Investigating neighbourhood determinants of individual alcohol use: A mixed methods study

Neighbourhoods and the resources embedded within them may be important determinants of alcohol and mental health outcomes. Previous research suggests that neighbourhood social capital (NSC) protects against mental distress but there are mixed and inconclusive findings in relation to alcohol use. This mixed methods programme of research used a three-stage sequential design to investigate the role of NSC in determining individual-level alcohol use. A systematic review and theory synthesis examined the association between NSC and alcohol use and established potential mechanisms underlying this relationship to develop a novel conceptual framework. Latent class growth analysis identified a six-class model of drinking trajectories in a large sample of the English general population (n=22,880) and examined associations of class membership with sociodemographic characteristics, mental health, and neighbourhood factors. Neighbourhood barriers and facilitators of drinking reductions and abstinence were explored through photo-elicitation interviews with Merseyside (UK) residents who were current and former drinkers. Triangulation of findings from the three studies suggests there are complex and mixed associations between NSC and alcohol use. The findings confirmed that NSC is an important determinant of alcohol consumption and drinking practices. Theoretical and empirical insights from this programme of work showed that higher levels of NSC may promote moderate drinking via increased opportunities for drinking and conformity to drinking norms. However, NSC can also reduce drinking and protect against alcohol use disorder through: combatting neighbourhood disorder and guiding socialisation to healthy norms, facilitating access to social support, information and resources, and affording opportunities to build psychosocial skills and supporting positive future prospects. Structural and cognitive dimensions of NSC differentially influence alcohol use trajectories and drinking practices, and mental health potentially plays a role in these relationships. Interventions to build NSC may be useful for tackling alcohol-related harms but the potential for these strategies to widen existing inequalities should be considered. Policies and interventions should address macro-level factors such as socioeconomic disadvantage and alcohol accessibility, which have implications for the development and maintenance of NSC. Increasing the visibility of alcohol-free recreational spaces may help to combat risky drinking norms and individual harms, as well as improve wellbeing more generally.