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.     

Multilevel spatiotemporal change-point models for evaluating the effect of an alcohol outlet control policy on changes in neighborhood assaultive violence rates

Many previous studies have suggested a link between alcohol outlets and assaultive violence rates. In 1997 the City of New Orleans adopted a series of policies, e.g., increased license fee, additional enforcement staff, and expanded powers for the alcohol license board. The policies were specifically enacted to address the proliferation of problem alcohol outlets believed to be the source of a variety of social problems including assaultive violence. In this research, we evaluate the impact of a city level policy in New Orleans to address the problem alcohol outlets and their influence on assaultive violence. The spatial association between rates of assaultive violence at the census tract level (n=170) over a ten year period raises a challenge in statistical analysis. To meet this challenge we developed a hierarchical change-point model that controls for important covariates of assaultive violence and accounts for unexplained spatial and temporal variability. While our model is somewhat complex, its hierarchical Bayesian analysis is accessible via the WinBUGS software program. Keeping other effects fixed, the implementation of the new city level policy was associated with a decrease in the positive association between census tract level rates of assaultive violence and alcohol outlet density. Comparing several candidate change-point models using the DIC criterion, the positive association began decreasing the year of the policy implementation. The magnitude of the association continued to decrease for roughly two years and then stabilized. We also created maps of the fitted assaultive violence rates in New Orleans, as well as spatial residual maps which, together with Moran's I's, suggest that the spatial variation of the data is well accounted for by our model. We reach the conclusion that the implementation of the policy is associated with a significant decrease in the positive relationship between assaultive violence and the off-sale alcohol outlet density.     

Alcohol outlet density and violence: a geospatial analysis

AIMS: To examine the relationship between alcohol outlet density and violent crime controlling for neighbourhood sociostructural characteristics and the effects of spatially autocorrelated error. DESIGN: The sample for this ecologic study comprised 188 census tracts from the City of Austin, Texas and 263 tracts from the City of San Antonio, Texas. Data pertaining to neighbourhood social structure, alcohol density and violent crime were collected from archival sources, and analysed using bivariate, multivariate and geospatial analyses. RESULTS: Using ordinary least squares analysis, the neighbourhood sociostructural covariates explained close to 59% of the variability in violent crime rates in Austin and close to 39% in San Antonio. Adding alcohol outlet density in the target and adjacent census tracts improved the explanatory power of both models. Alcohol outlet density in the target census tract remained a significant predictor of violent crime rates in both cities when the effects of autocorrelated error were controlled for. In Austin, the effects of alcohol outlet density in the adjacent census tracts also remained significant. The final model explains 71% of the variance in violent crime in Austin and 56% in San Antonio. CONCLUSIONS: The findings show a clear association between alcohol outlet density and violence, and suggest that the issues of alcohol availability and access are fundamental to the prevention of alcohol-related problems within communities.     

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.     

Social capital and the neighborhood alcohol environment

We examine whether neighborhood alcohol outlet density is associated with reduced social capital and whether this relationship is mediated by perceived neighborhood safety. Hierarchical models from a random sample of Los Angeles, CA, and Louisiana residents (N=2,881) from 217 census tracts were utilized. Substantial proportions of the variance in collective efficacy (intraclass correlation coefficient, ICC=16.3%) and organizational participation (ICC=13.8%, median odds ratio=1.99) were attributable to differences between neighborhoods-suggesting that these factors may be influenced by neighborhood-level characteristics. Neighborhood alcohol outlet density was strongly associated with reduced indicators of social capital, and the relationship between collective efficacy and outlet density appears to be mediated by perceived neighborhood safety. Findings support the concept that off-premise alcohol outlets in the neighborhood environment may hinder the development of social capital, possibly through decreased positive social network expansion.     

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.     

