The relationship between neighborhood poverty and alcohol use: estimation by marginal structural models.
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.
Cerdá
Magdalena
M
Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA. mcerda@nyam.org
Diez-Roux
Ana V
AV
Tchetgen
Eric Tchetgen
ET
Gordon-Larsen
Penny
P
Kiefe
Catarina
C
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data; D011204:Poverty Areas; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult