According to the United Hospital Fund (UHF), the neighborhood of Greenpoint (201) is located in northwest Brooklyn and is home to about 150,000 residents. It contains the four smaller neighborhoods of Williamsburg, East Williamsburg, North Side – South Side, and Greenpoint. Greenpoint generally tends to be a healthier neighborhood when compared to Brooklyn as a whole or the entire New York City. However, one health outcome that is predominant in Greenpoint is the liver disease with a higher mortality rate compared to the others. The mortality rate from liver disease in Greenpoint is 9.9 deaths per 100,000 people, compared to 8.4 per 100,000 in Brooklyn and 6.2 per 100,000 in New York City for example. The factors that contribute to liver disease include those discussed in the following sections.
Body
Our quantitative and qualitative findings revealed that high alcohol consumption was the most likely cause of liver disease mortality in Greenpoint. Those findings also revealed a high proportion of LGBTQ people, young people, and Eastern European immigrants represented in Greenpoint. Previous studies have shown that alcohol use is higher among people within the LGBTQ community because it is important in identity construction (Emslie, Lennox, and Ireland 2017). Younger people are also more likely to consume large amounts of alcohol, possibly in an effort to conform to social norms around drinking (International Center for Alcohol Policies 2009). Additionally, some Eastern European countries such as Poland have heavy drinking cultures (Cherpitel, Moskalewicz, and Swiatkiewicz 2004). The prevalence of Tobacco Retailers in the environment contributes to Tobacco use as well. Tobacco use and the problem of alcohol use are somehow linked to each other through behavioral conditioning (Drobes 2002).
Another direct contributor to the problem of the use of alcohol is the psychological factor of cute or chronic stress (Jones and Sumnall 2016). The social factors of Poverty and LGBTQ identity, both of which are overrepresented in Greenpoint, lead to higher levels of acute or chronic stress, which then contribute to problem of alcohol use (Newcomb, Heinz, and Mustanski 2012). This alcohol use issue then leads to Social and Economic Consequences including loss of earnings, financial problems, and breakdown of family and social support systems, which then feedback to reinforce poverty and acute or chronic stress (Jones and Sumnall 2016). In addition, people in Poverty and LGBTQ people may have Decreased Bargaining Power in relationships, which also contributes to higher rates of Intimate Partner Violence in these groups (Aizer 2011). We suspect that Intimate Partner Violence then feeds back to cause Poverty and Acute/chronic stress. By creating this cycle, intimate partner violence is not only a direct result of problem alcohol use but is also an indirect cause of problem alcohol use.
Discussion/Implications
At the beginning of our study, we hypothesized that alcoholic liver disease was the driver of this disparity, as rates of alcohol drinking, binge drinking, and heavy drinking are higher in Greenpoint. Given the high rates of binge drinking and problem drinking in Poland, it is possible that these drinking patterns were carried to the United States as well. Further supporting this hypothesis, as stated earlier, the high concentration of alcohol retailers in Greenpoint provides a favorable environment to drinking. Therefore, we conclude that the three highly represented social groups in our neighborhood such as the LGBTQ, the Youth, and Immigrant Communities, may utilize alcohol for the psychological reason of Identity Construction and Social Norms, which contribute to the behavioral outcome of Problem Alcohol Use. Alcohol consumption is typically higher among youth, those in poverty, and the LGBTQ community, therefore, it is likely that the reliance of these groups on alcohol for Identity Construction and Social Norms results in demand for Alcohol Retailers which is an environmental factor contributing to Problem Alcohol Use.
The expansion of our analysis of health characteristics to include characteristics that are often associated with drinking: tobacco use, depression, and intimate partner violence. Compared to Brooklyn or New York City, Greenpoint has a higher percentage of the population that is a current or former smoker and a lower percentage of the population that has never smoked. High levels of tobacco use and a high concentration of tobacco retailers in an area make one believe that the psychological factor of Identity Construction and Social Norms leads to higher Tobacco use and demand for Tobacco Retailers. Our quantitative analysis revealed higher levels of intimate partner violence in Greenpoint as well making it believable that the Problem Alcohol Use is likely leading to higher levels of Intimate Partner Violence.
Finally, while we did not evaluate any biological mechanisms of disease in our quantitative or qualitative analyses, we did want to note in our conceptual framework that Genetics and Neurobiological Mechanisms of reward behavior can make some individuals more predisposed to Problem Alcohol Use (Drobes 2002).