Elsevier

Drug and Alcohol Dependence

Volume 166, 1 September 2016, Pages 243-248
Drug and Alcohol Dependence

Short communication
Are area-level effects just a proxy for school-level effects? Socioeconomic differences in alcohol consumption patterns among Swedish adolescents

https://doi.org/10.1016/j.drugalcdep.2016.05.031Get rights and content

Highlights

  • Schools seem important when assessing contextual variations in adolescent alcohol use.

  • Past studies may have overestimated city district differences.

  • The socioeconomic gradient differ between the individual and the contextual level.

Abstract

Aims

Although recent studies have found significant variations in adolescent alcohol consumption across neighbourhoods, these investigations did not address another important context in adolescents’ lives: schools. The purpose of this study was to not only simultaneously assess variations in adolescent alcohol use and binge drinking at the city district level and the school level but also analyse whether any such variations could be ascribed to the socioeconomic characteristics of the examined city districts, schools, and students.

Design

Cross-sectional study.

Setting

Stockholm, Sweden.

Participants

Ninth-grade students (n = 4349) attending schools (n = 75) located in the city districts of the Stockholm municipality (n = 14).

Measurements

Two measures based on information regarding alcohol consumption were constructed: alcohol use (no or yes) and binge drinking among alcohol users (ranging from “very seldom” to “a few times a week”). A wide range of socioeconomic characteristics was included at the city district, school, and student levels. Alcohol use was analysed using mixed-effects logistic regression, whereas binge drinking among users was modelled using mixed-effects ordered logistic regression.

Findings

The results indicated that the school was more important than the city district in assessments of contextual variations in adolescent alcohol use in general and binge drinking in particular. Moreover, proportions of well-educated parents and high-performing students accounted for part of the school-level variation in alcohol use but not binge drinking.

Conclusions

Failure to account for the school context may have caused past research to overestimate city district differences in alcohol consumption among adolescents.

Introduction

The socioeconomic pattern of alcohol consumption is inconsistent compared to many other health behaviours (Harper and Lynch, 2007), particularly in the adolescent population (Hanson and Chen, 2007). Although certain studies have revealed a protective effect of growing up in families with low socioeconomic status, other investigations have highlighted this type of upbringing as a risk factor (Lemstra et al., 2008). In addition to these individual-level associations, researchers have investigated whether socioeconomic disadvantage at the contextual level can play a role in alcohol consumption. Two recent studies examined adolescents living in Oslo, Norway, and demonstrated that the highest levels of alcohol consumption and alcohol intoxication were reported by residents of more affluent city districts while the opposite pattern was observed for alcohol problems (Pedersen and Bakken, 2016, Pedersen et al., 2015). A third study revealed significant variation in adolescent alcohol use across neighbourhoods in the American city of Chicago, Illinois. However, except for immigrant concentration, which was negatively associated with the measured outcome, no indicator of neighbourhood socioeconomic disadvantage had any significant effect (Fagan et al., 2015). Despite the numerous differences between these studies with respect to measurements and design, these investigations shared one feature: neither study addressed schools, which provide another important context in adolescents’ lives. Other research has indeed identified significant school-to-school differences in alcohol consumption that have largely been driven by the lower rates of alcohol consumption in socioeconomically disadvantaged schools (Olsson and Fritzell, 2015). Given the burgeoning number of studies that have concluded that area-level effects in adolescent populations generally are simply a proxy for school-level characteristics (Bernelius and Kauppinen, 2012, Brännström, 2008, Rendón, 2014, Sykes and Musterd, 2010), the current investigation set out to simultaneously assess variations in adolescent alcohol use and binge drinking at the city district and school levels. Moreover, the aim was to analyse whether any such variations could be ascribed to the socioeconomic characteristics of the examined city districts, schools, and students.

Section snippets

Methods

The present study included data at the student level, the school level, and the administrative city district level of schools. The student-level data were derived from the Stockholm School Survey 2014, which was conducted among 9th and 11th graders attending schools located in the municipality of Stockholm, Sweden (n = 15,169). While all public schools in Stockholm municipality were urged to participate, private schools participated voluntarily. The response rate was 76% (n = 11,507). The present

Results

Table 2a demonstrates the results for alcohol use. The intra-class correlations (ICC) reflect the variation in alcohol use at the contextual levels. According to Model 1, the ICC for the city district level is 0.03 and significant, indicating that there is significant variation in alcohol use among city districts. Model 2 additionally accounts for the school-level ICC; although significant variation among city districts remains (ICC = 0.02), more variation is observed among schools (ICC = 0.04).

Discussion

Our findings suggest that it is more important to consider the school than the city district when assessing contextual variations in adolescent alcohol use in general and binge drinking in particular. Thus, failure to account for the school context may have caused past studies to overestimate city district-level differences in alcohol consumption among adolescents (Pedersen and Bakken, 2016, Pedersen et al., 2015). Furthermore, in an attempt to explain contextual variations in alcohol use and

Role of funding source

Nothing declared.

Contributors

Per Carlson stands behind the basic research idea, the statistical analyses and writing the methods section. Ylva B Almquist has gone through previous research and has written large parts of the introduction and the discussion. Both authors have approved the final article.

Conflict of interest

No conflict declared.

Acknowledgements

This study was funded by The Alcohol Research Council of ‘Systembolaget’ (SRA). Thank you to the City of Stockholm and The Social Development Unit for providing the data.

References (13)

  • A.A. Fagan et al.

    A multi-level analysis of the impact of neighborhood structural and social factors on adolescent substance use

    Drug Alcohol Depend.

    (2015)
  • E.J. Amundsen et al.

    Drinking pattern among adolescents with immigrant and Norwegian backgrounds: a two-way influence?

    Addiction

    (2005)
  • V. Bernelius et al.

    School outcomes and neighbourhood effects: a new approach using data from Finland

  • L. Brännström

    Making their mark: the effects of neighbourhood and upper secondary school on educational achievement

    Eur. Sociol. Rev.

    (2008)
  • M. Hanson et al.

    Socioeconomic status and health behaviors in adolescence: a review of the literature

    J. Behav. Med.

    (2007)
  • S. Harper et al.

    Trends in socioeconomic inequalities in adult health behaviors among U.S. States, 1990S. States, 1990–2004

    Public Health Rep.

    (2007)
There are more references available in the full text version of this article.

Cited by (0)

View full text