Alcohol risk environments, vulnerability and social inequalities in alcohol consumption

Abstract

Alcohol and alcohol related harm are key public health challenges. Research has shown that individual level factors, such as age and sex, are important predictors of alcohol consumption, but such factors provide only a partial account of the drivers of consumption. In this paper we argue that individual level factors interact with features of the 'risk environment' to increase the vulnerability of individuals to such environments. Features of the alcohol 'risk environment' include the density of alcohol premises in a neighbourhood. Previous research has shown that neighbourhoods with a higher density of alcohol outlets have higher levels of both alcohol consumption and alcohol related harm. There has however been a distinct lack of attention paid to the differential ways in which particular socio-demographic groups may be more vulnerable to such 'risk environments'. In this paper we address the risk environment through a primary focus on the local supply and availability of alcohol products (captured using a measure of outlet density) and the relationship with the harmful use of alcohol. Using responses to the Scottish Health Survey (2008-2011) we explore vulnerability through the interaction between individual level socio-economic position, measured using household income, and environmental risk to assess differential social vulnerability to such environments. We report findings showing that those in the lowest income groups may be disproportionately affected by outlet density. This evidence suggests that risk environments may not affect us all equally and that there may be socially differentiated vulnerability to such environments.

Keywords: Alcohol; outlet density; risk; vulnerability and health inequalities.

Figure 1

Adjusted^a interactive effects of total alcohol outlet density (AOD)^b on individual-level reporting of exceeding recommendationsc by household income, Scottish Health Survey 2008-2011 (n_weighted = 24,116). Note: ^amodel includes design variables (to account for sample stratification and nonresponse), alcohol outlet density and equalised household income, controlling for sex, age, religion, marital status, education and neighbourhood urban/rural status. ^bAOD 1: median of kernel density estimation values (KDE) = 0,6/km²; AOD 2: median KDE = 3,8/km²; AOD 3: median KDE = 7,5/km²; AOD 4: median KDE = 23,4/km²; ^cReference group: respondents not exceeding the drinking recommendations.

Figure 2

Adjusted interactive effects of total alcohol outlet density (AOD) on individual-level reporting of harmful drinking^c by household income, Scottish Health Survey 2008-2011 (n_weighted = 24,279). Adjustments and AOD ranges as per Figure 1. Reference group: those not reporting harmful drinking.

Figure 3

Adjusted interactive effects of total alcohol outlet density (AOD) on individual-level reporting of binge drinking^c by household income, Scottish Health Survey 2008-2011 (n_weighted = 24,237). Adjustments and AOD ranges as per Figure 1. Reference group: respondents not reporting binge drinking.

Figure 4

Adjusted^a interactive effects of total alcohol outlet density (AOD)^b on individual-level reporting of problem drinking ^c by household income, Scottish Health Survey 2008-2011 (n_weighted = 20,914). Adjustments and AOD ranges as per Figure 1. Reference group: respondents not reporting problem drinking.