Neighborhood Environment and Alcohol Health Disparities

描述（由申请人提供）：邻里环境和酒精健康差异越来越多的文献表明，酒精健康差异与独立于个人种族和社会经济地位的社区风险因素有关。虽然种族和个人社会经济地位与健康差距密切相关，但社区层面的结构，如收入不平等，社会资本和社区条件对健康结果有独立的影响。酒精出口密度是与导致酒精差异的许多结果相关的街区水平条件（例如，故意和非故意伤害死亡或与酒精有关的死亡）。然而，两个相互竞争的模型，已经提出来解释社区水平的结构对个人健康的影响，认为不同的酒精出口密度的作用。社会心理模型将酒精出口密度视为低社会资本的反映，而环境模型将酒精出口密度视为因果途径的一部分。 1992年，洛杉矶中南部的内乱导致279家酒类商店停止营业。提出了一个“自然实验”。研究区域被定义为发生内乱的洛杉矶县的477个人口普查区。年死亡率（即受伤死亡率，酒精相关的死亡率，和所有原因的死亡率）和酒精出口密度将使用地理信息系统（GIS）从1988年到2000年的所有年份。评估社会资本的其他措施和社区社会人口统计学的组成措施也将被纳入研究措施。 控制空间和时间自相关的分层面板分析将测试主要研究假设H1：如果酒精出口密度与结果存在因果关系，则一个或多个酒精销售停止的社区在关闭后应该经历较低的酒精相关死亡率。使用社区努力的定性评估结果，以防止网点重建的额外分析将试图控制非随机化造成的潜在选择偏差。 解释模型之间的区别占酒精健康差距是必不可少的效果预防干预措施的发展，因为这两个模型提出了显着不同的方法，在解决健康差距在社区一级。

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.