Structural Racism? City Level Segregation Explains Neighborhood Level Alcohol Outlet Exposure Risk

Purpose: The neighborhood alcohol environment is associated with a number of negative health outcomes. In addition, higher concentrations of alcohol outlets demonstrate a geographic association with poor and minority neighborhoods. The study examined whether the concentration of alcohol outlets across neighborhoods within a city could be explained by the level of black segregation for that city. Methods: Multilevel analysis of neighborhoods nested within Los Angeles County cities (N=104) were conducted. Measures of segregation at the city level (i.e., isolation index, dissimilarity index) were included to predict alcohol outlet density at the neighborhood level. Models included controls for neighborhood characteristics (e.g., poverty). Results: A significant amount of variance in the density of alcohol outlets for both off-premise outlets (e.g. convenience stores, liquor stores) (ICC=11.24%) and on-premise outlets (e.g. bars, restaurants) (ICC=2.50%) was explained at the city level in the empty model. The city level black dissimilarity index (black versus white) was positively associated with neighborhood level alcohol outlet density (beta =0.4156, p < 0.01). The black dissimilarity index also reduced the amount of variance in off-premise outlet density explained at the city level. The black isolation index was not significantly associated with alcohol outlet density. Conclusion: The manner in which a Los Angeles County city is socially structured (i.e., segregated) explains an inequality in the distribution alcohol outlets across neighborhoods in those cities. City levels policies may be responsible for this disparity.