The Relationship of Outlet Densities to Alcohol Consumption: A Time Series Cross-Sectional Analysis

The implementation of regulations on access to alcoholic beverages, whether through beverage taxes or restrictions on the availability of this commodity through alcohol outlets, has often been proposed as a legitimate and politically feasible approach to the prevention of alcohol-related problems. Empirical studies of the effects of these approaches to regulation on alcohol consumption and problems, however, have not been unanimous in their support of these preventive measures. While support exists for the suggestion that increases in alcohol beverage prices reduce consumption and have preventive effects upon the occurrence of problems, relatively little evidence exists for the supposition that the regulation of alcohol availability will have similar preventive effects. The lack of evidence in support of the latter thesis rests primarily upon the difficulty of obtaining sufficient data to examine comprehensive models of access to alcohol.
The current paper analyzes aggregate time series cross-sectional data from states of the U.S. to evaluate the relationships between alcohol beverage prices, availability, and alcohol sales within one analytic model. The model relates beverage prices and alcohol availability directly to alcohol sales in the context of an assumed simultaneous relationship between sales and availability. The results show that, independent of the effects of beverage prices, and controlling for the endogeneity of sales and availability, physical availability of alcohol was directly related to sales of spirits and wine.     

Routine Activities and Alcohol Use: Constraints on Outlet Utilization

Studies of consumers' use of alcohol beverage outlets have provided a basis for understanding drinking behaviors in different drinking environments. These studies have shown that drinking environments are related to both demographic and drinking pattern measures. Absent from these studies has been a theoretical basis on which to make predictions regarding drinking patterns and choices of drinking environments under the various social, economic, and environmental constraints typically confronting alcohol consumers. This study presents one such theoretical approach.
The approach assumes that, in the context of individual preferences for alcohol, drinking choices are constrained by consumers' economic and time-energy budgets for consumption. All other things being equal, it is suggested that greater budgets for consumption will be related to greater alcohol use, quality of beverages purchased, amenity values of purchase locations, or all three. Because on-premise drinking entails greater economic costs, greater drinking levels will be related to lower utilization of on-premise establishments.
The predictions of this approach were tested using data obtained from telephone surveys of consumers conducted in 1990 and 1991. The results showed that controlling for income, variables related to greater time-energy budgets for consumption (i.e., marital status and household composition) were related to greater consumption levels and greater utilization of on-premise establishments. Controlling for demographic measures, greater income was related to greater utilization of restaurants and increased beverage quality. Controlling for all other measures, frequencies of consumption were inversely related to consumption at on-premise establishments, reflecting the expected moderation in costs for heavier consumers on a limited alcohol budget.     

Alcohol Consumption, Alcohol Outlets, and the Risk of Being Assaulted With a Gun

Background: We conducted a population‐based case–control study to better delineate the relationship between individual alcohol consumption, alcohol outlets in the surrounding environment, and being assaulted with a gun. Methods: An incidence density sampled case–control study was conducted in the entire city of Philadelphia from 2003 to 2006. We enrolled 677 cases that had been shot in an assault and 684 population‐based controls. The relationships between 2 independent variables of interest, alcohol consumption and alcohol outlet availability, and the outcome of being assaulted with a gun were analyzed. Conditional logistic regression was used to adjust for numerous confounding variables. Results: After adjustment, heavy drinkers were 2.67 times as likely to be shot in an assault when compared with nondrinkers (p < 0.10) while light drinkers were not at significantly greater risk of being shot in an assault when compared with nondrinkers. Regression‐adjusted analyses also demonstrated that being in an area of high off‐premise alcohol outlet availability significantly increased the risk of being shot in an assault by 2.00 times (p < 0.05). Being in an area of high on‐premise alcohol outlet availability did not significantly change this risk. Heavy drinkers in areas of high off‐premise alcohol outlet availability were 9.34 times (p < 0.05) as likely to be shot in an assault. Conclusions: This study finds that the gun assault risk to individuals who are near off‐premise alcohol outlets is about the same as or statistically greater than the risk they incur from heavy drinking. The combination of heavy drinking and being near off‐premise outlets resulted in greater risk than either factor alone. By comparison, light drinking and being near on‐premise alcohol outlets were not associated with increased risks for gun assault. Cities should consider addressing alcohol‐related factors, especially off‐premise outlets, as highly modifiable and politically feasible approaches to reducing gun violence.     

