Growing evidence suggests that income inequality is associated with adolescent substance use behaviors, prompting the presumption that it may also be associated with poly-substance use. This study examined the association between income inequality and poly-substance use and tested whether anxiety indirectly affects this relationship. We used cross-sectional survey data from the 2018–2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behavior (COMPASS) project. The analytical sample comprised 71,396 students from 136 secondary schools and 43 census divisions across four Canadian provinces. Using multilevel path analyses, we examined the direct and indirect association between income inequality and poly-substance use. Students in neighborhoods with moderate income inequality relative to those in low-income inequality neighborhoods had higher odds of poly-substance use, with similar odds observed for both females (ORmod = 1.34; 95% confidence interval [CI] = [1.02, 1.66]) and males (ORmod = 1.38; 95% CI = [1.05, 1.72]). In relation to the indirect association through anxiety, gender-stratified results showed that attending schools in neighborhoods with moderate- and high-income inequality was associated with slightly higher odds of poly-substance use among females (ORmod = 1.09; 95% CI = [1.01, 1.18] and ORhigh = 1.10; 95% CI = [1.00, 1.21]). Income inequality is associated with poly-substance use, and this relationship is also indirectly influenced by anxiety among females. Reducing neighborhood income inequality may contribute to lowering poly-substance use among adolescents. In addition, anxiety management in schools located in highly unequal neighborhoods may be an effective intervention approach in reducing poly-substance use among female adolescents.
BaciuA.NegussieY.GellerA.WeinsteinJ. N. (2017). The root causes of health inequity. In BaciuA.NegussieY.GellerA.WeinsteinJ. N. (Eds.), Communities in Action: Pathways to health equity (pp. 99–164). National Academies Press. https://doi.org/10.17226/24624
2.
BahramiF.YousefiN. (2011). Females are more anxious than males: A metacognitive perspective. Iranian Journal of Psychiatry and Behavioral Sciences, 5(2), 83–90.
3.
BanksD. E.RoweA. T.MpofuP.ZapolskiT. C. B. (2017). Trends in typologies of concurrent alcohol, marijuana, and cigarette use among US adolescents: An ecological examination by sex and race/ethnicity. Drug and Alcohol Dependence, 179, 71–77. https://doi.org/10.1016/j.drugalcdep.2017.06.026
4.
BennyC.SteeleB. J.PatteK. A.LeatherdaleS. T.PabayoR. (2023). Income inequality and daily use of cannabis, cigarettes, and e-cigarettes among Canadian secondary school students: Results from COMPASS 2018–19. International Journal of Drug Policy, 115, 104014. https://doi.org/https://doi.org/10.1016/j.drugpo.2023.104014
5.
Boileau-FalardeauM.ContrerasG.GariépyG.LapriseC. (2022). Patterns and motivations of polysubstance use: A rapid review of the qualitative evidence. Health Promotion and Chronic Disease Prevention in Canada : Research, Policy and Practice, 42(2), 47–59. https://doi.org/10.24095/hpcdp.42.2.01
6.
BoydG. (2024). Exploring gender differences in substance abuse and recovery. Journal of Addictive Behaviours and Therapy, 8(1), 10–11.
7.
Canadian Centre on Substance Use and Addiction. (2023). Canadian substance use costs and harms. https://www.ccsa.ca/
8.
ConnellC. M.GilreathT. D.HansenN. B. (2009). A multiprocess latent class analysis of the co-occurrence of substance use and sexual risk behavior among adolescents. Journal of Studies on Alcohol and Drugs, 70(6), 943–951. https://doi.org/10.15288/jsad.2009.70.943
9.
ConwayK. P.VulloG. C.NichterB.WangJ.ComptonW. M.IannottiR. J.Simons-MortonB. (2013). Prevalence and patterns of polysubstance use in a nationally representative sample of 10th graders in the United States. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 52(6), 716–723. https://doi.org/10.1016/j.jadohealth.2012.12.006
10.
