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The approach described in this article is premised on the idea that drug and alcohol use-related problems are heterogeneously distributed with respect to population and geography, and therefore, are essentially local problems. More specifically, it is argued that viewing a local community as an interacting set of systems that support or buffer the occurrence of specific substance misuse outcomes, opens up to research two important prospects. The first of these involves creating adequate systems models that can capture the primary community structures and relationships that support public health problems such as alcohol and drug misuse and related outcomes. The second entails rationally testing control strategies that have the potential to moderate or reduce these problems. Understanding and controlling complex dynamic systems models nowadays pervades all scientific disciplines, and it is to research in areas such as biology, ecology, engineering, computer sciences, and mathematics that researchers in the field of addictions must turn to in order to better study the complexity that confronts them as they try to understand and prevent problems resulting from alcohol and drug use and misuse. Here we set out what such a systems-based understanding of alcohol- and drug use-related problems will require and discuss its implications for public policy and prevention programming.

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BACKGROUND: We analyzed the relationship between alcohol availability and injury that occurred during the 6 months before survey administration. METHOD: The data examined were from a general population survey administered to 13,440 California respondents as part of a community-based project to reduce alcohol-involved injury and death. Two separate analyses were performed. The first considered individual local outlet densities (which included both on-premise establishments such as bars and restaurants and off-premise establishments such as liquor and grocery stores) as they affect individual phone survey respondents' self-reported injuries. To address potential spatially autocorrelated errors and geographically lagged effects, a second analysis considered aggregate outlet densities within geographic areas as they affect the proportion of survey respondents who reported injury. No spatial autocorrelation or significant lagged effects were found, which supported our individual-level analyses. RESULTS: Our analyses indicated an association between both on-premise and off-premise individual-level outlet densities and self-reported injuries. CONCLUSION: Alcohol availability seems to be related to self-reported injury. The mechanisms behind this relationship, however, are not clear, and further study is indicated.

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OBJECTIVE: This study examined the relationship between neighborhood social structure, alcohol outlet densities and violent crime in Camden, New Jersey. METHOD: Data pertaining to neighborhood social structure, violent crime and alcohol density were collected for 98 block groups, and analyzed using bivariate, multivariate and spatial analyses. RESULTS: Each type of analysis showed that those areas with high alcohol outlet densities experienced more violent crime than low-density areas, after controlling for neighborhood social structure. In the multivariate regression analysis, alcohol outlet densities explained close to one fifth of the variability in violent crime rates across block groups--more than any one of the neighborhood structural variables included in the analysis. These findings were replicated in the spatial analysis, which also showed that alcohol outlet densities contributed significantly to violent crime within target block groups but not in adjacent block groups. CONCLUSIONS: High alcohol outlet density is associated with high rates of violent crime in this urban community. Spatial analysis suggests that alcohol outlets elevate the rate of violent crime within the immediate neighborhood context, not in surrounding neighborhoods.

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This study conducted a geostatistical analysis of ecological data to examine the relationships of neighborhood characteristics, including alcohol availability and alcohol consumption patterns to pedestrian injury collisions. The central research question asked whether it was possible to identify unique neighborhood characteristics related to alcohol- and non-alcohol-involved pedestrian injuries. It was hypothesized that greater numbers of alcohol-involved pedestrian injuries would be observed in areas with greater concentrations of alcohol outlets, even after adjusting for socioeconomic characteristics, environmental factors, and drinking patterns of neighborhood residents. It was also hypothesized that independent of drinking patterns and alcohol availability, greater numbers of pedestrian injuries would be observed in areas with higher unemployment, lesser income, greater population, and a predominance of younger or older age populations. Archival and individual-level data from a general population telephone survey were obtained from four California communities. The survey data included sociodemographic and drinking pattern measures. Archival data included environmental measures relevant to pedestrian travel and measures of alcohol availability. Units of analysis were geographic areas within each community defined by the spatial clustering of telephone survey respondents. The results showed that alcohol-involved pedestrian collisions occurred more often in areas with greater bar densities and greater population, and where the local population reported drinking more alcohol per drinking occasion. Pedestrian collisions not involving alcohol occurred more often in lower income areas with greater population and cross-street densities, and in areas having either younger or older age populations. The identification of neighborhood variables associated with pedestrian collisions has important implications for policy formation and targeted prevention efforts.