Alcohol Availability and the Formal Power and Resources of State Alcohol Beverage Control Agencies

The formal powers and resources of state alcohol beverage control agencies place them in a position to regulate access to alcoholic beverages through restrictions on retail distribution and sales. For example, monopoly states restrict access to spirits, and sometimes wine, by allowing retail sales only through state stores. On the other hand, license and monopoly states share in restricting sales through the use of price posting and fixing provisions. The degree to which these powers are realized in restrictions on alcohol outlets (e.g., licenses) and subsequent alcohol consumption (e.g., sales) was investigated in the current study. In a cross-sectional analysis of data available from 44 alcohol beverage control (ABC) jurisdictions in the United States, it was shown that states with greater restrictions on retail sales had greater resources for the conduct of ABC activities and lower densities of spirit outlets. These states, however, had greater densities of wine and beer outlets. States with greater marketplace restrictions had more resources for ABC enforcement activities and lower outlet densities across all beverage types. Further, supporting the suggestion that availability and demand may be simultaneously related, greater outlet densities were related to greater alcohol consumption (for beer) and greater levels of consumption were related to greater outlet densities (for wine).     

Alcohol Availability and Intimate Partner Violence Among US Couples

Objectives: We examined the relation between alcohol outlet density (the number of alcohol outlets per capita by zip code) and male‐to‐female partner violence (MFPV) or female‐to‐male partner violence (FMPV). We also investigated whether binge drinking or the presence of alcohol‐related problems altered the relationship between alcohol outlet density and MFPV or FMPV. Methods: We linked individual and couple sociodemographic and behavioral data from a 1995 national population‐based sample of 1,597 couples to alcohol outlet data and 1990 US Census sociodemographic information. We used logistic regression for survey data to estimate unadjusted and adjusted odds ratios between alcohol outlet density and MFPV or FMPV along with 95% confidence intervals (CIs) and p‐values. We used a design‐based Wald test to derive a p‐value for multiplicative interaction to assess the role of binge drinking and alcohol‐related problems. Results: In adjusted analysis, an increase of one alcohol outlet per 10,000 persons was associated with a 1.03‐fold increased risk of MFPV (p‐value for linear trend = 0.01) and a 1.011‐fold increased risk of FMPV (p‐value for linear trend = 0.48). An increase of 10 alcohol outlets per 10,000 persons was associated with 34% and 12% increased risk of MFPV and FMPV respectively, though the CI for the association with FMPV was compatible with no increased risk. The relationship between alcohol outlet density and MFPV was stronger among couples reporting alcohol‐related problems than those reporting no problems (p‐value for multiplicative interaction = 0.01). Conclusions: We found that as alcohol outlet density increases so does the risk of MFPV and that this relationship may differ for couples who do and do not report alcohol‐related problems. Given that MFPV accounts for the majority of injuries related to intimate partner violence, policy makers may wish to carefully consider the potential benefit of limiting alcohol outlet density to reduce MFPV and its adverse consequences.     

Alcohol, Injury, and Risk-Taking Behavior: Data from a National Sample

The association of alcohol consumption and injury is well documented in the literature. It has also been suggested that alcohol consumption is associated with risk-taking behaviors. No studies have reported the association of alcohol consumption and risk-taking behaviors with injury across all injury types, however. Data were collected (1990) from a national probability household sample ( n = 2058; weighted n = 1150) on: injuries that required treatment during the last year; quantity and frequency (Q-F) of drinking; and behaviors associated with risk perception, risk-taking/impulsivity, and sensation seeking. The injured (12% of the sample) were more likely to be male, younger, and to report moderate and heavy drinking and more frequent drunkenness compared with those with no injuries. They were also less likely to score high on risk perception and more likely to score high on risk-taking/impulsivity and sensation seeking than those with no injuries. However, using logistic regression analysis to predict a treated injury during the last year, only the interaction term of gender by Q-F was significant, with Q-F a significant predictor of injury among males but not among females.     

