Elsevier

Addictive Behaviors

Volume 27, Issue 3, May–June 2002, Pages 405-423
Addictive Behaviors

A structural equation model of the effect of poverty and unemployment on alcohol abuse

https://doi.org/10.1016/S0306-4603(01)00181-2Get rights and content

Abstract

The short- and long-term effects of poverty and unemployment on alcohol abuse are investigated using structural equation modelling (SEM) to better understand the observed conflicting relationships among them. We studied 795 community residents who provided complete data in both 1989 and 1991 in the Winnipeg Health and Drinking Survey (WHDS), with equal representation of males and females. Results indicate that (a) increased poverty causes increased alcohol use and alcohol problems, and (b) recent unemployment decreases alcohol use while longer unemployment increases it. It is concluded that the effect of unemployment on alcohol abuse changes direction with time and, thus, both cross-sectional and longitudinal data are required to assess any meaningful relationship between them.

Introduction

Alcohol abuse has been linked to genetic, biochemical, and social causes, among others. An understanding of at least the social causes of alcohol abuse will help us deal with resulting problems more effectively. It is important to study the social problems faced by abusers in their daily lives, and to assess whether such problems contribute to the perpetuation of abuse. Poverty and unemployment are two such important social problems that impose a constrained financial and psychological state on an individual and are believed to be factors affecting alcohol abuse.

Poverty implies the absence of basic necessities. For the poor, the lack of financial resources is self-evident. On the other hand, a lack of psychological resources frequently available to these individuals is indirect in nature and is evident in their inability to deal with stress, in the strategies adopted by them to cope with added stress, and in their access to different programs. Sustained economic hardship is positively related to poorer physical, psychological, and cognitive functioning (Lynch, Kaplan, & Shema, 1997). Lower education, a poor living environment, and often an unhealthy family life make these individuals vulnerable to different forms of abusive behaviour (Droomers, Schrijvers, Stronks, van de Mheer, & Muckenbach, 1999), which in turn adds stress Caton et al., 2000, Hien & Bukszpan, 1999. The view that alcohol helps to deal with stresses by screening out intolerable realities and enhancing the feelings of adequacy and worth makes common sense and as such is widely believed. Typical alcoholics are discontented with their lives and are unable or unwilling to tolerate tension and stress. Anyone who finds alcohol to be tension reducing is at some risk of becoming an alcoholic (Carson & Butcher, 1992). Various studies Brown, 1985a, Brown, 1985b, Brown et al., 1980 have shown that outcome expectations of the tension-reducing effects of alcohol are associated with or can predict problem drinking.

There are relatively few studies that address poverty and alcohol abuse directly. Studies on the relationship between alcohol abuse and income may provide further insight into the likely direction of causality. Conflicting findings have been reported on this issue, however. The most common finding is that households with increased alcohol consumption and other drug use and related problems have low education and lower income than the households with no problem drinkers Delva & Kameoka, 1999, Droomers et al., 1999. Further, higher alcohol consumption was found among households with poor, Black (Jones-Webb, Snowden, Herd, Short, & Hannan, 1997) and unemployed individuals (Singer, Valentin, Baer, & Jia, 1992). Acute and chronic alcohol-related mortality were also found more among low socioeconomic status groups (Makela, 1999). People living in poverty conditions have poorer mental health, have lower levels of social functioning and vitality and poorer physical health Kingree et al., 1999, Roberts et al., 1999.

On the other hand, a relationship between low income and high rates of abstention has also been reported (Hilton, 1991). Welte and Barnes (1992) reported rates of heavy drinking not appreciably higher among low-income groups than in the general population. A number of cross-sectional studies have reported that more affluent people typically drink more than less affluent people (Clark & Midanik, 1982), particularly among men (Hilton, 1991).

A variation in consumption level due to fluctuations in the price of alcohol and the real income of consumers has been reported (Sutton & Godfrey, 1995). However, a consistent decline in alcohol consumption was found for the decade of the 1980s, when prices were relatively stable and real income was increasing (Treno, Parker, & Holder, 1993). Thus, economic conditions may not be the primary determinant of changes in alcohol consumption (Brinkley, 1999). A number of additional social, psychological, and structural indicators should also be considered.

