Association between Financial Dependence and Tobacco Use among Young Adults Carolyn A. Stalgaitis, MPH; Jessica M. Rath, PhD, MPH, CHES; Valerie Williams, MA, MS; Heather J. Hoffman, PhD Objectives: To evaluate the relationship between financial dependence on parents and young adult tobacco use. Methods: Cross-sectional data (N = 4195) were analyzed. Multinomial and binary logistic regression were used to model financial dependence as a predictor of tobacco use and frequency of use. Results: Most participants were financially independent (53.5%) and current (27.3%) or previous (26.8%) users. Income, education, and employment interacted with financial dependence to predict tobacco use. De-
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espite steady declines in US tobacco use since the 1960s, in 2012, more than one in 4 Americans used tobacco.1,2 Tobacco use remains even higher among young adults, with more than one-third of 18-34 year-olds and 40.0% of 21-25 year-olds reporting past-month use of any tobacco product.2 In comparison, 24.7% of Americans ages 35 and older and 8.6% of 12-17 year-olds reported past-month use of any tobacco product in 2012.2 Despite reductions in tobacco use overall, young adults continue to use tobacco at alarmingly high rates. Current young adults are of the Millennial Generation, born approximately between 1977 and 1994.3 The largest influence on Millennials’ experiences as young adults so far has been the Great Recession, which began in 2007 as many Millennials entered higher education or the workforce.4 Whereas the Great Recession impacted all aspects of American society, young adults were differentially affected by the financial downturn.5 As a result of the Recession, full-time employment among
Carolyn A. Stalgaitis, Research Associate, Rescue Social Change Group, Washington, DC. Jessica M. Rath, Director of Research and Evaluation, American Legacy Foundation, Washington, DC. Valerie Williams, Research Associate II, American Legacy Foundation, Washington, DC. Heather J. Hoffman, Associate Professor, Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC. Correspondence Ms. Stalgaitis; [email protected]
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pendent participants had greater odds of current (OR range: 3.28-7.17) and lower odds of previous use (0.14-0.37) than independent participants. Financial dependence did not predict frequency of current use. Conclusions: Greater financial dependence on parents is associated with increased current and decreased previous tobacco use among young adults. Key words: young adult, tobacco, socioeconomic status Am J Health Behav. 2014;38(6):850-859 DOI: http://dx.doi.org/10.5993/AJHB.38.6.7
young adults fell while remaining relatively stable among older workers.4,6,7 Even Millennials who found and retained employment during the Great Recession faced financial obstacles, such as decreases in median weekly earnings for full-time employees, not experienced by older workers.8 Unemployment, underemployment, and continued education in the face of poor job prospects led onethird of all Millennials, including 14.0% of Millennials with full-time employment, to report financial dependence on their families in 2010.4 For many young adults, financial dependence includes living at home with their parents or moving back in with their parents after living independently.4 From 1968 to 2007, the percentage of 1831 year-olds who lived at home remained stable at 32.0%, even as the proportion of married young adults decreased.7 From 2007 to 2012, however, the proportion of young adults living at home increased significantly, with 36.0%, or 21.6 million Millennials, living with their parents in 2012.7 This includes 45.0% of unemployed young adults and almost one in 3 employed Millennials, an indication of the difficulty even employed young adults face in achieving financial independence.7 In addition, almost one-fourth of 18-34 year-olds reported moving back into their parents’ homes after living independently because of the Recession, including 34.0% of 25-29 year-olds.8 Although the Great Recession has affected young adults’ lifestyles, it is unclear how it has impacted other aspects of their lives, including health behav-
Stalgaitis et al iors. To date, little research has been published on the impact of the Recession on American health. Studies that do exist are mainly limited to alcohol use and provide mixed results.9–13 However, inferences about the effect of financial dependence on tobacco use can be drawn from studies of health behavior and life milestone trajectories in young adults. Milestones of adulthood such as moving out, getting married, and having children are generally associated with decreases in substance use, including tobacco.14–17 Millennials are achieving these milestones at much later ages than previous generations, often due to financial difficulties.8,18–22 With this delay in milestones, it follows that Millennials also may experience a delay in reductions in health risk behaviors often associated with these achievements, leading to increased levels of unhealthy behaviors in young adults. Given the high rates of tobacco use and unique financial difficulties of Millennials, it is important to understand how the Great Recession, and the lifestyle changes it has caused, have impacted tobacco use in this population to contextualize cessation and prevention interventions. The objective of the current study was to examine the relationship between financial dependence on parents and tobacco use in a sample of Millennials. This can be used as an indicator of how the Great Recession has affected young adult health behavior. The role of financial dependence was evaluated for both tobacco use status and frequency of current use. We hypothesized that greater financial dependence would be associated with a greater likelihood of current tobacco use. Financially dependent individuals are less likely to have experienced the adulthood milestones associated with a decrease in substance use behaviors, which could lead to higher rates of current use.14–17 We also hypothesized that, among current tobacco users, financially independent young adults would use tobacco more frequently than financially dependent Millennials. Independent individuals who continue using tobacco despite reaching adulthood milestones may be more likely to be heavy users who are unable to quit, whereas financially dependent users may be experimenters rather than daily users.
