Alcohol outlets,drug paraphernalia sales,and neighborhood drug overdose |
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| Institution: | 1. University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, 423 Guardian Dr, Philadelphia, PA, 19104, USA;2. Michigan State University College of Human Medicine, Department of Epidemiology and Biostatics, 200 East First Street, Flint, MI, 48502, USA;3. Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA;4. Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, 7th floor, Baltimore, MD, 21205, USA;1. Columbia University Medical Center, USA;2. Duke University, Department of Psychology and Neuroscience, Durham, NC, 27705, USA;3. New York State Psychiatric Institute, Columbia, University, Department of Psychiatry, New York, NY 10032, USA;4. Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya;5. Moi Teaching & Referral Hospital, Department of Behavioral Sciences, Eldoret, Rift Valley, Kenya;6. Duke University, Department of Psychology and Neuroscience; Duke Global Health Institute, Durham, NC, 27705, USA;1. Centre on Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON M5B 1T8, Canada;2. Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA;3. Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, United States;4. British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC V6Z 2A9, Canada;5. School of Public Policy, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada;6. Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada;7. Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada;8. Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St Room 425, Toronto, ON M5T 3M6, Canada;1. KADAP Income Reinvestment Program (KIRP), Division of Infectious Diseases, University of Kentucky, United States;2. Kentucky Department for Public Health, KY, United States |
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| Abstract: | BackgroundAlcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association.MethodsA cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly.ResultsEach additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose.ConclusionThis study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws. |
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