CurranP. J.ObeidatK.LosardoD. (2010). Twelve frequently asked questions about growth curve modeling. Journal of Cognition and Development, 11(2), 121–136. https://doi.org/10.1080/15248371003699969
11.
CzoliC.LuongoG.MischkiT. (2023). Characterizing polysubstance use: What do we know about use of cigarettes, vaping products, cannabis, and alcohol among Canadians?Health Reports, 34(4), 16–22. https://doi.org/10.25318/82-003-x202300400002-eng
12.
DorfmanR. (1979). A formula for the Gini coefficient. The Review of Economics and Statistics, 61(1), 146–149. https://doi.org/10.2307/1924845
13.
Elton-MarshallT.LeatherdaleS. T.ManskeS. R.WongK.AhmedR.BurkhalterR. (2011). Research methods of the Youth Smoking Survey (YSS). Chronic Diseases and Injuries in Canada, 32(1), 47–54.
14.
FanJ. X.WenM.Kowaleski-JonesL. (2016). Tract- and county-level income inequality and individual risk of obesity in the United States. Social Science Research, 55, 75–82. https://doi.org/10.1016/j.ssresearch.2015.09.008
15.
FergussonD. M.BodenJ. M.HorwoodL. J. (2011). Structural models of the comorbidity of internalizing disorders and substance use disorders in a longitudinal birth cohort. Social Psychiatry and Psychiatric Epidemiology, 46(10), 933–942. https://doi.org/10.1007/s00127-010-0268-1
16.
FigasK.GiannouchosT. V.CrouchE. (2023). Child and adolescent anxiety and depression prior to and during the COVID ‑ 19 pandemic in the United States. Child Psychiatry & Human Development, 56, 52–62. https://doi.org/10.1007/s10578-023-01536-7
17.
GakhM.CoughenourC.AssoumouB. O.VandersteltM. (2020). The relationship between school absenteeism and substance use: An integrative literature review. Substance Use & Misuse, 55(3), 491–502. https://doi.org/10.1080/10826084.2019.1686021
18.
Gonzalez-CasanovaI.SarmientoO. L.PrattM.GazmararianJ. A.MartorellR.CunninghamS. A.SteinA. (2014). Individual, family, and community predictors of overweight and obesity among Colombian children and adolescents. Preventing Chronic Disease, 11, E134. https://doi.org/10.5888/pcd11.140065
19.
HalladayJ.WoockR.El-KhechenH.MunnC.MacKillopJ.AmlungM.OgrodnikM.FavottoL.AryalK.NooriA.KiflenM.GeorgiadesK. (2020). Patterns of substance use among adolescents: A systematic review. Drug and Alcohol Dependence, 216, 108222. https://doi.org/10.1016/j.drugalcdep.2020.108222
20.
HoellerP.JoumardI.KoskeI. (2014). Reducing income inequality while boosting economic growth: Can it be done? Evidence from OECD countries. The Singapore Economic Review, 59(01), 1450001. https://doi.org/10.1142/S0217590814500015
HongS.HardiF.Maguire-JackK. (2022). The moderating role of neighborhood social cohesion on the relationship between early mother-child attachment security and adolescent social skills: Brief report. Journal of Social and Personal Relationships, 40(1), 277–287. https://doi.org/10.1177/02654075221118096
23.
JohnsonJ. L.GreavesL.ReptaR. (2009). Better science with sex and gender: Facilitating the use of a sex and gender-based analysis in health research. International Journal for Equity in Health, 8(1), 14. https://doi.org/10.1186/1475-9276-8-14
24.
KawachiI.BerkmanL. F. (2014). Social capital, social cohesion, and health. In BerkmanL. F.KawachiI.GlymourM. M. (Eds.), Social epidemiology (pp. 290–319). Oxford University Press. https://doi.org/10.1093/med/9780195377903.003.0008
25.
