Differential Consequences: Racial/Ethnic and Gender Differences in the Enduring Impact of Early Adversity on Heavy Drinking in Midlife

Background: Although some heavy drinking may be considered normative during late adolescence and young adulthood, recent research has highlighted racial/ethnic disparities in alcohol outcomes including heavy drinking later in the lifecourse. In this study, we identify factors that increase risk for prolonged heavy drinking in a nationally-representative sample of Americans followed to middle age. We focus on differential consequences of early exposure to family poverty and area-level disadvantage, emphasizing how pathways from early adversity to educational attainment and midlife heavy drinking vary for four population subgroups.

Methods: We used data from the restricted-use files of the 1979 National Longitudinal Survey of Youth for civilian respondents who were ages 14-19 at baseline (N=5,781) to examine midlife frequency of heavy drinking (average days drinking 6+ drinks in past month, reported between ages 42-52 on 4 surveys conducted between 2006-2012). Longitudinal path models assessed racial/ethnic and gender differences in the indirect effects of early adversity (proportion of time during adolescence respondents were exposed to family poverty and, separately, county-level disadvantage) on midlife heavy drinking, controlling for parents’ education and marital status during respondent’s adolescence, as well as respondent’s early childbearing, marital status and age cohort. Mediating variables were poor high school performance (remedial math or English), high school graduation or GED by age 19, and college graduation by age 25. Given sample size limitations and preliminary analyses, subgroups of interest were White males (n=1,501), White females (n=1,537), African American or Hispanic (minority) males (n=1,345), and minority females (n=1,398).

Results: In the full sample, there was a significant indirect path from family poverty during adolescence to high school performance, educational attainment and heavy drinking in midlife. Stratified path models showed this indirect pathway held for White males (p=.06), minority females (p=.04) and minority males (p<.10). For minority females, the indirect effects were not fully mediated through high school performance; there also were indirect effects from family poverty through both high school and college graduation to heavy drinking (both p<.10). For minority males, the strongest indirect pathway was not mediated through high school performance, but went from family poverty directly to high school graduation, college graduation and midlife heavy drinking (p=.04).

Conclusion: There are enduring impacts of exposure to family poverty during adolescence on educational attainment for African Americans and Hispanics. These effects of early adversity have differential consequences for health risk behaviors in midlife, with stronger enduring effects for minorities than Whites. Due to differential exposure to early adversity, intersectoral interventions are needed to reduce disparities in alcohol outcomes and to promote health equity among high-risk population subgroups.