Among studies of the relationship between alcohol use and unemployment, each of the following conclusions have been supported: (a) unemployment increases problem drinking, alcohol use and abuse Claussen, 1999, Dooley et al., 1996, Morrell et al., 1998, Mullahy & Sindelar, 1996, (b) unemployment reduces alcohol use and abuse Ettner, 1997, Leino-Arjas et al., 1999, (c) unemployment does not alter drinking behaviour (Hammer, 1992), no significant relationship exists between alcohol consumption and unemployment (Rehm & Gmel, 1999), and (d) some drink more, some less, and some do not change (Luoto, Poikolainen, & Uutela, 1998).

There is agreement at least that unemployment increases alcohol use and abuse among heavy drinkers, those who consumed six or more drinks on six or more occasions in the past 30 days Dooley & Prause, 1997, Dooley & Prause, 1998 and that moderate drinkers may decrease alcohol use when unemployed while heavy drinkers may increase it (Janlert & Hammarstrom, 1992). It is difficult to determine whether alcohol use causes unemployment or is mainly one of the symptoms of unemployment Claussen, 1999, Dooley et al., 1992.

The effect of unemployment on alcohol abuse remains inconclusive in terms of its direction mostly because of the differences in the definitions and designs used in various studies. However, the existence of an effect of unemployment on alcohol abuse is overwhelmingly acknowledged, irrespective of its magnitude. The central argument of the proponents who conclude that unemployment reduces alcohol abuse is that unemployment is followed by a reduction in real income leading to a lowering of alcohol consumption. On the other hand, studies showing an increase of alcohol use argue that alcohol serves as an instrument of coping with additional stress induced by unemployment and hence, consumption increases with unemployment. However, it is not necessarily true that the unemployed suffer reduced income. They may suffer less financially than people with low income because of their savings, severance payments, employment insurance or other family income. Therefore, it is imperative that a poverty measure be considered together with unemployment in order to study drinking behaviour and related social problems.

The purpose of this study is to assess the effects of poverty and unemployment on alcohol use and abuse, simultaneously in a causal model that incorporates longitudinal observations. Three distinct and complimentary aspects of alcohol abuse: alcohol consumption, alcohol problems, and alcohol dependence are considered together to measure alcohol abuse. It is hypothesized that alcohol use is dependent on poverty, alcohol problems on poverty and alcohol use, and alcohol dependence on alcohol use. Alcohol use is also hypothesized to be dependent on unemployment in both cross-sectional and longitudinal data. There is a general agreement that the nature of the relationship between alcohol abuse and unemployment is time dependent (Dooley & Prause, 1997) and hence, it is plausible to assume that the nature of the relationship may change with prolonged unemployment and poverty.

Whether an individual will increase alcohol consumption because of poverty or unemployment will depend on other moderating factors. Structural equation modelling (SEM) (Bentler & Wu, 1995) is used to conduct simultaneous analysis of the contribution of this diverse set of explanatory variables in a longitudinal design.

Section snippets

Sample

The cross-sectional and longitudinal data collected in 1989 (Wave 1) and 1991 (Wave 2) by the Winnipeg Health and Drinking Survey (WHDS) Barnes et al., 2000, Murray et al., 1994 were used in this study. The initial sample consisted of 4000 randomly selected residents of Winnipeg of which 1257 completed questionnaires in Wave 1. In the follow up study, 2 years later, it was possible to locate 977 subjects. The rest of the sample either could not be located (61), moved out of the city (83), died

Results

A demographic description of the study sample of 795 cases is shown in Table 3. The original sample design called for equal cell sizes in the six age–gender cells. As can be seen in the table, younger men and older women are somewhat underrepresented.

Discussion

Poverty (or lack of resources) causes psychological stress in an individual and, on an aggregate level, it is likely as found in this study that there will be an increase in the level of alcohol use to cope with this added stress. People living in poverty conditions develop low confidence, suffer from hopelessness, become restless, get involved in inappropriate behavior, and feel depressed from being alienated from healthy living and a healthy environment Kingree et al., 1999, Morrell et al.,

Limitations and future study

Limitations of this study are at least of two types. These are: (a) limitations due to a lack of complete description of certain variables in the data, and (b) limitations due to certain difficulties in the methodology. The first category includes collection of employment data as a category of employment status instead of a continuous variable as hours of structured work. This forced the study to assign relative scale values for the employment variable.

The second category of limitations

Acknowledgements

This research was funded by National Health Research and Development Program, Health Canada Grant No. 6607-1474-DA.

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