The Effect of Alcohol Use on Low-Income Neighborhoods

The use of alcohol in the United States has long been a topic of heated debate for a wide variety of reasons, especially due to its excessive use. According to the U.S. Department of Health and Human Services (HHS), health is negatively affected by the overuse of alcohol (such as cirrhosis and other chronic diseases) and other problems are also created, including domestic violence and driving while intoxicated (HHS, 2000). The environment in which people live has an obvious impact on many aspects of their lives, and this extends to issues that may negatively affect their health. Consequently, various entities have focused attention on the possible relationship between low-income neighborhoods and alcohol consumption (Macintyre, Ellaway, & Cummins, 2002). Based on the implications of alcohol use at many levels, the importance of this topic cannot be overstated.

This paper addresses alcohol usage in a particular special population in the U.S.—low-income neighborhoods (i.e., neighborhood income classified as at the poverty level). First, poverty is defined based on government guidelines. Evidence from the literature is then provided to support the paper’s thesis: a high density of alcohol outlets negatively affects low-income neighborhoods. Additional factors are also considered, including a possible relationship between race and excessive use of alcohol in neighborhoods impacted by poverty.

The Neighborhood Affect

While many people may have an opinion of what poverty is, the government establishes official guidelines that clearly define it. According to the U.S. Department of Health and Human Services (HHS), “the poverty guideline for one person in 2013 was $11,490 in income, and for a family of four, it was $23,550” (HHS, 2013). Official poverty guidelines fluctuate from year to year and are based on many factors, including the Consumer Price Index. There are also ways of measuring the level of poverty at the neighborhood level and such neighborhoods are clearly considered disadvantaged in numerous ways (Cerda´ et al., 2010). Using statistical measurements established by the government that are uniform and detailed provides researchers an ability to develop an understanding of factors that are commonly observed in neighborhoods.

The literature discusses a phenomenon termed the “neighborhood effect” especially in the context of how individuals are affected by specific neighborhood characteristics. This research started in the early 1970s with studies on income equality and expanded to other, related topics since that time (Reardon & Bischoff, 2011). According to one source, “Nearly 9 million Americans live in ‘extreme-poverty’ neighborhoods in which at least 40 percent of residents are poor” (Kneebone, Nadeau, & Berube, 2011). Understanding neighborhood effects allows the creation and implementation of policies that may provide benefits to individuals living there.

Exploring the literature related to the neighborhood effect allows the identification of consistent themes. One theme observed in the literature is a linkage between abuse of alcohol and residing in poverty-stricken neighborhoods, which suffer from social isolation and instability (see, e.g., Freisthler, Lascala, Gruenewald, & Treno, 2005). Admittedly, there is some question about the design of many studies reaching such conclusions since most are cross-sectional and lack a longitudinal context. In an attempt to address that gap, Cerda´, Johnson-Lawrence and Galea (2010) studied neighborhood contexts over time, especially how the incidence of alcohol abuse was reported over time. In effect, the study sought to determine whether there was actually a neighborhood effect or whether the increased use of alcohol was simply due to individual socioeconomic characteristics. While the study took an important step toward clarifying the true effect of a neighborhood on individual drinking behavior, including additional longitudinal studies are necessary to firmly verify the theme.

This is not to say that a longitudinal design has not been used in research. For example, three previous studies were located that used such a design to study the effect of living in a low-income neighborhood on the use—or more accurately, the misuse—of alcohol (Bu et al., 2007; Fauth, Leventhal & Brooks-Gunn, 2004; Hoffman, 2002). Of these, Bu et al. and Fauth et al. reported a positive relationship between alcohol abuse and low-income neighborhoods. The work by Cerda´ et al. (2010) confirmed those findings on young adults living in neighborhoods classified as at or below the poverty level. Such evidence on the neighborhood effect is significant in the support of this paper’s thesis.

