Income Inequality and Socioeconomic Disparities in Alcohol Use Among Eastern European Adolescents: A Multilevel Analysis

Purpose: In this study, we tested the “golden youth” hypothesis, which suggests that in Eastern Europe, affluent adolescents are at an increased risk of alcohol use. Also, we hypothesized that the relationship between high socioeconomic position (SEP) and more alcohol use is stronger in countries with wider income inequality. Methods: In total, 50,421 adolescents aged 13–15 years were included from 16 Eastern European countries participating in the 2013–2014 Health Behaviour in School-aged Children survey. Multilevel logistic regression analyses were performed. Results: Affluent adolescents had greater odds of weekly alcohol use (OR = 1.32, 95% CI = 1.23–1.41) and binge drinking (OR = 1.24, 95% CI = 1.16–1.32) than their peers from low-SEP families. However, no significant difference was observed between middle- and low-SEP adolescents. In countries with wider income inequality, the relationship between high family-SEP and weekly alcohol use (p interaction = .006), as well as high family-SEP and binge drinking (p interaction = .007), was stronger compared to countries with lower income inequality. Discussion: Possibly, influenced by the lifestyle choices of their parents, and using alcohol as a status symbol to establish and maintain friendly relationships with peers, Eastern European adolescents from affluent families, particularly in the most unequal settings, are at increased risk of alcohol use, confirming the golden youth hypothesis. Insecure self-image and perceived threat to their high status might be explanatory factors. More research is needed to identify the precise individual and family characteristics responsible for increased alcohol use among wealthy adolescents, especially in Eastern European countries with high income inequality.