Population-Level Alcohol Consumption and Homicide Rates in Latin America: A Fixed Effects Panel Analysis, 1961-2019.

Latin America and the Caribbean (LAC) possesses 8 per cent of the global population but approximately one-third of global homicides. The region also exhibits high per capita alcohol consumption, risky drinking patterns and a heterogeneous mix of beverage preferences. Despite this, LAC violence receives limited attention in the English-language literature and there are no studies of the population-level alcohol-homicide association in the region. We examined the effects on total, male and female homicide rates of total and beverage-specific alcohol consumption (22 nations, 1961-2019) and of risky drinking patterns (20 nations, 2005 and 2010). We collected homicide and alcohol data from the World Health Organization. Panel fixed effects models showed (1) per capita total and wine consumption were positively associated with total, male and female homicide rates, though effects were much stronger for males, (2) per capita beer consumption was positively associated with total and male homicide rates, (3) per capita spirits consumption was not associated with homicide rates, and (4) nations with riskier drinking patterns had higher total, male and female homicide rates than those with less risky drinking patterns.

The Neighborhood-Level Association Between Alcohol Outlet Density and Female Criminal Victimization Rates.

The aim of this study was to explore the neighborhood-level association between alcohol outlet density and non-intimate partner violent victimization rates among females. Violent offending and victimization are more prevalent for males than females, and most research on alcohol outlets and violence emphasizes males. Studies that do focus on alcohol outlets and female violent victimization tend to focus on intimate partner violence (IPV), yet non-IPV events are over three quarters of all female violent victimization incidents in the United States. We collected data on violent victimization rates, on- and off-premise alcohol outlet density, and neighborhood-level covariates of violence rates for Milwaukee block groups. We used spatially lagged regression models to test this association, to compare non-IPV results with those for overall female violent victimization rates, and to compare results for females with those for males. Our findings showed density of both on- and off-premise alcohol outlets was positively associated with non-IPV female violent victimization rates, which is an important finding given lack of research on this topic. We also found results for females (both overall and non-IPV violent victimization) were generally the same as for males, but the effect of off-premise outlets on non-IPV female violent victimization rates was weaker than the same association for males. Our findings have clear policy implications for local jurisdictions. Alcohol outlet density is important for both female and male violent victimization. Limiting the licensing of alcohol-selling establishments, especially those that engage in irresponsible retail practices, may be a suitable approach to address violent victimization.

A cross-national study of the population-level association between alcohol consumption and suicide rates.

INTRODUCTION: The objective of this study was to explore the association between population-level alcohol consumption and cross-national suicide rates. Suicide mortality rates vary substantially by nation, as do the level and character of alcohol consumption. Only a few prior studies examined this association, however, and they used a small number of nations and failed to test for the multiple hypothesized pathways through which any association may operate. MATERIAL AND METHODS: We obtained data from the World Health Organization for a sample of 83 nations. Controlling for potential structural covariates, we tested four theoretical mechanisms through which population-level alcohol consumption may influence national suicide rates. RESULTS: Results showed no evidence of threshold effects, nor were risky national drinking patterns associated with higher suicide rates. We found evidence for the most common explanation that total per capita consumption is linearly associated with suicide rates. Our other findings, however, suggested this linear association masks more complex beverage-specific effects. Per capita wine consumption was not associated with male or female suicide rates, per capita spirits consumption was associated with both male and female suicide rates, per capita beer consumption was associated with male suicide rates, and per capita consumption of "other" alcohol types was associated with female suicide rates. DISCUSSION AND CONCLUSIONS: Testing for only a linear association between total alcohol consumption and suicide rates fails to tell the whole story. Further research requires exploration of beverage-specific effects and other potential mechanisms, and consideration of national alcohol policies to reduce suicide rates.

What is past is prologue: A population-based case-control study of repeat victimization, premature mortality, and homicide.

