Public Health Alcohol Availability and Violence
by
Daikwon Han, Dennis M. Gorman
  • LAST REVIEWED: 07 January 2022
  • LAST MODIFIED: 22 April 2013
  • DOI: 10.1093/obo/9780199756797-0114

Introduction

Empirical studies of the effects of alcohol availability on violence began to emerge in the 1980s and 1990s. These initial studies were generally ecological and cross-sectional and tended to use official crime statistics as the source of data for violence and assess alcohol availability in terms of outlet density. Also, most studies were implicitly based on the availability theory of alcohol-related problems, that is, the idea that consumption will increase as availability increases and this, in turn, will lead to a rise in both excessive drinking and alcohol-related problems. These studies were also consistent in showing an association between alcohol outlet densities and violent crime, and these associations remained once social and demographic characteristics of the geographic units of analysis (such as poverty and residential mobility) were controlled for in the data analysis. Since these early studies, considerable advances have been made in the field, especially methodologically. These advances include the use of geospatial statistical methods and space-time models, the use of longitudinal study designs, and the assessment of interventions and policy initiatives that either increase or decrease the availability of alcohol. The latter includes studies that focus on the days of sale and hours of sale of alcohol, as well as studies that focus on changes in outlet density. Also, the types of violence that have been studied have expanded beyond police reports of violent crime to include hospital admission data pertaining to assaults and injuries, social service data pertaining to child abuse and neglect and domestic violence, and self-reports of victimization. Theoretical advances have been less noticeable as this essentially empirical and methodological literature has not, for the most part, been a source of theory development and testing. Hopefully, this will change in the near future as alcohol studies researchers start to draw on ecological theories from within criminology and other social sciences in an effort to better understand the empirical association between alcohol availability and violence.

General Overviews

Although not focused specifically on violence, Babor, et al. 2010 presents a global perspective on alcohol use and related problems and a thorough review of the evidence pertaining to prevention policies and programs. The NIAAA monograph Wilson and Dufour 2000 is also not focused specifically on violence, but it contains a number of excellent papers that address the methodological issues encountered when studying alcohol availability and alcohol-related problems in small geographic areas. Campbell, et al. 2009 and Popova, et al. 2009 each review the research literature pertaining to the association between alcohol availability and alcohol-related problems in general. Parker and Auerhahn 1998 and Livingston, et al. 2007, while not systematic, are focused specifically on the association between alcohol availability and violence and also discuss the theories that have been presented to explain the association between alcohol availability and violence. Roman, et al. 2008 reviews the studies that have specifically focused on the relationship between alcohol outlets and crime, including violence, child maltreatment, robbery, and property crime.

Data Sources

Uniform Crime Reports (UCR) and Hospital discharge data are the two primary data sources of violence outcomes in the United States. Additionally, recent geospatial studies conducted in the United States and internationally have utilized violence data available from local police departments to ensure the required spatial resolution that are most appropriate to the study. Violence data obtained from local police departments are often available at the individual level, without any identifiable information, and thus can be aggregated to any geographic unit after applying an address-matching process. Numerous police departments now have the online open data request systems; for example, the Houston Police Department maintains an online data query system, accessible online. Other data sources include population characteristic/social structure variables available from the decennial Census and American Community Survey, and place characteristics, including alcohol availability and other retail environments, available from several data sources. First, both alcohol and nonalcohol retail environments data are provided by the US Census Bureau’s County Business Pattern data (see County Business Patterns / ZIP Code Business Patterns). Also alcohol environment data can be obtained directly from the states’ Alcoholic Beverage Control Boards, as many states have such state government agency charged with regulation of alcoholic beverages. For example, the California Department of Alcoholic Beverage Control maintains an online license query reporting system, which provides data on license types (on- and off-premise) and status (issue and expiration dates), including the locations of alcohol outlets by license types and status. Lastly, similar to the annual statistical publications of crime in the United States, many countries collect and publish national crime statistics annually. Crime data sources that provide national crime statistics include the Uniform Crime Reporting Survey (Statistics Canada), Recorded Crime—Victims, Recorded Crime—Offenders (Australian Bureau of Statistics) and Crime in New Zealand (Statistics New Zealand and Minister of Police). Additionally, the United Nations Office on Drugs and Crime (UNODC) also produces worldwide crime statistics on violent crime, including homicide, assault, rape, and robbery, sourced from each country’s official statistics.

  • County Business Patterns / ZIP Code Business Patterns.

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    The US Census Bureau’s County Business Patterns (CBP) and ZIP Code Business Patterns (ZBP) provide economic data by industry, classified by the North American Industry Classification System (NAICS) code. Data on alcohol and nonalcohol establishments are available in small areas from the ZBP. Reporting is voluntary for small businesses that have no paid employees.

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  • Hospital discharge data.

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    Hospital admissions data are available at the state level. For instance, New York State maintains a statewide hospital discharge data system (Statewide Planning and Research Cooperative System) for reporting hospitalizations. Included are injuries resulting from interpersonal violence and/or assault admissions as primary diagnosis, classified by the International Classification of Disease (ICD) code.

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  • Uniform Crime Reports.

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    The FBI’s Uniform Crime Reporting (UCR) Program collects and maintains the nation’s crime data, working closely with local and state law enforcement agencies. The UCR data include violent offenses (homicide, rape, robbery, aggravated assault) known to law enforcement and reports on persons arrested, while only arrest data for other types of violence, including drug abuse violations and offenses against the family and children, are collected.

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Major Journals

Research articles pertaining to alcohol availability and violence have been published in a variety of academic journals within the field of addiction, as well as criminological journals and general social science journals. Within the addictions field, the major American journals to have published such research articles are Alcoholism: Clinical and Experimental Research, Contemporary Drug Problems, and the Journal of Studies on Alcohol and Drugs. In the United Kingdom, Addiction is the major outlet for publications pertaining to alcohol availability and violence, and in Australia it is the Drug and Alcohol Review.

Thematic Issues of Journals

Two recent editions of Drug and Alcohol Review and Contemporary Drug Problems have been devoted entirely to the issue of alcohol and violence. The first of these was Graham and Livingston 2011 and the second was Wilkinson and Room 2011.

  • Graham, K., and M. Livingston. 2011. Special issue: Alcohol and violence. Drug and Alcohol Review 30.5.

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    Contains twelve articles that were first presented at a conference in Melbourne, Australia, in 2010. Four of the papers focus specifically on availability and violence and three examine preventive interventions intended to reduce violence in and around outlets.

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  • Wilkinson, C., and R. Room. 2011. Special issue: Alcohol and violence: Relationship, causality, and policy. Contemporary Drug Problems 38.2.

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    Contains articles from the United States, the United Kingdom, Australia, Canada, Ireland, and the Nordic countries that were first presented at a conference in Melbourne, Australia, in 2010 and that pertain to the epidemiology of alcohol and violence, as well as community and policy interventions.

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Theories

Most studies of the association between alcohol outlet density and violence are implicitly or explicitly based on availability theory, i.e., the idea that consumption will increase as availability increases and this, in turn, will lead to a rise in both excessive drinking and alcohol-related problems. Some alcohol researchers have tried to move beyond simply examining the role of consumption in generating violence and explore in greater detail the effects of drinking environments. In addition to theories from within the field of alcohol studies, researchers have also applied criminological theories to the study of the association between alcohol availability and violence.

