High Outlet Density Research Articles

Did the association between alcohol outlet density and crime change during COVID shelter-in-place orders?

We investigated whether greater concentrations of on- and off-sale alcohol outlets were associated with crime and whether this association was moderated by COVID-19 shelter-in-place orders (SIP) that restricted on-premises consumption of alcohol. Crimes (2019-2020) and addresses of licenced alcohol outlets in a medium-sized California city were geocoded within census block groups (N = 61). On- and off-sale alcohol outlet density was calculated as licenced outlets/2.59 km2 (1 square mile). Multilevel negative binomial regression analyses were conducted to examine associations between alcohol outlet density and crime, and possible moderating effects of SIP, controlling for block group demographic characteristics and density of other retail businesses. On-sale outlet density was positively associated with total crimes and Part 2 crimes, while off-sale outlet density was inversely associated with total crime and Part 2 crimes. Overall, SIP was not significantly associated with crime, but moderated the associations of on-sale density with total crime and Part 1 crimes such that reductions in crime during SIP were observed in higher density areas. The association of off-sale outlets with crime was not moderated by SIP policies. On-sale outlet density, but not off-sale density, appears to be associated with increased crime. The results further indicate that restrictions in hours and service imposed by SIP policies reduced crime in high on-sale outlet density areas. These findings reinforce the importance of regulating alcohol outlet density and hours of service, especially for on-sale outlets, as a crime reduction strategy.

The potential adverse effects of minors' exposure to alcohol-related stimuli via licenced venues: A narrative review.

Young people are particularly impressionable when it comes to forming expectations and attitudes around alcohol consumption. Any stimuli that normalise and foster positive expectations around alcohol use may increase the risk of underage alcohol consumption. Alcohol venues that market themselves as being appropriate 'family friendly' establishments for children risk exposing minors to environments that are saturated with alcohol-related stimuli. However, research examining how exposure to licenced venues affects underage people is very limited. The aim of this narrative review was to identify and synthesise relevant evidence to better understand how attending these venues might affect minors. A narrative review of research published between January 2016 and November 2022 was conducted to investigate the potential effects on underage people of exposure to licenced venues and stimuli encountered in/around these venues. Examined stimuli included alcohol advertising, people consuming alcohol and alcohol outlets. The reviewed literature indicates that the risk of alcohol-related harm among minors is likely to increase with greater exposure to alcohol venues due to the associated exposure to alcohol advertising, exposure to others consuming alcohol and higher outlet density. In combination, these factors are likely to normalise alcohol consumption for minors and create positive alcohol expectancies. Venues serving alcohol should be discouraged from targeting families and parents should be warned about the risks associated with taking minors to venues where alcohol is sold and consumed.

Alcohol outlets and alcohol consumption in changing environments: prevalence and changes over time

BackgroundTo examine whether changes in density of neighborhood alcohol outlets affected changes in alcohol consumption 1-year after regulatory changes increased alcohol availability.MethodsPerson-level data came from a population-based cohort (aged 21–64) residing in/around the Philadelphia, Pennsylvania metropolitan area (2016–2018, N = 772). Fifty-eight percent lived in a state that began implementing new regulations (Pennsylvania) and the remainder lived in states without major regulatory changes (Delaware and New Jersey). Alcohol consumption was assessed as days per week (pw), drinks pw, high consumption (≥8 drinks pw), and binge drinking. Availability of off-premise alcohol outlets was assessed using 1-mile density and distance. Regression models adjusted for age, gender, race/ethnicity, income, education, health status, state and population density.ResultsCross-sectional analyses found that higher outlet density was associated with more alcohol consumption (days, drinks, high consumption; all p < 0.03) and residing farther from an outlet was associated with less alcohol consumption (days and drinks; all p < 0.04). In longitudinal analyses, relative to no change in outlets, exposure to more outlets was associated with 64% higher odds of drinking on more days pw (p < 0.049) and 55% higher odds of consuming more drinks pw (p < 0.081). However, the longitudinal association between changes in outlets and changes in consumption did not differ for residents in Pennsylvania vs. nearby states. In cross-sectional and longitudinal analyses, outlets were not related to binge drinking.ConclusionOff-premise outlets were associated with alcohol consumption consistently in cross-sectional analysis and in some longitudinal analyses. Results can inform future studies that wish to evaluate longer-term changes in increased alcohol availability and effects on consumption.

