Exploring violence: The role of neighborhood characteristics, alcohol outlets, and other micro-places

Examining the role of social vulnerability, neighborhood characteristics, and geospatial patterns of firearm-related injuries and clinical outcomes in Milwaukee county

BACKGROUND

Previous work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury.

METHODS

The trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage.

RESULTS

Most firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density.

CONCLUSIONS

In Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury.

Community-Level Risk Factors for Firearm Assault and Homicide: The Role of Local Firearm Dealers and Alcohol Outlets

BACKGROUND

Identifying community characteristics associated with firearm assault could facilitate prevention. We investigated the effect of community firearm dealer and alcohol outlet densities on individual risk of firearm assault injury.

METHODS

In this density-sampled case-control study of Californians, January 2005-September 2015, cases comprised all residents with a fatal or nonfatal firearm assault injury. For each month, we sampled controls from the state population in a 4:1 ratio with cases. Exposures were monthly densities of county-level pawn and nonpawn firearm dealers and ZIP code-level off-premises alcohol outlets and bars and pubs ("bars/pubs"). We used case-control-weighted G-computation to estimate risk differences (RD) statewide and among younger Black men, comparing observed exposure densities to hypothetical interventions setting these densities to low. We estimated additive interactions between firearm and alcohol retailer density. Secondary analyses examined interventions targeted to high exposure density or outcome burden areas.

RESULTS

There were 67,850 cases and 268,122 controls. Observed (vs. low) densities of pawn firearm dealers and off-premises alcohol outlets were individually associated with elevated monthly risk of firearm assault per 100,000 people (RD pawn dealers : 0.06, 95% CI: 0.05, 0.08; RD off-premises outlets : 0.01, 95% CI: 0.01, 0.03), but nonpawn firearm dealer and bar/pub density were not; models targeting only areas with the highest outcome burden were similar. Among younger Black men, estimates were larger. There was no interaction between firearm and alcohol retailer density.

CONCLUSIONS

Our results are consistent with the hypothesis that limiting pawn firearm dealers and off-premises alcohol outlet densities can reduce interpersonal firearm violence.

The Impact of Helping Children with Distance Learning During COVID-19 on U.S. Parents' Alcohol Consumption

We examined the impact of distance learning-related parental stress due to COVID-19 on parental alcohol consumption using an online survey in May 2020 with a convenience sample of U.S. adults. This article focuses on the 361 parents who had children under the age of 18 living with them. Seventy-eight percent had children who were engaged in distance learning; 59% reported being stressed because they were not sure how to help their children with distance learning. Stressed parents reported consuming significantly more alcohol and binge drinking more often than parents who were not stressed by distance learning. We hope that public health professionals can use our findings to better target alcohol prevention programs aimed at parents to reduce parental stress, and hopefully, parental alcohol consumption.

Neighborhood Ecological Models of Alcohol Outlet Density and Male–on–Female Domestic Violence: Accounting for Adjacent Place and Neighborhood Characteristics

Alcohol availability is a consistent predictor of domestic violence, including intimate partner violence. Less is known about the effects of alcohol availability in neighboring units of analysis on domestic violence. This study examined whether alcohol outlet density in Milwaukee, Wisconsin is associated with Male-on-Female domestic violence (MFDV). Using block groups as the unit of analysis ( N = 571), spatial regression models were estimated to model the relationship between the density of total, on-premise, and off-premise alcohol outlets on MFDV, while accounting for the spatial spillover effect (i.e., alcohol availability and neighborhood characteristics in focal and surrounding block groups). At the focal level, off-premise alcohol outlets are associated with MFDV, net of concentrated disadvantage, lack of health insurance, MFDV lag and total population. Additionally, off-premise alcohol outlet density in surrounding units of analysis is a significant predictor of MFDV. However, total and on-premise densities did not demonstrate a relationship with MFDV.

A systems framework depicting how complex neighborhood dynamics and contextual factors could impact the effectiveness of an alcohol outlet zoning policy

An updated zoning policy eliminating all alcohol outlets (liquor stores) in residential districts was implemented to reduce high rates of violent crime in Baltimore City. Diverse stakeholders were engaged in group model building (GMB) activities to develop causal loop diagrams (CLDs) that elucidate the impact of the new zoning policy on crime, and more broadly, the potentially unintended social and environmental consequences of the policy. Three distinct groups, community advocates, city officials/academics, and community residents, participated in three separate GMB sessions. Three CLDs, one from each stakeholder group, were created to depict the possible outcomes of the zoning policy. Our findings offer insight into potential unintended consequences of removing liquor stores from residential areas that may undermine the policy. Community members described the need for additional supports related to mental health and substance use, opportunities for investment in the community, access to other goods and services, and community-police relations to ensure the policy achieved its intended goal of reducing violent crime. Our findings highlight the importance of timely engagement of local stakeholders to understand how complex neighborhood dynamics and contextual factors could impact the effectiveness of a zoning policy change.

