NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Center for Substance Abuse Prevention (US); Grover PL, editor. Preventing Problems Related to Alcohol Availability: Environmental Approaches (Reference Guide). Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Prevention Enhancement Protocols System (PEPS), No. 3.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Preventing Problems Related to Alcohol Availability: Environmental Approaches (Reference Guide).

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1Public Health and Safety Problems Related to Alcohol Availability

The most effective prevention methods target the broad community problems caused by alcohol abuse.

Throughout its history, the United States has attempted to minimize the social problems that arise from the distribution, sale, and use of alcohol; over the course of two and a quarter centuries a variety of Federal, State, and local initiatives have been tried to prevent the alcohol-related problems that threaten public health and safety. For all their good intentions, however, many of these efforts have narrowly focused on managing individual alcohol outlets that serve customers to the point of intoxication, that sell alcohol to underage youth, or that threaten neighborhood safety, overlooking the larger environmental factors that are both more subtle and more pervasive. Effective prevention interventions must target not only specific problem drinkers and alcohol retailers but the broader communities they inhabit.

alcohol outlet - a business or location where alcoholic beverages are sold to the public or to a select membership.

According to a 1990 U.S. Department of Health and Human Services (DHHS) report, the most effective State and local approaches to solving the problems associated with alcohol use are those that involve the full range of community systems: health, education, transportation, law, engineering, architecture, and public safety. The participation of concerned citizens, community groups, and alcohol retailers themselves can also help with problems related to the distribution and sale of alcoholic beverages.

This guide focuses on broad, environmental approaches to prevention that take into account everything from social and economic factors to land use, framed by the public health model described by Fagan (1993a, b). Fagan's model emphasizes identifying the settings and circumstances within communities at highest risk for alcohol-related problems and applying interventions that address the links between problem behaviors and environmental factors.

This first chapter of the guide defines the terms used, presents data on alcohol-related problems, and their effects on public health. It also offers an assessment of community involvement in prevention efforts.

Alcohol Problems and Public Health Safety

The publication Healthy People 2000 (U.S. Department of Health and Human Services 1990), part of the Federal Government's initiative to reduce the incidence, prevalence, and consequences of high-priority health problems, indicated that alcohol use contributes to morbidity, injuries, and mortality from cirrhosis of the liver - the Nation's ninth leading cause of death - vehicular and workplace accidents, domestic violence, child abuse and neglect, and homicides and suicides.

The consequences of alcohol abuse call for government and community efforts in myriad areas: dealing with drunk-driving accidents; handling alcohol-related crime; treating alcohol dependence and related medical problems, including secondary consequences such as fetal alcohol syndrome; and making up for lost productivity from workers who are impaired, incarcerated, victims of crime, in need of medical treatment, or dead before their time due to alcohol. In addition to the tragedy is enormous expense: the economic costs of alcohol abuse in the United States came to approximately $99 billion in 1990 and were projected to reach $124 billion by 1997 (Parsons and Kamenca 1993; Rice 1993).

Alcohol and Non-Vehicular Trauma

People who abuse alcohol are both more likely to be involved in physically traumatic events and more likely to be seriously hurt in them than nondrinkers are. In fact, according to the National Hospital Ambulatory Medical Care Survey (Stussman 1997), more than half of all emergency-room visits associated with alcohol or drug use involve traumatic injuries. The report also notes that individuals who die from injuries are more likely to have used alcohol more frequently and heavily than are those who die from disease.

Other studies indicate that alcohol is a factor in 21 to 47 percent of drownings, 35 to 63 percent of deaths from falls, and 12 to 61 percent of fire-related deaths (Hingson and Howland 1993). Burn victims with blood alcohol concentrations (BAC's) above 0.06 percent were more than twice as likely to die as burn victims with BAC's of 0.06 or less (Haum et al. 1995).

