Estimating the impact of intervening on adolescent binge drinking on neighborhood-based disparities in HIV/STI prevalence: A causal mediation analysis


Adams, Joella W.; Howe, Chanelle J.; Zullo, Andrew R.; Keita, Akilah Dulin; & Marshall, Brandon D. L. (2017). Estimating the impact of intervening on adolescent binge drinking on neighborhood-based disparities in HIV/STI prevalence: A causal mediation analysis. Socierty for Adolescent Health and Medicine. New Orleans, LA: Journal of Adolescent Health.


Purpose Half of new sexually transmitted infections (STIs) in the U.S. occur among adolescents and young adults. Neighborhood-level characteristics (e.g., socioeconomic disadvantage) in early adolescence have been shown to influence the occurrence of STIs in young adulthood. Unhealthy alcohol use patterns in adolescence may serve as an important and modifiable mediator of the aforementioned influence, yet few studies have examined this relationship. Here we evaluate the potential impact of eliminating binge drinking in later adolescence on the relationship between early adolescent neighborhood poverty and HIV/STI prevalence in early adulthood. Methods Complex survey methods and causal mediation analysis techniques were used to analyze longitudinal survey data from three waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Based on the variable classifications for the Add Health data, high poverty neighborhoods were considered to be neighborhoods where >23.9% of residents had an income below the federal poverty level, or that included neighborhoods in the highest 25% for the proportion of residents in poverty based on a participant’s residential address at a single time point during Wave I (i.e., grades 7-11). Binge alcohol use was captured at a single time point during Wave II (i.e., grades 8-12) and was derived from self-reported incidents of drinking 5+ drinks in a row in the past year. The outcome was HIV infection or having an STI at a single time point in Wave III (i.e., ages 18-28). Covariates included sociodemographic variables (i.e., gender, age, race/ethnicity, parental education, receipt of welfare by a parent, two-parent household, U.S. born status), as well as behavioral and mental health-related factors (i.e., access to cigarettes, alcohol, and illegal drugs; suicidal ideation, sexual debut) from Wave I and illicit drug use in Wave II. Inverse probability weighted marginal structural models were used to estimate neighborhood poverty-based differences in HIV/STI prevalence before and after eliminating binge drinking. Results Of the 6,504 Add Health participants in the public-use dataset, 3,371 (52%) had complete information for all variables of interest and were included in the final analytic sample. In the final weighted sample, approximately half (53%) of participants were female and the majority (71%) were White. The prevalence of high poverty neighborhoods in Wave I was 19%, while the prevalence of binge drinking in Wave II and HIV/STIs in Wave III was 30% and 12%, respectively. Accounting for measured sources of potential confounding bias as well as selection bias related to excluding participants due to missing data, the prevalence difference [95% confidence limit] for HIV/STIs in adulthood for those living in high versus low or medium poverty neighborhoods during earlier adolescence was 0.042 [0.002, 0.082]. A hypothetical intervention to universally eliminate binge drinking among participants during later adolescence did not reduce the aforementioned prevalence difference. Conclusions Eliminating binge drinking during later adolescence may not lessen neighborhood poverty-based disparities in HIV/STI prevalence in early adulthood. However, binge drinking among adolescents should nonetheless still be targeted for reduction to address other alcohol-associated adverse outcomes (e.g., injuries).


Reference Type

Conference proceeding

Book Title

Socierty for Adolescent Health and Medicine


Adams, Joella W.
Howe, Chanelle J.
Zullo, Andrew R.
Keita, Akilah Dulin
Marshall, Brandon D. L.

Year Published


Volume Number





Journal of Adolescent Health

City of Publication

New Orleans, LA





Reference ID