Drinking Environments

A classic account of the association between average alcohol consumption within the population and the prevalence of heavy alcohol use is presented in Bruun, et al. 1975. Skog 1985 also examines the association between overall consumption and excessive use and alcohol-related harm but expands upon this through a focus on social influences and drinking cultures. Excellent overviews of availability theory are presented in Single 1988 and Stockwell and Gruenewald 2001. The former contains a detailed description of the theory and its development, its relation to theories from economics, sociology and psychology, and the methods and results from studies published primarily in the 1960s, 1970s, and 1980s. The latter focuses on studies published mainly in the 1990s. Both Gruenewald 2007 and Livingston, et al. 2007 focus more explicitly on the drinking environment and the characteristics of this that increase the risk of violence in and around alcohol outlets. Specifically, Gruenewald 2007 developed a more explicit ecological theory of alcohol outlets and alcohol-related problems, proposing that the sellers of alcohol market their products to specific segments of the drinking population (niche theory) and that different types of drinkers select into different types of drinking environments (assortive drinking). This model has recently been tested by the authors of Fitzpatrick and Martinez 2012 using computational models. Livingston, et al. 2007 also developed a more explicit ecological approach that examines the effect of neighborhood context on drinking and alcohol-related problems such as violence. Parker and Auerhahn 1998 reviews four theories that have been developed to explain the association between alcohol use and violence, and between drug use and violence, with the most relevant for alcohol availability being selective disinhibition theory and the cultural consequences of availability theory.

  • Bruun K., G. Edwards, M. Lumio, et al. 1975. Alcohol control policies in public health perspective. Helsinki: Finnish Foundation for Alcohol Studies.

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    This monograph presents an exposition of the association between mean alcohol consumption, prevalence of heavy drinking, and excess mortality associated with alcohol. It concludes that lowering total consumption would likely reduce prevalence of heavy drinking in a society and that control policies should take account of the customs, culture, and traditions surrounding drinking.

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  • Fitzpatrick, B., and J. Martinez. 2012. Agent-based modeling of ecological niche theory and assortive drinking. Journal of Artificial Societies and Social Simulation 15.2:4.

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    This study uses computational agent-based models to examine the dynamic spatial assortment of drinkers into alcohol outlets and the competition of outlets for drinkers, as suggested by Gruenewald’s ecological niche theory and assortive drinking.

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  • Gruenewald, P. J. 2007. The spatial ecology of alcohol problems: Niche theory and assortative drinking. Addiction 102:870–878.

    DOI: 10.1111/j.1360-0443.2007.01856.xSave Citation »Export Citation » Share Citation »

    This paper develops an ecological theory of alcohol-related problems derived from mathematical and computational models. The theory combines ideas from niche marketing theory and assortative drinking theory in an attempt to explain why problems such as violence concentrate in and around some alcohol outlets and not others. Available online for purchase or by subscription.

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  • Livingston, M., T. Chiikritzhs, and R. Room. 2007. Changing the density of alcohol outlets to reduce alcohol-related problems. Drug and Alcohol Review 26:557–566.

    DOI: 10.1080/09595230701499191Save Citation »Export Citation » Share Citation »

    Presents a discussion of the main theories that explain the relationship between alcohol availability and violence, and proposes a theory of alcohol outlet density that specifies its effects in terms of a proximity effect that pertains to the ease with which alcohol can be accessed and an amenity effect that pertains to how outlets influence local communities. Available online for purchase or by subscription.

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  • Parker, R. N., and K. Auerhahn. 1998. Alcohol, drugs, and violence. Annual Review of Public Health 24:291–311.

    DOI: 10.1146/annurev.soc.24.1.291Save Citation »Export Citation » Share Citation »

    This review discusses two theories relevant to the association between alcohol availability and violence: selective disinhibition and cultural consequences of availability. Both emphasize the importance of social context in linking alcohol-induced disinhibition to violence, while the latter also focuses on how spatial concentration of outlets can produce areas where social control is greatly diminished. Available online for purchase or by subscription.

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  • Single, E. W. 1988. The availability theory of alcohol-related problems. In Theories on alcoholism. Edited by C. D. Chaudron and D. A. Wilkinson, 325–351. Toronto: Addiction Research Foundation.

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    This chapter contains a very detailed review and discussion of the theoretical and empirical literature on the availability theory of alcohol-related problems published prior to 1990. The research discussed pertains to types of control systems, outlet density, pricing and taxation, days and hours of operation, and age limits.

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  • Skog, O.-J. 1985. The collectivity of drinking cultures: A theory of the distribution of alcohol consumption. British Journal of Addiction 80:83–99.

    DOI: 10.1111/j.1360-0443.1985.tb05294.xSave Citation »Export Citation » Share Citation »

    This paper provides a critique of the single distribution model of alcohol consumption and offers an alternative based on the hypotheses that drinking behavior is influenced by multiple interacting factors and that individual drinkers are largely influenced by their personal social networks. Available online for purchase or by subscription.

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  • Stockwell, T., and P. J. Gruenewald. 2001. Controls on the physical availability of alcohol. In International handbook of alcohol dependence and problems. Edited by N. Heather, T. J. Peters, and T. Stockwell, 699–719. New York: Wiley.

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    This chapter uses alcohol availability theory as a conceptual framework to review the evidence pertaining to the effects of a number of means through which changes in alcohol availability occur (including increases in outlet density) on high-risk drinking and alcohol-related problems (including violence).

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Application of Theories from Criminology

In recent years, there has been some application of theoretical models from the broader field of criminology to the study of alcohol availability and violence. The constructs that are most frequently applied come from two broad theoretical perspectives, namely, social cohesion theories (such as social disorganization theory and social capital theory) and opportunity theories (such as routine activities theory and crime potential theory). Opportunity theories are concerned with the manner in which individuals interact while going about their everyday activities (Roman, et al. 2008) and have been used by both criminologists (e.g., Block and Block 1995, Roncek and Maier 1991) and alcohol researchers (e.g., Freisthler, et al. 2004) to understand the geographic and spatial association between alcohol availability and the occurrence of violence. Social integration theories focus on the effects that neighborhood social and demographic characteristics have on violence and on the processes and mechanisms that link these (Bursik 1988). The key constructs from social cohesion theories have, for the most part, been poorly operationalized in the alcohol availability literature, in that most empirical studies simply use census data to control for variables pertaining to community structure and social demographics in their analyses (Gorman, et al. 2011). There has been little attempt to test the more sophisticated versions of these theories that involve mediating mechanisms such as social network density and social cohesion or to use anything other than census data to measure key theoretical constructs. One exception is Theall, et al. 2009, a study that posits social and organizational ties as the source of social cohesion within a community and as the mechanism through which increased alcohol outlet density adversely affects social capital. This study also uses questionnaire measures of organizational membership, social cohesion, and social control. Treno, et al. 2007 also used both individual-level and population-level data to examine the effects of social selection and social influence on the relationship between alcohol outlet density and violence. The former perspective was derived from routine activities theory and the latter from social disorganization theory.

  • Block, R. L., and C. R. Block. 1995. Space, place and crime: Hot spot areas and hot places of liquor-related crime. In Crime and place. Vol. 4 of Crime prevention studies. Edited by J. E. Eck and D. Weisburd, 145–183. Monsey, NY: Criminal Justice.

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    This paper uses data from Chicago to examine the association between alcohol availability and violence. The analyses presented lead the authors to draw a distinction between areas that generate crime and specific places that generate crime.

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  • Bursik, R. J., Jr. 1988. Social disorganization and theories of crime and delinquency: Problems and prospects. Criminology 26:519–551.

    DOI: 10.1111/j.1745-9125.1988.tb00854.xSave Citation »Export Citation » Share Citation »

    A classic account of the development of social disorganization theory and the criminological research which has utilized this theoretical perspective. Available online for purchase or by subscription.

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  • Freisthler, B., L. T. Midanik, and P. J. Gruenewald. 2004. Alcohol outlets and child physical abuse and neglect: Applying routine activities theory to the study of child maltreatment. Journal of Studies on Alcohol 65:586–592.

