Adverse Drinking-Related Consequences Among Lower Income, Racial, and Ethnic Minority Drinkers: Cross-Sectional Results

Alcohol policy effects on 100% chronic alcohol-attributable mortality across racial/ethnic subgroups

In the United States, some racial/ethnic minorities suffer from higher rates of chronic alcohol problems, and alcohol-related morbidity and mortality than Whites. Furthermore, state-level alcohol policies may affect racial/ethnic subgroups differentially. We investigate effects of beverage-specific taxes and government control of spirits retail on alcohol-related mortality among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic American Indians/Alaska Natives (AI/AN) and Hispanics using death certificate and state-level alcohol policy data for 1999-2016. Outcomes were analyzed as mortality rates (per 10,000) from 100% alcohol-attributable chronic conditions ("100% chronic AAD"). Statistical models regressed racial/ethnic-specific logged mortality rates on state-level, one-year lagged and logged beer tax, one-year lagged and logged spirits tax, and one-year lagged government-controlled spirits sales, adjusted for mortality trends, fixed effects for state, and clustering of standard errors. Government control was significantly (P < 0.05) related to 3% reductions in Overall and non-Hispanic White mortality rates, and 4% reductions in Hispanic mortality rates from 100% chronic AAD. Tax associations were not robust. Results support that government control of spirits retail is associated with significantly lower 100% AAD from chronic causes Overall and among non-Hispanic Whites and Hispanics. Government control of spirits retail may reduce both population-level 100% chronic AAD as well as racial/ethnic disparities in 100% chronic AAD.

The Effectiveness of Alcohol Impact Areas in Reducing Crime in Washington Neighborhoods

BACKGROUND

We evaluated the effectiveness of Alcohol Impact Areas (AIA) in reducing crime around off-premise alcohol outlets in 3 AIAs in Spokane and Tacoma, Washington, using an interrupted time series design with comparison groups. AIAs only exist in Washington and include designated areas in a city where specific brands of malt liquor are restricted. We hypothesized that mandatory restrictions on malt liquor sales in AIAs would be significantly associated with decreases in crime, especially less-serious crime.

METHODS

In Spokane and Tacoma, targets were 3 AIAs and 3 comparison areas with demographically similar neighborhoods without malt liquor restrictions in the same respective city. Nine different crime outcomes were evaluated: Part I selected crimes, Part II selected crimes (further split into nuisance crimes and other Part II crimes), assaults, vandalism, narcotics, disorderly conduct, and all selected crimes combined. Crime was typically compared 3 years prior to and 3 years following policy adoption using time series and negative-binomial modeling. Separate models were run for each area and each crime.

RESULTS

Study hypotheses were partially supported. Malt liquor restrictions in AIAs were associated with significant decreases in crime, particularly certain Part II crimes and assaults (simple and aggravated) in 12 of the 23 models. The strength of the observed associations varied by AIA. Average monthly crime counts across all crime categories decreased more in the Tacoma AIA than in Spokane AIAs, and average monthly crime decreased more in Spokane AIA 2 (East Central) than in AIA 1 (Downtown Core). Malt liquor restrictions were significantly associated with increases in disorderly conduct in the Tacoma AIA; the increase, however, was small.

CONCLUSIONS

Findings suggest that malt liquor policies such as AIAs may be one of a number of tools local officials can use to reduce alcohol-related crime in cities, especially less-serious crime.

The pattern of alcohol use and its relationship with consequences among problem alcohol users: A community-based cross-sectional study from India

BACKGROUND

Pattern of drinking has a strong bearing on alcohol-related negative consequences. Very few studies from India have assessed this relationship using any standardized instrument.

AIM

The current study aims to assess the relationship between pattern of alcohol use and negative consequences among problem alcohol users using a standardized instrument.

MATERIALS AND METHODS

This cross-sectional, observational study using snowball sampling technique was conducted among 75 participants in an urban slum of a metropolitan city of India. Screening of the participants was done by the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST). Alcohol use details and alcohol-related adverse consequences were obtained by a semi-structured questionnaire and Drinker Inventory of Consequences (DrInC) inventory, respectively. Descriptive statistics, Chi-square test, and logistic regression test were used to analyze the data.

