SAEP White Paper

8/14/2019 SAEP White Paper

http://slidepdf.com/reader/full/saep-white-paper 1/31

The Syracuse Alcohol Environment Project: Alcohol Availability and the Public Health

in Syracuse, New York

A White Paper

A collaborative project between

the Onondaga County Health Department

and the Syracuse/Onondaga Drug & Alcohol Abuse Commission

Robert Pezzolesi

Walden University

February, 2009



2

Executive Summary

Alcohol is a risk factor for a variety of health, social, and economic harms which plagueSyracuse and Central New York. Increased alcohol availability, as measured by alcohol

outlet density (AOD), has been shown to intensify those risks. Strong evidence exists

that AOD is factor in increased alcohol consumption, violent crime, suicide, child

abuse/neglect, gonorrhea incidence, and other alcohol-related health problems. More

limited evidence exists that AOD is a factor in alcohol-related motor vehicle crashes,

property crime, and pedestrian injury. Since broad-based, environmental solutions

have been shown to be the most effective way of reducing alcohol-related problems,

interventions which modify the alcohol environment in Syracuse offer the greatest

likelihood of reducing these harms.

Accordingly, this report presents the following recommendations:

1. Advocate for changes in New York State Alcohol Beverage Control (ABC) law that

give more power to local governments to regulate alcohol outlet density.

2. Garner more information through a) improved data collection; b) targeted research,

in partnership with local colleges and universities; and, c) “full cost” cost-benefit

analyses that take into account the social costs of alcohol consumption.

3. Establish an Alcohol Policy Coordinator position (similar to Madison, Wisconsin).



3

Introduction: Alcohol and the Public Health

Despite attempts to treat it as if it were just another consumer product, 1 alcohol isa largely underestimated cause of social, health, and economic harm. Excessive alcohol

consumption is the third leading root cause of preventable death in the United States2

and almost certainly has an even larger impact on morbidity and disability.3 Alcohol is

implicated in 46% of homicides,4 28% of suicides,5 50% of rapes/sexual assaults,6 42% of

motor vehicle accidents,7 43% of pedestrian deaths,8 35% of fatal falls,9 38% of

drownings,10 45% of deaths due to fire,11 and a range of other social problems including

adolescent pregnancy,12 sexual harassment,13 stalking,14 academic failure,15 and

divorce.16 Recent research has also established the role of alcohol in the development of

cancer, including cancers of the mouth,

17

larynx,

18

pharynx,

19

esophagus,

20

liver,

21

colon,22 rectum,23 lung,24 and female breast.25 Alcohol may also decrease survival rates

for all cancers due to acceleration of the wasting process.26 In addition, alcohol use is a

risk factor in the genesis and/or severity of a number of other health problems including

HIV/AIDS,27 cardiovascular disease,28 cerebrovascular disease,29 pneumonia and

influenza,30 diabetes,31 sepsis,32 autoimmune disorders,33 osteoporosis,34 gout,35 and

psoriasis,36 among many others. Neuropsychiatric disorders which have been shown to

be associated with alcohol abuse and dependence include epilepsy,37 nicotine

dependence,38 eating disorders,39 unipolar major depression,40 antisocial syndromes,41

and obsessive-compulsive disorder.42 While illicit drugs frequently garner more media

attention and attract more public resources, the global burden of disease attributable toalcohol is over five times that of all illegal drugs combined.43 As political scientist John

DiIulio has remarked, “compared to the consequences of [illegal drugs], the negative

social effects of alcohol are hardly dramatic, but they are almost surely more pervasive,

perverse, and persistent.”44

As one would expect, these outcomes result in considerable economic burdens

for our society. Underage drinking alone was responsible for about $62 billion in social

costs in the U.S. in 2001.45 The total economic burden of underage and pathological

drinking was $184.6 billion in 1998, according to the most comprehensive assessment.46

This includes the costs of specialty alcohol services, medical consequences, lost future

earnings (due to premature deaths), lost productivity (due to morbidity and disability),

lost earnings of crime victims, criminal justice services, social welfare administration,

and property damage (from motor vehicle accidents and fires). 47 Converted into 2008

dollars, this would equal approximately $241 billion.48 The Central New York (CNY)

share of that cost is most likely disproportionately high, given that the heavy drinking

and binge drinking rates are higher for CNY than for Upstate New York in general, the

State of New York, and the United States in general.49 Nonetheless, a conservative



4

proportionate estimate based on relative population50 yields an annual cost to the City

of Syracuse of about $113 million. This is roughly 43% of the 2008-2009 Syracuse

General City Budget.51

Even so, this figure is lower than an alternate estimate of $139million, extrapolated from a recent study of the state of California that found the

approximate cost of alcohol-related problems to be about $1,000 per resident per

annum.52

Furthermore, the vast majority of the resources that are directed toward alcohol

problems are what former Health, Education, and Welfare Secretary Joseph Califano, Jr.

characterizes as “shoveling up the wreckage”: cleaning up the consequences rather

than preventing the problems in the first place. 53 In fact, Califano reports that 96 cents of

every dollar that states spend on substance abuse-related issues is used this way.

Moreover, states spend 113 times more money on the aftereffects of substance abuse

than on prevention and treatment.54 This is unfortunate (and short-sighted), as

prevention has been shown to be much more cost-effective – at the primary (including

both supply-reduction55 and demand-reduction56), secondary,57 and tertiary58 levels –

than reactive approaches.

Public Health Approach to Alcohol Problems

Despite these stark realities, there have been promising developments in recent

decades with the emergence of a research-based, public health approach to alcoholproblems. The debut of this praxis could be said to be the World Health Organization’s

publication of the book Alcohol control policies in public health perspective in 1975.59 The

main theses of this book (which have been further reinforced and explored in the

“sequel” volumes Alcohol policy and the public good60 and Alcohol: No ordinary commodity:

Research and public policy61) are that: 1) there is solid research which convincingly

demonstrates the effectiveness of alcohol policy interventions; and, 2) alcohol policy

should aim to limit both high-risk consumption and overall levels of consumption.62

Two essential elements of public health philosophy are a focus on populationsrather than individuals, and a basis in science and research. Accordingly, modern

alcohol policy is primarily concerned with the environmental prevention of alcohol

problems across populations. Whereas traditional, individual prevention efforts focus

on imbuing knowledge and resistance skills, while accepting the environment as a

given, environmental approaches seek to modify the contexts in which drinking occurs.

Research analyses have determined that individual-focused, education-based efforts are

largely ineffective by themselves.63 In contrast, the majority of effective interventions

are based on environmental transformation.



5

Toward that end, one key environmental factor is the physical availability of

alcohol. Reductions in the availability of alcoholic beverages naturally result indecreased consumer convenience and increased full cost, with concomitant drops in

demand,64 although this relationship is complex and dependent on several variables.65

Such reductions can be implemented through “total or partial bans, restrictions on

hours and days of sale, and by controlling the number, location, and type of retail

premises.”66 The most common measure of retail alcohol availability has been that of

alcohol outlet density.

Alcohol Outlet Density – A Review of the Literature

Alcohol outlet density (AOD) is defined as the number of retail alcohol outlets

per population unit (e.g. 1,000), per geographic area, or per roadway mile. All three of

these methods have been utilized in research, and all have validity depending upon the

research context and other methodology. Some studies have employed more than one

of these methods.67 As in recent years methodologies have sharpened and statistical

analyses have become more sophisticated, a considerably large (and rapidly growing)

body of research on the effects of AOD has been developed. The strongest of these

studies tend to be of longitudinal design,68 with a particularly promising subset of these

studies being natural experiments stemming from the 1992 civil unrest in Los Angeles

(following the verdict in the Rodney King police brutality case). The rioting, burning,and looting that occurred in that massive disturbance resulted in the destruction of 270

alcohol outlets, several of which were not reestablished due to the utilization of new

conditional use zoning laws.69 This effectively turned those neighborhoods of Los

Angeles into laboratories for testing the effects of reduced AOD.

