Social capital and the neighborhood alcohol environment

The relationship between neighborhood social capital and health from a biopsychosocial perspective: A systematic review

BACKGROUND

The Social Determinants of Health (SDH) influence the health of people throughout their lives, and can be positive, protective or risk factors for the population and, in turn, biological, psychological, or social. The social environment conditions the health status of the neighborhood, population, and social group, which can be a health asset due to its strong psychosocial and socio-cultural influence. Social capital is a community asset of the healthy neighborhood that must be known in order to promote community health.

OBJECTIVES

The objective is to determine the relationship between social capital and neighborhood biopsychosocial health.

METHODS

A systematic review was conducted based on PRISMA: PubMed, Wos, Scopus, Embase, and Cochrane databases. The search was conducted from January to March 2023. Three authors independently extracted data using a structured form.

RESULTS

Out of 527 records, 17 results passed the inclusion and exclusion criteria. The positive and statistically significant relationship between neighborhood social capital (NSC) and the physical and mental health of neighbors is confirmed, that is, the higher the NSC, the more exercise, better oral health in children and physical health in pregnant women, lower tobacco consumption and lower prevalence of human immunodeficiency virus. At the psychological level, greater NSC leads to better mental health, mental well-being, life satisfaction, quality of life, self-perceived health, higher cognitive function, and less depression.

CONCLUSIONS

In conclusion, social capital is an important SDH and health asset that influences neighborhood biopsychosocial health and should be known and researched for health promotion in community settings. More evidence is needed to support the results obtained.

Perceived Neighbourhood Disorder, Alcohol Consumption and Alcohol-Related Problems in Chile

Background: Alcohol misuse is one of the most important preventable public health risk factors. Empirical research shows that alcohol misuse is related to social and economic losses. Both theoretical and empirical evidence suggests that neighborhood disorder impacts alcohol-related behavior. However, there is limited literature in the context of developing countries. Objectives: The aim of this research is to estimate the association between perceived neighborhood disorder and (1) alcohol-related behavior and (2) alcohol-related problems in the context of the Chilean population. Our contribution focuses on the examination of the perception of disorder in urban neighborhoods and alcohol use patterns in a wide age range and sample of Chilean cities. Results: High levels of neighbor disorder perception are associated with higher levels of drinking and hazardous alcohol use. In addition, perceived neighborhood disorder is directly associated with probability of alcohol-related problems (ranging from 2% to 11%). Conclusions/Importance: The results are consistent with empirical and theoretical frameworks. This research could be used to better guide place-based policies in emerging countries with high levels of alcohol consumption to prevent alcohol risk behaviors and alcohol-related problems.

Stress and Distress during the COVID-19 Pandemic: The Role of Neighborhood Context

Neighborhoods play a central role in health and mental health, particularly during disasters and crises such as the COVID-19 pandemic. We examined changes in psychological distress following the pandemic, and the potential role of neighborhood conditions among 244 residents of New Orleans, Louisiana. Using modified linear regression models, we assessed associations between neighborhood characteristics and change in psychological distress from before to during the pandemic, testing effect modification by sex and social support. While higher density of offsite alcohol outlets (β = 0.89; 95% CI: 0.52, 1.23), assault rate (β = 0.14; 95% CI: 0.03, 0.24), and walkable streets (β = 0.05; 95% CI: 0.02, 0.07) in neighborhoods were associated with an increase in distress, access to neighborhood parks (β = −0.03; 95% CI: −0.05, −0.01), collective efficacy (β = −0.23; 95% CI: −0.35, −0.09), and homicide rate (β = −1.2; 95% CI: −1.8, −0.6) were associated with reduced distress related to the pandemic. These relationships were modified by sex and social support. Findings revealed the important but complicated relationship between psychological distress and neighborhood characteristics. While a deeper understanding of the neighborhoods’ role in distress is needed, interventions that target neighborhood environments to ameliorate or prevent the residents’ distress may be important not only during crisis situations.

Alcohol outlets, drug paraphernalia sales, and neighborhood drug overdose

BACKGROUND

Alcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association.

METHODS

A cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly.

RESULTS

Each additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose.

CONCLUSION

This study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws.

Exposure to alcohol outlets, alcohol access, and alcohol consumption among adolescents

BACKGROUND

Adolescents who live near more alcohol outlets tend to consume more alcohol, despite laws prohibiting alcohol purchases for people aged <21 years. We examined relationships between adolescents' exposure to alcohol outlets, the sources through which they access alcohol, and their alcohol consumption.

