Microecological Relationships Between Area Income, Off‐Premise Alcohol Outlet Density, Drinking Patterns, and Alcohol Use Disorders: The East Bay Neighborhoods Study
Original Article
Abstract
Background
Distinguishing the impacts of neighborhood income and off‐premise alcohol outlet density on alcohol use has proven difficult, particularly given the conflation of these measures across neighborhood areas.
The researchers explicitly test for differential effects related to individual and area income and outlet densities on alcohol use and alcohol use disorders (AUDs) by implementing a stratified microecological sample.
Methods
The East Bay Neighborhoods Study included a survey of 984 residents of 72 microenvironments within a geographically contiguous 6‐city area in California and Systematic social observations of each site. The sites included 18 areas in each of 4 strata (high/low median household income and off‐premise outlet density).
The researchers assessed 4 outcomes:
- 28‐day alcohol use frequency,
- average quantity of alcohol consumed per occasion,
- 28‐day alcohol use volume, and
- Alcohol Use Disorders Identification Test (AUDIT) score.
The researchers used zero‐inflated negative binomial regression with standard errors adjusted for site clusters to relate alcohol use measures to individual‐level age, race/ethnicity, gender, marital status, education, and income, and neighborhood indicators of site strata, physical disorder, and physical decay.
An interaction term was tested representing site‐level by individual‐level income.
Results
Living in a high‐income site, regardless of off‐premise alcohol outlet density, was associated with more frequent alcohol use and higher alcohol dependence/problems.
Both individual‐level income and site‐level income were related to greater frequencies of use, but lower income alcohol users in high‐income areas consumed more alcohol than comparable alcohol users in low‐income areas.
Study participants living in high‐density off‐premise alcohol outlet sites consumed alcohol less frequently but did not differ in terms of either AUDIT scores or heavy alcohol use from participants living in low‐density sites.
Conclusions
Using a stratified microecological sampling design, the researchers were able to directly assess statistical associations of off‐premise outlet density and neighborhood median household income with patterns of alcohol use and AUDs.
Caution should be used interpreting prior study findings linking off‐premise outlet densities to alcohol use.