AOD AND DEMOGRAPHICS / NEIGHBORHOODS

Several studies have found that alcohol outlets tend to be clustered in minority

and impoverished neighborhoods.70

Romley and colleagues suggest that this representsa “mismatch” between supply and demand71 and thus becomes an issue of

environmental justice.72 Pollack, et al. (2005) also speak of a mismatch, determining that

measures of neighborhood deprivation (unemployment, etc.) were associated with

higher alcohol outlet density but lower rates of heavy drinking.73 LaVeist & Wallace

(2000) also determined that lower income, African-American census tracts had a

disproportionate number of off-premise alcohol outlets, and that this contributed to

health-related risks in those neighborhoods. Bluthental, et al. (2008), however, found a



6

correlation between AOD (per roadway mile) and household poverty, but an inverse

relationship between AOD and African-American race.74

With regard to the college environment, Wechsler, et al. (2002) demonstrated that

alcohol outlets near college campuses tend to be located in neighborhoods of lower

socioeconomic status, and that those neighborhoods experience a greater number of the

negative secondary effects of heavy alcohol use, including drunkenness, noise and

disturbances, public urination, vandalism, and vomiting.75 Similarly, an analysis of

liquor licenses in New South Wales, Australia connected AOD with reported

neighborhood problems with drunkenness.76

Another study77 with a longitudinal design found that the loss of off-premise

alcohol outlets resulting from the 1992 civil unrest in South Central Los Angeles led to

an increase in social capital (measured by the proxy of voting), considered to be an

important factor in population health.78

AOD&CONSUMPTION

As Livingston, et al. (2007) report, the research on the relationship between AOD

and consumption of alcohol has engendered “mixed results,” 79 although more recent

studies with more sophisticated statistical designs have generally found a positive, if

sometimes limited, relationship.80 Several early studies show a positive correlation between alcohol availability in the form of AOD and increased alcohol consumption

and alcohol-related problems, including alcoholism and cirrhosis of the liver.81 Some

studies that followed, including Abbey, et al. (1993),82 did not find such a relationship.

Studies in both categories were somewhat limited due to the coarse granularity of the

geographical unit of analysis. More recent research suggests that smaller geographical

units (zip code, neighborhood, census tract, census block group) are methodologically

preferable to larger geographical units (state, county, municipality) in studies of this

type. With that in mind, it is notable that Gruenewald, et al. (2000) did not find a

relationship at the neighborhood level83 in their attempt to replicate the Gruenewald, et

al. (1993) study that did find that AOD was significantly related to wine and spirit sales

in 38 states.84

Some studies have differentiated between the effects of on-premise and off-

premise outlets. Freisthler, et al. (2003) found that sales to pseudo-intoxicated patrons

were more frequent in areas with higher on-premise outlet density.85 Truong & Sturm

(2007) found that density of on-premise, but not off-premise, alcohol outlets was

associated with excessive and heavy episodic drinking. Furthermore, they determined



7

that “the effect was limited to outlets located to within proximity, roughly 1 mile from

residential homes.”86

AOD&CONSUMPTION IN SPECIFIC SUBPOPULATIONS

Youth

Three out of four recent studies which examined AOD and youth alcohol

consumption found a significant positive relationship.87 Huckle, et al. (2008) found that

AOD was associated with the quantity of alcohol consumed by teenage drinkers.88

Treno, et al. (2008)89 found that off-premise outlet density predicted both use of formal

sources of alcohol and perception of ease of access to formal sources, while finding a

negative association between off-premise outlet density and use of informal sources of

alcohol. These results, the authors suggest, point to a need for a “multi-faceted

intervention approach.”90 Adult – but not youth – drinking prevalence and binge

drinking were found by Nelson (2008) to be affected by AOD. Truong & Sturm (2009)

determined that “binge drinking and driving after drinking among adolescents aged 12

to 17 years were significantly associated with the presence of alcohol retailers within 0.5

miles of home.”91

College

The three studies which have focused exclusively on the college environment

have strongly pointed to a relationship between AOD and college drinking outcomes

including heavy drinking, frequent drinking, and drinking-related problems.92 These

findings demand attention in light of the degree of harm resulting from alcohol abuse in

that population93 and recent attempts in the academic community to abandon evidence-

based environmental prevention for dubious “solutions.”94

Pregnant Women

Sen & Swaminathan (2005) found that AOD (on-premise and off-premise liquor

outlets per capita) increased both prenatal alcohol use and prenatal smoking. Bearing

in mind the staggering social and economic costs of fetal alcohol spectrum disorder

(FASD) - the leading preventable cause of mental retardation 95 - and the numerous

deleterious effects of maternal smoking,96 these findings call for further research in this

area.



8

AOD&HEALTH

Alcohol-related, explicit

All of the studies considered here which have explored the correlation between

AOD and explicitly alcohol-related health outcomes (e.g. pellagra, alcoholic

polyneuropathy, alcoholic fatty liver) have demonstrated a significant positive

relationship. Tatlow, et al. (2000) – in a relational, secondary, multivariate analysis of

extant data - looked at the rate of alcohol-related hospitalizations (aggregated by 65

California zip codes) and alcohol outlet density, determining that there was a significant

association between the number of alcohol outlets in a zip code with the number of

alcohol-related hospital admissions.97 Son (2002) found a positive association between

AOD and alcohol-related primary cause mortality and homicide for African-Americans,

but not for Caucasians (where price was the more important regulatory variable).

According to Wilson’s (2002) study of Chicago neighborhoods, “the likelihood of a

hospital admission being alcohol related was higher in neighborhoods with a greater

number of alcohol outlets.”98 Moreover, as noted earlier, some studies have linked

greater AOD with rates of liver cirrhosis.99

In addition, Dill (2003) reported a greater number of health-threatening

behaviors (sedentary lifestyle, smoking inside the home, etc.) associated with AOD,

with the caveat that the study was limited to two communities.

HIV/AIDS

Scribner, et al. (2008) found a positive association among overall HIV rates,

higher on-site density, and lower off-site density.100 The injection drug users (IDU)

subgroup of HIV cases was associated with higher on-site and off-site density. These

findings appear to be consistent with studies which show alcohol abuse and

dependence to be a risk factor for HIV/AIDS101 and that alcohol control policies may

have a salutary effect.102

Gonorrhea

Scribner, Cohen, & Farley (1998) determined that AOD variables were positively

related to reported gonorrhea rates in a study of 155 urban residential census tracts in

New Orleans. These outcomes were reinforced by Cohen, et al. (2006) – another of the

aforementioned natural experiments from Los Angeles.103 The study found that alcohol

outlets had a positive association with gonorrhea rates, even after controlling for the

effect of property damage and number of surrendered licenses, as well as race/ethnicity,



9

age, socioeconomic status and baseline gonorrhea rate. The authors speculate that the

effect of alcohol outlets may be due to both the fact that alcohol is a “substance used to

facilitate sex”104

and that alcohol outlets may act as attractors for high-risk individuals(e.g. by selling drug paraphernalia).

Perinatal

The role of AOD in perinatal problems is less clear. The findings of Sen &

Swaminathan (2005) suggest that higher AOD leads to higher rates of prenatal drinking

and smoking, which are behavioral risk factors for a number of negative perinatal

outcomes. Nonetheless, Farley and colleagues (2006) found that “neither gestational

age nor birthweight-for-gestational-age was associated with the neighbourhood density

of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets.” 105

DWI/Related Behaviors and Outcomes

As with alcohol consumption, the relationship between AOD and driving while

intoxicated (DWI) and related behaviors and outcomes has been shown to be complex,

indeed, almost seeming to produce a “crazy quilt” of research outcomes. Some studies

have found clear positive effects. Escobedo & Ortiz (2002) found that AOD was

significantly related to alcohol-related crashes, alcohol-related crash fatalities, and

suicides. Van Oers & Garretsen (1993) conducted research in Rotterdam which foundsignificant correlations between the number of bars and traffic injuries per

neighborhood. Jewell & Brown (1995) found a relationship between alcohol outlets and

fatal DWI accidents using Texas county-level data on the number of licensed alcohol

vendors and lane miles of road.106

Another pair of studies failed to find positive effects. After adjusting for

potential confounders, Stevenson, et al. (1998) found no significant association between

alcohol-related single-vehicle crashes and close proximity to an on-site, retail alcohol

outlet.107 Meliker, et al. (2004) similarly found no significant association between

alcohol outlets and alcohol-related motor vehicle crashes.108

Other studies have found different effects for different kinds of outlets.

