Alcohol Outlet Density and Area-Level Heavy Drinking Are Independent Risk Factors for Higher Alcohol-Related Complaints

  • Yusuf RansomeEmail author
  • Hui Luan
  • Xun Shi
  • Dustin T. Duncan
  • S. V. Subramanian


Alcohol outlet density has well-documented associations with social and health indicators such as crime and injury. However, significantly less is known about the relationships among alcohol-related complaints. Bayesian hierarchical Poisson regression with spatial autocorrelation was used to model the association between on- and off-premises alcohol outlet density and area-level prevalence of current drinkers and heavy drinking, and graffiti density—an indicator of physical disorder—in association with calls from civilians reporting illegal use, alcohol sales, and other alcohol-related activities (hereafter alcohol-related complaints). Complaints were separated into two groups based on whether they occurred at (a) clubs/bars/restaurants or (b) elsewhere. Alcohol-related complaints and graffiti were collected from NYC Open Data. Alcohol density data are from ESRI Business Analyst and information on the prevalence of drinking from the New York City Community Health Survey. The unit of analysis consisted of ZIP codes in New York City (n = 167), and the design was a cross-sectional analysis of aggregated data between 2009 and 2015. In multivariable models, a one-unit increase in off-premises alcohol outlet density was associated with a 47% higher risk of alcohol-related complaints at clubs, bars, and restaurants [rate ratio (RR = 1.46, 95% CI = 1.21, 1.77)]. Area-level prevalence of heavy drinking was associated with a 59% higher risk of alcohol-related complaints at the club, bars, and restaurants (RR = 1.59, 95% CI = 1.34, 1.86) and a 40% higher risk of complaints elsewhere (RR = 1.40, 95% CI = 1.20, 1.63). In New York City, area-level heavy drinking prevalence is a strong independent mechanism that links alcohol outlet density to alcohol-related complaints. Area-level heavy drinking should be investigated as a predictor of other public health problems such as drug overdose mortality.


Alcohol availability Alcohol-related complaints New York City Heavy drinking 



We thank Bureau of Epidemiology Services in the New York City Department of Health and Mental Hygiene for providing access to the ZIP-code level CHS data.

We thank Jeffery Blossom and Giovanni Zambotti in the Center for Geographic Analyses, Harvard University for geographic information systems related support and acquiring data from Business Analyst in ArcGIS.


Y. Ransome received funding from the Alonzo Smythe Yerby Postdoctoral Fellowship at Harvard T.H. Chan School of Public Health, and the National Institute of Mental Health K01MH111374. Support for data collection and analysis came from pilot funding from the Robert Wood Johnson Foundation Health and Society Scholars Program at Harvard University. D. Duncan was supported by grants from the National Institutes of Health and the Center for Disease Control and Prevention, including R01MH112406, U01PS005122, R21MH110190, and R03DA039748.

Supplementary material

11524_2018_327_MOESM1_ESM.pdf (278 kb)
Supplementary Table 1 (PDF 277 kb)


