Impacts of New Zealand's lowered minimum purchase age on context-specific drinking and related risks.

AIMS: The minimum purchase age (MPA) for alcohol in New Zealand (NZ) was reduced from 20 to 18 years in 1999. We assessed the degree to which this change was associated with alterations in uses of drinking contexts, drinking and related problems. METHODS: NZ National Alcohol Surveys among people 14+ years of age provided demographics, frequencies and amounts consumed in drinking places, and problem measures for 1995, 2000 and 2004. Censored regression estimates of parameters of a context-specific dose-response model identified MPA-associated changes in drinking and problems. RESULTS: The lowered MPA was associated with more frequent drinking at pubs/nightclubs among the newly of-age 18-19-year-olds (b = 15.26, P = 0.009), moderated drinking quantities at these places (b = -0.94, P = 0.034) and greater quantities consumed at home (b = 1.01, P = 0.010) and others' homes (b = 0.87; P = 0.029). Drinking frequency and quantity in the 16-17-year age group increased at home (b = 22.11, P = 0.040 and b = 1.22, P = 0.002) and others' homes (b = 11.65, P = 0.002 and b = 0.91, P = 0.021). Problems associated with drinking contexts changed post-MPA (G(2) ≥ 27.45, P ≤ 0.002), specifically increased association with drinking in pubs/nightclubs (b = 0.09, P < 0.001) across both age groups. CONCLUSIONS: The 1999 change in New Zealand's minimum purchase age for alcohol from 20 to 18 years appears to have been associated with substantive changes in uses of drinking contexts, drinking and associated drinking problems among 16-19-year-olds.

A review of alcohol and other drug control policy research.

OBJECTIVE: This article provides a historical review of alcohol and other drug policy research and its impact on public health over the past 75 years. We begin our summary with the state of the field circa 1940 and trace the development across the subsequent decades. We summarize current thinking and suggest possible future directions the field of alcohol and other drug policy may take. Specific topics discussed include the minimum legal drinking age, pricing and taxation, hours and days of sale, outlet density, and privatization effects. The future of drug policy research is also considered. METHOD: A comprehensive search of the literature identified empirical studies, reviews, and commentaries of alcohol and other drug policy research published from 1940 to 2013 that contributed to the current state of the field. RESULTS: Our review demonstrates the historical emergence of alcohol problems as a public health issue over the early part of the 20th century, the public health policy response to this issue, subsequent research, and current and future research trends. CONCLUSIONS: Alcohol and other drug policy research over the last several decades has made great strides in its empirical and theoretical sophistication of evaluating alcohol policy effects. This history is not only remarkable for its analytic complexity, but also for its conceptual sophistication.

Assessing the Validity of On-Premise Alcohol License Data in Six Communities in California: Operating Characteristics and Outlet Densities.

This study evaluated State of California alcohol license records as a measure of businesses selling alcohol for consumption on premise. In 2008, researchers attempted to visit all 799 licensed restaurants, bars, and pubs in six medium-sized cities near San Francisco. Surveys collected detailed business characteristics for a subsample of 151 bars or restaurants that included a separate bar area. Results suggest inaccuracies of official records regarding license locations and types (bar/pub vs. restaurant). Analyses also indicate that establishment characteristics are related to local alcohol outlet densities. Study implications and limitations are discussed.

Alcohol outlet densities and alcohol price: the British Columbia experiment in the partial privatization of alcohol sales off-premise.