The combined impact of higher-risk on-license venue outlet density and trading hours on serious assaults in night-time entertainment precincts

BackgroundNight-time entertainment precincts (NEPs) are clusters of higher-risk on-licence venues, that pose a significant burden on health and social order services. Outlet density and trading hours are two of the most well researched contributors to alcohol availability within NEPs; increases in outlet density and late-night trading hours within NEPs have been independently associated with increased assaults. This is the first study to examine both factors across cities to predict alcohol-related assaults. MethodsLicensing data were used to investigate the effect of outlet density and trading hours on police recorded serious assaults in nine NEPs (9 cross-sectional units) across Queensland from January 2010 to July 2018 at monthly intervals (102 longitudinal units). Multi-level models were used to determine i) whether precinct-level trading hours moderated the relationship between outlet density and serious assaults; and ii) the impact of outlets closing before 12am, 3am, and 5am on serious assaults. FindingsThe positive relationship between outlet density and assaults was stronger in precincts with trading hours ending at 5am compared to 3am (IRR = 1.01, p = 0.03). The amount of venues closing before 12am was associated with reduced numbers of assaults (IRR = 0.97, p = 0.04), while venues closing between 12:01am-3am and 3:01am-5am were associated with increased assaults (IRR = 1.02, p<0.01; IRR = 1.01, p = 0.02). ConclusionsLate night service of alcohol creates more harm in areas of high outlet density, whereas early closing venues in areas where outlet density is low is associated with reduced number of assaults. This relationship should be taken into account in the development of future alcohol policies.

Where we eat is who we are: a survey of food-related travel patterns to Singapore\u2019s hawker centers, food courts and coffee shops

BackgroundThe development of empirically-grounded policies to change the obesogenic nature of urban environment has been impeded by limited, inconclusive evidence of the link between food environments, dietary behaviors, and health-related outcomes, in part due to inconsistent methods of classifying and analyzing food environments. This study explores how individual and built environment characteristics may be associated with how far and long people travel to food venues,that can serve as a starting point for further policy-oriented research to develop a more nuanced, context-specific delineations of ‘food environments’ in an urban Asian context.MethodsFive hundred twenty nine diners in eight different neighborhoods in Singapore were surveyed about how far and long they travelled to their meal venues, and by what mode. We then examined how respondents’ food-related travel differed by socioeconomic characteristics, as well as objectively-measured built environment characteristics at travel origin and destination, using linear regression models.ResultsLow-income individuals expended more time traveling to meal destinations than high-income individuals, largely because they utilized slower modes like walking rather than driving. Those travelling from areas with high food outlet density travelled shorter distances and times than those from food-sparse areas, while those seeking meals away from their home and work anchor points had lower thresholds for travel. Respondents also travelled longer distances to food-dense locations, compared to food-sparse locations.ConclusionThose seeking to improve food environments of poor individuals should consider studying an intervention radius pegged to typical walking distances, or ways to improve their transport options as a starting point. Policy-focused research on food environments should also be sensitive to locational characteristics, such as food outlet densities and land use.

Structural racism in the built environment: Segregation and the overconcentration of alcohol outlets.

Structural racism, evidenced in practices like residential racial segregation, has been linked to health inequities. We examined the relationship between an adverse environmental factor (alcohol outlet overconcentration), segregated neighborhoods, and county alcohol policy in Louisiana and Alabama to investigate this link. Multilevel analysis revealed high outlet density associated with segregated counties and predominantly black census tracts in counties with restrictive alcohol policy. This inverse association between policies designed to limit alcohol availability and overconcentration of outlets in black neighborhoods warrants consideration by policymakers given links between outlet density and health inequities. Consideration of these findings in historical context suggests these policies may function as a contemporary actualization of the historical use of alcohol policy to subjugate black people in the South, now over-concentrating instead of prohibiting access.

Restricting alcohol outlet density through cumulative impact provisions in planning law: Challenges and opportunities for local governments.

