Alcohol Retail Density and Demographic Predictors of Health Disparities: A Geographic Analysis

Objectives. We examined whether the geographic density of alcohol retailers was greater in geographic areas with higher levels of demographic characteristics that predict health disparities.Methods. We obtained the locations of all alcohol retailers in the continental United States and created a map depicting alcohol retail outlet density at the US Census tract level. US Census data provided tract-level measures of poverty, education, crowding, and race/ethnicity. We used multiple linear regression to assess relationships between these variables and retail alcohol density.Results. In urban areas, retail alcohol density had significant nonlinear relationships with Black race, Latino ethnicity, poverty, and education, with slopes increasing substantially throughout the highest quartile for each predictor. In high-proportion Latino communities, retail alcohol density was twice as high as the median density. Retail alcohol density had little or no relationship with the demographic factors of interest in suburban, large town, or rural census tracts.Conclusions. Greater density of alcohol retailers was associated with higher levels of poverty and with higher proportions of Blacks and Latinos in urban census tracts. These disparities could contribute to higher morbidity in these geographic areas.The geographic density of alcohol retailers is a community risk factor that may influence behavior. Alcohol access within a neighborhood may constitute a social influence as drinking behavior is observed and social norms are created in that neighborhood; there may be an accessibility effect resulting from convenience of and proximity to opportunities to purchase alcohol; there may be increased advertising within neighborhoods that have more alcohol retail outlets¹; or the alcohol point of sale may have an influence on the neighborhood itself, changing the characteristics of the neighborhood.To date, previous work researching the impact of retail alcohol density has mainly focused on regional or local assessments, except for a study that examined urban centers at the zip code level.² The methodologies of the regional studies have also varied, with assessments at a variety of geographic levels: counties,³ cities,^4–6 zip codes,^7,8 block groups,⁹ and census tracts.^10–14 Such area-level variation may make interpretation or generalizing difficult because individuals'' activities often cross administrative boundaries. There have been no national studies on retail alcohol density in nonurban settings; previous nonurban analyses were embedded within regional or state assessments. In addition, it is not known whether potentially important findings regarding the effects of alcohol availability can be applied to locales that have not been directly studied.To better understand the association between retail alcohol density and demographic predictors of health disparities, we created a continuous density map of alcohol retailers across the continental United States, and we assessed how these points of sale related to demographic characteristics at the census tract level.