Neighborhood education inequality and use of cigarettes, alcohol, and marijuana

Abstract

Income inequality at the state, county, and neighborhood levels has been studied in public health; however there has been little public health research on the potential role of education inequality. We assessed the relation between education inequality and substance use in New York City neighborhoods. We used Gini coefficients of education to describe neighborhood distribution of education. We used data from a random-digit-dial phone survey of adult residents of New York City to assess use of substances. Multilevel models were used to assess the relations between neighborhood education, education inequality, and prevalence and frequency of substance use in 59 New York City neighborhoods, while controlling for income and income inequality. Among 1355 respondents (female, 56.2%; white, 35.7%; mean age, 40.4), 23.9% (95% confidence interval CI = 20.3–27.5) reported smoking, 39.4 % (95% CI = 35.3–43.4) reported drinking, and 5.4% (95% CI = 3.6–7.3) reported using marijuana in the previous 30 days. Neighborhoods with both the lowest education inequality and the highest mean education had the highest prevalence of drinking (51.1%; 95% CI = 44.9–57.3) and of smoking marijuana (6.4%; 95% CI = 3.3–9.5). Living in a neighborhood with high education inequality was associated with a greater likelihood of drinking (P = 0.02) and of smoking marijuana (P = 0.004), but among those who did drink alcohol it was associated with having fewer drinks in separate multivariable regression models adjusting for neighborhood education, income distribution, and relevant individual-level covariates. Education inequality may represent a contextual factor that is independently associated with risk behavior. The association between neighborhood education inequality and fewer drinks consumed suggests that the presence of persons with higher education in a neighborhood can be salutary for all persons in a neighborhood. The relations between education inequality and substance use may be different from those between income inequality and substance use, suggesting that both may be important contextual determinants of health behavior.