults living in more disorganized neighborhoods over time reported more symptoms of AUD. A unique association between neighborhood disorganization and AUD symptoms remained in fully controlled models accounting for anxiety or depression and sociodemographic factors including education, marital status, income, parenthood, gender, and race/ethnicity. Anxiety or depression partially mediated the association between neighborhood disorganization and AUD symptoms over time. Results of these studies suggest that neighborhood socioeconomic factors play an important role in substance use and abuse during critical periods of youth and adult development above and beyond well-established risk and protective factors. Future research should seek to understand the unique risks for substance use and abuse associated with disadvantaged neighborhoods.