Alcohol consumption and alcohol home delivery laws during the COVID-19 pandemic

Background: Alcohol consumption in the U.S. is a public health problem that has been exacerbated by the COVID-19 pandemic. Relatedly, many states have responded to COVID-19 by relaxing their alcohol laws, making it possible for adults to have alcohol delivered to their homes. This study sought to understand the impact of allowing alcohol home delivery on self-reported adult alcohol consumption in the US. Methods: In May 2020, we surveyed a convenience sample of U.S. adults over 21 years of age recruited through social media and listservs. Eight hundred and thirty-two participants completed the online survey: 84% were female, 85% were White, and 72% were between the ages of 26 and 49. Results: Twenty-one percent of participants who consumed alcohol in the past month had at least some alcohol delivered, with 60% having it delivered from liquor stores, restaurants, or bars. The remainder of the participants purchased the alcohol in-person or owned it pre-COVID-19. Participants who reported having alcohol delivered also reported consuming more drinks (β = 13.3; 95% CI [8.2, 18.4]; p < .000) and drinking on more days (β = 5.0; 95% CI [2.9, 7.0]; p < .000) over the past month than participants who obtained alcohol through other methods. Participants who had alcohol delivered were nearly two times more likely to report engaging in binge drinking than those who obtained alcohol through other methods (OR = 1.96; 95% CI [1.3, 3.1]; p = .003). Conclusions: Obtaining alcohol through home delivery was associated with greater alcohol consumption including binge drinking. As states consider permanently allowing alcohol home delivery, it is important to consider the potential public health implications.

Examining Time-Variant Spatial Dependence of Urban Places and Shootings

Place-based interventions are increasingly implemented to address firearm violence. While research on the social determinants of health and criminological theories suggest that the built environment significantly influences health outcomes and the spatial distribution of crime, little is known about the attraction between urban places and shootings. The present study adds to the literature on firearm violence and micro-place research by exploring the spatial dependence in a Midwest metropolitan area between shootings and bus stops, vacant properties, alcohol outlets, and other locations that have been theoretically or empirically linked to firearm violence. The G-function and Cross-K function are used to characterize the univariate clustering of shootings and bivariate attraction with other locations, respectively. Bus stops, blighted vacant properties, alcohol outlets, and businesses/residential locations participating in a public-private-community initiative to reduce crime exhibited significant locational dependence with shootings at short distances. Attraction between on-premises alcohol outlets and shootings was observed only during the night. No attraction was found between schools and shootings. The findings reaffirm the importance of place-based research-especially at the micro-place level-and suggest that certain urban places may be appropriate targets for interventions that modify existing physical and/or social structures.

Multiresolution Analyses of Neighborhood Correlates of Crime: Smaller Is Not Better

Population analyses of the correlates of neighborhood crime implicitly assume that a single spatial unit can be used to assess neighborhood effects. However, no single spatial unit may be suitable for analyses of the many social determinants of crime. Instead, effects may appear at multiple spatial resolutions, with some determinants acting broadly, others locally, and still others as some function of both global and local conditions. We provide a multiresolution spatial analysis that simultaneously examines US Census block, block group, and tract effects of alcohol outlets and drug markets on violent crimes in Oakland, California, incorporating spatial lag effects at the 2 smaller spatial resolutions. Using call data from the Oakland Police Department from 2010-2015, we examine associations of assaults, burglaries, and robberies with multiple resolutions of alcohol outlet types and compare the performance of single (block-level) models with that of multiresolution models. Multiresolution models performed better than the block models, reflected in improved deviance and Watanabe-Akaike information criteria and well-supported multiresolution associations. By considering multiple spatial scales and spatial lags in a Bayesian framework, researchers can explore multiresolution processes, providing more detailed tests of expectations from theoretical models and leading the way to more effective intervention efforts.

Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults

Emerging but limited evidence suggests that alcohol consumption has increased during the COVID-19 pandemic. This study assessed: (1) whether drinking behaviors changed during the pandemic; and, (2) how those changes were impacted by COVID-19-related stress. We conducted a cross-sectional online survey with a convenience sample of U.S. adults over 21 years in May 2020. We conducted adjusted linear regressions to assess COVID-19 stress and alcohol consumption, adjusting for gender, race, ethnicity, age, and household income. A total of 832 responded: 84% female, 85% White, and 72% ages 26-49. Participants reported consuming 26.8 alcohol drinks on 12.2 of the past 30 days. One-third of participants (34.1%) reported binge drinking and 7.0% reported extreme binge drinking. Participants who experienced COVID-19-related stress (versus not) reported consuming more drinks (β = 4.7; CI (0.2, 9.1); p = 0.040) and a greater number of days drinking (β = 2.4; CI (0.6, 4.1); p = 0.007). Additionally, 60% reported increased drinking but 13% reported decreased drinking, compared to pre-COVID-19. Reasons for increased drinking included increased stress (45.7%), increased alcohol availability (34.4%), and boredom (30.1%). Participants who reported being stressed by the pandemic consumed more drinks over a greater number of days, which raises concerns from both an individual and public health perspective.