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    Where you live may impact how much you drink

    Neighborhoods with greater poverty and disorganization may play a greater role in problem drinking than the availability of bars and stores that sell hard liquor, a University of Washington-led study...

    HEALTH AND MEDICINE  |  NEWS RELEASES  |  RESEARCH  |  SOCIAL SCIENCE

    May 15, 2017

    Where you live may impact how much you drink

    Kim Eckart UW News

    Neighborhoods with greater poverty and disorganization may play a greater role in problem drinking than the availability of bars and stores that sell hard liquor, a University of Washington-led study has found.

    While there is evidence for the link between neighborhood poverty and alcohol use, the new twist — that socioeconomics are more powerful environmental factors than even access to the substance itself — suggests that improving a neighborhood’s quality of life can yield a range of benefits.

    “Is there something about the neighborhood itself that can lead to problems? As we learn more about those neighborhood factors that are relevant, then this might point to population-level strategies to modify or improve the environments where people live,” said Isaac Rhew, a research assistant professor in the Department of Psychiatry & Behavioral Sciences.

    A common way to think of such broader changes is the “broken windows” theory of maintaining neighborhoods to deter crime. In other words, implementing programs, services or clean-up efforts to improve a neighborhood could help attain another goal: reducing problem drinking.

    The UW study was published online May 8 in the Journal of Urban Health.

    In examining the combination of multiple neighborhood factors on alcohol use, UW researchers turned to an ongoing research study of adults the university’s Social Development Research Group has followed for decades. They interviewed more than 500 of the adults in the study, who were first identified as fifth-graders in Seattle elementary schools and now live throughout King County. In this neighborhood study, 48 percent of participants were women; people of color made up nearly 60 percent of respondents.

    Researchers determined the U.S. Census Block Group (a geographic area of roughly 1,000 people) of each participant’s residence, along with demographic data tied to that area and the number of locations that sold hard alcohol there. Participants also answered a series of questions about their alcohol consumption and their perceptions of their neighborhood.

    This information allowed researchers to classify neighborhoods according to poverty level, alcohol availability (location of bars and liquor stores) and “disorganization,” which included factors such as crime, drug selling and graffiti.

    The ability to consider a number of neighborhood characteristics simultaneously and to identify patterns of how these characteristics grouped together to form distinct neighborhood types made this study different from others that might focus on the impact of, say, poverty alone, Rhew said.

    And while poverty and disorganization often are assumed to go hand-in-hand, that’s not always the case, added study co-author Rick Kosterman, a research scientist in the UW School of Social Work. A socioeconomically disadvantaged neighborhood might also be highly organized, with strong leaders, a sense of identity and various programs and services for residents. At the same time, a low-poverty neighborhood might be highly disorganized, with a lack of resources or sense of community, or a few streets with more trouble than others.

    In this study, researchers found that residents of neighborhoods primarily characterized by high poverty and disorganization tended to drink twice as much in a typical week as those in other types of neighborhoods. Binge-drinking — generally defined as more than four drinks at a time for women, five for men — occurred in these high-poverty, highly disorganized communities about four times as frequently as in other types of neighborhoods. These findings are consistent with previous research indicating that people in lower income neighborhoods may be at greater risk for alcohol-related problems, Rhew said.

    What’s different, Rhew and Kosterman agreed, is the fact that neighborhoods characterized by greater alcohol availability showed no increased alcohol use among residents — suggesting that socioeconomic factors may pose a greater risk for substance abuse.

    “On its face, the connection between poverty and disorganization and alcohol use may not be all that surprising, but when you find that this connection may be even more important than the location of bars and liquor stores, then it’s those characteristics of a neighborhood that we want to pay attention to,” Kosterman said.

    Researchers pointed to an important change that has occurred since their original data was collected: the passage of a state law in 2011 privatizing liquor sales. The availability of liquor went from a little more than 300 state-run stores to some 1,500 pharmacies, grocery stores and warehouse clubs.

    “People who utilize the outlets aren’t just people from the neighborhood. We see stronger evidence of the link between where alcohol is sold and other problems such as violence, crime, and drinking and driving, but not necessarily consumption,” he added.

    The ability, thanks to recent funding, to overlay neighborhood data with the longitudinal Seattle Social Development Project — the study of 808 individuals begun in 1985 — presents opportunities for future analyses of a variety of behaviors and circumstances, the researchers said.

    Source : www.washington.edu

    The Relationship Between Neighborhood Poverty and Alcohol Use: Estimation by Marginal Structural Models

    Previous studies on the relationship of neighborhood disadvantage with alcohol use or misuse have often controlled for individual characteristics on the causal pathway, such as income—thus potentially underestimating the relationship between disadvantage ...

    Epidemiology. Author manuscript; available in PMC 2014 Jan 21.