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    This cross-sectional study examines the relationship of alcohol outlet density to rates of child physical abuse and neglect in 940 California census tracts. Constructs from social disorganization theory are measured using census data, while routine activities theory was operationalized in terms of alcohol availability. Available online for purchase or by subscription.

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  • Gorman, D. M., P. J. Gruenewald, and L. A. Waller. 2011. Linking places to problems: Geospatial theories of neighborhoods, alcohol and crime. GeoJournal 69.

    DOI: 10.1007/s10708-011-9425-7Save Citation »Export Citation » Share Citation »

    This paper critically reviews the two main groups of ecological theories that inform studies of alcohol availability and violence, namely, social integration theories and place-based theories, and examines the implications of each of these for the application of spatial statistical models. Available online for purchase or by subscription.

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  • Roman, C. G., S. E. Reid, A. S. Bhati, and B. Tereschchenko. 2008. Alcohol outlets as attractors of violence and disorder: A closer look at the neighborhood environment. Washington, DC: Urban Institute.

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    This report provides an excellent summary of the literature on opportunity theories and violence as well as testing a model based on these theories using data from Washington, DC.

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  • Roncek, D. W., and P. A. Maier. 1991. Bars, blocks, and crimes revisited: Linking the theory of routine activities to the empiricism of hot spots. Criminology 29:725–753.

    DOI: 10.1111/j.1745-9125.1991.tb01086.xSave Citation »Export Citation » Share Citation »

    This study operationalizes routine activities theory in terms of the number of bars on each city block in Cleveland, Ohio. Results showed that after controlling for social and environmental features of the block, each additional bar was associated with an increment of about one violent crime per block per year. Available online for purchase or by subscription.

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  • Theall, K. P., R. Scribner, D. Cohen, R. N. Bluthenthal, M. Schonlau, and T. A. Farley. 2009. Social capital and the neighborhood alcohol environment. Health and Place 15:323–332.

    DOI: 10.1016/j.healthplace.2008.06.001Save Citation »Export Citation » Share Citation »

    This study examines the effect of alcohol outlet density on social capital and whether this effect is mediated by perceived neighborhood safety. The results indicate that alcohol outlets facilitate the destruction of social networks through increasing both the social and physical incivilities of community life. Available online for purchase or by subscription.

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  • Treno, A. J., P. J. Gruenewald, L. G. Remer, F. Johnson, and E. A. LaScala. 2007. Examining multi-level relationships between bars, hostility and aggression: Social selection and social influence. Addiction 103:66–77.

    DOI: 10.1111/j.1360-0443.2007.02039.xSave Citation »Export Citation » Share Citation »

    This study used ecological and individual-level data from thirty-six zip codes in California to assess the role of social selection and social influence in explaining the association between alcohol availability and hostility and aggression. Available online for purchase or by subscription.

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Major Approaches

This section primarily outlines major approaches in the studies of alcohol availability and violence that have contributed to the advance in methodological approaches, but not the details of study findings. For the details of each study, refer to the descriptions under Ecological Studies. As Geographic Information Systems (GIS) and spatial data become more widely used, several studies have developed and modeled spatial relationships between alcohol outlet density and violence outcomes based on small area data, with subsequent advancement in methods that have accounted for spatial dependency in spatial data (Gorman, et al. 2001; Gruenewald 2006; Scribner, et al. 1999) (also see the works listed under Spatial Analysis Methods). More recently, longitudinal and space-time models have been developed to understand spatial, temporal, and spatio-temporal changes in the relationship between alcohol outlet density and violence (Gruenewald and Remer 2006, Norström 2000), including a few studies that have been built upon the development of Bayesian methods for space and time data (Banerjee, et al. 2008; Yu, et al. 2008).

  • Banerjee, A., E. LaScala, P. J. Gruenewald, B. Friesthler, A. Treno, and L. Remer. 2008. Social disorganization, alcohol and other drug markets: A space-time model of community structure. In Geography and drug addiction. Edited by Y. F. Thomas, 117–130. New York: Springer.

    DOI: 10.1007/978-1-4020-8509-3Save Citation »Export Citation » Share Citation »

    This study develops space-time methods in a Bayesian framework to identify the changes in the spatial patterns and interactions of violence across communities with diverse social structure and alcohol/drug availability.

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  • Gorman, D. M., P. W. Speer, P. J. Gruenewald, and E. W. Labouvie. 2001. Spatial dynamics of alcohol availability, neighborhood structure and violent crime. Journal of Studies on Alcohol 62:628–636.

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    To examine the relationship between neighborhood social structure, outlet density, and violent crimes, this study employs spatial methods that have accounted for spatial dependency in small area analysis. Available online for purchase or by subscription.

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  • Gruenewald, P. G., B. Freisthler, L. Remer, E. A. LaScala, and A. Treno. 2006. Ecological models of alcohol outlets and violent assaults: Crime potentials and geospatial analysis. Addiction 101:666–677.

    DOI: 10.1111/j.1360-0443.2006.01405.xSave Citation »Export Citation » Share Citation »

    This study explores the relationship among outlet density, place and population characteristics, and violence occurring across local areas using spatial models that have incorporated the effects of spatially autocorrelated and lagged covariates and outcome variables. Available online for purchase or by subscription.

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  • Gruenewald, P. G., and L. Remer. 2006. Changes in outlet densities affect violence rates. Alcoholism: Clinical and Experimental Research 30:1184–1193.

    DOI: 10.1111/j.1530-0277.2006.00141.xSave Citation »Export Citation » Share Citation »

    This study develops spatial and longitudinal models that have controlled for population characteristics to assess the association between alcohol outlet density and assault rates within local areas over time. Available online for purchase or by subscription.

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  • Norström, T. 2000. Outlet density and criminal violence in Norway, 1960–1995. Journal of Studies on Alcohol 61:907–911.

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    As one of the early studies, this study examines the ecological relationship between alcohol availability and violent crime using time-series models. Available online for purchase or by subscription.

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  • Scribner, R. A., D. A. Cohen, S. Kaplan, and S. H. Allen. 1999. Alcohol availability and homicide in New Orleans: Conceptual considerations for small area analysis of the effect of alcohol outlet density. Journal of Studies on Alcohol 60:310–316.

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    This study discusses several important methodological issues in small area analysis, including units of spatial analysis and types of neighborhoods (urban, suburban, and rural). Available online for purchase or by subscription.

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  • Yu, Q., R. Scribner, B. Carlin, et al. 2008. Multilevel spatio-temporal dual changepoint models for relating alcohol outlet destruction and changes in neighborhood raters of assaultive violence. Geospatial Health 2:161–172.

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    This study develops a spatio-temporal dual changepoint model to assess the effects of reductions in alcohol availability on assault rates following the 1992 civil unrest in Los Angeles, California.

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Spatial Analysis Methods

Spatial data are often characterized by two fundamental properties, spatial dependence (tendency for observations that are close in geographic space to be more alike than those that are further apart) and spatial heterogeneity (tendency for relationships between variables to vary from place to place across space). Because spatial dependency in spatial data results in the spatial autocorrelation of regression residuals, recent ecological studies have modeled spatial relationships between alcohol outlet density and violence outcomes that have accounted for the effects of spatially autocorrelated and lagged covariates and outcome variables (also see the works listed under Major Approaches). The following two sections (Introductory Works, Geocoding) outline several works of key methodological issues pertaining to the nature of spatial data in alcohol and violence research—introductory works of GIS and spatial analysis methods, followed by the studies on geocoding issues of alcohol and violence data pertaining to the quality of spatial data used in spatial analysis. Further, to incorporate the effects of location-specific spatial heterogeneity in spatial analysis, local statistical methods and advanced geospatial analysis and mapping methods have been developed. The last section, Development and Comparison of Advanced Spatial Methods, includes a few comparative studies outlining recent developments of advanced spatial methods, including geographically weighted regression, Bayesian spatially varying coefficient models, and spatial methods for nonlinear relationships.