  1. 1.
    Gruenewald PJ, Millar AB, Roeper P. Access to alcohol: geography and prevention for local communities. Alcohol Res Health. 1996;20(4):244.Google Scholar
  2. 2.
    Popova S, Giesbrecht N, Bekmuradov D, Patra J. Hours and days of sale and density of alcohol outlets: impacts on alcohol consumption and damage: a systematic review. Alcohol Alcohol. 2009;44(5):500–16.CrossRefGoogle Scholar
  3. 3.
    Lipton R, Yang X, Braga A, Goldstick J, Newton M, Rura M. The geography of violence, alcohol outlets, and drug arrests in Boston. Am J Public Health. 2013;103(4):657–64.CrossRefGoogle Scholar
  4. 4.
    Morrison C, Ponicki WR, Gruenewald PJ, Wiebe DJ, Smith K. Spatial relationships between alcohol-related road crashes and retail alcohol availability. Drug Alcohol Depend. 2016;162(May):241–4.CrossRefGoogle Scholar
  5. 5.
    Cohen DA, Ghosh-Dastidar B, Scribner R, Miu A, Scott M, Robinson P, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: a longitudinal analysis. Soc Sci Med. 2006;62(12):3062–71.CrossRefGoogle Scholar
  6. 6.
    Rossheim ME, Dl T, Suzuki S. Association between alcohol outlets and HIV prevalence in US counties. J Stud Alcohol Drugs. 2016;77(6):898–903.CrossRefGoogle Scholar
  7. 7.
    Morton CM, Simmel C, Peterson NA. Neighborhood alcohol outlet density and rates of child abuse and neglect: moderating effects of access to substance abuse services. Child Abuse Negl. 2014;38(5):952–61.CrossRefGoogle Scholar
  8. 8.
    Hobday M, Meuleners L, Liang W, Gilmore W, Chikritzhs T. Associations between alcohol outlets and emergency department injury presentations: effects of distance from the central business district. Aust N Z J Public Health. 2015;40(1):43–8.CrossRefGoogle Scholar
  9. 9.
    Donnelly N, Poynton S, Weatherburn D, Bamford E, Nottage J. Liquor outlet concentrations and alcohol-related neighbourhood problems. NSW Alcohol Stud Bull. 2006;8(April):15.Google Scholar
  10. 10.
    Stevenson RJ, Lind B, Weatherburn D. Property damage and public disorder: their relationship with sales of alcohol in New South Wales, Australia. Drug Alcohol Depend. 1999;54(2):163–70.CrossRefGoogle Scholar
  11. 11.
    LaScala E, Freisthler B, Gruenewald PJ. Population ecologies of drug use, drinking and related problems. In: Stockwell T, editor. Preventing harmful substance use : the evidence base for policy and Practice. Chichester, West Sussex: John Wiley & Sons; 2005. p. 67–78.CrossRefGoogle Scholar
  12. 12.
    Hughes K, Quigg Z, Eckley L, Bellis M, Jones L, Calafat A, et al. Environmental factors in drinking venues and alcohol-related harm: the evidence base for European intervention. Addiction. 2011;106:37–46.CrossRefGoogle Scholar
  13. 13.
    Theall KP, Scribner R, Cohen D, Bluthenthal RN, Schonlau M, Lynch S, et al. The neighborhood alcohol environment and alcohol-related morbidity. Alcohol Alcohol. 2009;44(5):491–9.CrossRefGoogle Scholar
  14. 14.
    Brenner AB, Diez Roux AV, Barrientos-Gutierrez T, Borrell LN. Associations of alcohol availability and neighborhood socioeconomic characteristics with drinking: cross-sectional results from the multi-ethnic study of atherosclerosis (MESA). Subst Use Misuse. 2015;50(12):1606–17.CrossRefGoogle Scholar
  15. 15.
    Livingston M, Chikritzhs T, Livingston M, et al. Changing the density of alcohol outlets to reduce alcohol-related problems. Drug Alcohol Rev. 2007;26(5):557–66.CrossRefGoogle Scholar
  16. 16.
    DiMaggio C, Mooney S, Frangos S, Wall S. Spatial analysis of the association of alcohol outlets and alcohol-related pedestrian/bicyclist injuries in New York City. Inj Epidemiol. 2016;3(1):1.CrossRefGoogle Scholar
  17. 17.