METHODS

Participants for this longitudinal study (n = 168) were aged 15-18 years and were from 10 cities in the San Francisco Bay Area. We collected survey data to measure participant characteristics, followed by 1 month of GPS tracking to measure exposure to alcohol outlets (separated into exposures near home and away from home for bars, restaurants, and off-premise outlets). A follow-up survey approximately 1 year later measured alcohol access (through outlets, family members, peers aged <21 years, peers aged ≥21 years) and alcohol consumption (e.g. count of drinking days in last 30). Generalized structural equation models related exposure to alcohol outlets, alcohol access, and alcohol consumption.

RESULTS

Exposure to bars and off-premise outlets near home was positively associated with accessing alcohol from peers aged <21, and in turn, accessing alcohol from peers aged <21 was positively associated with alcohol consumption. There was no direct association between exposure to alcohol outlets near home or away from home and alcohol consumption.

CONCLUSIONS

Interventions that reduce adolescents' access through peers aged <21 may reduce adolescents' alcohol consumption.

Neighborhood Alcohol Environment: Differential Effects on Hazardous Drinking and Mental Health by Sex in Persons Living with HIV (PLWH)

Despite greater mental health co-morbidities and heavier alcohol use among PLWH, few studies have examined the role of the neighborhood alcohol environment on either alcohol consumption or mental health. Utilizing cross-sectional data from a cohort study in a southern U.S. metropolitan area, we examine the association between neighborhood alcohol environments on hazardous drinking and mental health among 358 in-care PLWH (84% African American, 31% female). Multilevel models were utilized to quantify associations between neighborhood alcohol exposure on hazardous drinking and effect modification by sex. Neighborhood alcohol density was associated with hazardous drinking among men but not women. Women living in alcohol dense neighborhoods were nearly two-fold likely to report depression compared to those in less dense neighborhoods, with no association between neighborhood alcohol density and depression among men. Neighborhood alcohol environments may be an important contextual factor to consider in reducing heavy alcohol consumption and improving mental health among PLWH.

Neighborhood crime, disorder and substance use in the Caribbean context: Jamaica National Drug Use Prevalence Survey 2016

The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12–65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.

Social Capital and Tobacco Retail Outlet Density: An Empirical Test of the Relationship

PURPOSE

To examine the relationship between tobacco outlet density and social capital.

PARTICIPANTS

Parents of at least one teen (N = 2734) in a representative sample of US households with teens (ages 13-16).

DESIGN

Population-based, cross-sectional survey of a web panel of adolescent-parent pairs matched with spatial data for address to characterize household neighborhoods.

SETTING

US households identified by latitude and longitude with a 50-ft random shift.

MEASURES

Perceived social capital (trust and informal social control as reported by parents), tobacco outlet density (retailers per land area in 1/2-mile buffer around each household), neighborhood demographics (derived from American Community Survey), and parent demographics.

ANALYSIS

Multivariable regression examined the relationship between tobacco outlet density and social capital controlling for household buffer and individual-level covariates, including correlates of social capital.

RESULTS

Tobacco outlet density was inversely correlated with perceived trust in neighbors (B = -1.12, P = .0004), but not social control (B = 0.11, P = .731).

CONCLUSION

This study is the first we are aware of to find that social capital is related to tobacco outlet density. The results imply that individuals with low social capital may benefit from policies regulating tobacco outlet density and may benefit from policies that address neighborhood inequality by increasing social capital and reducing poverty.

Understanding the relationship between alcohol outlet density and life expectancy in Baltimore City: The role of community violence and community disadvantage

This research investigated the relationship between alcohol outlet density (AOD) and life expectancy, as mediated by community violence and community disadvantage. We used linear regression models to assess bivariate and multivariate relationships. There was a negative bivariate association between liquor store density and average life expectancy (β = -7.3370, p < 0.001). This relationship was partially attenuated when controlling for community disadvantage and fully attenuated when controlling for community violence. Bars/taverns (i.e., on-premise) were not associated with average life expectancy (β = -0.589, p = 0.220). Liquor store density is associated with higher levels of community disadvantage and higher rates of violence, both of which are associated with lower life expectancies. Future research, potential intervention, and current related policies are discussed.