Introductory Works

This section provides overviews and introductions to geospatial analysis methods in alcohol and violence research. Anselin, et al. 2000 provides an excellent overview of place-based theories of violence and an introduction to spatial data analysis tools and spatial modeling methods. Millar and Gruenewald 1997 and Wieczorek 1997 introduce fundamental concepts of GIS and geospatial analysis and discuss important methodological issues pertaining to the nature of spatial data and appropriate use of spatial analysis methods in alcohol epidemiology research.

Geocoding

Data quality is of paramount importance in geospatial analyses. Geocoding is the first step in any spatial analyses of alcohol and violence, and there are numerous potential sources of errors associated with the geocoding process, especially in small area analysis. McCarthy and Ratcliffe 2005 discusses the importance of geocoding quality in spatial analysis of violence, including implications of positional accuracy—discrepancy in GIS-based geocoded location relative to the true position on the earth’s surface. Hay, et al. 2009 assesses potential bias (selection bias and misclassification error) associated with the completeness and accuracy of geocoded alcohol and violence data in New Zealand, while Ratcliffe 2004 provides quantitative estimates of the minimum level of geocoding rates to retain overall accuracy.

Development and Comparison of Advanced Spatial Methods

With the recent advance in computational power and statistical methods, a few studies have compared efficiency and fit of advanced spatial analysis and mapping methods in the context of alcohol and violence. Waller, et al. 2007 compares two primary methods for the estimation of and inference for spatially heterogeneous effects—geographically weighted regression and spatial random effect methods. Livingston 2008 compares linear and nonlinear spatial relationships between alcohol availability and assault, while Yu, et al. 2009 develops a hierarchical nonlinear model to account for nonlinear association and spatial heterogeneity effects in the relationship of alcohol availability with violence outcomes.

Ecological Studies

Ecological studies have been consistent in providing a link between alcohol availability and violence outcomes within and across geographical areas; there is now accumulated evidence that increased outlet density is associated with an increased level of violent crime. However, the specific relationship among outlet and violence types has varied across the studies (see the works listed under Ecological Association and Spatial Association). Cross-sectional studies have primarily been conducted to identify the ecological relationship of various outlet density measures, place and population characteristics, with violent crime and domestic/intimate partner violence across local areas, while longitudinal studies have been conducted to explore the link within local areas over time (see the works listed under Domestic/Intimate Partner Violence and Time-Series and Longitudinal Studies). While most studies have been conducted in the United States, a number of significant studies have been carried out in Europe, Australasia, Russia, and Canada (see the works listed under International Studies).

Ecological Association

The ecological relationship between rate of assaultive violence and density of alcohol outlets across geographical areas in the United States has been well documented (Gorman, et al. 1998; Reid, et al. 2003; Scribner, et al. 1995; Scribner, et al. 1999; Speer, et al. 1998). While these cross-sectional studies have primarily focused on identifying the ecological association between city-specific rates of violence and outlet density measures using non-spatial, multiple regression analysis methods, studies differed in the use of alcohol outlet measures (on-premise, off-premise, and both on- and off-premises outlets combined) and units of local areas (city, municipality, and smaller geographic units like census tracts, block groups, zip codes). Specifically, Scribner, et al. 1995 explored the ecological association between on- and off-premises outlets and city-specific rates of violence among seventy-four cities in Los Angeles County, while Gorman, et al. 1998 extends the study by employing a different measure of outlet density (on- and off-premises outlets combined) and municipality-specific violence rates in New Jersey. Later studies have also employed outlet density and violence rates in small geographic areas, including census tracts (Reid, et al. 2003; Scribner, et al. 1999), while Speer, et al. 1998 used violence rates at two small geographic units (both census tracts and block groups), but also both on- and off-premises outlets combined as a measure of alcohol availability.

  • Gorman, D. M., P. W. Speer, E. W. Labouvie, and A. P. Subaiya. 1998. Risk of assaultive violence and alcohol availability in New Jersey. American Journal of Public Health 88:97–100.

    DOI: 10.2105/AJPH.88.1.97Save Citation »Export Citation » Share Citation »

    This study explores the ecological association between rates of assaultive violence and density of alcohol outlets in New Jersey. The authors found that sociodemographic variables explained two-thirds of the variance in violent crime, while outlet density was not associated with city-specific rates of assaultive violence.

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  • Reid, R. J., J. Hughey, and N. A. Peterson. 2003. Generalizing the alcohol outlet-assaultive violence link: Evidence from a U.S. midwestern city. Substance Use and Misuse 38:1971–1982.

    DOI: 10.1081/JA-120025122Save Citation »Export Citation » Share Citation »

    This study explores the ecological association between outlet density, sociodemographic factors, and rates of assaultive violence across local areas within a city. Higher levels of alcohol outlet density were associated with higher rates of assaultive violence. Available online for purchase or by subscription.

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  • Scribner, R. A., D. A. Cohen, S. Kaplan, and S. H. Allen. 1999. Alcohol availability and homicide in New Orleans: Conceptual considerations for small area analysis of the effect of alcohol outlet density. Journal of Studies on Alcohol 60:310–316.

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    This study explores the ecological association between alcohol outlet density and homicide rates across census tracts in New Orleans. Findings indicated that sociodemographic factors explained 58 percent, and off-sale outlets explained an additional 4 percent, of variance in homicide rates. Available online for purchase or by subscription.

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  • Scribner, R. A., D. P. MacKinnon, and J. H. Dwyer. 1995. The risk of assaultive violence and alcohol availability in Los Angeles County. American Journal of Public Health 85:335–340.

    DOI: 10.2105/AJPH.85.3.335Save Citation »Export Citation » Share Citation »

    This cross-sectional study on the ecological association between alcohol availability and violence reported that both sociodemographic variables and outlet density contributed significantly to the explained variance in city-specific rates of assaultive violence in California.

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  • Speer, P. W., D. M. Gorman, E. W. Labouvie, and M. J. Ontkush. 1998. Violent crime and alcohol availability: Relationships in an urban community. Journal of Public Health Policy 19:303–318.

    DOI: 10.2307/3343538Save Citation »Export Citation » Share Citation »

    The ecological association between outlet density (on- and off-premises outlets combined) and rates of violent crime was investigated across small areas (census tracts and block groups), and findings showed that alcohol outlet density contributed significantly to the explained variance in violence at both geographic scales. Available online by subscription.

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Spatial Association

Cross-sectional studies on the ecological association between alcohol availability and violence have further incorporated the effects of spatial autocorrelation and/or geographically adjacent population and outlet characteristics to identify the spatial relationship across small geographic areas, for example, census block groups in New Jersey (Gorman, et al. 2001), zip codes in California (Lipton and Gruenewald 2002), and unique “neighborhoods” in Minneapolis, Minnesota (Britt, et al. 2005). Similarly, several ecological studies have explored spatial association and interaction effects of place and population characteristics on violent crime, based on two underlying spatial theories of violence—social disorganization and routine activities perspectives (Gruenewald, et al. 2006; Nielsen and Martinez 2003; Smith, et al. 2000). More recently, a few studies have investigated interaction effects of alcohol and drug availability on violence outcomes (Gorman, et al. 2005; Zhu, et al. 2006).

  • Britt, H., B. P. Carlin, T. L. Toomey, and A. C. Wagenaar. 2005. Neighborhood level spatial analysis of the relationship between alcohol outlet density and criminal violence. Environmental and Ecological Statistics 12:367–382.

    DOI: 10.1007/s10651-005-1518-3Save Citation »Export Citation » Share Citation »

    The ecological and spatial relationship between violent crime and outlet density was examined using Bayesian spatial methods. While controlling for neighborhood-level social structure variables, a positive association between outlet density and violent crime was observed. Available online for purchase or by subscription.