We examined risk of male premature mortality associated with recent criminal victimization. Prior victimization is among the most consistent predictors of future risk but the explanation of repeat victimization remains elusive. Two general perspectives frame this debate. According to the state-dependence perspective, repeat victimization is forged through intervening processes connecting an initial with a subsequent violent victimization. According to the risk-heterogeneity perspective, this association is spurious because all victimization events for a person result from underlying individual traits. Research on health outcomes and premature mortality provides related, but often overlooked, conceptual assumptions about the co-occurring health burden of preventable injuries and disease. We extend and apply each of these perspectives in the current study to assess the nature and sources of repeat violent victimization. Data were from the Izhevsk (Russia) Family Study, a large-scale population-based case-control study. Cases (n = 1750) were all male deaths aged 25-54 living in Izhevsk between October 2003 and October 2005. Controls (n = 1750) were randomly selected from a city population register. Key independent variables were prior year prevalence of violent, property, and residential victimization. We used logistic regression to estimate mortality odds ratios. Results provided evidence for state dependence. We found that (i) after controlling for indicators of risk heterogeneity men who had been victims of violence (but not property or residential crime) within the past year were 2.6 times more likely than those who had not to die prematurely; and (ii) the only type of death for which risk was higher was homicide. Aggr. Behav. 43:176-189, 2017. © 2016 Wiley Periodicals, Inc.

Comparative approaches for assessing access to alcohol outlets: exploring the utility of a gravity potential approach.

BACKGROUND: A growing body of research recommends controlling alcohol availability to reduce harm. Various common approaches, however, provide dramatically different pictures of the physical availability of alcohol. This limits our understanding of the distribution of alcohol access, the causes and consequences of this distribution, and how best to reduce harm. The aim of this study is to introduce both a gravity potential measure of access to alcohol outlets, comparing its strengths and weaknesses to other popular approaches, and an empirically-derived taxonomy of neighborhoods based on the type of alcohol access they exhibit. METHODS: We obtained geospatial data on Seattle, including the location of 2402 alcohol outlets, United States Census Bureau estimates on 567 block groups, and a comprehensive street network. We used exploratory spatial data analysis and employed a measure of inter-rater agreement to capture differences in our taxonomy of alcohol availability measures. RESULTS: Significant statistical and spatial variability exists between measures of alcohol access, and these differences have meaningful practical implications. In particular, standard measures of outlet density (e.g., spatial, per capita, roadway miles) can lead to biased estimates of physical availability that over-emphasize the influence of the control variables. Employing a gravity potential approach provides a more balanced, geographically-sensitive measure of access to alcohol outlets. CONCLUSIONS: Accurately measuring the physical availability of alcohol is critical for understanding the causes and consequences of its distribution and for developing effective evidence-based policy to manage the alcohol outlet licensing process. A gravity potential model provides a superior measure of alcohol access, and the alcohol access-based taxonomy a helpful evidence-based heuristic for scholars and local policymakers.

A method for reclassifying cause of death in cases categorized as "event of undetermined intent".

BACKGROUND: We present a method for reclassifying external causes of death categorized as "event of undetermined intent" (EUIs) into non-transport accidents, suicides, or homicides. In nations like Russia and the UK the absolute number of EUIs is large, the EUI death rate is high, or EUIs comprise a non-trivial proportion of all deaths due to external causes. Overuse of this category may result in (1) substantially underestimating the mortality rate of deaths due to specific external causes and (2) threats to the validity of studies of the patterns and causes of external deaths and of evaluations of the impact of interventions meant to reduce them. METHODS: We employ available characteristics about the deceased and the event to estimate the most likely cause of death using multinomial logistic regression. We use the set of known non-transport accidents, suicides, and homicides to calculate an mlogit-based linear score and an estimated classification probability (ECP). This ECP is applied to EUIs, with varying levels of minimal classification probability. We also present an optional second step that employs a population-level adjustment to reclassify deaths that remain undetermined (the proportion of which varies based on the minimal classification probability). We illustrate our method by applying it to Russia. Between 2000 and 2011, 521,000 Russian deaths (15 % percent of all deaths from external causes) were categorized as EUIs. We used data from anonymized micro-data on the ~3 million deaths from external causes. Our reclassification model used 10 decedent and event characteristics from the computerized death records. RESULTS: Results show that during this period about 14 % of non-transport accidents, 13 % of suicides, and 33 % of homicides were officially categorized as EUIs. Our findings also suggest that 2011 levels of non-transport accidents and suicides would have been about 24 % higher and of homicide about 82 % higher than that reported by official vital statistics data. CONCLUSIONS: Overuse of the external cause of death classification "event of undetermined intent" may indicate questionable quality of mortality data on external causes of death. This can have wide-ranging implications for families, medical professionals, the justice system, researchers, and policymakers. With our classification probability set as equal to or higher than 0.75, we were able to reclassify about two-thirds of EUI deaths in our sample. Our optional additional step allowed us to redistribute the remaining unclassified EUIs. Our method can be applied to data from any nation or sub-national population in which the EUI category is employed.