KawachiI.KennedyB. (1999). Income inequality and health: Pathways and mechanisms. Health Services Research, 34(1 Pt. 2), 215–227.
26.
KeyesK. M.PlattJ. M. (2024). Annual research review: Sex, gender, and internalizing conditions among adolescents in the 21st century—Trends, causes, consequences. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 65(4), 384–407. https://doi.org/10.1111/jcpp.13864
27.
KimD.WangF.ArcanC. (2018). Geographic association between income inequality and obesity among adults in New York state. Preventing Chronic Disease, 15, E123. https://doi.org/10.5888/pcd15.180217
28.
KondoN.SaitoM.HikichiH.AidaJ.OjimaT.KondoK.KawachiI. (2015). Relative deprivation in income and mortality by leading causes among older Japanese men and women: AGES cohort study. Journal of Epidemiology \& Community Health, 69(7), 680–685. https://doi.org/10.1136/jech-2014-205103
29.
LansfordJ. E.Killeya-JonesL. A.MillerS.CostanzoP. R. (2009). Early adolescents’ social standing in peer groups: Behavioral correlates of stability and change. Journal of Youth and Adolescence, 38(8), 1084–1095. https://doi.org/10.1007/s10964-009-9410-3
30.
LayteR. (2012). The association between income inequality and mental health: Testing status anxiety, social capital, and neo-materialist explanations. European Sociological Review, 28(4), 498–511. http://www.jstor.org/stable/23272534
31.
LeatherdaleS. T.BrownK. S.CarsonV.ChildsR. A.DubinJ. A.ElliottS. J.FaulknerG.HammondD.ManskeS.SabistonC. M.LaxerR. E.BredinC.Thompson-HaileA. (2014). The COMPASS study: A longitudinal hierarchical research platform for evaluating natural experiments related to changes in school-level programs, policies and built environment resources. BMC Public Health, 14(1), Article 331. https://doi.org/10.1186/1471-2458-14-331
32.
LoweS. A. J.BasnetS.LeatherdaleS. T.PatteK. A.PabayoR. (2023). Inequality’s on tap: A longitudinal study of area-level income inequality and alcohol consumption among Canadian adolescents. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 73(6), 1093–1100. https://doi.org/10.1016/j.jadohealth.2023.07.015
33.
LynchJ.SmithG. D.HarperS.HillemeierM.RossN.KaplanG. A.WolfsonM. (2004). Is income inequality a determinant of population health? Part 1. A systematic review. The Milbank Quarterly, 82(1), 5–99. https://doi.org/10.1111/j.0887-378x.2004.00302.x
34.
MageeJ. C.GalinskyA. D. (2008). Social hierarchy: The self-reinforcing nature of power and status. The Academy of Management Annals, 2(1), 351–398. https://doi.org/10.1080/19416520802211628
35.
ManleyD.van HamM.DohertyJ. (2011). Social mixing as a cure for negative neighbourhood effects: Evidence-based policy or urban myth? In BridgeG.ButlerT.LeesL. (Eds.), Mixed communities: Gentrification by Stealth? (pp. 151–168). Policy Press. https://doi.org/10.1332/policypress/9781847424938.003.0011
36.
MaxwellA. M.HarrisonK.RawlsE.ZilverstandA. (2022). Gender differences in the psychosocial determinants underlying the onset and maintenance of alcohol use disorder. Frontiers in Neuroscience, 16, Article 808776. https://doi.org/10.3389/fnins.2022.808776
37.
McHughR. K.VotawV. R.SugarmanD. E.GreenfieldS. F. (2018). Sex and gender differences in substance use disorders. Clinical Psychology Review, 66, 12–23. https://doi.org/10.1016/j.cpr.2017.10.012
38.
MelitaD.Rodríguez-BailónR.WillisG. B. (2023). Does income inequality increase status anxiety? Not directly, the role of perceived upward and downward mobility. The British Journal of Social Psychology, 62(3), 1453–1468. https://doi.org/10.1111/bjso.12641
39.