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  • Gorman, D. M., P. W. Speer, P. J. Gruenewald, and E. W. Labouvie. 2001. Spatial dynamics of alcohol availability, neighborhood structure and violent crime. Journal of Studies on Alcohol 62:628–636.

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    This cross-sectional study examines the ecological relationship between neighborhood (block groups) social structure, outlet density, and violence using both non-spatial and spatial regression methods. Findings indicated that alcohol outlets in the target areas, not in the surrounding areas, were associated with violent crime in New Jersey. Available online for purchase or by subscription.

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  • Gorman, D. M., L. Zhu, and S. Horel. 2005. Drug “hot-spots,” alcohol availability and violence. Drug Alcohol Review 24:507–513.

    DOI: 10.1080/09595230500292946Save Citation »Export Citation » Share Citation »

    This study compares the effects of alcohol outlet density and drug hot spots on rates of violence using multivariate and spatial analysis methods. Findings indicated that both drug crime and alcohol outlet density were associated with violence, with stronger effects for drug use. Available online for purchase or by subscription.

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  • Gruenewald, P. G., B. Freisthler, L. Remer, E. A. LaScala, and A. Treno. 2006. Ecological models of alcohol outlets and violent assaults: Crime potentials and geospatial analysis. Addiction 101:666–677.

    DOI: 10.1111/j.1360-0443.2006.01405.xSave Citation »Export Citation » Share Citation »

    This cross-sectional study explores spatial and ecological relationships (and interaction effects) of place and population characteristics on violent crime across local areas. After controlling for population and social structure variables, off-premises outlets were positively associated with assault rates, with bars positive in certain socially disorganized areas. Available online for purchase or by subscription.

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  • Lipton, R., and P. J. Gruenewald. 2002. The spatial dynamics of violence and alcohol outlets. Journal of Studies on Alcohol 63:187–195.

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    This study explores the association between assaults and outlet density measures based on small areas (zip codes). Findings showed that both on- and off-premises outlets were positively associated with assault hospitalizations, with the strongest effects for bar density in urban areas. Available online for purchase or by subscription.

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  • Nielsen, A. L., and R. Martinez Jr. 2003. Reassessing the alcohol-violence linkage: Results from a multiethnic city. Justice Quarterly 20:445–469.

    DOI: 10.1080/07418820300095581Save Citation »Export Citation » Share Citation »

    This study explores interaction effects of outlet density, combined with social organization and routine activities variables, on the rates of assault and robbery in Miami, Florida. Alcohol availability was positively associated with violence rates, while the effects did not vary with social disorganization. Available online for purchase or by subscription.

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  • Smith, W. R., S. G. Frazee, and E. L. Davison. 2000. Furthering the integration of routine activity and social disorganization theories: Small units of analysis and the study of street robbery as a diffusion process. Criminology 38:489–524.

    DOI: 10.1111/j.1745-9125.2000.tb00897.xSave Citation »Export Citation » Share Citation »

    To provide empirical evidence on the ecological association and interaction effects between social disorganization and routine activities variables, this study reported that alcohol availability was positively associated with street robbery, with stronger effects in socially disorganized areas. Available online for purchase or by subscription.

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  • Zhu, L., D. M. Gorman, and S. Horel. 2006. Hierarchical Bayesian spatial models for alcohol availability, drug “hot spots” and violent crime. International Journal of Health Geographics 7.5: 54.

    DOI: 10.1186/1476-072X-5-54Save Citation »Export Citation » Share Citation »

    This study extends Gorman, et al. 2005 using advanced spatial methods (hierarchical Bayesian model) to uncover the ecological and spatial associations and interaction effects between alcohol availability, drug availability, and violent crime in Houston, Texas.

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Domestic/Intimate Partner Violence

There have been relatively few studies of the association between alcohol availability and domestic violence involving either an intimate partner such as a spouse or girlfriend or the abuse and neglect of children. One study conducted in the United States (Gorman, et al. 1998) and two conducted in Melbourne, Australia (Livingston 2010, Livingston 2011) examined the association between rates of police-reported domestic violence (primarily involving adult females as victims) and alcohol outlet density. McKinney, et al. 2009 also examined the association between alcohol outlet density and violence towards intimate partners but assessed the later using surveys and included both male-to-female partner violence and female-to-male partner violence. With regard to child abuse and neglect, Freisthler and colleagues have conducted a series of studies in California using state social services (Freisthler 2004, Freisthler, et al. 2007) and hospital discharge (Freisthler, et al. 2008) data. A review of ecological studies that have examined the effect of alcohol availability and other neighborhood characteristics on child maltreatment is presented in Freisthler, et al. 2006.

  • Freisthler, B. 2004. A spatial analysis of social disorganization, alcohol access, and rates of child maltreatment in neighborhoods. Child and Youth Services Review 26:803–819.

    DOI: 10.1016/j.childyouth.2004.02.022Save Citation »Export Citation » Share Citation »

    This cross-sectional ecological study examines the association between alcohol outlet density and child abuse and neglect in 940 census tracts in three counties in California. Results showed that the density of bars, but not restaurants or off-sale outlets, was positively associated with rates of child maltreatment. Available online for purchase or by subscription.

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  • Freisthler, B., P. J. Gruenewald, L. G. Remer, B. Lery, and B. Needlel. 2007. Exploring the spatial dynamics of alcohol outlets and Child Protective Services referrals, substantiations, and foster care entries. Child Maltreatment 12.2: 114–124.

    DOI: 10.1177/1077559507300107Save Citation »Export Citation » Share Citation »

    This study examines the relationship of alcohol outlets with rates of Child Protective Services referrals, substantiations, and foster care entries in 579 California zip codes between 1998 and 2003. After controlling for neighborhood sociodemographic variables, zip codes with higher concentrations of off-premises alcohol outlets were found to have higher rates of child maltreatment. Available online for purchase or by subscription.

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  • Freisthler, B., P. J. Gruenewald, L. Ring, and E. A. LaScala. 2008. An ecological assessment of the population and environmental correlates of childhood accident, assault, and child abuse injuries. Alcoholism: Clinical and Experimental Research 32.11: 1969–1975.

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    This cross-sectional ecological study examines the association between population and environmental characteristics of neighborhoods and hospital discharge data for childhood accidents, assaults, and injuries using data from 1,646 California zip codes. Off-premises alcohol outlet density was one of the few environmental characteristics associated with the three childhood outcomes. Available online for purchase or by subscription.

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  • Freisthler, B., D. H. Merritt, and E. A. LaScala. 2006. Understanding the ecology of child maltreatment: A review of the literature and directions for future research. Child Maltreatment 11.3: 263–280.

    DOI: 10.1177/1077559506289524Save Citation »Export Citation » Share Citation »

    This paper reviews eighteen ecological studies that have examined the association between neighborhood-level variables and child maltreatment, including the role that alcohol availability plays in child abuse and neglect. Available online for purchase or by subscription.

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  • Gorman, D. M., E. W. Labouvie, P. W. Speer, and A. P. Subaiya. 1998. Alcohol availability and domestic violence. American Journal of Drug and Alcohol Abuse 24.4: 661–673.

    DOI: 10.3109/00952999809019615Save Citation »Export Citation » Share Citation »

    This ecological study examines the association between alcohol outlet density and domestic violence in 223 municipalities in the state of New Jersey. The findings did not show an association between alcohol outlet density and domestic violence once sociodemographic variables were controlled for in the analysis. Available online for purchase or by subscription.

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  • Livingston, M. 2010. The ecology of domestic violence: The role of alcohol outlet density. Geospatial Health 5.1: 139–149.

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    This ecological study examines the association between alcohol outlet density and domestic violence in 217 postcodes in Melbourne, Australia. The findings showed a positive effect for density of premises that could sell alcohol both on- and off-premises and a negative associate for on-premises license density.

