Abstract
BackgroundPlace-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.MethodsThe 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.ResultsOLS 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.ConclusionsThese 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.
Highlights
Place-based factors have been implicated as root causes of socioeconomic disparities in risky health behaviors such as tobacco and alcohol use
Income is strongly correlated with tobacco and alcohol use [30, 31], and counties are often involved in policies that affect labor markets or other economic factors, like setting a local minimum wage [32]
In this study, we investigated how three measures of county-level socioeconomic disadvantage were associated with individual tobacco and alcohol use, using a large longitudinal nationally representative U.S data set
Summary
Place-based factors have been implicated as root causes of socioeconomic disparities in risky health behaviors such as tobacco and alcohol use. 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. Place-based characteristics have been implicated as determinants of socioeconomic disparities in risky health behaviors, over and above the effects of individual-level socioeconomic status. Income is strongly correlated with tobacco and alcohol use [30, 31], and counties are often involved in policies that affect labor markets or other economic factors, like setting a local minimum wage [32]
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