Testing a social ecological model of alcohol use: the California 50-city study.

Background and Aims Social ecological theories suggest that greater community alcohol availability and individual drinker characteristics should jointly affect drinking patterns and the use of drinking contexts. We assessed relationships of demographic and personality characteristics of individual drinkers and environmental characteristics at the city-level to measures of drinking patterns and use of drinking contexts. Design Multi-level statistical analyses of archival and survey data from 50 cities in California, USA. Settings An ecological sample of 50 geographically distinct cities with populations from 50 000 to 500 000 people. Participants General population telephone survey of 8553 adults 18 years of age and older stratified by cities. Measurements Archival data on city-level alcohol outlet densities were combined with individual survey data identifying community conditions, individual demographic and psychosocial characteristics, frequencies of use of drinking contexts and drinking patterns. Findings Greater on-premise outlet densities were related to greater drinking frequencies ( b = 2.9671, z = 4.688, P < 0.001) and volumes ( b = 0.6274, z = 3.394, P < 0.001) and use of on-premises drinking places (bars, b = 0.3340, z = 2.645, P < 0.006 and restaurants, b = 0.1712, z = 2.770, P = 0.005). Individual demographic and personality characteristics were related to drinking and use of drinking contexts. For example, greater impulsivity was related to greater drinking frequencies ( b = 0.2001, z = 2.088, P = 0.023) and logged quantities ( b = 0.0151, z = 2.009, P = 0.026) and proportionately more drinking at bars ( b = 0.0332, z = 2.016, P = 0.026) and parties ( b = 0.1712, z = 2.770, P = 0.004). Conclusion Community availability of alcohol and individual drinker characteristics appear to act jointly to affect drinking levels and use of drinking contexts. These effects may increase risks related to drinking in some contexts (e.g. bars) much more than others (e.g. at friends' or relatives' homes). [ABSTRACT FROM AUTHOR]