Relating off-premises alcohol outlet density to intentional and unintentional injuries.
OBJECTIVE
This study investigated the hypotheses that (i) intentional and unintentional injuries occur more frequently in areas with greater density of off-premises alcohol outlets; and (ii) larger and chain outlets selling cheaper alcohol contribute more substantially to injury risk than smaller and independent outlets.


METHODS
Ecological cross-sectional.


METHODS
From the 256 Statistical Area level 2 (SA2) census units in Melbourne, Australia, we selected a random sample of 62 units. There were 2119 Statistical Area level 1 (SA1) units nested within the selected SA2 units.


METHODS
The selected units contained 295 off-premises outlets.


METHODS
Two independent observers conducted premises assessments in all off-premises outlets, assessing the volume of alcohol available for sale (paces of shelf space), price (least wine price) and other operating characteristics (chain versus independent, drive-through). Outlet counts, assessed outlet characteristics and other area characteristics (population density, median age, median income, retail zoning) were aggregated within SA1 units. Dependent variables were counts of ambulance attended intentional injuries (assaults, stabbings, shootings) and unintentional injuries (falls, crush injuries and object strikes).


RESULTS
In univariable analyses, chain outlets were larger (r = 0.383; P < 0.001) and sold cheaper alcohol (r = -0.484; P < 0.001) compared with independent outlets. In Bayesian spatial Poisson models, off-premises outlet density was positively related to both intentional [incidence rate ratio (IRR) = 1.38; 95% credible interval (CI) = 1.19, 1.60] and unintentional injuries (IRR = 1.18; 95% CI = 1.06, 1.30). After disaggregation by outlet characteristics, chain outlet density was also related to both intentional (IRR = 1.35; 95% CI = 1.11, 1.64) and unintentional injuries (IRR = 1.20; 95% CI = 1.08, 1.38).


CONCLUSIONS
Greater off-premises outlet density is related to greater incidence of traumatic injury, and chain outlets appear to contribute most substantially to traumatic injury risk.
Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.|Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA.
Christopher
C
Morrison
Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.|Ambulance Victoria, Strategic Planning Department, Blackburn, Victoria, Australia.|University of Western Australia, School of Primary, Aboriginal and Rural Health Care, Crawley, Western Australia, Australia.
Karen
K
Smith
Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA.
Paul J
PJ
Gruenewald
Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA.
William R
WR
Ponicki
Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA.
Juliet P
JP
Lee
Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.
Peter
P
Cameron
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000434:Alcoholic Beverages / Q000191:economics* / Q000706:statistics & numerical data*; D001315:Australia / Q000453:epidemiology; D002648:Child; D003132:Commerce / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006801:Humans; D008875:Middle Aged; D011156:Population Density; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult
Alcohol outlets; availability; injury; outlet density; trauma