Full length articleThe association of unemployment from age 21 to 33 with substance use disorder symptoms at age 39: The role of childhood neighborhood characteristics
Introduction
During the economic crisis of 2007 and the subsequent recession, the United States experienced an increased unemployment rate. In 2010, the rate was 9.8% (U.S. Bureau of Labor Statistics, 2014), more than twice the rate in 2009 (4.7%; U.S. Bureau of Labor Statistics, 2014). For young adults, the unemployment rate was substantially higher than the national average in 2010 (17.2%; U.S. Congress Joint Economic Committee, 2010). Since 1971, young adults in the United States have been relatively more vulnerable to unemployment (Edwards and Hertel-Fernandez, 2010; Taylor et al., 2012). Thus advancing knowledge about the potential impact of unemployment on young adults is an important contemporary public health goal.
It has been consistently suggested that unemployment may be linked to substance use (Catalano et al., 2011, Henkel, 2011). However, the nature of this association has been widely debated and two lines of argument have emerged: social causation and social selection (Catalano et al., 2011, Henkel, 2011, Sareen et al., 2011). Social causation suggests that unemployment might increase substance use, because an unemployed person might use substances to manage stress associated with unemployment (Boden et al., 2014, Catalano et al., 2011, Henkel, 2011, Mossakowski, 2008) or lose latent benefits accompanying employment, such as time structure, that likely mitigate substance use (Jahoda, 1981, Jahoda, 1982). In contrast, social selection proposes that preexisting substance use problems preclude individuals from retaining their employment (Boden et al., 2014, Sareen et al., 2011), although the extent of such reverse causality might differ depending on the type of substances; for example, nicotine versus alcohol. Considering the debate, it is critical to investigate whether unemployment is associated with substance use, beyond preexisting substance use, as suggested by the social selection hypothesis.
These hypotheses have been invoked in empirical studies, and existing evidence is mixed (Catalano et al., 2011, Mossakowski, 2008). Unemployment has been associated with an increase in alcohol abuse (Redonnet et al., 2012), a decrease in substance use (Ettner, 1997, Khan et al., 2002) and no change in cannabis abuse (Melchior et al., 2015). Such mixed findings warrant further inquiry. In particular, considering that most studies have focused on alcohol (Boden et al., 2014, Ettner, 1997, Khan et al., 2002, Mulia et al., 2014) with very few exceptions (e.g., Melchior et al., 2015; Redonnet et al., 2012), elevated risk of widely used other substances, such as nicotine and cannabis (Substance Abuse and Mental Health Services Administration, 2014), should be investigated. It is feasible that unemployment may have differential associations with different substances, given variation in their legal status under laws governing drug use. Considering the positive association among legal restrictions on a drug, its availability, and substance use (Hawkins et al., 1992), alcohol and tobacco might be more easily accessible options for unemployed people, compared to cannabis. By extension, unemployment might be strongly associated with alcohol and tobacco. Because studies examining substances other than alcohol have been limited, this hypothesis remains a conceptual speculation.
The life course perspective suggests that each developmental period should be understood in tandem with the circumstances of earlier developmental periods (Elder, 1994, McLeod and Almazan, 2003). Specifically, studies have consistently documented that childhood experiences might cast long-lasting effects on adult developmental outcomes (e.g., Duncan and Magnuson, 2011). Socioecological theories (Bronfrenbrenner, 2005, Zucker, 2006) underscore the potential salience of childhood neighborhood context.
Life course theory (Braveman and Barclay, 2009, Hertzman and Power, 2003) and developmental psychopathology (Cicchetti and Toth, 2009, Sroufe, 2007) offer three hypotheses conceptualizing how an earlier risk factor, such as child neighborhood context, can influence the link between a more proximal risk factor (i.e., unemployment) and developmental outcome. First, the common determinant hypothesis (Cicchetti and Toth, 2009, Schunck and Rogge, 2012, Sroufe, 2007) suggests childhood neighborhood context might be a common source that shapes both adult employment status and substance use. Second, the additive effect (Braveman and Barclay, 2009, Hertzman and Power, 2003) suggests that earlier neighborhood characteristics would exert an independent impact on substance use outcomes beyond unemployment, a proximal risk factor. Finally, the interactive effect (Braveman and Barclay, 2009, Hertzman and Power, 2003) posits that an additional early risk factor would amplify the impact of a proximal risk factor on substance use. For example, the resource substitution hypothesis (Ross and Mirowsky, 2011) specifically posits that downward movement in adult socioeconomic status, such as unemployment, might disproportionately affect individuals with a more disadvantaged childhood background, because their attained socioeconomic status and its accompanying resources are the primary source of support for maintaining behavioral health.
Empirical studies have provided suggestive evidence supporting the contention that child neighborhood context might function as a common determinant, additive, or interactive risk factor in the context of unemployment and substance use. Neighborhood factors during childhood, such as neighborhood-level poverty, have been negatively associated with labor force participation (Galster et al., 2016). Similarly, emerging evidence has suggested the salience of neighborhood context in substance use, although these studies either relied on data from cross-sectional designs (Galea et al., 2007, Karriker-Jaffe, 2013, Winstanley et al., 2008) or examined adolescent substance use (Breslin and Adlaf, 2005, Furr-Holden et al., 2015, Tucker et al., 2013). In contrast to studies related to adolescent substance use (Breslin and Adlaf, 2005, Furr-Holden et al., 2015, Tucker et al., 2013), studies of the influence of childhood neighborhood context on adult substance use, particularly beyond the normative peak age, appear to be lacking. This represents an important gap in the knowledge base for developing and tailoring preventive strategies to curb substance use problems that persist beyond the normative peak age.
