The Influence of Neighborhood and Household-Level Socioeconomic Status on Adolescent and Young Adult Alcohol Use Behaviors: A Longitudinal Analysis

Alcohol use is widespread in the United States, with over 177 million Americans reporting past-year use and an estimated 28.8 million meeting criteria for Alcohol Use Disorder (AUD) annually (NIAAA, 2023). Alcohol use typically begins between ages 12 and 14, increases through high school and young adulthood, and peaks between ages 18 and 24 before declining in middle adulthood (Chassin et al., 2004; Chen et al., 2022; Windle, 2020). Individuals from low socioeconomic backgrounds may face heightened risk of problematic alcohol use during this developmental window (Hurd et al., 2014; Peviani et al., 2024). However, the relationship between socioeconomic status (SES) and alcohol use is complicated by the "alcohol harm paradox": high-SES individuals often report higher alcohol consumption but experience fewer negative consequences, whereas low-SES individuals report lower consumption yet suffer higher rates of alcohol-related problems and mortality (Dietze et al., 2009; Foster et al., 2018; Gauffin et al., 2013). Evidence for this paradox is mixed, as some studies suggest lower-SES individuals actually engage in heavier drinking (Beard et al., 2019), highlighting the need for more comprehensive investigation. Existing research linking childhood SES and alcohol use has notable limitations. Most studies rely on cross-sectional data collected at a single time point, precluding examination of developmental changes. Additionally, prior work typically operationalizes SES using a single indicator, failing to capture the construct's multidimensional nature—research suggests that neighborhood-level SES (e.g., Area Deprivation Index) may produce different associations than household-level indicators like parental education and income. Finally, past studies frequently focus on a single binary outcome (AUD diagnosis), neglecting the heterogeneity of alcohol involvement reflected in other indicators such as binge drinking, blackouts, maximum consumption, and symptom counts. The current study addresses these limitations by operationalizing SES at both household (parental income, education, occupation) and neighborhood (Area Deprivation Index) levels and examining associations with a comprehensive range of alcohol use phenotypes spanning consumption quantity, problematic use patterns, and clinical severity. We assess these associations at two developmental time points—adolescence (age 17) and young adulthood (age 24)—to evaluate whether SES effects differ across development. This multi-level, multi-phenotype approach will clarify the nuanced relationship between childhood socioeconomic circumstances and the heterogeneous presentations of alcohol involvement, informing public health strategies aimed at reducing alcohol-related disparities.