Alcohol abuse is particularly prevalent among patients with head trauma. Research findings vary, but generally indicate that more than 50 percent of those who sustain head injuries were drinking alcohol before or at the time of injury (Kraus 1993). To put the consequences in hard dollar terms, in 1994 the National Head Injury Foundation estimated the lifetime medical expenses for a person with a severe head injury at $4.6 million.

Alcohol, Crime, and Violence

The use of alcohol is indisputably associated with homicide, sexual and other assault, domestic violence, and child abuse (Roizen 1997). A review of several studies of drinking patterns and homicides shows that 7 to 85 percent of murderers had been drinking when they committed their crimes; most of the studies reported that 60 percent of homicide offenders were drinking at the time of the offense (Murdoch, Pihl, and Ross 1990). A study of police reports in northern Ontario revealed that among the several hundred incidents reported by community residents, 20 percent involved marital abuse, in which 44 percent of the assailants and 14 percent of the victims had been drinking (Pernanen 1991).

According to a 1990 study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol also has factored in approximately a third of all suicides. In addition, positive blood alcohol levels are frequently found among victims of drug overdoses (Commonwealth of Massachusetts 1995).

Alcohol and Youth

Nationwide studies report that more than half of America's 8th graders and 80 percent of 12th graders have tried alcohol, even though buying it is illegal for anyone under 21. Even worse, heavy drinking is reported by 15 percent of 8th graders, 28 percent of 12th graders, and 34 percent of college students (Johnston, O'Malley, and Bachman 1995). While these percentages appear to be on the decline, they remain disturbingly high. Comparing data from 1990 with 1984 surveys, Midanik and Clark (1995) reported a significant increase among 18- to 29-year-olds who have experienced two or more negative social consequences due to drinking. Among all age groups, these young adults also comprised the highest percentage of individuals classified as alcohol abusers and alcohol dependents (Catalano and Room 1994; Grant et al. 1994).

Among young people in particular, alcohol use is known to be associated with a decreased likelihood of condom use and other measures to prevent pregnancy and disease transmission from sexual intercourse (Strunin and Hingson 1992). Heavy consumption of alcohol along with other drug use is also associated with poor school performance, high school dropout, and problems with work productivity later in life (Cook and Moore 1992). Young people entering the work force immediately after high school tend to maintain the drinking patterns established in their last school years; approximately 30 percent report that they are heavy drinkers (Harford 1993).

A survey at 140 colleges found that 44 percent of students reported binge drinking, defined as five or more drinks per sitting. Frequent binge drinkers were 10 times more likely than non-binge drinkers to report trouble with campus police, damages to property, injuries, and unplanned or unprotected sex (Wechsler et al. 1994). A nationwide survey of students in grades 9 through 12 found that the prevalence of drinking and driving increased substantially with alcohol use and especially binge drinking (Escobedo, Chorba, and Waxweilen 1995).

Alcohol Consumption and Related Problems

It is clear that an individual's level of consumption is related to the nature and extent of any problems that result from alcohol use, as demonstrated by risk function analysis, which looks at relationships between volumes of alcohol consumed and the social consequences (NIAAA 1997). A report by Room, Bondy, and Ferris (1995) states that in six life areas, the probability of harm rises steadily with the respondent's alcohol consumption. Considering similar findings by other researchers, Edwards et al. (1994) observe that the lessons "for the individual and society are outstandingly clear - less is better, more drinking carries more risk for a wide range of adverse happenings, and heavy drinking is distinctly dangerous behavior" (p. 68).

The health and social problems associated with alcohol do not apply only to individuals who are clinically dependent on alcoholabout 7 percent of the population (Moore and Gerstein 1981). In fact, many problems occur among individuals who are not dependent on alcohol, while many others use alcohol without experiencing negative health consequences (NIAAA 1993). But problems also occur as a result of community tolerance of the social and economic norms for alcohol availability and use. Therefore, understanding the risks can play a significant role in shaping a community's response to alcohol-related problems.

Researchers in the field are looking for effective methods to curtail these problems while at the same time allowing for the responsible and appropriate distribution of alcohol. This Reference Guide analyzes research and practice findings on efforts to manage alcohol availability and synthesizes the available knowledge on the effectiveness of these approaches in solving specific problems.