There is international interest in how to limit growth in alcohol availability in areas of high outlet density in order to reduce alcohol-related harms. Town planning legislation in Victoria, Australia, allows local government officers to refuse planning permits for new licensed premises on 'cumulative impact' grounds (impacts from existing alcohol outlet density). State guidelines (PN61) outline how local government planners should approach cumulative impact assessments. This paper explores officers' views and experience assessing cumulative impact in order to understand whether the legislation assists officers limit alcohol availability in areas of high outlet density. Interviews with 22 officers from 11 local governments who were recruited with purposive sampling to reflect a range of licensing environments. Interview transcripts were analysed inductively, and content categorized accordingly. Officers challenged the definition and relevance of the alcohol outlet density threshold provided in state guidelines. They faced problems securing relevant amenity data for assessing cumulative impact and pointed to the guidelines' inadequacy for assessing off-premise licences. They pointed to the limits of cumulative impact assessments as a tool for planning and were unconvinced they would lead to reductions in permits granted. A single state-wide density threshold to guide cumulative impact assessments is unlikely to be a relevant measure for several local governments. A greater orientation towards municipal variation and alcohol outlet characteristics is needed. Further research is needed to investigate whether cumulative impact assessments increase restrictions on liquor licence planning permits and whether the adoption of local planning policies strengthens restrictive permit decision-making. International implications of the research are noted.

Longitudinal impacts of two causal drivers of alcohol demand on outlet concentrations within community settings: Population size and income effects

We analyzed counts of licensed bars, restaurants and off-premise alcohol outlets within 53 California cities from 2000–2013. Poisson models were used to assess overall space-time associations between outlet numbers and population size and median household income in local and spatially adjacent block groups. We then separated covariate effects into distinct spatial and temporal components (“decomposed” models). Overall models showed that densities of all outlet types were generally greatest within block groups that had lower income, were adjacent to block groups with lower income, had greater populations, and were adjacent to block groups that had greater populations. Decomposed models demonstrate that over time greater income was associated with increased counts of bars, and greater population was associated with greater numbers of restaurants and off-premise outlets. Acknowledging the many negative consequences for populations living in areas of high outlet density, these effects are a predictable and powerful social determinant of health.

Space-Time Analyses of Alcohol Outlets and Related Motor Vehicle Crashes: Associations at City and Census Block-Group Levels.

Past research has linked alcohol outlet densities to drinking, drunken driving, and alcohol-related motor vehicle crashes (MVCs). Because impaired drivers travel some distances from drinking places to crash locations, spatial relationships between outlets and crashes are complex. We investigate these relationships at 3 geographic levels: census block groups (CBGs), adjacent (nearby) areas, and whole cities. We examined risks of all injury MVCs as well as "had been drinking" (HBD) and single-vehicle-nighttime (SVN) subgroups using data from the Statewide Integrated Traffic Records System across CBGs among 50 California cities from 2001 to 2008. Relationships between outlet densities at the city level, within CBGs, and in adjacent CBGs and crashes were examined using Bayesian Poisson space-time analyses controlling for population size income and other demographics (all as covariates). All injury MVCs were positively related to adjacent CBG population size (relative rate [RR]=1.008, 95% credible interval (CI)=1.004, 1.012), and outlet densities at CBG (RR=1.027, CI=1.020, 1.035), nearby area (RR=1.084, CI=1.060, 1.106) and city levels (RR=1.227, CI=1.147, 1.315), and proportion of bars or pubs at the city level (RR=2.257, CI=1.187, 4.125). HBD and SVN crashes were comparatively less frequent in high outlet density CBG (RR=0.993, CI=0.987, 0.999; RR=0.963, CI=0.951, 0.975) and adjacent areas (RR=0.979, CI=0.962, 0.996; RR=0.909, CI=0.883, 0.936), but positively associated with city-level proportions of bars (RR=3.373, CI=0.736, 15.644; RR=10.322, CI=1.704, 81.215). Overall, a 10% increase in alloutlets was related to 2.8% more injury crashes (CI=2.3, 3.3) and 2.5% more HBDs (CI=1.7, 3.3). A10% increase in bars was related to 1.4% more crashes, 4.3% more HBDs, and 10.3% more SVNs. Population size and densities of bars or pubs were found to be associated with crash rates, with population effects appearing across cities and outlet effects appearing within dense downtown areas. Summary estimates of outlet and population impacts on MVCs must consider varying contributions at multiple spatial scales.

