Drug 'hot-spots', alcohol availability and violence

Ecological studies have shown a relationship between alcohol outlet densities and violence and between the location of crimes related to illicit drug use (so-called 'hot spots') and violence. To date, no study has compared the effects of alcohol outlets and drug hot spots on rates of violence. The present study examined this relationship in the City of Houston, Texas. An ecological study design was employed, using a sample of 439 census tracts from Houston, Texas. Neighborhood socio-structural, alcohol outlet density, drug crime density and violent crime density data were collected from archival sources and analyzed using multivariate and spatial statistics. Using ordinary least-squares analysis, the neighborhood socio-structural covariates explained about 40% of the variability in violent crime. Adding alcohol outlet density in the target census tracts explained an additional 6%, while the addition of drug crime density explained an additional 32%. In the final model, that controlled for the effects of autocorrelated error, both drug crime density in the target and adjacent census tracts remained significant predictors of violent crime, while only off-sale density in the target census tract remained significant in the model. The findings indicate that drug crime density explained a greater amount of variance in violent crime rates than the alcohol outlet density. The methodological and policy implications of these findings are discussed, along with the shortcomings of the analysis presented. [Gorman DM, Zhu L, Horel S. Drug 'hot-spots', alcohol availability and violence. Drug Alcohol Rev 2005;24:507-513]     

Associations of Alcohol Availability and Neighborhood Socioeconomic Characteristics With Drinking: Cross-Sectional Results From the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Living in neighborhoods with a high density of alcohol outlets and socioeconomic disadvantage may increase residents’ alcohol use. Few researchers have studied these exposures in relation to multiple types of alcohol use, including beverage-specific consumption, and how individual demographic factors influence these relationships. Objective: To examine the relationships of alcohol outlet density and neighborhood disadvantage with alcohol consumption, and to investigate differences in these associations by race/ethnicity and income. Methods: Using cross-sectional data (N = 5,873) from the Multi-ethnic Study of Atherosclerosis in 2002, we examine associations of residential alcohol outlet density and neighborhood socioeconomic disadvantage with current, total weekly and heaviest daily alcohol use in gender-specific regression models, as well as moderation by race/ethnicity and income. Results: Drinking men living near high densities of alcohol outlets had 23%–29% more weekly alcohol use than men in low density areas. Among women who drank, those living near a moderate density of alcohol outlets consumed approximately 40% less liquor each week than those in low density areas, but higher outlet densities were associated with more wine consumption (35%–49%). Living in highly or moderately disadvantaged neighborhoods was associated with a lower probability of being a current drinker, but with higher rates of weekly beer consumption. Income moderated the relationship between neighborhood context and weekly alcohol use. Conclusions/Importance: Neighborhood disadvantage and alcohol outlet density may influence alcohol use with effects varying by gender and income. Results from this research may help target interventions and policy to groups most at risk for greater weekly consumption.     

The spatial dynamics of violence and alcohol outlets

OBJECTIVE: This study examines whether the association between violence and population density is moderated by the presence of alcohol outlets, both within a target geographical area and in adjacent geographical areas. The effect of sociodemographic variables on violence is also examined controlling for spatial confounding. METHOD: Zip code areas (N = 766) in California from four distinct areas (three urban and one rural) were examined for rates of violence, taking into consideration population characteristics of persons living in those areas and the potential interaction effects of alcohol outlets on violence rates. Population characteristics were assessed using Census data: outlet densities were obtained from the California Department of Alcohol Beverage Control; and violence rates were abstracted from hospital discharge data. A spatial population model of the production of violence was used to examine the relationships of population characteristics of target and surrounding areas to violence rates. RESULTS: The density of bars was found to be strongly associated with greater rates of assault, while density of restaurants was associated with less violence. Both appeared to have greatest effect in densely populated areas. Local and nearby population characteristics were also found to be related to greater rates of violence. CONCLUSIONS: While limited to cross-sectional data, the current study suggests that alcohol outlets, in the presence of socioeconomic measures, moderate the occurrence of violence in urban areas.     