CHARACTERISTICS OF VIOLENT ALCOHOLICS

This study is based on interviews with 53 male alcoholics. Itspurpose was to study the relationship between childhood conditions,history of alcohol and drug misuse and assaultive and suicidalbehaviour. Fifty-seven per cent of the alcoholics reported ahistory of violent behaviour. Hidden violence, often towardswomen, was common. One-third of the violent patients had a historyof attempted suicide compared to 17% in the non-violent group.The assaultive alcoholics also had a more violent childhood,a higher proportion of fathers with alcohol problems and hadstarted drinking earlier in life. Drug addiction was much morecommon in this group too. We find support for our hypothesisthat there is a positive correlation between violence in theparental home and assaultive and suicidal behaviour and drugmisuse later in life. When violent and non-violent alcoholicsare compared many of the same characteristics appear as whensuicidal and non-suicidal and type 2 and type 1 alcoholics arecompared. This study raises the question of adding attemptedsuicide as a characteristic of the type 2 alcoholic.     

Hierarchical Bayesian spatial models for alcohol availability, drug "hot spots" and violent crime

Background  

Ecologic studies have shown a relationship between alcohol outlet densities, illicit drug use and violence. The present study examined this relationship in the City of Houston, Texas, using a sample of 439 census tracts. Neighborhood sociostructural covariates, alcohol outlet density, drug crime density and violent crime data were collected for the year 2000, and analyzed using hierarchical Bayesian models. Model selection was accomplished by applying the Deviance Information Criterion.     

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.     

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.     

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     

Prevalence, proximity and predictors of alcohol ads in Central Harlem

AIMS: This study examined the prevalence of alcohol ads, the spatial relationship between alcohol ads and schools, churches and playgrounds, and area-level determinants of alcohol ad density in Central Harlem, New York City. METHODS: Alcohol advertising was quantified using street observation. Data on city demographics and infrastructure were obtained from the census and municipal databases. RESULTS: Alcohol ads were densely distributed; almost half of ads fell within a 152 m buffer of schools, churches and playgrounds; and ad density was positively associated with retail liquor outlet density. CONCLUSIONS: Predominantly Black neighbourhoods continue to face high exposure to outdoor alcohol advertising, including around sites at which youth congregate.     

Alcohol outlet density is related to police events and motor vehicle accidents in Manukau City,New Zealand

Objectives: To explore the cross‐sectional association between alcohol outlet density and police events in Manukau City, New Zealand. Methods: Using data for the Census Area Unit (suburb) level, per‐capita measures of alcohol outlet density for January 2009 were calculated for off‐licence outlets, clubs and bars, and restaurants and cafés. Data on police events and motor vehicle accidents were obtained for the period 1 July 2008 to 30 June 2009, and also converted into per capita measures. A spatial seemingly unrelated regression model was developed, which simultaneously assessed the relationship between densities and all nine categories of police events, and motor vehicle accidents, while controlling for relevant covariates. Results: All three outlet density measures were significantly associated with a range of police events, but only off‐licence density was significantly associated with motor vehicle accidents. An additional off‐licence outlet in a given area was associated with 85.4 additional police events and 10.3 additional motor vehicle accidents; an additional club or bar was associated with 34.7 additional police events and 0.5 additional motor vehicle accidents; and an additional restaurant or cafe was associated with 13.2 additional police events and 2.1 additional motor vehicle accidents. Conclusions: The results do not imply causality. However, they are broadly consistent with availability theory, and imply that local alcohol policy should account for the effects of additional outlets when new licences are granted. While the methodological approach described here is easily transferable to investigate the relationships elsewhere, we suggest some areas for improvement of future studies.     

Workplace violence prevention programs in hospital emergency departments

OBJECTIVE: Hospital violence is a growing concern, yet little is known about existing programs. This study compared workplace violence programs in high-risk emergency departments among a representative sample of 116 hospitals in California and 50 hospitals in New Jersey. METHODS: Information was collected through interviews, a facility walk-through, and review of written policies, procedures, and training material. Programs were scored on the components of training, policies and procedures, security, and environmental approaches. RESULTS: California had significantly higher scores for training and policies and procedures, but there was no difference for security and environmental approaches. Program component scores were not highly correlated. For example, hospitals with a strong training program were not more likely to have strong policies and procedures. CONCLUSIONS: Most hospitals in California and New Jersey had implemented a workplace violence prevention program, but important gaps were found.     

Alcohol and intimate partner violence: do we have enough information to act?

