The Effectiveness of Limiting Alcohol Outlet Density As a Means of Reducing Excessive Alcohol Consumption and Alcohol-Related Harms

Community Guide Branch of the National Center for Health Marketing, CDC, Atlanta, Georgia 30333, USA.
American journal of preventive medicine (Impact Factor: 4.53). 12/2009; 37(6):556-69. DOI: 10.1016/j.amepre.2009.09.028
Source: PubMed


The density of alcohol outlets in communities may be regulated to reduce excessive alcohol consumption and related harms. Studies directly assessing the control of outlet density as a means of controlling excessive alcohol consumption and related harms do not exist, but assessments of related phenomena are indicative. To assess the effects of outlet density on alcohol-related harms, primary evidence was used from interrupted time-series studies of outlet density; studies of the privatization of alcohol sales, alcohol bans, and changes in license arrangements-all of which affected outlet density. Most of the studies included in this review found that greater outlet density is associated with increased alcohol consumption and related harms, including medical harms, injury, crime, and violence. Primary evidence was supported by secondary evidence from correlational studies. The regulation of alcohol outlet density may be a useful public health tool for the reduction of excessive alcohol consumption and related harms.

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    • "Research shows that alcohol-related problems can be minimized by limiting availability through reducing hours of sale and/or lowering alcohol outlet density (Chaloupka et al., 2002; Loxley et al., 2004; Anderson et al., 2009; Campbell et al., 2009; Casswell and Thamarangsi, 2009; Hahn et al., 2010; Martineau et al., 2013; Kypri et al., 2014). As people in more deprived areas are often in closer proximity to alcohol outlets than those in wealthier areas (Romley et al., 2007; Pearce et al., 2008; Hay et al., 2009; Berke et al., 2010; Livingston, 2012b), neighbourhood planning and zoning to reduce availability in disadvantaged areas may assist in decreasing inequities. "
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    ABSTRACT: Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.
    Health Promotion International 09/2015; 30(S2):ii20-ii35. DOI:10.1093/heapro/dav030 · 1.94 Impact Factor
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    • "Structural conditions such as alcohol availability comprise a second major focus of investigation into community-level determinants of alcohol use. Alcohol outlet density increases physical access to alcohol, which may lower alcohol prices and shape social behavior around drinking (Campbell et al., 2009). Ecologic studies from developed countries have shown overall alcohol consumption and alcohol-related harms to be higher in areas with greater outlet density (Popova et al., 2009). "
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    ABSTRACT: Alcohol use contributes to morbidity and mortality in developing countries by increasing the risk of trauma and disease, including alcohol dependence. Limited research addresses determinants of alcohol use beyond the individual level in sub-Saharan Africa. We test the association of community collective efficacy and alcohol outlet density with young men's drinking in a cross-sectional, locally representative survey conducted in rural northeast South Africa. Informal social control and cohesion show protective associations with men's heavy drinking, while alcohol outlet density is associated with more potential problem drinking. These findings provide initial support for intervening at the community level to promote alcohol reduction. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Health & Place 07/2015; 34:190-198. DOI:10.1016/j.healthplace.2015.05.014 · 2.81 Impact Factor
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    • "A substantial body of research indicates that characteristics of the physical and social environment play a role in patterns of alcohol use (Becares et al., 2012; Campbell et al., 2009; Karriker-Jaffe, 2011; Lindstrom, 2008; Murayama et al., 2012; Popova et al., 2009; Renalds et al., 2010). Interventions informed by this work that target physical and social aspects of environments have been developed and shown to be efficacious (Campbell et al., 2009; Moreira et al., 2009). Alcohol outlet density and group norms around alcohol consumption are two of the features of the alcohol environment for which the best evidence exists. "
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    ABSTRACT: Alcohol outlet density and norms shape alcohol consumption. However, due to analytic challenges we do not know: (a) if alcohol outlet density and norms also shape alcohol use disorder, and (b) whether they act in combination to shape disorder. We applied a new targeted minimum loss-based estimator for rare outcomes (rTMLE) to a general population sample from New York City (N=4000) to examine the separate and combined relations of neighborhood alcohol outlet density and norms around drunkenness with alcohol use disorder. Alcohol use disorder was assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) alcohol module. Confounders included demographic and socioeconomic characteristics, as well as history of drinking prior to residence in the current neighborhood. Alcohol use disorder prevalence was 1.78%. We found a marginal risk difference for alcohol outlet density of 0.88% (95% CI 0.00-1.77%), and for norms of 2.05% (95% CI 0.89-3.21%), adjusted for confounders. While each exposure had a substantial relation with alcohol use disorder, there was no evidence of additive interaction between the exposures. Results indicate that the neighborhood environment shapes alcohol use disorder. Despite the lack of additive interaction, each exposure had a substantial relation with alcohol use disorder and our findings suggest that alteration of outlet density and norms together would likely be more effective than either one alone. Important next steps include development and testing of multi-component intervention approaches aiming to modify alcohol outlet density and norms toward reducing alcohol use disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 03/2015; 151. DOI:10.1016/j.drugalcdep.2015.03.014 · 3.42 Impact Factor
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