The association of county-level socioeconomic factors with individual tobacco and alcohol use: a longitudinal study of U.S. adults.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Environment* ; Socioeconomic Factors*; Alcohol Drinking/*epidemiology ; Tobacco Use/*epidemiology; Adolescent ; Female ; Humans ; Income ; Longitudinal Studies ; Male ; Unemployment ; United States/epidemiology ; Young Adult

Background: Place-based factors have been implicated as root causes of socioeconomic disparities in risky health behaviors such as tobacco and alcohol use. Yet few studies examine the effects of county-level socioeconomic characteristics, despite the fact that social and public health policies are often implemented at the county level. In this study, we tested the hypothesis that county-level socioeconomic disadvantage was associated with individual tobacco and alcohol use.
Methods: The sample included a panel of participants from the National Longitudinal Survey of Youth (N = 9302). The primary predictors were three time-varying measures of socioeconomic disadvantage in an individual's county of residence: educational attainment, percent unemployment, and per capita income. We first conducted traditional ordinary least squares (OLS) models, both unadjusted and adjusted for individual-level covariates. We then conducted fixed effects (FE) models to adjust for confounding by unmeasured time-invariant individual-level factors.
Results: OLS and FE models yielded contrasting results: higher county-level per capita income was associated with decreased drinking in OLS models and increased drinking in FE models, while decreased county-level educational attainment was associated with decreased smoking in OLS models and more cigarettes per day in FE models. The findings from FE models suggest that OLS models were confounded by unobserved time-invariant characteristics. Notably, the point estimates for the county-level measures were small, and in many cases they may not represent a clinically meaningful effect except at the population level.
Conclusions: These results suggest that county-level socioeconomic characteristics may modestly influence tobacco and alcohol use. Future work should examine the effects of specific county policies that might explain these findings.

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K08 HL132106 National Institutes of Health; DP2 MD010478 National Institutes of Health

Keywords: Alcohol; Area effects; County effects; Fixed effects; Health disparities; Social epidemiology; Tobacco

Date Created: 20190412 Date Completed: 20190530 Latest Revision: 20200612

20240104

PMC6458796

10.1186/s12889-019-6700-x

30971249