Incarceration and Health.

The expansion of the penal system has been one of the most dramatic trends in contemporary American society. A wealth of research has examined the impact of incarceration on a range of later life outcomes and has considered how the penal system has emerged as a mechanism of stratification and inequality in the United States. In this article, we review the literature from a comparatively new vein of this research: the impact of incarceration on health outcomes. We first consider the impact of incarceration on a range of individual outcomes, from chronic health conditions to mortality. We then consider outcomes beyond the individual, including the health of family members and community health outcomes. Next, we discuss mechanisms linking incarceration and health outcomes before closing with a consideration of limitations in the field and directions for future research.

Off-premise alcohol outlet characteristics and violence.

BACKGROUND: There is considerable evidence of an association between alcohol outlet density and violence. Although prior research reveals the importance of specific characteristics of bars on this association and that the relationship between bar density and violence may be moderated by these characteristics, there are few similar studies of the characteristics of off-premise outlets (e.g., liquor and convenience stores). OBJECTIVES: We examined whether immediate environment, business practice, staff, and patron characteristics of off-premise alcohol outlets are associated with simple and aggravated assault density. METHODS: Cross-sectional design using aggregate data from 65 census block groups in a non-metropolitan college town, systematic social observation, and spatial modeling techniques. RESULTS: We found limited effects of immediate environment, business practice, staff, and patron characteristics on simple assault density and no effect on aggravated assault density. Only two out of 17 characteristics were associated with simple assault density (i.e., nearby library and male patrons). CONCLUSION: This is the first study to examine the association between several off-premise alcohol outlet characteristics and assault. Our findings suggest that where the off-premise outlets are located, how well the immediate environment is maintained, what types of beverages the outlets sell, who visits them, and who works there matter little in their association with violence. This suggests the importance of outlet density itself as a primary driver of any association with violence. Public policies aimed at reducing alcohol outlet density or clustering may be useful for reducing violence.

The Mortality Penalty of Incarceration: Evidence from a Population-based Case-control Study of Working-age Males.

There is a growing body of research on the effects of incarceration on health, though there are few studies in the sociological literature of the association between incarceration and premature mortality. This study examined the risk of male premature mortality associated with incarceration. Data came from the Izhevsk (Russia) Family Study, a large-scale population-based case-control design. Cases (n = 1,750) were male deaths aged 25 to 54 in Izhevsk between October 2003 and October 2005. Controls (n = 1,750) were selected at random from a city population register. The key independent variable was lifetime prevalence of incarceration. I used logistic regression to estimate mortality odds ratios, controlling for age, hazardous drinking, smoking status, marital status, and education. Seventeen percent of cases and 5 percent of controls had been incarcerated. Men who had been incarcerated were more than twice as likely as those who had not to experience premature mortality (odds ratio = 2.2, 95 percent confidence interval: 1.6-3.0). Relative to cases with no prior incarceration, cases who had been incarcerated were more likely to die from infectious diseases, respiratory diseases, non-alcohol-related accidental poisonings, and homicide. Taken together with other recent research, these results from a rigorous case-control design reveal not only that incarceration has durable effects on illness, but that its consequences extend to a greater risk of early death. I draw on the sociology of health literature on exposure, stress, and social integration to speculate about the reasons for this mortality penalty of incarceration.