    Ahern J, Margerison-Zilko C, Hubbard A, Galea S. Alcohol outlets and binge drinking in urban neighborhoods: the implications of nonlinearity for intervention and policy. Am J Public Health. 2013;103(4):e81–7.CrossRefGoogle Scholar
  18. 18.
    Silver H, Messeri P. Concentrated poverty, racial/ethnic diversity and neighborhood social capital. In: Amina C, Davis JB, editors. Social capital and economics: social values, power, and social identity. New York City, New York (NY): Routledge; 2014. p. 115–39.Google Scholar
  19. 19.
    Lim S, Harris T. Neighborhood contributions to racial and ethnic disparities in obesity among New York City adults. Am J Public Health. 2015;105(1):159–65.CrossRefGoogle Scholar
  20. 20.
    New York City Department of City Planning. BYTES of the BIG APPLE. 2016. Accessed 5th Dec 2016.
  21. 21.
    The City of New York. Drinking Complaint. You can report the illegal drinking of Alcohol Underage drinking outside and drinking in unlicensed establishments are considered emergency situations. When they are not handling emergency situations, officers from your local police precinct will respond to complaints about underage drinking in bars or clubs or anyone drinking alcohol outdoors. Call 911 to report: underage drinking of alcohol outside or in a parked vehicle, Drinking of alcohol in an unlicensed establishment, social club, or bodeg. (2016). Available at: Accessed 15 Nov 2016.
  22. 22.
    Environmental Systems Research Institute (ESRI). ESRI Business Analyst. 2014. Accessed 5 Nov 2016.
  23. 23.
    United States Census Bureau. North American Industry Classification System (NAICS). 2016. Accessed 5 Nov 2016.
  24. 24.
    Freisthler B, Gruenewald PJ, Treno AJ, Lee J. Evaluating alcohol access and the alcohol environment in neighborhood areas. Alc Clin Exp Res. 2003;27(3):477–84.CrossRefGoogle Scholar
  25. 25.
    Norström T, Miller T, Holder H, Österberg E, Ramstedt M, Rossow I, et al. Potential consequences of replacing a retail alcohol monopoly with a private licence system: results from Sweden. Addiction. 2010;105(12):2113–9.CrossRefGoogle Scholar
  26. 26.
    Shi, Xi. ArcHealth v10.2 [computer program]. Bow, New Hamshire (NH): Spatial Inference Enterprises. 2014.Google Scholar
  27. 27.
    Environmental Systems Research Institute (ESRI). ArcGIS Desktop: Release 10.2. Redlands.; 2014.Google Scholar
  28. 28.
    Carlos HA, Shi X, Sargent J, Tanski S, Berke EM. Density estimation and adaptive bandwidths: a primer for public health practitioners. Int J Health Geogr. 2010;9(1):39.CrossRefGoogle Scholar
  29. 29.
    New York City Department of City Planning. Current estimates of New York City's population for July 2016. 2017; Accessed 19 Sept 2017.
  30. 30.
    Berke EM, Tanski SE, Demidenko E, Alford-Teaster J, Shi X, Sargent JD. Alcohol retail density and demographic predictors of health disparities: a geographic analysis. Am J Public Health. 2010;100(10):1967–71.CrossRefGoogle Scholar
  31. 31.
    New York City Department of Health and Mental Hygiene. Community Health Survey: public use data. 2013; Accessed 25 June 2013.
  32. 32.
    Capua J, Tuazon E, Paone D. Binge drinking and associated health-related behaviors among adults in New York City, 2014. New York: New York City Department of Health and Mental Hygiene; 2016.Google Scholar
  33. 33.
    United States Department of Health and Human Services. United States Department of Agriculture. 2015–2020 Dietary guidelines for Americans, 8th edn. Washington; 2015. Accessed 25 June 2017
  34. 34.
    United Hospital Fund Staff. New York City Community Health Atlas, 2002: Section III. sources, methods, and definitions. 2002. Accessed 25 Aug 2016.
  35. 35.