The neighbourhood social environment and alcohol use among urban and rural Scottish adolescents

OBJECTIVES

This research examined the relationship between neighbourhood social environmental characteristics and drinking outcomes among a sample of urban and rural adolescents.

METHODS

From a sample of 1558 Scottish secondary schoolchildren, surveyed as part of the 2010 Health Behaviour in School-aged Children study, we modelled three drinking outcomes on a variety of neighbourhood conditions, including social cohesion, disorder, alcohol outlet density, deprivation, and urban/rurality. Nested and cross-classified multilevel logistic regressions were specified.

RESULTS

An urban-to-rural gradient was found with non-urban adolescents exhibiting higher odds of having ever drank. Neighbourhood social cohesion related to having ever drank. Among drinkers, those living in accessible small towns had higher odds of weekly drinking and drunkenness compared to urban areas. Higher odds of drunkenness were also found in remote rural areas. Those residing in the least deprived areas had lower odds of weekly drinking.

CONCLUSIONS

In Scotland, inequalities exist in adolescent alcohol use by urban/rurality and neighbourhood social conditions. Findings support regional targeting of public health efforts to address inequalities. Future work is needed to develop and evaluate intervention and prevention approaches for neighbourhoods at risk.

Alcohol Outlets, Neighborhood Retail Environments, and Pedestrian Injury Risk

BACKGROUND

Alcohol outlet density has been associated with increased pedestrian injury risk. It is unclear whether this is because alcohol outlets are located in dense retail areas with heavy pedestrian traffic or whether alcohol outlets contribute a unique neighborhood risk. We aimed to compare the pedestrian injury rate around alcohol outlets to the rate around other, similar retail outlets that do not sell alcohol.

METHODS

A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury emergency medical services (EMS) records from January 1, 2014 to April 15, 2015 (n = 848); locations of alcohol outlets licensed for off-premise (n = 726) and on-premise consumption (n = 531); and corner (n = 398) and convenience stores (n = 192) that do not sell alcohol. Negative binomial regression was used to determine the relationship between retail outlet count and pedestrian injuries, controlling for key confounding variables. Spatial autocorrelation was also assessed and variable selection adjusted accordingly.

RESULTS

Each additional off-premise alcohol outlet was associated with a 12.3% increase in the rate of neighborhood pedestrian injury when controlling for convenience and corner stores and other confounders (incidence rate ratio [IRR] = 1.123, 95% confidence interval [CI] = 1.065, 1.184, p < 0.001). The attributable risk was 4.9% (95% CI = 0.3, 8.9) or 41 additional injuries. On-premise alcohol outlets were not significant predictors of neighborhood pedestrian injury rate in multivariable models (IRR = 0.972, 95% CI = 0.940, 1.004, p = 0.194).

CONCLUSIONS

Off-premise alcohol outlets are associated with pedestrian injury rate, even when controlling for other types of retail outlets. Findings reinforce the importance of alcohol outlets in understanding neighborhood pedestrian injury risk and may provide evidence for informing policy on liquor store licensing, zoning, and enforcement.

Alcohol use and change over time in firearm safety among families with young children

BACKGROUND

Improperly stored firearms pose a clear health risk to children. Previous research concurrently links alcohol use with lower levels of firearm safety. The objectives of this study were to assess (1) how families move from unsafe to safer firearm storage practices and (2) how parental drinking was associated with moving away from unsafe firearm storage practices.

METHODS

This study used data from the Early Childhood Longitudinal Study-Birth Cohort, 2003 when children were two years old and again when they were four years old. Parents were asked about firearm storage practices, alcohol consumption, and information to measure other confounding variables. Their responses were used to identify families who engaged in unsafe firearm storage practices (n = 650) during the initial testing period and to assess how alcohol consumption and other variables were associated with moving to safer firearm storage practices at the second testing period.

RESULTS

Families grew more likely to adopt safer firearm storage practices as their children aged, compared with continuing unsafe practices. Multivariate logistic regressions indicated that parental drinking, however, reduced the likelihood that parents moved to safer storage practices, controlling for covariates. Other families- and community-level variables, in particular, family structure, were also associated with the likelihood of moving to safer firearm storage behaviors.

CONCLUSIONS

Families with higher levels of alcohol use may need additional assistance in addressing firearm safety. The findings call for future research to better understand how physicians can counsel at-risk families to help them store firearms more securely.