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  • Livingston, M. 2011. A longitudinal analysis of alcohol outlet density and domestic violence. Addiction 106.5: 919–925.

    DOI: 10.1111/j.1360-0443.2010.03333.xSave Citation »Export Citation » Share Citation »

    This longitudinal study examines if changes in alcohol outlet density were related to changes in domestic violence rates over a ten-year period in 186 postcodes in Melbourne, Australia. Increased outlet density was associated with increased levels of domestic violence, with the strongest effects for off-premises outlets. Available online for purchase or by subscription.

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  • McKinney, C. M., R. Caetano, T. R. Harris, and M. S. Ebama. 2009. Alcohol availability and intimate partner violence among US couples. Alcoholism: Clinical and Experimental Research 33.1: 169–176.

    DOI: 10.1111/j.1530-0277.2008.00825.xSave Citation »Export Citation » Share Citation »

    This population-based study of couples in forty-eight states uses individual-level survey data and zip code level alcohol and sociodemographic data to examine the relationship between alcohol outlet density and male-to-female partner violence and female-to-male partner violence. The findings show that the risk of the former, but not the latter, increases as outlet density increases. Available online for purchase or by subscription.

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Time-Series and Longitudinal Studies

To address the question of how changes in alcohol availability over time are related to changes in rates of violent crime, longitudinal studies are being conducted in a variety of violence context and geographic settings. Since the initial study by Norström 2000, there has been a growing number of time-series and longitudinal studies that have examined the spatial and temporal relationship of outlet density measures with specific outcomes of violence, including assault (Gruenewald and Remer 2006; Livingston 2008; Yu, et al. 2008), and domestic violence and child abuse (Freisthler, et al. 2007; Freisthler and Weiss 2008; Livingston 2011). These studies cover diverse population groups in different geographic settings. Most have investigated the effects of increases in alcohol availability, while one study focused on the effects of reductions in alcohol availability on violence (Yu, et al. 2008).

  • Freisthler, B., P. J. Gruenewald, L. G. Remer, B. Lery, and B. Needell. 2007. Exploring the spatial dynamics of alcohol outlets and Child Protective Services referrals, substantiations, and foster care entries. Child Maltreatment 12:114–124.

    DOI: 10.1177/1077559507300107Save Citation »Export Citation » Share Citation »

    This study focuses on how changes in the numbers of alcohol outlets are related to measures of child maltreatment rates in California. A positive association between off-premises outlet and CPS referral was found, indicating that a one-unit increase in outlets would lead to an increase of about 1,040 CPS referral cases. Available online for purchase or by subscription.

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  • Freisthler, B., and R. E. Weiss. 2008. Using Bayesian space-time models to understand the substance use environment and risk for being referred to Child Protective Services. Substance Use and Misuse 43:239–251.

    DOI: 10.1080/10826080701690649Save Citation »Export Citation » Share Citation »

    This study explores how spatial and spatio-temporal changes in alcohol availability are related to changes in child maltreatment rates in California. Findings indicated that alcohol outlet density was positively related to CPS referral rates, with significant spatial structure (clustering) and space-time trends and relationships. Available online for purchase or by subscription.

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  • Gruenewald, P. G., and L. Remer. 2006. Changes in outlet densities affect violence rates. Alcoholism: Clinical and Experimental Research 30:1184–1193.

    DOI: 10.1111/j.1530-0277.2006.00141.xSave Citation »Export Citation » Share Citation »

    This study explores how changes in off-premises outlets, bars/pubs, and restaurants are related to changes in assault rates, based on longitudinal data from small areas in California. A positive association between outlet density, especially bars and off-premises outlets, and assault rates was observed, after controlling for population characteristics as well as spatial effects. Available online for purchase or by subscription.

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  • Livingston, M. 2008. A longitudinal analysis of alcohol outlet density and assault. Alcoholism: Clinical and Experimental Research 32:1074–1079.

    DOI: 10.1111/j.1530-0277.2008.00669.xSave Citation »Export Citation » Share Citation »

    This study explores spatial and longitudinal relationships between various types of alcohol outlets and night-time assault rates in Melbourne, Australia. Overall, a positive association between alcohol availability and assault rates was observed; however, the specific relationship varied depending on outlet types and locational characteristics of regions. Available online for purchase or by subscription.

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  • Livingston, M. 2011. A longitudinal analysis of alcohol outlet density and domestic violence. Addiction 106:919–925.

    DOI: 10.1111/j.1360-0443.2010.03333.xSave Citation »Export Citation » Share Citation »

    This study investigates spatial and longitudinal associations between various types of alcohol outlets and domestic violence based on ten years of small area data in Australia. A positive association between alcohol availability, especially off-premises outlets, and domestic violence was found. Available online for purchase or by subscription.

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  • Norström, T. 2000. Outlet density and criminal violence in Norway, 1960–1995. Journal of Studies on Alcohol 61:907–911.

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    This cross-sectional time-series study focuses on temporal changes in the association between violent crime and on-premises outlet density over a thirty-five-year period in Norway. Alcohol availability was positively associated with violence, and a one-unit increase in outlet density was associated with a 6 percent increase in violence. Available online for purchase or by subscription.

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  • Yu, Q., R. Scribner, B. Carlin, et al. 2008. Multilevel spatio-temporal dual changepoint models for relating alcohol outlet destruction and changes in neighbourhood rates of assaultive violence. Geospatial Health 2:161–172.

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    To evaluate the effects of off-premises outlet closures due to civil unrest, this study compares changes in assault rates over time across census tracts with varying degrees of changes in alcohol outlets using a space-time dual changepoint model. Results indicated that a 10 percent reduction in outlets was associated with a 2.6 percent reduction in violence.

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International Studies

The works included in the previous sections on Ecological Studies are mostly ones that have been conducted in the United States. This section includes studies conducted in other geographical settings, since different localities may be another important contextual factor in understanding the link between alcohol and violence. Two comparative studies, Landberg and Norström 2011 and Rossow 2001, have provided cross-cultural and cross-national evidence on the association between alcohol and violence among population groups in Europe, and between the United States and Russia. The ecological association between alcohol consumption (alcohol sales) and homicide rates was investigated in Russia (Pridemore 2002), in Canada (Rossow 2004), and across fourteen European countries (Rossow 2001). Further, both alcohol outlet density and alcohol sales measures were utilized to identify differential effects on violence in recent studies that have been conducted in Australia (Liang and Chikritzhs 2011, Livingston 2011) and in New Zealand (Connor, et al. 2010; Day, et al. 2012). Unlike previous studies, Day, et al. 2012 explored the effects of spatial accessibility—measured by road travel distance to the closest alcohol outlets—on violence outcomes in a national study conducted in New Zealand.

  • Connor, J. L., K. Kypri, M. L. Bell, and K. Cousins. 2010. Alcohol outlet density, levels of drinking and alcohol-related harm in New Zealand: A national study. Journal of Epidemiology and Community Health 65:841–846.

    DOI: 10.1136/jech.2009.104935Save Citation »Export Citation » Share Citation »

    This cross-sectional study explores the association of outlet density with alcohol consumption and two measures of problems (harms and troubles due to drinking) in New Zealand. A positive association was observed between outlet density and alcohol-related harms and between off-premises outlets and binge drinking; however, no association was seen between outlet density and either average alcohol consumption or risky drinking.

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  • Day, P., G. Breetzke, S. Kingham, and M. Campbell. 2012. Close proximity to alcohol outlets is associated with increased serious violent crime in New Zealand. Australian and New Zealand Journal of Public Health 36:48–54.

    DOI: 10.1111/j.1753-6405.2012.00827.xSave Citation »Export Citation » Share Citation »

    A national study of alcohol availability and violence reported that geographic access to alcohol outlets (measured by road travel distance) was positively associated with increased levels of violence outcomes in New Zealand. Available online for purchase or by subscription.

