Alcohol and Alcoholism Advance Access originally published online on August 10, 2009
Alcohol and Alcoholism 2009 44(5):491-499; doi:10.1093/alcalc/agp042
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The Neighborhood Alcohol Environment and Alcohol-Related Morbidity
1 Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA, USA
2 RAND Corporation, Santa Monica, CA, USA
3 California State University Dominguez Hills, Carson, CA, USA
4 Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
* Corresponding author: Louisiana State University Health Sciences Center, School of Public Health, 1615 Poydras St., Suite 1400, Room 1536, New Orleans, LA 70112. Tel: +(504) 568-5936; Fax: +(504) 568-5701; E-mail: kthea1{at}lsuhsc.edu
Received 4 March 2009; first review notified 23 April 2009; in revised form 15 July 2009; accepted 17 July 2009; advance access publication 10 August 2009
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Abstract |
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Aims: The aims of this study were (1) to examine the association between neighborhood alcohol outlet density and individual self-reported alcohol-related health outcomes in the last year—sexually transmitted infections (STI), motor vehicle accidents, injury, liver problems, hypertension and experienced violence; (2) to determine whether the relationship between morbidity and alcohol outlet density is mediated by individual alcohol consumption; and (3) to explore the role of alcohol outlet density in explaining any observed racial and ethnic differences in morbidity. Method: Hierarchical models from a random sample of Los Angeles, CA, and Louisiana residents (N = 2881) from 217 census tracts were utilized. The clustering of health and social outcomes according to neighborhood varied by health problem examined. Results: There was substantial clustering of STI (intraclass correlation coefficient, ICC = 12.8%) and experienced violence (ICC = 13.0%); moderate clustering of liver problems (ICC = 3.5%) and hypertension (ICC = 3.9%); and low clustering of motor vehicle accident (ICC = 1.2%) and injury (ICC = 1.4%). Alcohol outlet density was significantly and positively associated with STI (crude OR = 1.80, 95% CI = 1.10–3.00), liver problems (crude OR = 1.33, 95% CI = 1.02–1.75) and experienced violence (crude OR = 1.31, 95% CI = 1.13–1.51) although not with other morbidity outcomes. Mediation analyses of morbidity outcomes revealed partial mediation of individual alcohol consumption in the relationship between alcohol density and STI and violence, and full mediation for liver problems. Conclusions: Findings support the concept that off-premise alcohol outlets in the neighborhood environment may impact health and social outcomes, either directly or indirectly, through individual alcohol consumption and these associations may be heterogeneous with respect to race and ethnicity.