Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study

Inequality's on Tap: A Longitudinal Study of Area-Level Income Inequality and Alcohol Consumption Among Canadian Adolescents

PURPOSE

To determine if income inequality at the census division level is associated with alcohol consumption and abuse among junior high and high school students.

METHODS

Data on adolescents are from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. Participant data (n = 19,759) were collected during three survey waves (2016-2017, 2017-2018, and 2018-2019) and linked to 30 census divisions within four Canadian provinces. Data on income inequality and other area-level factors were derived from the 2016 Canadian census. Multilevel logistic regression modelling was used to quantify the associations between income inequality, monthly alcohol consumption, and binge drinking.

RESULTS

After adjusting for covariates, students living in census divisions within the second and third quintiles of income inequality experienced an average 80% (OR = 1.80, 95% CI = 1.08-3.02) and 92% (OR = 1.92, 95% CI = 1.05-3.51) increased odds of engaging in monthly binge drinking, respectively, compared to those living in the first quintile. Similarly, adolescents living in census divisions within the second inequality quintile experienced an average 169% (OR = 2.69, 95% CI = 1.45, 4.99) increased odds of engaging in weekly binge drinking, compared to those living in the first quintile. There was no significant association between higher income inequality and current monthly alcohol consumption.

DISCUSSION

Moderate area-level income inequality within census divisions was adversely associated with alcohol consumption among adolescents. Future work should investigate the potential mechanisms that mediate this relationship.

Distribution of the compression and expansion of morbidity in 194 countries and territories, 1990-2016: The role of income inequality

Studies on detailed types of health changes and the associations between the types and income inequality are inadequate. This study analyses the global distribution of the compression and expansion of morbidity in 194 countries and territories between 1990 and 2016, and investigates the role of income inequality in the distribution. This study shows that all seven types of health changes coexist, despite being distributed unevenly. The relative expansion of morbidity with increased or constant life expectancy (Type 6, 54.48%) is the most popular type, followed by the relative compression of morbidity with increased or constant life expectancy (Type 3, 30.71%). Income distribution within a society matters for health changes. Societies with greater income inequality tend to have Type 6, a worse scenario of health changes. Measures to reduce income inequality or mitigate its adverse effects will contribute to the relative compression of morbidity with increased or constant life expectancy.

While Some Things Change, Do Others Stay the Same? The Heterogeneity of Neighborhood Health Returns to Gentrification

Gentrification is associated with decreases in neighborhood poverty and crime, increases in amenities and services, among other benefits-all identified as structural determinants of health. However, gentrification is also associated with population-level replacement of the existing community, or threats thereof. Combining census data from the ten largest MSAs in the U.S. with tract-level estimates from the CDC-PLACES Project from 2013-14 to 2017-18, we explore how the changing socioeconomic conditions in gentrifying neighborhoods correlate with changes in neighborhood health. We find significant differences between gentrifying and non-gentrifying neighborhoods in their associations with neighborhood health. The sociodemographic changes occurring in gentrifying neighborhoods generally correspond with simultaneous decreases in aggregate health risk behaviors and negative health outcomes. However, these changes are heterogeneous and complex. Whether and how neighborhood health changes alongside other components of neighborhood change depends on whether gentrification occurs in majority Black, Hispanic, or White neighborhoods. Our findings provide preliminary evidence that the changes accompanying gentrification extend to neighborhood health, but the direction of influence varies by neighborhood composition, type of sociodemographic change, specific health outcome, and spatial spillover. We discuss theoretical implications for future work addressing the mechanisms driving changes in neighborhood health, and potential approaches that differentiate policy responses.

Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism

Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.