A study on the association between educational attainment and substance use disorder from ages 33 to 47, and the moderating role of perceived neighborhood social cohesion

A study on the association between educational attainment and substance use disorder from ages 33 to 47, and the moderating role of perceived neighborhood social cohesion. Shawna Hui Chair of the Supervisory Committee:Isaac Rhew Department of Epidemiology & Department of Psychiatry and Behavioral Sciences Purpose: Examine the association between educational attainment at age 27 and later substance use disorder (SUD), and if the hypothesized association is modified by perceived neighborhood social cohesion assessed at age 27.

Methods: This study used data from the Seattle Social Development Project (SSDP), a prospective cohort study that recruited 5th graders in 1985 [N = 808] from 18 elementary schools in lower income neighborhoods in Seattle. The study collected data via interviews conducted from 5th grade through age 47. Participants were asked at age 30 about their educational attainment at age 27. A binary variable was created to reflect if the participant completed at least a 4-year college degree or not [0 = completed at least a 4-year college degree or more, 1 = completing less than 4-year college degree]. Participants were administered relevant SUD modules from the Diagnostic Interview Schedule to determine if they met DSM-IV criteria in the past year for abuse, dependence, or both for alcohol, cannabis, and other drugs. A binary variable was created to reflect if the participant met criteria for abuse and dependence (SUD) for any of those substances at any time at ages 33, 39, and 47 [1 = met SUD criteria at least once for at least once substance based on interviews from age 33, 39, and 47, 0 = did not met SUD criteria based on interviews at age 30, 33, 39, and 47]. Perceived neighborhood social cohesion was measured at age 27 using a subscale of the Collective Efficacy measure created by Sampson and Raudenbush. A dichotomous variable was created to indicate low vs. high perceived neighborhood social cohesion. Poisson regression was used to estimate prevalence ratios for the association between educational attainment and SUD. To assess effect modification, analyses were stratified by high and low perceived neighborhood social cohesion.

Results: Participants missing data on the exposure or covariates were excluded, resulting in a final analytic sample size of 613 participants. Among this sample, about 75% of participants completed less than a 4-year college degree and about 30% of the total participants met criteria for SUD. Individuals with less than a 4-year college degree had 1.17 times (95% CI: 0.84, 1.65) higher prevalence of later SUD compared to individuals with college education or more after adjusting for previous substance use assessed at age 18, sex, and race and ethnicity. After stratifying by low (PR = 1.23, 95% CI: 0.72, 2.08) and high social cohesion (PR = 1.17, 95% CI: 0.75, 1.83), the prevalence ratios were slightly different.

Conclusions: The study did not find evidence for an association between low educational attainment and SUD from ages 33 to 47 after adjusting for previous history of substance use, race and ethnicity, and sex. The results of the stratification analysis suggest that neighborhood social cohesion is not an effect modifier in the relationship between educational attainment and SUD from ages 33 to 47. Future research should continue to examine the role of neighborhood factors as a buffer against low SES to expand opportunities for interventions.