The effects of the 2006 Russian alcohol policy on alcohol-related mortality: an interrupted time series analysis.

BACKGROUND: The aim of this study was to determine the impact of a set of 2006 Russian alcohol policies on alcohol-related mortality in the country. METHODS: We used autoregressive integrated moving average interrupted time series techniques to model the impact of the policy on the number of sex-specific monthly deaths of those aged 15+ years due to alcohol poisoning, alcoholic cardiomyopathy, alcoholic liver cirrhosis, and alcohol-related mental and behavioral disorders. The time series began in January 2000 and ended in December 2010. The alcohol policy was implemented in January 2006. RESULTS: The alcohol policy resulted in a significant gradual and sustained decline in male deaths due to alcohol poisoning (ωo = -92.631, p < 0.008, δ1 = 0.883, p < 0.001) and in significant immediate and sustained declines in male (ω0 = -63.20, p < 0.05) and female (ω0 = -64.28, p < 0.005) deaths due to alcoholic liver cirrhosis. CONCLUSIONS: The 2006 suite of alcohol policies in Russia was responsible for an annual decline of about 6,700 male alcohol poisoning deaths and about 760 male and about 770 female alcoholic liver cirrhosis deaths. Without the alcohol policy, male alcohol poisoning deaths would have been 35% higher and male and female alcoholic liver cirrhosis deaths would have been 9 and 15% higher, respectively. We contextualize our findings in relation to declining mortality in Russia and to results from recent studies of the impact of this law on other causes of death.

Reduction in male suicide mortality following the 2006 Russian alcohol policy: an interrupted time series analysis.

OBJECTIVES: We took advantage of a natural experiment to assess the impact on suicide mortality of a suite of Russian alcohol policies. METHODS: We obtained suicide counts from anonymous death records collected by the Russian Federal State Statistics Service. We used autoregressive integrated moving average (ARIMA) interrupted time series techniques to model the effect of the alcohol policy (implemented in January 2006) on monthly male and female suicide counts between January 2000 and December 2010. RESULTS: Monthly male and female suicide counts decreased during the period under study. Although the ARIMA analysis showed no impact of the policy on female suicide mortality, the results revealed an immediate and permanent reduction of about 9% in male suicides (Ln ω0 = -0.096; P = .01). CONCLUSIONS: Despite a recent decrease in mortality, rates of alcohol consumption and suicide in Russia remain among the highest in the world. Our analysis revealed that the 2006 alcohol policy in Russia led to a 9% reduction in male suicide mortality, meaning the policy was responsible for saving 4000 male lives annually that would otherwise have been lost to suicide. Together with recent similar findings elsewhere, our results suggest an important role for public health and other population level interventions, including alcohol policy, in reducing alcohol-related harm.

The impact of hazardous drinking on suicide among working-age Russian males: an individual-level analysis.

AIMS: To estimate the association between hazardous drinking and suicide among working-age Russian males. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Data are from the Izhevsk Family Study (IFS), a population-based case-control study of premature mortality among working-age Russian men. The present study used two sets of cases: all men aged 25-54 years living in Izhevsk who, during October 2003-October 2005, (i) died of suicide (n = 120) or (ii) died of suicide or of injuries of undetermined intent (n = 231). Controls were selected at random from a city population register. Drinking data were obtained from proxy informants living in the same household as cases and controls. Drinking exposures were defined by liters of ethanol consumed as a continuous variable, liters of ethanol as a categorical variable, frequency of consumption of non-beverage alcohol (e.g. colognes, medicines, cleaning fluids) and a measure of problem drinking based on behavioral indicators. The association between hazardous drinking and suicide was estimated by mortality odds ratios, adjusting for age, marital status, education and smoking status. FINDINGS: A total of 57% of cases and 20% of controls were problem drinkers. Men who drank 20+ liters of ethanol in the prior year were 2.7 times more likely [95% confidence interval (CI) = 1.5-5.0] to die from suicide than moderate drinkers. Men who drank non-beverage alcohols one to two times/week were 3.9 times more likely (95% CI, 1.3-11.0) to die from suicide than men who rarely or never drank them. Problem drinkers were 3.7 times more likely (95% CI, 2.5-5.6) to die from suicide relative to non-problem drinkers. Forty-three per cent of suicides were attributed to hazardous drinking (problem drinking or consuming non-beverage alcohol at least once/week or both). CONCLUSIONS: Hazardous drinking substantially increases the risk of suicide among working-age Russian males, with nearly half of all suicides attributed to this drinking pattern.