BACKGROUND: Alcohol beverage prices or taxes have been shown to be related to alcohol sales and use and related problems. What is not clear are the mechanisms underlying these relationships. METHODS: This study examines the relationship between alcohol outlet density under conditions of the partial privatization of off-premise consumption in British Columbia (BC) occurring over the past decade. Two hypotheses are tested. First, reflecting basic supply-demand principles, greater geographic densities of alcohol outlets will be directly related to reductions in beverage prices in response to greater competition. Second, reflecting the effects of niche marketing and resulting market stratification, increased densities of private liquor stores will be especially related to reductions in beverage prices within this outlet category. Data were collected from: (i) a survey of BC private store prices and practices, (ii) alcohol outlet location information, and (iii) data on demographic characteristics. Multilevel models examine the relationships between prices at individual private liquor stores and the densities of government liquor stores, private liquor stores, bars, and restaurants, controlling for background demographics and geographic unit level effects. Spatial dependencies were also examined. RESULTS: Increased densities of private liquor stores were associated with lower mean prices of beer and all alcohol aggregated across brands at the store level. There appeared to be no outlet level effect on discounting patterns, however, with the mean price differences apparently reflecting differences in the quality of brands carried rather than unequal prices for any given brand. CONCLUSIONS: Increased densities of private off-sale alcohol outlets appear to result in lower prices charged at said establishments independently of other types of alcohol outlets suggesting that they represent an emerging marketing niche in the context of off-sale outlet privatization.

Ecological associations of alcohol outlets with underage and young adult injuries.

OBJECTIVE: This paper argues that associations between rates of 3 specific problems related to alcohol (i.e., accidents, traffic crashes, and assaults) should be differentially related to densities of alcohol outlets among underage youth and young adults based upon age-related patterns of alcohol outlet use. METHODS: Zip code-level population models assessed local and distal effects of alcohol outlets upon rates of hospital discharges for these outcomes. RESULTS: Densities of off-premise alcohol outlets were significantly related to injuries from accidents, assaults, and traffic crashes for both underage youth and young adults. Densities of bars were associated with more assaults and densities of restaurants were associated with more traffic crash injuries for young adults. CONCLUSIONS: The distribution of alcohol-related injuries relative to alcohol outlets reflect patterns of alcohol outlet use.

Alcohol outlets, youth drinking, and self-reported ease of access to alcohol: a constraints and opportunities approach.

BACKGROUND: Despite recent research examining youth access to alcohol, the extent to which relative ease of access to alcohol from various sources translates into the use of these sources is not known. METHODS: Patterns of adolescent alcohol access in California were studied using a hierarchical analysis of self-reported and archival measures. A survey of 30 youths age 14 to 16 in each of 50 zip codes selected to maximize variability in median household income and off-premise outlet densities was conducted. RESULTS: (1) Both actual use of and perceived ease of access to formal sources were positively associated with off-premise outlet density (a measure of formal access). (2) Actual use of informal sources was negatively associated with outlet densities. (3) Perceived and realized informal access were associated positively with deviance and negatively with conventionality. (4) Deviance was associated with increased perceived and realized access from both formal and social sources, whereas conventionality was only associated with realized and perceived informal access. CONCLUSIONS: Correlates of perceived and actual alcohol access differ somewhat, and the differences between informal and formal access (both perceived and actual) are many, creating a complex picture of the patterns of underage access to alcohol. Youth drinking is affected by opportunities and constraints. Specifically, as one form of access becomes constrained, youth appear to circumvent restrictions by relying on other modes of access. Thus interventions targeting formal alcohol access by youth may result in a shift to reliance on social sources. This complex problem requires a multi-faceted intervention approach.

Examining multi-level relationships between bars, hostility and aggression: social selection and social influence.

