A systematic review of the influence of community level social factors on alcohol use
Highlights
► The review disentangles evidence on community level social factors and alcohol use. ► Results suggest social capital characteristics are protective against alcohol use. ► Results inconclusive for the influence on alcohol use of the other social factors.
Introduction
Alcohol is one of the leading contributors to the global burden of disease, and the leading contributor to premature death and disability worldwide in the 15–59 age group (World Health Organisation, 2009, World Health Organisation, 2011). Alcohol consumption also has major psychosocial consequences, including breakdown of relationships and families, violence, crime, child neglect and abuse, and reduced individual and community productivity (Babor et al., 2010, Cercone, 1994, Graham and West, 2001).
Many studies have attempted to identify risk- and protective-factors associated with alcohol misuse. Most of these studies have focused on individual, peer, parental and genetic correlates of alcohol use. However, an individual's behaviour may also be shaped by the physical and social environment in which they live (Chow et al., 2009, Jencks and Meyer, 1990), an issue of growing interest to researchers. In a recent systematic review (Bryden et al., 2012) we have examined the influence of availability and advertising of alcohol within a community on the drinking behaviour of local residents. In order to provide as complete a summary as possible of evidence on potentially modifiable community-level factors, this partner paper focuses on community level social factors that may influence alcohol consumption locally. These include socio-economic factors (deprivation, income and employment), disorder and crime (including disorder, safety, violence/crime), social capital (community attachment, closeness and supportiveness and community participation) and social norms – all of which are factors that may offer scope for interventions to complement those targeted individually. There has been no previous systematic review specifically focusing on how these community level social factors influence alcohol use. In combination with its partner paper on availability and advertising of alcohol, such a review could help guide policy makers seeking to tackle hazardous drinking at a local level, as together they highlight potentially modifiable community-level factors that affect alcohol misuse.
This systematic review examines the associations between community level social factors and alcohol use. The specific research objectives were to (i) describe the methodological and other characteristics of the studies identified following a systematic search (including study locations, populations, research methods, outcomes and exposures of interest); (ii) assess the methodological quality of the studies included, (iii) and assess the strength of the evidence that community level social factors are significantly associated with alcohol use in adults and adolescents.
Section snippets
Methodology
A systematic review of observational (cross-sectional and longitudinal) and intervention studies was conducted according to PRISMA systematic review guidelines (Liberati et al., 2009); a completed checklist is provided in Web Annex 5. Primary research studies published in peer-reviewed journals or which were found in grey literature were eligible to be included. Only quantitative studies were included in order to quantify any associations between community level social factors and alcohol use.
Search strategy
Studies were initially identified by searching the electronic databases Medline, Web of Science, IBSS and PsycInfo on 26th August 2011. Limits were applied to include titles only, but no limits were applied for language, country or publication start date. The core search strategy is shown below, and search terms were amended for use as necessary in the different databases:
(area⁎ OR geogr⁎ OR place OR local⁎ OR neighborhood⁎ OR neighbourhood⁎ OR community OR communities OR environment OR
Selection of studies
There were four stages in selecting studies for inclusion in the review: (i) identification of studies from bibliographic databases and references; (ii) screening of titles and abstracts; (iii) review of full papers to identify eligibility, and (iv) in-depth review and narrative synthesis of final selected papers. Papers which failed to distinguish exposures, or separating alcohol from substance use (e.g. tobacco and drugs) in general, were deemed ineligible.
Stages 1 and 2 were independently
Data extraction and analysis
The findings of the primary studies were grouped into the four main categories of exposure (socio-economic factors, disorder and crime, social capital and social norms). Studies with multiple exposures were included in more than one category where appropriate. Due to substantial methodological diversity, differences in methodological quality and in the exposure and outcomes measures used in the primary studies, a narrative synthesis is used to describe the studies and their results. It was not
Results of study selection process
The study selection process is summarised in Fig. 1. A total of 4563 papers (excluding duplicates) were identified by the database searches (Stage 1). Of these, 4429 studies were excluded based on their titles and abstracts (Stage 2). The use of combined exposure or outcome measures resulted in some studies being rejected at this stage. For example, some studies focused on all substance use (including alcohol, tobacco and drugs). One hundred and thirty four full papers were eligible for
Discussion
This is, to our knowledge, the first systematic review of the association between alcohol use and community level social factors. The study included a wide range of exposure variables and four databases were searched, along with an extensive search of cited references. The selected studies included a wide variety of community settings and countries and were conducted among adolescent, student and adult populations.
There were inconclusive results on the associations between socio-economic
Conclusions
This is the first systematic review of community level social influences on alcohol use. It found inconclusive results on the influence on alcohol use of socio-economic factors such as deprivation, poverty, income and unemployment. Similarly inconclusive findings were found for the influence of social disorder and crime on alcohol use. These findings reflect the varied outcome and exposure methods used and the broader limitations with the evidence-base. Clearer associations were found for
Funding source
No external funding was used to conduct this review.
Competing interests
The authors declare no competing interests
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