The impact of a national alcohol policy on deaths due to transport accidents in Russia.

AIMS: To determine the impact of a suite of 2006 Russian alcohol control policies on deaths due to traffic accidents in the country. DESIGN, SETTING AND PARTICIPANTS: We used autoregressive integrated moving average (ARIMA) interrupted time-series techniques to model the impact of the intervention on the outcome series. The time-series began in January 2000 and ended in December 2010. The alcohol policy was implemented in January 2006, providing 132 monthly observations in the outcome series, with 72 months of pre-intervention data and 60 months of post-intervention data. MEASUREMENTS: The outcome variables were the monthly number of male- and female-specific deaths of those aged 15+ years due to transport accidents in Russia. FINDINGS: The 2006 set of alcohol policies had no impact on female deaths due to traffic accidents (ω0 = -50.31, P = 0.27). However, the intervention model revealed an immediate and sustained monthly decrease of 203 deaths due to transport accidents for males (ω0 = -203.40, P = 0.04), representing an 11% reduction relative to pre-intervention levels. CONCLUSION: The implementation of the suite of 2006 Russian alcohol control policies is partially responsible for saving more than 2400 male lives annually that would otherwise have been lost to traffic accidents.

Alcohol outlet density and violence: the role of risky retailers and alcohol-related expenditures.

AIMS: The aim of the study was to assess the association between alcohol outlet density and violence controlling for alcohol expenditures and the density of other retailers. METHODS: Cross-sectional ecological study of 1816 block groups in Philadelphia. We obtained 2010 data for aggravated assaults, alcohol outlets, alcohol expenditures, business points, land use and socioeconomic and demographic characteristics. We mapped the spatial distribution of alcohol outlets and aggravated assaults using a geographic information system. We estimated the association between assault density and total, on-premise and off-premise alcohol outlet densities using spatial regression models and controlling for the covariates of urban crime rates, alcohol expenditures, and the presence of other general and risky commercial retail outlets. RESULTS: The strong and positive association between alcohol outlet density and violence remained after controlling for alcohol expenditures and the density of other retailers. CONCLUSION: Findings support the concept that off-premise alcohol outlets in the neighborhood environment may impact health and social outcomes. The positive outlet-violence association in the face of these controls means it is not an association due solely to alcohol availability or to retail density. It also suggests that there is something unique about alcohol outlets or their density that makes them crime generators and links them to violence.

The effect of poverty and social protection on national homicide rates: Direct and moderating effects.

Social protection is the ability of a government to insulate its citizens from the problems associated with poverty and market forces that negatively affect their quality of life. Prior research shows that government policies that provide social protection moderate the influence of inequality on national homicide rates. Recent research, however, reveals a strong association between poverty and national homicide rates. Further, theory and evidence suggest that social protection policies are meant to aid in providing a subsistence level of living, and thus to alleviate the vagaries of poverty not inequality. To this point, however, no studies have examined the potentially moderating effect of social protection on the strength of the association between poverty and homicide rates cross-nationally. We do so in the present study. Employing data for the year 2004 from a sample of 30 nations, we estimate a series of weighted least squares regression models to test three hypotheses: the association between poverty and homicide will remain significant and positive when controlling for social protection, social protection will have a significant negative direct effect on national homicide rates, and social protection will diminish the strength of the poverty-homicide association. The results provided evidence supporting all three hypotheses. We situate our findings in the cross-national empirical literature on social structure and homicide and discuss our results in the theoretical context of social protection.