RESULTS

There was a significant association between high total DrInC score and ≥3 subscale scores with employment status, percentage of total family income spent on alcohol, source of income to procure alcohol, amount of alcohol, morning drinking, alcohol use for relaxation, and drinking throughout the day (Chi-square test). Age ≤35 years, current unemployment/part-time employment state, spending ≥25% of total family income on alcohol, family history, and drinking throughout the day were more likely to have high total DrInC score and ≥2 subscale scores (logistic regression analysis).

CONCLUSION

A large proportion of the participants were suffering significantly from alcohol-related consequences but still were not receiving any treatment. It emphasizes the need for more epidemiological studies in this area for its treatment and policy-level implication.

Effects of Restricting High Alcohol Content Beverages on Crime in California

Background: Policy restrictions on malt liquor sales have been adopted in several cities throughout the United States in an effort to reduce crime around off-premise alcohol outlets. Although California has implemented the most restrictions on malt liquor sales, no studies in the published literature have evaluated the effects of these policies on reducing crime. Objectives: We evaluated the effectiveness of malt liquor restrictions on reducing crime around off-premise alcohol outlets in six California cities. We hypothesized that adoption of malt liquor policies would be significantly associated with decreases in crime within areas surrounding targeted outlets. Methods: We used an interrupted time-series design with control areas to examine the relationship between malt liquor policies and crime reduction. We compared crime rates three years prior and following adoption of malt liquor policies. Results: Malt liquor policies were associated with modest decreases in crime, largely Part II or less serious crimes such as simple assaults. The effectiveness of malt liquor policies varied by city, with reductions in crime greatest in Sacramento where policies were more restrictive than in other cities. Malt liquor policies were also associated with small increases in nuisance crime, especially in San Francisco. Conclusion: Results suggest that malt liquor policies may have modest effects on reducing crime when they include strong restrictions on the sale of malt liquor products. Results may be informative to other cities considering whether to maintain or change their malt liquor policies as well as cities considering placing restrictions on other high content beverages.

The Impact of Single-Container Malt Liquor Sales Restrictions on Urban Crime

Many US cities have adopted legal restrictions on high-alcohol malt liquor sales in response to reports of crime and nuisance behaviors around retail alcohol outlets. We assessed whether these policies are effective in reducing crime in urban areas. We used a rigorous interrupted time-series design with comparison groups to examine monthly crime rates in areas surrounding alcohol outlets in the 3 years before and after adoption of malt liquor sales restrictions in two US cities. Crime rates in matched comparison areas not subject to restrictions served as covariates. Novel methods for matching target and comparison areas using virtual neighborhood audits conducted in Google Street View are described. In Minneapolis, Minnesota, sales of single containers of 16 oz or less were prohibited in individual liquor stores (n = 6). In Washington, D.C., the sale of single containers of any size were prohibited in all retail alcohol outlets within full or partial wards (n = 6). Policy adoption was associated with modest reductions in crime, particularly assaults and vandalism, in both cities. All significant outcomes were in the hypothesized direction. Our results provide evidence that retail malt liquor sales restrictions, even relatively weak ones, can have modest effects on a range of crimes. Policy success may depend on community support and concurrent restrictions on malt liquor substitutes.

An Implementation Model to Increase the Effectiveness of Alcohol Control Policies

Purpose.

Public policies that reduce the availability of alcohol in communities can reduce consumption and related harms. In this article, we propose a practical model to guide alcohol policy implementation.

Approach.

The conceptual model is informed by a case study of three U.S. cities that adopted restrictions on high-alcohol malt liquor sales.

Setting.

The three cities included Seattle, Washington; Santa Ana, California; and Washington, D.C.

Participants.

Participants (n = 39) represented neighborhood groups, city officials, local police, Alcohol Beverage Control (board members and enforcement personnel), alcohol retailers, alcohol industry representatives, and advocacy and service organizations.

Method.

We conducted key informant interviews with participants in each city. We coded and analyzed the data by using a grounded theory approach. Findings were used to identify and illustrate model components.

Results.

Implementation components include building public awareness and educating stakeholders, monitoring and enforcing compliance, evaluating process and outcomes, and institutionalizing the policy. The experiences of study cities illustrate the importance of these activities in maintaining policy effectiveness; for example, a lack of enforcement resources appeared to contribute to the erosion of compliance over time.