AIMS: This paper considers statistical relationships often observed between densities of bars and pubs and rates of violence as suggested by two general approaches: (i) social influence and (ii) social selection. METHODS: A stratified sample of 36 zip code areas in California was identified as having 'high', 'medium' and 'low' densities of bars and pubs. Aggregate US Census 2000 data were used to characterize population demographics of each zip code area. Telephone surveys were conducted assessing respondent demographics, drinking patterns, utilization of different places for drinking, self-report measures of hostility, norms for aggression and norms for alcohol-related aggression. Hierarchical linear models assessed the degree to which densities of bars and pubs were related to self-reports of hostility and norms for aggression, and if the individual measures of hostility and norms for aggression were related to choice of drinking venue. RESULTS: Respondents living in areas with greater densities of bars and pubs reported lower norms for aggression and greater norms for alcohol-related aggression. Greater peak drinking levels were related directly to greater levels of hostility and norms for both aggression and alcohol-related aggression. Self-reported hostility and norms for alcohol-related aggression were related directly to drinking at bars and pubs, parties and friends' homes. Aggressive norms were related to drinking at parties. CONCLUSIONS: Whether bars serve to concentrate aggressive people into selected environments, whether these environments serve to increase levels of aggression, or whether both these processes reinforce each other mutually is not known. However, our findings do indicate relationships between certain exogenous measures, including alcohol outlet densities and social-psychological characteristics associated with violence. Many of these measures are also associated with the social contexts in which people drink.

The Sacramento Neighborhood Alcohol Prevention Project: outcomes from a community prevention trial.

OBJECTIVE: This article reports the results of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP). SNAPP set as its goal the reduction of alcohol access, drinking, and related problems in two low-income, predominantly ethnic minority neighborhoods, focusing on individuals between the ages 15 and 29, an age group identified with high rates of alcohol-involved problems. METHOD: Two neighborhoods in Sacramento were selected to be the intervention sites because they were economically and ethnically diverse and had high rates of crime and other drinking-related problems. The quasi-experimental design of the study took a "phased" approach to program implementation and statistical examination of outcome data. Outcome-related data were collected in the intervention sites as well as in the Sacramento community at large. Five project interventions included a mobilization component to support the overall project, a community awareness component, a responsible beverage-service component, an underage-access law enforcement component, and an intoxicated-patron law enforcement component. Archival data were collected to measure and evaluate study outcomes and to provide background and demographic information for the study. RESULTS: Overall, we found significant (p < .05) reductions in assaults as reported by police, aggregate emergency medical services (EMS) outcomes, EMS assaults, and EMS motor vehicle accidents. CONCLUSIONS: Results from the Sacramento Neighborhood Alcohol Prevention Project demonstrate the effectiveness of neighborhood-based interventions in the reduction of alcohol-related problems such as assaults, motor vehicle crashes, and sale of alcohol to minors.

The impact of outlet densities on alcohol-related crashes: a spatial panel approach.

BACKGROUND: A number of studies using cross-sectional data have demonstrated that the availability of alcohol, measured by the number and types of alcohol outlets, is directly related to numerous measures associated with drinking and driving. The current study contributes the first observation of relationships over time between alcohol outlet densities on one hand and both automobile crashes and related injuries on the other hand. METHOD: The study examined longitudinal data from 581 consistently defined zip code areas represented in the California Index Locations Database, a geographic information system that coordinates population and ecological data with spatial attributes for areas across the state. Six years of data were collected on features of local populations (e.g., demographics, household size) and places (e.g., retail markets) thought to be related to two measures of automobile crashes (hospital discharges related to car crash injuries geocoded to the zip code of patient residence, and police reports associated with car crashes geocoded to the zip code of crash location). Both crash measures were positively associated with two outlet types: bars, and off-premise outlets. Additionally, restaurants appear to provide a protective effect relative to the residence-based measure. Crash rates were also related to changes in population and place characteristics using random effects models with controls for spatial autocorrelation (nxt=3486 observations). Changes in population and place characteristics of adjacent (spatially lagged) areas were also considered. RESULTS: Over time, both local and lagged population and place characteristics were related to automobile crash-related measures. CONCLUSION: Controlling for cross-sectional differences between zip code areas, changes in numbers of licensed alcohol retail establishments, especially bars and off-premise outlets, affect rates of car crashes and related injuries.

The price of alcohol: a consideration of contextual factors.