Neighbourhood alcohol environment and injury risk: a spatial analysis of pedestrian injury in Baltimore City

OBJECTIVES

The purpose of this study was to investigate the contribution of neighbourhood disorder around alcohol outlets to pedestrian injury risk.

METHODS

A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury EMS records from 1 January 2014 to 15 April 2015 (n=858), off-premise alcohol outlet locations for 2014 (n=693) and neighbourhood disorder indicators and demographics. Negative binomial regression models were used to determine the relationship between alcohol outlet count and pedestrian injuries at the block group level, controlling for other neighbourhood factors. Attributable risk was calculated by comparing the total population count per census block group to the injured pedestrian count.

RESULTS

Each one-unit increase in the number of alcohol outlets was associated with a 14.2% (95% CI 1.099 to 1.192, P<0.001) increase in the RR of neighbourhood pedestrian injury, adjusting for traffic volume, pedestrian volume, population density, per cent of vacant lots and median household income. The attributable risk was 10.4% (95% CI 7.7 to 12.7) or 88 extra injuries. Vacant lots was the only significant neighbourhood disorder indicator in the final adjusted model (RR=1.016, 95% CI 1.007 to 1.026, P=0.003). Vacant lots have not been previously investigated as possible risk factors for pedestrian injury.

CONCLUSIONS

This study identifies modifiable risk factors for pedestrian injury previously unexplored in the literature and may provide evidence for alcohol control strategies (eg, liquor store licencing, zoning and enforcement).

How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters?

BACKGROUND

Place of residence has been associated with HIV transmission risks. Social capital, defined as features of social organization that improve efficiency of society by facilitating coordinated actions, often varies by neighborhood, and hypothesized to have protective effects on HIV care continuum outcomes. We examined whether the association between social capital and 2 HIV care continuum outcomes clustered geographically and whether sociocontextual mechanisms predict differences across clusters.

METHODS

Bivariate Local Moran's I evaluated geographical clustering in the association between social capital (participation in civic and social organizations, 2006, 2008, 2010) and [5-year (2007-2011) prevalence of late HIV diagnosis and linkage to HIV care] across Philadelphia, PA, census tracts (N = 378). Maps documented the clusters and multinomial regression assessed which sociocontextual mechanisms (eg, racial composition) predict differences across clusters.

RESULTS

We identified 4 significant clusters (high social capital-high HIV/AIDS, low social capital-low HIV/AIDS, low social capital-high HIV/AIDS, and high social capital-low HIV/AIDS). Moran's I between social capital and late HIV diagnosis was (I = 0.19, z = 9.54, P < 0.001) and linkage to HIV care (I = 0.06, z = 3.274, P = 0.002). In multivariable analysis, median household income predicted differences across clusters, particularly where social capital was lowest and HIV burden the highest, compared with clusters with high social capital and lowest HIV burden.

DISCUSSION

The association between social participation and HIV care continuum outcomes cluster geographically in Philadelphia, PA. HIV prevention interventions should account for this phenomenon. Reducing geographic disparities will require interventions tailored to each continuum step and that address socioeconomic factors such as neighborhood median income.

Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state

OBJECTIVES

To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs.

DESIGN

A cross-sectional analysis of public hospital episode data (2007-2013).

SETTING

Hospitalisations from the ACT, Australia at very small geographic areas.

PARTICIPANTS

Secondary data on 75 290 unique hospital episodes representing 39 851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity.

MAIN EXPOSURE MEASURES

Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability.

MAIN OUTCOME MEASURES

Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers.

RESULTS

Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestyle-related cancers.

CONCLUSIONS

Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health.

Differential Effects of Neighborhood Type on Adolescent Alcohol Use in New Zealand

Identifying neighborhood typologies associated with adolescent alcohol use can inform the development of harm reduction strategies. Utilizing data from a nationally representative youth survey (n = 4267) in New Zealand, latent class analysis was used to categorize neighborhood types (defined by 10 demographic, social and environmental indicators) to investigate their association with alcohol consumption and related harm. Three neighborhood types were distinguished: (1) "high outlet density and economic deprivation" (30 % of all neighborhoods); (2) "high deprivation, social disorganization, and unsafe" (38 %); and (3) "higher income, safe, and socially organized" (32 %). Significant ethnic variation was evident between neighborhood types. There was an age-group interaction in the main effects with significant associations between neighborhood type and drinking measures and harm most apparent among younger adolescents (<16 years), as described next. Compared to students residing in "higher income, safe, and socially organized" neighborhoods, the frequency of binge drinking and high typical consumption was significantly higher in students residing in "high outlet density and economic deprivation" and "high deprivation, social disorganization, and unsafe", with students residing in "high outlet density and economic deprivation" also experiencing higher levels of alcohol-related harm. The findings that neighborhoods characterized by high deprivation and alcohol outlet density and low social organization and perceptions of safety were associated with risky drinking patterns and harm, specifically among young adolescents, underscores the importance of adopting a developmental approach to the study of contextual effects on adolescents.