el members without Internet access were provided a computer and Internet access to reduce response bias and increase the representativeness of the sample. Data were weighted to adjust for nonresponse and non-coverage bias to create a nationally representative sample. The Legacy Young Adult Cohort Study was approved by the Independent Investigational Review Board, Inc. The current study consisted of an analysis of cross-sectional data from Wave 3 of the study, collected in July 2012. Cross-sectional data were used because data collection was not complete at the time of analysis; Wave 3 was selected based on the financial dependence and tobacco use measures assessed in this particular wave. Analyses were conducted using data from the 4195 participants who answered questions assessing ever tobacco use; 44 participants missing these data were excluded.
METHODS The current study used cross-sectional data from the Legacy Young Adult Cohort Study, a 3-year, 6-wave (5 waves completed to date) longitudinal study of 18-34 year-old Americans to examine tobacco use trajectories throughout young adulthood. This sample consists of Millennials as participants were born between 1977 and 1994.3 Participant recruitment and data collection have been described in detail elsewhere.23 Briefly, the cohort consisted of members of an online panel of US adults recruited via address-based sampling, a probability-based random sampling method that generates a nationally representative sample. Pan-
Measures Sociodemographic items assessed included age (years); sex (men, women); race/ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic, Other non-Hispanic); employment status (employed ≥35 hours per week, employed 15-34 hours per week, employed
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espite steady declines in US tobacco use since the 1960s, in 2012, more than one in 4 Americans used tobacco.1,2 Tobacco use remains even higher among young adults, with more than one-third of 18-34 year-olds and 40.0% of 21-25 year-olds reporting past-month use of any tobacco product.2 In comparison, 24.7% of Americans ages 35 and older and 8.6% of 12-17 year-olds reported past-month use of any tobacco product in 2012.2 Despite reductions in tobacco use overall, young adults continue to use tobacco at alarmingly high rates. Current young adults are of the Millennial Generation, born approximately between 1977 and 1994.3 The largest influence on Millennials’ experiences as young adults so far has been the Great Recession, which began in 2007 as many Millennials entered higher education or the workforce.4 Whereas the Great Recession impacted all aspects of American society, young adults were differentially affected by the financial downturn.5 As a result of the Recession, full-time employment among
Carolyn A. Stalgaitis, Research Associate, Rescue Social Change Group, Washington, DC. Jessica M. Rath, Director of Research and Evaluation, American Legacy Foundation, Washington, DC. Valerie Williams, Research Associate II, American Legacy Foundation, Washington, DC. Heather J. Hoffman, Associate Professor, Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC. Correspondence Ms. Stalgaitis; [email protected]
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pendent participants had greater odds of current (OR range: 3.28-7.17) and lower odds of previous use (0.14-0.37) than independent participants. Financial dependence did not predict frequency of current use. Conclusions: Greater financial dependence on parents is associated with increased current and decreased previous tobacco use among young adults. Key words: young adult, tobacco, socioeconomic status Am J Health Behav. 2014;38(6):850-859 DOI: http://dx.doi.org/10.5993/AJHB.38.6.7
young adults fell while remaining relatively stable among older workers.4,6,7 Even Millennials who found and retained employment during the Great Recession faced financial obstacles, such as decreases in median weekly earnings for full-time employees, not experienced by older workers.8 Unemployment, underemployment, and continued education in the face of poor job prospects led onethird of all Millennials, including 14.0% of Millennials with full-time employment, to report financial dependence on their families in 2010.4 For many young adults, financial dependence includes living at home with their parents or moving back in with their parents after living independently.4 From 1968 to 2007, the percentage of 1831 year-olds who lived at home remained stable at 32.0%, even as the proportion of married young adults decreased.7 From 2007 to 2012, however, the proportion of young adults living at home increased significantly, with 36.0%, or 21.6 million Millennials, living with their parents in 2012.7 This includes 45.0% of unemployed young adults and almost one in 3 employed Millennials, an indication of the difficulty even employed young adults face in achieving financial independence.7 In addition, almost one-fourth of 18-34 year-olds reported moving back into their parents’ homes after living independently because of the Recession, including 34.0% of 25-29 year-olds.8 Although the Great Recession has affected young adults’ lifestyles, it is unclear how it has impacted other aspects of their lives, including health behav-
