Alcohol Retail Density and Demographic Predictors of Health Disparities: A Geographic Analysis

Abstract

Objectives We examined whether the geographic density of alcohol retailers was greater in geographic areas with higher levels of demographic characteristics that predict health disparities. Methods We obtained the locations of all alcohol retailers in the continental United States and created a map depicting alcohol retail outlet density at the US Census tract level. US Census data provided tract-level measures of poverty, education, crowding, and race/ethnicity. We used multiple linear regression to assess relationships between these variables and retail alcohol density. Results In urban areas, retail alcohol density had significant nonlinear relationships with Black race, Latino ethnicity, poverty, and education, with slopes increasing substantially throughout the highest quartile for each predictor. In high-proportion Latino communities, retail alcohol density was twice as high as the median density. Retail alcohol density had little or no relationship with the demographic factors of interest in suburban, large town, or rural census tracts. Conclusions Greater density of alcohol retailers was associated with higher levels of poverty and with higher proportions of Blacks and Latinos in urban census tracts. These disparities could contribute to higher morbidity in these geographic areas.

Neighbourhood deprivation and outlet density for tobacco, alcohol and fast food: first hints of obesogenic and addictive environments in Germany

“…The local availability of tobacco, alcohol and food is especially relevant and worth assessing in the investigation of place effects on health (12) . In fact, some studies have previously shown a positive correlation between neighbourhood deprivation and the availability of tobacco (13)(14)(15)(16)(17)(18) , alcohol (4,19,20) as well as convenience and fast foods (18,(21)(22)(23)(24) .…”

Race, Ethnicity, and Exposure to Alcohol Outlets

“…States with higher proportions of Black and Hispanic residents have greater concentrations of alcohol outlets (Berke et al, 2010;Gorman & Speer, 1997;LaVeist & Wallace Jr., 2000;Romley et al, 2007). This observation is highly relevant to public health because there is considerable evidence that problems such as intentional injuries (Cunradi et al, 2012;Gruenewald & Remer, 2006;Livingston, 2008Livingston, , 2011Mair et al, 2013;Toomey et al, 2012), road trauma (McMillan et al, 2007;Ponicki et al, 2013), and child abuse and neglect (Freisthler & Weiss, 2008;Freisthler et al, 2007) occur more frequently in areas with more alcohol outlets (Campbell et al, 2009).…”

“…However, these studies contain a number of key limitations, and theory regarding the spatial dynamics of retail markets predicts that Black and Hispanic groups will in fact have fewer outlets near their residences because these populations consume less alcohol. In that context, this study examined the claim that excess exposure to alcohol outlets is an issue of environmental justice for racial and ethnic minorities (Berke et al, 2010;LaVeist & Wallace Jr., 2000;Romley et al, 2007).…”

“…The theory therefore predicts that there will be fewer outlets in areas with greater proportions of Black and Hispanic residents because of reduced alcohol demand. Berke et al (2010) conducted the largest study to date examining racial and ethnic correlates of outlet density. Using North American Industry Classification System (NAICS) business lists, the authors spatially smoothed the combined density of liquor stores, taverns and bars, grocery stores, gas stations, and convenience stores (representing potential outlets) across the surface of the continental United States and then constructed linear regression models for outlets per population within census tracts.…”

“…These previous studies were conducted using the relatively large spatial units of census tracts (Berke et al, 2010;Gorman & Speer, 1997;LaVeist & Wallace Jr., 2000) or zip codes (Romley et al, 2007) in single-level models. However, the spatial dynamics of alcohol markets likely operate at multiple scales, possibly including smaller spatial scales than these units of analysis.…”