Bars and nightclubs associated with higher HIV prevalence

BACKGROUND

Alcohol outlet density is positively associated with alcohol consumption and a number of related risk behaviors. However, very little is known about the effects of different types of alcohol outlets on HIV prevalence. The current cross-sectional study examines associations between the number of each type of alcohol outlet and HIV prevalence within 350 cities located in 26 U.S. metropolitan statistical areas.

METHODS

State and local health department and U.S. Census Bureau surveillance data were analyzed from 1056 ZIP codes, where an estimated 39 million people reside. Multilevel negative binomial regression models were used to examine the association between the number of each type of alcohol outlet in ZIP codes and HIV prevalence.

RESULTS

Number of on-premise alcohol outlets within a ZIP code was associated with greater HIV prevalence. In this sample, the presence of one additional on-premise outlet in a ZIP code was associated with a 1.5% increase in the HIV prevalence rate in that location.

CONCLUSION

This study extends previous research by examining the relationship between alcohol outlets and HIV prevalence in a large sample of U.S. ZIP codes. Research is needed to more closely examine the mechanisms by which on-premise alcohol outlets may affect HIV transmission. Effective policies to reduce HIV transmission may include limiting the density of on-premise alcohol establishments.

Household and neighborhood conditions partially account for associations between education and physical capacity in the National Health and Aging Trends Study

Socioeconomic resources, such as education, prevent disability but are not readily modifiable. We tested the hypothesis that household and neighborhood conditions, which may be modifiable, partially account for associations between education and physical capacity in a population-based sample of older adults. The National Health and Aging Trends Study measured education (<high school, high school, some college, and ≥Bachelor's), household and neighborhood conditions, using a 16-item environmental checklist and a 3-item social cohesion scale, and physical capacity with the Short Physical Performance Battery (SPPB), grip strength and peak expiratory flow. Structural equation models were used to decompose total educational effects into direct effects and indirect effects via household and neighborhood conditions, using sample weights and adjusting for age, sex, race/ethnicity, marital status, household size, BMI, self-reported health, and number of medical conditions in 6874 community-dwelling participants. Education was directly associated with SPPB scores (β = 0.055, p < 0.05) and peak flow (β = 0.095, p < 0.05), but not grip strength. Also, indirect effects were found for household disorder with SPPB scores (β = 0.013, p < 0.05), grip strength (β = 0.007, p < 0.05), and peak flow (β = 0.010, p < 0.05). Indirect effects were also found for street disorder with SPPB scores (β = 0.012, p < 0.05). Indirect effects of household and neighborhood conditions accounted for approximately 35%, 27% and 14% of the total association between education and SPPB scores, grip strength level, and peak expiratory flow level, respectively. Household disorder and street disorder partially accounted for educational disparities in physical capacity. However, educational disparities in SPPB scores and peak expiratory flow persisted after accounting for household and neighborhood conditions and chronic conditions, suggesting additional pathways. Interventions and policies aiming to support aging in place should consider addressing household-level and street-level disorder.

The impact of spatial and temporal availability of alcohol on its consumption and related harms: a critical review in the context of UK licensing policies

ISSUES

Reviews recommend controlling alcohol availability to limit alcohol-related harm. However, the translation of this evidence into policy processes has proved challenging in some jurisdictions.

APPROACH

This paper presents a critical review of empirical spatial and temporal availability research to identify its features and limitations for informing alcohol availability policies. The UK is used as an example jurisdiction. It reviews 138 studies from a 2008 systematic review of empirical availability research and our update of this to January 2014. Data describing study characteristics (settings, measures, design) were extracted and descriptively analysed.

