Early Life Adversity and Adult Substance Misuse: The Moderating Role of Residential Characteristics

RPL Blakelee Kemp- "Early Life Adversity and Adult Substance Misuse: The Moderating Role of Residential Characteristics": As the population ages, there is growing concern over substance misuse among midlife and older adults. Among the two most common substances used by older adults, alcohol and tobacco, rates of misuse have increased or remained stable despite declines among other age groups. It has been well documented that childhood adversity, such as socioeconomic hardship and parental abuse, leads to lasting structural and functional changes in the body (e.g., “gets under the skin”) that considerably increase the risk of substance misuse in midlife and beyond. However, there are significant gaps in knowledge about the multiple contextual factors that diminish or heighten the risk of substance misuse after experiencing childhood adversity decades earlier, and differences in those contextual effects according to individual characteristics (e.g., age, education). Studies of contextual factors that modify the association between childhood adversity and adult substance misuse often narrowly focus on individual and micro-level environments such as family and peer relationships, without much consideration of place-based contextual factors. This is a critical gap because modifiable features of the places in which people live and age can dramatically shape, for better or worse, the availability of resources, exposures to risks, and responses to early life adverse experiences. The proposed study seeks to identify adult residential characteristics that promote resilience and mitigate substance misuse as well as those that present additional challenges and enable substance misuse, especially among individuals who are at heightened risk from early life adversity. We use data from the 1998–2022 waves of the Health and Retirement Study on over 17,000 individuals over the age of 50 linked to contextual data from the National Neighborhood Data Archive at the level of census tracts. Using multilevel models, we first identify the physical (e.g., alcohol outlet density) and social (e.g., neighborhood affluence) residential characteristics that intensify or diminish associations of childhood adversity with alcohol and tobacco misuse among midlife and older adults (Aim 1). We then identify variation across individual characteristics (e.g., age, education) in the moderating effects of residential characteristics on associations of childhood adversity with alcohol and tobacco misuse (Aim 2). To examine interactive effects, we test average marginal effects and provide clear data visualization to aid interpretation. Guided by life course and contextual frameworks, the central hypothesis is that physical and social residential characteristics are salient modifiers in the relationships between childhood adversity and substance misuse among midlife and older adults; however, the role and relative strength of residential contexts will be contingent upon individuals’ characteristics.