BACKGROUND: Male alcohol consumption is one of the accepted risk factors for intimate partner violence. The aim of this study is to assess the magnitude of the association between male alcohol consumption and intimate partner violence against women and the quality of the evidence of published papers exploring this relationship empirically. METHODS: Systematic review and meta-analysis of quantitative studies (1966-2004). Eight databases from Social and Behavioural Sciences, Clinical Medicine, and Life Sciences were reviewed. Studies with available 2 x 2 table or odds ratio were analysed using meta-analytic techniques. RESULTS: A total of 22 studies fulfilled the inclusion criteria for the systematic review: 14 (63.6%) were cross-sectional studies, 6 (27.3%) case-series, 2 (9.1%) case-control studies. Ten studies analysed the relationship between alcohol and violence as their primary hypothesis and only two used a direct measure of alcohol consumption. Of them, 11 papers were included in the meta-analysis. The overall pooled odds ratio was 4.57 (95% confidence limits 3.30-6.35), but a high degree of heterogeneity was observed. The magnitude of the effect was inversely associated with the year of publication. The biggest odds ratios were obtained in the studies with the smallest sample sizes. CONCLUSIONS: The evidence about the relationship between alcohol consumption and intimate partner violence is of low quality in the study designs and maybe biased by publication of positive results. Currently there is not enough empirical evidence to support preventive policies based on male alcohol consumption as a risk factor in the particular case of intimate partner violence.     

The Geography of Violence,Alcohol Outlets,and Drug Arrests in Boston

Objectives. We examined the relationship between alcohol outlets, drug markets (approximated by arrests for possession and trafficking), and violence in Boston, Massachusetts, in 2006. We analyzed geographic and environmental versus individual factors related to violence and identified areas high in violent crime.Methods. We used data from the Boston Police Department, US Census, and Massachusetts State Alcohol Beverage Control Commission. Spatial modeling was employed at the block group level, and violent crime, alcohol outlets, and drug markets were mapped.Results. Relative to other block groups, block groups in the highest decile of violent crime (n = 55) were found to be poorer (e.g., lower incomes, higher percentages of vacant homes), and they had greater numbers of alcohol outlets and higher drug arrest rates. Alcohol outlets and drug possession and trafficking arrests were predictive of violent crime. Also, spatial effects resulting from neighboring block groups were related to violent crime. Both alcohol outlet density and type were associated with violent crime in a differentiated and complex way.Conclusions. With drug possession and trafficking arrests as a proxy for drug markets, spatial relationships between alcohol outlets and violence were found in addition to typical sociodemographic predictors.Understanding the environmental and social contexts in which violence occurs has been an increasingly important area of research, one that has broad applicability to public policies on violence mitigation far beyond purely research issues. Increased theoretical understanding of the spatial and environmental contexts of violence, such as theories relating alcohol outlets to violence, have gone hand in hand with improvements in spatial techniques and computing power, transforming this area of research. Furthermore, although there have been studies on violence related to types and densities of alcohol outlets,1–5 there has been less research attempting to include measures of drug arrests and to more fully incorporate spatial features such as characteristics of adjacent geographic areas.Locations of alcohol outlets are frequently related to occurrence of violence. The incidence of interpersonal violence appears to increase in and around locations with alcohol outlets, particularly bars and liquor stores.1,3–5 There are several possible mechanisms. First, bars and liquor stores often attract individuals likely to be involved in violent interactions, such as young males (alcohol availability theory).6 Second, these retail alcohol outlets are often located in areas with less guardianship than others (social disorganization theory).1,3,7 Third, these types of outlets provide opportunities for social interactions that may lead to violence (alcohol availability and niche theory).Finally, establishments serving alcohol can foster increased expressions of aggression.6 Empirical studies have shown a correlation between higher rates of violence and increased proximity to bars and liquor stores1,8–10 as well as sales through alcohol outlets.11 Similar arguments have been suggested to support empirically observed cross-sectional relationships between rates of violence and locations of off-premise establishments.9,12Establishment effects, however, may be related to other crime-related aspects of the environments of off-premise outlets, such as illegal drug activity and prostitution.13 Questions remain as to whether effects related to alcohol outlets are due to the outlets themselves or the general characteristics of the areas in which they are located. Recent criminological research on bars and taverns suggests that managers of these establishments create environments that suppress or facilitate violence through business-related choices such as types of activities and entertainment, staff and training, and property characteristics.14Two theoretical concerns have guided much of the empirical work over the past 2 decades. First, alcohol outlets might serve as markers for other population or environmental features that are related to violence. These markers could consist of specific population characteristics related to greater levels of violence (e.g., poverty, female-headed households)10 or place-based characteristics related to lower levels of police enforcement and surveillance (e.g., vacant retail establishments).15 Second, violence and alcohol outlets are part of the continuous spatial fabric of communities, and thus standard statistical analyses of data, which assume independence of observations, are complicated by spatial autocorrelation between observations.16 Spatial models have been applied to help correct for bias or increased sampling variation of effect estimates arising from a lack of spatial independence in modeling violence outcomes.17We examined the relationship between alcohol outlets and violent crime in an analytical framework that treats alcohol outlets as potentially both “producers” of violent behavior and markers or attractors of violence. Our initial assessments of the effects of typical sociodemographic measures demonstrated that there remained effects of alcohol outlet presence not accounted for by these features. Subsequently, to capture more spatial and environmental characteristics and to illustrate the presence of spatial effects that were distinct from the 2 types of effects just mentioned, we assessed how adjacent area characteristics relate to violent crime in the target area. To deal with the different ways in which outlets are posited to be related to violence, we accounted for outlet density and type and whether a violent crime occurred on a weekend or weekday.In addition, we included information on drug arrests for trafficking and possession (as estimators of drug markets) to properly account for the relationship between violence and drug markets when assessing the effects of alcohol outlets. Although Martinez et al.18 found a significant relationship between drug markets and violence when accounting for social disorganization, our analysis is the first, to our knowledge, to also include alcohol outlet type and density.     