KEY FINDINGS

Important limitations in current evidence were identified: (i) outlet-level temporal availability was only measured in three studies, and there has been little innovation in measurement of spatial availability; (ii) empirical analyses focus on acute harms with few studies of longer-term harms; (iii) outlets are typically classified at aggregated levels with little empirical analysis of variation within outlet categories; (iv) evidence comes from a narrow range of countries; and (v) availability away from home, online availability and interactions between availability, price and place are all relatively unexamined.

IMPLICATIONS

Greater innovation in study and measure design and enhanced data quality are required. Greater engagement between researchers and policy actors when developing studies would facilitate this.

CONCLUSIONS

Research and data innovations are needed to address a series of methodological gaps and limitations in the alcohol availability evidence base, advance this research area and enable findings to be translated effectively into policy processes.

Neighbourhood availability of alcohol outlets and hazardous alcohol consumption in New Zealand

The socio-spatial arrangement of alcohol retailers is potentially important in understanding the relationship between neighbourhood context and 'excessive' alcohol consumption. This New Zealand study examines whether the availability of alcohol products is associated with individual-level alcohol consumption. Measures capturing the availability of alcohol retailers were calculated for neighbourhoods across the country and then appended to a national health survey. At the national level there was no evidence for an association between hazardous consumption and alcohol outlet access. However, there was evidence of associations with neighbourhood retailing for younger Māori and Pacific peoples males; younger European females; middle-aged European men; and older men. The findings provide evidence that 'alcogenic' environments are associated with excessive drinking in New Zealand, albeit that the associations are restricted to particular vulnerable groups.

Does walkable neighbourhood design influence the association between objective crime and walking?

Background

Few studies have investigated associations between objectively measured crime and walking, and findings are mixed. One explanation for null or counterintuitive findings emerges from criminology studies, which indicate that the permeable street layouts and non-residential land uses that underpin walkable neighbourhoods are also associated with more crime. This study examined associations between objective crime and walking, controlling for the characteristics of walkable neighbourhoods.

Methods

A population representative sample of adults (25–65 years) (n = 3,487) completed the Western Australian Health and Wellbeing Survey (2006–2008) demographic and walking frequency items. Objective environmental measures were generated for each participant’s 400 m and 1600 m neighbourhood areas, including burglary, personal crime (i.e., crimes committed against people) in public space, residential density, street connectivity and local destinations. Log-linear negative binomial regression models were used to examine associations between crime and walking frequency/week, with progressive adjustment for residential density, street connectivity and local destinations.

Results

Burglary and personal crime occurring within a participant’s 400 m and 1600 m neighbourhoods were positively and significantly associated with walking frequency. For example, for every additional 10 crimes against the person/year within 400 m of a participant’s home, walking frequency increased by 8% (relative change = 1.077, p = 0.017). Associations remained constant after controlling for residential density and street connectivity, but attenuated after adjusting for local destinations (e.g., for personal crime in 400 m: relative change = 1.054, p = 0.104). This pattern of attenuation was evident across both crime categories and both neighbourhood sizes.

Conclusions

The observed positive associations between objective crime and walking appear to be a function of living in a more walkable environment, as the presence of destinations has the capacity to both promote walking and attract crime. This study provides a plausible explanation for some mixed findings emerging from studies examining crime as a barrier to walking. In some settings, the hypothesised deterrent effect of crime on walking may be insufficient to outweigh the positive impacts of living in a more walkable environment.

Exploring Spatial Associations between On-Sale Alcohol Availability, Neighborhood Population Characteristics, and Violent Crime in a Geographically Isolated City

Objectives. Despite the increasing evidence of the associations between alcohol availability and violence, there are still inconsistent findings on the effects of on- and off-sale alcohol outlets on violent crime. The aim of this study was to examine spatial associations between on-sale alcohol availability, neighborhood characteristics, and violent crime in a geographically isolated city in Texas. Methods. Geographically weighted regression (GWR) and global regression models were employed to analyze the nature of the spatial relationship between violent crime, neighborhood sociocultural characteristics, and on-sale alcohol environment. Results. We found strong effects of neighborhood characteristics combined with on-sale alcohol availability on violence outcomes. Several neighborhood variables combined with alcohol availability explained about 63% of the variability in violence. An additional 7% was explained by the GWR model, while spatially nonstationary associations between violence and some predictor variables were observed. Conclusions. This study provided more credible evidence of the influence of on-sale alcohol outlets on violence in a unique setting. These findings have important policy implications in addressing the question of public health consequences of alcohol-related violence in local contexts.