    Skogan WG. Measuring what matters: crime, disorder, and fear. In: Langworthy RH, editor. Measuring what matters: proceedings from the policing research institute meetings. Washington, DC: National Institute of Justice and Office of Community Oriented Policing Services; 1999. p. 55–64.Google Scholar
  36. 36.
    Ross CE, Mirowsky J. Disorder and decay: the concept and measurement of perceived neighborhood disorder. Urban Aff Rev. 1999;34(3):412–32.Google Scholar
  37. 37.
    Mair C, Gruenewald PJ, Ponicki WR, Remer L. Varying impacts of alcohol outlet densities on violent assaults: explaining differences across neighborhoods. J Stud Alcohol Drugs. 2013;74(1):50–8.CrossRefGoogle Scholar
  38. 38.
    Hobday M, Chikritzhs T, Liang W, Meuleners L. The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010. Addiction. 2015;110(12):1901–9.CrossRefGoogle Scholar
  39. 39.
    LaVeist TA, WallaceJr JM. Health risk and inequitable distribution of liquor stores in African American neighborhood. Soc Sci Med. 2000;51(4):613–7.CrossRefGoogle Scholar
  40. 40.
    Ayuka F, Barnett R, Pearce J. Neighbourhood availability of alcohol outlets and hazardous alcohol consumption in New Zealand. Health Place. 2014;29:186–99.CrossRefGoogle Scholar
  41. 41.
    Hannon L, Cuddy MM. Neighborhood ecology and drug dependence mortality: an analysis of New York City census tracts. Am J Drug Alcohol Abuse. 2006;32(3):453–63.CrossRefGoogle Scholar
  42. 42.
    Stockwell T, Zhao J, Macdonald S, Vallance K, Gruenewald P, Ponicki W, et al. Impact on alcohol-related mortality of a rapid rise in the density of private liquor outlets in British Columbia: a local area multi-level analysis. Addiction. 2011;106(4):768–76.CrossRefGoogle Scholar
  43. 43.
    Garvin E, Branas C, Keddem S, Sellman J, Cannuscio C. More than just an eyesore: local insights and solutions on vacant land and urban health. J Urban Health. 2013;90(3):412–26.CrossRefGoogle Scholar
  44. 44.
    Linton SL, Jennings JM, Latkin CA, Gomez MB, Mehta SH. Application of space-time scan statistics to describe geographic and temporal clustering of visible drug activity. J Urban Health. 2014;91(5):940–56.CrossRefGoogle Scholar
  45. 45.
    Ransome Y, Kawachi I, Braunstein S, Nash D. Structural inequalities drive late HIV diagnosis: the role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place. 2016;42:148–58.CrossRefGoogle Scholar
  46. 46.
    Infoshare Associates LLC. Infoshare online. 2000. Accessed 25 June 2015.
  47. 47.
    Haining R, Law J, Griffith D. Modelling small area counts in the presence of overdispersion and spatial autocorrelation. Comput Stat Data Anal. 2009;53(8):2923–37.CrossRefGoogle Scholar
  48. 48.
    Besag J, York J, Mollie A. Bayesian image restoration with two application in spatial statistics. Ann Inst Statistic Math. 1991;43(1):1–59.CrossRefGoogle Scholar
  49. 49.
    Leckie G, Charlton C. Runmlwin-a program to run the MLwiN multilevel modeling software from within Stata. J Stat Softw. 2013;52(11):1–40.Google Scholar
  50. 50.
    Lawson AB. Hierarchical modeling in spatial epidemiology. Wiley Interdiscip Rev Comput Stat. 2014;6(6):405–17.CrossRefGoogle Scholar
  51. 51.
    Gruenewald PJ, Millar AB, Treno RJ, Yang Z, Ponicki WR, Roeper P. The geography of availability and driving after drinking. Addiction. 1996;91(7):967–83.CrossRefGoogle Scholar
  52. 52.
    Anselin L, Ibnu S, Youngihn K. GeoDa: An introduction to spatial data analysis. Geogr Anal. 2006;38(1):5–22.CrossRefGoogle Scholar
  53. 53.
    Duncan DT, Aldstadt J, Whalen J, White K, Castro MC, Williams DR. Space, race, and poverty: spatial inequalities in walkable neighborhood amenities. Demogr Res. 2012;26:409–48.Google Scholar
  54. 54.
    Anselin L. An introduction to spatial autocorrelation analysis with GeoDa. Spatial Analysis Laboratory, University of Illinois, Champagne-Urbana, IL. 2003.Google Scholar