Community organization moderates the effect of alcohol outlet density on violence.

There is growing evidence from multiple disciplines that alcohol outlet density is associated with community levels of assault. Based on the theoretical and empirical literatures on social organization and crime, we tested the hypothesis that the association between alcohol outlet density and neighbourhood violence rates is moderated by social organization. Using geocoded police data on assaults, geocoded data on the location of alcohol outlets, and controlling for several structural factors thought to be associated with violence rates, we tested this hypothesis employing negative binomial regression with our sample of 298 block groups in Cincinnati. Our results revealed direct effects of alcohol outlet density and social organization on assault density, and these effects held for different outlet types (i.e., off-premise, bars, restaurants) and levels of harm (i.e., simple and aggravated assaults). More importantly, we found that the strength of the outlet-assault association was significantly weaker in more socially organized communities. Subsequent analyses by level of organization revealed no effects of alcohol outlet density on aggravated assaults in organized block groups, but significant effects in disorganized block groups. We found no association between social (dis)organization and outlet density. These results clarify the community-level relationship between alcohol outlets and violence and have important implications for municipal-level alcohol policies.

Alcohol beverage control, privatization and the geographic distribution of alcohol outlets.

BACKGROUND: With Pennsylvania currently considering a move away from an Alcohol Beverage Control state to a privatized alcohol distribution system, this study uses a spatial analytical approach to examine potential impacts of privatization on the number and spatial distribution of alcohol outlets in the city of Philadelphia over a long time horizon. METHODS: A suite of geospatial data were acquired for Philadelphia, including 1,964 alcohol outlet locations, 569,928 land parcels, and school, church, hospital, park and playground locations. These data were used as inputs for exploratory spatial analysis to estimate the expected number of outlets that would eventually operate in Philadelphia. Constraints included proximity restrictions (based on current ordinances regulating outlet distribution) of at least 200 feet between alcohol outlets and at least 300 feet between outlets and schools, churches, hospitals, parks and playgrounds. RESULTS: Findings suggest that current state policies on alcohol outlet distributions in Philadelphia are loosely enforced, with many areas exhibiting extremely high spatial densities of outlets that violate existing proximity restrictions. The spatial model indicates that an additional 1,115 outlets could open in Philadelphia if privatization was to occur and current proximity ordinances were maintained. CONCLUSIONS: The study reveals that spatial analytical approaches can function as an excellent tool for contingency-based "what-if" analysis, providing an objective snapshot of potential policy outcomes prior to implementation. In this case, the likely outcome is a tremendous increase in alcohol outlets in Philadelphia, with concomitant negative health, crime and quality of life outcomes that accompany such an increase.

A spatial analysis of the moderating effects of land use on the association between alcohol outlet density and violence in urban areas.

AIMS: While there is substantial evidence of an association between alcohol outlet density and assault, it is unlikely this association is constant across the urban environment. This study tested the moderating influence of land use on the outlet-violence association. DESIGN: Cross-sectional ecological study that controlled for spatial autocorrelation. SETTING, PARTICIPANTS AND MEASUREMENTS: Police-recorded data on simple and aggravated assaults were obtained for all 302 block groups (mean population = 1038) in Cincinnati, Ohio, USA. Addresses of alcohol outlets for Cincinnati were obtained from the Ohio Division of Liquor Control, geocoded to the street level, and aggregated to census block groups. Data on eight categories of land use were obtained from the Cincinnati Area Geographic Information System, with location quotients computed for each block group. FINDINGS: We found substantial evidence that the impact of total alcohol outlet density, bar density and carryout density on assault density was moderated by land use. CONCLUSIONS: By taking into account local characteristics, policy-makers can make more informed decisions when regulating the placement and density of alcohol licenses in urban areas. Similarly, more systematic knowledge of how the association between alcohol outlet density and assault varies across the urban landscape should reduce harm and promote responsible retailing. Nevertheless, ours is one of the first studies to address the moderating effect of land use and we encourage further research to test the stability and generalisability of our results.