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Risk for Exposure to Alcohol, Tobacco, and Other Drugs on the Route to and from School: The Role of Alcohol Outlets
Abstract
Despite the national push encouraging children to walk to school, little work has been done to examine what hazards children encounter on the route to school. This study examined the association between the presence of alcohol outlets on children's route to school and perceived safety on the route to school as well as exposure to alcohol, tobacco, and other drugs (ATOD). Data come from a community-based epidemiological study of 394 urban elementary school students. Participants' residential address, school location, and alcohol outlet data were geocoded and the route to school was mapped. The route to school layer and the geocoded alcohol outlet data were joined to determine the number of alcohol outlets children pass on the route to school. Logistic regression models estimated the association between the presence of alcohol outlets on the route to school, alcohol and drug exposure, and self-reported safety. Children with an alcohol outlet on the route to school were more likely to be offered ATOD (OR = 2.20, p = 0.02) as well as be exposed to drug selling (OR = 1.72, p = 0.02) and seeing people using drugs (OR = 1.93, p = 0.02). After adjusting for individual-level variables, the relationship between presence of alcohol outlets and being offered ATOD and seeing people using drugs remained significant. However, after adjusting for individual-level control variables and a proxy for the larger neighborhood context, the association between the presence of alcohol outlets and exposure to ATOD was no longer significant. As national campaigns are encouraging children to walk to school, it is essential to consider what children are exposed to on the route to school.
... Alcohol outlet oversaturation can have disastrous public health consequences (Campbell et al. 2009). Density and proximity of alcohol outlets are associated with excessive drinking (Ahern et al. 2013;Kypri et al. 2008;Schonlau et al. 2008), drug markets , violent crime (Campbell et al. 2009, Franklin et al. 2010Furr-Holden et al. 2016;Jennings et al. 2013), and fear among children (Milam et al. 2014). Even though communities with higher levels of education and income (Kanny et al. 2013) and higher white populations are more strongly associated with alcohol consumption (Chartier and Caetano 2010), alcohol outlet oversaturation is more common in poor, minoritymajority communities (LaVeist and Wallace 2000; Pollack et al. 2005;Truong & Sturm 2009). ...
... Second, violent crime was higher around alcohol outlets and decreased by 5.6% for every 100-ft increase in distance from the alcohol outlet (Furr-Holden et al. 2016). Relatedly, marijuana use decreased as distance to off-premise outlets increased (Milam et al. 2014). Lastly, children who passed alcohol outlets on their way to school were more likely to be offered alcohol, tobacco, or other drugs (Milam et al. 2014). ...
... Relatedly, marijuana use decreased as distance to off-premise outlets increased (Milam et al. 2014). Lastly, children who passed alcohol outlets on their way to school were more likely to be offered alcohol, tobacco, or other drugs (Milam et al. 2014). To mitigate the public health consequences of alcohol outlet oversaturation, the Baltimore City Council passed the first major zoning rewrite in more than 40 years, TransForm Baltimore (hereafter referred to as TransForm). ...
The oversaturation of alcohol outlets can have disastrous public health consequences. The goal of this study was to evaluate the potential impact of new zoning legislation, TransForm Baltimore on locations of alcohol outlets. More specifically, the study sought to determine the effect of the new zoning code on the potential redistribution of alcohol outlets and also provide empirical support for the need to actively monitor redistribution of outlets to avoid further inequitable oversaturation in disadvantaged neighborhoods. Data on off-premise alcohol outlets (e.g., packaged goods stores) were obtained from the Board of Liquor License Commissioners for Baltimore City. The alcohol outlets were geocoded and assigned to zoning parcels. Churches and schools were also geocoded. The alcohol outlets were also assigned to census tracts to calculate socioeconomic statuses. One hundred seventy-two of the 263 off-premise packaged goods stores (PGS) were in violation of the new zoning law. TransForm will reduce the land parcels available to alcohol outlets by 27.2%. Areas containing non-conforming PGS were more likely to have a higher percentage of Black residents, single parent-families, unemployment, household poverty, and vacancy compared to Baltimore City averages and areas without non-conforming PGS. Planning enforcement efforts need to accompany related laws to prevent/reduce overconcentration of PGS in disadvantaged neighborhoods.
... The NIfETy is a valid and reliable, standardized inventory (Milam, Furr-Holden, Cooley-Strickland, et al. 2014). It has been widely used in previous studies to examine the impact of neighborhood characteristics on a variety of topics, including drug use risk factors (Furr-Holden, Lee, et al. 2011;Milam, Furr-Holden, Harrell, et al. 2014), exposure to community violence (Furr-Holden, Rossen et al. 2011), and other injury outcomes (Nesoff, Milam, Pollack, Curriero, Bowie, Knowlton, et al. 2018). ...
... These 7 items have been shown in the literature to have an important impact on neighborhood disorder and have been used in previous studies of neighborhood disorder using the NIfETy (e.g. count of liquor stores, count of bars, presence of memorials) (Milam, Furr-Holden, Cooley-Strickland, et al. 2014;Rossen et al. 2011). Due to the low prevalence of many items, all the items were dichotomized (presence versus absence of item) for the analyses. ...
A growing body of evidence suggests that characteristics of the neighborhood environment in urban areas significantly impact risk for drug use behavior and exposure to violent crime. Identifying areas of community need, prioritizing planning projects, and developing strategies for community improvement require inexpensive, easy to use, evidence-based tools to assess neighborhood disorder that can be used for a variety of research, urban planning, and community needs with an environmental justice frame. This study describes validation of the Neighborhood Inventory for Environmental Typology (NIfETy), a neighborhood environmental observational assessment tool designed to assess characteristics of the neighborhood environment related to violence, alcohol, and other drugs, for use with Google Street View (GSV). GSV data collection took place on a random sample of 350 blocks located throughout Baltimore City, Maryland, which had previously been assessed through in-person data collection. Inter-rater reliability metrics were strong for the majority of items (ICC ≥ 0.7), and items were highly correlated with in-person observations (r ≥ 0.6). Exploratory factor analysis and constrained factor analysis resulted in one, 14-item disorder scale with high internal consistency (alpha = 0.825) and acceptable fit indices (CFI = 0.982; RMSEA = 0.051). We further validated this disorder scale against locations of violent crimes, and we found that disorder score was significantly and positively associated with neighborhood crime (IRR = 1.221, 95% CI = (1.157, 1.288), p < 0.001). The NIfETy provides a valid, economical, and efficient tool for assessing modifiable neighborhood risk factors for drug use and violence prevention that can be employed for a variety of research, urban planning, and community needs.
... [32][33][34][35][36] Alcohol outlets are a prevalent and salient retail space for the purchase and consumption of not only alcohol products, but also processed foods, lottery tickets, and tobacco products such as cigarettes and cigarillos in Baltimore, Maryland. 37,38 The abundance of alcohol outlets in Baltimore and the consequential widespread availability of alcohol and other products provide a practical analog for the availability of e-cigarettes in the city. 39,40 Therefore, this study investigates the presence of e-cigarettes within licensed alcohol outlets in Baltimore. ...
... Oversaturation of alcohol outlets has long been a public health challenge in Baltimore, and recent research has shown positive associations between outlet density and proximity to detrimental behavioral outcomes such as violent crime and substance use. [37][38][39][40] This has catalyzed zoning reform initiatives and policy recommendations to reduce alcohol outlets and further prevent alcohol sales to youth, a highly vulnerable population. 41 The larger study aimed to provide substantial evidence of pervasive fraudulent license use as well as failure to take established measures to prevent youth from obtaining alcohol and other prohibited products. ...
There is limited research on e-cigarette availability despite increased use. E-cigarette availability within Baltimore alcohol outlets was analyzed for disparities among residential neighborhoods. Data were obtained via field surveys of alcohol outlets, and then spatially merged with sociodemographic data; 18.8% of alcohol outlets had any e-cigarette availability. Regression models showed greater odds ratios for e-cigarette availability when cigarettes, cigars, or hookah paraphernalia were sold, and lower odds ratios when alcohol outlets had an on-site consumption license. Outlets with e-cigarette availability were in predominantly lower-income, nonwhite neighborhoods. It is important to assess exposure of another potentially damaging substance among perpetually disadvantaged populations.
... This discrepancy has been attributed to the distribution of social (Cornwell & Cornwell, 2008) and health resources (Cooper, Bossak, Tempalski, Friedman, & Des Jarlais, 2009;Sarrazin, Campbell, Richardson, & Rosenthal, 2009) across communities. Alcohol outlets, along with check cashing establishments (Matheson et al., 2014), drug treatment centers, corner stores (Furr-Holden et al., 2014), and a host of other potentially predatory businesses have been identified as locations that disrupt and damage the social infrastructure of a community (Laviest & Wallace, 2000). Further, not only are alcohol outlets, specifically, forms of physical disorder (Bennet et al., 1996) in and of themselves, but they also shape the ecology of the neighborhoods and communities and may disrupt the distribution of these resources. ...
... Alcohol outlets can be either on-premise, where alcohol is purchased and consumed at the same location (such as bars, taverns, and restaurants), or off-premise, where alcohol is purchased in one location but consumed in another (such as grocery stores or liquor stores; Campbell et al., 2009;Milam, Furr-Holden, Cooley-Strickland, Bradshaw, & Leaf, 2014). Research has found that both on-premise and off-premise outlets have different effects on their communities. ...