    Published in final edited form as:

    Epidemiology. 2010 Jul; 21(4): 482–489.

    doi: 10.1097/EDE.0b013e3181e13539

    PMCID: PMC3897210

    NIHMSID: NIHMS450353

    PMID: 20498603

    The Relationship Between Neighborhood Poverty and Alcohol Use: Estimation by Marginal Structural Models

    Magdalena Cerdá,a,b Ana V. Diez-Roux,c Eric Tchetgen Tchetgen,d Penny Gordon-Larsen,e and Catarina Kiefef

    Author information Copyright and License information Disclaimer

    The publisher's final edited version of this article is available at Epidemiology

    See other articles in PMC that cite the published article.

    Associated Data

    Supplementary Materials

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    Abstract

    Background

    Previous studies on the relationship of neighborhood disadvantage with alcohol use or misuse have often controlled for individual characteristics on the causal pathway, such as income—thus potentially underestimating the relationship between disadvantage and alcohol consumption.

    Methods

    We used data from the Coronary Artery Risk Development in Young Adults study of 5115 adults aged 18–30 years at baseline and interviewed 7 times between 1985 and 2006. We estimated marginal structural models using inverse probability-of-treatment and censoring weights to assess the association between point-in-time/cumulative exposure to neighborhood poverty (proportion of census tract residents living in poverty) and alcohol use/binging, after accounting for time-dependent confounders including income, education, and occupation.

    Results

    The log-normal model was used to estimate treatment weights while accounting for highly-skewed continuous neighborhood poverty data. In the weighted model, a one-unit increase in neighborhood poverty at the prior examination was associated with a 86% increase in the odds of binging (OR = 1.86 [95% confidence interval = 1.14–3.03]); the estimate from a standard generalized-estimating-equations model controlling for baseline and time-varying covariates was 1.47 (0.96–2.25). The inverse probability-of-treatment and censoring weighted estimate of the relative increase in the number of weekly drinks in the past year associated with cumulative neighborhood poverty was 1.53 (1.02–2.27); the estimate from a standard model was 1.16 (0.83–1.62).

    Conclusions

    Cumulative and point-in-time measures of neighborhood poverty are important predictors of alcohol consumption. Estimators that more closely approximate a causal effect of neighborhood poverty on alcohol provided a stronger estimate than estimators from traditional regression models.

    Several studies have reported that alcohol abuse and dependence, as well as other risk behaviors, cluster in contexts of poverty, residential instability, and social isolation.1–5 Most of these studies are cross-sectional and do not account for the fact that neighborhoods change over time, or allow us to assess how such changes might affect alcohol misuse. The question remains whether such multilevel associations are actually due to the influence of neighborhood contextual characteristics on health outcomes such as alcohol abuse, or whether they merely reflect the selection of persons with similar socioeconomic characteristics and health problems into particular types of neighborhoods. Longitudinal studies that follow people and neighborhoods over time are needed to better estimate the nature of the association of neighborhood conditions with alcohol use.

    Traditionally, longitudinal studies examining the association between neighborhood characteristics and risk behaviors have attempted to address individual selection into neighborhoods by using standard regression models or propensity-score analysis to control tightly for individual-level characteristics (such as socioeconomic position) that are causally related both to the type of neighborhood a person lives in and to the person's use of alcohol. A major concern with such methods, however, is that many of the time-varying potential confounders are also affected by prior neighborhood conditions, and are thus in the causal pathway between the exposure of interest and the outcome, at the same time that they affect the types of neighborhoods that persons move into.6 Individual socioeconomic position, for example, not only contributes to the type of neighborhood a person can afford to live in and the level of alcohol consumed, but it is also a product of the types of income-generating opportunities afforded by the neighborhood socioeconomic environment.5 By controlling for the individual-level composition of neighborhoods, to address individual selection into neighborhoods, traditional regression analytic techniques run the risk of also controlling for individual-level mediators of earlier neighborhood characteristics and thus underestimating the impact that long-term cumulative neighborhood exposure has on health outcomes. Unadjusted estimates are confounded by individual-level characteristics related to selection of persons into neighborhoods.7

    Marginal structural models offer a particularly useful tool for research on neighborhoods and health, where there are often time-dependent covariates that act simultaneously as confounders and as intermediate variables in the causal pathway between the neighborhood exposure of interest and the outcome.8 Marginal structural models describe the marginal causal relationship between a time-varying exposure such as neighborhood poverty and alcohol use, and therefore, allow us to control for time-varying confounders without conditioning on these variables. Formally, a marginal structural model for repeated measures is a parametric regression model relating any possible exposure history, up to time t, to the corresponding counterfactual outcome at time t. Marginal structural models are also useful in the case of loss-to-follow-up in longitudinal studies, because they allow us to account for differential loss to follow-up. Assuming ignorable treatment assignment and the absence of differential misclassification,9 the parameters of a marginal structural model can be estimated in an unbiased manner with inverse probability-of-treatment and censoring weighting. This is a product of inverse probability-of-treatment weights and inverse probability-of-censoring weights. Such weighting makes it possible to obtain a comparable “pseudopopulation” in terms of stable and time-varying confounders across levels of the exposure, and thus estimate the unconfounded association between the exposure and outcome without conditioning on the covariate through its inclusion as a predictor in the outcome model.8 A detailed example illustrating how weighting creates an unbiased “pseudopopulation” is provided in the eAppendix (http://links.lww.com/EDE/A397).