Forms of Alcohol Availability and Related Terms

Three forms of alcohol availability are of particular interest to local communities concerned with alcohol-related problems. In this guide, the term availability refers primarily to the means by which alcohol is made available at the community level. As broken down by Wittman and Shane (1988), this includes retail availability (commercial alcohol outlets), public availability (alcohol at public events and in public places), and social availability (alcohol served privately according to social customs and traditions):

  • Public Availability. Alcohol is often available at public events and in public places that are the responsibility of agencies such as city parks departments. Public availability is usually controlled by local jurisdictions, but State Alcoholic Beverage Control Boards 1 (ABC's) may also control availability if alcohol is sold to the public or is available at State-sponsored events or locations. Public agencies also influence availability through their drinking policies for employees and by hosting social events at which alcohol may be present. The relationships among alcohol's public availability, consumption, and public health problems are of relatively recent interest and have not been the subject of extensive research, except in Canada.
  • Retail Availability. Alcohol available by commercial sale affects communities in a number of ways. Considerations relevant to retail availability include economic factors (price), the density of outlets in a given area, types of outlets (defined in the following section), conditions of sale (serving practices), hours and days of sale, and the issuance of one-day and other short-term licenses for serving alcohol. Retail availability is controlled by both State and local jurisdictions. The relationships among retail availability, consumption of alcohol, and public health problems are of longstanding interest to researchers and are the primary focus of this guide.
  • Social Availability. Hardest to quantify, alcohol's social availability in any given community depends on the accepted norms for drinking at private events established through the community's history, culture, and beliefs. A number of studies have defined social availability and discussed its relationship to other forms of availability (Abbey et al. 1990; Calahan, Cisin, and Crossley 1969; Rabow et al. 1982; Room and Roizen 1973; Smart 1980). While not the primary focus of this guide, social availability is considered here in light of its significant effects on other forms of alcohol availability. The relationship between social drinking norms and regulatory controls is a critical subject in need of further research.

Other terms used in this guide's discussion of retail availability are explained below; a comprehensive glossary appears in appendix F.

Alcohol Outlet - A retail business that sells alcoholic beverages to the public or to a select membership. Under the 21st Amendment, each State has the power to control the means by which alcohol is made available to the public. Thus, States either establish a monopoly on retail sales of alcohol (see Control State) or issue various types of retail licenses to private parties to sell alcoholic beverages (see License State). These variations in States' regulations and the resulting variety of retail alcohol licenses largely account for the differing availabilities of alcohol products across the United States.

Alcohol Outlet Density - The number of outlets licensed to sell alcohol within a specific geographic area. To understand and compare the problems associated with alcohol availability within and among States, the following measures have been proposed to categorize outlets according to density (Wittman 1994):

  • Commercial Density - The percentage of alcohol outlets in relation to the total number of commercial outlets in a given planning area. For example, if a neighborhood has 16 stores and 4 of them sell alcohol, the commercial density for alcohol sales is 25 percent. Commercial density can also be measured by the relative share of floor space assigned to on- or off-sale alcohol sales. For example, in a convenience store with 1,000 square feet accessible to the customer, if 320 square feet were devoted to alcoholic beverages, then 30 percent of the store would be devoted to alcohol sales.
  • Geographic Density - The number of alcohol outlets per unit of land area within a given geographic area, such as a planning district, police reporting district, ZIP Code, or census tract. Geographic density reflects travel time and other costs incurred to obtain alcoholic beverages.
  • On-Sale Capacity - The aggregate number of spaces for alcoholic beverages in on-sale outlets within a determined geographic area.
  • Population Density - The density of alcohol outlets per population unit, or the number of outlets for a given population (see figure 2-1 in chapter 2). Population density figures are calculated for a defined geographic area.