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  • Landberg, J., and T. Norström. 2011. Alcohol and homicide in Russia and the United States: A comparative analysis. Journal of Studies on Alcohol and Drugs 72:723–730.

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    This time-series comparative analysis on the relationship between alcohol and homicide in Russia and in the United States found that alcohol consumption was positively associated with homicide death rates, with larger effects in Russia than in the United States. Available online for purchase or by subscription.

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  • Liang, W., and T. Chikritzhs. 2011. Revealing the link between licensed outlets and violence: Counting venues versus measuring alcohol availability. Drug and Alcohol Review 30:524–535.

    DOI: 10.1111/j.1465-3362.2010.00281.xSave Citation »Export Citation » Share Citation »

    This study explores the differential association of assault with outlet density and alcohol sales, and with on- and off-premises drinking in Australia. Results indicated that off-premises outlet sales were associated with assault at all locations, while on-premises outlet density was associated with assault only in particular places (on-premises or nonresidential places). Available online for purchase or by subscription.

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  • Livingston, M. 2011. Alcohol outlet density and harm: Comparing the impacts on violence and chronic harms. Drug and Alcohol Review 30:515–523.

    DOI: 10.1111/j.1465-3362.2010.00251.xSave Citation »Export Citation » Share Citation »

    This longitudinal study explores the relationships between various types of alcohol outlets and two violence outcomes (assault and alcohol-related chronic disorder) in Australia. A positive association was found between pubs and assault rates, and between off-premises outlets and alcohol use disorders. Available online for purchase or by subscription.

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  • Pridemore, W. A. 2002. Vodka and violence: Alcohol consumption and homicide rates in Russia. American Journal of Public Health 92:1921–1930.

    DOI: 10.2105/AJPH.92.12.1921Save Citation »Export Citation » Share Citation »

    This cross-sectional study investigates the relationship between alcohol consumption (deaths due to alcohol poisoning) and homicide death rates among a high-risk population in Russia. Results indicated that higher regional rates of alcohol consumption were associated with higher rates of homicide.

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  • Rossow, I. 2001. Alcohol and homicide: A cross-cultural comparison of the relationship in 14 European countries. Addiction 96: S77–S92.

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    This comparative analysis of alcohol sales and homicide rates over fourteen countries across northern, central, and southern Europe found that overall alcohol sales were positively associated with homicide rates, with the strongest association in the northern European countries. Specific associations between beverage types and homicide varied across countries, indicating the effects of drinking culture by individual countries. Available online for purchase or by subscription.

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  • Rossow, I. 2004. Alcohol consumption and homicides in Canada, 1950–1999. Contemporary Drug Problems 31:541–559.

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    This time-series study explores the association between alcohol sales and homicide rates in Canada. Alcohol sales were positively associated with national rates of homicide, with stronger effects for male homicide rates than for female rates, and in some provinces within the country.

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Youth

This section introduces a few recent studies that have examined the relationship of alcohol availability (alcohol outlet density and/or consumption) with drinking and related problems and violence (Kypri, et al. 2008; Scribner, et al. 2008; Weitzman, et al. 2003), and with alcohol-related violence outcomes (Bye and Rossow 2010; Parker, et al. 2011; Scribner, et al. 2010), among adolescents and college students. More specifically, Bye and Rossow 2010 have conducted comparative analyses of alcohol availability, drinking culture, and violence outcomes in thirteen European countries. Several studies have been conducted in a multisite setting; Scribner, et al. 2010 evaluated the relationships among campus violence, student drinking levels, and the physical availability of alcohol at off-campus outlets, while Kypri, et al. 2008 and Weitzman, et al. 2003 focused on drinking-related problems associated with outlet density. Lastly, Parker, et al. 2011 conducted a pooled time-series and cross-sectional study of alcohol availability and youth homicide in the ninety-one largest US cities between 1984 and 2006.

Evaluations of Policies and Laws

Local, state, and national laws and policies that are intended to reduce alcohol availability, alcohol consumption, and alcohol-related harms generally focus on hours of sales, days of sales, and density of outlets. The Centers for Disease Control’s Task Force on Community Preventive Services has produced excellent systematic reviews of the literature in each of these areas. Hahn, et al. 2010 reviewed the literature pertaining to the effects of changes in hours of sale at on- and off-premises outlets on a number of alcohol-related harms including violence. All of the studies reviewed pertained to increases in hours of sales, and the authors did not find any studies conducted in the United States. Middleton, et al. 2010 reviewed the evidence from fourteen studies that assessed the effects of increasing or decreasing the days of sale of alcohol, but the vast majority of these studies focused on alcohol consumption and alcohol-related problems other than violence (e.g., motor vehicle injuries and deaths). Similarly, few of the policy evaluations reviewed in Campbell, et al. 2009 had violence as a primary outcome. Thus, while each of these systematic reviews is an excellent source of information about policies and procedures that can be used to restrict and limit alcohol availability, evidence pertaining specifically to the effects of such measures on violence is really available only for changes in the hours of sales. Chikritzhs and Stockwell 2002 is an example of one of the studies included in the Hahn, et al. 2010 review. Two more-recent studies of the effects on violence of increases in hours of alcohol sales are reported in Newton, et al. 2007 and Rossow and Norström 2012. The former examines the effects of the introduction of the 2003 UK licensing law, and the latter assesses the liberalization of laws pertaining to bar closing hours in Norway. There have also been two recent studies published examining the effects of restricting hours of sales on violence. Duailibi, et al. 2007 assessed the impact of such laws on homicide and assaults against women in a Brazilian city, and Kypri, et al. 2010 their effect in the central business district of an Australian city.

  • Campbell, C. A., R. A. Hahn, R. Elder, et al. 2009. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. American Journal of Preventive Medicine 37:556–569.

    DOI: 10.1016/j.amepre.2009.09.028Save Citation »Export Citation » Share Citation »

    This paper presents a systematic review of studies of alcohol outlet density and alcohol-related problems. The policy evaluations reviewed include interrupted time-series studies, privatization studies, and assessments of alcohol bans and licensing policy changes, but unfortunately most of these do not include violence as an outcome. Available online for purchase or by subscription.

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  • Chikritzhs, T., and T. Stockwell. 2002. The impact of later trading hours for Australian public houses (hotels) on levels of violence. Journal of Studies on Alcohol 63:591–599.

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    This study used time-series analysis to examine the effect of extended trading hours on assault rates among public houses in Perth, Australia. The mean monthly assault rate increased by 55 percent among public houses with extended hours compared to 19 percent among those without. Available online for purchase or by subscription.

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  • Duailibi, S., W. Ponicki, J. Grube, I. Pinsky, R. Laranjeira, and M. Raw. 2007. The effect of restricting opening hours on alcohol-related violence. American Journal of Public Health 97:2276–2280.

    DOI: 10.2105/AJPH.2006.092684Save Citation »Export Citation » Share Citation »

    This study assessed the effects on homicide and assaults against women of a law introduced in the city of Diadema, Brazil that mandated that all bars close at 11:00 p.m. Homicide declined by almost nine murders a month following the introduction of the law. While assaults also declined, this was not significant in the analysis that controlled for underlying time trends.

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  • Hahn, R. A., J. L. Kuzara, R. Elder, et al. 2010. Effectiveness of policies restricting hours of alcohol sales in preventing excessive alcohol consumption and related harms. American Journal of Preventive Medicine 39:590–604.

    DOI: 10.1016/j.amepre.2010.09.016Save Citation »Export Citation » Share Citation »

    A systematic review of studies examining the effects of increasing hours of alcohol sales on alcohol consumption and alcohol-related problems including violence. The review found sufficient evidence to conclude that increasing sales by two hours or more increased problems but insufficient evidence to determine the effects of increases of less than two hours. Available online for purchase or by subscription.

