Close proximity to alcohol outlets is associated with increased serious violent crime in New Zealand

Objective: To examine the association between geographic access to alcohol outlets and serious violent crime in New Zealand. Methods: A national study of alcohol outlet access and serious violent crime used a cross‐sectional ecological analysis. Serious violence offences recorded between 2005 and 2007 were aggregated for 286 police station areas. Using Geographical Information Systems (GIS), 9,320 licensed premises were geocoded and road travel distances to the closest alcohol outlet type/category were calculated for each area. Negative binomial regression models measured the association between the distance to the closest alcohol outlet and the number of serious violent offences in each police station area, controlling for area‐level measures of social deprivation, Māori population, young males 15–29 years and population density. Results: There were significant negative associations between distance (access) to licensed outlets and the incidence of serious violent offences with greater levels of violent offending recorded in areas with close access to any licensed premises compared to those areas with least access (IRR 1.5, 95% CI 1.10–2.03); with on‐licensed premises (IRR 1.6, 95% CI 1.16–2.08); and off‐licensed premises (IRR 1.4, 95% CI 1.05–1.93). Conclusion: Having greater geographic access to alcohol outlets was associated with increased levels of serious violent offending across study areas. Implications: Alcohol availability and access promoted under the current liberalised licensing regime are important contextual determinants of alcohol‐related harm within New Zealand communities.     

The social gradient of alcohol availability in Victoria, Australia

Objectives: To explore the socioeconomic gradient of alcohol availability in Victoria, Australia. Methods: Using data for the smallest geographic units available, per‐capita and area‐based measures of alcohol outlet density were calculated for four types of alcohol outlet (broadly: restaurants, hotels, packaged liquor outlets and licensed clubs). These densities were aggregated across deciles of socioeconomic disadvantage, to compare the average density of alcohol outlets across ten levels of socioeconomic status. In addition, negative binomial regression models were developed, assessing the relationship between density and socioeconomic status while controlling for relevant covariates. Results: In urban areas, both takeaway liquor outlets and licensed clubs were significantly more likely to be located in areas of socioeconomic disadvantage, while hotel and restaurant licences were more prevalent in advantaged areas. In rural and regional Victoria, all types of outlet types were more prevalent in areas of socioeconomic disadvantage. Conclusions: The findings suggest that disparities in exposure to alcohol outlets in Victoria may play a role in explaining socioeconomic disparities in health outcomes, with Victorians living in disadvantaged areas generally faced with higher levels of alcohol availability.     

Associations between alcohol outlets and emergency department injury presentations: effects of distance from the central business district

Objective : To examine the effects of licensed outlets and sales on levels of alcohol‐related injuries presenting to emergency departments (EDs) in the Inner, Middle and Outer postcode zones of Perth, Australia. Methods : Using panel data (2002–2010), a surrogate measure (based on day of week and time of day of presentation) was used to identify alcohol‐related injuries presenting at EDs. Postcodes were grouped according to their distance from the central business district (CBD). Numbers of alcohol outlets and their sales were the primary explanatory variables. Data were analysed using negative binomial regression with random effects. Results : In the Inner and Outer postcode zones, counts of on‐site outlets were positively associated with alcohol‐related injury (IRR: 1.008; 95%CI 1.003–1.013 and IRR: 1.021; 95%CI 1.013–1.030 respectively). An additional off‐site outlet was associated with 6.8% fewer alcohol‐related injuries (95%CI 0.887–0.980). In the Middle postcode zone, mean off‐site sales were positively associated with injury (IRR: 1.024; 95%CI 1.003–1.044). Conclusions : Associations between alcohol availability variables and injury differed by outlet type and distance from the CBD. Implications : These findings provide further evidence to support stronger controls on liquor licensing, and indicate the need for different controls according to the location and type of licence.     