This research investigated the relationship between alcohol outlet density (AOD) and life expectancy, as mediated by community violence and community disadvantage. We used linear regression models to assess bivariate and multivariate relationships. There was a negative bivariate association between liquor store density and average life expectancy (β = −7.3370, p < 0.001). This relationship was partially attenuated when controlling for community disadvantage and fully attenuated when controlling for community violence. Bars/taverns (i.e., on‐premise) were not associated with average life expectancy (β = −0.589, p = 0.220). Liquor store density is associated with higher levels of community disadvantage and higher rates of violence, both of which are associated with lower life expectancies. Future research, potential intervention, and current related policies are discussed.
... Moreover, the existing results emphasize the significance of safety-related elements of the school neighborhood. These results are in accordance with prior studies indicating that industrial land use, abandoned structures, and bars reduce the likelihood of youngsters walking or riding their bikes to school [87][88][89][90]. More importantly, the study discovered that not only safety-related built environment characteristics, but also children's perception of safety had a substantial impact on their proclivity to walking. ...
While car-centric culture and children’s mobility have been studied in industrialized countries, there are limited data on developing countries in Latin America and the Caribbean. This study analyzes children’s active transportation to school in the Dominican Republic using audit observations of the built environment and surveys. The study assesses how parents’ and children’s environmental perceptions vary and how children’s mode choice is influenced by physical features and perceived safety levels. Land use and built environment attributes were evaluated for each street segment within a 400-m radius of 20 schools using the audit method. The findings indicate that safety problems are the main obstacle preventing children from bicycling or walking to school. Particularly, industrial land use, abandoned buildings, and bars hampered children’s active travels to school. Interestingly, public school students are nearly four times more likely to walk or bike to school than private school students. Furthermore, children who live in an area with fast-moving cars were more inclined to walk to school as captive walkers. The study’s conclusions have implications for urban environments where children’s independent mobility is constrained by car-oriented policies.
... The physical environment in this case includes watching people smoke marijuana and sell drugs, as well as being children of low socioeconomic level. For instance, with a 2.6-time greater probability of seeing someone smoke marijuana, there is a three-time greater probability of selling drugs (Milam et al., 2014). In our results, the areas with higher risk point density coincided with the more marginalised and violent areas of the city. ...
This study examined the relationship between community risk factors (drug outlets density and crime hot spots) and family factors on the risk behaviours (drugs consumption and delinquent behaviour) of male adolescent Mexican students. Results were obtained based on data bank analysis and direct collection of information regarding family factors and risk behaviours of adolescents attending school. Spatial and statistical analysis was performed. The final sample was composed of 1450 male adolescents, from 11 secondary and high schools located in marginal and violent areas of Mexico. Spatial analysis revealed that when considering only the prevalence of the risk behaviours of the adolescents, the area of highest risk was the northwestern area of the city. However, after performing conjunct analysis of all evaluated variables using density point risk (aside from confirming that the northwestern area is still the one with the greatest risk), results indicated that the southern area has a high-density point risk. All densities of the variables showed a statistically significant positive association (p<0.05). However, the results of the structural equation model indicated than only the family factors influenced the risk behaviours of adolescents (p<0.05). The spatial distribution of the risk behaviours in male adolescent students and community risk variables surrounding the area where schools are located allows for the description of patterns and hotspot detection that facilitate the prioritization of where interventions must be directed. Besides, the interventions should target family factors.
... The findings permit supporting said hypothesis; according to the neighborhood characteristics, in this study a negative effect was shown, that is, a better perception of the quality in the neighborhood environment indicates lower probability of consumption. These data agree with the literature, (21,22) which indicate that unfavorable neighborhood conditions are a risk factor for the onset of drug use. ...
Objectives:
This research sought to analyze the predictive effect of personal (personality traits), social (social support and social stigma) and community factors (characteristic of the neighborhood and exposure to consumption) on the transition of drug use in young adults.
Methods:
Case and control study. The cases were 70 individuals from 18 to 34 years of age who had already transitioned into illicit drug use and the controls were 210 legal drug usuers (tobacco or alcohol) in the same age range who had not had the transition. A data file was applied along with seven instruments that measured the transition and consumption variables.
Results:
Marihuana was the illicit drug of highest transition. It was shown that greater personality traits of neuroticism, extraversion, and openness to the experience meant higher probability of drug use transition; while greater personality traits of agreeableness and conscience meant lower probability for the transition. The characteristics of the neighborhood environment and exposure to the opportunity of consumption increase the probability of the drug use transition. Social support and social stigma influenced negatively upon the drug use transition.
Conclusions:
Personality traits, neighborhood characteristics, exposure to drug use, social support, and the social stigma of drug use are factors that intervene in the transition from legal to illicit drug use.
... Alcohol outlets licensed to sell alcohol for off-premise consumption are more strongly associated with drinking problems, crime, and violence compared to outlets licensed for on-premise consumption only (Branas et al., 2011;Furr-Holden et al., 2016;Han et al., 2016;Schonlau et al., 2008). Off-premise settings include grocery and convenience stores, as well as liquor and package stores and taverns that sell liquor, beer, and wine; on-premise settings include restaurants, bars, hotels, and ballparks (Campbell et al., 2009;Milam et al., 2014). Unlike on-premise outlets, off-premise alcohol outlets can sell alcoholic beverages in large quantities that are distributed to patrons who are unmonitored by servers and often left to drink in nearby, uncontrolled environments such as motor vehicles, liquor store parking lots, or street corners (Branas et al., 2009;LaVeist and Wallace, 2000). ...
... 19 NIfETy is a standardised inventory designed to assess characteristics of the neighbourhood environment related to violence, alcohol and other drug exposures. 20 For this analysis, we used data collected from July to November 2012, the last year city-wide data collection took place; data collection took place on a random sample of 802 blocks located throughout the city. Full details of the data collection methodology and block selection can be found in Furr-Holden et al. 19 Vacant lots: addresses for all vacant lots in 2015 were compiled by the Baltimore City Housing Authority (BCHA); BCHA updates its list of vacant lots twice a month for the purposes of monitoring code violations and streamlining remediation projects. ...
Objectives
The purpose of this study was to investigate the contribution of neighbourhood disorder around alcohol outlets to pedestrian injury risk.
Methods
A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury EMS records from 1 January 2014 to 15 April 2015 (n=858), off-premise alcohol outlet locations for 2014 (n=693) and neighbourhood disorder indicators and demographics. Negative binomial regression models were used to determine the relationship between alcohol outlet count and pedestrian injuries at the block group level, controlling for other neighbourhood factors. Attributable risk was calculated by comparing the total population count per census block group to the injured pedestrian count.
Results
Each one-unit increase in the number of alcohol outlets was associated with a 14.2% (95% CI 1.099 to 1.192, P<0.001) increase in the RR of neighbourhood pedestrian injury, adjusting for traffic volume, pedestrian volume, population density, per cent of vacant lots and median household income. The attributable risk was 10.4% (95% CI 7.7 to 12.7) or 88 extra injuries. Vacant lots was the only significant neighbourhood disorder indicator in the final adjusted model (RR=1.016, 95% CI 1.007 to 1.026, P=0.003). Vacant lots have not been previously investigated as possible risk factors for pedestrian injury.
Conclusions
This study identifies modifiable risk factors for pedestrian injury previously unexplored in the literature and may provide evidence for alcohol control strategies (eg, liquor store licencing, zoning and enforcement).
... These findings also have potential policy significance regarding alcohol outlets, which are a salient environmental feature that can be regulated by zoning and land use regulations (Ashe et al., 2003). These regulations are permissible as a public health intervention strategy given that alcohol outlets are associated with public health problems such as crime, problematic alcohol use, and adolescent behavioral health (Ashe et al., 2003;Wittman 1997;Milam et al., 2014). For example, in Maryland there is a law that prohibits alcohol outlets to be within 300 feet of a school. ...
Few studies have considered the potential role of the built environment in increasing adolescent substance use. The current study explored the relationship between alcohol outlets, a potential malleable component of the neighborhood environment, and adolescent behavioral outcomes. Specifically, we investigated the relationship between alcohol outlet density, perceived alcohol, tobacco, and marijuana availability (ATOD), perception of substance use as a problem at the school, and self-reported ATOD use. Data come from Maryland Safe and Supportive Schools (MDS(3)) Initiative, a statewide project focused on measuring and improving school climate. The sample includes 25,308 adolescents from 58 high schools (9(th)-12(th) grade) across 12 counties. Multi-level path models indicated a positive relationship between the count of alcohol outlets and perceived availability of ATOD among girls but not boys. Perceived availability was associated with increased ATOD use at both the individual- and school-level, as well as other students' ATOD use. Findings provide support for the potential role of the built environment in adolescent risk for substance use, particularly among girls.
... All of these substance use behaviors were aggregated into one substance variable for analysis and converted to a single binary variable (1 = any substance use in the past month; 0 = no substance use in the past month). Previous research shows that aggregated these substances into a single variable is appropriate given that all of the substances are illegal for this age group (Li, Pentz, & Chou, 2002;Milam, Furr-Holden, Cooley-Strickland, Bradshaw, & Leaf, 2014) and problem substance use behaviors tend to cluster into a syndrome (Donovan & Jessor, 1985). ...
