Comparing the Effectiveness of City Policy and Structure in Health Disparities

描述(由申请人提供)：本申请涉及广泛的挑战领域(05)比较有效性研究。在这个挑战领域内，具体的挑战主题是05-MD-101：健康的社会决定因素。这项研究的目标是比较新奥尔良城市层面的政策在控制问题酒精销售点方面的有效性，这些问题导致贫困人口和少数族裔人口之间的健康不平等。1997年，新奥尔良市通过了一系列政策，实际上代表着一种社会干预，以解决贫困和少数族裔社区健康差距的社会决定因素，在这些社区，酒精出口扩散是一个主要问题。这些政策是专门为了解决问题酒精销售点的激增问题而制定的，这些问题酒精销售点被认为是各种社会问题的根源，包括攻击性暴力以及对健康的不利影响。为了实现这一目标，建议对酒精出口暴露的变化对攻击暴力和酒精相关死亡率的影响进行纵向研究。这项研究将跨越十年(即从1994年到2004年)。它将在人口普查区域一级进行组织，这是与接触酒精场所有关的结构性影响最密切的分析单位。这项研究将在路易斯安那州的两个城市进行：新奥尔良和巴吞鲁日。由于这些政策是在新奥尔良实施的，那里的人口普查区域将被用作“干预”区域，而巴吞鲁日的人口普查区域将被用作“控制”区域。研究假设1：在新奥尔良的人口普查区域中，在研究期间，攻击性暴力和与酒精相关的死亡结果的趋势将显示出比巴吞鲁日人口普查区域更负的趋势。研究假设2：人口普查区域酒精销售点密度的下降将在很大程度上解释研究期间攻击性暴力和与酒精有关的死亡率的趋势。证明城市一级旨在纠正社会不平等的政策变化将导致相应的减少，这将是对公共卫生文献的重大贡献。拟议中的项目就是为了做到这一点。比较酒精控制政策在两个城市的社区中对攻击性暴力和与酒精相关的死亡率的有效性，其中一个城市制定了该政策，另一个城市没有实施该政策。

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.