An examination of the literature also revealed other outcomes of this neighborhood effect. A neighborhood environment experienced over a period of years will very likely have a causal effect on individuals’ life in the long run (Ludwig et al., 2013). One reason why this occurs is the added exposure to negative social influences that often accompanies life in a low-income neighborhood. Disadvantaged neighborhoods are notorious for a lack of access to critical services as well as a population that is typically less educated and possessing few opportunities.

Low-Income Neighborhoods and Race

Much of the research on low-income neighborhoods includes articles from the U.S. as well as Europe since many similarities exist. For example, neighborhoods classified as low-income are largely populated by non-whites (or immigrants in Europe) and are consistently found to suffer from a lack of social cohesion and more informal social structures across the neighborhood (Galster, 2010). Negative consequences are widely identified, including criminal activity, delinquency, mental problems, and increased use of alcohol. While these connections are clear in the literature, it is also important to understand that multiple mechanisms may influence overall behavior, so careful examination of the literature is needed.

A connection between the overuse of alcohol in low-income neighborhoods and race is a common topic of research. The relationship between low-income neighborhoods and prevalence of excessive drinking was investigated in the U.S. by Karriker-Jaffe et al. (2012), for example, who observed differences in behavior between races and genders. The researchers proposed a hypothesis that assumed a higher rate of excessive alcohol use by males, African Americans, and Hispanics. Karriker-Jaffe and colleagues utilized merged data collected from the 2000 Census and the 2000 and 2005 National Alcohol Surveys, which included a statistically equal number of Whites, non-whites, males, and females (2012). Results included a finding of negative consequences related to increased drinking levels that were modified by race. Higher levels of overdrinking were found in non-whites and males living in neighborhoods populated by individuals and families classified as predominantly at the poverty level (Karriker-Jaffe et al., 2012). The researchers identified the need for interventions specifically targeted at such neighborhoods designed to reduce the negative effects of alcohol. Such research needs to include factors relevant to the racial groups most affected by socioeconomic status.

The Density of Alcohol Outlets in Neighborhoods

One area that many stakeholders are concerned with is the seemingly excessive number of alcohol outlets located in poorer neighborhoods. Research has linked a higher density of bars, liquor stores, and other outlets where alcohol is easily purchased with an increase in crime and violence in the neighborhood where these are located (Gruenewald, 2008). Multiple theories are proposed to explain the relationship between a higher density of alcohol outlets and criminal activity (Mair et al., 2013), with the predominant belief positing that the primary motivator is simply ease of access. This problem is further complicated when a low-income neighborhood is a home to multiple alcohol outlets. Oftentimes, the easy access to alcohol creates an environment where a core of heavy drinkers with little else to do become involved in criminal activity (Mair et al., 2013). It seems clear that different neighborhoods provide the stimulus for individuals to act in one way or another regarding the availability of alcohol. Unfortunately, a neighborhood predominated by low-income households is much more likely to be affected by the prevalence of liquor outlets than are neighborhoods that are more socially stable.

Neighborhood characteristics are critical in determining the effect of increased alcohol availability. In the study by Mair et al. (2013), evidence was reported that confirmed a connection between the density of alcohol outlets (including bars or pubs) and reported crimes including those resulting in hospitalizations. That study also included alcohol outlets that may be located in areas close to a low-income neighborhood. Results left little doubt of a strong correlation between low-income neighborhoods, which are typically populated largely by at-risk individuals and households, and increased risk for violence related to excessive drinking. In light of such study results, responsible individuals would do well to look for ways to limit the density of alcohol outlets in or near low-income neighborhoods.

Numerous studies addressed this issue and the majority reached similar conclusions. McKinney et al. (2012) investigated the relationship between the number of alcohol outlets in a neighborhood with over-drinking and family problems resulting from an abuse of alcohol. This study used a specific definition of alcohol outlet density based on the number of outlets per 10,000 population and calculated according to U.S. zip codes. A neighborhood was considered at the poverty level if approximately 20 percent of the individuals or households in the neighborhood live at the poverty level (according to the Census Department data). Similar to the results reported by Karriker-Jaffe et al. (2012), McKinney and associates (2012) identified an increased level of binge drinking that was stronger among males than females in the studied low-income neighborhoods. The risk of violence perpetrated upon an intimate partner was also found to be more likely in low-income neighborhoods with an excessive number of alcohol outlets. There is, therefore, a need for designing interventions directed toward the male partners who may be at risk of perpetrating such behavior. Since households in low-income neighborhoods are less likely to have the necessary social structure and leadership, such interventions will typically be introduced by external sources.