Background:
Substance use can occur as a result of coping with stress. Within the school context, youth are exposed to stressors related to school achievement and peer-relationships. Protective factors, such as spirituality, may moderate adolescents' engagement in substance use.
Objective:
The current study investigated the role of spirituality in the association between stress and substance use, in an effort to test the hypothesis that spirituality moderates the association between stress and substance use.
Methods:
This study used data from youth in grades 6-8 attending 40 parochial private schools. A total of 5,217 students participated in the web-based survey administered in Spring 2013. Multilevel structural equation models were used to examine the association between stress, spirituality, and substance use, while accounting for the nested nature of the data (i.e., students within schools).
Results:
Higher stress was significantly associated with increased alcohol, tobacco, and other drug use among youth (b =.306, p <.001). In addition, lower spiritual beliefs were associated with greater substance use (b =.349, p <.001). Spiritual beliefs did not moderate the relationship between stress and substance use. Conclusions/Importance: Implications for increasing students' adaptive coping when confronted with school-related stressors and the role of school climate are discussed.
... Alcohol, tobacco, and drug-use behaviors have also been linked with environmental factors, with work emphasizing environmental exposure to opportunities (alcohol outlets, tobacco sales) as well as perceptions of neighborhood environments (Brown et al., 2013b;Datta et al., 2006;Furr-Holden et al., 2010;Milam et al., 2012;Oman et al., 2013;Reitzel et al., 2012;Tanjasiri et al., 2013). Substance-use behaviors (initiating substance use and/or failing to cease substance use) are known to be used as coping mechanisms to deal with stressors (Lopez et al., 2011;Siahpush et al., 2009)dincluding those generated by environmental conditions. ...
Chronic diseases have been defined as diseases of long duration and slow progression, including well-known conditions such as heart disease, cancer, and diabetes. Environmental causes of chronic disease are increasingly implicated, as elements of the built and social environments are generally recognized, along with environmental contaminants in air, soil, and water, as important influences on chronic disease development. In this chapter, we consider the burdens, causes, and responses to major chronic environmental diseases. We begin with a review of recent epidemiological evidence for several categories of disease that place a heavy burden on the global population and are known to be influenced by environmental causes. We consider briefly the important ideas of inequality and disparity, which affect populations and diseases at a variety of spatial scales. We then turn to consider the mechanisms linking environments to chronic diseases, including exposure to contaminants, health behaviors, health care access issues, and stress. We conclude by discussing intervention and preparedness strategies that have been, or could be, employed to reduce burdens of chronic environmental diseases worldwide. Throughout the chapter, we present brief sidebars that highlight case studies or important processes complementary to the main text.
... In low-income African American communities, illegal drug activity (e.g., selling drugs) often occurs around tobacco and alcohol outlets, especially corner stores. Greater density of these outlets may increase exposure to drug activity (Milam et al. 2013). Exposure to drug activity could be a potential form of stress for this population, which mediates the relationship between tobacco outlet density and tobacco use. ...
Tobacco outlet exposure is a correlate of tobacco use with potential differences by gender that warrant attention. The aim of this study is to explore the moderating role of gender in the relationship between tobacco outlet exposure and past month tobacco use among African American young adults 21 to 24 years old. This cross-sectional study (n = 283) used geospatial methods to determine the number of tobacco outlets within walking distance (i.e., a quarter mile) of participants' homes and distance to the nearest outlet. Logistic regression models were used to test interactions between gender and tobacco outlet exposure (i.e., density and proximity). Tobacco outlets were classified based on whether or not they were licensed to sell tobacco only (TO outlets) or tobacco and alcohol (TA outlets). Neither density nor proximity was associated with past month tobacco use in the pooled models. However, gender modified the relationship between TO outlet density and tobacco use, and this relationship was significant only among women (OR = 1.02; p < 0.01; adjusted OR = 1.01; p < 0.05). This study underscores the importance of reducing tobacco outlet density in residential neighborhoods, especially TO outlets, as well as highlights potential gender differences in the relationship between tobacco outlet density and tobacco use.
... For example, research on effective methods of violence prevention in neighbourhoods with high levels of violence in the US cities may inform design of interventions to prevent renewed violence in post-conflict settings. Similarly, lessons learned from studies that identified effective ways of building a more positive school climate (Bradshaw et al. 2009) or the effectiveness of policies to reduce alcohol use are likely relevant to MHPSS interventions (Furr-Holden et al. 2004;Milam et al. 2014). ...
Aims:
To discuss the potential usefulness of a public health approach for 'mental health and psychosocial support' (MHPSS) interventions in humanitarian settings.
Methods:
Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries.
Results:
A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between 'mental health' and 'psychosocial' practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology.
Conclusions:
The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.
... Stress theories emphasize that living in low-income and poor neighborhoods contribute to feelings of powerlessness, helplessness, fear of violence, and depression, all of which increase the risk for tobacco use as a strategy to manage a stress response (Datta et al., 2006;Kendzor et al., 2012;Lambert et al., 2004). Objective neighborhood disorder (i.e., abandoned buildings, graffiti, drug paraphernalia) is prevalent in low income, African American neighborhoods (Furr-Holden et al, 2011a;Kelly et al., 2007), and was found to be associated with a higher odds of seeing people using or selling drugs among a cohort of Baltimore City youth (Milam et al., 2013). Seeing people using or selling drugs and being exposed to other facets of neighborhood drug involvement are potential sources of stress for low-income, inner-city youth. ...
The spatial analysis of primary schools is needed to ensure that they meet standards set by the Government of India. Therefore, mapping of Prayagraj district primary schools is carried out in this research work. The spatial analysis of schools is performed using various parameters that include: literacy rate, student gender ratio, teacher taught ratio, and students’ toilets ratio. Several problems were revealed in the GIS based analysis of schools by highlighting their locations on the map. The results identify the location of all those schools where there is a need to take corrective measures. Further, the route analysis between home and school is handled in this research work. Sometimes, commutation is the sole criteria in the selection of a school. Therefore, optimal path analysis has been performed based on three parameters, i.e. population density, traveling distance and traveling time. A combined weight function is also given to find the optimal path. This work will help people to select the best possible path based upon their requirements. There is often a requirement to reach all the schools to distribute the goods or other physical monitoring activities. This work gave the optimal route to visit all the schools by using the Travelling Salesman Problem (TSP). School accessibility results obtained in this research through TSP will assist in choosing the best possible route. This will help the government identify locations where new roads need to be constructed to have road connectivity.
Secondhand smoking has a serious negative impact on human health, but this can be mitigated by anti-smoking policies. The enforcement of these policies is always accompanied by the voices of the hospitality venues representatives, concerned about the economic decline and the loss of customers. The aim of our research was to analyse the impact of the anti-smoking act on the operation of individual hospitality venues and to uncover the role of spatial relations and the extent of their impact. Correlation and regression, along with spatial analysis, were used to model the impact of the ban. The businesses felt the impact of the changes in visitor rates immediately after the introduction of the act, yet within two years there were no differences in visitor rates or revenues. One of the strongest correlations was in the spatial clusters where businesses of the same type (smoking/non-smoking) had been concentrated before the ban came into force. Our findings proved that, regarding visitor rates and revenues, from the spatial perspective there was no statistically significant connection with the more tourist-oriented centre, or with the distance of businesses from their nearest competitor. Conversely, the presence of hospitality venues in a cluster did prove statistically significant.
Resumo O objetivo foi caracterizar o entorno das escolas estaduais de Curitiba em relação à comercialização de bebidas alcoólicas e investigar a associação com indicadores socioeconômicos dos locais. Trata-se de um estudo transversal em estabelecimentos comerciais do entorno de 30 escolas estaduais do município. Aplicou-se questionário para descrever as características dos locais em relação à disponibilidade de bebidas alcóolicas. Diferenças nos entornos das escolas de acordo com a renda foram estimadas por modelo de regressão multinível misto. Foram avaliados 200 estabelecimentos, 66,0% comercializavam bebidas alcoólicas. Dos locais avaliados, 52 (39,4%) foram pontos de venda para consumo de álcool no local, e 80 (60,6%) para consumo fora do local. Nesta categoria, os mercados de bairro (16,5%) e os postos de gasolina (10,1%) tiveram maior presença e metade das escolas tinham esse tipo de estabelecimento em sua vizinhança. Esses locais apresentaram maior variedade de bebidas alcoólicas e menores preços. Nos entornos das escolas localizadas em bairros de menor renda, o número de mercados de bairro e bares foi maior. Observou-se presença de estabelecimentos que comercializavam bebidas alcoólicas e com atendimento ao público durante o período de aulas nas proximidades das escolas avaliadas.
Background
Alcohol 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.
Methods
A 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.
Results
Each 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.
Conclusion
This 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.
Objective:
In June 2012, Baltimore City, MD, enacted legislation (commonly referred to as the Mosby Bill) prohibiting all liquor stores (outlets that primarily sell alcoholic beverages) from selling "any food, goods, wares, supplies, or other merchandise to any person under the age of 18." Three years after enactment, we evaluated the impact of this legislation on non-alcohol product sales among youth.