Determining the density of alcohol outlets (typically per 1,000 residents) provides community members, city and local officials, and public policymakers with information that can support the development of effective public health intervention strategies. For example, an analysis of the number of licenses issued in a community at high risk for alcohol-related problems might prevent the issuance of additional licenses that would increase the threats to public health and safety.

Alcoholic Beverage Control Agency - The State agency responsible for regulating the manufacture, transportation, distribution, and sale of alcoholic beverages, as required by the 21st Amendment to the U.S. Constitution (the Prohibition Repeal Amendment).

Conditional-Use Permit (CUP) - An alcohol-sale permit granted to retail outlets on a case-by-case basis according to the merits of the permit application. The local review process may impose requirements designed to protect the community's health, safety, and welfare as a condition of the local zoning authority's approving the permit. The use of CUPs offers communities a significant opportunity to apply local land-use and planning ordinances to prevent health and safety problems associated with alcohol availability. CUPs can also be used as a means to eliminate public nuisances related to alcohol outlets.

Control State - A State that operates retail alcohol outlets for the sale of at least one of the three basic beverage types (wine, beer, and distilled spirits). These outlets, sometimes called "State stores," typically sell spirits and wine or spirits only, with private retailers permitted to sell beer. Control States historically have maintained tighter controls than others on the distribution and operation of alcohol outlets, but recent efforts by some control States to privatize retail sales are gradually blurring the distinctions from license States (see chapter 3).

License State - A State that issues licenses to retailers for the sale of alcoholic beverages.

Local Control - The powers of cities and counties to establish local public policies to regulate alcohol outlets. Several States give local jurisdictions the right of first review of any applications for State licenses. Most States reserve this right but give local jurisdictions the power to shape the local distribution and operation of alcohol outlets through planning and zoning permits. The latter method allows jurisdictions the flexibility to tailor policies to local conditions. The city or county might choose passive zoning, which issues permits automatically ("as of right") if the applicant meets minimum published standards, or it might use more active zoning to review each case on its merits through conditional-use permit reviews (see Conditional-Use Permit; active and passive zoning are discussed in detail in chapter 2).

Nexus - The relationship between an alcohol outlet and consequent alcohol-related problems. The term nexus is used both by ABC's considering the case of an individual outlet and to refer to classes of problems related to groups of alcohol outlets, such as community concerns about convenience stores' laxity regarding alcohol sales to minors.

Off-Sale Outlet - An establishment licensed to sell alcohol for consumption outside, but not within, its premises. Examples of off-sale outlets include liquor stores, supermarkets, specialty wine shops, and some gas stations and minimarkets (see Table 1-1).

TABLE 1-1: Average Age in Years at First Cigareete Use, by Age Group, 1994.

Table

TABLE 1-1: Average Age in Years at First Cigareete Use, by Age Group, 1994.

On-Sale Outlet - An establishment licensed to sell alcohol for consumption within, but not outside, its premises. Examples of on-sale outlets include bars, taverns, clubs, and restaurants where alcohol is served. These outlets may sell alcoholic beverages only or they may provide snacks, other food items, and sometimes entertainment. State ABC's and local jurisdictions often distinguish between bars, which are primarily drinking establishments, and restaurants, where alcoholic beverage sales are incidental to the serving of meals (see Table 1-1).

In a small number of States, variations in on- and off-sale licensing result in combined forms of alcohol sales. For example, some on-sale alcohol outlets, such as bars, are licensed to sell packaged alcoholic beverages such as six-packs of beer for consumption off the premises. (See chapter 2 for a more detailed description of on- and off-sale outlets.)

Responsible Beverage Service - A general term describing a range of preventive policies and practices for the sale or service of alcoholic beverages in off- and on-sale establishments. These policies, mandatory in some States, are designed to prevent patrons from becoming intoxicated, to ensure that those who are intoxicated are not served and are not exposed to harm, and to prevent the sale of alcohol to minors.