Injury and the Role of Alcohol: County-Wide Emergency Room Data

The purpose of this study is to describe variables associated with injury in an emergency room (ER) sample that is representative of an entire U.S. county. A probability sample ( n = 3717) of ER patients from the county hospital, 3 of the 0 community hospitals, and the three health maintenance organization hospitals in a single Northern California county were breathalyzed and interviewed at the time of the ER visit. Injured were most likely to consume only 1 or 2 drinks within el hr of injury occurrence. Twenty-three percent reported feeling drunk at the time of the event, and of these, 45% felt the event would not have happened if they had not been drinking. Breathalyzer reading, feeling drunk at the time of the event, and quantity-frequency (Q-F) of usual drinking were found to be predictive of admission to the ER with an injury, whereas breathalyzer reading, Q-F, and being injured in someone's home were predictive of reporting drinking prior to injury. Although feeling drunk at the time of the event and usual drinking patterns are predictive of injury occurrence, drinking prior to the event may not entail large quantities of alcohol consumed, but relatively small amounts consumed in close proximity to the injury event. These alcohol consumption variables may vary, however, depending on the type, cause, and severity of injury.     

Alcohol and Fatal Injury: The Use of Routinely Collected Fatality Data in Community Prevention Evaluation

BACKGROUND: This study analyzed patterns of alcohol involvement among coroners' cases (which typically include blood alcohol content information) to develop a method for weighting death-certificate cases (which typically do not include blood alcohol content information) for likelihood of alcohol involvement for purposes of alcohol-involved injury intervention evaluation. METHODS: The coroners' data analyzed here were collected from four California communities and correspond to all injury coroner cases between 1987 and 1996 in those communities. The death-certificate data were provided by the State of California, Department of Health Services, and correspond to all injury deaths occurring in that state between 1980 and 1996. Each injury fatality in the death-certificate data was assigned a probability of alcohol involvement based upon the coroners' data. These were then summed to provide an estimate of, or "surrogate measure" for, the total number of alcohol-involved fatal injuries per 10,000 California residents aggregated across the state of California by month for the period from January 1980 to 1990. As a test of this estimate, we examined its responsiveness to an intervention designed to reduce alcohol-involved injuries which was implemented in California in 1990 using a time series analysis technique (ARIMA) that corrects for serial autocorrelation typically found in time ordered data. RESULTS: This analysis found an effect during the postintervention period (p = 0.046). An alternative model testing for intervention effects on all injury fatalities did not find an effect. CONCLUSIONS: This surrogate measure seems responsive to intervention effects and may provide a useful tool for interventions designed to reduce alcohol-involved injuries.     

Alcohol and Colorectal Cancer: The Role of Alcohol Dehydrogenase 1C Polymorphism

Background:  Chronic alcohol consumption is a risk factor for colorectal cancer. Animal experiments as well as genetic linkage studies in Japanese individuals with inactive acetaldehyde dehydrogenase leading to elevated acetaldehyde concentrations following ethanol ingestion support the hypothesis that acetaldehyde may be responsible for this carcinogenic effect of alcohol. In Caucasians, a polymorphism of alcohol dehydrogenase 1C ( ADH1C ) exists resulting in different acetaldehyde concentrations following ethanol oxidation.
Methods:  To evaluate whether the association between alcohol consumption and colorectal tumor development is modified by ADH1C polymorphism, we recruited 173 individuals with colorectal tumors diagnosed by colonoscopy and 788 control individuals without colorectal tumors. Genotyping was performed using genomic DNA extracted from whole blood followed by polymerase chain reaction.
Results:  Genotype ADH1C*1/1 was more frequent in patients with alcohol-associated colorectal neoplasia compared to patients without cancers in the multivariate model controlling for age, gender, and alcohol intake (odds ratio = 1.674, 95% confidence interval = 1.110–2.524, 2-sided p from Wald test = 0.0139). In addition, the joint test of the genetic effect and interaction between ADH1C genotype and alcohol intake (2-sided p  = 0.0007) indicated that the difference in ADH1C*1 polymorphisms between controls and colorectal neoplasia is strongly influenced by the alcohol consumption and that only individuals drinking more than 30 g ethanol per day with the genotype ADH1C*1/1 had an increased risk for colorectal tumors.
Conclusions:  These data identify ADH1C homozygosity as a genetic risk marker for colorectal tumors in individuals consuming more than 30 g alcohol per day and emphasize the role of acetaldehyde as a carcinogenic agent in alcohol-related colorectal carcinogenesis.     