Alcohol Outlets,Neighborhood Characteristics,and Intimate Partner Violence: Ecological Analysis of a California City

Neighborhood indicators of social disadvantage, such as poverty and unemployment, are associated with intimate partner violence (IPV). Despite the well-established link between heavy drinking and IPV, few studies have analyzed the contribution of alcohol outlet density to the occurrence of IPV. Greater numbers of alcohol outlets in a community may be a sign of loosened normative constraints against violence, promote problem drinking among at-risk couples, and provide environments where groups of persons at risk for IPV may form and mutually reinforce IPV-related attitudes, norms, and problem behaviors. This study used ecological data to determine if alcohol outlet density (number of bars, restaurants serving alcohol, and off-premise outlets per unit area) is related to rates of IPV-related police calls and IPV-related crime reports in Sacramento, California. Separate analyses for IPV calls and crime reports were conducted using Bayesian space–time models adjusted for area characteristics (poverty rate, unemployment rate, racial/ethnic composition). The results showed that each additional off-premise alcohol outlet is associated with an approximate 4% increase in IPV-related police calls and an approximate 3% increase in IPV-related crime reports. Bars and restaurants were not associated with either outcome. The findings suggest that alcohol outlet density, especially off-premise outlets, appear to be related to IPV events. Further research is needed to understand the mechanisms by which neighborhood factors, such as alcohol outlet density, affect IPV behaviors. Understanding these mechanisms is of public health importance for developing environmental IPV prevention strategies, such as changes in zoning, community action, education, and enforcement activities.     

Density of tobacco retail outlets near schools and smoking behaviour among secondary school students

Objective: To investigate whether the density of tobacco retail outlets near schools in Victoria, Australia, is associated with adolescent smoking behaviour. Methods: Cross‐sectional survey data of 2,044 secondary school students aged 12–17 years was combined with tobacco outlet audit data. Associations between students' self‐reported tobacco use and the density of tobacco outlets near schools was examined using multilevel logistic and negative binomial regression models, with cigarette price at local milk bars and key socio‐demographic and school‐related variables included as covariates. Results: Increased tobacco retail outlet density was associated with a significant increase in the number of cigarettes smoked in the previous seven days among students who smoked in the past month (IRR=1.13; 95% CI 1.02–1.26), but not the odds of smoking in the past month in the larger sample (OR=1.06; 95% CI 0.90–1.24), after controlling for local mean price of cigarettes and socio‐demographic and school‐related variables. Conclusions and implications: This study suggests there is a positive association between tobacco retail outlet density and cigarette consumption among adolescent smokers, but not smoking prevalence, in the Australian context. There is value in considering policy measures that restrict the supply of tobacco retail outlets in school neighbourhoods as a means of reducing youth cigarette consumption.     

Does Alcohol Outlet Density Affect Youth Access to Alcohol?

PurposeTo investigate how community alcohol outlet density may be associated with alcohol access among adolescents.MethodsData were collected through a three-wave panel study with youth aged 14–16 at baseline using computer-assisted telephone interviews. Study participants were recruited from 50 zip codes with varying alcohol outlet density and median household income in California. Data analyses were conducted using multilevel, linear growth models and data from 1028 youth (52% male, 51% white).ResultsAfter taking into account individual-level factors and zip code median household income, zip code alcohol outlet density was significantly and positively related to the initial levels of the likelihood and frequency of getting alcohol through various sources including commercial outlets, shoulder tapping, home or family members, and underage acquaintances.ConclusionsHigh levels of alcohol outlets in the community enable youth access to alcohol through commercial outlets, family, and social networks.     

Evaluation of alcohol outlet density and its relation with violence

OBJECTIVES: The current study set out to investigate alcohol availability in a densely populated, residential area of suburban S?o Paulo associated with high levels of social deprivation and violence. Gun-related deaths and a heavy concentration of alcohol outlets are notable features of the area surveyed. Given the strong evidence for a link between alcohol availability and a number of alcohol-related problems, including violent crime, measures designed to reduce accessibility have become a favored choice for alcohol prevention programs in recent years. METHODS: The interviewers were 24 residents of the area who were trained for the study. It was selected an area of nineteen streets, covering a total distance of 3.7 km. A profile of each alcohol outlet available on the area was recorded. RESULTS: One hundred and seven alcohol outlets were recorded. The number of other properties in the same area was counted at 1,202. Two measures of outlet density may thus be calculated: the number of outlets per kilometer of roadway (29 outlets/km); and the proportion of all properties that sold alcohol (1 in 12). CONCLUSIONS: The results of this study is compared with others which are mainly from developed countries and shown that the area studied have the highest density of alcohol outlet density ever recorded in the medical literature. The implication of this data related to the violence of the region is discussed. By generating a profile of alcohol sales and selling points, it was hoped to gain a better understanding of alcohol access issues within the sample area. Future alcohol prevention policy would be well served by such knowledge.     