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CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.

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OBJECTIVE: This study tested whether the association of beer drinking with drinking and driving is due to cultural norms or is an artifact arising from the demographic profile of beer drinkers (young and male), the drinking patterns of this subpopulation (frequent and heavy), and the venues in which they prefer to drink (bars and restaurants). METHOD: Telephone survey data from six U.S. communities were used to establish the demographic characteristics of drinkers, their consumption patterns, beverage preferences, preferred drinking venues and self-reported drinking and driving rates. The survey completion rate was 64.6%. A total sample of 5,231 drinkers was divided into test and validity samples. After deletion of cases with missing data, the test sample included 2,275 drinkers, of whom 985 had driven after drinking. RESULTS: Controlling for a broad set of covariates, the analyses showed that frequent consumers were more likely to drink outside the home, preferred beer and spirits to wine, and were more likely than others to drink and drive. Beverage preferences were not directly associated with drinking and driving. Beer drinkers, however, were from the subpopulation most likely to drink and drive: heavier drinking younger men, who prefer to drink at bars and restaurants. CONCLUSIONS: These results suggest that the association of beer consumption with drinking-driving arises from the circumstances in which the subpopulation of beer drinkers more commonly find themselves (as a result of their efforts to maximize, within economic constraints, the social and amenity value of drinking), as opposed to any culturally induced disposition beer drinkers may have to drink and drive.

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Pedestrian injury collisions often occur when and where large numbers of pedestrians travel within complex roadway systems with high traffic flow. The pedestrian injury literature suggests a number of individual and environmental correlates of injury risks, however studies in this area have primarily focused upon demographic differences (e.g. related to age) and a few global characteristics of the roadway system (e.g. aspects of pedestrian traffic). Studies in which the geography of communities has been considered are primarily descriptive, identifying pedestrian injury 'hot spots'. The current study more extensively explores some geographic correlates of pedestrian injury collisions through a spatial analysis of data from the city of San Francisco, CA. A spatial autocorrelation corrected regression model was used to determine factors associated with pedestrian traffic injury in 1990. The study used a geographic information system to map locations of pedestrian injuries, and environmental and demographic characteristics of the city across census tract units. In addition to a number of demographic factors (gender, age, marital status, education, income and unemployment), it was proposed that several environmental features of the city would be related to injury rates (high traffic flow, complex roadway systems, greater population densities and alcohol availability). Results of the study showed that pedestrian injury rates were related to traffic flow, population density, age composition of the local population, unemployment, gender and education. Availability of alcohol through bars was directly related to pedestrian injury collisions in which the pedestrian had been drinking alcohol.

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AIMS: This paper extends a prior analysis of drinking patterns to consider the influence of non-economic variables on the selection of drinking locations. DESIGN: Using data from a general population telephone survey conducted as a part of the Community Trials Project, Tobit models are estimated to determine the influence of background demographic characteristics upon the selection of drinking locations net of other model control variables. PARTICIPANTS AND SETTING: 24,778 current drinkers from four California and two South Carolina communities. FINDINGS: Distinct patterns of premise utilization are found to be associated with age, gender and ethnic subgroups. Additionally these patterns of utilization are differentially linked to drinking and driving, suggesting that patterns of outlet utilization are differentially linked to acute drinking problems (e.g. drunken driving and alcohol-related car crashes). CONCLUSIONS: Observed differences in outlet utilization patterns between age, gender and ethnic subgroups imply that preventive interventions should take into account the manner in which these subpopulations make use of drinking venues.

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This paper discusses how economic and geographic distributions of local supply affect patterns of alcohol problems in state and community settings. It is argued that characteristics of local supply directly affect the economic and social behaviors of consumers when purchasing and using alcohol. For example, although taxes may be raised in order to lower alcohol use, the manner in which tax increases are translated into price increases, and the way consumers respond to price increases through alterations in purchase patterns, may strongly mitigate price effects. Similarly, although overall alcohol availability may be reduced in order to lower alcohol use, the tendency for greater numbers of outlets to be focused in low-income areas and the manner in which consumers bundle alcohol purchases with other routine activities (e.g. shopping) may also strongly mitigate such effects.