A spatial analysis of the moderating effects of land use on the association between alcohol outlet density and violence in urban areas

Aims. While there is substantial evidence of an association between alcohol outlet density and assault, it is unlikely this association is constant across the urban environment. This study tested the moderating influence of land use on the outlet–violence association. Design. Cross‐sectional ecological study that controlled for spatial autocorrelation. Setting, Participants and Measurements. Police‐recorded data on simple and aggravated assaults were obtained for all 302 block groups (mean population = 1038) in Cincinnati, Ohio, USA. Addresses of alcohol outlets for Cincinnati were obtained from the Ohio Division of Liquor Control, geocoded to the street level, and aggregated to census block groups. Data on eight categories of land use were obtained from the Cincinnati Area Geographic Information System, with location quotients computed for each block group. Findings. We found substantial evidence that the impact of total alcohol outlet density, bar density and carryout density on assault density was moderated by land use. Conclusions. By taking into account local characteristics, policy‐makers can make more informed decisions when regulating the placement and density of alcohol licenses in urban areas. Similarly, more systematic knowledge of how the association between alcohol outlet density and assault varies across the urban landscape should reduce harm and promote responsible retailing. Nevertheless, ours is one of the first studies to address the moderating effect of land use and we encourage further research to test the stability and generalisability of our results.[Pridemore WA, Grubesic TH. A spatial analysis of the moderating effects of land use on the association between alcohol outlet density and violence in urban areas. Drug Alcohol Rev 2012;31:385–393]     

Alcohol outlets and child physical abuse and neglect: applying routine activities theory to the study of child maltreatment

OBJECTIVE: The purpose of this study is to examine whether or not alcohol access in neighborhood areas is differentially related to substantiated reports of child physical abuse and neglect. METHOD: This cross-sectional ecological study uses spatial regression procedures to examine the relationship between the number of bars, restaurants and off-premise outlets per population and rates of child physical abuse and neglect in 940 census tracts in California, while controlling for levels of social disorganization, population density and county of residence. RESULTS: The number of off-premise outlets per population was positively associated with rates of child physical abuse (b = 3.34, SE = 1.14), and the number of bars per population was positively related to rates of child neglect (b = 1.89, SE = 0.59). CONCLUSIONS: These results suggest that alcohol access is differentially related to type of child maltreatment, with higher densities of bars being related to higher rates of child neglect, and higher rates of off-premise outlets related to higher rates of child physical abuse. The findings suggest there is a spatial dynamic of neighborhoods that can result in child maltreatment and underscore the importance of examining the alcohol environment when developing programs to prevent child maltreatment.     

Outlets,drinking and driving: a multilevel analysis of availability

OBJECTIVE: This study examines the degree to which the physical availability of alcohol as measured by outlet densities is related to self-reported individual drinking patterns, preferred drinking location, as well as both driving after drinking (DAD) and driving while intoxicated (DWI). METHOD: Data from 7,826 drinkers were obtained from a general-population telephone survey of 1,353 zip code areas in California. Measures of individual alcohol consumption included drinking frequency, drinks per occasion and variance in quantities consumed per occasion. Preferred drinking locations included bars, restaurants and the homes of drinkers and of their friends. DAD was defined as driving a motor vehicle within 4 hours of having one or more alcoholic drinks, and DWI was defined as driving after having too much to drink and drive safely. Geographic measures of outlet densities were obtained for bars, restaurants and off-premises establishments, using zip codes as geographic units of analysis. Hierarchical linear modeling was used to relate outlet densities within and surrounding respondents' area of residence to respondents' drinking and to respondents' drinking and driving. RESULTS: Whereas restaurant densities were directly related to greater drinking frequencies and DAD, bar densities were inversely related to DAD. There were no direct effects of drinking patterns on drinking and driving. Drinking and driving was strongly related to drinking location preference (e.g., bars and restaurants) only when considered simultaneously with individual drinking patterns, particularly drinking frequency. CONCLUSIONS: Increased restaurant density is strongly related to higher rates of both self-reported driving after drinking and drinking frequency. The strongest influence on both driving after drinking and driving while intoxicated is preferred drinking location considered together with individual drinking patterns. Outlet density and preferred drinking location when considered together with individual drinking patterns support driving after drinking and thereby increase the potential for alcohol-related accidents.     

