title: The neighborhood alcohol environment and alcohol-related morbidity.
abstract: OBJECTIVE
  The aims of this study were (1) to examine the association between neighborhood alcohol outlet density and individual self-reported alcohol-related health outcomes in the last year-sexually transmitted infections (STI), motor vehicle accidents, injury, liver problems, hypertension and experienced violence; (2) to determine whether the relationship between morbidity and alcohol outlet density is mediated by individual alcohol consumption; and (3) to explore the role of alcohol outlet density in explaining any observed racial and ethnic differences in morbidity.
  
  
  METHODS
  Hierarchical models from a random sample of Los Angeles, CA, and Louisiana residents (N = 2881) from 217 census tracts were utilized. The clustering of health and social outcomes according to neighborhood varied by health problem examined.
  
  
  RESULTS
  There was substantial clustering of STI (intraclass correlation coefficient, ICC = 12.8%) and experienced violence (ICC = 13.0%); moderate clustering of liver problems (ICC = 3.5%) and hypertension (ICC = 3.9%); and low clustering of motor vehicle accident (ICC = 1.2%) and injury (ICC = 1.4%). Alcohol outlet density was significantly and positively associated with STI (crude OR = 1.80, 95% CI = 1.10-3.00), liver problems (crude OR = 1.33, 95% CI = 1.02-1.75) and experienced violence (crude OR = 1.31, 95% CI = 1.13-1.51) although not with other morbidity outcomes. Mediation analyses of morbidity outcomes revealed partial mediation of individual alcohol consumption in the relationship between alcohol density and STI and violence, and full mediation for liver problems.
  
  
  CONCLUSIONS
  Findings support the concept that off-premise alcohol outlets in the neighborhood environment may impact health and social outcomes, either directly or indirectly, through individual alcohol consumption and these associations may be heterogeneous with respect to race and ethnicity.
authors: Louisiana State University Health Sciences Center, New Orleans, USA. kthea1@lsuhsc.edu
authors: Katherine P
authors: KP
authors: Theall
authors: Richard
authors: R
authors: Scribner
authors: Deborah
authors: D
authors: Cohen
authors: Ricky N
authors: RN
authors: Bluthenthal
authors: Matthias
authors: M
authors: Schonlau
authors: Sara
authors: S
authors: Lynch
authors: Thomas A
authors: TA
authors: Farley
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D002391:Catchment Area, Health; D003469:Culture; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology; D008145:Louisiana / Q000453:epidemiology; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data; D012931:Social Environment; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data