Gruenewald, et al. (1996) employed a surrogate measure for alcohol-related crashes:

single vehicle night-time crashes (SVN) between 8 p.m. and 4 a.m.109 The geographic

unit of analysis was not census tracts or zip codes (considered too coarse), but new

geographic units based on population gradients uncovered by the mapping procedure.

The authors found that physical availability of alcohol was significantly related to SVN

crashes but not to self-reports of driving after drinking or driving while intoxicated. It



10

was surmised that “geographic processes underlying crash events are in some respects

distinct from the processes underlying drinking and driving in general.”110 Gruenewald,

et al. (2002) determined that restaurant densities were found to be directly related togreater self-reported drinking frequencies and driving after drinking (DAD).111

Surprisingly, bar densities were inversely related to DAD. The authors deduce from

this that perhaps “bars attract patrons locally and not from outside the area in which

they live.” 112 They also found that DWI was unrelated to outlet density. Scribner, et al.

(1994) found that alcohol-related crashes resulting in injuries were found to be

positively related to overall AOD, and the densities of restaurants, liquor stores, and

mini-marts – but not bars. Alcohol-related crashes with property damage were found

to be related (at a smaller level of significance) to restaurants and bars.113 A longitudinal

study undertaken by Treno, et al. (2007) examined the relationship between AOD and

automobile crashes and related injuries – operationalized as 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). 114 Both crash

measures were found to be positively associated with bars and off-premise outlets,

while, interestingly; “restaurants appear[ed] to provide a protective effect relative to the

residence-based measure.”115

Additionally, Hingson, et al. (2005) found that five communities which had

implemented the Fighting Back (FB) program (funded by the Robert Wood Johnson

Foundation) and had reduced alcohol availability and increased availability ofsubstance abuse treatment experienced considerable reductions in alcohol-related fatal

crashes relative to fatal crashes not involving alcohol (22% at BAC of 0.01% or higher;

20% at 0.08% or higher; and, 17% at 0.15% or higher). 116 Three of those FB sites – San

Antonio, Santa Barbara, & Vallejo, California – reduced alcohol availability by closing

liquor stores, blocking new stores, and monitoring problematic outlets. Of course, these

results only suggest the efficacy of reducing alcohol availability, as the study design did

untangle the effects of these interventions.

Studies examining the relationship between AOD and youth/young adult

drinking after driving have been less ambiguous. Treno, et al. (2003) AOD, at both on-

premise and off-premise levels, was found to be associated with adolescent/young adult

(15-20) behaviors of drinking and driving and riding with a drinking driver.117

Similarly, Truong & Sturm (2009) found that having an alcohol outlet within .5 miles of

residence was associated with driving after drinking in 12-17-year-old population.

Two studies examining pedestrian collisions with injury - LaScala, et al. (2000)

and LaScala, et al. (2001) – found, respectively, that 1) “availability of alcohol through

bars was directly related to pedestrian injury collisions in which the pedestrian had



11

been drinking alcohol;”118 and, 2) alcohol-involved pedestrian collisions were associated

with greater bar density and individual drinking patterns reflecting higher volume per

occasion.119

Other Injury

Treno, et al. (2001) found a positive association between both on-premise and off-

premise individual-level outlet densities and self-reported injuries. This is consistent

with studies showing from 12-35% of US emergency room injury cases to be alcohol-

related.120 Freisthler, et al. (2008) found that off-premise AOD was associated with a

greater number of hospital discharges for childhood accident, assault, and child abuse

injuries among youth from 0 to 17.121

AOD&PUBLIC SAFETY

Violence

Of all the outcomes considered here, the evidence linking AOD to violent crimes

is especially strong. This is not surprising considering the robust body of literature

documenting the role of alcohol in violent behavior,122 including intimate partner

violence (IPV)123 and suicide.124 Nonetheless, this relationship is not always

straightforward, but reflects, as Harold Holder attests, “a complex nexus of drinkingenvironment and drinking pattern.”125 AOD appears to be one important ingredient in

that “recipe.” Again, the strongest evidence comes from longitudinal studies.

Gruenewald & Remer (2006) examined six years of data from 581 zip codes and

found that greater numbers of licensed alcohol retail establishments – especially bars

and off-premise outlets – were related to rates of assault. The study controlled for

known factors in violent assault, including median household income and minority

population.

Norstrom (2000) also performed a longitudinal analysis – on 35 years of data in

Norway - finding that rates of crimes of violence investigated by the police (per 100,000

population) had a positive and statistically significant relationship to the number of

drinking places per 100,000 population.

Yu, et al. (2008) – another study resulting from the Los Angeles 1992 civil

unrest126 - determined that a drop in AOD at the census tract level resulted in a

reduction in assaultive violence within that census tract. Their statistical analysis found



12

that this reduction occurred about one year after the change in availability, with the

effect lasting about five years.

One of the few studies not to find a significant correlation between AOD and

assaultive violence – Gorman, et al. (1998a) – focused on the municipality level.127 As

discussed previously, the level of geographic analysis may have been too coarse. In

fact, in subsequent studies (Speer, et al., 1998; Gorman, et al., 2001), three of the

previous two studies’ authors recognized the need for “more refined levels of

analysis”128 and focused on the census tract and census block group levels (in Newark

and Camden, New Jersey, respectively), concluding that high AOD areas experienced

more criminal violence than low AOD areas.129 In the Gorman, et al. (2001) study, the

authors controlled for neighborhood social structure – a construct consisting of a

plethora of census variables including unemployment rate; welfare rate; median

household income; households per population; proportion black; proportion Latino;

residential tenure; proportion of high school dropouts; proportion of college educated;

FHH to total households; ratio of males to females; and, proportion of children,

adolescents, young adults, and older adults.

Other studies which have found a significant positive relationship between total

AOD and violent crime (aggravated assault, rape/sexual assault, robbery, and/or

homicide) include: DiIulio (1995); Scribner, et al (1995);130 Gyimah-Brempong (2001);

Nielsen & Martinez (2003); Reid, et al. (2003);131 Weijuan (2004); Zhu, et al. (2004);132

Britt, et al. (2005); 133 Gyimah-Brempong & Racine (2006); Zhu, et al. (2006);134 and, La

Valle (2007). Studies which connect off-premise AOD to violent crime include:

Scribner, et al. (1999);135 Lipton & Gruenewald (2002); Gorman, et al. (2005);136 and,

Gruenewald, et al. (2006).137

Roncek & Maier (1991) found an effect of on-premise outlets on violent and

property crime at the block level in Cleveland, Ohio. Roman, et al. (2008) – in a study at

the block group level in Washington, D.C. - found that on-premise AOD, but not off-

premise AOD, was a significant predictor of aggravated assault.138 Smith, Frazee, &

Davison (2000) considered the smallest unit of analysis - the face block level – and

found that “each bar, restaurant, or gas station [had] a substantial criminogenic

effect.”139 Brower & Carroll (2007), in a descriptive study using GIS mapping, observed

that the peak of fights, batteries, and other assaults clustered around the area of

heaviest bar density in Madison, Wisconsin.