Neighborhood characteristics contribute to urban alcohol availability: Accounting for race/ethnicity and social disorganization

This study examined the role that race/ethnicity and social disorganization play in alcohol availability in Milwaukee, Wisconsin, census block groups. This study estimated negative binomial regression models to examine separately the relationship between neighborhood racial/ethnic composition and social disorganization levels for (1) total, (2) on-premise, and (3) off-premise alcohol outlets. Results of this study suggest that proportion Hispanic was positively associated with total and with off-premise alcohol outlets. Second, proportion African American was negatively associated with on-premise alcohol outlets and positively associated with off-premise alcohol outlets. Proportion Asian was not associated with total, on-premise, or off-premise alcohol outlets. However, the effects of race/ethnicity on alcohol availability were either unrelated or negatively related to alcohol outlet availability once neighborhood social disorganization levels were taken into account, and social disorganization was positively and significantly associated with all alcohol outlet types. Neighborhood characteristics contribute to alcohol availability and must be considered in any efforts aimed toward prevention of alcohol-related negative health and social outcomes.     

Alcohol outlets,drug paraphernalia sales,and neighborhood drug overdose

BackgroundAlcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association.MethodsA cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly.ResultsEach additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose.ConclusionThis study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws.     

The economic geography of medical cannabis dispensaries in California

BackgroundThe introduction of laws that permit the use of cannabis for medical purposes has led to the emergence of a medical cannabis industry in some US states. This study assessed the spatial distribution of medical cannabis dispensaries according to estimated cannabis demand, socioeconomic indicators, alcohol outlets and other socio-demographic factors.MethodsTelephone survey data from 5940 residents of 39 California cities were used to estimate social and demographic correlates of cannabis consumption. These individual-level estimates were then used to calculate aggregate cannabis demand (i.e. market potential) for 7538 census block groups. Locations of actively operating cannabis dispensaries were then related to the measure of demand and the socio-demographic characteristics of census block groups using multilevel Bayesian conditional autoregressive logit models.ResultsCannabis dispensaries were located in block groups with greater cannabis demand, higher rates of poverty, alcohol outlets, and in areas just outside city boundaries. For the sampled block groups, a 10% increase in demand within a block group was associated with 2.4% greater likelihood of having a dispensary, and a 10% increase in the city-wide demand was associated with a 6.7% greater likelihood of having a dispensary.ConclusionHigh demand for cannabis within individual block groups and within cities is related to the location of cannabis dispensaries at a block-group level. The relationship to low income, alcohol outlets and unincorporated areas indicates that dispensaries may open in areas that lack the resources to resist their establishment.     

Alcohol use by violent and property offenders

Offenders incarcerated for violent and property crimes were compared with respect to their alcohol and drug use, both chronic and immediately before their crime. There were only slight differences between the groups. The proportions of violent offenders who drank before the crime were greater than the proportion of property offenders, but this was not true for offenders with low education. The disinhibition theory of alcohol involvement in violent crime was not supported.     

Alcohol and Malt Liquor Availability and Promotion and Homicide in Inner Cities

We investigated the role of the alcohol environment in explaining disparities in homicide rates among minorities in 10 cities in the United States using 2003 data from the Malt Liquor and Homicide study. We hypothesized that (a) higher concentrations of African Americans would be associated with higher homicide rates, as well as higher alcohol and malt liquor availability and promotion, and (b) the relationship between neighborhood racial/ethnic concentration and homicide would be attenuated by the greater alcohol and malt liquor availability and promotion in African American neighborhoods. Hypotheses were tested using separate Poisson, linear, and logistic regression models that corrected for spatial autocorrelation. Census block groups served as the unit of analysis (n = 450). We found that higher concentrations of African Americans were associated with higher homicide rates as well as greater alcohol availability, especially malt liquor availability. The promotion of malt liquor on storefronts was also significantly greater in African American than in other neighborhoods. However, none of the measures representing alcohol or malt liquor availability and promotion variables changed the effect of neighborhood racial/ethnic concentration on homicide. Limitations and implications of our findings are discussed.     