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OBJECTIVE: The relationships between on-premise drinking places, beverage specific alcohol sales and drinking and driving were examined in a time series cross-sectional study of place-of-last-drink data from Perth, Western Australia. METHOD: At arrest, 2,411 drinking drivers reported their last location of consumption. Tabulated by 57 premises over 4 years, the rates at which individual premises were referenced as the place-of-last-drink were taken to reflect the relative distributions of numbers of drinking drivers coming from different premise types (hotels, taverns and nightclubs). The data were then statistically related to measures of premise types and characteristics and beverage specific alcohol sales. RESULTS: Significant cross-sectional relationships were obtained between measures of premise types, alcohol sales and drinking and driving. Greatest numbers of drinking drivers came from taverns and from places selling greater amounts of beer and spirits. Significant longitudinal effects were obtained for sales of beer, proportions of high alcohol beer sold and sales of spirits. CONCLUSIONS: As a whole, the results suggest that, at least for Western Australia, outlets selling greater amounts of beer and spirits, and greater amounts of high alcohol beer, will produce larger numbers of drinking drivers.

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OBJECTIVE: This study examines drinking patterns over the life course among males and females and among three ethnic groups (whites, blacks and Hispanics) in order to compare gender group and ethnic group differences in alcohol use as a continuous function of age. METHOD: Data are from a general population sample of 13,553 respondents aged 12 to 80 interviewed by telephone in 20 urban areas of the United States. Drinking measures include total consumption, drinking participation, drinking frequency and average drinks per occasion. RESULTS: In the total sample over age cohorts, total consumption, participation and average drinks per occasion rose rapidly before age 21, peaked in young adulthood and declined gradually thereafter. Drinking frequency rose rapidly before age 21, but generally showed no decline thereafter. As expected, compared to women, men consumed more total alcohol, were more likely to participate in drinking, drank more often and drank more per occasion. Men did not differ from women in the age at which peak drinking occurred. Relationships of drinking to ethnicity were more complex. Although white total consumption exceeded that of blacks and Hispanics over the entire life course, the other drinking measures involved interactions in which white participation and frequency exceeded that of blacks and Hispanics in later adulthood, but black and Hispanic average drinks per occasion exceeded that of whites in later adulthood. CONCLUSIONS: Differences in drinking patterns over the life course among gender groups and ethnic groups are largely a result of differences in rates of change over age cohorts in alcohol use, both in rates of increase in youth and of decrease thereafter.

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AIMS: Injury location, injury cause and patient drinking patterns were used to predict blood alcohol content (BAC) and self-reported drinking before injury using emergency room (ER) data. DESIGN: Models estimating both BAC and self-reported drinking among emergency room injury patients were used; the ER sample was also compared to an injured sample from the general population. SETTING: Data were from three of six communities participating in the project "Preventing Alcohol Trauma: a community trial". PARTICIPANTS: ER data were collected from nine hospitals on Friday and Saturday nights between 6 p.m. and 2 a.m. on alternate weekends from June 1992 to December 1995. Telephone survey data were collected between April 1992 and March 1996. MEASUREMENTS: Drinking measures included drinking frequency, drinks per occasion, and variance. Other measures involved injury time, location, and type; drinking before and after injury; and age, race, gender, education, marital status and household income. Model estimation corrected both for selection bias and censoring of the dependent measure. FINDINGS: The results indicate: (1) ER populations tended to be female, less well educated, non-white, poor and younger; (2) there were significant selection bias effects in the ER sample; (3) assaults were more likely to involve drinking than other injury types; (4) drinking patterns were significant non-linear predictors of alcohol involvement; and (5) self-reported drinking before injury was both a sensitive and specific indicator of measured BAC. CONCLUSIONS: Assaults uniquely involve the use of alcohol and selection bias may threaten ER study validity.