Some studies indicate special interrelationships with regard to AOD and the

African-American population. Son (2002) found that AOD was a factor in African-

American – but not white – homicide. Contrarily, Nielsen, et al. (2005) determined that



13

AOD was a significant factor in Latino violent victimization, but not black violent

victimization, in 70 census tracts in Miami.140 Jones-Webb and colleagues (2008) found

that measures of alcohol availability (including those specifically of malt liquoravailability) did not modify the effect of neighborhood racial/ethnic concentration on

homicide rates.141

A few Australian studies which found a relationship between alcohol availability

and violence142 and/or injury143 have an advantage which is absent in US studies: the

availability of small-scale alcohol sales data. Still, Stevenson, et al. (1999) found that

AOD was a factor in violent crime apart from alcohol sales in an urban area (Sydney),

but not in a rural area. In the rural area, only alcohol sales were a factor.144

Gang Violence

Parker, et al. (2007) measured AOD and gang violence cross-sectionally and

longitudinally, finding a direct relationship between them.145

Youth Violence

Alaniz, et al. (1998) found that the arrest rate for violent crimes for Latino youth

(ages 15-24) was significantly and positively related to the number of alcohol outlets,

even after controlling for socioeconomic characteristics.146

Intimate Partner Violence

Gorman, et al. (1998b)147 found no correlation between AOD and domestic

violence in 223 municipalities New Jersey. But, as with Gorman, et al. (1998a),148 the

study was methodological limited by its level of analysis. McKinney, et al. (2009), in a

study of 1,537 couples in 587 zip codes across the contiguous United States, found that

AOD was positively associated with male-to-female partner violence (MFPV), with

smaller effects for female-to-male partner violence (FMPV).149 Likewise, Roman, et al.

(2008) determined that off-premise outlets were associated with a significant increase in

domestic violence in census block groups in Washington, D.C., although on-premise

outlets (specifically restaurants and nightclubs) were actually associated with a decrease

in domestic violence.150



14

Suicide

As indicated earlier, Escobedo & Ortiz (2002) found a significant positiverelationship between AOD and suicide.

Other Crime

Other crimes which have been found to be related to AOD include: the overall

crime rate (DiIulio, 1995); total and property crime rates (Gyimah-Brempong, 2001);

burglary, larceny, and motor vehicle theft (Gyimah-Brempong & Racine, 2006); and,

drunkenness and property damage (Donnelly, et al., 2006).151

Lugo (2008) looked at crime data (vandalism, liquor law violations,152 and

disorderly conduct violations) in Madison, Wisconsin over a 1-year period, finding that

irresponsible serving practices (e.g. “offering deeply discounted alcohol on weekends”

(p. 11)) were more of a factor than overall alcohol outlet density. While this study

undoubtedly has value in its emphasis on quality as well as quantity of alcohol outlets,

some of the author’s analysis suffers from oversimplification, i.e. equating the lack of a

visible pattern in a geographic information system (GIS) map with the absence of a

statistical relationship.

AOD&CHILD ABUSE & NEGLECT

The scholarship investigating the interrelationship between alcohol availability

and child abuse and neglect has largely been the province of Bridget Freisthler of the

UCLA Department of Social Welfare and the Prevention Research Center. Dr.

Freisthler’s research has found relationships between:

1) bar density and substantiated rates of child maltreatment (Freisthler, 2004;

Freisthler, et al., 2005)153

2) higher off-premise AOD and child maltreatment (referral and substantiation)

rates and foster care entries (Freisthler et al., 2007a)154

3) AOD and rates of child maltreatment for black – but not white or Hispanic –

children (Freisthler et al., 2007b)155

4) hospital discharges for childhood accident, assault, and child abuse injuries

among youth from 0 to 17 and off-premise AOD (Freisthler, et al., 2008)156



15

5) total AOD and referrals for child maltreatment investigations (Freisthler &

Weiss, 2008)

6) off-premise AOD with greater rates of child abuse, with a corresponding

association between on-premise AOD and greater rates of child neglect in 940

census tracts in California (Freisthler, et al., 2004)157

In another, earlier, study, Markowitz & Grossman (1998) found a relationship

between number of alcohol outlets and severe domestic violence toward children, but

not overall domestic violence toward children.

Theoretical Considerations

Several theories in the areas of alcohol studies, economics, public health,

criminology, and sociology have been referenced in order to explain the nature of the

relationship between AOD and harms. Many studies have relied on classic alcohol

availability theory, which posits that: 1) increased availability of alcohol results in

greater average consumption; 2) greater average consumption results in a greater

number of pathological drinkers; and, 3) a greater number of pathological drinkers

results in more alcohol-related problems.158 Livingston, et al. (2007) note that while

there is an abundance of evidence to confirm classic availability theory, that theory

alone is insufficient to explain the multiplicity of findings of AOD research. 159 Thus,other theories have been applied to explain specific areas of health/behavioral

outcomes.

Theories addressing AOD and crime/violence have included those of:

Selective disinhibition. More outlets lead to more drinking, with more

drinking leading to poorer judgment.160 Consequently, “alcohol

consumption may serve to selectively disinhibit active constraint—

constraint that is needed to stop violent behavior in the face of conflictingor ambiguous norms concerning its use.”161

Routine activities. Crime is the result of potential victims and offenders

interacting during daily activities.162 Several features of alcohol outlets

(presence of cash, possible intoxication of perpetrators and victims,

accessibility, large numbers of “uninhibited young males”163) lend them to

be foci of illegal activity.164



16

Social disorganization. Crime occurs primarily in environments lacking

collective efficacy or informal social control.165 Three key structural factors

contributing to the erosion of social control are poor economic conditions,population turnover, and racial-ethnic heterogeneity.166 Alcohol outlets

may represent a form of neighborhood disorder, contributing to the

absence of social control.167 Alternately, alcohol outlets may be a surrogate

for low social control, as better-organized and politically empowered

neighborhoods may be able to prevent the entrance of alcohol outlets into

their communities in the first place.168

These three theories are not mutually exclusive,169 and some studies have found

empirical data to support elements of various combinations of selective disinhibition,

routine activities and social disorganization theories with regard to AOD.170

Gruenewald (2007) features perhaps the most comprehensive theoretical

overview in specific regard to motor vehicle injury. He posits a dual population theory

of drinking and driving with two “iconic” types of drink-drivers – occasional drink-

drivers and repeated drink-drivers. The two types of drink-drivers will differ across

four core components of the theoretical framework: 1) agency (specific personality

correlates); 2) contexts (social and physical); 3) contacts; and, 4) topology (geographic

distribution of drinking outlets). He further suggests that the next steps in this area of

research should address both the social mechanisms of drinking and driving andtopological issues related to alcohol outlets.171

An integrated theory of AOD effects is proffered by Livingston, et al. (2007), who

theorize that alcohol outlets have both a proximity effect and an amenity effect. The

proximity aspect is a variation on classic availability theory: increased availability of

alcohol through retail outlets leads to higher consumption and more alcohol-related

problems.172 Also, a higher number of outlets may intensify retail competition, resulting

in lowered prices and commensurate growth in consumption.173 The amenity aspect is

the “attractor” effect of alcohol outlets whereby the outlets effect a “simple

redistribution of where consumption takes place.”174 This is consonant with routine

activities theory.



17

Policy Analysis

PRELIMINARY DISCUSSION: THREE NECESSARY CHARACTERISTICS OF SOUND ALCOHOL POLICY

Research-based

The science of epidemiology has made astounding progress in the last several

decades, especially in the area of infectious and food-borne diseases. 175 This has been

observed in the Syracuse area with the recent rapid and effective response of the

Onondaga County Health Department to local outbreaks of Legionnaire’s disease,

Salmonellosis, and Campylobacteriosis.176 In cases of this nature, most citizens are more

than happy to depend on the expertise of public health professionals. Unfortunately,

when the focus shifts to behavioral health problems with complex etiology (notably

alcohol problems, with their aptly characterized “biopsychosocial matrix of risk” 177),

other considerations begin to dominate the conversation. This may be due to the fact

that, as Meier (1994) expresses, “the prevalence of alcohol in American society means

virtually everyone is an expert on the topic.”178 Indeed, most people have either

struggled with alcohol problems or know someone with alcohol problems. This

familiarity contributes to a shift in reliance from scientific expertise to a variety of folk

wisdom, subjective insight, and anecdotal observation.