  55. 55.
    Openshaw S, Taylor P. A million or so correlation coefficients: three experiments on the modifiable area unit problem. In: Wrigley N, editor. Statistical applications in the spatial sciences. Willesden Green, London: Pion Ltd; 1979. p. 127–44.Google Scholar
  56. 56.
    Chinman M, Burkhart Q, Ebener P, Fan CC, Imm P, Osilla KC, et al. The premises is the premise: understanding off-and on-premises alcohol sales outlets to improve environmental alcohol prevention strategies. Prev Sci. 2011;12(2):181–91.CrossRefGoogle Scholar
  57. 57.
    Campanile C. Mayor’s plan to limit booze sales. 2012; Accessed 1 Dec 2016.
  58. 58.
    Butterworth T. The bizarre logic behind Mayor Bloomberg's booze crackdown: target moderate drinkers. 2012; Accessed 9 Dec 2016.
  59. 59.
    Wilson WJ. When work disappears: new implications for race and urban poverty in the global economy. Ethn Racial Stud. 1999;22(3):479–99.CrossRefGoogle Scholar
  60. 60.
    Theall KP, Lancaster BP, Lynch S, et al. The neighborhood alcohol environment and at-risk drinking among African Americans. Alcohol Clin Exp Res. 2011;35(5):996–1003.CrossRefGoogle Scholar
  61. 61.
    Sampson RJ, Raudenbush SW. Seeing disorder: neighborhood stigma and the social construction of “broken windows”. Soc Psychol Q. 2004;67(4):319–42.CrossRefGoogle Scholar
  62. 62.
    Duncan DT, Tamara K, Reagan SD, et al. Quantifying spatial misclassification in exposure to noise complaints among low-income housing residents across New York City neighborhoods: a global positioning system (GPS) study. Ann Epidemiol. 2017; 27(1):67-75.Google Scholar
  63. 63.
    Stockwell T, Auld MC, Zhao J, Martin G. Does minimum pricing reduce alcohol consumption? the experience of a Canadian province. Addiction. 2012;107(5):912–20.Google Scholar
  64. 64.
    Ellickson PL, Collins RL, Hambarsoomians K, McCaffrey DF. Does alcohol advertising promote adolescent drinking? results from a longitudinal assessment. Addiction. 2005;100(2):235–46.CrossRefGoogle Scholar
  65. 65.
    Young R, Macdonald L, Ellaway A. Associations between proximity and density of local alcohol outlets and alcohol use among Scottish adolescents. Health Place. 2013;19:124–30.CrossRefGoogle Scholar
  66. 66.
    Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186(1):125–45.CrossRefGoogle Scholar
  67. 67.
    Greenland S. Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects. Int J Epidemiol. 2001;30(6):1343–50.CrossRefGoogle Scholar
  68. 68.
    Gmel G, Holmes J, Studer J. Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence. Drug Alcohol Rev. 2016;35(1):40–54.CrossRefGoogle Scholar
  69. 69.
    Pitpitan EV, Kalichman SC. Reducing HIV risks in the places where people drink: prevention interventions in alcohol venues. AIDS Behav. 2016;20(1):119–33.CrossRefGoogle Scholar
  70. 70.
    Campbell CA, Hahn RA, Elder R, Brewer R, Chattopadhyay S, Fielding J, et al. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. Am J Prev Med. 2009;37(6):556–69.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  • Yusuf Ransome
    • 1
    • 2
    Email author
  • Hui Luan
    • 3
    • 4
  • Xun Shi
    • 5
  • Dustin T. Duncan
    • 6
  • S. V. Subramanian
    • 2
  1. 1.Department of Social and Behavioral SciencesYale School of Public HealthNew HavenUSA
  2. 2.Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.School of Geodesy and GeomaticsWuhan UniversityWuhan, HubeiChina
  4. 4.Department of GeographyUniversity of OregonEugeneUSA
  5. 5.Department of GeographyDartmouth CollegeHanoverUSA
  6. 6.Spatial Epidemiology Lab, Department of Population HealthNew York University School of MedicineNew YorkUSA

Personalised recommendations