Table 1-1. Types of Alcohol Outlets and Conditions of Sale
Types of Off-Sale Outlets Types of On-Sale Outlets
Beer-only stores
Wine-only stores
Beer and wine stores
Beer, wine, and distilled spirits stores
State-owned stores
Local corner ("Mom & Pop") stores
Winery outlets
Supermarket stores
Gas stations/minimarkets
Delivery order services
Wine clubs
Cross-border shopping
Duty-free purchases
Illegal sales (e.g., home production, bootlegging, after-hour sales, distilling and winemaking operations)
Licensed restaurants:
Dining rooms
Fast-food establishments
Alternative venues:
Music halls
Nightclubs
Theaters
Art galleries
Sports arenas
Bars:
Within clubs (e.g., golf, bowling, Bingo)
Hair salons
Airport lounges
Hotel minibars
Vending machines

Effects of Availability on Alcohol Problems

A significant body of research points to a strong association, or nexus, among alcohol availability, rates of consumption, and drinking-related problems (Bruun et al. 1975; Edwards et al. 1994). These relationships are most apparent where a sudden, sharp decrease in alcohol availability occurs. In several European countries, for example, strikes by liquor store workers eliminated nearly all legal alcohol sales. As a result, most individuals drank less (although some turned to illegally sold alcohol products). In some of these countries, the decrease in alcohol consumption was accompanied by a decline in alcohol-related problems such as traffic crashes, arrests for drunkenness, and admissions to detoxification centers (Edwards et al. 1994).

Recent research (Holder 1993a, b) has focused on several public health and safety problems related to alcohol availability, including general public consumption, crime and safety issues, traffic crashes, and youth access to alcohol, such as sales to underage drinkers.

The following sections briefly examine each of these research areas. A more detailed analysis of studies on specific interventions aimed at reducing alcohol availability problems appears in chapter 3.

natural experiment - a change in a situation, policy, or process typically not initiated by researchers but which can be evaluated by them.

Alcohol Availability and General Public Consumption

Studies of natural experiments clarify the relationships among alcohol availability, consumption, and related problems by analyzing the effects of market-driven or other naturally occurring changes in alcohol availability. Such studies have examined strikes by liquor store workers, prohibitions on alcohol sales, and shifts from monopoly to private alcohol sales and vice versa. Despite considerable variations in the ways these natural experiments took place, in general they indicate that a reduction in alcohol availability appears to reduce the rates of consumption and drinking-related problems such as public drunkenness, assaults, and drunk driving, at least immediately following the change in availability (Edwards et al. 1994).

Alcohol Availability and Crime and Safety Issues

Alcohol consumption is a factor in more than half of all homicides and serious assaults (Pernanen 1991). Among the respondents to Pernanen's study who had visited a public site where drinking took place at least twice in the previous 30 days, alcohol-related violence was more likely to be reported at on-sale outlets than in homes, work sites, schools, or the streets. Pernanen points out, however, that the relationship between alcohol and violence is complex and influenced by a variety of cultural, historical, personal, and other situational factors that in combination with the arousing effects of alcohol can turn into aggressive behaviors that lead to sexual and other types of assault.

Studies suggest a strong association between violence and the retail availability of alcohol (Cook and Moore 1993a, b; Fagan 1993a, b; Lester 1993; Parker and Rebhun 1995). As a result, public health officials and legislators as well as researchers are furthering their efforts to understand this relationship. For example, the higher rates of violence at bars have inspired studies of management practices and policies for serving alcohol, leading researchers to look at placing greater responsibility for any resulting problems on the managers of on-sale alcohol outlets (Holder and Wagenaar 1994).

Alcohol Availability and Traffic Crashes

Various links between alcohol availability and traffic crashes have been examined (Gruenewald et al. 1996; Holder 1993a; O'Malley and Wagenaar 1991; Scribner, Mackinnon, and Dwyer 1994; Van Oers and Garretsen 1993), including the relationships between alcohol-related crashes and minimum legal drinking age; density of licensed alcohol outlets; and place of last drink and the resulting incidence of driving while intoxicated (DWI) arrests.

