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Article Excerpt
DISPARITIES IN HEALTH RISKS across racial/ethnic and income groups have been documented for toxic waste sites, air pollution, and industrial sites (Brown, 1995; Environmental Protection Agency, 1992). In response, a 1994 Presidential Order requires every federal agency to make "... achieving environmental justice part of its mission ..." and to reduce disproportionate impacts on minority low-income populations (Federal Register, 1994, p. 1). Most of the research and policy efforts have focused on toxic substances near residences, but environmental justice advocates argue that a wider range needs to be considered. The Institute of Medicine (1999) report expands the focus to all places where people live, work, and play; others include in the definition of a "toxic environment" (Horgen and Brownell, 2002) factors that compromise healthy lifestyles, such as barriers to physical activity/healthy eating or environmental factors that encourage tobacco use or excess alcohol consumption.
This broader view may be particularly relevant for reducing sociodemographic health disparities, because health behaviors are the main causes of premature mortality (McGinnis, 1993; Mokdad, 2004, 2005). Yet whereas national data show that there are sociodemographic disparities in unhealthy lifestyles, data on environmental influences are almost all of limited geographic scope. This is true for alcohol or tobacco availability, food outlets, or environments conducive to physical activity.
In this article, we study the association between residential sociodemographic characteristics and alcohol outlet density. There are several local studies that have found higher alcohol outlet density (Gorman and Speer, 1997; LaVeist and Wallace, 2000) or more outdoor advertising of alcohol or tobacco (Altman et al., 1991; Hackbarth et al., 1995) in minority neighborhoods. Although the studies cover very different cities, including Baltimore, Chicago, San Francisco, and a city in New Jersey, it is not clear whether these studies reflect a general pattern. In New Jersey, the neighborhood with the highest alcohol outlet density was also one of the wealthiest (Gorman and Speer, 1997). There may also be a selection bias from those case studies, because they are most likely to be conducted in sites where there appear to be noticeable inequities. For example, the Chicago study is often cited, but it is also the same site where the city council passed one of the nation's toughest anti-alcohol and tobacco billboard ordinances because of perceived disparities (Hackbarth et al., 2001). There are no data on a national scale showing that alcohol retailer presence is greater in high-minority and lower-income minority neighborhoods. This article tries to fill this gap.
Higher alcohol availability in minority neighborhoods is unlikely to be a result of higher demand. To the contrary, national individual-level data show lower consumption by blacks, Hispanics, and Asians than non-Hispanic whites (Native Americans have higher consumption). This is true for both any alcohol consumption (55% for non-Hispanic whites compared with 39.9% for blacks and 42.3% for Hispanics) and heavy alcohol use (7.5% for non-Hispanic whites compared with 4.4% for blacks or 5.9% for Hispanics) (National Center for Health Statistics, 2004). Lower-income groups do have higher alcohol consumption; therefore, demand factors may lead to higher alcohol availability in lower-income neighborhoods. However, the most recent study based on four cities in California concludes that, although alcohol availability is concentrated in the most-deprived neighborhoods, more women and men in the least-deprived neighborhoods are heavier drinkers (Pollack et al., 2005). This mismatch between supply and demand may cause people in the most-deprived neighborhoods to disproportionately suffer the negative health consequences of living near alcohol outlets (Pollack et al., 2005). Such mismatches are at the heart of the environmental justice movement.
There are several pathways through which differential availability of alcohol can contribute to sociodemographic disparities. In California, type and number of outlets predict arrest rates for public drunkenness, misdemeanor, and felony drunken-driving arrest rates and cirrhosis mortality rate (Rabow and Watts, 1982). Spatial analysis suggests that alcohol outlets elevate the rate of violent crime within the neighborhood context (Gorman et al., 2001; Scribner et al., 1995, 1999; Speer et al., 1998; Zhu et al., 2004), and alcohol availability seems to be related to self-reported injury rates (Treno et al., 2001), both health problems that are greater in more-deprived neighborhoods. Data from some cities suggest that the physical availability of alcohol is a contextual factor that may increase alcohol consumption and alcohol-related problems over what individuals in those communities would otherwise consume (Scribner et al., 1994, 2000), although data from other cities find no evidence for this (Pollack et al., 2005). Discrepancies in findings may be a consequence of the level of geographic units analyzed, and it is desirable to examine the relationship between alcohol availability and consequences at geographic units of analysis that are smaller than cities (Gorman et al., 2001; Scribner et al., 1999).
The ideal measure of exposure to alcohol outlets depends on the scale of the processes through which alcohol outlets are thought to affect social outcomes. For drunk driving accidents, the scale is obviously much larger than for barroom brawls, but heavy drinking, alcoholism, crime, and assaults fall somewhere in the middle ground. Empirical evidence is sparse because data are generally available only at a fixed resolution, which does not permit testing different spatial definitions. Some studies have measured outlet density at the city level...
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