The association between neighborhood disorder, social cohesion and hazardous alcohol use: A national multilevel study

Abstract

Background

Evidence on associations of alcohol use with neighborhood disorder and social cohesion is limited. The aim of this study was to further investigate these associations.

Methods

Individual data of 14,258 Dutch adults, living in 1546 neighborhoods across the Netherlands, were obtained from the 2006 to 2009 national health survey (POLS). Data on neighborhood disorder and social cohesion were derived from the 2006 Netherlands Housing Research (WoON). Hazardous drinking was measured as: ≥14, ≥21, and ≥28 drinks/week for women, and ≥21, ≥28, and ≥35 for men. Multilevel logistic regression models were adjusted for age, gender, ethnicity, marital status, education, income, wealth, predominant neighborhood religion, and population density. Potential mediation of psychological distress (depression and anxiety) and general mental health (MHI-5 score) was tested.

Results

High neighborhood disorder was associated with more hazardous alcohol use for women (OR cut-off 3: 3.72 [2.03–6.83]), but not for men (OR cut-off 3: 1.08 [0.72–1.62]). There was no mediation by psychological distress, and modest mediation by general mental health. Social cohesion had no linear association with hazardous alcohol use, but for males moderate social cohesion was associated with more hazardous alcohol use (OR cut-off 1: 1.29 [1.08–1.53]). In predominantly Protestant neighborhoods this association seemed weaker.

Conclusions

Hazardous alcohol use seems to have a stronger and more consistent relationship with neighborhood disorder than with social cohesion. This suggests that negative aspects of the social environment have more impact on the prevalence of hazardous alcohol use than positive factors related to sociability and support.

Introduction

The use of alcohol is widely accepted in society, even though hazardous consumption still forms a major threat for public health (Anderson and Baumberg, 2006, Corrao et al., 2004, Puddey and Beilin, 2006). Evidence for the influence of environmental causes of hazardous alcohol use is growing. Important neighborhood influences on alcohol use include the availability of alcohol in the neighborhood (Hay et al., 2009, Picone et al., 2010, Pollack et al., 2005, Popova et al., 2009, Schonlau et al., 2008, Theall et al., 2009, West et al., 2010), the urbanization of the area (Anderson and Baumberg, 2006, Verdurmen et al., 2003), and neighborhood deprivation (Adams et al., 2009, Bernstein et al., 2007, Cerda et al., 2010, Matheson et al., 2011). These characteristics are mainly determined by the physical features of the neighborhood, rather than reflecting social norms and behavioral patterns of the residents. The influence of social aspects of neighborhoods on hazardous alcohol use of the residents has been studied less extensively (Diez Roux and Mair, 2010). The social environment of the neighborhood is potentially important, because it shapes social norms, enforces patterns of social control, and reduces or produces stress (Institute of Medicine, 2003).

Neighborhood disorder is a concept representing an area characterized by, among others, vandalism, graffiti, noise and dirt. Neighborhood disorder seems to be negatively associated with physical functioning and self-reported health (Agyemang et al., 2007, Hill et al., 2005, Ross, 1993, Ross and Mirowsky, 2001). One study observed that residents consume more alcohol when they perceive more neighborhood disorder (Hill and Angel, 2005). Hill and Angel (2005) suggested that the influence of neighborhood disorder on alcohol use may be mediated by psychological distress. However, their study population was limited to low-income women in the USA. Different associations might be found for other populations, including males and higher socioeconomic status (SES) groups or the European context.

Social cohesion is an indicator of attachment to and satisfaction with the neighborhood and its residents. Strong social cohesion has been shown to positively influence various health outcomes, including all-cause mortality (Martikainen et al., 2003), mental health (Almedom, 2005), physical activity (Lindstrom et al., 2001, McNeill et al., 2006) and self-rated health (Mohnen et al., 2011, Poortinga, 2006). High social cohesion has also been suggested to be associated with lower alcohol use among adolescents (Winstanley et al., 2008), fewer perceived youth alcohol problems (Duncan et al., 2002) and lower alcohol related mortality (Anderson and Baumberg, 2006, Martikainen et al., 2003). However, studies to establish the association of social cohesion with the actual intake of alcohol by adults are not yet available.

Earlier studies have shown that alcohol use of individuals depends on the norm toward alcohol use in the social environment (Galea et al., 2004), including the neighborhood (Ahern et al., 2008). In the Netherlands, the social norm toward the use of alcohol traditionally varied between regions with different religious domination (Mulder, 2010). Protestant Christian religion discouraged alcohol use, while Catholics were much more tolerant (Ellison et al., 2008). We expect, if social cohesion does influence the prevalence of hazardous alcohol use, this effect to be negative in Protestant neighborhoods but positive among Catholic areas.

This is the first study that aims to simultaneously investigate the relationship of neighborhood disorder and social cohesion with hazardous alcohol use. Analyses were performed using a large national survey database which covers the national Dutch population. Extensive measurements of the social environment of each neighborhood in the Netherlands were available, including a distinction between concepts of neighborhood disorder and social cohesion.

Associations of neighborhood disorder and social cohesion with hazardous alcohol use will be investigated, while adjusting for a broad range of individual and neighborhood confounders. For neighborhood disorder, the mediating effect of individual-level psychological distress and general mental health is tested.