Number and density of alcohol outlets
Excessive alcohol consumption caused approximately 88,000 deaths and 2.5 million years of potential life lost annually in the United States from 2006 to 2010, making it the fourth leading preventable cause of death. Evidence shows that high density and proximity to alcohol outlets in neighborhoods is associated with higher rates of binge drinking and associated harms, like drinking and driving, motor vehicle-related pedestrian injuries, child abuse and neglect, youth drinking, intimate partner violence, and violent crime.
In California, the rate of alcohol-attributable deaths (ADD/year/100,000 population, 2006–2010) is higher for males (43.6) and African Americans/Blacks (36.6) in comparison with the total population (29.4). Low-income and minority neighborhoods are more likely to have higher concentrations of stores selling alcohol.
Alcohol outlet density is controlled by the states and local regulations. In California the number of on-sale and off-sale alcohol licenses at the county level is restricted based upon the ratio of number of current licenses to the population within each Census tract. Additional licenses may be allowed based on a showing of public convenience or necessity. Limiting alcohol outlet density through the use of regulatory authority (e.g., licensing and zoning) is a public health strategy to prevent deaths and harms associated with excessive alcohol consumption. Multiple studies provide empirical evidence that higher alcohol outlet density and closer proximity to alcohol outlets is positively associated with outcomes like excessive alcohol consumption and other alcohol related harms like injuries and violence. However, some studies have found variations in the patterns; for example, four California cities showed higher rates of heavy drinking in high income neighborhoods with low alcohol outlet density than in lower income neighborhoods.
Raw data is available from the California Department of Alcoholic Beverage Control (ABC) and is refreshed on a weekly basis. https://www.abc.ca.gov/datport/DataExport.html. The data are available in an unformatted ASCII file for the entire state.
STEP 01. After downloading the file from the website, open Microsoft Excel. Choose “Open” from the File menu and in the dropdown menu choose “All Files (*.*)”. Navigate to the place where the downloaded file is saved, select the file and choose “Open”.
STEP 02. To format the file, use the Data Layout and Code References available on the ABC website to determine the column placement. Using Microsoft Excel, the file can be formatted by selecting “Text to Columns” under the Data menu in Excel, choosing “Fixed Width” and then manually selecting the column width and choosing the column locations based on the reference PDF file. Excel versions may vary slightly, but all versions will have the capacity to delineate the columns manually upon opening the unformatted file.
Data are restricted by license type, application status, and duplication in this example. Data were restricted to Contra Costa County and then restricted by license types 20 and 21 for off-sale. For these retail outlets, alcohol is sold in sealed original containers for consumption off the premises of the retailer. For reference, review license types on the ABC website at http://www.abc.ca.gov/permits/licensetypes.html. We further restricted the data for analysis to licenses (removing applications for which licenses have not yet been issued) and to active status licenses (removing pending and expired licenses). We removed duplicates in the dataset by excluding entries with identical premise name and premise address.
To calculate alcohol outlet density, it is not necessary to geocode the data at this point. The Census tracts provided in the download from ABC are adequate to proceed with mapping. However, if other analyses are required, it is possible to geocode the data using the premise address for further spatial analysis.
To calculate density, the number of outlets per Census tract can be calculated by importing the data into a statistical package (e.g., SAS) or by using a pivot table in Microsoft Excel. To construct a pivot table in Excel 2010:
STEP 04. Select the column with the Census tracts in the spreadsheet.
STEP 05. In the Insert menu, select Add PivotTable and add the table to a new worksheet.
STEP 06. Click the Census tract box in the pivot table field list.
STEP 07. Drag the Census tract label in the field list and drop it in the value field.
STEP 08. For Values, ensure value field settings is set to Count.
To calculate and map outlets and display the relative numbers, you must join the table to a shapefile by Census tract. In this case, we used a 2010 Census layer that includes 2010 population numbers. After joining, Census tracts with no outlets will have a value for outlet number. To convert those values to 0, export the data to a new shapefile and show that shapefile on the map.
Figure 39: Number of Alcohol Outlets by Census Tract, Contra Costa County, 2014
To map the number of alcohol outlets per 10,000 people by Census tract, carry out the following steps.
STEP 09. Export the shapefile created above from ArcGIS.
STEP 10. Open the .dbf file, which contains the spreadsheet of data, in Excel.
STEP 11. Delete all columns except the Census tract identifier, number of outlets, and 2010 Census population numbers.
STEP 12. Calculate the density per 10,000 people by creating an additional column and dividing the number of outlets by the 2010 Census population and multiplying by 10,000.
STEP 13. Save and close the new Excel file.