BACKGROUND: The current study considers the determinants of prices charged for alcoholic beverages by on-premise and off-premise outlets in Alaska. Alcohol outlet densities, a surrogate measure for local retail competition, are expected to be negatively associated with prices while costs associated with distribution are expected to be positively related to prices. Community demographic and economic characteristics may affect observed local prices via the level of demand, retail costs borne by retailers, or the quality of brands offered for sale. METHODS: The core data for these analyses came from a telephone survey of Alaskan retail establishments licensed to serve alcohol. This survey utilized computer-assisted telephone interviewing (CATI) techniques to collect alcohol-pricing information from on-premise (i.e., establishments where alcohol is consumed at the point of purchase such as bars and restaurants) and off-premise (i.e., establishments such as grocery stores and convenience markets where consumption occurs in other locations) alcohol retailers throughout the state of Alaska. Price estimates were developed for each beverage-type based on alcohol content. Separate regression analyses were used to model each of the 8 price indices (on-premise and off-premise measures for beer, spirits, wine, and the average price across beverage types). All regressions also controlled for a set of zip-code level indicators of community economic and demographic characteristics based on census data. RESULTS: Outlet density per roadway mile was unrelated to price for both on- and off-premise establishments, either across or between beverage types. In contrast, overall distribution costs did appear to be related to alcohol price. The demographic and economic variables, as a group, were significantly related to observed prices. CONCLUSIONS: More attention needs to be directed to the manner in which sellers and buyers behave relative to alcoholic beverages. Alcohol demand remains responsive to prices; yet, consumers have considerable latitude in determining the price that they pay for alcohol.

An exploratory study examining the spatial dynamics of illicit drug availability and rates of drug use.

This study examines the spatial relationship between drug availability and rates of drug use in neighborhood areas. Responses from 16,083 individuals were analyzed at the zip code level (n = 158) and analyses were conducted separately for youth and adults using spatial regression techniques. The dependent variable is the percentage of respondents using drugs in the past year. Neighborhood drug availability (the major independent variable) was measured by the percentage of non-drug users who had been approached to purchase drugs. Data were obtained as part of the Fighting Back community evaluation. For youth (aged 12 to 18), drug sales in adjacent and surrounding areas were positively associated with self-reported drug use in areas where youth were residents. For adults, drug sales within the neighborhood were negatively associated with drug use, while drug sales in immediately adjacent neighborhoods were positively related to self-reports of drug use. Findings suggest that the areas where rates of drug users are greatest are not necessarily the same area where drugs are sold. Designing strategies to reduce the supply of drugs should receive input from city and regional planners and developers, as well as law enforcement and public health professionals.

An examination of drug activity: effects of neighborhood social organization on the development of drug distribution systems.

OBJECTIVE: The ability to determine the geographic locations of illicit drug markets is central to the development of preventive interventions that address access to drugs and associated problems, such as violence and crime. METHOD: The current study examined individual self-reports of drug activities and demographic information obtained from two waves of a telephone survey of 1704 individuals aged 15 to 29 conducted in 1999 and 2001 across 95 census tracts in a Northern California city and measures of neighborhood characteristics derived from Census 2000 measures. RESULTS: The results of the study showed that, at the individual level, younger people and male respondents reported most drug activities. At the aggregate level, neighborhood poverty was directly related to higher rates of drug activity. Residential stability was found to moderate reports of drug activity observed by African-Americans and young people. CONCLUSION: Social processes reflected in neighborhood characteristics of census tracts influence rates of self-reports of individuals' exposures to drug activities.

The geography of COPD hospitalization in California.