Alcohol outlets, youth drinking, and self-reported ease of access to alcohol: a constraints and opportunities approach

Background:  Despite recent research examining youth access to alcohol, the extent to which relative ease of access to alcohol from various sources translates into the use of these sources is not known.
Methods:  Patterns of adolescent alcohol access in California were studied using a hierarchical analysis of self-reported and archival measures. A survey of 30 youths age 14 to 16 in each of 50 zip codes selected to maximize variability in median household income and off-premise outlet densities was conducted.
Results:  (1) Both actual use of and perceived ease of access to formal sources were positively associated with off-premise outlet density (a measure of formal access). (2) Actual use of informal sources was negatively associated with outlet densities. (3) Perceived and realized informal access were associated positively with deviance and negatively with conventionality. (4) Deviance was associated with increased perceived and realized access from both formal and social sources, whereas conventionality was only associated with realized and perceived informal access.
Conclusions:  Correlates of perceived and actual alcohol access differ somewhat, and the differences between informal and formal access (both perceived and actual) are many, creating a complex picture of the patterns of underage access to alcohol. Youth drinking is affected by opportunities and constraints. Specifically, as one form of access becomes constrained, youth appear to circumvent restrictions by relying on other modes of access. Thus interventions targeting formal alcohol access by youth may result in a shift to reliance on social sources. This complex problem requires a multi-faceted intervention approach.     

Alcohol, Central Nervous System Injury, and Time to Fatal Motor Vehicle Crashes

Objectives: Motor vehicle crash (MVC) studies have found that alcohol (ALC) is associated with increased mortality and decreased time to death (TTD). Clinical and experimental data suggest that ALC potentiates central nervous system injury (CNSI). We hypothesize that ALC-intoxicated, MVC fatalities with CNSI are more likely to die in the immediate postinjury period than are sober victims with CNSI. Methods: Design—A retrospective cohort of 401 MVC fatalities from four Michigan counties for the time period 1985 to 1991 was studied. Measurements—Medical examiner records were reviewed to determine age, blood alcohol concentration (BAC), and TTD. Injury severity was calculated with the Abbreviated Injury Scale (1985 version). Anatomical profile scores and G scores were also calculated and used to identify CNSI subjects. Analysis—χ² and Student's t test were used, and odds ratios with 0.95 confidence intervals (CIs) were calculated. Results: ALC(+) cases (BAC ≥ 100 mg/dl) (n= 99) were significantly younger and more frequently had TTD < 1 hr than ALC(-) cases (n= 233): odds ratio 1.62 [0.95 CI (1.02 to 2.50)]. Overall, CNSI cases (n= 297) were significantly younger and had fewer thoracic injuries, but did not have significantly shorter TTD, compared with non-CNSI cases. However, ALC(+) CNSI cases (n= 77) were over twice as likely to have TTD < 1 hr (odds ratio 2.04 [0.95 CI (1.13 to 3.70)]}. For ALC(+) isolated CNSI cases, the odds ratio for TTD < 1 hr, compared with nonisolated CNSI cases was 8.25 (0.95; CI 0.66 to 102.5). Injury Severity Score, anatomical profile, and G scores were not Significantly different for ALC(+) CNSI cases, compared with ALC(-) CNSI cases, whether isolated or nonisolated. Conclusions: These data suggest that alcohol intoxication is associated with increased frequency of early death in MVC victims with CNSI, despite there being no detectable difference in anatomical injury scoring.