Alcohol and malt liquor availability and promotion and homicide in inner cities

We investigated the role of the alcohol environment in explaining disparities in homicide rates among minorities in 10 cities in the United States using 2003 data from the Malt Liquor and Homicide study. We hypothesized that (a) higher concentrations of African Americans would be associated with higher homicide rates, as well as higher alcohol and malt liquor availability and promotion, and (b) the relationship between neighborhood racial/ethnic concentration and homicide would be attenuated by the greater alcohol and malt liquor availability and promotion in African American neighborhoods. Hypotheses were tested using separate Poisson, linear, and logistic regression models that corrected for spatial autocorrelation. Census block groups served as the unit of analysis (n = 450). We found that higher concentrations of African Americans were associated with higher homicide rates as well as greater alcohol availability, especially malt liquor availability. The promotion of malt liquor on storefronts was also significantly greater in African American than in other neighborhoods. However, none of the measures representing alcohol or malt liquor availability and promotion variables changed the effect of neighborhood racial/ethnic concentration on homicide. Limitations and implications of our findings are discussed.     

Alcohol and Crimes of Violence: Present Issues

Current issues in alcohol-related violence are highlighted through the examination of correlational studies between alcohol and violent crime. Alcohol is associated with violent crime at a greater than chance level and at a significantly higher level than it is associated with nonviolent crime. Heavy drinking and a verbal argument usually precede the violent act and the victim is as likely as the offender to initiate the altercation. However, it is the precipitator of the altercation who is more likely to be intoxicated. Alcohol and aggression are more strongly related than expected with violent offenders demonstrating psychopathology. Marital violence appears related to alcohol independent of other marital problems. Although there exists a strong correlational relationship between alcohol and violent crime, the nature of the evidence prohibits the establishment of a causal link. In particular, methodological problems, such as a lack of appropriate comparison groups, make it difficult to draw conclusions in this area.     

Alcohol availability and targeted advertising in racial/ethnic minority communities

Alcohol availability and advertising are disproportionately concentrated in racial/ethnic minority communities. Although research on alcohol availability and alcohol advertising in racial/ethnic minority communities is limited, evidence does show a relationship between minority concentration, alcohol outlet density, and alcohol problems. This article reviews research showing that certain neighborhood characteristics, such as alcohol outlet density, can be stronger predictors of homicide and violence than are race or ethnicity.     

Alcohol and crime in China

This study examines the pattern of alcohol involvement across violent and property crimes in China. We describe and discuss the cultural and biological differences between Chinese and Westerners concerning alcohol and the features of Chinese culture concerning violence. Drawing upon the disinhibition perspective in alcohol and crime, a specific hypothesis derived from the sociocultural context of Chinese society is that alcohol is more likely to be involved with violent crime than with property crime. Using data from a survey of inmates in China, we assess this hypothesis and the possible variables that may moderate this hypothesis. The data support the hypothesis that disinhibition is applicable to the alcohol-violence relationship in Chinese culture. However, the predicted pattern of alcohol use in violent and property crimes does not vary across different offender groups, which is inconsistent with some United States research. A tentative explanation is provided for this inconsistency.     

Place management in off-premise alcohol outlets: Results of a multi-methods study in a six-city California area

BackgroundAssociations between neighborhood crime and alcohol outlets are often theorized as resulting from poor place management. Barriers and supports to place management have been examined for on-premise (bars, restaurants) but not for off-premise alcohol outlets. Few studies have assessed place management issues across a range of off-premise outlet and neighborhood types, and none have included the perspectives of off-premise outlet managers themselves. Combining qualitative and quantitative methods within an ethnographic approach, we investigated barriers and supports to place management across off-premise outlets in a large urban area.MethodsWe unobtrusively assessed outlet operating characteristics including crime prevention strategies at all 403 off-premise outlets in six contiguous California cities; interviewed managers in 40 outlets; and conducted extensive naturalistic observations in 15 of these 40 outlets. We analyzed data for frequencies and thematic content.ResultsSmall and independently operated off-premise outlets were the most common type of outlet in our study, but demonstrated fewer resources and more challenges to place management compared to large and chain establishments. Security guards were more observed in large and chain outlets. Small and independent outlets were more likely to post signs prohibiting loitering and to enable surveillance of interior spaces. Problems most commonly cited by managers were theft and loitering. Challenges to place management included physical and verbal threats from customers and intoxicated persons, and insufficient law enforcement. Managers evidenced some ability to assert authority over interior, private space, but less so over exterior, public space.ConclusionsAlthough tasked with maintaining public health and safety, small and independent store managers reported challenges that are seldom acknowledged in policy or research literature. Managers may provide valuable insights on preventing and reducing neighborhood-level problems associated with off-premise alcohol outlets. Local communities should consider enhancing place management resources for managers of small and independent outlets.     