A number of studies have found an inverse relationship between raising the minimum legal drinking age and the number of traffic crashes resulting in personal injury or death (O'Malley and Wagenaar 1991; Wagenaar and Wolfson 1994). The rate of crashes was shown to decline when the minimum age for legally purchasing alcohol was raised from 18 to 20 or 21 years.

As might be expected, researchers have identified a direct relationship between the density of alcohol outlets and the number of traffic crashes in a given area (Scribner, Mackinnon, and Dwyer 1995; Van Oers and Garretsen 1993). Research also has shown that the highest percentage of individuals charged with DWI consumed their last drink in a bar or restaurant; a study by Fell (1988), discussed in McKnight (1991), for example, reported that 30 percent of drivers arrested for DWI in Maryland were en route from bars or restaurants. Furthermore, data collected in roadside surveys indicated that a major share of the drinking by intoxicated drivers occurred in bars and restaurants (Interministerial Committee on Drinking-Driving 1980; McKnight 1991; Palmer 1986; Wolfe 1975). Overall, the proportion of DWI arrests after drinking at bars and restaurants to arrests after drinking at residences is greater than might be expected, even taking into consideration the relative proportions of alcohol sold through on- and off-sale outlets.

Alcohol Availability and Youth Access to Alcohol

In July 1984, Federal legislation resulted in all 50 States and the District of Columbia setting a minimum legal drinking age of 21 years. Despite retailers' awareness of these laws, research reveals that persons under 21 are frequently and even routinely able to purchase alcohol (Forster et al. 1994; Preusser and Williams 1992; Wagenaar and Wolfson 1994). In fact, of a U.S. population of more than 18 million 16- to 20-year-olds, most report drinking alcohol (University of Michigan Institute for Social Research 1998).

Community Involvement in Prevention Efforts

In this guide, a community is defined as a group of people in one geographic area who share social and cultural ties under the same government and political jurisdiction (usually a city or county). At this grassroots level, local communities play a key role in decisions about alcohol availability. Influences on the extent to which communities exercise this role include the following:

  • Local Government - Affords a central mechanism for addressing availability-related problems and working toward solutions through local public policies and programs.
  • Physical Proximity - Sets the stage for common concerns about excessive drinking and related problems as well as for sharing in the benefits of reducing the problems.
  • Shared Social and Cultural Experiences - Provide motivation for identifying and assessing problems and developing plans to address them.

State and Local Responsibilities for Alcohol Availability-Related Problems

The 21st Amendment to the U.S. Constitution gave control over alcohol availability to the individual States, which have chosen to share much of the responsibility with local jurisdictions. States generally look to their cities and counties to establish the conditions under which an outlet may sell alcohol (location, hours of operation, type and size of establishment, and business practices) within the State's broader constraints, such as taxes, retail licenses, and prohibitions on sales to minors. States also leave decisions about alcohol sales at public events and in public places owned by the city, county, or other public agencies to the localities. Along the same lines, the States do little to influence the advertising and promotion of alcoholic beverages at the local level and tend to rely on local police for assistance in enforcing existing regulations. As a result, communities have considerable authority to manage local alcohol availability in the interest of public health and safety; these powers are addressed in detail in chapter 2.

on-sale outlet - a retail alcohol outlet licensed to sell alcohol for consumption within, but not outside, the licensed establishment.

Local decisions about alcohol availability are based in part on local perceptions of the potential problems and benefits from specific policies. These perceptions are influenced by factors such as recognition of the relationship between alcohol availability and health and safety problems and the community's values and traditions regarding alcohol. Regional traditions and practices often determine the places, times, and occasions at which drinking occurs. Socioeconomic factors, such as the availability of alcohol and the purchasing power of local consumers, also play a significant role: to a considerable extent a local economy's dependence on alcohol sales and the interests of alcoholic beverage retailers and distributors shape communities' decisions about alcohol availability (Holder and Giesbrecht 1989).

