Unequal effects of health behaviors in adolescence on adult cardiovascular disease and hypertension by family financial situation in the US: A cohort study

BackgroundAdolescent health risk behaviors may have unequal effects on adult cardiovascular diseases (CVDs) and hypertension, with individuals from disadvantaged socioeconomic backgrounds potentially experiencing stronger harmful effects due to heightened susceptibility. Using data from the US National Longitudinal Study of Adolescent to Adult Health, we quantified differential effects of adolescent health behaviors on CVDs and hypertension by family financial situation. MethodsWe identified behavior clusters via latent class modeling and estimated effects using double-robust inverse probability weighted methods. Exposures were adolescent health risk behaviors (breakfast skipping, cigarette smoking, frequent alcohol use, and infrequent physical activity), measured at ages 12-19 (1994-1995, n=4452), with parental difficulty paying bills as the effect modifier. CVDs and hypertension were assessed at ages 33-43 (2016-2018) using biomarkers and self-reports. ResultsAfter 21 years, 33.2% of participants had CVD or hypertension. Frequent alcohol use and concurrent cigarette smoking led to 11.1 percentage points more cases (95% CI: 0.1-22.1) among adolescents with parental financial difficulty compared to peers without. Alcohol use alone exhibited a differential effect of 9.7 percentage points (95% CI: 0.8-18.5). The differential effect of breakfast skipping was inconsistent across sensitivity analyses, and no strong evidence was found for infrequent physical activity. ConclusionsThese findings from a US cohort indicate that frequent alcohol use in adolescence, particularly with concurrent smoking, increases risk of adult CVD and hypertension unequally based on socioeconomic background. This differential susceptibility suggests that population-level interventions targeting alcohol use and concurrent smoking could help reduce cardiovascular inequalities.