Neighborhood effects on the efficacy of a program to prevent youth alcohol use

This study examines how neighborhood characteristics affect program efficacy. Data come from a randomized trial of a substance use prevention program called keepin' it REAL, which was administered to a predominantly Mexican American sample of 4,622 middle school students in Phoenix, Arizona, beginning in 1998. Multilevel models and multiple imputation techniques address clustered data and attrition. Among less linguistically acculturated Latinos, living in poorer neighborhoods and those with many single-mother families decreased program effectiveness in combating alcohol use. High neighborhood immigrant composition increased program effectiveness. Unexpectedly, the program was also more effective in neighborhoods with higher rates of crime. There were no significant effects on program efficacy for the more linguistically acculturated Latinos and non-Hispanic White students. Findings are discussed in light of theories of neighborhood social disorganization, immigrant adaptation, and social isolation.     

Gender differences in the association of alcohol intoxication and illicit drug abuse among persons arrested for violent and property offenses

Purpose: To explore the associations between violent and other crimes, and alcohol intoxication and recent use of cocaine, marijuana, and other drugs among men and women arrestees and examine gender differences in these relationships. Methods: We conducted a secondary analysis of 1998 using Arrestee Drug Abuse Monitoring (ADAM) system data using a sample of 9242 male and 2594 women arrested for violent and property offenses in 35 cities. Logistic regression was used to predict arrest for a violent offense (rather than a property crime) from drug- and alcohol-related, and other variables. Results: Both gender and alcohol intoxication are significantly related to arrest for a violent offense. However, the intoxication effects (in the absence of cocaine) are more than three times as great for female (Exp(β)=5.59) as male arrestees (Exp(β)=1.74), while the combined effects of alcohol and cocaine predict a property offense for women but are insignificant for men. Implications: To achieve further reductions in violent crime, intervention strategies need to focus on reducing alcohol intoxication as well as illicit drug use. Research on the role of alcohol on women's aggression and violence also is suggested.     

Neighborhood Effects on the Efficacy of a Program to Prevent Youth Alcohol Use

This study examines how neighborhood characteristics affect program efficacy. Data come from a randomized trial of a substance use prevention program called keepin′ it REAL, which was administered to a predominantly Mexican American sample of 4,622 middle school students in Phoenix, Arizona, beginning in 1998. Multilevel models and multiple imputation techniques address clustered data and attrition. Among less linguistically acculturated Latinos, living in poorer neighborhoods and those with many single-mother families decreased program effectiveness in combating alcohol use. High neighborhood immigrant composition increased program effectiveness. Unexpectedly, the program was also more effective in neighborhoods with higher rates of crime. There were no significant effects on program efficacy for the more linguistically acculturated Latinos and non-Hispanic White students. Findings are discussed in light of theories of neighborhood social disorganization, immigrant adaptation, and social isolation.     

The Quiescent Heroin Scene: Incidence and Prevalence in the San Francisco Bay Area

Abstract

A case is presented of a 20-year-old man who became violent on many occasions after ingesting alcohol. On one occasion he committed an armed robbery. Two brain SPECT studies were performed: one when he was alcohol free, and one after he ingested alcohol in the same patternas the night of the crime. The “alcohol free” study revealed marked hyperactivity in the eingulate gyrus, right and left lateral frontal lobes, right and left lateral parietal lobes and the right lateral temporallobe. The “alcohol intoxication” study showed an overall dampening effect on the hyperactive areas of the brain, with only the anterior cingulate gyrus showing excessive activity. In addition, the right and left prefrontal cortex became hypoperfused, decreasing impulse control and judgment, as did the left and right temporal lobes, increasing the likelihood for aggression. This study suggests that this man may have been “self-medicating” an overactive brain, but in the process induced a state that increased the likelihood for aggressive behavior. This case study suggests the need for further research in the area of alcohol-induced violence and the potential usefulness of SPECT imaging, although no conclusions can be drawn from one case.