The literature reports a consistent link between increased levels of violence and a higher density of alcohol outlets in neighborhoods. One such study, Mair et al. (2013), reported a specific connection between violence and low-income neighborhoods that are highly populated by minorities. Their results supported the findings of Gruenewald (2008) who observed correlation between three highly contributing factors: a predominantly African American population, a neighborhood at the poverty level, and alcohol outlets—especially bars—that are in higher density than average. Mair and colleagues (2013) also noted that other environmental characteristics may also be instrumental in the observed actions although the low-income nature of a neighborhood with high-density alcohol outlets appears to play a critical role. There is still a need for additional research that could provide tools for interventions in neighborhoods plagued with increased levels of violence.

The effect of a higher density of alcohol outlets extends to others besides the individual engaged in increased drinking. For example, Freisthler et al. (2008) reported an increase in negative outcomes for children in these neighborhoods, including child abuse, accidents, and assaults. Consistent with other studies (e.g., Gruenewald & Remer, 2006), the research found higher levels of violence and crime in neighborhoods that had a high density of alcohol outlets, especially liquor stores. More precise data was reported by another study that found nearly three and one half additional incidents of assault each year for every newly opened liquor store in a low-income neighborhood (Moore et al., 2009). Interestingly, Moore and colleagues further reported that a higher number of liquor stores represent a greater risk of higher crime rates than a low-income neighborhood or any other factor. The combination of poverty and high-density liquor outlets would tend to create an environment even more conducive to crime and violence.

A high concentration of alcohol outlets in combination with widespread advertising of alcohol (such as via billboards) creates a very negative environment for low-income neighborhoods, especially those that are predominantly African-American. A significant amount of research indicates that non-whites are typically exposed to liquor stores and alcohol advertising far more often than whites, and this includes adults and young people (Romley et al., 2007). As reported by Moore et al. (2009), predominantly black West Oakland California has one liquor store per 298 residents, which is nearly ten times the volume of liquor stores present in neighboring largely-white Piedmont. Consequently, members of neighborhoods in West Oakland are much more likely to have easy access to a liquor store than to a supermarket.

Many negative results arise from a high density of alcohol outlets. One of the most troubling is economic and social instability due to a lack of leadership that can shape a positive vision of the neighborhood (Moore et al., 2009). Few members of a community—even those that experience poverty and diminished access to services—desire property to be used to build additional liquor stores. Certainly, better use of land in any neighborhood is the construction of parks or schools. An overabundance of alcohol outlets in any neighborhood projects an appearance of instability and lack of safety. Furthermore, the high density of liquor stores creates a constraint for potential economic or business opportunities otherwise available.

An Opposing Viewpoint

Most of the literature examined the effect of alcohol in a short-tern context. However, the study by Cerda´ et al. (2010) investigated the impact of alcohol consumption on income over a period of decades. The study examined data from five income groups, including those classified as low-income over 27 years. Somewhat surprisingly, there was a significant relationship between individuals with lower income levels (regardless of drinking age) and reporting a lower incidence of drinking. Alcohol use was most widely reported in the 45-59 age cohort. At the same time, the study indicated that significant changes in income level over time were related to increased levels of drinking alcohol. Interestingly, the greatest increase in drinking was reported among those who went from a low-income level early in life to a higher income level later (Cerda´ et al., 2010). These results are contrary to the majority of other studies reported on in the literature.