Is access to alcohol associated with alcohol/substance abuse among people diagnosed with anxiety/mood disorder?

ObjectivesTo investigate the relationship between access to off-license alcohol outlets and areas with dual treatment for alcohol/drug abuse and anxiety/mood disorder compared to areas with anxiety/mood disorder only in an urban setting in New Zealand.Study designEcologic study.MethodsWithin small areas (2840 meshblocks, mean size 0.05 km²) in the city of Auckland, New Zealand, counts of adults receiving anxiety/mood disorder treatment (2008–9) were identified and the proportions of these individuals also receiving treatment for alcohol/drug abuse were generated. Access to off-license alcohol outlets were defined as: 1) shortest road distance from the population-weighted centroid of each small area to an outlet; 2) count of outlets within a 3 km road network buffer; and 3) relative density of outlets across Auckland (determined through kernel density estimates). To test for the relationship between access to alcohol outlets and dual diagnosis, meshblocks without any cases of anxiety/mood disorder were excluded from analyses. Remaining meshblocks were dichotomized into any or no dual diagnosis. Logistic regression was used to estimate the association between access to alcohol outlets and treatment for the dual conditions.ResultsNeighbourhoods with dual diagnosis were generally similar to those with anxiety/mood disorder only, in terms of ethnic and gender/age composition. Regression analyses indicated statistically significant decreased risk of dual diagnosis for those areas with the lowest density (using a buffer) of alcohol outlets (OR = 0.75, P-value = 0.027) compared with areas with the highest density, after adjustment for deprivation and population density. All access measures also indicated significant linear trends where dual diagnosis was more likely in areas with greater access.ConclusionsGenerally, decreased access to alcohol outlets was associated with decreased odds of dual diagnosis of alcohol/drug abuse and anxiety/mood disorder. Measures to control access to alcohol outlets may be an important area for alcohol/substance abuse intervention, particularly for vulnerable sub-populations.     

Failure in the control of the number of traffic accident victims in Spain. Is this a result of the correct answer to the wrong question?

Although various measures have been implemented in Spain with the aim to modifying the behavior of motor vehicle users, it has not been observed a descending trend in traffic accident and injuries from traffic accident. This article considers the question of whether the measures taken to reduce motor vehicle crash-related injuries in Spain have targeted the causes that are truly responsible for this trend. Using several sources of data, beginning in 1990 it has been observed a significant reduction in traffic accidents and their consequences, but in the second half of the 90s the growth in motor vehicle crash-related injuries was similar to the increase observed in the 80s. Likewise per capita alcohol consumption shows a downward trend from 1980 while the number of injuries has been strong associated with the economic cycle during the last twenty years. We conclude pointing out that intervention measures to control this problem in Spain have focused mainly on modifying behaviour that increases the risk and severity of traffic accident injuries and have ignored the macro-economic determinants that explain the trend in the frequency of this health problem.     

Alcohol Availability and Neighborhood Characteristics in Los Angeles, California and Southern Louisiana

The objective of this study was to examine the associations between alcohol availability types and community characteristics in randomly selected census tracts in Southern California and Southeastern Louisiana. Outlet shelf space and price by beverage type was collected from all off-sale alcohol outlets in 189 census tracts by trained research personnel. Three aspects of alcohol availability at the census tract level were considered—outlets per roadway mile, shelf space, and least price by beverage type. Using multivariate analyses, we examined the associations between census tract socioeconomic and demographic characteristics and alcohol availability types. Fifteen measures of alcohol availability were calculated—total shelf space and shelf space by beverage types (beer, malt liquor, and distilled spirits); outlets per roadway mile, per tract, and per capita; and least price by beverage type (including wine). In multivariate analyses controlling for state, male unemployment rate was inversely associated with total shelf space (p = 0.03) and distilled spirit shelf space (p = 0.05). Malt liquor shelf space was inversely associated with percent White (p = 0.02). Outlets per roadway mile was positively associated with household poverty (p < 0.0001), whereas percent African American was inversely associated with outlets per roadway mile (p = 0.03). Beverage-specific least prices were not associated with any socioeconomic or demographic community characteristics. Alcohol availability types, but not least price, were associated with some community characteristics. More research exploring how alcohol availability types vary by community and their relationship to alcohol-related harms should be conducted.     

