Examining place influence on alcohol related behaviour and health outcomes in New Zealand.

Abstract

Much of the literature on the determinants of health, including alcohol consumption, has focussed on differences in individual socio-economic status as a primary risk factor. However, it has been shown that variation in health between places can be attributed to both the characteristics of the people who live in those places (composition) and also to the characteristics of the places where people live (context). From the 1990s, there has been considerable interest in the role of neighbourhoods, specifically whether their social and physical characteristics are important in explaining inequalities in health. The main aim of this thesis is to determine the influence of ‘place’ effects on alcohol-related behaviour and health and social outcomes in New Zealand. To achieve this, data was obtained for hospitalisation and mortality directly related to alcohol consumption. Age standardised rates of alcohol related hospitalisation and mortality were calculated for different census areas units over time. Secondly, a database of all alcohol outlets including type and category was obtained from the Liquor Licensing Authority and geocoded for all meshblocks in New Zealand. Using ArcGIS road network functionality, least cost distance to nearest alcohol outlets was calculated. In addition, two buffers (800 and 3000 metres) were created around the population weighted centroids of each meshblock. Statistical analysis was undertaken to examine the distribution of alcohol outlets in areas of differing socio-economic status. Thirdly, binary logistic regression was used to examine the relationship between various access measures developed and individual alcohol related behaviour from the New Zealand Health Survey (2006/07). Lastly, Ordinary Least Squares regression was used to establish the association between the density of alcohol outlets and crime, and alcohol related hospitalisation. The results reveal there is increasing geographic inequality of both hospitalisation and mortality between the most and the least deprived areas in New Zealand. Secondly, the results consistently show there is inequity in the availability of alcohol outlets; there are clear social patterns in the distribution of alcohol outlets with disproportionately high numbers in more socially deprived neighbourhoods. Thirdly, at the national level, after controlling for potential confounding factors, there was no association between either hazardous or frequent consumption of alcohol and access to alcohol outlets. However, there was an association for particular sub-populations in regards to hazardous and frequent consumption and access to alcohol outlets. Fourthly, although the explained variance was often quite low in outcome models for crime and hospitalisation, nevertheless most of the variance for crime was predicted by the density of alcohol outlets. A number of important theoretical and policy implications flow from this study. Alcohol outlets are modifiable structures in the environments that are amenable to policy interventions at a community and national level. Interventions could concentrate on three aspects to reduce excess consumption; zoning ordinances, reducing alcohol outlets in deprived areas and increased alcohol taxation. Starting with the first proposed intervention, zoning ordinances provide communities and local governments with the opportunity to regulate outlet numbers and locations as well as their trading hours. This intervention has the potential to reduce opportunities for obtaining alcohol. Secondly, a reduction in the number of alcohol outlets is likely to reduce consumption and consequently improve health and social outcomes. Finally, higher alcohol prices via increased taxation is likely to be a deterrent to excess consumption and related health outcomes. Three priority areas are identified and recommended for future research. Studies using a mixture of both qualitative and quantitative methods, to better understand the association between local purchases of alcohol, consumption and proximity to alcohol outlets would be beneficial. In addition, the use of qualitative methods to examine the influence of social capital and cohesion, culture and norms on alcohol consumption in areas with higher densities of, and better access to alcohol outlets, is imperative. Lastly, longitudinal studies are also recommended to investigate increases or decreases in the number of alcohol outlets over time and the impact of such changes on the consumption patterns of different sub-populations.