Method:
Research assistants (RAs) ages 16-20 were trained in using a standardized observational tool to quantify and record characteristics of the outlets, including products sold. A trained pair comprising one RA age 16 to 20 and one RA exactly age 18 were sent into every liquor store (i.e., packaged goods stores and bar/taverns with packaged goods sales) in Baltimore to conduct the assessment and make a non-alcohol purchase. Since the research was not conducted in concert with the police, the 18-year-old RA made the purchase attempt while the other (age 16 to 20) RA completed the assessment.
Results:
Purchase attempts were made at 502 liquor stores, and 352 of those attempts were successful (able to make purchase without being asked for identification or age; noncompliance rate = 68.1%). Noncompliance was highest among packaged goods stores compared with bar/taverns, and in neighborhoods with a lower median household income and a higher proportion of African American residents (p < .050). Noncompliant outlets were also located closer to public schools (p < .050).
Conclusions:
This evaluation demonstrates that, in the absence of enforcement, ordinances are neither likely to be honored nor to achieve the intended public health benefits.
Background:
The availability of local, state, and national data on alcohol outlet density have important implications for policies and interventions aiming to reduce alcohol-related problems. High-quality data on locations of alcohol outlets is important to accurately inform community interventions and public health initiatives, but such data is often not maintained, readily available, or of sufficient quality. Objectives: This study aims to examine the discrepancies between alcohol outlet databases and how neighborhood characteristics (i.e. income, majority racial population, urbanicity) are associated with the discrepancies between databases. Methods: Data was collected from national (n = 1), local (n = 2), and state databases (n = 3). Negative binomial regression models were used to assess discrepancies in alcohol outlet count at the ZIP code level based on the data source. Results: The average density of alcohol outlets (per 1000 residents) ranged from 0.71 to 2.17 in Maryland, 1.65 to 5.17 in Wisconsin, and 1.09 to 1.22 in Oregon based on different sources of data. Findings suggest high income areas (>200% poverty level) have fewer discrepancies (IR = 0.775, p < 0.01), low income areas (below poverty level) have greater discrepancies (IR = 4.990, p < 0.01), and urban areas tend to have fewer discrepancies (IR = 0.378, p < 0.01) between datasets. Conclusion: Interventions and policies depend on valid and reliable data; researchers, policymakers, and local agencies need to collaborate to develop methods to maintain accurate and accessible data.
Alcohol outlet oversaturation often exacerbates negative public health outcomes. Recently, Baltimore City passed an extensive zoning rewrite (“TransForm Baltimore”) that sought to give local government and residents a tool to reduce alcohol outlet oversaturation through land use regulation. The present investigation evaluated the outlet and neighborhood characteristics of stores impacted by two components of TransForm Baltimore: (1) a requirement that taverns licensed for on-premise consumption in addition to off-premise, carryout sales generate at least 50% of their business from on-premise sales, and (2) a requirement to close, repurpose, or relocate all package stores (i.e., off-premise alcohol outlets) that have been operating as “non-conforming” in residential zones since 1971. Research assistants visited every off-premise alcohol outlet in the city (n = 685) to complete an observational assessment. Approximately 77% (n = 530) of these off-premise alcohol outlets were open, including 292 taverns and 238 package stores. t tests and chi-square tests were used to compare neighborhood characteristics (neighborhood disadvantage, median household income, and racial segregation) of sham taverns (i.e., taverns with less than 50% space dedicated for on-premise sales that were primarily operating as a package store) and non-conforming package stores. Of the 292 taverns accessible during the study, the remainder were chronically closed (n = 130); 24 (8.2%) were deemed sham taverns. Sham taverns were more likely to be located in communities with more economic disadvantage and lower median household income (t test; p < 0.05). Compared to taverns, a lower proportion of sham taverns had visible dance floor space, patrons drinking, and menus available (chi-square test; p < 0.001). There were 80 residentially zoned, non-conforming alcohol outlets. These non-conforming alcohol outlets were disproportionately distributed in predominately poor and African American communities (t test; p < 0.05). As compared to conforming alcohol outlets, more non-conforming alcohol outlets sold sex paraphernalia and healthy foods (chi-square test; p < 0.05). With active enforcement, TransForm Baltimore offers the opportunity for local government and residents to improve public health and increase health equity in vulnerable and marginalized neighborhoods.
There is increasing evidence that place-based interventions reduce crime and interpersonal violence in urban settings. However, evidence concerning the impacts of these neighborhood interventions on domestic crime (crime between intimate partners, family, or household members) is inconclusive. We used data from a New Orleans, Louisiana, place-based blighted property remediation intervention to test the hypothesis that the intervention was associated with changes in domestic crime. Because there is evidence that alcohol availability is related to domestic crime, we also assessed whether this association was moderated by alcohol outlet density. We assessed overall associations using a difference-in-difference approach and assessed moderation using a triple-difference approach. The analytic sample consisted of 204 remediated lots and 612 non-remediated matched control lots over 84 months (2011–2017), for a total of 68,544 lot-months. In difference-in-differences analyses, the place-based intervention was associated with additional domestic crime incidence (β = 0.311, 95% CI: 0.016, 0.605; p = 0.039). In triple-difference analyses, on-premise bar density modified this association (β = −0.119, 95%CI: −0.147, −0.092; p < 0.001): in areas with higher bar density, increases in domestic crime were lower near remediated lots compared with control lots. Place-based interventions to reduce blighted properties may have contributed to fewer domestic crime incidents in areas with more bars.
The Community Readiness Model for Change describes nine stages of incremental changes for community prevention. In this chapter, we utilize this model to describe 8 years of change led by South Tucson Prevention Coalition (STPC) that transformed one community from a level of tolerance of adolescent alcohol use to a level of professionalization of prevention strategies. This model helps to identify the incremental changes over time in community alcohol norms that indicate how ready the community is to receive different prevention strategies. The Community Readiness Model for Change requires community involvement to develop prevention strategies that are rooted in community strengths. This model also requires that the community assesses their own level of readiness for change in order to develop their capacity to determine the type and level of intervention that would be most appropriate. In this chapter, we describe the model and then apply it to 8 years of work by STPC to highlight changes in community alcohol norms, changes in prevention strategies, and integration of research techniques. Utilizing community readiness interviews and retrospective interviews with coalition members, we describe the community transformations that occurred.
This study draws on cultivation analysis (Gerbner, 1969) to explore the interrelating factors concerning the role of media in young people’s consumption of alcohol at a south-eastern Nigerian university. Nigeria has the second highest alcohol consumption in Africa. Traditionally, drinking spaces were dominated by adult males for socio-cultural reasons but in contemporary Nigeria there is increasing concern that younger men and women are now also drinking harmfully.
Qualitative interviews were conducted with 22 male and 9 female undergraduate students (aged 19-23 years) to explore the ways in which media consumption shapes their drinking behaviour. Whilst young people’s consumption of both local and foreign media was high and gendered, one key motivation for using alcohol was aspirational, particularly among those who consumed Hollywood films. Many of the participants who consumed Hollywood films may have learned to associate heavy consumption with high social status. Importantly, this thesis demonstrates that although local films portray alcohol in a mainly negative light, this also motivates young people to drink as they learn how to use alcohol to ameliorate anxiety or depression.
Young people’s drinking patterns were found to be gendered, underscoring a resilient socio-cultural belief in which men see alcohol as good for males while women believe that it should not be confined to men. Consequently, the women employed male-gendered drinking behaviours such as heavy drinking to develop social capital. At the same time, both male and female participants discussed taking part in risky sexual behaviour but the outcomes differed for males and females, with this behaviour being more stigmatised in women. Alcohol advertising and promotion were found to be highly influential because they encourage brand preference and brand allegiance, actively facilitate change of brand, and lead to excessive consumption amongst male and female participants. Although the participants confirmed that promotional activities facilitate alcohol misuse, they argued that promotions should not be regulated because promotional prizes alleviate poverty.
This study furthers the discussion on cultivation theory by demonstrating that heavy television viewing cultivates alcohol consumption among this population and it contributes to cultivation and audience research by revealing that negative portrayals can also influence young people. This study’s findings can inform educational campaigns and policy formulation in Nigeria, particularly those that tackle alcohol availability, heavy episodic drinking and risky sexual behaviour; and those that encourage media literacy and more positive and equal relationships between women and men.
School safety is of great concern for prevention researchers, school officials, parents, and students, yet there are a dearth of assessments that have operationalized school safety from an organizational framework using objective tools and measures. Such a tool would be important for deriving unbiased assessments of the school environment, which in turn could be used as an evaluative tool for school violence prevention efforts. The current paper presents a framework for conceptualizing school safety consistent with Crime Prevention through Environmental Design (CPTED) model and social disorganization theory, both of which highlight the importance of context as a driver for adolescents' risk for involvement in substance use and violence. This paper describes the development of a novel observational measure, called the School Assessment for Environmental Typology (SAfETy), which applies CPTED and social disorganizational frameworks to schools to measure eight indicators of school physical and social environment (i.e., disorder, trash, graffiti/vandalism, appearance, illumination, surveillance, ownership, and positive behavioral expectations). Drawing upon data from 58 high schools, we provide preliminary data regarding the validity and reliability of the SAfETy and describe patterns of the school safety indicators. Findings demonstrate the reliability and validity of the SAfETy and are discussed with regard to the prevention of violence in schools.