Conclusion.

The model addresses an important gap in alcohol policy research. It is intended to spur further research on the subject, provide a guide for policy practitioners, and ultimately improve the long-term effectiveness of alcohol control policies.

Epidemiology of drinking, alcohol use disorders, and related problems in US ethnic minority groups

This chapter reviews selected epidemiologic studies on drinking and associated problems among US ethnic minorities. Ethnic minorities and the White majority group exhibit important differences in alcohol use and related problems, including alcohol use disorders. Studies show a higher rate of binge drinking, drinking above guidelines, alcohol abuse, and dependence for major ethnic and racial groups, notably, Blacks, Hispanics, and American Indians/Alaskan Natives. Other problems with a higher prevalence in certain minority groups are, for example, cancer (Blacks), cirrhosis (Hispanics), fetal alcohol syndrome (Blacks and American Indians/Alaskan Natives), drinking and driving (Hispanics, American Indians/Alaskan Natives). There are also considerable differences in rates of drinking and problems within certain ethnic groups such as Hispanics, Asian Americans, and American Indians/Alaskan Natives. For instance, among Hispanics, Puerto Ricans and Mexican Americans drink more and have higher rates of disorders such as alcohol abuse and dependence than Cuban Americans. Disparities also affect the trajectory of heavy drinking and the course of alcohol dependence among minorities. Theoretic accounts of these disparities generally attribute them to the historic experience of discrimination and to minority socioeconomic disadvantages at individual and environmental levels.

Neighborhood disadvantage, high alcohol content beverage consumption, drinking norms, and drinking consequences: a mediation analysis

Alcohol use can cause significant harm. We examined the relationships between neighborhood disadvantage, consumption of high-alcohol-content beverages (HACB), drinking norms, and self-reported drinking consequences using data from the 2000 and 2005 National Alcohol Surveys (N = 9,971 current drinkers) and the 2000 Decennial Census. We hypothesized that (1) individuals living in disadvantaged neighborhoods would report more negative drinking consequences than individuals living in more affluent neighborhoods, and (2) this relationship would be mediated by HACB consumption and pro-drunkenness drinking norms. Neighborhood disadvantage was based on a composite measure of socioeconomic indicators from the 2000 Decennial Census (five-item composite, alpha = 0.89). We measured high alcohol content beverage consumption in terms of whether respondents engaged in frequent or heavy consumption of malt liquor, fortified wine, or distilled spirits/liquor. The outcome was a dichotomous indicator of two or more of 15 past-year social, legal, work, and health consequences. Simultaneous, multivariate path modeling tested direct and indirect effects of neighborhood disadvantage, HACB consumption, and pro-drunkenness norms on consequences. Individuals living in disadvantaged neighborhoods reported significantly more negative drinking consequences than individuals living in more affluent neighborhoods. Consumption of high-alcohol-content beverages and pro-drunkenness norms did not mediate this relationship. However, heavy distilled spirits/liquor use was a significant mediator of other neighborhood characteristics (i.e., percent African American). Living in an African American neighborhood was related to increased spirits/liquor consumption and, in turn, reporting more negative drinking consequences. Greater scrutiny of advertising and tax policies related to distilled spirits/liquor is needed to prevent future drinking problems, especially in minority neighborhoods.

Are neighborhood conditions associated with HIV management?

OBJECTIVES

HIV infection has become a manageable chronic disease as a result of treatment advances. Secondary prevention efforts have proved inadequate to reduce the estimated incidence of new HIV infections. Epidemiological data suggest that geographical clustering of new HIV infections is a common phenomenon, particularly in urban areas among populations of low socioeconomic status. This study aimed to assess the relationship between neighbourhood conditions and HIV management and engagement in high-risk behaviours.

METHODS

During routine out-patient HIV clinic visits, 762 individuals from the St Louis metropolitan area completed behavioural assessments in 2008. Biomedical markers were abstracted from their medical records. Multi-level analyses were conducted based on individuals' census tracts.

RESULTS

The majority of the sample were male and African American. In the adjusted models, individuals residing in neighbourhoods with higher poverty rates were more likely to have lower CD4 cell counts and be current smokers. In neighbourhoods with higher rates of unemployment, individuals were less likely to have a current antiretroviral prescription. In more racially segregated neighbourhoods, individuals reported more depressive symptoms.