The density of alcohol outlets and adolescent alcohol consumption: An Australian longitudinal analysis

Higher density of alcohol outlets has been linked to increased levels of adolescent alcohol-related behaviour. Research to date has been cross-sectional. A longitudinal design using two waves of annual survey data from the Australian arm of the International Youth Development Study was used. The sample comprised 2835 individuals with average age at wave 2 of 14 years (SD=1.67; range=11–17 years). GSEM was used to examine how absolute levels of alcohol outlet density was associated with student-reported alcohol use one year later, while controlling for prior alcohol use, risk factors at wave one and changes in density over the 2 years. Adolescents' perception of alcohol availability and friends' alcohol use were tested as potential mediators of the association between alcohol outlet density and adolescent alcohol use. Elasticity modelling identified a 10% increase in overall density at wave one was associated with an approximately 17% increase in odds of adolescent alcohol consumption at wave two. Living in areas with a higher density of outlets was associated with a statistically significant increase in the likelihood of adolescents developing early age alcohol consumption.     

Perpetration of intimate partner violence by young adult males: The association with alcohol outlet density and drinking behavior

ObjectiveThis study examined the association between alcohol outlet density and male to female intimate partner violence (IPV).MethodData were analyzed from a national probability sample of males who reported a current heterosexual relationship (N=3194). Multinomial logistic regression was used to examine the likelihood of having perpetrated IPV.ResultsHigh alcohol outlet density was associated with having perpetrated physical only IPV (odds ratio [OR]=2.51; 95% confidence interval [CI]: 1.21–5.20). Outlet density was not associated with greater odds of sexual IPV perpetration.ConclusionsAlcohol outlet density was found to be associated with perpetration of physical IPV. Developing environmental strategies with respect to alcohol outlets could potentially reduce perpetration of male-to-female physical IPV.     

The Premises is the Premise: Understanding Off- and On-premises Alcohol Sales Outlets to Improve Environmental Alcohol Prevention Strategies

Environmental strategies to prevent the misuse of alcohol among youth—e.g., use of public policies to restrict minors’ access to alcohol—have been shown to reduce underage drinking. However, implementation of policy changes often requires public and private partnerships. One way to support these partnerships is to better understand the target of many of the environmental strategies, which is the alcohol sales outlet. Knowing more about how off-premises outlets (e.g., liquor and convenience stores) and on-premises outlets (e.g., bars and restaurants) are alike and different could help community-based organizations better tailor, plan, and implement their environmental strategies and strengthen partnerships between the public and commercial sectors. We conducted a survey of managerial or supervisory staff and/or owners of 336 off- and on-premises alcohol outlets in six counties in South Carolina, comparing these two outlet types on their preferences regarding certain alcohol sales practices, beliefs toward underage drinking, alcohol sales practices, and outcomes. Multilevel logistic regression showed that while off- and on-premises outlets did have many similarities, off-premises outlets appear to engage in more practices designed to prevent sales of alcohol to minors than on-premises outlets. The relationship between certain Responsible Beverage Service (RBS) practices and outcomes varied by outlet type. This study furthers the understanding of the differences between off- and on-premises alcohol sales outlets and offers options for increasing and tailoring environmental prevention efforts to specific settings.     

The Moderating Role of Gender in the Relationship Between Tobacco Outlet Exposure and Tobacco Use Among African American Young Adults

Tobacco outlet exposure is a correlate of tobacco use with potential differences by gender that warrant attention. The aim of this study is to explore the moderating role of gender in the relationship between tobacco outlet exposure and past month tobacco use among African American young adults 21 to 24 years old. This cross-sectional study (n?=?283) used geospatial methods to determine the number of tobacco outlets within walking distance (i.e., a quarter mile) of participants’ homes and distance to the nearest outlet. Logistic regression models were used to test interactions between gender and tobacco outlet exposure (i.e., density and proximity). Tobacco outlets were classified based on whether or not they were licensed to sell tobacco only (TO outlets) or tobacco and alcohol (TA outlets). Neither density nor proximity was associated with past month tobacco use in the pooled models. However, gender modified the relationship between TO outlet density and tobacco use, and this relationship was significant only among women (OR?=?1.02; p?<?0.01; adjusted OR?=?1.01; p?<?0.05). This study underscores the importance of reducing tobacco outlet density in residential neighborhoods, especially TO outlets, as well as highlights potential gender differences in the relationship between tobacco outlet density and tobacco use.     

