title: Neighbourhood deprivation and alcohol consumption: does the availability of alcohol play a role?
abstract: BACKGROUND
  Previous studies suggest that the physical availability of alcohol may mediate the association between neighbourhood-level material deprivation and alcohol consumption. This study tests the relationships between neighbourhood-level deprivation, alcohol availability, and individual-level alcohol consumption using a multilevel analysis.
  
  
  METHODS
  Data are from cross-sectional surveys conducted between 1979 and 1990 as part of the Stanford Heart Disease Prevention Program (SHDPP). Women and men (n = 8197) living in four northern/central California cities and 82 neighbourhoods were linked to neighbourhood deprivation variables derived from the US census (e.g. unemployment, crowded housing) and to measures of alcohol availability (density of outlets in the respondent's neighbourhood, nearest distance to an outlet from the respondent's home, and number of outlets within a half mile radius of the respondent's home). Separate analyses were conducted for on- and off-sale outlets.
  
  
  RESULTS
  The most deprived neighbourhoods had substantially higher levels of alcohol outlet density than the least deprived neighbourhoods (45.5% vs 14.8%, respectively). However, multilevel analyses showed that the least deprived neighbourhoods were associated with the heaviest alcohol consumption, even after adjusting for individual-level sociodemographic characteristics (OR 1.30, CI 1.08-1.56). Alcohol availability was not associated with heavy drinking and thus did not mediate the relationship between neighbourhood deprivation and heavy alcohol consumption.
  
  
  CONCLUSIONS
  Although alcohol availability is concentrated in the most deprived neighbourhoods, women and men in least deprived neighbourhoods are most likely to be heavy drinkers. This mismatch between supply and demand may cause people in the most deprived neighbourhoods to disproportionately suffer the negative health consequences of living near alcohol outlets.
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Craig Evan
authors.initials: CE
authors.lastname: Pollack
authors.forename: Catherine
authors.initials: C
authors.lastname: Cubbin
authors.forename: David
authors.initials: D
authors.lastname: Ahn
authors.forename: Marilyn
authors.initials: M
authors.lastname: Winkleby
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D003132:Commerce / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires