Health Disparities
Income inequality and risk for early age of initiation of alcohol use. A longitudinal examination of Canadian secondary school students Jason Were* Jason Were Karen A. Patte Scott T. Leatherdale Roman Pabayo
Background: Early initiation to alcohol is a known predictor of long-term usage of alcohol with severe impacts on health. Income inequality has been associated with underage drinking. However, less is known about its influence to early initiation of alcohol use. This study examined the association between income inequality and the early age of initiation to alcohol.
Methods: We used student cohort data (2017-2020) from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking and Sedentary behavior project and census division (CD) data from the 2016 Canada census. Our sample was composed of 28,732 adolescents from 118 schools distributed in 39 CDs in 4 provinces in Canada (BC, AB, ON, QC). The outcome was defined as a nominal variable describing the age (in years) at which the student first drank alcohol that was more than a sip (never drunk, 8–12, 13-17, ≥18, and do not know). Income inequality (measured using the Gini index at the CD level) was grouped into tertiles (low, moderate, and high). Multilevel multinomial regression was used to examine the study objective.
Results: After adjusting for individual (age, gender, ethnicity, spending money, physical activity, smoking status, cannabis use, depression status and province) and CD (income and population size) covariates, the odds of early initiation to alcohol at 8–12 years old relative to those who have never consumed alcohol was higher for students attending schools in areas with moderate (OR=1.37; 95% CI=1.18–1.60), and high (OR=1.43; 95% CI=1.16–1.78) income inequality areas compared to areas with low income inequality. The association between income inequality and other age groups was not significant.
Conclusion: Our findings suggest that reducing income inequality may subsequently curb the initiation of alcohol consumption in the preadolescence stage. Public health should target alcohol prevention strategies among high school students in areas characterized with high-income inequality.