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  • Kypri, K., C. Jones, P. McElduff, and D. Barker. 2010. Effects of restricting pub closing times on night-time assaults in an Australian city. Addiction 106:303–310.

    DOI: 10.1111/j.1360-0443.2010.03125.xSave Citation »Export Citation » Share Citation »

    This nonequivalent control group study examined the effects of restricting closing hours to 3:30 a.m. in the central business district (CBD) of Newcastle, Australia. Following the restriction, there was a 34 percent reduction in assaults in the CBD compared to just a 2 percent reduction in the control area of the city. Available online for purchase or by subscription.

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  • Middleton, J. C., R. A. Hahn, J. L. Kuzara, et al. 2010. Effectiveness of policies maintaining or restricting days of alcohol sales on excessive alcohol consumption and related harms. American Journal of Preventive Medicine 39:590–604.

    DOI: 10.1016/j.amepre.2010.09.016Save Citation »Export Citation » Share Citation »

    This paper presents an excellent review of studies that have examined the effects of changes in days of sale of alcohol on alcohol consumption and related harms. Unfortunately, most of the studies do not include violence among the harms that are assessed. Available online for purchase or by subscription.

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  • Newton, A., S. J. Sarker, G. S. Pahal, E. van den Bergh, and C. Young. 2007. Impact of the new UK licensing law on emergency hospital attendances: A cohort study. Emergency Medicine Journal 24:532–534.

    DOI: 10.1136/emj.2007.046094Save Citation »Export Citation » Share Citation »

    This retrospective cohort study conducted in the emergency department of a large London hospital found a statistically significant increase in the number of assaults following the implementation of legislation in 2005 that allowed twenty-four-hour drinking in England and Wales. Available online for purchase or by subscription.

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  • Rossow, I., and T. Norström. 2012. The impact of small changes in bar closing hours on violence: The Norwegian experience from 18 cities. Addiction 107.3: 530–537.

    DOI: 10.1111/j.1360-0443.2011.03643.xSave Citation »Export Citation » Share Citation »

    This quasiexperimental study used data from eighteen cities in Norway to assess the effects of changes in the closing hours of on-premises outlets on violence. It was found that each additional hour of alcohol sales was associated with a 16 percent increase in assaults per quarter. Available online for purchase or by subscription.

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Evaluations of Comprehensive Interventions

Intervention programs designed to reduce alcohol-related violence through decreasing availability typically focus on small geographic areas such as cities or towns or neighborhoods within such locations. These community-based programs generally involve more than one form of intervention activity, and very often these different components are introduced into the community at different points in time. Wallin, et al. 2003, for example, assessed an intervention that included community mobilization, responsible beverage service training, and stricter enforcement of existing alcohol laws. The intervention evaluated in Miller, et al. 2011 comprised the use of two-way radios to connect the police and security personnel, the use of scanners to detect fake IDs, maximum police visibility during high-risk hours, and an alcohol awareness campaign (each introduced at different points in time over a fifteen-month period). In the United States, the most sophisticated evaluation of such community-based interventions was the five-year trial conducted by Holder and colleagues in three experimental communities (two in California and one in South Carolina) and three control communities. This intervention was comprised of five components, including community mobilization and responsible beverage service training. One component was also directly focused on assisting communities in the use of local controls such as zoning ordinances to limit alcohol availability (Holder, et al. 1997). Among the outcomes assessed in the trial was assault, as measured by presentations in emergency rooms and hospital admissions (Holder, et al. 2000). Reviews of multicomponent community intervention strategies that target violence are presented by Homel, et al. 2001 and Treno and Holder 2001. Graham 2000 presents a very detailed review of prevention strategies that are implemented in drinking establishments. Graham, et al. 2004 presents the findings from a randomized control trial that assessed the effect of one such intervention in a sample of forty bars (eighteen in the intervention group and twelve in the control group) in Toronto, Canada.

  • Graham, K. 2000. Preventive interventions for on-premise drinking: A promising but underresearched area of prevention. Contemporary Drug Problems 27:593–668.

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    This paper reviews the evidence pertaining to eight prevention strategies designed to reduce alcohol-related problems, including violence, in licensed establishments. Some evidence for positive effects is found for some strategies (e.g., responsible beverage server training) but many of the approaches lack rigorous evaluation. Available online for purchase or by subscription.

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  • Graham, K., D. W. Osgood, E. Zibrowski, et al. 2004. The effect of the Safer Bars programme on physical aggression in bars: Results of a randomized controlled trial. Drug and Alcohol Review 23:31–41.

    DOI: 10.1080/09595230410001645538Save Citation »Export Citation » Share Citation »

    This paper presents the results of an evaluation of a brief violence prevention intervention comprised of a risk-assessment workbook and three-hour training program for bar staff and managers. The results showed a reduction in both severe and moderate violence in the bars that received the intervention. Available online for purchase or by subscription.

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  • Holder, H. D., P. J. Gruenewald, W. R. Ponicki, et al. 2000. Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of the American Medical Association 284.18: 2341–2347.

    DOI: 10.1001/jama.284.18.2341Save Citation »Export Citation » Share Citation »

    This paper presents the results of the Prevention Research Center’s five-year community prevention trial, including its effects on assault injuries presenting at emergency rooms and hospitalizations for assault.

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  • Holder, H. D., R. F. Saltz, J. W. Grube, R.B. Voas, P. J. Gruenewald, and A. J. Treno. 1997. A community prevention trial to reduce alcohol-involved accidental injury and death: Overview. Addiction 92.6s1: 155–172.

    DOI: 10.1046/j.1360-0443.92.6s1.1.xSave Citation »Export Citation » Share Citation »

    This paper presents an overview of the conceptual model upon which the Prevention Research Center’s five-year community prevention trial was developed, along with a detailed description of the five intervention components and how they were implemented over the course of the project. Available online for purchase or by subscription.

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  • Homel, R., G. McIlwain, and R. Carvlth. 2001. Creating safer drinking environments. In International handbook of alcohol dependence and problems. Edited by N. Heather, T. J. Peters, and T. Stockwell, 721–740. New York: Wiley.

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    This chapter reviews the literature that examines risk factors in the physical and social environment that contribute to violence in drinking establishments. It also discusses the main prevention strategies, such as responsible server programs and community action projects, which have been developed to reduce violence in drinking environments.

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  • Miller, P., A. Sønderlund, K. Coomber, et al. 2011. Do community interventions targeting licensed venues reduce alcohol-related emergency department presentations? Drug and Alcohol Review 30:546–553.

    DOI: 10.1111/j.1465-3362.2011.00337.xSave Citation »Export Citation » Share Citation »

    This quasiexperimental study used time-series analysis to assess the effects of a multicomponent community-based intervention on alcohol-related injury presentations at an emergency room in one Australian city. The intervention was found to have no positive effect. Available online for purchase or by subscription.

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  • Treno, A. J., and H. D. Holder. 2001. Prevention at the local level. In International handbook of alcohol dependence and problems. Edited by N. Heather, T. J. Peters, and T. Stockwell, 771–783. New York: Wiley.

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    This chapter reviews the evidence from evaluations of the major community-based prevention programs that have used environmental approaches to reduce local alcohol use and alcohol-related problems including violence.

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  • Wallin, E., T. Norström, and S. Andréasson. 2003. Alcohol prevention targeting licensed premises: A study of effects on violence. Journal of Studies on Alcohol 64:270–277.

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    This quasiexperimental study used time-series analysis to assess the effects of a multicomponent community-based intervention on police-reported violence in Stockholm, Sweden. Violent crime decreased by 29 percent in the intervention area after controlling for changes in the control area of the city. Available online for purchase or by subscription.

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