Because community residents are often the first to experience the effects of alcohol-related problems, they are in an ideal position to start solving those problems at the neighborhood level by calling on local governments, schools, neighborhood and religious groups, and voluntary and business organizations. Community-based organizations play a major role in identifying problem areas, linking existing resources, developing recommendations for solutions, and creating effective policies to reduce alcohol-related problems. One example of successful community action occurred in South Central Los Angeles, where problems caused by alcohol availability received considerable media attention in the aftermath of the April 1992 civil disturbances over the acquittal of four white policemen charged with beating black motorist Rodney King (see appendix F). A local community coalition for the prevention of alcohol and other drug problems had been meeting, to little effect, with city officials to address the high density of liquor stores and their proximity to residences in two city council districts. The riots put a third of the off-sale alcohol outlets in these districts out of business, setting the stage for community action against drug-dealing, excessive drinking, and other outlet-related problems - actions supported by public health activists, lawyers, bureaucrats, and elected officials throughout California. The Los Angeles Police Department and researchers from the University of Southern California report that the rate of crimes associated with proximity to liquor stores has declined as a result. (Chapter 4 examines specific problem-solving processes local agencies and community groups have used to tackle alcohol-related problems.)

High-Risk Alcohol Outlets

Many communities across the United States have not only public health and safety but broader "quality-of-life" concerns related to alcohol availability. Some studies have found that the complaints about alcohol outlets most often reported to city planners had to do with noise, traffic, litter, or loitering (Wittman and Hilton 1987). While these may seem relatively minor aesthetic concerns, they can indicate serious underlying problems; poor property maintenance, for example, appears to be closely linked to health and safety problems (Wilson and Kelling 1982), and loitering with drug dealing and prostitution.

off-sale outlet - a retail alcohol outlet licensed to sell alcohol for consumption outside, but not inside, the licensed establishment.

Violations of health and safety standards provide a basis for State ABC license sanctions and local agency code enforcement. After all, freedom from unwanted interruptions in one's home and place of business are fundamental legal rights.2 [2 Land-use law, for example, is dedicated to protecting the occupants' "health, safety, welfare, and morals" (City of Euclid v. Ambler Realty Company 1926).] A basic tenet of law is the right to "quiet enjoyment" of one's own property. When these rights of residents, shopkeepers, and others who live and work in an area are threatened, local zoning laws as well as police enforcement can be brought to bear. (This issue is discussed in detail in chapter 2.)

Communities can prevent or reduce such problems by identifying alcohol outlets at high risk for generating them and then taking action to eliminate or at least reduce the risks. Designating an outlet as high-risk is a matter of both community perceptions and a legal determination by State and local agencies. An outlet is determined to be at high risk by law if it endangers the public health, safety, and well-being of the community through one or more of the activities highlighted in the box at right.

Research continues to show a correlation between a high density of alcohol outlets and a high rate of alcohol-related problems in a community (Edwards et al. 1994). Studies have identified three indicators of local alcohol outlet density that merit the attention of prevention planners (Wittman 1986):

  • Infiltration - The introduction of alcohol outlets to commercial establishments from which they had been excluded, such as beer and wine sales in fast-food chains. Infiltration is associated with general increases in alcohol consumption levels and other documented outlet-related problems (Bruun et al. 1975; Edwards et al. 1994; Gruenewald, Ponicki, and Holder 1993).
  • Overconcentration - The clustering of alcohol outlets in a confined geographic area. Overconcentration is characterized by the presence of several alcohol outlets within a city block or other area small enough for people to walk easily from one alcohol outlet to another. Overconcentration is associated with crime and public safety problems, economic displacement, and deteriorating quality of life. For example, one city with a population of 90,000 has 44 bars and restaurants in a four-block entertainment district that accounts for some 25 percent of the city's calls for police service (Vasquez, Wittman, and Harding 1998).
  • Proliferation - The establishment of retail alcohol outlets in a given area at a faster rate than that of other commercial outlets. The sudden proliferation of alcohol outlets can be especially troublesome in rapidly expanding areas such as suburban housing developments, dislocating other retail businesses. In one community, for example, over some 6 years an eight-block commercial district that became "trendy" experienced a fourfold increase in bars and restaurants, driving out other businesses and boosting criminal activity in the area.

