We propose to investigate the relationship between the neighborhood-level availability and promotion of alcohol and alcohol-related mortality, and to study the degree to which racial and socioeconomic differences in alcohol-related mortality may be accounted for by the neighborhood-level availability and promotion of these substances. Alcohol availability and promotion are modifiable neighborhood-level risk factors because they are regulated by local, state and federal agencies. We intend to focus on a stratified sample of 114 urban census tracts in California and 114 urban census tracts in Louisiana randomly sampled so that the median income is equally divided into high, medium and low SES tracts. In these census tracts we will conduct observations of the availability of alcohol products at neighborhood stores as well as the density of billboards promoting alcohol; we will collect very specific information about malt liquor, which is believed to be heavily promoted in low-income neighborhoods. In addition, we will conduct telephone interviews of residents in the selected census tracts to measure social capital, collective efficacy, alcohol consumption, and alcohol-related morbidity. Our outcomes of interest will be self-reported alcohol use, alcohol related morbidity, and census tract rates of alcohol-related mortality. We will use geographic information systems (GIS) to map the spatial relationships between alcohol promotion, alcohol consumption and alcohol related mortality. Hierarchical linear models and structural equation modeling to distinguish between individual and structural risk factors will be used for the data analysis. Because alcohol marketing is already regulated, if certain marketing techniques are disproportionately associated with alcohol consumption and alcohol-related mortality, the findings can be used to inform public policy.
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