Neighborhood Contextual Factors, Alcohol Use, and Alcohol Problems in the United States: Evidence From a Nationally Representative Study of Young Adults

Abstract

Background: There is considerable variation in alcohol use and problems across the United States, suggesting that systematic regional differences might contribute to alcohol involvement. Several neighborhood contextual factors may be important aspects of this "alcohol environment."

Methods: Participants were 15,197 young adults (age 18 to 26) from Wave III of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative U.S. survey. Measures of past-year alcohol use and problems were obtained via structured in-home interviews. Tract-level neighborhood contextual factors (density of on- and off-premises alcohol outlets, neighborhood disadvantage, rural vs. urban residence) were derived from census indicators and geocoded state-level alcohol outlet licenses. Multivariate logistic regression, ordered logistic regression, or negative binomial regression models, including age, sex, race, and household income as covariates, were fit to examine the relation of the neighborhood contextual factors with alcohol use and problems.

Results: The most consistent finding across 4 of the 5 measures of alcohol involvement was their association with neighborhood advantage; the active ingredient underlying this effect was primarily the proportion of educated residents in the neighborhood. The densities of alcohol outlets were associated with any alcohol use-they were not associated with binge drinking or alcohol problems, nor could they explain any of the neighborhood advantage effects. The influence of alcohol outlet densities on alcohol involvement did not differ for those above or below the legal age to purchase alcohol. Living in a rural versus an urban neighborhood was associated with a different alcohol use pattern characterized by a lower likelihood of any drinking, but among those who drank, consuming more alcohol per occasion.

Conclusions: Living in a more advantaged and educated urban neighborhood with greater densities of bars and restaurants is associated with greater alcohol involvement among 18- to 26-year-olds in the United States.

Keywords: Add Health; Alcohol Outlets; Alcohol Problems; Alcohol Use; Neighborhood Disadvantage; Rural; Young Adults.

Figure 1

Unadjusted and model-estimated proportions of any alcohol use in the past year as a function of (a) census-tract-level density of on-premises alcohol outlets (b) census-tract-level density of off-premises alcohol outlets, (c) neighborhood disadvantage, and (d) urbanicity. The model-estimated proportions are at the mean of all other variables in the model; the following variables were included in each of the models: age, sex, race, household income, on-premises outlet density, off-premises outlet density, neighborhood disadvantage, urbanicity, and state of residence. The densities of on-premises alcohol outlet quartiles correspond to: 1 (mean = 0.00, range = 0–0.009), 2 (mean = 0.14, range = 0.01 – 0.39), 3 (mean = 0.91, range = 0.38–1.72), 4 (mean = 9.15, range = 1.73–434.36). The densities of off-premises alcohol outlet quartiles correspond to: 1 (mean = 0.00, range = 0–0.024), 2 (mean = 0.18, range = 0.02 – 0.50), 3 (mean = 1.06, range = 0.50–1.95), 4 (mean = 8.34, range = 1.95–249.68).