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We examine the extent to which empirically observed age-related differences in rates of drinking and driving can be explained by concurrent differences in drinking patterns. Building on previous research showing significant age differences in drinking patterns between men and women and among three ethnic groups, Whites, Blacks, and Hispanics, our study considers whether there are unique gender and ethnic group differences in patterns of drinking and driving. Data were from 4395 respondents 12 to 80 years old in a general population survey of 20 urban areas in the United States. During the month preceding the interview, 1130 (25.7%) of all respondents had driven after having one or more drinks. Drinking pattern measures included drinking frequency, average drinking quantity, and the variance in the number of drinks consumed per occasion. To assess the relationships of drinking patterns to drinking and driving across age groups, two sets of analyses were conducted, one set in which age differences in drinking patterns were statistically controlled and one set in which they were not. Although the statistical control for drinking patterns reduced age differences between gender and ethnic groups, it did not eliminate them. The reduction demonstrated that part of observed group differences in driving after drinking over age among gender and ethnic groups is due to age-related differences in drinking patterns. However, despite controlling drinking patterns young respondents remained more likely to drink and drive. A supplementary analysis of self-reported incidents of driving while intoxicated (i.e., driving after having five or more drinks) further indicated that, controlling for drinking patterns, young respondents are most at risk.

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OBJECTIVE: This article reports the results of an analysis of the relationships between demographic and alcohol consumption variables and the likelihood of injury occurring during the 6-month period prior to survey administration. METHODS: The date examined are from a general population survey administered to 22,626 respondents (56.9% female) as part of a community trial project to reduce alcohol-involved injury currently being conducted in six communities in California and South Carolina. Three models that relate consumption patterns and exogenous background variables to injury are evaluated. The first considers only demographic background variables. The second model adds three consumption measures (i.e., frequency, average drinks per occasion and variance) to the first. The third adds a control for community of residence. A fourth model is estimated using frequency and average drinks per occasion, by omitting variance. RESULTS: Findings indicate that likelihood of injury is affected by demographic, alcohol consumption and community of residence variables. Specifically, likelihood of injury is significantly related to being young, white, male and single, and having a high variance drinking pattern. Community level effects were found, with California respondents being more likely to experience injuries, controlling for other model variables. Although measures for education and income were included in our analysis, no effects for these variables could be found. Also, other drinking measures (i.e., drinking frequency and average drinks per occasion) were not found to be significantly related to injury, although estimated coefficients were in the predicted direction. CONCLUSIONS: Complementary to studies that have noted that a large portion of injuries involve persons who have been drinking prior to injury, our findings suggest a link between likelihood of injury and general drinking patterns.

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In July 1992, the Swedish alcohol retail monopoly reset the taxes for alcohol sold in state stores according to absolute alcohol content. This provided a unique opportunity to examine the effects on alcohol sales within the three beverage classes (beer, wine and spirits) in a situation where price is purposely linked to alcohol content. The most notable effects of the taxation change were a substantial compression of the range of prices for spirits and wine and a corresponding expansion of the price spectrum for beer. Consumers appear to have responded to these tax changes by shifting away from beverage brands that became relatively more expensive. These results suggest that alcohol policy strategies to reduce total alcohol consumption should consider the entire price/quality spectrum as well as differences in absolute alcohol per volume across the three alcohol beverage types.

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The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.

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The Drinking and Driving Component, one of five elements of the Community Trials Project, involved the implementation of a special drink driving countermeasure in the three experimental communities, one in Northern California, one in Southern California and another in South Carolina. This intensified enforcement of driving under the influence (DUI) was designed to deter potential drinking drivers by increasing their perception of the risk of being arrested leading to a reduction in the consumption of alcohol before driving. See component detailed description in Voas (1997, this issue). The evaluation found that media advocacy training and technical assistance resulted in increased DUI news coverage and that additional police officer hours for DUI enforcement, greater use of breathalyzer equipment, increased officer training and more checkpoints produced increased DUI enforcement. The combined effects of increased DUI news coverage and DUI enforcement yielded increased public perceived risk of arrest and subsequently less drinking and driving. Overall the evaluation found that alcohol-involved traffic crashes were reduced as a result of this component in the experimental communities as contrasted with the matched comparison communities.

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This paper describes the design, rationale and implementation of the Alcohol Access Component within the Community Trials Project of the Prevention Research Center. The Alcohol Access Component was to reduce the concentration or density of alcohol outlets in each experimental community by a combination of local zoning and land-use planning approaches which was an effect to occur over several years. During the time of this trial, local regulations of alcohol outlets and public sites for drinking were changed in all three experimental communities. The amount of such alcohol policy change exceeded the goals for this component.

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