Scribner R A, Cohen D A, Fisher W
Louisiana State University School of Medicine, New Orleans, USA.
Alcohol Clin Exp Res. 2000 Feb;24(2):188-95.
Ecological studies reveal that alcohol-related outcomes tend to occur in high alcohol outlet density neighborhoods. The ecological design of these studies limits the interpretation of the findings in terms of the level of the effect. The effect of alcohol outlet density could be related to greater individual access to alcohol, an individual level effect, or to the grouping of drinkers by neighborhood, a structural effect at the neighborhood level.
To differentiate between individual and neighborhood level possibilities, we conducted a multilevel study. Individual distance to the closest alcohol outlet was the individual level measure of the effect of alcohol outlet density, whereas the mean distance to the closest alcohol outlet for all individuals within a census tract was the neighborhood level measure for the effect of alcohol outlet density. We analyzed telephone surveys of 2604 telephone households within 24 census tracts stratified by poverty status and alcohol outlet density. Individual distance to alcohol outlets, age, sex, race/ethnicity, and level of education were entered as individual level covariates, and their corresponding aggregated means were entered as census tract level covariates (i.e., mean distance to outlets, mean age, percentage male, percentage Black, mean education).
Analysis of variance revealed that 16.2% of the variance in drinking norms and 11.5% of the variance in alcohol consumption were accounted for at the census tract level. In multivariate hierarchical analysis, individual distance to the closest alcohol outlet was unrelated with drinking norms and alcohol consumption, whereas mean distance to the closest alcohol outlet demonstrated a negative relation with drinking norms (betae = -5.50+/-2.37) and with alcohol consumption (betae = -0.477+/-0.195); that is, the higher the mean distance to the closest alcohol outlet, the lower the mean drinking norms score and mean level of alcohol consumption.
The findings suggest that the effect of alcohol outlet density on alcohol-related outcomes functions through an effect at the neighborhood level rather than at the individual level. Problem drinkers tend to be grouped in neighborhoods, an effect predicted by alcohol outlet density.
生态学研究表明，与酒精相关的后果往往发生在酒精销售点密度高的社区。这些研究的生态学设计限制了从效应水平角度对研究结果的解释。酒精销售点密度的效应可能与个人更容易获得酒精有关，这是个体层面的效应，或者与社区中饮酒者的聚集有关，这是社区层面的结构效应。
为了区分个体层面和社区层面的可能性，我们进行了一项多层次研究。个体到最近酒精销售点的距离是酒精销售点密度效应的个体层面衡量指标，而普查区所有个体到最近酒精销售点的平均距离是酒精销售点密度效应的社区层面衡量指标。我们分析了对24个按贫困状况和酒精销售点密度分层的普查区内2604个电话家庭的电话调查。个体到酒精销售点的距离、年龄、性别、种族/民族和教育水平作为个体层面的协变量输入，其相应的汇总平均值作为普查区层面的协变量输入（即到销售点的平均距离、平均年龄、男性百分比、黑人百分比、平均教育程度）。
方差分析显示，普查区层面解释了饮酒规范方差的16.2%和酒精消费方差的11.5%。在多变量层次分析中，个体到最近酒精销售点的距离与饮酒规范和酒精消费无关，而到最近酒精销售点的平均距离与饮酒规范呈负相关（βe = -5.50±2.37），与酒精消费呈负相关（βe = -0.477±0.195）；也就是说，到最近酒精销售点的平均距离越高，平均饮酒规范得分和平均酒精消费水平越低。
研究结果表明，酒精销售点密度对与酒精相关后果的影响是通过社区层面而非个体层面起作用的。问题饮酒者往往聚集在社区中，这是酒精销售点密度所预测的一种效应。