MorleyK. I.LynskeyM. T.MoranP.BorschmannR.WinstockA. R. (2015). Polysubstance use, mental health and high-risk behaviours: Results from the 2012 Global Drug Survey. Drug and Alcohol Review, 34(4), 427–437. https://doi.org/10.1111/dar.12263
40.
MossH. B.ChenC. M.YiH.-Y. (2014). Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample. Drug and Alcohol Dependence, 136, 51–62. https://doi.org/10.1016/j.drugalcdep.2013.12.011
MuthénB. O.MuthénL. K.AsparouhovT. (2017). Regression and mediation analysis using Mplus. In Regression and mediation Analysis Using Mplus (pp, 307–374).
PeiF.WangY.WuQ.Shockley McCarthyK.WuS. (2020). The roles of neighborhood social cohesion, peer substance use, and adolescent depression in adolescent substance use. Children and Youth Services Review, 112, 104931. https://doi.org/https://doi.org/10.1016/j.childyouth.2020.104931
45.
PickettK.WilkinsonR. (2010). The spirit level: Why equality is better for everyone (Di 1 ban). Penguin Books.
RoseR. A.EvansC. B. R.SmokowskiP. R.HowardM. O.StalkerK. L. (2018). Polysubstance use among adolescents in a low income, rural community: Latent classes for middle- and high-school students. Journal of Rural Health, 34(3), 227–235. https://doi.org/10.1111/jrh.12268
48.
SchneiderK. E.BrighthauptS.-C.WinikerA. K.JohnsonR. M.MusciR. J.LintonS. L. (2020). Characterizing profiles of polysubstance use among high school students in Baltimore, Maryland: A latent class analysis. Drug and Alcohol Dependence, 211, 108019. https://doi.org/10.1016/j.drugalcdep.2020.108019
49.
SpitzerR. L.KroenkeK.WilliamsJ. B. W.LöweB. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
50.
SubramanianS. V.KawachiI. (2004). Income inequality and health: What have we learned so far?Epidemiologic Reviews, 26(1), 78–91. https://doi.org/10.1093/epirev/mxh003
51.
TibberM. S.WaljiF.KirkbrideJ. B.HuddyV. (2022). The association between income inequality and adult mental health at the subnational level-a systematic review. Social Psychiatry and Psychiatric Epidemiology, 57(1), 1–24. https://doi.org/10.1007/s00127-021-02159-w
52.
TurnerS.MotaN.BoltonJ.SareenJ. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and Anxiety, 35(9), 851–860. https://doi.org/10.1002/da.22771
53.
WhiteJ.WaltonD.WalkerN. (2015). Exploring comorbid use of marijuana, tobacco, and alcohol among 14 to 15-year-olds: Findings from a national survey on adolescent substance use. BMC Public Health, 15(1), Article 233. https://doi.org/10.1186/s12889-015-1585-9
54.
WilkinsonR. G.PickettK. E. (2017). The enemy between us: The psychological and social costs of inequality. European Journal of Social Psychology, 47(1), 11–24. https://doi.org/https://doi.org/10.1002/ejsp.2275
55.
WongS. L.ShieldsM.LeatherdaleS.MalaisonE.HammondD. (2012). Assessment of validity of self-reported smoking status. Health Reports, 23(1), 47–53.
56.
ZuckermannA. M. E.WilliamsG.BattistaK.de GrohM.JiangY.LeatherdaleS. T. (2019). Trends of poly-substance use among Canadian youth. Addictive Behaviors Reports, 10, 100189. https://doi.org/https://doi.org/10.1016/j.abrep.2019.100189
57.
ZuckermannA. M. E.WilliamsG. C.BattistaK.JiangY.de GrohM.LeatherdaleS. T. (2020). Prevalence and correlates of youth poly-substance use in the COMPASS study. Addictive Behaviors, 107, 106400. https://doi.org/10.1016/j.addbeh.2020.106400
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
