Alcohol Outlet Density and Related Use in an Urban Population in Philadelphia Public Housing Communities

Purpose: Social determinants of health at the family and neighborhood levels are well-known influences on health behaviors; alcohol misuse is linked to a number of adverse outcomes in adults and adolescents. Adolescents’ alcohol use behaviors are influenced by familial patterns of communication and parental role-modeling, as well as by contextual neighborhood factors such as poverty density, housing status, and access to alcohol distribution outlets. Using mother-son data paired with census and city alcohol dispensary data, this work explores the influence of individual, family and environmental factors on alcohol use among Black mothers and sons living in public housing communities.

Methods: Baseline data from a randomized controlled trial with dyads (n = 382) living in 35 housing communities were paired with census tract and alcohol control board data. ArcGIS was used to create hot spot and kernel density analyses assessing spatial distribution of the alcohol outlets in Philadelphia. Then, using the geoprocessing tool, the number of alcohol outlets located within a 400-meter radius for each dyad’s address was calculated. A 400-meter distance was chosen based on prior research that estimated that the average adult can walk 400-meters in 5 minutes.  A multi-level model was created to assess relationships between individual, family and environmental level variables and recent and lifetime alcohol use for mothers and sons.  

Results: Alcohol outlet density was correlated with two census variables: percent of black residents and percent of families living in poverty (by census tract). Percent of high school graduates in the census tract buffered this effect. Among mothers, younger age and living in a census tract with fewer percent high school graduates were significantly associated with recent alcohol use. Specifically, the density of alcohol outlets around housing communities was positively related to maternal alcohol use.  Older reported age among sons was associated with having used alcohol; this was also true for  sons that lived in a census tract with a greater percentage of Black residents.

Implications:  There is a little research exploring multilevel influences on adolescent alcohol use and no study has used primary data from both parents and children alongside neighborhood-level factors collected through administrative data to explore this issue. These findings highlight neighborhood influence, above family qualities, in association with alcohol use.  Our findings support results from previous work indicating that accessibility is significantly related to alcohol use. Findings from this study serve as a reminder that interventions must account for the varied influences within the community when addressing alcohol use problems and imply that assessment of neighborhood affluence or disadvantage can inform local governing entities regarding community planning and licensing policies related to alcohol outlets. Implications for the incorporation of geospatial visualization in social services research and public policy are discussed.