Linking Places to Problems: Geospatial Theories of Neighborhoods, Alcohol and Crime

This paper provides a critical review of two broad categories of social ecological theories of crime, social integration and place-based theories, and their relationships to spatial assessments of crime patterns. Social integration theories emphasize the role of neighborhood disorganization on crime, while place theories stress the social interactions within and between places as a source of crime. We provide an analysis of the extent to which these two types of theorizing describe processes and mechanisms that are truly ecologic (identify specific interactions between individuals and their environments) and truly spatial (identify specific movement and interaction patterns of individuals and groups) as they endeavor to explain crime outcomes. We suggest that social integration theories do not provide spatial signatures of sufficient specificity to justify the application of spatial statistical techniques as quantitative arbiters of the theory. On the other hand, place based theories go some way toward addressing these issues because the emphasis is placed on understanding the exact physical and social characteristics of place and the activities that occur around locations as sources of crime. Routine activities and crime potential theories attempt to explain clustering or "hot spots" of crime in ways that give clear spatial dimension by looking at micro-spatial interactions between offenders and targets of crime. These theories have strong ecological implications as well, since they contain specific statements about how people use the space around them and how these patterns of use are related to patterns of criminal activity. We conclude by identifying a set of requirements for successful empirical tests of geospatial theories, including the development of valid measures of key theoretical constructs and the formulation of critical empirical assessments of geospatial hypotheses derived from motivating theory.

Impact of individual-level social capital on quality of life among AIDS patients in China

Background

With growing recognition of the social determinants of health, social capital is an increasingly important construct in international health. However, the application of social capital discourse in response to HIV infection remains preliminary. The aim of this study was to assess the impact of social capital on quality of life (QoL) among adult patients with acquired immune deficiency syndrome (AIDS).

Methods

A convenient sample of 283 patients receiving antiretroviral treatment (ART) was investigated in Anhui province, China. QoL data were collected using the Medical Outcomes Study HIV Survey (MOS-HIV) questionnaire. Social capital was measured using a self-developed questionnaire. Logistic regression models were used to explore associations between social capital and QoL.

Results

The study sample had a mean physical health summary (PHS) score of 50.13±9.90 and a mean mental health summary (MHS) score of 41.64±11.68. Cronbach's α coefficients of the five multi-item scales of social capital ranged from 0.44 to 0.79. When other variables were controlled for, lower individual levels of reciprocity and trust were associated with a greater likelihood of having a poor PHS score (odds ratio [OR] = 2.02) or PHS score (OR = 6.90). Additionally, the factors of social support and social networks and ties were associated positively with MHS score (OR = 2.30, OR = 4.17, respectively).

Conclusions

This is the first report to explore the effects of social capital on QoL of AIDS patients in China. The results indicate that social capital is a promising avenue for developing strategies to improve the QoL of AIDS patients in China, suggesting that the contribution of social capital should be fully exploited, especially with enhancement of QoL through social participation. Social capital development policy may be worthy of consideration.

The association between neighborhood disorder, social cohesion and hazardous alcohol use: a national multilevel study

BACKGROUND

Evidence on associations of alcohol use with neighborhood disorder and social cohesion is limited. The aim of this study was to further investigate these associations.

METHODS

Individual data of 14,258 Dutch adults, living in 1546 neighborhoods across The Netherlands, were obtained from the 2006 to 2009 national health survey (POLS). Data on neighborhood disorder and social cohesion were derived from the 2006 Netherlands Housing Research (WoON). Hazardous drinking was measured as: ≥14, ≥21, and ≥28 drinks/week for women, and ≥21, ≥28, and ≥35 for men. Multilevel logistic regression models were adjusted for age, gender, ethnicity, marital status, education, income, wealth, predominant neighborhood religion, and population density. Potential mediation of psychological distress (depression and anxiety) and general mental health (MHI-5 score) was tested.

RESULTS

High neighborhood disorder was associated with more hazardous alcohol use for women (OR cut-off 3: 3.72 [2.03-6.83]), but not for men (OR cut-off 3: 1.08 [0.72-1.62]). There was no mediation by psychological distress, and modest mediation by general mental health. Social cohesion had no linear association with hazardous alcohol use, but for males moderate social cohesion was associated with more hazardous alcohol use (OR cut-off 1: 1.29 [1.08-1.53]). In predominantly Protestant neighborhoods this association seemed weaker.

