Examining Economic Risks in Adolescents’ Families, Neighborhoods, and Schools: Implications for Mental and Behavioral Health in Early Adulthood



      This study assessed long-term links among adolescent family, neighborhood, and school economic contexts and mental and behavioral health in early adulthood, irrespective of adult economic contexts.


      Data were drawn from Add Health, following 10,180 participants from adolescence through early adulthood in the United States. Early adults self-reported on their depressive symptoms, perceived psychological stress, and alcohol use disorder. Income at family and school levels was drawn from youth and parent report; neighborhood income was derived from US Census Data. Multilevel models assessed associations between income in adolescence and early adult outcomes 13 years later while accounting for adolescent outcomes and income in early adulthood. Links with depressive symptoms and stress were assessed utilizing ordinary least squares regression; alcohol use disorder was assessed using ordered logistic regression. Nonlinearities in income effects were assessed with quadratic income variables in adolescence and early adulthood.


      Family income emerged as the most consistent predictor of depressive symptoms (p < .01) and stress (p < .01), showing negative curvilinear associations. In contrast, exposure to higher income schools (p < .01) and neighborhoods (p < .01) during adolescence was associated with heightened risks for alcohol use disorder in early adulthood. These links emerged over and above concurrent negative connections between early adult family and neighborhood economic contexts and depressive symptoms and stress.


