title: The roles of outlet density and norms in alcohol use disorder.
abstract: BACKGROUND
  Alcohol outlet density and norms shape alcohol consumption. However, due to analytic challenges we do not know: (a) if alcohol outlet density and norms also shape alcohol use disorder, and (b) whether they act in combination to shape disorder.
  
  
  METHODS
  We applied a new targeted minimum loss-based estimator for rare outcomes (rTMLE) to a general population sample from New York City (N = 4000) to examine the separate and combined relations of neighborhood alcohol outlet density and norms around drunkenness with alcohol use disorder. Alcohol use disorder was assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) alcohol module. Confounders included demographic and socioeconomic characteristics, as well as history of drinking prior to residence in the current neighborhood.
  
  
  RESULTS
  Alcohol use disorder prevalence was 1.78%. We found a marginal risk difference for alcohol outlet density of 0.88% (95% CI 0.00-1.77%), and for norms of 2.05% (95% CI 0.89-3.21%), adjusted for confounders. While each exposure had a substantial relation with alcohol use disorder, there was no evidence of additive interaction between the exposures.
  
  
  CONCLUSIONS
  Results indicate that the neighborhood environment shapes alcohol use disorder. Despite the lack of additive interaction, each exposure had a substantial relation with alcohol use disorder and our findings suggest that alteration of outlet density and norms together would likely be more effective than either one alone. Important next steps include development and testing of multi-component intervention approaches aiming to modify alcohol outlet density and norms toward reducing alcohol use disorder.
authors: Division of Epidemiology, School of Public Health, University of California, Berkeley, 101 Haviland Hall, Berkeley, CA 94720-7358, USA. Electronic address: jahern@berkeley.edu.
authors: Jennifer
authors: J
authors: Ahern
authors: Division of Biostatistics, School of Public Health, University of California, Berkeley, 101 Haviland Hall, Berkeley, CA 94720-7358, USA. Electronic address: lbbalzer@berkeley.edu.
authors: Laura
authors: L
authors: Balzer
authors: School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118, USA. Electronic address: sgalea@bu.edu.
authors: Sandro
authors: S
authors: Galea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D000435:Alcoholic Intoxication / Q000523:psychology*; D005260:Female; D062306:Geography, Medical; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D066262:Social Norms; D055815:Young Adult
keywords: Alcohol outlets; Alcohol-related disorders; Residence characteristics; Semi-parametric estimation; Social norms