Differential Consequences: Racial/Ethnic and Gender Differences in the Enduring Impact of Early Disadvantage on Heavy Drinking in Midlife.

We use a "chain of risks" model to identify risk factors for prolonged heavy drinking in a nationally representative US sample followed from adolescence to middle age, focusing on educational mediators and differential consequences of early exposure to family poverty and area-level disadvantage. Using data from the 1979 National Longitudinal Survey of Youth (civilian respondents ages 14-19 at baseline, N = 5781), longitudinal path models assessed racial/ethnic and gender differences in indirect effects of early disadvantage (duration of exposure to family poverty and area-level disadvantage during adolescence) on midlife heavy drinking. Educational mediators were high school academic performance (taking remedial coursework), high school completion, and attaining a college education. Subgroups were based on race/ethnicity (50.7% White, 30.5% Black, 18.8% Hispanic respondents) and gender (49.6% males). There was a significant indirect path from family poverty during adolescence to poor high school academic performance, lower educational attainment, and more heavy drinking in midlife. For Black respondents, there was an additional direct effect of early area-level disadvantage on greater midlife heavy drinking that was not seen for other groups. The effect of family poverty on reduced high school graduation was stronger for males than females. Enduring impacts of family poverty duration during adolescence on educational attainment have consequences for health risk behaviors in midlife. Due to differential exposure to early adversity, intersectoral interventions are needed to reduce disparities in alcohol outcomes and to promote health equity among high-risk populations.