Neighbourhood deprivation and alcohol consumption: does the availability of alcohol play a role?

BACKGROUND: Previous studies suggest that the physical availability of alcohol may mediate the association between neighbourhood-level material deprivation and alcohol consumption. This study tests the relationships between neighbourhood-level deprivation, alcohol availability, and individual-level alcohol consumption using a multilevel analysis. METHODS: Data are from cross-sectional surveys conducted between 1979 and 1990 as part of the Stanford Heart Disease Prevention Program (SHDPP). Women and men (n = 8197) living in four northern/central California cities and 82 neighbourhoods were linked to neighbourhood deprivation variables derived from the US census (e.g. unemployment, crowded housing) and to measures of alcohol availability (density of outlets in the respondent's neighbourhood, nearest distance to an outlet from the respondent's home, and number of outlets within a half mile radius of the respondent's home). Separate analyses were conducted for on- and off-sale outlets. RESULTS: The most deprived neighbourhoods had substantially higher levels of alcohol outlet density than the least deprived neighbourhoods (45.5% vs 14.8%, respectively). However, multilevel analyses showed that the least deprived neighbourhoods were associated with the heaviest alcohol consumption, even after adjusting for individual-level sociodemographic characteristics (OR 1.30, CI 1.08-1.56). Alcohol availability was not associated with heavy drinking and thus did not mediate the relationship between neighbourhood deprivation and heavy alcohol consumption. CONCLUSIONS: Although alcohol availability is concentrated in the most deprived neighbourhoods, women and men in least deprived neighbourhoods are most likely to be heavy drinkers. This mismatch between supply and demand may cause people in the most deprived neighbourhoods to disproportionately suffer the negative health consequences of living near alcohol outlets.     

The effect of tobacco outlet density and proximity on smoking cessation

Objectives. We examined the influence of tobacco outlet density and residential proximity to tobacco outlets on continuous smoking abstinence 6 months after a quit attempt.Methods. We used continuation ratio logit models to examine the relationships of tobacco outlet density and tobacco outlet proximity with biochemically verified continuous abstinence across weeks 1, 2, 4, and 26 after quitting among 414 adult smokers from Houston, Texas (33% non-Latino White, 34% non-Latino Black, and 33% Latino). Analyses controlled for age, race/ethnicity, partner status, education, gender, employment status, prequit smoking rate, and the number of years smoked.Results. Residential proximity to tobacco outlets, but not tobacco outlet density, provided unique information in the prediction of long-term, continuous abstinence from smoking during a specific quit attempt. Participants residing less than 250 meters (P = .01) or less than 500 meters (P = .04) from the closest tobacco outlet were less likely to be abstinent than were those living 250 meters or farther or 500 meters or farther, respectively, from outlets.Conclusions. Because residential proximity to tobacco outlets influences smoking cessation, zoning restrictions to limit tobacco sales in residential areas may complement existing efforts to reduce tobacco use.Although the prevalence of smoking has decreased substantially over the past few decades, smoking remains the leading cause of preventable death and disability among adults in the United States.¹ A key public health strategy to reduce the deleterious health effects of tobacco use is to decrease the prevalence of smoking by increasing smoking cessation rates.² Previous public health and policy approaches to affect smoking prevalence have included restrictions on tobacco advertising, counter-advertising campaigns, bans on smoking in public places, increases in federal and state cigarette excise taxes, and increases in the availability of treatment programs. The effectiveness of these approaches in increasing smoking cessation rates has been supported by the literature.^3–5 However, additional tobacco control strategies are needed to achieve national public health goals.²One potential area of expansion for tobacco control policies is the regulation of tobacco retail outlets. Regulation strategies are designed to facilitate behavior change by altering structural aspects of the community context in which problematic behavior occurs.⁶ An analogous area in which regulation strategies have been applied is alcohol beverage retail outlets. In this case, regulation strategies have included the implementation of zoning restrictions to reduce the density of alcohol outlets and the proximity of alcohol outlets to residential areas. It was hypothesized that such regulations would affect problematic alcohol use at a community level by decreasing residents’ access to alcohol, reducing exposure to on-site product marketing, and changing social norms about alcohol use.⁷ Ultimately, research supported the success of these policies in reducing problematic alcohol use and alcohol-related injury, crimes, and violence.^7–9 In contrast to the alcohol arena, little attention has been paid thus far to the potential utility of tobacco outlet regulation strategies as a supplement to existing tobacco control policies.The Family Smoking Prevention and Tobacco Control Act, signed into law in June 2009, greatly expands the federal government''s ability to enact new public health policies related to tobacco sales in the United States. If one considers the success of alcohol outlet regulation strategies on curbing alcohol use, an increased understanding of the effects of tobacco retail outlets on smoking behaviors may provide direction to emerging tobacco control policies. Thus far, studies largely support associations between tobacco retail outlets and smoking behaviors. For example, the density of tobacco retail outlets around schools has been linked to adolescent smoking initiation¹⁰ and purchasing habits.¹¹ Similarly, the density of tobacco outlets around the home, as well as the proximity of tobacco outlets to the home, has been associated with the number of cigarettes consumed per day among adult smokers.¹² In another study, greater smoker sensitivity to point-of-sale advertising at tobacco outlets predicted a reduced likelihood of having quit smoking 18 months later.¹³ However, no previous studies have directly examined the effects of tobacco outlet density and proximity on smoking cessation during a specific quit attempt.The purpose of our study was to examine the effect of tobacco retail outlet density and proximity on smoking cessation among a racially/ethnically diverse group of smokers undergoing a specific quit attempt. We had two hypotheses. The first was that greater density of tobacco outlets around participants’ homes would be associated with lower odds of cessation. The second was that close residential proximity to a tobacco retail outlet would be associated with lower odds of cessation. All analyses controlled for participant demographics and tobacco-related variables. To our knowledge, this is the first study to examine the effects of tobacco retail outlets on a smoking quit attempt using a prospective, longitudinal design and biochemically verified smoking abstinence.     