Exposure to tobacco smoke is an important risk factor for chronic obstructive pulmonary disease. We investigated the relationship between chronic obstructive pulmonary disease hospitalization counts (and hospitalization-related charges) in California and sociodemographic and smoking measures, employing geospatial techniques that permit more sensitive scrutiny at the zip code level while controlling for spatial confounding. We analyzed 1,707 zip code tabulation areas in California for chronic obstructive pulmonary disease hospitalization rates and related hospitalization charges (using 1999 hospital discharge data). After controlling for spatial auto-correlation, positive relationships were found for age, percentage Hispanics, number of tobacco outlets and level of smoking. Inverse relationships were found for percentage with undergraduate degrees and income level. When examining "hotspot" zip code tabulation areas (those with higher than expected model-based chronic obstructive pulmonary disease hospitalization counts), minority/immigrant status, depressed socioeconomic measures, and elevated tobacco use were clearly associated, suggesting the need for increased intervention among the poor and persons of color. Although limited by the availability of air pollution monitoring data, a preliminary descriptive analysis indicated that the numbers of particulate matter exceedances mirrored both the hotspots of the Los Angelesair basin and coldspots in the San Francisco Bay Area.

Ethnic differences in driving after drinking and riding with drinking drivers among adolescents.

BACKGROUND: This study examined the relationship between ethnicity and driving after drinking (DD) and riding with drinking drivers (RWDD) while controlling for drinking patterns, driving practices, and background demographic characteristics including age and gender. METHODS: Using random-digit dialing procedures, 1534 young adults ranging from 15- to 20-years of age(mean = 17.6) living in California were recruited to participate in a telephone survey. Latinos, African Americans, and Asian Americans were oversampled to allow cross-group comparisons. RESULTS: Rates of DD were lower for females than for males and were also lower for African Americans and Asian Americans than for whites. However, after we controlled for drinking patterns and driving practices, the results showed Latinos at greater risk for DD than white adolescents. Compared with whites and males, Asian American and female adolescents were less likely to report RWDD. When drinking patterns and driving practices were taken into account, Latino adolescents were nearly twice as more likely to ride with drinking drivers than whites. CONCLUSIONS: These findings indicate a greater need for directing prevention efforts to target Latino youth and youth at risk. Moreover, research aimed at elucidating the social and environmental factors involved in the low prevalence rates of DD and RWDD among Asian American youth may indicate possible protective factors to DD and RWDD operating within the Asian American community.

Alcohol availability as a predictor of youth drinking and driving: a hierarchical analysis of survey and archival data.

BACKGROUND: Much attention has recently been directed toward developing preventive interventions to reduce drinking and driving through efforts to limit the numbers and locations of alcohol outlets at the community level. Although evaluations of these efforts have suggested linkages between alcohol outlets and problem outcomes, they have not addressed the linkage between outlets and drinking and driving among youth. The analysis reported here investigates the relationship between alcohol outlet densities and underage drinking and driving as self-reported on two telephone surveys conducted in California. METHODS: These analyses were based on data obtained from two telephone surveys conducted by the Prevention Research Center and archival data collected by the California Department of Alcoholic Beverage Control and the US Census Bureau. The sample for the first survey consisted of 15- to 20-year-old adolescents and young adults contacted by telephone, using a random digit dialing of exchanges in the greater San Francisco Bay Area. A second set of survey data was similarly collected by a random sample of households throughout California, and the Bay Area subset was also used for this analysis. RESULTS: At the individual level, older respondents were more likely to report drinking and driving and riding with drinking drivers, whereas females and Asians were less so. At the aggregate or city-level, alcohol outlet density, as measured by the number of on- and off-premises establishments licensed to sell alcohol, was associated with both drinking and driving and riding with drinking drivers. These effects were moderated by a number of individual level effects, with younger respondents and females more likely to be affected by outlet densities. CONCLUSIONS: The findings here provide support for the implementation of policies targeting alcohol outlet density reductions. Areas with large numbers of such outlets provide ample opportunities to youth for alcohol purchases.

Evaluating alcohol access and the alcohol environment in neighborhood areas.