One other contradictory study was located. In contrast to the bulk of the research reported on previously in this paper, Pollack et al. (2005) indicated that alcohol consumption levels are higher in neighborhoods with higher income levels. The authors speculated that this result may be due to differences in the cultural or social environment in those neighborhoods. Moreover, the type and tone of advertising for alcohol are different in low-income neighborhoods and more affluent communities (Pollack et al., 2005). Unlike the vast majority of previously reviewed studies, Pollack and associates did not find a correlation between a high density of alcohol outlets and increased levels of drinking in the neighborhood. Nonetheless, the researchers did note a link between other negative outcomes, such as assault, vehicle accidents, and murder, and a high density of alcohol outlets in a low-income neighborhood. This may indicate that alcohol availability could have broader effects on low-income neighborhoods than simply a potential for contributing to binge drinking or overuse of alcohol. Pollack and colleagues noted that “a concentration of outlets may create areas of decreased monitoring and relaxed social restrictions where people congregate to drink. This may, in turn, give rise to a greater number of accidents and/or criminal offences and increased health risks” (p. 778). While reaching a different conclusion than most of the literature, this study should be taken into consideration in any attempt to form some sort of intervention tools to assist those in low-income neighborhoods to avoid the negative influence that alcohol availability can exert.

Conclusion

This paper discussed alcohol usage in low-income neighborhoods (i.e., neighborhood income classified as at the poverty level) in the United States. Poverty was defined based on government guidelines and evidence from the literature was provided to support the paper’s thesis that a high density of alcohol outlets negatively affects low-income neighborhoods. The thesis proposed for this paper was: high density of alcohol outlets negatively affects low-income neighborhoods. Two opposing viewpoints were considered, which did not meet a level of prevalence in the literature to overcome the consistent support for this paper’s thesis. Additional factors were also considered, including a relationship between race and excessive use of alcohol in neighborhoods impacted by poverty. The literature indicated the need for limiting the number of alcohol outlets in many neighborhoods, especially those suffering from poverty since there appears to be a connection between availability and overuse of alcohol in low-income neighborhoods.

Most of the literature reviewed for this paper supported the thesis and indicated that there is a connection between an increased density of alcohol outlets in low-income neighborhoods and negative outcomes for the population. In many cases, the negative outcome is simply increased levels of alcohol consumption on a personal basis. Depending on the amount of alcohol consumed, an individual’s health could be negatively affected over time. In other cases, the increase in alcohol consumption results in increases in criminal activity and violent actions. Furthermore, even in the studies that did not report a connection between low-income neighborhoods and increased alcohol consumption, other serious consequences were reported, such as vehicle accidents (due to driving while intoxicated) as well as violence directed toward children.

This review of research related to alcohol use in low-income neighborhoods indicated a need for interventions designed to prevent the negative effects of the high density of alcohol outlets in low-income neighborhoods. In most cases, the literature was clear that low-income neighborhoods are predominantly non-white. Researchers and policymakers at the local and state level can play a critical role in changing the current environment that permits low-income neighborhoods to become the target of a high concentration of alcohol outlets. Whatever the actual impact of these outlets, they often prevent other businesses—which could bring real benefits to the neighborhood—from entering the area.

Importantly, since these neighborhoods typically lack the necessary leadership to develop needed programs or provide the required political or business clout to make required changes, interventions need to be developed and sponsored from outside the neighborhood. Every neighborhood can add something beneficial to the larger community if given an opportunity so efforts designed to counteract negative influences are important for the residents of less-privileged neighborhoods. Certainly, individual members of a neighborhood should take responsibility for their behavior, but in many cases, these individuals simply need support from others to set them on a better course. As stated at the outset, based on the implications of alcohol use at many levels, the importance of this topic cannot be overstated.

References

Bu, A., Mansour, M., Wang, J., Refior, S., Fitzgerald, H., & Zucker, R. (2007). Alcoholism effects on social migration and neighborhood effects on alcoholism over the course of 12 years. Alcohol Clin Exp Res., 31, 1545-1551.