Regardless, policymakers need to fix their gaze on the weight of evidence and (inthe words of sociologist Peter L. Berger) keep a “kosher kitchen” with regard to the

separation of empirical analysis and subjective insight.179 This requires that we rely on

the best scholarship and the leadership of the public and non-profit organizations

which have demonstrated a commitment to solid scholarship and evidence-based

policies: the National Institute on Alcoholism and Alcohol Abuse (NIAAA), the Centers

for Disease Control and Prevention (CDC), the Institute of Medicine (IOM), the

American Public Health Association (APHA), the American Medical Association

(AMA), the Prevention Research Center (PRC), and the National Highway Traffic Safety

Administration (NHTSA), among others.

Disinterested

While there are other types of bias which can plague research,180 financial

interests must be considered the most insidious and corruptive influence on public

health research.181 And whereas perhaps the most egregious examples of this dynamic

are in the field of tobacco,182 it is also operative in the field of alcohol studies. The

alcohol and its allied industries have sponsored and cultivated dubious research, often



18

framed to either promote an individual-risk perspective (as opposed to a population

perspective) or promote the benefits of drinking.183 More troubling, perhaps, is the

industry’s (sometimes surreptitious) funding of front groups whose purposes seem to be to manufacture doubt,184 to promote ineffective, red herring policies,185 and attack

public health advocates and scientists.186 Former Surgeon General C. Everett Koop has

trenchantly commented on the nature of corporate lobbying “institutes” such as the

Tobacco Institute and the Beer Institute:

In the 1850s, John Snow ended an epidemic of cholera in London by removing the handle of

the Broad Street pump, 30 years before the bacterium that causes cholera was first

identified. Fortunately, there was no Cholera Institute that lobbied against removal of the

pump handle until it could be proved that the water from that pump was causing cholera. 187

Measured

Legal scholar Richard J. Bonnie has spoken of the need to “strike the right

balance” in “develop[ing] and implement[ing] effective ways to protect young people

from the dangers of early drinking while respecting the interests of responsible adult

consumers of alcohol.”188 This need for balance applies to the mitigating of alcohol-

related problems stemming from AOD, as well. The key is a careful, measured

approach. (We deliberately avoid using the term “targeted” here, as that term has been

co-opted by the alcohol industry to describe interventions aimed at high-riskindividuals rather than population-wide strategies).189

Alcohol outlet density

Although the bulk of the research addressing AOD has occurred in the last few

decades, the connection between alcohol outlets and health and social problems is not a

recent discovery. Temperance maps from the late 19 th century showed the relationship

between public drinking places and alcohol-related arrests and problems.190 As we have

seen, more recent research - employing sophisticated statistical and spatial analysis and

GIS techniques - has drawn a more nuanced picture. Nonetheless, researchers havevariously described alcohol as a “destabilizer”191 and alcohol outlets as “attractors,”192

“generators,”193 and “multipliers,”194 of crime and violence. It follows logically that

reductions in the numbers of alcohol outlets (and mitigation of problem alcohol outlets)

would help to curb alcohol-related problems.

Not surprisingly, then, the most comprehensive guide to alcohol policy places

outlet density restrictions as a “best practice.”195 The World Health Organization has

also recommended the practice of reducing the number and placement of alcohol



19

outlets in order to reduce alcohol-related problems.196 Several of the authors of the

studies considered here come to similar conclusions.197

More recently, the CDC’s Task Force for Community Preventive Services has

designated the limiting of AOD as a “recommended” intervention. To wit:

The Task Force recommends the use of regulatory authority (e.g., through licensing and

zoning requirements) to limit alcohol outlet density on the basis of sufficient evidence of a

positive association between outlet density and excessive alcohol consumption and related

harms.198

Robert Brewer (the Alcohol Team Leader of the National Center for Chronic Disease of

the CDC) has explained that this designation is based on the “consistent evidence” thatincreased AOD is associated with increased alcohol consumption; suicides, assaults,

and other violent crimes; and, alcohol-related medical visits. The research examining

AOD and motor vehicle crashes are said to have “inconsistent findings,” with this

“heterogeneity” possibly “due to results from studies of ‘dry’ communities.” 199

Benefits

In terms of the specific benefits of reducing AOD, Table 1 assembles

quantifications of some of the reductions in problems which were hypothesized bystudy authors according to their models.

Economic benefits

Because of the cost-intensive nature of many of the problems engendered by

alcohol-related and AOD-related problems, the economic benefits of AOD

reduction/mitigation are most likely quite sizeable. To illustrate the economic impact of

alcohol problems, the San Diego Serial Inebriate Program found that 529 individuals

with multiple arrests for public intoxication amassed total health care charges of $17.7

million (including $1.3 million in EMS, $2.5 million in ED, and $13.9 in inpatient care) inthe years 2000-2003.200 Other studies have verified the resource- and effort-intensive

nature of these “frequent flyers.”201 Moreover, reductions in AOD are cost-effective in

that they can mitigate problems without the expenditure of additional resources.



20

Table 1: Quantification of AOD reduction benefits

Study An increase of: In: Will result in An increase of: In:

Scribner, Mason,et al. (2008)

1 standard deviation on-premise AOD Will result in 0.57 Average # of drinks

Scribner, Mason,et al. (2008)

2 standard deviations AOD Will result in 1 .32 Avera ge # of drinkin g occasions

Scribner, et al.

(1999)10% off-premise AOD Will result in 2.4% Homicide rate

Scribner, et al.

(1994)1 # of alcohol outlets Will result in 3 .4 Addition al a ssault ive violen t offe nses

Tatlow, et al.

(2000)1

# of liquor outlets

per 10,000 popWill result in 0.48

# of hospital admissions due to

alcohol-related morbidity

Gruenewald &

Remer (2006)10%

# of off-premise

outletsWill result in 1.67% Rate of violence

Gruenewald &

Remer (2006)10% # of bars Will result in 2.06% Rate of violence

McKinney, et al.

(2009)10

# of alcohol outlets

per 10,000 popWill result in 3 4% Ris k o f m ale-to-f em ale p artne r violen ce

Watts & Rabow

(1983)1% Density of beer bars Will result in >1%

Arrests for public drunkenness &

misdemeanor DWI

Study A decrease of: In: Will result in An decrease of: In:

Freisthler, et al.

(2007)

Average of 1 across

579 zip codes

# of off-premise

outletsWill result in 1,040 Total CPS cases

Freisthler, et al.

(2007)

Average of 1 across

579 zip codes

# of off-premise

outletsWill result in 180 Total CPS substantiations

Freisthler, et al.

(2007)

Average of 1 across

579 zip codes

# of off-premise

outletsWill result in 93 Total foster care entries

Son (2002) 10% # of alcohol outlets Will result in 2% Black homicide rate

Son (2002) 10% # of alcohol outlets Will result in 3% Black primary cause mortality rate

Markowitz &Grossman (1998)

1# of alcohol outlets

per 1,000 popWill result in 4%

Probability of severe violence toward

children

Truong & Sturm

(2008)4


within .05 milesWill result in 0.8% Youth binge drinking

Truong & Sturm

(2008)4


within .05 milesWill result in 1.9% Youth driving after drinking



21

Barriers

The primary barrier is state preemption of the field of alcohol control. States

were granted the power to “regulate the taxation, distribution, and manufacture of

alcohol,” per the Twenty-first Amendment to the United States Constitution (Repeal of

Prohibition).202 This has resulted in a good deal of latitude regarding how states

implement these powers. Alcohol policy expert James Mosher has described the

sometimes byzantine relationship between state alcohol beverage control laws and local

authority to regulate alcohol-related problems.203 There is a continuum of control, from

almost complete state control (e.g., North Carolina, Texas) to local communities being

the licensing agent, with minimum state standards (e.g. Minnesota, Wisconsin). New

York would be probably most be correctly described as falling into Mosher’s second

category – “Exclusive state licensing authority, [with some] local regulatory

authority.”204 This makes direct regulation of AOD per se by local communities in New

York State untenable.