Controlling alcohol availability through local policy: an observational study to evaluate Cumulative Impact Zones in a London borough.

Cumulative impact zones (CIZs) are a discretionary policy lever available to local government, used to restrict the availability of alcohol in areas deemed already saturated. Despite little evidence of their effect, over 200 such zones have been introduced. This study explores the impact of three CIZs on the licensing of venues in the London Borough of Southwark. Using 10 years of licensing data, we examined changes in the issuing of licences on the introduction of three CIZs within Southwark, relative to control areas. The number of licence applications made (N = 1110), the number issued, and the proportion objected to, were analysed using negative binomial regression. In one area tested, CIZ implementation was associated with 119% more licence applications than control areas (incidence rate ratios (IRR) = 2.19, 95% confidence intervals (CI): 1.29-3.73, P = 0.004) and 133% more licences granted (IRR = 2.33, 95% CI: 1.31-4.16, P = 0.004). No significant effect was found for the other two areas. CIZs were found to have no discernible effect on the relative proportion of licence applications receiving objections. CIZs are proposed as a key lever to limit alcohol availability in areas of high outlet density. We found no evidence that CIZ establishment reduced the number of successful applications in Southwark.

Investigations about the effect of fractal distributors on the hydrodynamics of fractal packs of novel plate and frame designs

Flow distributors are extensively adopted by chemical industry to distribute process fluid for the downstream equipment. Conventional flow distributors in general have limited number of outlets. Their low outlet densities cannot distribute the incoming process stream uniformly and efficiently, which consequently undermine the overall equipment performance. In contrast, fractal distributors can achieve high outlet densities because of their inherent self-similarity feature. In this study, we fabricated two fractal packs of novel plate and frame designs. Each fractal pack was comprised of a fractal distributor, a resin bed and a fractal collector. The fractal distributors/collectors in these two fractal packs have 256 and 16 outlets/inlets, respectively. In this study, we carried out both CFD modeling and experiments to understand the effect of outlet density on the hydrodynamics of the downstream resin bed. By comparing the predicted velocity fields and the measured residence time distribution (RTD) curves, we noticed that a fractal distributor of high outlet density can distribute the process stream uniformly at a low pressure drop to the resin bed. The process streams entering the resin bed reach plug flow profile within a short bed depth. As a result of the uniform flow distribution, mal-distribution such as channeling and dead space are minimized, and the process streams have a uniform RTD in the fractal pack. In comparison, the fractal distributor of low outlet density, which mimics some aspects of a conventional distributor, is found to have severe mal-distribution in the resin bed and consequently poor RTD inside the fractal packs. In addition, the RTD analysis confirms that the fractal distributor of high outlet density shows consistently good distributing performance for a wide range of operating flow rates. This study confirms the advantages of fractal distributors over conventional ones and demonstrates the benefit of fractal distributors in improving the overall performance of chemical equipment, indicating that fractal distributors are promising to enable process intensification for the chemical industry.

Environmental characteristics of hotspots of alcohol-related health incidents outside of the entertainment districts of Amsterdam

While hotspots of alcohol-related incidents have been associated with alcohol outlet density, few studies have considered other environmental factors. We aimed to characterise the environment of hotspots outside of outlet density areas in Amsterdam. Using geographical information systems, we identified hotspots of alcohol-related health incidents outside of outlet density areas based on the registry of alcohol related ambulance attendances. While quantitative data and methods were used to analyse victim profiles (including age, sex and home address) and temporal profiles (time of incident), we combined quantitative and qualitative information to develop environmental profiles of these hotspots. We identified 11 hotspots with 242 incidents outside outlet density areas. Results indicate substantial differences between incidents in these hotspots and incidents in high outlet density areas. Victims in these hotspots are older, more often male and live closer to the incident location compared to victims in high outlet density hotspots. Incidents are less likely to take place during the night and at weekends. In-depth analysis of four hotspots showed different combinations of contributing environmental factors, including (a) public parks bordering deprived neighbourhoods, (b) dance event facilities close to a traffic black spot, and (c) residential services for disadvantaged groups near ‘hang-outs’. The study shows that hotspots of alcohol-related incidents can arise outside outlet density areas at locations where several other environmental factors cluster, particularly in more deprived areas. Such hotspots can be addressed in urban planning and urban design.