CONCLUSIONS

Despite the advances in HIV disease management, neighbourhood characteristics contribute to disparities in HIV care. Interventions that address neighbourhood conditions as barriers to HIV management may provide improved health outcomes.

The Role of Intrapersonal Factors on Alcohol and Drug Use Among Latinos With Physical Disabilities

Persons with disabilities are disproportionately impacted by alcohol and drug use. Social work best practice approaches require an understanding of the effects of intrapersonal factors on alcohol and drug use, yet the theoretical and empirical literature remain underdeveloped, especially among ethnic minority populations. We sought to obtain a detailed description of the role of intrapersonal factors, including perceptions and life experiences, on alcohol and drug use among Latinos with physical disabilities. We employed community-based participatory research in conjunction with photovoice. A total of 17 focus group interviews were completed. Three rounds of photography and focus group interviews occurred with a total of 28 participants who participated in each round. Data analyses followed the tenets of descriptive phenomenology. Results highlight intrapersonal risk and protective factors to inform social work practice and work toward developing and evaluating alcohol and drug use preventive interventions for this overlooked and vulnerable population.

Adopting local alcohol policies: a case study of community efforts to regulate malt liquor sales

PURPOSE

To learn how the local context may affect a city's ability to regulate alcohol products such as high-alcohol-content malt liquor, a beverage associated with heavy drinking and a spectrum of nuisance crimes in urban areas.

APPROACH

An exploratory, qualitative case study comparing cities that adopted policies to restrict malt liquor sales with cities that considered, but did not adopt policies.

SETTING

Nine large U.S. cities in seven states.

PARTICIPANTS

City legislators and staff, alcohol enforcement personnel, police, neighborhood groups, business associations, alcohol retailers, and industry representatives.

METHOD

Qualitative data were obtained from key informant interviews (n = 56) and media articles (n = 360). The data were coded and categorized. Similarities and differences in major themes among and across Adopted and Considered cities were identified.

RESULTS

Cities faced multiple barriers in addressing malt liquor-related problems, including a lack of enforcement tools, alcohol industry opposition, and a lack of public and political will for alcohol control. Compared to cities that did not adopt malt liquor sales restrictions, cities that adopted restrictions appeared to have a stronger public mandate for a policy and were less influenced by alcohol industry opposition and lack of legislative authority for alcohol control. Strategies common to successful policymaking efforts are discussed.

CONCLUSION

Understanding the local context may be a critical step in winning support for local alcohol control policies.

Effects of policies to restrict malt liquor sales on neighborhood crime

We examined the effectiveness of malt liquor sales restrictions adopted in 2005 in three liquor stores in a large Midwestern U.S. city. We hypothesized that the restrictions would be associated with crime reductions in adjacent neighborhoods. Using Poisson regression modeling, we compared crime rates two years prior to, and two years following policy adoption. Findings were mixed; malt liquor restrictions were associated with reductions in disorderly conduct citations, but increases in larceny/theft, beyond citywide trends. Limitations and implications of our study are discussed, and further research suggested. The study was funded by the U.S. Centers for Disease Control and Prevention.

Opioid detection in maternal and neonatal hair and meconium: characterization of an at-risk population and implications to fetal toxicology

Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of a reliable self-report. We aimed to characterize an at-risk neonatal population for opioid exposures as well as other drugs of abuse and alcohol. From June 2007 to January 2009, 563 neonatal hair and 1318 meconium specimens were assessed for opioids and were positive in 11.4% and 17.0%, respectively. Neonates testing positive for opioids in hair or meconium analysis were also more likely to test positive for other licit and illicit substances (odds ratiohair, 1.75; 95% confidence interval, 1.03-2.97; odds ratiomeconium, 1.61; 95% confidence interval, 1.16-2.22). Specifically, a positive neonatal hair test for opioids also predicted a positive result for oxycodone. In addition, a positive meconium test result for opioids was associated with positive results for cocaine, oxycodone, methadone, benzodiazepines, and fatty acid ethyl esters (alcohol). Finally, there was a significant correlation between maternal and neonatal hair test results for opioids (Spearman rank rho = 0.657, P = 0.03). Understanding the addiction profiles of these women may lead to better clinical and social management and may largely benefit an at-risk population.