Another, related, barrier is the influence of the alcohol industry. Thomas Babor

describes the environment in Britain:

Alcohol producers and retailers, supported by the Portman Group [consortium of alcohol

producers], are dictating licensing decisions to the point where a small city like Nottinghamnow has 356 licensed premises concentrated in just one square mile of the city. The result is

an escalating rate of drunk and disorderly conduct, not to mention the injuries and violence

that goes with it.205

It must be noted that, within the broader alcohol industry, there are community-

minded wholesalers and small retailers who have a genuine desire to limit alcohol-

related problems. While there are, of course, smaller merchants who are also

irresponsible, it is the larger (increasingly multi-national) corporate alcohol producers

who typically seek to increase the overall volume of consumption of alcohol 206 and who

lobby so effectively at the federal, state, and local levels.207

States and municipalities which have implemented or attempted to implement AOD

restrictions

California

Because of community outcry regarding the proliferation of liquor licenses and

the resulting alcohol-related problems, the California state legislature passed laws in



22

1994 to reduce this growth. New licenses would not be allowed in areas where there

was an “undue concentration of liquor stores,” defined as 1) having at least twenty

percent more crime than the police jurisdiction where it was located, or 2) areas wherethe ratio of liquor licenses exceeded the general ratio of the jurisdiction.208 Exceptions to

these restrictions would be made if the establishment could be shown to serve “public

necessity or convenience.”209 Critics charged that this exception was unduly vague and

effectively shifted the burden of proof to local communities.210 Currently, the state of

California has a ratio-based moratorium on the issuance of retail liquor licenses in every

county with fewer than 300,000 residents, and all counties with low population

densities.211 The restrictions do not apply to more densely populated counties with

more than 1 million residents. The moratorium is triggered when ratios exceed one on-

premise license for every 2,000 persons or one off-premise license for every 2,500

persons.212

Chicago, Illinois

36 out of 50 wards of Chicago had issued moratoria on alcohol licenses by

1997.213 These were accomplished through community action, city councilors, and/or

planning ordinances.214 Nonetheless, Chicago may be a special case, considering that

each precinct can vote to ban alcohol sales locally. 215 Nearly one-third of Chicago’s

2,575 voting precincts are dry or partially dry.216

Madison, Wisconsin

The Central Commercial District of Madison experienced an increase of 125% in

the number of alcohol beverage licenses between 1997 and 2006, with a concomitant

spike in alcohol-related problems.217 As a result, the city sought to implement a careful

limit on alcohol outlet density in order to “decrease the strain on public resources

caused by a high density of alcohol-related businesses while simultaneously providing

opportunities in the downtown area for businesses that are either not associated with

the sale of alcohol or that sell alcohol incidental to their principal business.”218 Part of

the outlet density plan is an annual review of license activity, alcohol-related crime and

disorder, the correlation between alcohol license density and alcohol-related problems,

and an analysis of the economic impact of the plan. Initial data from the first year of the

plan seems to indicate that there has been a modest reduction in alcohol-related

problems.219

Other communities which have implemented or attempted to implement AOD

restrictions are listed in Table 2.



23

Table 2: Actual, attempted, or proposed restrictions/reductions of alcohol outlet density

Geography Restriction Source

Contra Costa County,

California

Buffer: No new outlets within 400 ft

of schools, parks or recreation areas,

churches, alcohol or drug treatment

programs, and county social service

offices

Craun & Freisthler (2008)

Tampa, Florida

Buffer: No new outlets within 1000 ft.

of parks, churches, schools, day care

centers or government buildings

Hill (2004)

Contra Costa County,

California

No new outlets in crime districts with

higher-than-average crime rates

Craun & Freisthler (2008)

New York City Targeted cap on liquor licenses Lugo (2008)

Cambridge, Mass. Targeted cap on liquor licenses Lugo (2008)

Reno, Nevada Targeted cap on liquor licenses Lugo (2008)

Florida Statewide cap on liquor licenses Lugo (2008)

Wisconsin Statewide cap on liquor licenses Lugo (2008)

Las VegasProposed cap on liquor licenses in

northeast Las Vegas neighborhoodChoate (2009)

National Harbor, Md.Proposed cap on liquor licenses in

large development

Helderman, Wiggins, &

Rucker (2008)



24

Policy Recommendations

1. Advocate for changes in New York State Alcohol Beverage Control (ABC) lawwhich cede more control of alcohol outlets and their related problems to local

governments.

As noted above, New York State ABC law is heavily weighted toward complete State

control, with some respect of local zoning ordinances, as long as alcohol is not explicitly

addressed. While the State Liquor Authority (SLA) has, at times, been very open to

community input,220 ultimately, local communities are forced to abide by the decisions

of the SLA.

Especially considering the drastic reductions in New York State ABC enforcement staff

in recent years (in 2006, there were 28 investigators charged with overseeing 27,062

bars),221 it makes eminent sense for there to be a stronger state-local partnership with

regard to both alcohol policy and enforcement. Mosher articulates the most rational

policy:

States are responsible for establishing minimum alcohol availability regulatory standards

applicable to all communities in their jurisdiction. Local governments cannot override these

minimum requirements, but should have flexibility to create additional, more restrictive

standards that respond to local needs and circumstances.222

Similarly, a report from the National Highway Traffic Safety Administration (NHTSA)

on state ABC laws includes the following recommendation:

Develop effective partnerships between State ABC agencies and local governments and law

enforcement agencies. This should include encouraging local input into State licensing

decisions, permitting independent authority at the local level to enhance (but not loosen)

minimum State restrictions, and establishing procedures for joint law enforcement

initiatives.223

Were New York State localities given local control, the City of Syracuse could then:

1a. Limit alcohol outlet density in neighborhoods with the highest rates of alcohol-

related problems.

Undertake targeted moratoria on liquor licenses in census tracts or census block groups

with both high alcohol outlet density and high rates of alcohol-related problems.



25

1b. Cap current level of alcohol outlet density in Armory Square district.

Livingston, Room, & Chikritzhs (2007) postulate an exponential effect of additionalalcohol outlets in already dense entertainment districts. A cap of liquor licenses in the

Armory Square district should be considered, dependent on the results of the

econometric analysis described below (Recommendation 2c).

2. Broaden the knowledge base regarding alcohol-related problems in Syracuse and

Onondaga County.

2a. Improve official data collection to include alcohol-related data, at the finest

possible level.

Analysts at the Urban Institute, through their National Neighborhood Indicators

Partnership, have made a compelling case that neighborhood-level indicators are

necessary to effectively address issues of public health and public safety in our cities. 224

Toward that end, specific alcohol-related data to be compiled and analyzed at the city

and county levels could include:

Domain Data

Social Services Child Protective Services cases (referrals and substantiations) Alcohol-positive TANF substance abuse screens

Emergency Services Alcohol-related calls for service

Law Enforcement Routine notation of alcohol involvement in calls/arrests

(perpetrator and/or victim)

Corrections Self-reported alcohol involvement

Probation Alcohol involved crime

Probationers in need of alcohol treatment

Health Alcohol-related conditions (all conditions with established

alcohol attributable fractions – AAFs) at the census tract level

2b. Partner with local colleges and universities (including new MPH program at

SUNY/Syracuse University) to study local alcohol-related impact, especially the

impact of alcohol availability.