    Source : www.ncbi.nlm.nih.gov

    Alcoholism And Bad Neighborhoods: A Two

    A bad neighborhood is known to contribute to the development and maintenance of an individual's alcohol use and alcohol-related problems. A first-of-its kind study shows that alcohol problems may also lead an individual to live in a bad neighborhood. Analysis indicates that alcoholism has long-term negative effects on place of residence, and vice versa. First, the more alcohol problems a man has, the more likely he is going to remain in -- or migrate into -- a disadvantaged neighborhood. Second, recovery from alcoholism is both protective against a downward social drift and favorable to improved social conditions. In addition, living in worse neighborhoods appears to have an adverse effect on alcoholic symptomatology over time.

    Science News

    from research organizations

    Alcoholism And Bad Neighborhoods: A Two-way Street

    Date: August 29, 2007 Source:

    Alcoholism: Clinical & Experimental Research

    Summary:

    A bad neighborhood is known to contribute to the development and maintenance of an individual's alcohol use and alcohol-related problems. A first-of-its kind study shows that alcohol problems may also lead an individual to live in a bad neighborhood. Analysis indicates that alcoholism has long-term negative effects on place of residence, and vice versa. First, the more alcohol problems a man has, the more likely he is going to remain in -- or migrate into -- a disadvantaged neighborhood. Second, recovery from alcoholism is both protective against a downward social drift and favorable to improved social conditions. In addition, living in worse neighborhoods appears to have an adverse effect on alcoholic symptomatology over time.

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    Living in neighborhoods characterized by unemployment, poverty, poor family integration and high residential mobility is known to contribute to a greater risk for alcohol problems. New research, the first of its kind, has found that the reverse relationship is also true: alcoholism has a negative effect on where someone lives.

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    "Most studies have looked at the effects of neighborhood characteristics on alcohol use, and only a few have looked at alcohol dependence," said Anne Buu, research investigator of psychiatry at the University of Michigan and corresponding author. "None have looked at these effects over a time span as long as 12 years; most cover only a one- or two-year time span. In addition, we looked at these relationships bidirectionally, that is, the effects of alcohol dependence on place of residence, and the long-term effects of neighborhood on alcohol dependence."

    "This type of research is quite innovative and reflects a growing interest in 'macro-level' influences on alcohol-related outcomes," said Ryan Trim, research psychologist at the VA San Diego Healthcare System. "Unlike the extensive research on individual- and family-level risk factors, studies examining the link between alcohol use and neighborhoods have only gained momentum in recent years. Since a large proportion of the risk for alcoholism is environmental -- approximately 40 percent -- it will be increasingly important for researchers and clinicians to have a better understanding of neighborhood-level influences on alcohol use."

    Researchers recruited 206 Caucasian men, with an average age of 33 years, through community and district court recruitment from a four-county-wide region. Alcohol-dependence diagnoses were established through semi-structured diagnostic interviews. Residential addresses were noted at baseline, and then at three-year intervals for a 12-year period. Census-tract variables were used to identify neighborhood characteristics.

    Analysis indicates that alcoholism has long-term negative effects on place of residence, and vice versa. First, the more alcohol problems a man has, the more likely he is going to remain in -- or migrate into -- a disadvantaged neighborhood. Second, recovery from alcoholism is both protective against a downward social drift and favorable to improved social conditions. In addition, living in worse neighborhoods appears to have an adverse effect on alcoholic symptomatology over time.

    In short, said Buu, the causal relationship between alcoholism and neighborhood social environment is a two-way instead of a one-way street. "Continuous alcohol involvement has long-term negative effects on place of residence," she said. "In contrast, recovery from alcoholism is protective against downward social drift."

    Both Buu and Trim said that these findings have implications for women, even though they were not among the target study population.

    "The effects may be even stronger on women because alcoholic women have a high tendency to marry alcoholic men, referred to as 'assortative mating,' said Buu. "Alcoholic involvement of both partners could speed up the downward social drift."

    Buu noted that the study's findings show that the damaging effects of alcoholism are much broader than simple health consequences. "The effects also have a long-term impact on quality of life, including where one lives and their quality of life. Social environment appears to play some role in keeping the disorder going, and possibly even making it worse: we can see effects going from community to individual, and from individual to social environment. Preventive efforts therefore may also have effects in both directions."

    Trim added that the results have both cautionary and optimistic applications for alcohol misuse. "The findings highlight the far-reaching impact of alcohol problems on the type of neighborhood an individual could reside in as an adult. Thus, high-risk adults who drift into lower-SES neighborhoods will likely face even greater challenges at recovery due to lack of resources and increased environmental stressors. However, adults who successfully treat their alcohol problems early in life are no more likely to experience this downward social drift than non-alcoholics. I would hope these findings provide additional incentive to any individuals who are unsure or unwilling to enter treatment for alcohol-related problems."

    Results are published in the September issue of Alcoholism: Clinical & Experimental Research.

    Source : www.sciencedaily.com

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