Comparing the Effectiveness of City Policy and Structure in Health Disparities

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DESCRIPTION (provided by applicant): This application addresses the broad Challenge Area (05) Comparative Effectiveness Research. Within this Challenge Area the specific Challenge Topic is 05-MD-101: Social Determinants of Health. This study's goal is to compare the effectiveness of a city level policy in New Orleans to control problem alcohol outlets that contribute to health inequalities among poor and minority populations. In 1997 the City of New Orleans adopted a series of policies that in effect represent a societal intervention to address the social determinants of health disparities in poor and minority neighborhoods, where problem alcohol outlet proliferation is a major problem. The policies were specifically enacted to address the proliferation of problem alcohol outlets believed to be the source of a variety of social problems including assaultive violence as well as adverse health effects. To accomplish this goal a longitudinal study of the effect of changes in alcohol outlet exposure on assaultive violence as well as alcohol related mortality is proposed. The study will span ten years (i.e., 1994 through 2004). It will be organized at the census tract level, the unit of analysis most strongly associated with structural effects associated with alcohol outlet exposure. The study will be conducted in two Louisiana cities: New Orleans and Baton Rouge. Since the policies were enacted in New Orleans, census tracts there will serve as "intervention" tracts while census tracts in Baton Rouge serve as the "control" tracts. Study Hypothesis 1: Among census tracts in New Orleans the trend in assaultive violence and alcohol-related mortality outcomes over the study period will demonstrate a significantly more negative slope than occurs among census tracts in Baton Rouge. Study Hypothesis 2: Decreases in alcohol outlet density at the census tract level will explain a significant amount of the trend in assaultive violence and alcohol-related mortality over the study period. Demonstrating that policy change at the city level designed to remedy a social inequality will result in a corresponding reduction is health disparities would represent a major contribution to the public health literature. The proposed project is designed to do just that. Compare the effectiveness of an alcohol control policy on rates of assaultive violence and alcohol related mortality across neighborhoods in two cities, one where the policy was enacted and one where it was not.