The assessment and promotion of childrens’ healthful physical activity is important: (i) to combat the international obesity epidemic that extends to childhood; and (ii) to establish an early habit of lifestyle physical activity that can be sustained into adolescence and adulthood. The primary focus of both assessment and promotion efforts has been on in-school physical education classes and, to a lesser extent, out-of-school structured exercise, sport and play. A potential source of continuous moderate activity, active commuting to school by means of walking or by bicycle, has been largely ignored in surveys of physical activity. Suggestive evidence of steep declines in the amount of childrens’ destination walking can be gleaned from national transportation surveys. At the same time, there has been a dramatic increase in the reported use of motorised vehicles, including the use for chauffeuring children. There is very little evidence to support or refute active commuting to school as an important source of childrens’ physical activity; however, this is largely because it has been overlooked in the stampede to assess time in more vigorous activities.
The promotion of active commuting to school must be considered in the context of parents’ real and perceived concerns for their children’s personal and pedestrian safety. We certainly do not have a full understanding at this time of all the factors related to decisions about transportation mode, whether by child, parent, community, or school. Such information is necessary if successful and sustainable interventions can be implemented, important transport policy decisions can be made, and community and school designs can be modified. Practice rarely waits for research, however, and there are numerous examples of innovative programming, policies and environmental designs occurring internationally that can serve as natural experiments for enterprising researchers willing to push the envelope of our understanding of active commuting and childrens’ physical activity. Since we know so little, there is much to learn.
Walking or bicycling to school could contribute to children's daily physical activity, but physical environment changes are often needed to improve the safety and convenience of walking and cycling routes. The California Safe Routes to School (SR2S) legislation provided competitive funds for construction projects such as sidewalks, traffic lights, pedestrian crossing improvements, and bicycle paths.
A cross-sectional evaluation examined the relationship between urban form changes and walking and bicycle travel to school. Surveys were distributed to parents of third- through fifth-grade children at ten schools that had a completed SR2S project nearby. Two groups were created based on whether parents stated that their children would pass the SR2S project on the way to school or not.
Children who passed completed SR2S projects were more likely to show increases in walking or bicycle travel than were children who would not pass by projects (15% vs 4%), based on parents' responses.
Results support the effectiveness of SR2S construction projects in increasing walking or bicycling to school for children who would pass these projects on their way to school.
Few studies have combined factors related to social disorganisation and factors related to opportunity theory at the microspatial level, with most studies aggregating to the block group or census tract. This study disaggregates block group census data in and around the vicinity of locations believed to encourage outdoor drug markets in Philadelphia, Pennsylvania, USA. A location quotient analysis finds that drug arrests cluster within a block or two of many suspected crime generators/attractors. Results from a zero-inflated Poisson model suggest some land use variables and factors associated with social disorganisation can help predict the location and size of drug markets; however, at the city level only retail alcohol outlets remained significant when combined with the social disorganisation-related variables, as a predictor of drug markets. The article discusses a number of potential reasons for these findings.
The transition to high school has been identified as a potentially difficult time in adolescents’ lives. Reductions in both
academic and social functioning often accompany this transition. While these effects have been documented in urban youth,
the move to high school has not been extensively studied in rural minority youth. Toward that end, the academic grades and
substance use in ninth grade of 447 (184 male and 263 female) African-American adolescents from two rural counties in a state
in the deep South were examined in relation to configurations of adaptation from sixth through eighth grade. Results indicate
that individual with consistently positive patterns across middle school had higher grades and lower rates of substance use
compared to individuals with persistent difficulties or those that transitioned to problem behavior. Many individuals who
improved in their patterns of adaptation had relatively high grades, but also rather high rates of substance use in the ninth
grade.
The purpose of this study is to examine whether or not alcohol access in neighborhood areas is differentially related to substantiated reports of child physical abuse and neglect.
This cross-sectional ecological study uses spatial regression procedures to examine the relationship between the number of bars, restaurants and off-premise outlets per population and rates of child physical abuse and neglect in 940 census tracts in California, while controlling for levels of social disorganization, population density and county of residence.
The number of off-premise outlets per population was positively associated with rates of child physical abuse (b = 3.34, SE = 1.14), and the number of bars per population was positively related to rates of child neglect (b = 1.89, SE = 0.59).
These results suggest that alcohol access is differentially related to type of child maltreatment, with higher densities of bars being related to higher rates of child neglect, and higher rates of off-premise outlets related to higher rates of child physical abuse. The findings suggest there is a spatial dynamic of neighborhoods that can result in child maltreatment and underscore the importance of examining the alcohol environment when developing programs to prevent child maltreatment.
This study examines the growth of neighborhood disorder and subsequent marijuana use among urban adolescents transitioning into young adulthood.
Data are derived from a longitudinal sample of 434 predominately African American 12th graders followed-up at 2 years after high school. The data are rich in repeated measures documenting substance use and misuse and neighborhood characteristics. Growth mixture modeling was used to examine how neighborhood disorder trajectories, measured through the presence of abandoned buildings on the blocks where participants reside, influence subsequent drug use beginning in late adolescence and into young adulthood.
A four-class solution characterizing neighborhood growth was selected as the final model and included rapidly improving, slightly improving, always-good, and deteriorating neighborhoods. Young adults living in neighborhoods that had been deteriorating over time were 30% more likely to use marijuana 2 years after high school than adolescents living in always-good neighborhoods (odds ratio = 1.30, p = .034). There was no relationship between living in a neighborhood that was improving and marijuana use.
This study identified a salient and malleable neighborhood characteristic, abandoned housing, which predicted elevated risk for young-adult marijuana use. This research supports environmental strategies that target abandoned buildings as a means to improve health and health behaviors for community residents, particularly young-adult substance use.
Walking to school is an important source of physical activity among children. There is a paucity of research exploring environmental determinants of walking to school among children in urban areas.
A cross-sectional secondary analysis of baseline data (2007) from 365 children in the "Multiple Opportunities to Reach Excellence" (MORE) Study (8 to 13 years; Mean 9.60 years, SD 1.04). Children and caregivers were asked about walking to school and perceived safety. Objective measures of the environment were obtained using a validated environmental neighborhood assessment.
Over half (55.83%) of children reported walking to school most of the time. High levels of neighborhood incivilities were associated with lower levels of perceived safety (OR: 0.39, 95% CI: 0.21 to 0.72). Living on a block above the median in incivilities was associated with a 353% increase in odds of walking to school (OR: 3.53; 95% CI: 1.68 to 7.39).
Children residing in neighborhoods high in incivilities are more likely to walk to school, in spite of lower levels of perceived safety. As a high proportion of children residing in disadvantaged neighborhoods walk to school, efforts should be directed at minimizing exposure to neighborhood hazards by ensuring safe routes to and from school.
Alcohol is more likely than any other drug to be involved in substance-related violence. In 2000 violence-related and self-directed injuries accounted for an estimated $37 billion and $33 billion in productivity losses and medical treatment, respectively. A review of emergency department data revealed violence and clinically identified trauma-related injuries have the strongest correlation among alcohol-dependent injuries. At the environmental level there is a relationship between alcohol outlet density and violent crime. A limited number of studies have examined the relationship between alcohol outlet type and the components of violent crime. The aim of this study is to examine the relationship between the aggregate components of violent crime and alcohol outlet density by type of outlet.
For this study we used Washington, D.C. census tract data from the 2000 census to examine neighborhood characteristics. Alcohol outlet, violent crime, and population-level data for Washington, D.C. were drawn from various official yetpublicly available sources. We developed an analytic database to examine the relationship between alcohol outlet category and four types of violent crime. After estimating spatial correlation and determining spatial dependence, we used a negative binomial regression analysis to assess the alcohol availability-violent crime association, while controlling for structural correlates of violence.
Independent of alternative structural correlates of violent crime, including the prevalence of weapons and illicit drugs, community-level alcohol outlet density is significantly associated with assaultive violence. Outlets were significantly related to robbery, assault, and sexual offenses. In addition, the relationship among on-premise and off-premise outlets varied across violent crime categories.
In Washington, D.C., alcohol outlet density is significantly associated with the violent crimes. The science regarding alcohol outlet density and alcohol-related harms has clearly identified the use of limiting outlet density to reduce the associated adverse health consequences. Moreover, the disproportionate burden among poor urban and minority communities underscores the urgency to develop context-appropriate policies to regulate the functioning of current alcohol outlet establishments and to prevent the proliferation of future outlets.
Establish metric properties of the Neighborhood Inventory for Environmental Typology (NIfETy).
A total of 919 residential block faces were assessed by paired raters using the NIfETy. Reliability was evaluated via interrater and internal consistency reliability; validity by comparing NIfETy data with youth self-reported violence, alcohol, and other drug exposure and crime statistics.
Validity and reliability metrics were moderate to exemplary for the total scale and subscales. NIfETy data correlated strongly with crime data and youth self-reported exposure.
The NIfETy is valid and reliable. Future investigations will explore its use in other urban centers and association to other health outcomes.
Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health,
2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.
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.
We investigated sociodemographic disparities in alcohol environments and their relationship with adolescent drinking.