Several of the maps in the accompanying report call for deeper, “fine-grain”225 analysis

of the relationship between alcohol availability and public health and public safety



26

problems in the Syracuse area. There is also potential for local, ground-breaking

research regarding the effects of AOD. Such research could cut across a variety of

disciplines (including public health, medicine, public policy and administration, andsocial work) and provide benefits to both the participating academic institutions and

the municipality.

2c. Conduct a cost/benefit analysis of additional outlets in Armory Square

While alcohol outlets provide tax revenue and related economic activity, these benefits

are at least somewhat offset by the costs associated with the crime and health problems

engendered. Some Armory Square merchants have claimed that the tax revenue they

generate exceeds the costs to the City (at least in terms of police security).226 A

comprehensive econometric analysis is called for.

3. Establish an Alcohol Policy Coordinator position (similar to Madison, Wisconsin)

The manner in which alcohol issues cut across the traditional silos of government –

health, public safety, social services, economics - points to the need for an integrated

administrative approach. Madison, Wisconsin, answered this need by creating the

position of Alcohol Policy Coordinator (APC) - funded jointly by the City and the

University of Wisconsin at Madison. The APC answers to the Mayor and conducts

public policy related research, coordinates the development of a comprehensive alcoholpolicy for the City, coordinates the development of a policy regarding alcohol parties at

private residences, promotes and trains toward tavern safety, and creates education

materials, among other duties.

Funding for this position could derive jointly from a range of agencies, including Stop

DWI funds, the County Attorney office, the State Attorney’s General office, the U.S.

Attorney’s office, the County Sheriff, the Onondaga County Health Department, the

Onondaga County Department of Mental Health, the New York State Office of

Alcoholism and Substance Abuse Services, and the Onondaga County Department of

Social Services, among others.

Endnotes:

1 Cowan & Mosher (1985)2 Mokdad, Marks, Stroup, & Gerberding (2000)3 Rehm, Gmel, Sempos, & Trevisan (2003)4 National Institutes of Health (1994)5 Ibid.6 Abbey, Zawacki, Buck, Clinton, & McAuslan (2001).



27

7 National Institutes of Health (1994)8 Cherpitel (1992)

9 National Institutes of Health (1994)10 Ibid.11 Ibid.12 Strunin & Hingson (1992)13 Bacharach, Bamberger, & McKinney (2007)14 Tjaden & Theonnes (1998)15 Bryant, Schulenberg, & O’Malley (2003).16 Collins, Ellickson, & Klein (2007).17 Boffetta, Hashibe, La Vecchia, Zatonski, & Rehm (2006)18 Ibid.19 Ibid.20 Ibid.21 Ibid.22 Cho, Smith-Warner, Ritz, van den Brandt, Colditz, Folsom, et al. (2004)23 Ibid.24 Bandera, Freudenheim, & Vena (2001)25 Zhang, Lee, Manson, Cook, Willett, & Buring (2007)26 Nunnez, Carter, & Meadows (2002)27 Lucas, Gebo, Chaisson, & Moore (2002)28 National Institutes of Health (1994)29 Ibid.30 Ibid.31 Ibid.32 Moss (2005)33 Nelson & Kolls (2002); Cook (1998)34 Malik, Gasser, Kemmler, Moncayo, Finkenstedt, Kurz, et al. (2008)35 Choi, Atkinson, Karlson, Willett, & Curhan (2004)36

National Institutes of Health (1994)37 National Institutes of Health (1994)38 Dani & Harris (2005)39 Krahn, Kurth, Gomberg, & Drewnowski (2005)40 Substance Abuse & Mental Health Service Administration (2006)41 Goldstein, Dawson, Saha, Ruan, Compton, & Grant (2007)42 Douglass, Moffitt, Dar, McGee, & Silva (1995)43 Rodgers, Ezzati, Vander Hoorn, Lopez, Lin, Murray, et al. (2004), p. 4844 DiIulio (1995), p.245 Miller, Levy, Spicer, & Taylor (2006)46 Harwood (2000)47 Ibid.48 Utilizing a conversion factors of 0.765, per Sahr (2008).49 New York State Department of Health (2003); Centers for Disease Control and Prevention (2006).50 U.S. Census Bureau (2005-2007)51 Syracuse (2008)52 Rosen, Miller, & Simon (2008)53 Califano (2001)54 Ibid55 Månsdotter, Rydberg, Wallin, Lindholm, & Andréasson (2007)56 Aos, Lieb, Mayfield, Miller, & Pennucci (2004)57 Andréasson, Hjalmarsson, & Rehnman (2000)58 Mortimer & Segal (2005)59 Bruun, Edwards, Lumio, Makela, Pan, Popham, et al. (1975); Brand, Saisana, Rynn, Pennoni, & Lowenfels (2007).60 Edwards, Anderson, Babor, Casswell, Ferrence, Giesbrecht, et al. (1995)61 Babor, Caetano, Casswell, Edwards, Giesbrecht, Graham, et al. (2003)62 Ibid, p. 5



28

63 Ibid., p. 27064 Ibid.

65 Gruenewald & Treno (2000)66 Babor, Caetano, Casswell, Edwards, Giesbrecht, Graham, et al. (2003), p. 11867 e.g., Scribner, Cohen, Kaplan, & Allen (1999)68 Livingston, Chikritzhs, & Room (2007)69 Cohen, Ghosh-Dastidar, Scribner, Miu, Scott, Robinson, et al. (2006), p. 270 Gorman & Speer (1997); Alaniz, Parker, Gallegos, & Cartmill (1996); LaVeist & Wallace (2000); Romley, Cohen,Ringel, & Sturm (2007); Pollack, Cubbin, Ahn, & Winkleby (2005); Jones-Webb, McKee, Hannan, Wall, Pham,Erickson, et al. (2008); Truong & Sturm (2009)71 Romley, Cohen, Ringel, & Sturm (2007), p. 5472 Ibid., p. 54.73 Pollack, Cubbin, Ahn, & Winkleby (2005)74 Bluthenthal, Cohen, Farley, Scribner, Beighley, Schonlau, et al. (2008).75 Wechsler, Lee, Hall, Wagenaar, & Hang (2002)76 Donnelly, Poynton, Weatherburn, Bamford, & Nottage (2006)77 Scribner, Theall, Ghosh-Dastidar, Mason, Cohen, & Simonsen (2007)78 Kawachi, Kennedy, Lochner, & Prothrow-Stith (1997); De Leonardis (2006)79 Livingston, Chikritzhs, & Room (2007), p. 55880 Scribner, Cohen, & Fisher (2000); Truong & Sturm (2007); Nelson (2008); Huckle, Huakau, Sweetsur, Huisman, &Casswell (2008); Treno, Ponicki, Remer, & Gruenewald (2008); Truong & Sturm (2009)81 Parker, Wolz, & Harford (1978); Colón, Cutter, & Jones (1982); Gliksman & Rush (1986); Watts & Rabow (1983)82 Abbey, Scott, & Smith (1993); Pollack, Cubbin, Ahn, & Winkleby (2005) (see above)83 Gruenewald, Millar, Ponicki, & Brinkley (2000)84 Gruenewald, Ponicki, & Holder (1993)85 Freisthler, Gruenewald, Treno, & Lee (2003)86 Truong & Sturm (2007), p. 92387 Huckle, Huakau, Sweetsur, Huisman, & Casswell (2008); Treno, Ponicki, Remer, & Gruenewald (2008); Nelson(2008); Truong & Sturm (2009)88