      Findings call attention to persistent health-related risks across the income spectrum—not only at the lower end—and also highlight the long-term importance of broader economic contexts beyond the family context.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kessler R.C.
        • Petukhova M.
        • Sampson N.A.
        • et al.
        Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.
        Int J Methods Psychiatr Res. 2012; 21: 169-184
        • Roshanaei-Moghaddam B.
        • Katon W.J.
        • Russo J.
        The longitudinal effects of depression on physical activity.
        Gen Hosp Psychiatry. 2009; 31: 306-315
        • Cuijpers P.
        • Vogelzangs N.
        • Twisk J.
        • et al.
        Comprehensive meta analysis of excess mortality in depression in the general community versus patients with specific illnesses.
        Am J Psychiatry. 2014; 171: 453-462
        • Coley R.L.
        • O’Brien M.
        • Spielvogel B.
        Secular trends in adolescent depressive symptoms: Growing disparities between advantaged and disadvantaged schools.
        J Youth Adolesc. 2019; 48: 2087-2098
        • Twenge J.M.
        • Cooper A.B.
        • Joiner T.E.
        • et al.
        Age, period and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017.
        J Abnorm Psychol. 2019; 128: 185-199
        • Kessler R.C.
        The cost of depression.
        Psychiatr Clin North Am. 2012; 35: 1-14
        • Stewart W.F.
        • Ricci J.A.
        • Chee E.
        • et al.
        Cost of lost productive work time among US workers with depression.
        JAMA. 2003; 289: 3135-3144
        • Bagnardi V.
        • Rota M.
        • Botteri E.
        • et al.
        Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis.
        Br J Cancer. 2015; 112: 580-593
        • Taylor B.
        • Irving H.M.
        • Baliunas D.
        • et al.
        Alcohol and hypertension: Gender differences in dose-response relationships determined through systematic review and meta-analysis.
        Addiction. 2009; 104: 1981-1990
        • Greenfield T.K.
        • Karriker-Jaffe K.J.
        • Kaplan L.M.
        • et al.
        Trends in alcohol’s harms to others (AHTO) and co-occurrence of family-related AHTO: The four US national alcohol surveys, 2000-2015.
        Subst Abuse. 2015; 9: 23-31
        • Grant B.F.
        • Chou S.P.
        • Saha T.D.
        • et al.
        Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013.
        JAMA Psychiatry. 2017; 74: 911-923
        • Sacks J.J.
        • Gonzales K.R.
        • Bouchery E.E.
        • et al.
        2010 National and state costs on excessive alcohol consumption.
        Am J Prev Med. 2015; 49: e73-e79
        • Kuh D.
        • Ben-Shlomo Y.
        • Lynch J.
        • et al.
        Life course epidemiology.
        J Epidemiol Community Health. 2003; 57: 778-783
        • Halfon N.
        • Hochstein M.
        Life Course Health Development: An integrated framework for developing health, policy, and research.
        Milbank. 2002; 80: 433-479
        • Elder G.H.
        Time, human agency, and social change: Perspectives on the life course.
        Soc Psychol Q. 1994; 57: 4-15
        • Shonkoff J.P.
        • Boyce W.T.
        • McEwen B.S.
        Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention.
        JAMA. 2009; 301: 2252-2259
        • Romeo R.D.
        The teenage brain: The stress response and the adolescent brain.
        Curr Dir Psychol Sci. 2013; 22: 140-145
        • Gilman S.E.
        • Kawachi I.
        • Fitzmaurice G.M.
        • et al.
        Socioeconomic status in childhood and the lifetime risk of major depression.
        Int J Epidemiol. 2002; 31: 359-367
        • Patrick M.E.
        • Wightman P.
        • Schoeni R.F.
        • et al.
        Socioeconomic status and substance use and socioeconomic status among young adults.
        J Stud Alcohol Drugs. 2012; 73: 772-782
        • Viner R.M.
        • Ozer E.M.
        • Denny S.
        • et al.
        Adolescence and the social determinants of health.
        Lancet. 2012; 379: 1641-1652
        • Najman J.M.
        • Hayatbakhsh M.R.
        • Clavarino A.
        • et al.
        Family poverty over the early life course and recurrent adolescent and young adult anxiety and depression: A longitudinal study.
        Am J Public Health. 2010; 100: 1719-1723
        • Duncan G.J.
        • Ziol-Guest K.M.
        • Kalil A.
        Early childhood poverty and adult attainment, behavior, and health.
        Child Dev. 2012; 81: 306-325
        • Coley R.L.
        • Sims J.
        • Dearing E.
        • et al.
        Locating economic risks for adolescent well-being: Poverty and affluence in families, schools, and neighborhoods.
        Child Dev. 2018; 89: 360-369
        • Lund T.
        • Dearing E.
        • Zachrisson H.D.
        Is affluence a risk for adolescents in Norway?.
        J Res Adolesc. 2017; 27: 628-643
        • Luthar S.S.
        • Barkin S.H.
        • Crossman E.J.
        “I can, therefore I must”: Fragility in the upper-middle classes.
        Dev Psychopathol. 2013; 25: 1529-1549
        • Hanson M.D.
        • Chen E.
        Socioeconomic status and health behaviors in adolescence: A review of the literature.
        J Behav Med. 2007; 30: 263-285
        • Anderson S.
        • Leventhal T.
        • Dupéré V.
        Exposure to neighborhood affluence and poverty in childhood and adolescence and academic achievement and behavior.
        Appl Dev Sci. 2014; 18: 123-138
        • Lund T.J.
        • Dearing E.
        Is growing up affluent risky for adolescents or is the problem growing up in an affluent neighborhood?.
        J Res Adolesc. 2013; 23: 274-282
        • Jackson N.
        • Denny C.
        • Ameratunga S.
        Social and socio-demographic neighborhood effects on adolescent alcohol use: A systematic review of multi-level studies.
        Soc Sci Med. 2014; 115: 10-20
        • Karriker-Jaffe K.J.
        Areas of disadvantage: A systematic review of effects of area-level socioeconomic status on substance use.
        Drug Alcohol Rev. 2011; 30: 84-95
        • Lee J.O.
        • Jones T.M.
        • Kosterman R.
        • et al.
        Childhood neighborhood context and adult substance use problems: The role of socio-economic status at the age of 30 years.
        Public Health. 2018; 165: 58-66
        • Zucker R.A.
        Alcohol use and the alcohol use disorders: A developmental-biopsychosocial systems formulation covering the life course.
        in: Cicchetti D. Cohen D.J. Developmental Psychopathology. 2nd edition. Wiley, New York, NY2006: 620-656
        • Coley R.L.
        • Sims J.
        • Votruba-Drzal E.
        • et al.
        The intergenerational transmission of socioeconomic inequality through school and neighborhood processes.
        J Child Poverty. 2019; 25: 79-100
        • Muntaner C.
        • Eaton W.W.
        • Miech R.
        • et al.
        Socioeconomic position and major mental disorders.
        Epidemiol Rev. 2004; 26: 53-62
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • White H.
        A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity.
        Econometrica. 1980; 48: 817-838
        • Chuang Y.C.
        • Ennett S.T.
        • Bauman K.E.
        Neighborhood influences on adolescent cigarette and alcohol use: Mediating effects through parent and peer behaviors.
        J Health Soc Behav. 2005; 46: 187-204
        • Anderson P.
        • Chisholm D.
        • Fuhr D.C.
        Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.
        Lancet. 2009; 373: 2234-2246
        • Reiss F.
        Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review.
        Soc Sci Med. 2013; 90: 24-31
        • Pedrelli P.
        • Nyer M.
        • Yeung A.
        • et al.
        College students: Mental health problems and treatment considerations.
        Acad Psychiatry. 2015; 39: 503-511