Differential Effects of Neighborhood Type on Adolescent Alcohol Use in New Zealand.

Identifying neighborhood typologies associated with adolescent alcohol use can inform the development of harm reduction strategies. Utilizing data from a nationally representative youth survey (n = 4267) in New Zealand, latent class analysis was used to categorize neighborhood types (defined by 10 demographic, social and environmental indicators) to investigate their association with alcohol consumption and related harm. Three neighborhood types were distinguished: (1) "high outlet density and economic deprivation" (30 % of all neighborhoods); (2) "high deprivation, social disorganization, and unsafe" (38 %); and (3) "higher income, safe, and socially organized" (32 %). Significant ethnic variation was evident between neighborhood types. There was an age-group interaction in the main effects with significant associations between neighborhood type and drinking measures and harm most apparent among younger adolescents (<16years), as described next. Compared to students residing in "higher income, safe, and socially organized" neighborhoods, the frequency of binge drinking and high typical consumption was significantly higher in students residing in "high outlet density and economic deprivation" and "high deprivation, social disorganization, and unsafe", with students residing in "high outlet density and economic deprivation" also experiencing higher levels of alcohol-related harm. The findings that neighborhoods characterized by high deprivation and alcohol outlet density and low social organization and perceptions of safety were associated with risky drinking patterns and harm, specifically among young adolescents, underscores the importance of adopting a developmental approach to the study of contextual effects on adolescents.

Examining local processes when applying a cumulative impact policy to address harms of alcohol outlet density

One approach to addressing the negative health and social harms of excessive drinking has been to attempt to limit alcohol availability in areas of high outlet density. The Licensing Act (2003) enables English local authorities the power to implement a Cumulative Impact Policy (CIP) in order to tackle alcohol challenges. More than 100 English local authorities have implemented a CIP in one or more designated areas. We examined local licence decision-making in the context of implementing CIPs. Specifically, we explored the activities involved in alcohol licensing in one London local authority in order to explicate how local decision-making processes regarding alcohol outlet density occur. Institutional ethnographic research revealed that CIPs were contested on multiple grounds within the statutory licensing process of a local authority with this policy in place. CIPs are an example of multi-level governance in which national and local interests, legal powers and alcohol licensing priorities interface. Public health priorities can be advanced in the delivery of CIPs, but those priorities can at times be diluted by those of other stakeholders, both public sector and commercial.

Tobacco outlet density and converted versus native non-daily cigarette use in a national US sample

ObjectiveInvestigate whether non-daily smokers’ (NDS) cigarette price and purchase preferences, recent cessation attempts, and current intentions to quit are associated with the density of the retail cigarette product landscape surrounding...

Compulsive buying and depressive symptoms among female citizens of the United Arab Emirates

Compulsive buying is particularly relevant in nations with high levels of consumer spending. Most previous studies have focused on European and North America populations. This study explores compulsive buying amongst citizens of the United Arab Emirates, an Arab nation with high retail outlet density, and high levels of consumer spending. Female college students (N=100) completed an English/Arabic version of the compulsive buying scale along with a measure of depression. Rates of compulsive buying were higher than those reported in any previously published study. Furthermore, in line with previous findings from other nations, compulsive buying was associated with elevated depressive symptomatology.