Huckle, Huakau, Sweetsur, Huisman, & Casswell (2008)89 Treno, Ponicki, Remer, & Gruenewald (2008)90 Ibid., p. 137291 Truong & Sturm (2009), p. 192 Weitzman, Folkman, Folkman, & Wechsler (2003); Kypri, Bell, Hay, & Baxter (2008); Scribner, Mason, Theall,Simonsen, Schneider, Towvim, et al. (2008)93 Hingson, Heeren, Winter, & Wechsler (2005)94 Cf. Wechsler (2008); Parker (2008)95 LaChausse (2008)96 Including stillbirth, preterm birth, fetal growth restriction, sudden infant death syndrome, and child behaviorproblems. Cnattingius (2004)97 Tatlow, Clapp, & Hohman (2000)98 Wilson (2002), p. iii99 cf. Rabow & Watts (1983)100 Scribner, Johnson, Cohen, Robinson, Farley & Gruenewald (2008)101 Woolf & Maisto (2008); Lucas, Gebo, Chaisson, & Moore (2002)102 Taylor, Collins, Elliott, Ringel, Kanouse, & Beckman (2009); Grossman, Kaestner, & Markowitz (2004)103 Cohen, Ghosh-Dastidar, Scribner, Miu, Scott, Robinson, et al. (2006)104 Ibid., p. 7105 Farley, Mason, Rice, Habel, Scribner, & Cohen (2006), p. 188106 Jewell & Brown (1995)107 Stevenson, Brewer, & Lee (1998)108 Meliker, Maio, Zimmerman, Kim, Smith, & Wilson (2004)109 Gruenewald, Millar, Treno, Yang, Ponicki, & Roeper (1996)110 Ibid., p. 979111 Gruenewald, Johnson, & Treno (2002)112 Ibid., p. 466



29

113 Scribner, MacKinnon, & Dwyer (1994)114 Treno, Johnson, Remer, & Gruenewald (2007)

115 Ibid., p. 894116 Hingson, Zakocs, Heeren, Winter, Rosenbloom, & DeJong (2005)117 Treno, Grube, & Martin (2003)118 LaScala, Gerber, Gruenewald (2000)119 LaScala, Johnson, & Gruenewald (2001)120 Cherpitel (2007)121 Freisthler, Gruenewald, Ring, & LaScala (2008)122 Cf. Bushman & Cooper (1990); Norris, Davis, George, Martell, & Heiman (2002); Parker & Rebhun (1995); Rossow (2001)123 Fals-Stewart (2003); Leonard (2001)124 Rossow & Amundsen (1995); Miller, Mahler, & Gold (1991)125 Holder (2008), p. 78126 Yu, Scribner, Carlin, Theall, Simonsen, Ghosh-Dastidar (2008)127 Gorman, Speer, Labouvie, & Subaiya (1998)128 Speer, Gorman, Labouvie, & Ontkush (1998), p. 303129 Speer, Gorman, Labouvie, & Ontkush (1998); Gorman, Speer, Gruenewald, & Labouvie (2001)130 Scribner, Dwyer, & MacKinnon (1995)131 Reid, Hughey, & Peterson (2003)132 Zhu, Gorman, & Horel (2004)133 Britt, Carlin, Toomey, & Wagenaar (2005)134 Zhu, Gorman, & Horel (2006)135 Scribner, Cohen, Kaplan, & Allen (1999)136 Gorman, Li, & Horel (2005)137 Gruenewald, Freisthler, Remer, LaScala, & Treno (2006)138 Roman, Reid, Bhati, & Tereshchenko (2008)139 Smith, Frazee, & Davison (2000), pp. 507-508140 Nielsen, Martinez, & Lee (2005)141

Jones-Webb, McKee, Hannan, Wall, Pham, Erickson, et al. (2008)142 Midford, Masters, Phillips, Daly, Stockwell, Gahegan, et al. (1998);143 Jonas, Dietze, Rumbold, Hanlin, Cvetkovski, & Laslett (1999)144 Stevenson, Lind, & Weatherburn (1999)145 Parker, Luther, & Murphy (2007)146 Alaniz, Cartmill, & Parker (1998)147 Gorman, Labouvie, Speer, & Subaiya (1998)148 Gorman, Speer, Labouvie, & Subaiya (1998)149 McKinney, Caetano, Harris, & Ebama (2009)150 Roman, Reid, Bhati, & Tereshchenko (2008)151 Donnelly, Poynton, Weatherburn, Bamford, & Nottage (2006)152 Liquor law violations included underage person in a licensed premise, open intoxicant on public property, possessionof fake identification, detox transport, public drunkenness, and underage consumption. (Lugo, 2008, p. 20).153 Freisthler, Needell, & Gruenewald (2005)154 Freisthler, Gruenewald, Remer, Lery & Needell (2007)155 Freisthler, Bruce, & Needell (2007)156 Freisthler, Gruenewald, Ring, & LaScala (2008)157 Freisthler, Midanik, & Gruenewald (2004)158 Babor, Caetano, Casswell, Edwards, Giesbrecht, Graham, et al. (2003)159 Livingston, Chikritzhs, & Room (2007)160 Parker & Rebhun (1995)161 Nielson & Martinez (2003), p. 452162 Livingston, Chikritzhs, & Room (2007), p. 561163 Livingston, Chikritzhs, & Room (2007), p. 561164 Roncek & Maier (1991)165 Livingston, Chikritzhs, & Room (2007), p. 561166 Nielson & Martinez (2003)



30

167 Nielson & Martinez (2003)168 Livingston, Chikritzhs, & Room (2007), p. 561

169 Treno, Gruenewald, Remer, Johnson, & LaScala (2008)170 Smith, Frazee, & Davison (2000); Treno, Gruenewald, Remer, Johnson, & LaScala (2008)171 Gruenewald (2007), pp. 116-117172 Livingston, Chikritzhs, & Room (2007), p. 561173 Ibid., p. 561174 Ibid., p. 561175 Nelson, Williams, & Graham (2005)176 Mulder (2008, October); Mulder (2008, September); Mulder (2008, July)177 Zucker, Boyd, & Howard (1994)178 Meier (1994), p. 177179 Berger (1963), p. 124180 E.g. publishing bias (cf. Song, Eastwood, Gilbody, & Duley, 1999)181 Cf. Krimsky (2006)182 Landman & Glantz (2009)183 McCreanor, Casswell, & Hill (2000)184 Parry (2000);185 Chamberlain & Solomon (2001)186 Cf. Mindus (2003)187 Koop (1989), p. 13. Emphasis his.188 Bonnie & Battle (2003), p. 9189 Caetano (2008), p. 175190 Kneale (2001)191 Lusignan & Marleau (2007)192 Gruenewald & Treno (2000); Alaniz, Cartmill, & Parker (1998)193 McCord, Ratcliffe, Garcia, & Taylor (2007)194 DiIulio (1995)195 Babor, Caetano, Casswell, Edwards, Giesbrecht, Graham, et al. (2003), p. 270196

Ashe, Jernigan, Kline, & Galaz (2003)197 McKinney, Caetano, Harris, & Ebama (2009), p. 175198 Brewer (2009)199 Brewer (2009)200 Dunford, Castillo, Chan, Vilke, Jenson, & Lindsay (2006)201 Moore (2005); Fullerton, Olson, Crandall, Lee, & Sklar (1998)202 Mack (1997), p. 7203 Mosher (2001)204 Mosher (2001), p. 4205 Babor (2004), p. 1091206 Global Alcohol Policy Alliance (2007)207 Mosher & Jernigan (1989)208 Mack (1997), p. 7209 Ibid., p. 7210 Ibid.211 Truong & Sturm (2007)212 Ibid.213 Hill (2004)214 Ibid.215 FACE (2009)216 Ibid.217 Madison, City of (n.d.)218 Ibid., p. 1219 K. Plominski (personal communication, January 15, 2009)220 Ocejo (2008) asserts that the SLA “regularly communicates and collaborates with community boards, locally electedofficials at the city and State levels, and the police” (p. 9). Ocejo notes that this has not always been the case, suggesting that policies may change with SLA personnel.



31

221 O’Toole (2006)222 Mosher (2001), p. 6

223 NHTSA (2005), p. 10224 Howell, Pettit, Ormond, & Kingsley (2003)225 Gruenewald, Freisthler, Remer, LaScala, & Treno (2006), p. 675226 Perez (2002)

SAEP White Paper

Documents

Transcript of SAEP White Paper