title: Diminished Alternative Reinforcement as a Mechanism Underlying Socioeconomic Disparities in Adolescent Substance Use.
abstract: OBJECTIVE
  This study examined socioeconomic disparities in adolescent substance use utilizing a behavioral economic theoretical framework. We tested the hypothesis that teens of lower (vs. higher) socioeconomic status (SES) are vulnerable to substance use because they engage in fewer pleasurable substance-free activities that provide reinforcement and may deter substance use.
  
  
  METHODS
  In a cross-sectional correlational design, 9th grade students (N=2839; mean age=14.1years) in Los Angeles, California, USA completed surveys in Fall 2013 measuring SES (i.e., parental education), alternative reinforcement (engagement in pleasurable substance-free activities, e.g., hobbies), substance use susceptibility, initiation, and frequency, and other factors.
  
  
  RESULTS
  For multi-substance composite outcomes, lower parental education was associated with greater likelihood of substance use initiation in the overall sample, frequency of use among lifetime substance users, and susceptibility to substance use in never users. Substance-specific analyses revealed that lower parental education was associated with higher likelihood of initiating cigarettes, alcohol, and marijuana use as well as greater susceptibility to use cigarettes in never smokers. Each inverse association between parental education and substance-related outcomes was statistically mediated by diminished alternative reinforcement; lower parental education was associated with lower engagement in alternative reinforcers, which, in turn, was associated with greater substance use susceptibility, initiation, and frequency.
  
  
  CONCLUSIONS
  These results point to a behavioral economic interpretation for socioeconomic disparities in adolescent substance use. Replication and extension of these findings would suggest that prevention programs that increase access to and engagement in healthy and fun activities may reduce youth socioeconomic health disparities related to substance use.
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, USA; Department of Psychology, University of Southern California, USA. Electronic address: adam.leventhal@usc.edu.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Leventhal
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, USA.
authors.forename: Mariel S
authors.initials: MS
authors.lastname: Bello
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Unger
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Strong
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Kirkpatrick
authors.affiliation: Department of Psychiatry, University of Pennsylvania, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Audrain-McGovern
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology; D012054:Reinforcement, Psychology; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D019966:Substance-Related Disorders / Q000191:economics*; D000066608:Underage Drinking
keywords: Adolescents; Behavioral economics; Health disparities; Socioeconomic status; Substance use