Stalgaitis et al iors. To date, little research has been published on the impact of the Recession on American health. Studies that do exist are mainly limited to alcohol use and provide mixed results.9–13 However, inferences about the effect of financial dependence on tobacco use can be drawn from studies of health behavior and life milestone trajectories in young adults. Milestones of adulthood such as moving out, getting married, and having children are generally associated with decreases in substance use, including tobacco.14–17 Millennials are achieving these milestones at much later ages than previous generations, often due to financial difficulties.8,18–22 With this delay in milestones, it follows that Millennials also may experience a delay in reductions in health risk behaviors often associated with these achievements, leading to increased levels of unhealthy behaviors in young adults. Given the high rates of tobacco use and unique financial difficulties of Millennials, it is important to understand how the Great Recession, and the lifestyle changes it has caused, have impacted tobacco use in this population to contextualize cessation and prevention interventions. The objective of the current study was to examine the relationship between financial dependence on parents and tobacco use in a sample of Millennials. This can be used as an indicator of how the Great Recession has affected young adult health behavior. The role of financial dependence was evaluated for both tobacco use status and frequency of current use. We hypothesized that greater financial dependence would be associated with a greater likelihood of current tobacco use. Financially dependent individuals are less likely to have experienced the adulthood milestones associated with a decrease in substance use behaviors, which could lead to higher rates of current use.14–17 We also hypothesized that, among current tobacco users, financially independent young adults would use tobacco more frequently than financially dependent Millennials. Independent individuals who continue using tobacco despite reaching adulthood milestones may be more likely to be heavy users who are unable to quit, whereas financially dependent users may be experimenters rather than daily users.
el members without Internet access were provided a computer and Internet access to reduce response bias and increase the representativeness of the sample. Data were weighted to adjust for nonresponse and non-coverage bias to create a nationally representative sample. The Legacy Young Adult Cohort Study was approved by the Independent Investigational Review Board, Inc. The current study consisted of an analysis of cross-sectional data from Wave 3 of the study, collected in July 2012. Cross-sectional data were used because data collection was not complete at the time of analysis; Wave 3 was selected based on the financial dependence and tobacco use measures assessed in this particular wave. Analyses were conducted using data from the 4195 participants who answered questions assessing ever tobacco use; 44 participants missing these data were excluded.
METHODS The current study used cross-sectional data from the Legacy Young Adult Cohort Study, a 3-year, 6-wave (5 waves completed to date) longitudinal study of 18-34 year-old Americans to examine tobacco use trajectories throughout young adulthood. This sample consists of Millennials as participants were born between 1977 and 1994.3 Participant recruitment and data collection have been described in detail elsewhere.23 Briefly, the cohort consisted of members of an online panel of US adults recruited via address-based sampling, a probability-based random sampling method that generates a nationally representative sample. Pan-
Measures Sociodemographic items assessed included age (years); sex (men, women); race/ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic, Other non-Hispanic); employment status (employed ≥35 hours per week, employed 15-34 hours per week, employed