Trauma exposure and posttraumatic stress disorder: A study of youths in urban America

We estimate the cumulative occurrence of traumatic events and posttraumatic stress disorder (PTSD), using Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria, in a high-risk sample of young people in urban United States. The epidemiological sample (n=2,311) was recruited in 1985–1986 at entry into first grade of a public school system of a large mid-Atlantic city. Participants were interviewed about history of trauma and PTSD in 2000–2002 when their mean age was 21 years (n=1,698). We found that the lifetime occurrence of assaultive violence was 62.6% in males and 33.7% in females. The risk of assaultive violence in males (but not females) varied by childhood area of residence within the city; the occurrence of other traumas did not vary by area of childhood residence. Females had a higher risk of PTSD than males following assaultive violence (odds ratio=4.0, 95% confidence interval 2.0–8.3), but not following other traumas. A comparison of the results from this largely inner-city sample with the results from a recent study of a largely suburban sample in another region of the United States in which the same criteria and measures of trauma and PTSD were used suggested the possibility that males’ risk for assaultive violence and females’ risk for PTSD following exposure to assaultive violence might vary by characteristics of the social environment.     

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.     

Alcohol outlets and youth alcohol use: Exposure in suburban areas

The purpose of this study was to explore how exposure to alcohol outlets (around home and school) influenced alcohol use among 242 high-school students (mean age 16.4, 48.8% male, 93.4% White). Results found no relationship between alcohol outlet exposure, using a measure of both distance to and density around students’ homes and schools, and alcohol use. This study suggests that outlet exposure may not influence alcohol use among mostly White, middle-class, and suburban youth. However, the lack of association may also reflect the lower level of alcohol outlets present in low-density residential environments as well as differences in accessibility.     

Geographic concentration of violence between intimate partners.

OBJECTIVES: To explore geographic patterns of violence between intimate partners in a metropolitan area with one of the highest injury mortality rates in the nation-Duval County, Florida, which includes the city of Jacksonville. METHODS: Using police reports of all serious violent incidents in Duval County in 1992 excluding robberies, the authors analyzed patterns in the location of the incidents. Only cases for which the relationship between the offender and victim was recorded were used. RESULTS: Thematic maps reveal that census tracts with rates above the 75th percentile of assaultive violence between intimates are clustered in certain parts of the city. Concentrated poverty tracts had median rates of violence between intimate nine times higher than other tracts. CONCLUSIONS: The finding that violence between intimate partners is concentrated in central city poverty neighborhoods opens up avenues for prevention.