Cerda´, M., Johnson-Lawrence, V., & Galea, S. (2010). Income and alcohol consumption: Investigating the links between lifecourse income trajectories and adult drinking patterns. Bethesda, MD: National Institutes of Health. Retrieved from http://paa2010.princeton.edu/papers/101517

Fauth, R., Leventhal, T., & Brooks-Gunn, J. (2004). Short-term effects of moving from public housing in poor to middle-class neighborhoods on low-income, minority adults’ outcomes. Soc Sci Med., 59, 2271-2284.

Freisthler, B., Gruenewald, P., Ring, L., & LaScala, E. (2008). An ecological assessment of the population and environmental correlates of childhood accident, assault, and child abuse injuries. Alcoholism: Clinical and experimental research, 32(11), 1969-1975.

Galster, G. C. (2010). The mechanism(s) of neighborhood effects theory, evidence, and policy implications. Paper for presentation at the ESRC Seminar: Neighbourhood Effects: Theory & Evidence, St. Andrews University, Scotland, UK. Retrieved from http://www.researchgate.net/

Gruenewald, P. (2008). Why do alcohol outlets matter anyway? A look into the future. Addiction, 103, 1585-1587.

Gruenewald, P., & Remer, L. (2006). Changes in outlet densities affect violence rates. Alcoholism: Clinical and Experimental Research, 30(7), 1184-1193.

Hoffman, J. (2002). The community context of family structure and adolescent drug use. J Marriage Fam., 64, 314-330.

Karriker-Jaffe, K. J., Zemore, S. E., Nina Mulia, Jones-Webb, R., Bond, J., & Greenfield, T. K. (2012). Neighborhood disadvantage and adult alcohol outcomes: Differential risk by race and gender. J. Stud. Alcohol Drugs, 73, 865-873.

Kneebone, E., Nadeau, C., & Berube, A. (2011). The Re-Emergence of Concentrated Poverty: Metropolitan Trends in the 2000s. Washington, DC: The Brookings Institution, Metropolitan Policy Program. Retrieved from www.brookings.edu/

Ludwig, J. (2013). Long-term neighborhood effects on low-income families: Evidence from moving to opportunity. American Economic Review Papers and Proceedings, 103(3), 226-231.

Macintyre, S., Ellaway, A., & Cummins, S. (2002). Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med, 55, 125-39.

Mair, C., Gruenewald, P. J., Ponicki, W. R., & Remer, L. (2013). Varying impacts of alcohol outlet densities on violent assaults: Explaining differences across neighborhoods. J Stud Alcohol Drugs, 74(1), 50-58.

McKinney, C. M., Chartier, Raul Caetano, K. G., & Harris, T. R. (2012). Alcohol availability and neighborhood poverty and their relationship to binge drinking and related problems among drinkers in committed relationships. J Interpers Violence, 27(13), 2703-2727. doi: 10.1177/0886260512436396

Moore, E. et al. (2009). Measuring what matters: Neighborhood research for economic and environmental health and justice in Richmond, North Richmond, and San Pablo. Oakland, CA: Pacific Institute, pp. 56-62. Retrieved from http://www.pacinst.org/wp-content/uploads/sites/21/2013/02/final7.pdf

Pollack, C. E., Cubbin, C., Ahn, D., & Winkleby, M. (2005). Neighbourhood deprivation and alcohol consumption: does the availability of alcohol play a role? International Journal of Epidemiology, 34, 772-780.

Reardon, S. F., & Bischoff, K. (2011). Income Inequality and Income Segregation. American Journal of Sociology, 116(4), 1092-1153.

Romley, J., Cohen, D., Ringel, J., & Sturmhttp, R. (2007). Alcohol and Environmental Justice: The density of liquor stores and bars in urban neighborhoods in the United States. Journal of Studies on Alcohol and Drugs, 68(1), 48-55.

U. S. Department of Health and Human Services. (2013). 2013 Poverty guidelines. Retrieved from http://aspe.hhs.gov/poverty/13poverty.cfm#thresholds

U.S. Department of Health and Human Services. (2000). 10th Special Report to the U.S. Congress on Alcohol and Health, National Institute on Alcohol Abuse and Alcoholism. Bethesda, MD: National Institutes of Health, REP023.