The risk of assaultive violence and alcohol availability in Los Angeles County.

OBJECTIVES. Although there is considerable evidence that alcohol consumption facilitates assaultive violence, the extent to which alcohol outlets in a community influence assaultive violence remains controversial. METHODS. To assess the geographic association between city-specific rates of assaultive violence and alcohol-outlet density, an ecologic analysis of the 74 larger cities in Los Angeles County was conducted for the 1990 reporting year. RESULTS. Sociodemographic factors alone accounted for 70% (R2 = .70) of the variance in the rate of assaultive violence in a multiple regression model. Adding the variable for alcohol-outlet density to the model yielded a significant positive slope. The magnitude of this relation indicates that in a typical Los Angeles County city (50,000 residents, 100 outlets, 570 offenses per year), one outlet was associated with 3.4 additional assaultive violence offenses in 1990. CONCLUSIONS. These findings indicate that higher levels of alcohol-outlet density are geographically associated with higher rates of assaultive violence. This association is independent of measured confounders, including city-level measures of unemployment, ethnic/racial makeup, income, age structure, city size, household size, and female-headed households.     

The population consumption model, alcohol control practices, and alcohol-related traffic fatalities

BACKGROUND: More than 40% of urban traffic fatalities are alcohol related and the rate of such fatalities varies more than 10-fold across U.S. cities. These variations might be explained by differences in local alcohol control policies and practices. METHODS: We conducted a cross-sectional survey of state Alcohol Beverage Control agencies and local city police departments in 107 cities that participate in the National Highway and Traffic Safety Administration's Fatality Analysis Reporting System. We examined the association of alcohol control practices in 1997 and alcohol-related traffic fatalities per daily vehicle miles traveled, 1995-1997. RESULTS: Ninety-seven (91%) cities participated. Regulations related to alcohol accessibility, licensure of alcohol outlets, disciplinary procedures of alcohol outlets, and enforcement of blood alcohol concentration laws were associated with lower rates of fatalities. Cities with 9 or fewer of the 20 regulations had 1.46-fold greater alcohol-related traffic fatality rates than cities with 15 or more of these regulations, representing 392 excess deaths annually. Beer consumption was found to be a potential mediator of the effect of regulations on traffic fatalities. CONCLUSIONS: Alcohol beverage regulations are associated with alcohol-related traffic fatalities. Localities should consider greater restrictions on alcohol accessibility, stricter disciplinary measures for violations, and stricter licensure requirements as a potential means to reduce alcohol-related traffic fatalities.     