Characteristics of High-Risk Alcohol Outlets

  • Aggressive sales that endanger staff and patrons, such as sales with the intent to intoxicate
  • Selling alcohol to underage youths
  • Selling alcohol to obviously intoxicated patrons
  • Accommodating or neglecting illicit drug trafficking on the premises
  • Encouraging or allowing loitering on or near the premises
  • Ignoring on-site consumption of alcoholic beverages in an off-sale outlet or on the surrounding premises of an on- or off-sale outlet
  • Failing to install adequate lighting or other crime prevention methods in known high-crime areas
  • Violating license requirements or restrictions concerning hours or days of alcohol sales
  • Marketing by distributors of specific beverages, such as fortified wines, in areas that sell to a high-risk consumer group such as impoverished inner-city residents
  • Advertising promotions that encourage overconsumption, such as offering multiple drinks for a single price
  • Resisting cooperation with police officials and neighborhood groups to address problems (such as loitering) at a given retail alcohol outlet

Mixed Messages About Alcohol Consumption

The conflicting messages American pop culture sends about alcohol use complicate community attitudes toward alcohol availability. National marketers use myriad media to encourage the consumption of alcohol: many newspapers, magazines, and radio and television programs put forth themes and characters that promote not only tolerance but a downright positive image of alcohol use. What's more, alcohol manufacturers and distributors broadcast and publish state-of-the-art advertisements aimed to impress youth and push not only brand loyalty but alcohol consumption in general. Although Federal licensing guidelines require radio and television stations to air public service announcements, very few of these messages convey the hazards of drinking or promote the acceptability of temperance.

Of course, it is for obvious economic reasons that the alcoholic beverage industry presents its products in the best possible light and rarely mentions the negative consequences of drinking (Wallack et al. 1993). Those prevention messages the industry does send, such as "Know when to say when," are difficult for the public to use as a practical guideline. Meanwhile, local media interest in news with novelty may lead to inaccurate or incomplete coverage of public health and safety issues concerning alcohol. For example, when research indicated that modest levels of alcohol consumption (up to two drinks per day) may be associated with a lower incidence of heart disease while higher rates of consumption over long periods may be very harmful (Klatsky 1994), media reports appeared on the "health benefits" of alcohol without mentioning the appropriate caveats and clarifications - omissions that could be misleading and even damaging to the public's health.

Society's mixed messages about alcohol are highlighted in many communities' controversies over the availability of alcoholic beverages at public events in public places, such as county fairs and Fourth of July celebrations. Supporters of availability view alcoholic beverages as a fund-raising tool that should be readily available for people to enjoy; prevention workers and some community groups, on the other hand, object to the identification of community and cultural events with alcohol products, while public officials have reason to be concerned about behavior problems, extra clean-up costs, and property damage resulting from alcohol availability at such events.

Overall, mixed messages about alcohol can create an environment hostile to local groups and agencies engaged in prevention activities. Prevention planners are therefore faced with disentangling the conflicting messages about the risks of alcohol consumption and its potential benefits in limited quantities. Effective strategies for responding to such challenges are reviewed in chapter 2.

Conclusion

Past efforts to reduce alcohol-related problems by focusing solely on individual outlets or drinkers have proven inadequate to address the severity and persistence of these problems at the community level. Broader strategies for controlling alcohol availability are needed to permit low-risk drinking while minimizing alcohol-related threats to public health and safety. Communities will benefit from research that continues to home in on the relationship between local alcohol availability and related problems, suggesting new strategies that prove effective in countering those problems.

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Footnotes

1

After the repeal of prohibition, State ABC's were established as enforcement agencies to manage the alcoholic beverage industry and collect tax revenues to revive the economy after the Great Depression. The evolution and authority of these agencies is described in chapter 2.]

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