Associations of Alcohol Availability and Neighborhood Socioeconomic Characteristics With Drinking: Cross-Sectional Results From the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Living in neighborhoods with a high density of alcohol outlets and socioeconomic disadvantage may increase residents’ alcohol use. Few researchers have studied these exposures in relation to multiple types of alcohol use, including beverage-specific consumption, and how individual demographic factors influence these relationships. Objective: To examine the relationships of alcohol outlet density and neighborhood disadvantage with alcohol consumption, and to investigate differences in these associations by race/ethnicity and income. Methods: Using cross-sectional data (N = 5,873) from the Multi-ethnic Study of Atherosclerosis in 2002, we examine associations of residential alcohol outlet density and neighborhood socioeconomic disadvantage with current, total weekly and heaviest daily alcohol use in gender-specific regression models, as well as moderation by race/ethnicity and income. Results: Drinking men living near high densities of alcohol outlets had 23%–29% more weekly alcohol use than men in low density areas. Among women who drank, those living near a moderate density of alcohol outlets consumed approximately 40% less liquor each week than those in low density areas, but higher outlet densities were associated with more wine consumption (35%–49%). Living in highly or moderately disadvantaged neighborhoods was associated with a lower probability of being a current drinker, but with higher rates of weekly beer consumption. Income moderated the relationship between neighborhood context and weekly alcohol use. Conclusions/Importance: Neighborhood disadvantage and alcohol outlet density may influence alcohol use with effects varying by gender and income. Results from this research may help target interventions and policy to groups most at risk for greater weekly consumption.

Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities?

Alcohol consumption may be influenced by the local alcohol retailing environment. This study is the first to examine neighbourhood alcohol outlet availability (on- and off-sales outlets) and alcohol-related health outcomes in Scotland. Alcohol-related hospitalisations and deaths were significantly higher in neighbourhoods with higher outlet densities, and off-sales outlets were more important than on-sales outlets. The relationships held for most age groups, including those under the legal minimum drinking age, although were not significant for the youngest legal drinkers (18–25 years). Alcohol-related deaths and hospitalisations were higher in more income-deprived neighbourhoods, and the gradient in deaths (but not hospitalisations) was marginally larger in neighbourhoods with higher off-sales outlet densities. Efforts to reduce alcohol-related harm should consider the potentially important role of the alcohol retail environment.

The association between the density of retail tobacco outlets, individual smoking status, neighbourhood socioeconomic status and school locations in New South Wales, Australia

AimWe explored the association between the density of tobacco outlets and neighbourhood socioeconomic status, and between neighbourhood tobacco outlet density and individual smoking status. We also investigated the density of tobacco outlets around primary and secondary schools in New South Wales (NSW). MethodsWe calculated the mean density of retail tobacco outlets registered in NSW between 2009 and 2011, using kernel density estimation with an adaptive bandwidth. We used generalised ordered logistic regression model to explore the association between socioeconomic status and density of tobacco outlets. The association between neighbourhood tobacco outlet density and individuals’ current smoking status was investigated using random-intercept generalised linear mixed models. We also calculated the median tobacco outlet density around NSW schools. ResultsMore disadvantaged Census Collection Districts (CDs) were significantly more likely to have higher tobacco outlet densities. After adjusting for neighbourhood socioeconomic status and participants’ age, sex, country of birth and Aboriginal status, neighbourhood mean tobacco outlet density was significantly and positively associated with individuals’ smoking status. The median of tobacco outlet density around schools was significantly higher than the state median. ConclusionPolicymakers could consider exploring a range of strategies that target tobacco outlets in proximity to schools, in more disadvantaged neighbourhoods and in areas of existing high tobacco outlet density.

Have drivers at alcohol outlets changed their behavior after the new traffic law?

In an attempt to reduce high levels of traffic crashes, a new legislation was approved in Brazil in 2008. This study aimed to assess behavioral change among drivers who had drunk at alcohol outlets (AO) after implementation of the law. A three-stage probability sampling survey was conducted in Porto Alegre, state of Rio Grande do Sul, Brazil. Individuals seen leaving AOs after drinking were approached (n=3,018). Selected drivers (n=683) answered a structured interview, were breathalyzed, and had saliva specimens collected for drug screening. Overall, 60.3% (SE 4.5) of drivers reported they did not change their behavior. Among those who reported behavioral changes, most reported drinking less as their main strategy toward safer driving behavior. Variables independently associated with behavior change included having drunk at a high outlet density area (odds ratio [OR] 1.7 [1.1-2.8]) and having a favorable opinion about the law (OR 4.3 [2.1-8.9]). Our findings suggest that awareness of the law has not been enough to promote behavioral change. As most drivers had a favorable opinion of the law and this variable was found to be the strongest predictor of behavior change, efforts to better integrate education and enforcement seem to be pivotal and might be well received by the population.