Educational level and alcohol use in adolescence and early adulthood—The role of social causation and health-related selection—The TRAILS Study

Abstract

Both social causation and health-related selection may influence educational gradients in alcohol use in adolescence and young adulthood. The social causation theory implies that the social environment (e.g. at school) influences adolescents’ drinking behaviour. Conversely, the health-related selection hypothesis posits that alcohol use (along other health-related characteristics) predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as drinking may be both a cause and consequence of low educational attainment. Furthermore, educational gradients in alcohol use may reflect the impact of ‘third variables’ already present in childhood, such as parental socioeconomic status (SES), effortful control, and IQ. We investigated social causation and health-related selection in the development of educational gradients in alcohol use from adolescence to young adulthood in a selective educational system. We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level and drinking at ages around 14, 16, 19, 22, and 26 years (waves 2 to 6). First, we evaluated the directionality in longitudinal associations between education and drinking with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of childhood characteristics around age 11 (wave 1), i.e. IQ, effortful control, and parental SES, both as confounders in these associations, and as predictors of educational level and drinking around age 14 (wave 2). In fixed effects models, lower education around age 14 predicted increases in drinking around 16. From age 19 onward, we found a tendency towards opposite associations, with higher education predicting increases in alcohol use. Alcohol use was not associated with subsequent changes in education. Childhood characteristics strongly predicted education around age 14 and, to a lesser extent, early drinking. We mainly found evidence for the social causation theory in early adolescence, when lower education predicted increases in subsequent alcohol use. We found no evidence in support of the health-related selection hypothesis with respect to alcohol use. By determining initial educational level, childhood characteristics also predict subsequent trajectories in alcohol use.

Alcohol and khat dual use among male adults in Ethiopia: A multilevel multinomial analysis

“…Despite multiple studies have shown that uneducated people are more likely to be affected by khat and alcohol [ 48 – 50 ], our study reported the reverse. Thus, men with higher educational level were more likely to use alcohol, and alcohol and khat in combination.…”

Annual Research Review: Stability of psychopathology: lessons learned from longitudinal population surveys

“…Whereas that might be true in general, some of the reviewed studies suggest a shift from more social influence in adolescence (Barzeva et al., 2020; Defoe et al., 2019) to more health‐related selection in adulthood (Pettit et al., 2010). Moreover, the relative influence of these two processes may vary among domains of mental health: with regard to academic achievement, social selection effects were reported for attentional problems (Schmengler et al., 2021) and social influence effects for alcohol use (Schmengler et al., 2022). It is conceivable that externalizing problems exert a stronger effect on the social environment than internalizing problems and substance use because externalizing problems are inherently more outward‐directed.…”

“…Children and adolescents do not occupy socioeconomic positions themselves yet, but educational attainment is an important mediator between parental socioeconomic position and their own adult socioeconomic position, and possibly also between parental socioeconomic position in childhood and adult mental health problems, and between childhood mental health problems and adult socioeconomic position (Hoffmann et al, 2019). Schmengler et al (2021) conducted two studies on self-reported mental health problems and educational attainment during adolescence and young adulthood in the TRAILS cohort (N = 2,229, initial age 13.5 years, five waves in 13 years), both with proper adjustment for stable individual differences: one on externalizing behaviors (Schmengler et al, 2021), one on alcohol use (Schmengler, Peeters, Kunst, Oldehinkel, & Vollebergh, 2022). Whereas longitudinal associations between externalizing problems and educational attainment were mainly due to health-related selection driven by attention problems (coefficients ranging between À.07 and À.04, all significant; social influence effects between À.06 and .01, all nonsignificant), high alcohol use was primarily caused by social influences (health-related selection effects all around .00): in middle adolescence, it was predicted by low education attainment (À.17); in late adolescence and young adulthood by high educational attainment (.07-.09).…”

Socioeconomic inequalities in adolescent health behaviours across 32 different countries – The role of country-level social mobility

“…increased health-related selection, stronger country-level meritocratic beliefs). Psychological characteristics relevant to health-related selection, such as behavioural control (Schmengler et al, 2022), are expected to predict multiple health behaviours simultaneously (Gray-Burrows et al, 2019;Stautz et al, 2016), rather than only physical activity specifically (Audiffren and André, 2019;Padin et al, 2017). Similarly, country-level meritocratic beliefs, which are potentially more prevalent in socially mobile societies, are unlikely to explain why we found a significant interaction for physical activity only, as SES-related stigmatization, partly by affecting mental health (Simons et al, 2018), would be expected to be associated with multiple health behaviours, including diet and smoking.…”

“…Information on other important dimensions of adolescents' SES, such as own educational level, were also not included in our study. Previous research suggests that different aspects of SES have distinct associations with health behaviours (Kuntz and Lampert, 2013;Schmengler et al, 2022) and may also interact differently with country-level factors, as compared to family affluence (Weinberg et al, 2021). Future studies may include more detailed assessments of SES, including adolescents' educational level, as well as parent-report questionnaires to additionally collect information on parents' educational level, income, and occupational status.…”