Further, studies have reported evidence suggesting that neighborhood context might moderate the relationship between a more proximal risk factor or stressor and adolescent substance use (i.e., interactive effect; Fagan et al., 2014, Snedker et al., 2009, Zimmerman and Vasquez, 2011). A recent study, for example, reported that the impact of violent victimization on any use of alcohol, tobacco, or cannabis was exacerbated among adolescents in neighborhoods with lower levels of perceived neighborhood collective efficacy (Fagan et al., 2014). Extrapolating from the aforementioned conceptual speculation and relevant empirical evidence regarding adolescent substance use, it is plausible that earlier neighborhood contexts might moderate the impact of unemployment, a more proximal risk factor or stressor, on adult substance use disorders. To our knowledge, no longitudinal study has examined this hypothesis and thus it is unknown whether earlier neighborhood contexts might function as an interactive risk factor a decade later in the life course.
Importantly, relevant literature has underscored the importance of considering multiple dimensions of neighborhood context (Schüle and Bolte, 2015)—including economic disadvantage, safety, violence, and social norms—on substance use (Jackson et al., 2014). Emerging literature has provided a basis for conceptualizing these multiple dimensions of neighborhood context as general versus outcome-specific risk factors (Capaldi et al., 2009, Duncan et al., 2006, Furr-Holden et al., 2015, Lee et al., 2012, Moffitt, 1993). Moffitt (1993) posited that general (e.g., neighborhood safety) and outcome-specific (e.g., social norms for substance use) environmental risk factors may lose or gain salience for substance use persisting beyond its normative peak age. Childhood exposure to substance use-specific neighborhood characteristics, for example, might lead to an individual to develop a more tolerant attitude toward substance use, which can lead to greater reliance on substance use as a coping strategy during periods of stress, such as unemployment. To our knowledge, the predictive capacity of general and substance use-specific neighborhood factors during childhood on problematic substance use during adulthood has not been examined.
Consistent with the notion of gender socialization (Chodorow, 1978), women might resort to coping behaviors other than substance use, because externalizing behaviors such as substance use might not fit gendered norms about behavior (Broidy and Agnew, 1997, Nolen-Hoeksema, 2004) and women might experience unemployment as less seriously damaging to their status compared to men (Jukkala et al., 2008, Leana and Feldman, 1994, Taylor et al., 2008). Empirical studies have also documented possible gender differences in the association of financial and employment-related stressors with substance use (Boden et al., 2014, Mulia et al., 2014, Redonnet et al., 2012, Rospenda et al., 2008) in the impact of neighborhood factors on substance use (Fone et al., 2013, Kuipers et al., 2012, Leifheit et al., 2015, Matheson et al., 2012).
Using a prospective longitudinal design, this study examined the link between unemployment and symptoms of alcohol use disorder, nicotine dependence, and cannabis use disorder. We addressed four central research questions. First, we examined whether unemployment during young adulthood (ages 21–33) is associated with substance use disorder symptoms at age 39, after taking into account childhood and young adult involvement in substance use. Second, we investigated whether general and substance use-specific neighborhood contexts in childhood differentially predict adult disorder symptoms. Third, we tested how childhood neighborhood characteristics specifically influence the link between unemployment and adult disorder symptoms (i.e., a common determinant, additive effect, or interactive effect). Fourth, we tested potential gender differences in these associations.
Section snippets
Participants
The present study used data from the Seattle Social Development Project (SSDP), a longitudinal panel study that began in 1985. Participants were sampled from 18 elementary schools, over-representing high-crime neighborhoods.1
Associations of unemployment duration with substance use disorder symptoms, net of the social selection possibility2
Descriptive statistics for all model variables are included in Table 1. First, the bivariate association between years of unemployment and symptom counts for each substance was estimated. Table 2 (Model 1) shows that the number of alcohol use, nicotine dependence, and cannabis use disorder symptoms increased as unemployment duration increased. For example, a 1-year increase in duration of unemployment was associated with a 14% higher count of alcohol use disorder symptoms (RR = 1.14; 95% CI:
Discussion
Results from this study provide evidence that duration of unemployment during young adulthood may be an important risk factor for alcohol use and nicotine dependence disorder symptoms at age 39, even after adjusting for childhood and early adult substance use along baseline symptoms of psychopathology, which is consistent with prior studies (Redonnet et al., 2012). The unemployment duration measure was not significantly associated with cannabis use disorder symptoms at age 39 when a set of
Conflict of interest
No conflict declared.
Role of funding source
Nothing declared.
Contributors
JOL conceptualized the study; JOL and TMJ analyzed the data; ICR provided expertise in the analysis and interpretation of the association between neighborhood characteristics and substance use; GSL provided expertise in the interpretation of the association between neighborhood characteristics and substance use; RK, KGH, RFC, and JDH collected the data; JOL, RK, KGH, and RFC contributed to the interpretation of findings; and JOL, TMJ, RK, ICR, GSL, KGH, and RFC wrote and edited the manuscript.
Acknowledgements
This research was supported by grants 1R01DA033956-01, and 1R01DA024411-05-07 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The funding agencies played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit this article for publication. We would like to extend our gratitude to
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