Understanding Associations Between Neighborhood Socioeconomic Status and Negative Consequences of Drinking: A Moderated Mediation Analysis

Our health and behavior are influenced by where we live. We explored how neighborhood socioeconomic status (SES) is related to negative consequences of drinking to illuminate some reasons why racial/ethnic minority group members are more at risk for adverse alcohol outcomes if they live in disadvantaged neighborhoods. Because less is known about benefits and risks of living in affluent areas, we examined contributions of both neighborhood disadvantage and affluence to negative consequences of drinking and identify unique processes associated with each context. Theories suggest several plausible psychosocial pathways from neighborhood SES to alcohol outcomes, yet few studies have examined this issue, particularly for adults. We included 3 possible mediators of associations of neighborhood SES with negative drinking consequences: increased heavy alcohol use, distress and perceived norms about drinking. We examined differences by sex and race to highlight possible sources of disparities in negative alcohol outcomes for racial/ethnic minority group members. Data came from the 2000 and 2005 National Alcohol Surveys (N = 7,912 current drinkers ages 18 and up; 49% female) linked with the 2000 Decennial Census. Analyses involved simultaneous multivariate path models with multiple groups analysis to assess differences by sex and race. Covariates included neighborhood immigrant concentration and individual-level demographics. In the full sample, neighborhood disadvantage had a significant direct path to increased negative consequences, with no indirect paths through either distress or pro-drinking norms. Neighborhood affluence had significant indirect paths to increased negative consequences through both pro-drinking norms and increased heavy drinking. Sub-group analyses showed the indiret path from affluence to conseqeunces held for White men, with no effects of neighborhood disadvantage. For racial/ethnic minority men, there were significant indirect paths from both neighborhood disadvantage and affluence to increased consequences that each were partially explained by both pro-drinking norms and increased heavy drinking. There were limited neighborhood effects for both White and racial/ethnic minority women. Context is important when considering alcohol outcomes in diverse groups, but existing theories of neighborhood effects are insufficient. Interventions targeting pro-drinking norms in both affluent and disadvantaged areas may help reduce alcohol-related problems, particularly among men. These findings are important for the development of prevention programs for people and neighborhoods at risk, because they identify potential points of intervention to reduce the burden of heavy alcohol use and alcohol problems.