Recall that as the shapefile includes both boundaries and population estimates, the exported joined data will have both the 2010 population estimates and alcohol outlets. These data can also be obtained in American Factfinder, for details on how to download ACS or decennial data, please see the Appendix B.
Figure 40 shows the density of alcohol outlets per 10,000 people. By normalizing to population numbers, we see more areas of high density than on the previous map. To understand the impact of alcohol outlets on the population, the density relative to the number of people is a more effective measure.
III. BAY AREA LOCAL HEALTH DEPARTMENT EXAMPLES
How a community is designed can significantly affect the health of those who live there. Community design can affect public safety, housing, food security, and transportation, which also affects access to health care, school, and work; air pollution and other aspects of environmental quality; alcohol, tobacco, and fast food density and other aspects of land use; and social isolation. Improving the built environment of communities across Alameda County will ensure that everyone has an opportunity to be healthy and thrive.
The Ashland/Cherryland community is seeking to address health inequities by creating a health element in their county general plan. The general plan serves as the “constitution” of a community and guides all local government land use decisions and policies. Since general plans create a long-term vision, strong health elements can powerfully orient government actions for decades and can help prioritize a community’s health-related goals. Developing a health element is also an opportunity to engage community members in identifying important local health issues. The Alameda County Public Health Department (ACPHD) assisted the community in providing data and other support to include this health element. Funding for this project was provided jointly by the ACPHD, the Alameda County Planning Department, and Supervisor Nate Miley. For more information, visit http://ashlandcherryland.org/.
Once input has been gathered from internal Alameda County stakeholders, the health element will be presented at various community meetings to gain feedback from the community. The health element should be approved by the Board of Supervisors in early 2015.
In 2005, a Youth Access Survey, administered locally, assisted in uncovering the retail and social outlet sources of alcohol for youth. The survey found that 77% of teen surveyed reported family and friends as a primary source of alcohol for youth. Few municipalities had ordinances or laws in place to address young people accessing alcohol in retail or social settings, and those in place were not being routinely and consistently enforced.
Starting in October 2006, and continuing over the following three years, a total of twelve Social Host Accountability Ordinances (SHAOs) were passed or amended in Marin County. These policy changes came as part of a coordinated effort under the Marin County Alcohol and Other Drug Prevention Strategic Plan to reduce youth access to alcohol and to transition alcohol and other drug prevention efforts from an individual-focused approach to a community-focused approach, using evidence-based environmental prevention strategies. The first new ordinance was passed in 2006 by the Marin County Board of Supervisors and covered unincorporated Marin County. During the following three years, all of Marin’s cities and towns used the county ordinance as a model to pass their own ordinances or amend existing ordinances. Sausalito, Mill Valley, Tiburon, Fairfax, Novato, Ross, and San Anselmo amended existing ordinances. Belvedere, Corte Madera, Larkspur, and San Rafael adopted new SHAOs.
SHAOs discourage parents and other adults from hosting underage drinking parties. They also address the commonly held belief that underage drinking is inevitable or simply a rite of passage and that it is, therefore, acceptable to give alcohol to underage youth. SHAOs work as a nuisance abatement strategy, deterring underage drinking parties “by imposing a civil fine on the person responsible for loud or unruly gatherings where alcohol is consumed by, served to or in the possession of underage persons.” Under SHAOs, the property owner, renter, or lessee, or the party organizer, is held responsible for the event. When a juvenile is the party host, the juvenile, and the parents or guardians of that juvenile, are jointly and severally liable for fines imposed and costs incurred for public safety services. SHAOs send a clear message to adults that providing alcohol to teens is not acceptable.
Michigan Department of Community Health, Bureau of Disease Control, Prevention & Epidemiology. 2011. The Association of Increased Alcohol Outlet Density & Related Harms: Summary of Key Literature. Accessed May 2014.
California Department of Alcohol and Drug Programs. Racial/Ethnic Disparities—A Data Informed Perspective. 2013. https://www.michigan.gov/documents/mdch/Outlet_Density_Associated_Harms_Summary-3.10.2011_373894_7.pdf. Accessed May 2014.
ABC Act (Business and Professions Code Sections 23815-23827). 2014. http://www.abc.ca.gov/cbnpc.html. Accessed May 2014.
Community Anti-Drug Coalitions of America, Center on Alcohol Marketing and Youth, Johns Hopkins Bloomberg School of Public Health. 2011. Regulating Alcohol Outlet Density: an Action Guide. Accessed May 2014.
Guide to Community Preventive Services. 2014. Preventing Excessive Alcohol Consumption. http://www.thecommunityguide.org/alcohol/index.html. Accessed October 2014.