CONCLUSIONS

Hazardous alcohol use seems to have a stronger and more consistent relationship with neighborhood disorder than with social cohesion. This suggests that negative aspects of the social environment have more impact on the prevalence of hazardous alcohol use than positive factors related to sociability and support.

MODELING BINGE DRINKING

We develop a two-stage (four component) model for youths with serious drinking problems and their treatment. The youths with alcohol problems are split into two classes, namely those who admit to having a problem and those who do not. It is shown that the model possesses two steady states, one where people have no alcohol problems and one where there is an endemic state involving those with an alcohol problem. The stability of these states is analyzed and a threshold established such that each state will be stable depending on whether the incidence rate is above or below the threshold. The model is analyzed in the context of actual data.

The neighborhood alcohol environment and at-risk drinking among African-Americans

BACKGROUND

Our objective was to examine whether components of the neighborhood alcohol environment-liquor store, on-premise outlet, convenience store, and supermarket densities-are positively associated with at-risk alcohol consumption among African-American drinkers.

METHODS

A multilevel cross-sectional sample of 321 African-American women and men ages 21 to 65 years recruited from April 2002 to May 2003 from three community-based healthcare clinics in New Orleans, Louisiana, was studied.

RESULTS

The alcohol environment had a significant impact on at-risk alcohol consumption among African-American drinkers, specifically liquor store density (adjusted OR = 3.11, 95% CI = 1.87, 11.07). Furthermore, the influence of the alcohol environment was much stronger for African-American female drinkers (adjusted OR = 6.96, 95% CI = 1.38, 35.08).

CONCLUSIONS

Treatment and prevention programs should take into account the physical environment, and the concentration of outlets in minority neighborhoods must be addressed as it poses potential health risks to the residents of these neighborhoods.

The contribution of urban foodways to health disparities

How do urban food environments produce health disparities? The literature currently emphasizes the etiologic relevance of urban food deserts and their nutritional shortcomings. This paper instead examines the health relevance of foodways--the social dynamics surrounding the production, purchase, and consumption of food. We report on data from 32 photo-elicitation interviews conducted with adult residents of Philadelphia, examining distinct foodways and health concerns that play out in the most commonly discussed retail establishments: corner stores, "Stop and Go's" (delis that also sell beer), and Chinese takeout restaurants. Corner store visits, described as a routinized element of children's school day, were implicated in early life patterning of unsound nutritional choices. Stop and Go's were described as a health threat because of their alcohol sales and tacit promotion of public drunkenness, coupled with accessibility to youth. Stop and Go's and Chinese takeouts both were perceived as generators of violence in part because of on-site sales of alcohol, drug paraphernalia, and illicit drugs. Chinese takeouts also were described as symbolic reminders of African Americans' economic exclusion and as places infused with race/ethnic tension and hostile merchant-customer interactions. Instead of viewing the food environment simply as a source of calories and nutrients, participants discussed the complex social dynamics that play out therein, raising a range of important considerations for (especially disadvantaged) urban residents' safety, physical well-being, and mental health.

HIV risk and the alcohol environment: advancing an ecological epidemiology for HIV/AIDS

The study of individual risk factors is inadequate to address the current public health challenges associated with HIV/AIDS. Rather, an ecological epidemiological study of HIV/AIDS is needed to address these challenges. A socioecological framework has been proposed for HIV/AIDS, including influences at the individual level, the interpersonal level, the neighborhood level, and the societal level. This framework provides the basis for a conceptual model with specific risk factors at each of these levels and cross-level associations. The nature of the associations also is important, in particular the assumption that the neighborhood alcohol environment exerts its effect on HIV risk through both direct and indirect pathways.

The neighborhood alcohol environment and alcohol-related morbidity

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.

Alcohol outlets and youth alcohol use: exposure in suburban areas

The purpose of this study was to explore how exposure to alcohol outlets (around home and school) influenced alcohol use among 242 high-school students (mean age 16.4, 48.8% male, 93.4% White). Results found no relationship between alcohol outlet exposure, using a measure of both distance to and density around students' homes and schools, and alcohol use. This study suggests that outlet exposure may not influence alcohol use among mostly White, middle-class, and suburban youth. However, the lack of association may also reflect the lower level of alcohol outlets present in low-density residential environments as well as differences in accessibility.