A Multilevel Analysis of Social Environmental Factors Related to Substance Use, Tobacco Use, and Binge Drinking Behaviors Among Older Adults.

Abstract

Social environmental factors are associated with risky health behaviors. However, limited research examines these relationships among older adults and across multiple levels of the social environment. This study analyzed data from a 2021 survey of older adults (aged ≥50 years, n=2,774) in the mid-Atlantic region of the U.S. Using a socioecologic framework, the social environment was measured at the levels of the individual (loneliness, resilience, perceived discrimination), interpersonal (emotional social support), neighborhood (attraction to neighborhood, acts of neighboring, sense of belonging), and community (crime, area deprivation, racial residential segregation). Generalized structural equation models were used to examine the pathways from multilevel social environmental factors to risk behaviors (substance misuse, tobacco use, binge drinking), controlling for age, sex (male or female), race/ethnicity, marital status, educational level, household income, and metropolitan status. Analyses were conducted in 2024. Individual characteristics, including higher loneliness and discrimination and lower resilience, were associated with a higher likelihood of risk behaviors. Attraction to neighborhood, acts of neighboring, and sense of belonging were indirectly, negatively associated with risk behaviors through their relationships with individual characteristics and social support. However, acts of neighboring and sense of belonging were directly, positively associated with tobacco use and binge drinking. Racial segregation was indirectly, positively associated with risk behaviors through discrimination and neighborhood factors. A multilevel approach is essential for understanding risk behaviors among older adults. Enhancing the built environment to improve neighborhood attractiveness and addressing structural factors that contribute to racial segregation could help reduce risk behaviors in this population.