The role of the neighbourhood in adolescent alcohol use

Abstract

Background In Aotearoa New Zealand, adolescents experience disproportionately more harm from their drinking when compared to older drinkers. The social gradient in adolescent drinking and harm presents important implications for health equity, underscoring the need to identify and address the social determinants of adolescent alcohol use, including the physical and social features of the neighbourhood environment. The overarching aim of this research was to identify salient neighbourhood exposures associated with adolescent drinking and subgroups of adolescents who may have heightened vulnerability to their effects. Methods This thesis comprises one systematic review of the literature and four studies utilising data from the Youth’07 and Youth’12 nationally-representative surveys of secondary school students in Aotearoa New Zealand: a) Systematic review: Multilevel studies of neighbourhood effects (excluding alcohol outlet density) on adolescent alcohol use were identified and synthesised. b) Adolescent drinking typologies: Latent Class Analysis (LCA) was undertaken to identify drinking typologies among current drinkers in the Youth’07 survey. Proximal predictors of each drinking typology were identified so that potential mediators on the pathway(s) of neighbourhood effects could be further investigated. c) Changes in drinking between 2007 and 2012: Changes in drinking were examined among demographic subgroups characterised by age, sex, and household and neighbourhood socioeconomic position (SEP). d) Neighbourhood typologies and adolescent alcohol use: Ten indicators of the neighbourhood socio-economic, social, and physical environment were utilised in a LCA to identify neighbourhood typologies. Associations between neighbourhood typology and alcohol use were examined using multilevel modelling. e) Pathways of neighbourhood effects: Multilevel path analysis was used to examine the direct and indirect pathways of neighbourhood disadvantage, physical disorder, collective efficacy, and alcohol outlet density on drinking behaviours. Results Systematic review: 30 multilevel studies examining 12 neighbourhood-level exposures were identified. The majority of studies found no associations between measures of adolescent drinking and residential mobility, neighbourhood disorder or crime, employment or job availability, neighbourhood attitudes to drinking, social capital, and collective efficacy. Inconsistent results were found across studies examining the effects of neighbourhood-level socio-economic disadvantage. High levels of both adult and adolescent alcohol use in the neighbourhood showed positive associations with adolescent alcohol use whilst protective effects were found for enforcement of liquor laws. Adolescent drinking typologies: LCA revealed four drinking typologies amongst drinkers, reflecting an overall linear relationship between levels of consumption and alcohol-related harms. One class was an exception to this pattern, with moderate consumption associated with disproportionately high levels of alcohol-related harms. Having a positive attitude to regular alcohol use, buying own alcohol, peers using alcohol, and obtaining alcohol from friends and/or other adults were found to be the strongest predictors of belonging to high-risk drinking typologies. Changes in drinking between 2007 and 2012: Aggregate data for students in all groups characterised by age, sex, household SEP, and neighbourhood SEP showed declines in the prevalence and frequency of drinking. Reductions in the typical quantity of alcohol consumed by drinkers were only apparent among young males (<16 years). The gradient of this change was unequal across household SEP strata, whereby young males of low SEP showed smaller reductions compared to their more advantaged counterparts. Significant increases in high typical quantities (i.e. 5+ drinks per occasion) were evident in young females of low household and neighbourhood SEP. Neighbourhood typologies and adolescent alcohol use: Three neighbourhood types were identified: (1) “high outlet density and economic disadvantage”; (2) “high disadvantage, disorder, and social disorganisation”; and (3) “higher income and socially organised”. Interaction analyses showed that the effects of neighbourhood type on drinking were moderated by age. Among young adolescents (<16 years), students residing in type 1 and 2 neighbourhoods were more likely to consume high typical quantities when compared to students in type 3. Students in type 1 neighbourhoods were also more likely to be current drinkers. No significant associations between neighbourhood type and measures of drinking were found among older (≥16 years) adolescents. Pathways of neighbourhood effects: Neighbourhood disadvantage was positively associated with increased perceptions of physical disorder, which in turn was associated with lower levels of neighbourhood collective efficacy. Age was shown to moderate the relationship between collective efficacy and drinking. Specifically, collective efficacy was found to be protective against risky drinking among young adolescents (<16 years), but predicted increased risky drinking and current drinking in older adolescents (≥16 years). Alcohol outlet density was not implicated in the collective efficacy pathway, but showed direct relationships with drinking in both age groups. Among older adolescents, off-licence density was significantly associated with increased binge drinking and current drinking. Among younger adolescents, club density was positively associated with high typical quantities and current drinking. Conclusion An adolescent’s place of residence is often beyond their control, yet the findings from this thesis indicate that the neighbourhood can be an important influence on their alcohol use. In particular, exposure to area-level socio-economic disadvantage, physical disorder, alcohol outlets, and low collective efficacy may give rise to experiencing inequalities in harmful alcohol use. The interrelated nature of neighbourhood characteristics and variations in effects based on age point to the need for future research to employ developmentally-appropriate innovative methods that can better capture relevant exposures, pathways, and interactions of adolescents with their neighbourhood environments.