Social and socio-demographic neighborhood effects on adolescent alcohol use: a systematic review of multi-level studies.

There is growing interest in the role of the neighborhood environment on adolescent alcohol use. Multi-level designs are ideally suited to this investigation due to their ability to examine area-level effects over and above the effects due to neighborhood composition. To date, most research in this area has focused on the physical availability of alcohol in the neighborhood. We reviewed the multi-level evidence on neighborhood-level risk and protective factors which influence adolescent alcohol use, excluding studies which assessed the impact of neighborhood-level alcohol availability and advertising. Systematic searches in Medline, EMBASE, CINAHL Plus, PsycINFO, Sociological Abstracts and SCOPUS identified 23 studies, examining 11 different neighborhood-level exposures. The majority of studies found no associations with residential mobility, neighborhood disorder or crime, employment or job availability, neighborhood attitudes to drinking, social capital and collective efficacy. For studies examining neighborhood-level socio-economic disadvantage mixed results were found. High levels of both adult and adolescent alcohol use in the community appeared to be associated with alcohol use whilst protective effects were found for enforcement of liquor laws. Methodological limitations within studies were evident. The dearth of high-quality, multi-level studies indicate that further research is required to inform the development of multi-faceted place-based policy and preventative interventions to reduce adolescent alcohol use. Future studies should consider the neighborhood context from the outset of study design and identify the individual-level control variables to adequately isolate neighborhood effects. Inclusion of moderation and mediation analyses would greatly contribute towards the understanding of causal pathways of neighborhood effects.