Education and alcohol use in adolescence – The role of social causation and health-related selection

Abstract

Abstract Background Both social causation and health-related selection may influence educational gradients in alcohol use in adolescence. From past studies it is unclear which of these mechanisms predominates, as drinking may be both a cause and consequence of low educational attainment. Furthermore, gradients in alcohol use may reflect 'third variables' already present in childhood, such as parental socioeconomic status (SES), effortful control, and IQ. We investigated social causation and health-related selection in the development of educational gradients in alcohol use. Methods We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level and drinking at ages around 14, 16, 19, 22, and 26 years. First, we evaluated the directionality in longitudinal associations between education and alcohol use with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of childhood characteristics around age 11, i.e. IQ, effortful control, and parental SES, both as confounders in these longitudinal associations, and as predictors of educational level and drinking around age 14. Results In fixed effects models, lower education at age 14 strongly predicted increases in drinking at 16. From age 19 onward, we found a non-significant tendency towards opposite associations, with higher education predicting increases in alcohol use. Alcohol use was not associated with subsequent changes in education. All childhood characteristics strongly predicted education around age 14 and, to a lesser extent, early drinking. Conclusions We found conclusive evidence for social causation from education to alcohol use in early adolescence only, and no evidence for selection attributable to alcohol use. By determining initial educational level, childhood characteristics also predict subsequent trajectories in alcohol use. Key messages Our findings illustrate the importance of social causation in relation to alcohol use in early adolescence, while no support was found for health-related selection from alcohol use to education. Parental SES, effortful control, and IQ in childhood strongly predicted educational level in early adolescence, which subsequently predicted trajectories in alcohol use during adolescence.