Risk of assaultive violence and alcohol availability in New Jersey.

OBJECTIVES: This study examined the relationship between rate of assaultive violence and density of alcohol outlets in New Jersey. METHODS: Data pertaining to assaultive violence, alcohol outlet density, and sociodemographic factors were obtained from municipalities in New Jersey (n = 223) and assessed through bivariate and multivariate analyses. RESULTS: Sociodemographic factors accounted for 70% (R(2)=.70) of the variance in the rate of assaultive violence. Outlet density did not add significantly to the explained variance of this model. CONCLUSIONS: In New Jersey, alcohol outlet density is not geographically associated with higher rates of violence. Alternative methodological and analytic techniques are required to better specify the relationship between alcohol availability and violence.     

Alcohol Outlets and Binge Drinking in Urban Neighborhoods: The Implications of Nonlinearity for Intervention and Policy

Objectives. Alcohol outlet density has long been associated with alcohol-related harms, and policymakers have endorsed alcohol outlet restriction to reduce these harms. However, potential nonlinearity in the relation between outlet density and alcohol consumption has not been rigorously examined.Methods. We used data from the New York Social Environment Study (n = 4000) to examine the shape of the relation between neighborhood alcohol outlet density and binge drinking by using a generalized additive model with locally weighted scatterplot smoothing, and applied an imputation-based marginal modeling approach.Results. We found a nonlinear relation between alcohol outlet density and binge drinking; the association was stronger at densities of more than 80 outlets per square mile. Binge drinking prevalence was estimated to be 13% at 130 outlets, 8% at 80 outlets, and 8% at 20 outlets per square mile.Conclusions. This nonlinearity suggests that reductions in alcohol outlet density where density is highest and the association is strongest may have the largest public health impact per unit reduction. Future research should assess the impact of policies and interventions that aim to reduce alcohol outlet density, and consider nonlinearity in effects.A substantial body of research has found that availability of alcohol, as measured by alcohol outlet density, is related to societal problems that include driving under the influence,1,2 automobile crashes,3–6 injuries,7 suicide,6 and violence.8–22 Alcohol outlet density has also been related to higher mean alcohol consumption,23–26 binge or heavy drinking,27,28 alcohol disorders,29 and liver problems.30Recent systematic reviews have concluded that the literature supports restriction of alcohol outlet density as an effective measure to reduce alcohol-related harms.31,32 Furthermore, a variety of policymaking bodies have endorsed alcohol outlet density restriction, specifically the Task Force on Community Preventive Services, the European Union, the World Health Organization, and Substance Abuse and Mental Health Services Administration.31,33–36Although the literature strongly suggests that alcohol outlet density shapes alcohol-related outcomes, most of the existing research makes the implicit assumption that the relation is essentially linear. A recent review called for research that considers the shape of the relation between alcohol outlet density and alcohol-related outcomes because the shape has practical implications for intervention and policy.31 If the relation were linear, interventions that aim to reduce alcohol outlet density at any baseline density would be equally effective. However, if the shape of the relation were nonlinear, interventions would have differing degrees of effectiveness in reducing alcohol-related harms depending on the baseline alcohol outlet density.There is a limited body of work that has considered the shape of the relation between alcohol outlet density and various outcomes. Two studies on violence assessed potential nonlinear associations with alcohol outlet density, and found stronger relations with violence at higher outlet densities.37,38 Only 1 study examined potential nonlinearity in the relation between alcohol outlet density and alcohol consumption; this study found substantially stronger relations between outlet density and harmful alcohol consumption for the highest category of outlet density. However, the use of a categorical approach (with an open-ended upper category) to examine density provides a limited assessment of the shape of the relation.39There is a need for research that rigorously examines the shape of the relation between alcohol outlet density and alcohol consumption. Building on the extant research, we examined the relation between neighborhood alcohol outlet density and binge drinking in an urban population. We examined the shape of the relation by using a semiparametric general additive model with locally weighted scatterplot smoothing (loess) instead of assuming a standard form. Then we applied a marginal modeling approach to estimate prevalences of binge drinking associated with “setting” neighborhood alcohol outlet density to levels across the range of the data.40,41