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 article, 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 neighborhood. Previous research has shown that neighborhoods 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 sociodemographic groups might be more vulnerable to such risk environments. In this article, 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 socioeconomic 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 might be disproportionately affected by outlet density. This evidence suggests that risk environments might not affect us all equally and that there could be socially differentiated vulnerability to such environments.

酒精与酒精相关的伤害, 是主要的公共健康挑战。研究显示, 诸如年龄与性别的个人层级因素, 是酒精消费的重要预测指标, 但这些指标仅提供驱动消费的部分解释。我们于本文中主张, 个人层级因素与风险环境特徵的互动, 增加了个人面对此般环境的脆弱性。酒精风险环境的特徵, 包括社区中酒精营业场所的密集度。过往的研究显示, 具有较高密度的酒精饮料卖场的社区, 同时具有较高程度的酒精消费与酒精相关的伤害。但对于特定社会人口群体对此般风险环境更具脆弱性的不同方式, 却明显缺乏关注。我们于本文中, 主要透过聚焦酒精产品的在地供给与可及性(通过测量卖场密度进行记录)及其与酒精的有害使用之关系, 处理风险环境问题。我们运用苏格兰健康调查 (2008–2011) 的回覆, 透过以家户所得测量的个人层级社经位置与环境风险之间的互动来探讨脆弱性, 以测量对这些环境的差异化社会脆弱性。我们的研究发现, 展现最低所得群体可能不成比例地受到酒精卖场密度的影响。此一证据显示, 风险环境可能不是平等地影响所有人, 而且面对此般环境的脆弱性有着社会差异。

El consumo alcohólico y los daños relacionados con el alcohol son retos claves de la salud pública. La investigación ha mostrado que los factores a nivel de individuo, tales como edad y sexo, son predictores importantes del consumo alcohólico, aunque esos factores apenas suministran una explicación parcial de tal consumo. En este artículo, arguyo que los factores a nivel individual interactúan con algunos rasgos del entorno riesgoso para incrementar la vulnerabilidad de los individuos frente a tales entornos. Entre los rasgos del entorno de riesgo alcohólico se incluye la densidad de premisas alcohólicas en un vecindario. La investigación previa ha permitido establecer que los vecindarios que tengan una densidad más alta de expendios de alcohol registran mayores niveles tanto de consumo de alcohol como de los daños derivados de su uso. Sin embargo, ha existido una manifiesta falta de atención a las maneras diferenciadas como grupos sociodemográficos particulares podrían ser más vulnerables a tales entornos de riesgo. En este artículo, abocamos el entorno de riesgo a través de un enfoque primario a la oferta local y a la disponibilidad de productos alcohólicos (registrados con el uso de una medida de densidad de expendios) y la relación con el uso peligroso del alcohol. Utilizando las respuestas dadas al Estudio de la Salubridad Escocesa (2008–2011), exploramos la vulnerabilidad a través de la interacción entre la posición socioeconómica a nivel individual, medida a partir del ingreso familiar, y el riesgo ambiental, para evaluar la vulnerabilidad social diferencial a tales entornos. Informamos sobre los descubrimientos que indican que quienes se hallan en los grupos de más bajos ingresos podrían estar afectados de manera desproporcionada por la densidad de expendios. Esta evidencia sugiere que los entornos riesgosos podrían no afectarnos a todos por igual y que podría existir una vulnerabilidad socialmente diferenciada a tales entornos.

Palabras clave:

• alcohol
• health inequalities
• outlet density
• risk
• vulnerability

关键词：:

• 酒精
• 健康不平等
• 卖场密度
• 风险
• 脆弱性。

Palabras clave:

• alcohol
• desigualdades de la salud
• densidad de expendios
• riesgo
• vulnerabilidad

Acknowledgments

Many thanks to colleagues who commented on earlier drafts, including Catherine Tisch, Elizabeth Richardson, Helena Tunstall, Tom Clemens, and Mark Cherrie. Thanks also to Julie Landsberg and other SHeS personnel.

Additional information

Funding

This work was supported by the Scottish Collaboration for Public Health Research and Policy and the European Resarch Council (ERC-2010-StG Grant 263501). Richard Mitchell's contribution was also funded by the UK Medical Research Council as part of the Neighbourhoods and Communities Programme (MC_UU_12017-10).

Notes on contributors

Niamh K. Shortt

NIAMH K. SHORTT is a Reader in Human Geography and Co-Director of the Centre for Research on Environment, Society & Health in the School of GeoSciences, University of Edinburgh, Edinburgh EH8 9XP, UK. E-mail: [email protected]. Her research interests include exploring the relationship aong health behaviors, the environment, and health inequalities.

Esther Rind

ESTHER RIND is a researcher and project manager at the Institute of Occupational and Social Medicine & Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany. E-mail: [email protected]. Her research interests include the study of health behaviors and health inequalities and the prevention of mental distress for personnel working in the health care system.

Jamie Pearce

JAMIE PEARCE is Professor of Health Geography and Co-Director of the Centre for Research on Environment, Society & Health in the School of GeoSciences, University of Edinburgh, Edinburgh EH8 9XP, UK. E-mail: [email protected]. His research interests include geographical explanations for health inequalities and behaviors including the consumption of tobacco and alcohol.

Richard Mitchell

RICHARD MITCHELL is Professor of Health and Environment, and leads the Neighbourhoods and Communities Research Program, at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3QB, UK. E-mail: [email protected]. He is also a Co-Director of the Centre for Research on Environment, Society & Health. His research interests include how social and physical environment can protect health and narrow health inequalities, the health impacts of natural environments, and the application of complex systems approaches to these topics.

Sarah Curtis

SARAH CURTIS is Honorary Professor, University of Edinburgh and Professor Emeritus, Durham University, Durham DH1 3LE, UK. E-mail: [email protected]. She specializes in geographies of health and health care.