We geocoded and mapped alcohol license data with ArcMap to construct circular buffers centered at 14 595 households with children that participated in the California Health Interview Survey. We calculated commercial sources of alcohol in each buffer. Multivariate logistic regression differentiated the effects of alcohol sales on adolescents' drinking from their individual, family, and neighborhood characteristics.
Alcohol availability, measured by mean and median number of licenses, was significantly higher around residences of minority and lower-income families. Binge drinking and driving after drinking among adolescents aged 12 to 17 years were significantly associated with the presence of alcohol retailers within 0.5 miles of home. Simulation of changes in the alcohol environment showed that if alcohol sales were reduced from the mean number of alcohol outlets around the lowest-income quartile of households to that of the highest quartile, prevalence of binge drinking would fall from 6.4% to 5.6% and driving after drinking from 7.9% to 5.9%.
Alcohol outlets are concentrated in disadvantaged neighborhoods and can contribute to adolescent drinking. To reduce underage drinking, environmental interventions need to curb opportunities for youth to obtain alcohol from commercial sources by tightening licensure, enforcing minimum-age drinking laws, or other measures.
The objective of this study was to assess the relationship between alcohol availability, as measured by the density of off-premise alcohol outlets, and alcohol consumption in Los Angeles county and southern Louisiana, USA. Consumption information was collected through a telephone survey of 2,881 households in Los Angeles county and pre-Katrina southern Louisiana, nested within 220 census tracts. Respondents' addresses were geo-coded and both neighbourhood (census tracts and buffers of varying sizes) and individual (network distance to the closest alcohol outlet) estimates of off-sale alcohol outlet density were computed. Alcohol outlet density was not associated with the percentage of people who were drinkers in either site. Alcohol outlet density was associated with the quantity of consumption among drinkers in Louisiana but not in Los Angeles. Outlet density within a one-mile buffer of the respondent's home was more strongly associated with alcohol consumption than outlet density in the respondent's census tract. The conclusion is that the relationship between neighbourhood alcohol outlet density and alcohol consumption is complex and may vary due to differences in neighbourhood design and travel patterns.
There are limited validated quantitative assessment methods to measure features of the built and social environment that might form the basis for environmental preventive interventions. This study describes a model approach for epidemiologic assessment of suspected environmental determinants of violence, alcohol and other drug (VAOD) exposure and fills this gap in current research. The investigation sought to test the feasibility of a systematic and longitudinal assessment of residential block characteristics related to physical and social disorder and indicators of VAOD exposure. Planometric data were used to establish a stratified random sample of street segments within defined neighborhoods of an urban metropolitan area. Field rater assessments of these neighborhood street segments were conducted using the Neighborhood Inventory for Environmental Typology (NIfETy). This report provides a detailed description of the NIfETy Method, including metric properties of the NIfETy Instrument and outcomes of training procedures and quality control measures. Also presented are block-level characteristics and estimates of observable signs of VAOD activity. This work is a first step toward developing future community-level environmental preventive interventions geared to reduce community VAOD exposure among youthful urban populations and may prove to be useful to other public health research groups as well.
The objectives of this study were to determine: (1) if the number of outdoor alcohol advertisements around schools varied by ethnicity of students in the school; and (2) how the content of alcohol advertising around schools varied by the ethnicity of students in the school.
All outdoor alcohol advertisements within 1500 feet of 63 Chicago schools were documented and coded for content and theme. On average, the ethnic make-up of schools was 54.9% African American, 24.4% Hispanic, and 16.2% White; 79.7% of students were low SES. To compare the mean number and type of ads by ethnicity of the school, schools were coded by ethnicity (i.e., 20% or more Hispanic students compared with less than 20% Hispanic students).
Youth attending schools with 20% or more Hispanic students were exposed to 6.5 times more alcohol advertising than students attending schools with less than 20% Hispanic students. Schools with 20% or more Hispanic students were also surrounded by more beer advertising and alcohol advertisements on bars and liquor stores.
Alcohol advertising is more prevalent around schools with 20% or more Hispanic students. Policies should be considered to reduce the amount of alcohol advertising around schools.
An epidemiologic study of urban-dwelling children aged 8-10 years in Baltimore, Maryland, was undertaken to test the hypothesis that close monitoring and supervision by parents might signal a reduced risk of drug use in the elementary school years. Drug use, monitoring by parents, peer drug use, and other suspected risk factors for early drug use were first assessed in 1989, identifying 947 children with no prior history of drug use. One year later, 4.2 percent of these children were found to have started using alcohol, tobacco, or other drugs on their own for the first time during the follow-up observation interval. Risk of starting drug use was higher for children with lower levels of parent monitoring (relative risk = 4.39, 95% confidence interval 1.48-13.0). In addition, for children with declining levels of parent monitoring, there was an increased risk of starting to use drugs on their own.
This study examined whether interventions aimed at aggressive/disruptive classroom behavior and poor academic achievement would reduce the incidence of initiation of smoking.
An epidemiologically based, universal randomized preventive trial involved 2311 children in 2 classroom-based preventive interventions or controls. Each intervention was directed at 1 of the aforementioned 2 antecedents over first and second grades in 19 urban schools.
Smoking initiation was reduced in both cohorts for boys assigned to the behavioral intervention.
Targeting early risk antecedents such as aggressive behavior appears to be an important smoking prevention strategy.
High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings.
To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults.
A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site.
Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning.
Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals.
Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%.
A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.
The assessment and promotion of childrens' healthful physical activity is important: (i) to combat the international obesity epidemic that extends to childhood; and (ii) to establish an early habit of lifestyle physical activity that can be sustained into adolescence and adulthood. The primary focus of both assessment and promotion efforts has been on in-school physical education classes and, to a lesser extent, out-of-school structured exercise, sport and play. A potential source of continuous moderate activity, active commuting to school by means of walking or by bicycle, has been largely ignored in surveys of physical activity. Suggestive evidence of steep declines in the amount of childrens' destination walking can be gleaned from national transportation surveys. At the same time, there has been a dramatic increase in the reported use of motorised vehicles, including the use for chauffeuring children. There is very little evidence to support or refute active commuting to school as an important source of childrens' physical activity; however, this is largely because it has been overlooked in the stampede to assess time in more vigorous activities. The promotion of active commuting to school must be considered in the context of parents' real and perceived concerns for their children's personal and pedestrian safety. We certainly do not have a full understanding at this time of all the factors related to decisions about transportation mode, whether by child, parent, community, or school. Such information is necessary if successful and sustainable interventions can be implemented, important transport policy decisions can be made, and community and school designs can be modified. Practice rarely waits for research, however, and there are numerous examples of innovative programming, policies and environmental designs occurring internationally that can serve as natural experiments for enterprising researchers willing to push the envelope of our understanding of active commuting and childrens' physical activity. Since we know so little, there is much to learn.
We examine the question of whether living in a disadvantaged neighborhood damages health, over and above the impact of personal socioeconomic characteristics. We hypothesize that (1) health correlates negatively with neighborhood disadvantage adjusting for personal disadvantage, and that (2) neighborhood disorder mediates the association, (3) partly because disorder and the fear associated with it discourage walking and (4) partly because they directly impair health. Data are from the 1995 Community, Crime, and Health survey, a probability sample of 2,482 adults in Illinois, with linked information about the respondent's census tract. We find that residents of disadvantaged neighborhoods have worse health (worse self-reported health and physical functioning and more chronic conditions) than residents of more advantaged neighborhoods. The association is mediated entirely by perceived neighborhood disorder and the resulting fear. It is not mediated by limitation of outdoor physical activity. The daily stress associated with living in a neighborhood where danger, trouble, crime and incivility are common apparently damages health. We call for a bio-demography of stress that links chronic exposure to threatening conditions faced by disadvantaged individuals in disadvantaged neighborhoods with physiological responses that may impair health.
This study examined the relationship between neighborhood social structure, alcohol outlet densities and violent crime in Camden, New Jersey.
Data pertaining to neighborhood social structure, violent crime and alcohol density were collected for 98 block groups, and analyzed using bivariate, multivariate and spatial analyses.
Each type of analysis showed that those areas with high alcohol outlet densities experienced more violent crime than low-density areas, after controlling for neighborhood social structure. In the multivariate regression analysis, alcohol outlet densities explained close to one fifth of the variability in violent crime rates across block groups--more than any one of the neighborhood structural variables included in the analysis. These findings were replicated in the spatial analysis, which also showed that alcohol outlet densities contributed significantly to violent crime within target block groups but not in adjacent block groups.
High alcohol outlet density is associated with high rates of violent crime in this urban community. Spatial analysis suggests that alcohol outlets elevate the rate of violent crime within the immediate neighborhood context, not in surrounding neighborhoods.
We desired to understand how legal tools protect public health by regulating the location and density of alcohol, tobacco, firearms, and fast food retail outlets. We reviewed the literature to determine how land use regulations can function as control tools for public health advocates.
We found that land use regulations are a public health advocacy tool that has been successfully used to lessen the negative effects of alcohol retail outlets in neighborhoods. More research is needed to determine whether such regulations are successful in reducing the negative effects of other retail outlets on community health.
