Neighborhood Environment and Alcohol Health Disparities

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DESCRIPTION (provided by applicant): Neighborhood Environments and Alcohol Health Disparities A growing literature demonstrates that alcohol health disparities are associated with community level risk factors independent of individual race and SES. While race and individual SES are strongly associated with health disparities, neighborhood level constructs like income inequality, social capital and neighborhood conditions have independent effects on health outcomes. Alcohol outlet density is a neighborhood level condition associated with numerous outcomes responsible for alcohol disparities (e.g., intentional and unintentional injury deaths or alcohol related mortality). However, the two competing models that have been put forward to explain the effects of community level constructs on individual health view the role of alcohol outlet density differently. The psychosocial model views alcohol outlet density as a reflection of low social capital while the environmental model views alcohol outlet density as part of the causal pathway. The 1992 Civil Unrest in South Central Los Angeles resulted in 279 alcohol outlets ceasing operation. A "natural experiment" is proposed. The study area is defined as the 477 census tracts that make of the region of Los Angeles County where the civil unrest took place. Annual mortality rates (i.e. injury mortality, alcohol related mortality, and all cause mortality) and alcohol outlet densities will be generated using a Geographic Information System (GIS) for all years from 1988 to 2000. Additional measures assessing social capital and compositional measures of neighborhood socio-demographics will also be included as study measures. The hierarchical panel analysis with controls for spatial and temporal autocorrelation will test the primary study hypothesis H1: Neighborhoods in which alcohol sales ceased for one or more outlets should have experienced lower rates of alcohol related mortality after their closure if alcohol outlet density is causally linked to outcomes. Additional analysis using the results of a qualitative assessment of the effort of neighborhoods to prevent the rebuilding of outlets will attempt to control for the potential selection bias caused by non randomization. Differentiating between explanatory models accounting for alcohol health disparities is essential for the development of effect preventive interventions since the two models suggest dramatically different approaches in addresses health disparities at the neighborhood level.