Income inequality and alcohol use: a multilevel analysis of drinking and drunkenness in adolescents in 34 countries.

BACKGROUND Economic inequality has been hypothesized to be a health determinant, independent of poverty and household income. The goal of this study was to explore the contextual influences of income inequality on alcohol use and frequency of drunkenness in adolescents. METHODS The Health Behaviour in School-aged Children study surveyed 162 305 adolescents (ages 11, 13 and 15 years) in 34 countries, providing self-report data on family affluence, alcohol consumption and episodes of drunkenness. Country-level data on income inequality and overall wealth were retrieved from the United Nations Development Program. RESULTS Multilevel logistic regression revealed that 11- and 13-year-olds in countries of high income inequality consumed more alcohol than their counterparts in countries of low income inequality (after adjustment for sex, family affluence and country wealth). No such effect on alcohol consumption was found in 15-year-olds. Eleven-year-olds in countries of high income inequality reported more episodes of drunkenness than their counterparts in countries of low income inequality. No such effect of income inequality on drunkenness was found in 13- or 15-year-olds. CONCLUSIONS Income inequality may have a contextual influence on the use of alcohol among younger adolescents. Findings suggest that economic policies that affect the distribution of wealth within societies may indirectly influence the use of alcohol during early and mid-adolescence.