Recently created policies and programs target urban form as a primary factor in changes in children’s travel behavior to school. Unfortunately, little research exists that supports a direct relationship between urban form and a child’s trip to school. This article first discusses the transportation and health problems these policies attempt to address. It then reviews the current planning and public health literature on the relationship between urban form and children’s travel behavior. Finally, a conceptual framework is outlined that addresses the complexity of the relationship between urban form and a child’s trip to school to guide future policy and research.
... con- ducted in as little as ten-minute bouts three times a day —the equivalent of ... Boarnet and Crane 2001; Boarnet and Sarmiento 1998; Crane and Crepeau 1998; Boarnet and Greenwald ... per- sonal health and the environment, discomfort, and no knowledge of safe travel routes ...
There are two purposes to the present study. Our methodological purpose is to develop and test a procedure and instrument for assessing crime- and fear-related features of the urban residential environment. We examine three classes of cues: symbols of social and physical disorder, territorial functioning, and architectural ‘defensible space’ features. Past research examining the physical environment correlates of fear of crime has relied almost exclusively on subjective perceptions of the environment rather than on independent and objective measures thereof. Our theoretical purpose is to test the ‘disorder’ thesis of Skogan, and Wilson and Kelling, that actual physical incivilities erode resident's confidence in their neighborhood and lead them to infer that serious local problems, unrelated to the physical environment, are serious. We conducted environmental assessments and resident interviews (n = 412) on 50 blocks in 50 Baltimore neighborhoods. The assessments demonstrated high levels of inter-rater reliability and concurrent validity, controlling for social class. Regression analyses showed that physical incivilities were independently linked to perceptions of social and crime-related problems. The results show that reliable and valid assessment of crime- and fear-related environmental features can be conducted. They also support the central kernel of the Wilson and Kelling, and Skogan thesis, that the actual presence of disorder-related cues engender perceptions of social and crime problems.
Evidence was reviewed suggesting that children entering middle school are undergoing a life transition with considerable stress-inducing and pathogenic qualities. Middle school administrators and children entering middle school were surveyed about stressors encountered, perceptions of school, and sources of support during the transition. The data illuminated a distinct set of stressors and prototypical patterns of linkage and the impact of these stressors. A possible mismatch in administrators and children's views of sources of support was seen as especially significant. Implications for clinical and preventive research and intervention, particularly around substance abuse, were discussed.
Contouring allows for a three dimensional view in two dimensions and is a fundamental technique for spatial data representation in the earth sciences. This book details the practice and principles of the contouring method using a PC. Aspects covered include data preparation; the selection of contour intervals; interpolation and gridding, computing volumes; output and display. A set of 12 programs in BASIC is included on disk and published programs are compiled in an appendix along with a glossary and references. The book is divided into two parts: part 1 presents a practical guide to the software; part 2 presents the rationale and concepts of the technique. -M.Dean
This study evaluated the sensitivity of maximum likelihood (ML)-, generalized least squares (GLS)-, and asymptotic distribution-free (ADF)-based fit indices to model misspecification, under conditions that varied sample size and distribution. The effect of violating assumptions of asymptotic robustness theory also was examined. Standardized root-mean-square residual (SRMR) was the most sensitive index to models with misspecified factor covariance(s), and Tucker-Lewis Index (1973; TLI), Bollen's fit index (1989; BL89), relative noncentrality index (RNI), comparative fit index (CFI), and the ML- and GLS-based gamma hat, McDonald's centrality index (1989; Mc), and root-mean-square error of approximation (RMSEA) were the most sensitive indices to models with misspecified factor loadings. With ML and GLS methods, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, CFI, gamma hat, Mc, or RMSEA (TLI, Mc, and RMSEA are less preferable at small sample sizes). With the ADF method, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, or CH. Finally, most of the ML-based fit indices outperformed those obtained from GLS and ADF and are preferable for evaluating model fit. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper describes the design, rationale and implementation of the Alcohol Access Component within the Community Trials Project of the Prevention Research Center. The Alcohol Access Component was to reduce the concentration or density of alcohol outlets in each experimental community by a combination of local zoning and land-use planning approaches which was an effect to occur over several years. During the time of this trial, local regulations of alcohol outlets and public sites for drinking were changed in all three experimental communities. The amount of such alcohol policy change exceeded the goals for this component.
The present study examined the patterns of individual adjustment changes in a sample of 99 early adolescents during an ecological transition from elementary school to middle school. Early adolescents in the sample showed significant changes in their adjustment following the transition, as indicated by their increased psychological distress or decreased academic achievement following the transition. Gender differences were found in adjustment changes over time, suggesting that boys and girls may be differentially affected by middle school transition. Different patterns of adjustment changes were explored by means of cluster analysis on the basis of psychological distress scores before and after the transition. Three distinct patterns were identified across genders, including (a) an average start but increasing to high pattern, (b) an initial low but increasing to moderately high pattern, and (c) a pattern of consistently high scores over time. The results are discussed in terms of individual differences among early adolescents in their adjustment to middle school transition. Implications for research and practice in school psychology also are elaborated.
Objective:
To examine whether parental supervision and monitoring in middle childhood might have a sustained impact on risk of drug use later in childhood and adolescence.
Method:
An epidemiological sample of 926 urban-dwelling youths were individually interviewed annually, beginning in 1989 when the children were 8 to 10 years old, continuing through 1992. Standardized questions measured drug use, parenting behaviors, and other suspected determinants of drug use.
Results:
Survival analysis estimates indicated that children in the lowest quartile of parent monitoring initiated drug use at earlier ages. The contrast in risk of initiating alcohol, tobacco, or other drug use across levels of parent monitoring was greatest when children were under 11 years old; at older ages there was no difference in risk. However, in analyses focused specifically on marijuana, cocaine, and inhalant drugs, we observed a sustained higher risk of starting to use these drugs among youths who had been monitored at the lowest levels in middle childhood.
Conclusion:
These results add to the chain of inference that effective supervision and monitoring in middle childhood by parents or guardians might induce a delay or prevent onset of drug use among youths living in urban areas, a hypothesis that now ought to be tested in rigorous field experiments.
To examine whether male-female differences in rates of drug use could be traced back to differences in rates of exposure to initial opportunities to try drugs, rather than to sex differences in the probability of making a transition to use, once opportunity has occurred.
Cross-sectional sample survey research with nationally representative samples and retrospective assessments.
United States, 1979-94.
Respondents were 131,226 residents aged 12 years and older, recruited for the National Household Surveys on Drug Abuse by multi-stage probability sampling at nine time points.
Estimated proportion of males and females with an opportunity to use marijuana, cocaine, hallucinogens and heroin; proportions reporting use among those having an opportunity to use each drug; proportion making a "rapid transition" from initial opportunity to initial use.
For each survey year, males were more likely than females to have an initial opportunity to use drugs. However, few male-female differences were observed in the probability of making a transition into drug use, once an opportunity had occurred.
Previously documented male excess in rates of drug use may be due to greater male exposure to opportunities to try drugs, rather than to greater chance of progressing from initial opportunity to actual use. This suggests that sex differences in drug involvement emerge early in the process. Implications of these findings are discussed in relation to the epidemiology and prevention of drug use, and future research on sex differences in drug involvement.
A text detailing critical aspects of geographic information systems for land resources assessment. Nine chapters cover themes on: 1. Overview of GIS components - computer mapping, data bases, future directions. 2. Data structures for thematic maps, including files, spatial data definitions, vector and raster structures, database facilities. 3. Digital elevation models. 4. Data input, verification, storage and output. 5. Methods of spatial data analysis and modelling, ranging from basic map overlay, to natural language processing. 6. Data quality, errors, and the nature of spatial data on maps. 7. Classification techniques - multivariate, and using expert systems. 8. Spatial interpolation methods. 9. Selecting a GIS. Each chapter has a list of references, and two appendices give a glossary of terms, and a list of selected information sources.-after Author
A regulation banning new fast-food establishments for one year in Los Angeles, California, was passed unanimously by the city council in July 2008. It was motivated by health concerns and excessive obesity rates in South Los Angeles. However, it might not have had the impact that was intended. This paper reviews the empirical evidence for the regulation and whether it is likely to target the primary levers of obesity. We argue that the premises for the ban were questionable. For example, the density of fast-food chain restaurants per capita is actually higher in other parts of Los Angeles than in South LA. Other changes, such as menu calorie labeling, are likely to have a bigger impact on overweight and obesity.
This study examines the relationship between physical, socio-economic and social environments and alcohol consumption and drunkenness among a general population sample of drinkers aged 12-17 years. DESIGN, SETTING, PARTICIPANTS AND MEASURES: The study was conducted in Auckland, New Zealand. The design comprised two components: (i) environmental measures including alcohol outlet density, locality-based measure of willingness to sell alcohol (derived from purchase surveys of outlets) and a locality-based neighbourhood deprivation measure calculated routinely in New Zealand (known as NZDEP); and (ii) the second component was a random telephone survey to collect individual-level information from respondents aged 12-17 years including ethnicity, frequency of alcohol supplied socially (by parents, friends and others), young person's income; frequency of exposure to alcohol advertising; recall of brands of alcohol and self-reported purchase from alcohol outlets. A multi-level model was fitted to predict typical-occasion quantity, frequency of drinking and drunkenness in drinkers aged 12-17 years.