BACKGROUND: This paper examines neighborhood, outlet, and server characteristics related to successful purchases of alcohol by intoxicated patrons and underage drinkers at alcohol establishments. It is hypothesized that outlets in commercial areas near to other premises, with poor exterior maintenance, much advertising, and inexperienced youthful servers will be more likely to sell alcohol to intoxicated and underage patrons. METHODS: Data were collected using pseudo-intoxicated patron and apparent minor surveys of randomly selected alcohol establishments in a metropolitan area of northern California. Data collection operations included independent surveillance of these drinking places to establish neighborhood and premise characteristics and pseudo-intoxicated patron and apparent minor stings to assess rates of these forms of illegal alcohol sales. Male actors feigning intoxication and female of-age youth identified as appearing to be 20 years or younger attempted to purchase alcohol at on- and off-premise establishments, respectively. Rates of sales (off-premise) and service (on-premise) were the primary outcomes. RESULTS: Apparent minors purchased alcohol in 39% of attempts (95% CI, 34-45%) while pseudo-intoxicated patrons were served alcohol in 58% of attempts (95% CI, 50-67%). Sales to apparent minors were significantly related to percentage of Hispanic residents and areas with greater population density. Sales to pseudo-intoxicated patrons were more frequent when the server was male and appeared to be under the age of 30. These sales were also more frequent in Hispanic neighborhoods with high population density and high numbers of on-premise outlets but were less frequent in African American neighborhoods. CONCLUSION: The findings suggest that underage and intoxicated patron sales differ by areas. Both forms of illegal sales of alcohol are more likely in highly populated areas of communities. The findings also suggest that server characteristics are strongly related to sales to intoxicated patrons, suggesting some leverage for responsible beverage service programs in these environments.

Approaching alcohol problems through local environmental interventions.

One approach for reducing alcohol and other drug problems is community-based prevention programs. These programs focus on changing the environment in which a person consumes alcohol rather than the behavior of the individual drinker. Several international and U.S. programs have assessed the effectiveness of such approaches in reducing alcohol-related problems. Some of those analyses have had inconclusive results. Others, however, found reductions in alcohol-related problems such as drunk driving, alcohol-related car crashes and their consequences, the sale of alcohol to underage drinkers, and assault injuries. Nevertheless, several aspects of community-based prevention programs require further study.

Outlets, drinking and driving: a multilevel analysis of availability.

OBJECTIVE: This study examines the degree to which the physical availability of alcohol as measured by outlet densities is related to self-reported individual drinking patterns, preferred drinking location, as well as both driving after drinking (DAD) and driving while intoxicated (DWI). METHOD: Data from 7,826 drinkers were obtained from a general-population telephone survey of 1,353 zip code areas in California. Measures of individual alcohol consumption included drinking frequency, drinks per occasion and variance in quantities consumed per occasion. Preferred drinking locations included bars, restaurants and the homes of drinkers and of their friends. DAD was defined as driving a motor vehicle within 4 hours of having one or more alcoholic drinks, and DWI was defined as driving after having too much to drink and drive safely. Geographic measures of outlet densities were obtained for bars, restaurants and off-premises establishments, using zip codes as geographic units of analysis. Hierarchical linear modeling was used to relate outlet densities within and surrounding respondents' area of residence to respondents' drinking and to respondents' drinking and driving. RESULTS: Whereas restaurant densities were directly related to greater drinking frequencies and DAD, bar densities were inversely related to DAD. There were no direct effects of drinking patterns on drinking and driving. Drinking and driving was strongly related to drinking location preference (e.g., bars and restaurants) only when considered simultaneously with individual drinking patterns, particularly drinking frequency. CONCLUSIONS: Increased restaurant density is strongly related to higher rates of both self-reported driving after drinking and drinking frequency. The strongest influence on both driving after drinking and driving while intoxicated is preferred drinking location considered together with individual drinking patterns. Outlet density and preferred drinking location when considered together with individual drinking patterns support driving after drinking and thereby increase the potential for alcohol-related accidents.