Researchers: Childhood Economic Status Affects Substance Use Among Young Adults

by Rukmani Krishna on? August 02, 2013 at 12:09 AM Lifestyle News According to researchers at Duke Medicine, children who grow up in poverty are more likely than wealthier children to smoke cigarettes, but they are less likely to binge drink and are no more prone to use marijuana.
The researchers also found that economic strains in early life - including family worries about paying bills or needing to sell possessions for cash - independently erode a child's self-control, regardless of strong parenting in adolescence. Lack of self-control often leads to substance use.

The findings, appearing July 30, 2013, in the Journal of Pediatric Psychology, debunk common assumptions about who abuses substances, and provide a basis for better approaches to prevent young people from falling into drug and alcohol addiction.

"Poverty during childhood not only appears to affect child development, but can have lasting effects on the types of health choices made during adolescence and early adulthood, especially as it relates to cigarette smoking," said senior author Bernard Fuemmeler, Ph.D., MPH, MS, associate professor in Community and Family Medicine at Duke University School of Medicine. "Economic strains may shape an individual''s capacity for self-control by diminishing opportunities for self-regulation, or affecting important brain structures."

Fuemmeler and colleagues at Duke set out to examine the direct effect of childhood economic strains on smoking, binge drinking, and marijuana use in young adults. They also sought to determine how financial difficulties impact self-control, and how positive parenting might mitigate the tendency to use drugs and alcohol.

The group analyzed data from 1,285 children and caregivers included in a representative sample of U.S. families studied from 1986-2009. Economic status was measured by annual family income, plus a survey with questions about economic problems such as difficulty paying bills or postponing medical care. Additional information was gathered to gauge childhood self-control and parental interactions.

Among the study participants who were transitioning to adulthood, young people who lived in poverty as children were far more likely to become regular cigarette smokers than children who grew up in wealthier households. The impoverished children also scored low on self-control measures.

"Poor self-control may be a product of limited learning resources and opportunities for developing appropriate behaviors," Fuemmeler said.

Binge drinking, however, was much more common among the wealthier young people. And surprisingly, those who had good self-control as children were more likely to engage in heavy episodic drinking as young adults.

Neither wealth nor poverty appeared to influence marijuana use, although positive parenting did reduce the use of this drug. Parents who were nurturing and accepting, in fact, diminished the likelihood of young people using any of the substances.

The researchers also found no correlation between economic hardship and poor parenting - a contradiction to some other studies.

"We suspected we'd find a relationship between parenting and economic problems - the idea that economic strains may cause parents to have less capacity to deal with their children, but that relationship wasn't there," Fuemmeler said. "That means it's not necessarily poverty that affects the parenting strategy, but poverty that affects the children's self-control."

Fuemmeler said the findings are important given the increase in U.S. children living in poverty. The U.S. Census Bureau reported 22 percent of children lived in poverty in 2010, compared to 18 percent in 2000.

"Continued work is needed to better understand how economic strains may influence the development of self-control, as well as to identify other potential mediators between economic strains and substance use outcomes," Fuemmeler said.

In addition to Fuemmeler, study authors include Chien-Ti Lee, Joseph McClernon, Scott H. Kollins and Kevin Prybol.

The National Institutes of Health (RO1 DA030487), the National Cancer Institute (K07CA124905) and the National Institute on Drug Abuse (K24DA023464) funded the study.

Source-Newswise

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Economic Incentives Increase Blood Donation

Pointing to a large body of recent research that supports their argument, the three economists write in the May 24, 2013, issue of Science that the World Health Organization and national blood collection agencies should reconsider their opposition to economic incentives for much-needed blood donations.

Macis and his co-authors - Nicola Lacetera of the University of Toronto and Robert Slonim of the University of Sydney - state that such opposition has been based in part on evidence from uncontrolled studies using non-random samples, and on surveys and artificial scenarios using hypothetical questions. These and other tests typically have suggested that economic incentives can decrease intrinsic motivations to donate and may also attract blood donations with greater risks such as viruses and infectious diseases.

But now field-based evidence from large, representative samples is available on actual donations, the authors write, and the results clearly refute the previous findings. Economic rewards do have a positive effect on donations, without negative consequences on the safety of the blood.

They cite the work of other researchers, as well as their own extensive work in this area, which examined incentives for actual blood donors in the United States, Argentina, Switzerland, and Italy. In one of their studies, the three authors examined individual data from nearly 100,000 donors at 72 American Red Cross blood drives in northern Ohio from September 2009 through August 2010. Gift cards were offered at half of the blood-drive sites; no incentives were provided at the other sites, which served as controls for the study.

They found that an advertised offer of a $5 gift card increased the likelihood of giving among people with a history of donating by 26 percent; and a $10 gift card produced a 52 percent rise.

The offer of gift cards even caused people to motivate others, including people who previously had never given blood, to donate. The incentives also induced regular donors to switch from their usual donation sites to locations where rewards would be available.

"There are several differences between the earlier studies and the new field evidence," Macis explained, noting that in the field studies "donors do not feel scrutinized by the researcher and thus might be less concerned about their image and more excited about the rewards."

Moreover, in the new studies the incentives were not framed as "payment" and thus may have been perceived as tokens of appreciation, which can reinforce rather than undermine donors'' intrinsic motivation.

Meantime, added Macis, advances in screening technology since the World Health Organization guidelines were established have greatly reduced the risk of tainted or otherwise unusable blood being used later in transfusions. Also, the rewards are typically provided for presenting at the blood drives, not for donating blood, which should reduce the risk that an ineligible donor would misrepresent health or other information.

Macis additionally noted that incentives could be strategically employed to attract blood donations at times when blood supplies are particularly low, such as holidays and summer months. Although many individuals are eligible to donate blood, only a small percentage of them, less than 10 percent, give blood in the United States, and even fewer donate in low-income countries, where shortages have very serious consequences.

"This raises the question of whether pure altruism is sufficient to guarantee a sufficient, steady supply of blood," Macis said.

The research has implications beyond blood reserves, he added. Although more research is needed and multiple strategies should be pursued simultaneously to encourage donations, some form of economic compensation could bring a much-needed boost to the supplies of bone marrow, organs, and body parts for transplants.

Selling organs and body parts is illegal in the United States. Donors of blood plasma, however, can be paid. A federal appellate court ruled Dec. 1, 2011, that most donors of bone marrow can receive compensation, overturning a law that had made such arrangements punishable by up to five years in prison.

The three authors conclude in their Science article, which appears in the magazine''s "Policy Forum" section: "Debates on ethical issues around giving rewards for donations are inevitable and should be encouraged. But there should be little debate that the most relevant empirical evidence shows positive effects of offering economic rewards on donations."

Source-Newswise

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