Typical-occasion quantity was predicted by: frequency of social supply (by parents, friends and others); ethnicity and outlet density; and self-reported purchasing approached significance. NZDEP was correlated highly with outlet density so could not be analysed in the same model. In a separate model, NZDEP was associated with quantity consumed on a typical drinking occasion. Annual frequency was predicted by: frequency of social supply of alcohol, self-reported purchasing from alcohol outlets and ethnicity. Feeling drunk was predicted by frequency of social supply of alcohol, self-reported purchasing from alcohol outlets and ethnicity; outlet density approached significance. Age and gender also had effects in the models, but retailers' willingness to sell to underage patrons had no effects on consumption, nor did the advertising measures. The young person's income was influential on typical-occasion quantity once deprivation was taken into account.
Alcohol outlet density was associated with quantities consumed among teenage drinkers in this study, as was neighbourhood deprivation. Supply by family, friends and others also predicted quantities consumed among underage drinkers and both social supply and self-reported purchase were associated with frequency of drinking and drunkenness. The ethnic status of young people also had an effect on consumption.
Longitudinal data sets are comprised of repeated observations of an outcome and a set of covariates for each of many subjects. One objective of statistical analysis is to describe the marginal expectation of the outcome variable as a function of the covariates while accounting for the correlation among the repeated observations for a given subject. This paper proposes a unifying approach to such analysis for a variety of discrete and continuous outcomes. A class of generalized estimating equations (GEEs) for the regression parameters is proposed. The equations are extensions of those used in quasi-likelihood (Wedderburn, 1974, Biometrika 61, 439-447) methods. The GEEs have solutions which are consistent and asymptotically Gaussian even when the time dependence is misspecified as we often expect. A consistent variance estimate is presented. We illustrate the use of the GEE approach with longitudinal data from a study of the effect of mothers' stress on children's morbidity.
This paper describes a study of billboard advertising of tobacco and alcohol products in the city of Chicago. All billboards were counted and their advertising themes noted. These data were matched with information on population and race from the 1990 census in order to document which geographic areas of the city, if any, had excess tobacco or alcohol billboards. The data revealed that minority wards were burdened with three times as many tobacco billboards and five times as many alcohol billboards when compared to white wards. The findings are congruent with studies conducted in other urban areas, which demonstrate a consistent pattern of tobacco and alcohol advertisers targeting poor and minority neighborhoods for outdoor advertising of their dangerous products. Chicago legislative initiatives based on the billboard study are described.
To probe the meaning of reported racial and ethnic group differences in the prevalence of crack cocaine smoking and to estimate the degree to which crack cocaine smoking is associated with personal factors specific to race/ethnicity.
Through reanalysis of data from the 1988 National Household Survey of Drug Abuse (NHSDA), we compared racial/ethnic group differences in crack cocaine smoking. To hold constant social and environmental risk factors that might potentially confound racial comparisons, we used an epidemiologic strategy that involves poststratification of respondents into neighborhood risk sets. A conditional logistic regression model was used to estimate the relative odds of crack use by race/ethnicity.
The 1988 NHSDA interviewed 8814 individuals residing within households in the United States. Subjects were selected using a multistage area probability sampling of all residents aged 12 years and older.
Once respondents were grouped into neighborhood clusters, the relative odds (RO) of crack use did not differ significantly for African Americans (RO, 0.85; 95% confidence interval [Cl], 0.37 to 1.93) or for Hispanic Americans (RO, 0.88; 95% Cl, 0.47 to 1.67) compared with white Americans.
Findings of race-associated differences are often presented as if a person's race has intrinsic explanatory power. This analysis provides evidence that, given similar social and environmental conditions, crack use does not strongly depend on race-specific (eg, biologic) personal factors. Although the study finding does not refute the previous analysis, it provides evidence that prevalence estimates unadjusted for social environmental risk factors may lead to misunderstanding about the role of race or ethnicity in the epidemiology of crack use. Future research should seek to identify which characteristics of the neighborhood social environment are important and potentially modifiable determinants of drug use.
We hypothesized that neighborhood disadvantage might function as a determinant of "exposure opportunity', an intermediate step on a path toward starting to use drugs illicitly. Testing this hypothesis, we analyzed self-report data gathered in 1992 by means of confidential interviews with 1416 urban-dwelling middle-school participants in a longitudinal field study. Within this epidemiologic sample, 50 youths said that someone actively had offered them a chance to take cocaine or smoke crack; tobacco had been offered to 395 youths; alcohol to 429 youths. Using multiple logistic regression to hold constant grade, sex, minority status, and peer drug use, we found a moderately potent association between neighborhood disadvantage and exposure to cocaine: youths living in the most disadvantaged neighborhoods (highest tertile) were an estimated 5.6 times more likely to have been offered cocaine, as compared to those in relatively advantaged neighborhoods (P = 0.001). By comparison, there were weaker but statistically significant associations involving tobacco exposure opportunity (odds ratio, OR = 1.7, P = 0.004) and alcohol exposure opportunity (OR = 1.9, P = 0.0005). Future research will clarify the etiologic significance of neighborhood disadvantage in pathways leading toward illicit drug use.
This paper describes the design, rationale and implementation of the Alcohol Access Component within the Community Trials Project of the Prevention Research Center. The Alcohol Access Component was to reduce the concentration or density of alcohol outlets in each experimental community by a combination of local zoning and land-use planning approaches which was an effect to occur over several years. During the time of this trial, local regulations of alcohol outlets and public sites for drinking were changed in all three experimental communities. The amount of such alcohol policy change exceeded the goals for this component.
To determine the geographic relation between homicide rate and two competing measures of exposure to alcohol outlets, alcohol outlets per square mile and alcohol outlets per person.
Homicides occurring in 1994 and 1995 and on-sale and off-sale alcohol outlets with active 1995 licenses were geocoded by address for aggregation at the census tract level. Ecologic analysis of the 155 urban residential census tracts in New Orleans was conducted with controls for potential sociodemographic confounders (% black, % adults unemployed, % unmarried households, and ratio males 15-24/males 35-44).
After logarithmic transformation of all study variables, sociodemographic confounders alone accounted for 58% (R2 = .58) of the variance of homicide rates. Adding off-sale alcohol outlet density to the models, measured (beta +/- SE) either as outlets per square mile (beta = .211 +/- .062) or outlets per person (beta = .244 +/- .063), yielded strong geographic relations with homicide and increased the amount of variance explained (R2 = .62). A 10% higher off-sale outlet density accounted for a 2.4% higher homicide rate.
Both off-sale alcohol outlets per square mile and off-sale outlets per person demonstrate strong geographic associations with homicide rates among urban residential census tracts in New Orleans. These findings suggest that communities faced with high rates of assaultive violence might consider policy interventions that address alcohol outlet related factors.
In this paper we examine whether the physical availability of alcohol is greater in predominantly African American communities compared to predominantly white communities as indicated by the presence of off premises liquor stores. We investigate the extent to which the income status of the residents of a community mediates the relationship between community racial composition and alcohol availability; and explore whether the intersection of race and class places low income African American communities at increased risk to have such stores located in their communities. Multivariate analytic techniques are used to examine the relationship between community racial composition, median income of neighborhood residents and per capita number of alcohol outlets in 194 census tracts in Baltimore, Maryland. The analysis found that liquor stores are disproportionately located in predominantly black census tracts, even after controlling for census tract socioeconomic status. Census tracts that are both low income and predominantly African American have substantially more liquor stores per capita than other census tracts. Although it is beyond the scope of the present study, our data reveal significant associations between the presence of liquor stores and the risk of health-related social problems in low income neighborhoods. More research needs to be done on the impact of alcohol on the social, psychological, and physiological health of low income urban populations.
Drawing upon an "exposure opportunity" concept described by Wade Hampton Frost, the authors studied two mechanisms to help account for prior observations about the "stepping-stone" or "gateway" sequences that link the use of alcohol, tobacco, marijuana, and cocaine. Data were obtained from four nationally representative and independent cross-sectional samples of US household residents (n = 44,624 persons aged 12-25 years). Data were gathered using standardized self-report methods and were analyzed via survival methods. Results indicated that users of tobacco and alcohol were more likely than nonusers to have an opportunity to try marijuana and were more likely to actually use marijuana once a marijuana opportunity had occurred. Opportunity to use cocaine was associated with prior marijuana smoking. Among young people with a cocaine opportunity, those who had used marijuana were more likely to use cocaine than were those with no history of marijuana use. The observed associations did not seem to arise solely as a result of young drug users' seeking out opportunities to use drugs. Applying Frost's epidemiologic concept of exposure opportunity, the authors offer new epidemiologic evidence on the sequences that link earlier use of alcohol and tobacco to later illegal drug involvement.
To determine whether alcohol outlet density was correlated with heavy and frequent drinking and drinking-related problems, we compared ecological measures of outlet density with survey measures of drinking using a geographic information system and the Harvard School of Public Health College Alcohol Study (n=3,421, site n=8). We identified 966 outlets within 8 2-mile study areas. Densities/site ranged from 32 to 185. Density was correlated with heavy drinking (r=0.82, p=0.01), frequent drinking (r=0.73, p=0.04) and drinking-related problems (r=0.79, p=0.02). Women, underage students and students who picked up binge drinking in college were affected. Implications for prevention and research are discussed.