European Journal of Public Health, 2005 Vol. 15, No. 3, 245-250

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

Frank J. Elgar1, Chris Roberts2, Nina Parry-Langdon2, William Boyce3

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.
Keywords: adolescents, alcohol, cross-national, Health Behaviour in
School-aged Children, inequality,

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