Syracuse

Alcohol
Environment
Project

A collaborative project between

the Onondaga County Health Department
and the Syracuse/Onondaga Drug & Alcohol Abuse Commission

Robert Pezzolesi
Walden University
February, 2009
Introduction

The availability of alcohol has been linked to a panoply of harmful public health
and public safety outcomes including underage drinking, violence, motor vehicle
accidents, child abuse & neglect, sexually transmitted diseases, and alcohol-related
hospitalization. In order to begin to gauge these relationships locally, this project
encompasses an exploratory analysis of the alcohol environment in Syracuse, New York
utilizing geographic information system (GIS) mapping. The subjects of the maps were
suggested by extant research, dependant upon the availability and/or suitability of data.
Additionally, we opted for breadth (a wide range of issues) rather than depth (intensive
statistical analysis of any specific relationship).

The maps contained herein, even those with clearly definable patterns, are not
intended to establish a causal relationship between alcohol outlet placement/density
and the problems in question. Rather, as Gruenewald, Remer, & Lipton (2002) posit,
“spatial analysis can reveal descriptive associations between events and places,
providing a preliminary look at potential causal associations between problems and
places” (emphasis added).

It is hoped that these maps will spark conversation, spur further local research
on this important public health issue, and suggest (in tandem with the research
literature on alcohol availability) the value of environmental interventions to mitigate
alcohol problems in the Syracuse area.

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Maps: Alcohol Outlets/Alcohol Outlet Density

Our Maps Indicate

 Clustering of alcohol outlets both in
commercial/entertainment areas (e.g., Armory Square)
and mixed-use areas.

 Areas of intense clustering adjacent to residential

neighborhoods include Little Italy, James/Lodi,
Richmond/Frazer, Tipperary Hill, and Westcott.

Why It Matters
 Alcohol outlet density (AOD) has been linked to
greater alcohol consumption, and greater consumption
has been linked to higher rates of alcohol-related
problems.
(Babor, Caetano, Casswell, Edwards, Giesbrecht, Graham, et al., 2003; Livingston,
Chikritzhs, & Room, 2007)

 Studies have correlated AOD with a number of health,

social, and economic harms including violent crime,
property crime, DWI, pedestrian injury, alcohol-related
hospitalization, gonorrhea, and child abuse & neglect.

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Map: Armory Square detail

Our Maps Indicate

 Armory Square features extremely dense clustering of
on-premise outlets.

Why It Matters
 Entertainment districts featuring high numbers of on-
premise alcohol outlets may intensify alcohol problems
by facilitating the circulation of large crowds.
(Livingston, Chikritzhs, & Room, 2007)

 At a certain point, additional outlets may have an

exponential effect on alcohol related problems (see
figure below).

Figure from Livingston,

Chikritzhs, & Room (2007), p. 562

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Maps: Poverty and Off-Premise Alcohol Outlets

Our Maps Indicate

 A general pattern of placement of off-premise alcohol
outlets in relatively impoverished neighborhoods.

 A noticeably smaller number of alcohol outlets in

relatively affluent neighborhoods, including
Meadowbrook, Sedgwick, South Valley, and
University neighborhoods.

Why It Matters
 The concentration of alcohol outlets in impoverished
neighborhoods amounts to a “double whammy” on
public health and public safety.

 A 1995 Syracuse University study of Onondaga

County commissioned by the Syracuse/Onondaga
Drug & Alcohol Abuse Commission found a clear,
inverse relationship between neighborhood income
and number of alcohol outlets.
(Doherty, 1995)

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Map: Vacant Housing Units & Off-Premise Alcohol Outlets

Our Maps Indicate

 A modest relationship between off-premise outlets and
vacant housing units.

Why It Matters
 Large numbers of vacant housing units have been
connected with neighborhood crime.
(Roncek & Maier, 1991; Parker, Luther, & Murphy, 2007)

 The interrelationship of concentrated alcohol outlets

and vacant housing units may intensify the social
disorganization of Syracuse neighborhoods.
(Gruenewald & Remer, 2006)

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Maps: Race/Ethnicity and Off-Premise Alcohol Outlets

Our Maps Indicate

 Little apparent relationship between either African-
American race or Hispanic ethnicity and location of
off-premise alcohol outlets.

Why It Matters
 Several studies have found disproportionate number
of alcohol outlets in minority neighborhoods.
(Alaniz, Parker, Gallegos, & Cartmill, 1996; LaVeist & Wallace, 2000; Romley,
Cohen, Ringel, & Sturm, 2007; Pollack, Cubbin, Ahn, & Winkleby, 2005)

 African-Americans as a group paradoxically have

overall light patterns of drinking and
disproportionately high rates of alcohol problems.
Higher AOD may be one factor in this disparity.
(Godette, Headen, & Ford, 2006)

 Latinos are also disproportionately affected by alcohol-

related illness and violence, with higher AOD possibly
contributing to this disparity.
(Alaniz, Cartmill, & Parker, 1998)

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Map: School Proximity to Off-Premise Alcohol Outlets

Our Maps Indicate

 68% of Syracuse City schools have an off-premise alcohol
outlet within ¼ mile.

Why It Matters
 Radius of 0.5 mile represents a 10–15 minute walk,
considered a standard maximum walking distance.
(Lee, Reese-Smith, Regan, Booth, & Howard, 2003)
Syracuse City School District walking distance is 1.5 miles for
elementary school students and 2 miles for junior/senior high
school students.
(Stonecash, 2007)

 According to SAMHSA, a large number (30.6%) of underage

drinkers ages 12-20 purchased the last alcohol they used
(SAMHSA, 2008)

 In a US study, the vast majority (94%) of stores that sold

alcohol displayed alcohol ads. 44% of those stores displayed
such ads within 3.5 feet of the floor.
(Terry-McElrath, Harwood, Wagenaar, Slater, Chaloupka, Brewer, et al., 2003)

 Exposure to in-store alcohol advertising has been associated

with increased adolescent drinking.
(Hurtz, Henriksen, Wang, Feighery, & Fortmann, 2007; Ellickson, Collins,
Hambarsoomians, & McCaffrey, 2005)

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Map: School Detail

Our Maps Indicate

 Our example - Franklin Magnet School - is proximate
to several off-premise alcohol outlets which have been
cited for selling to underage patrons.

Why It Matters
 At least 50% of alcohol outlets within ½ mile of
Franklin Magnet School have been cited for underage
sales in the last 8 years.
(Syracuse Post-Standard, 2001-2006)

 This analysis did not include the considerable number

of other crimes committed at the other outlets.

 The rate of illegal merchant sales in communities has

been linked to youth drinking frequency, binge
drinking, drinking at school, and drinking and driving.
(Dent, Grube, & Biglan, 1995)

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Map: Youth Program Proximity to Off-Premise Alcohol Outlets

Our Maps Indicate

 88% of identified youth programs have an off-premise
alcohol outlet within ¼ mile.

Why It Matters
 A community GIS project in Tucson, Arizona, found the ratio
of alcohol retailers to youth attractions to be 3:1 (within 1 mile
radius).
(Baldasare & Palm, 2008)

 According to SAMHSA, a large number (30.6%) of underage

drinkers ages 12-20 purchased the last alcohol they used
(SAMHSA, 2008)

 In a US study, the vast majority (94%) of stores that sold

alcohol displayed alcohol ads. 44% of those stores displayed
such ads within 3.5 feet of the floor.
(Terry-McElrath, Harwood, Wagenaar, Slater, Chaloupka, Brewer, et al., 2003)

 Exposure to in-store alcohol advertising has been associated

with adolescent drinking.
(Hurtz, Henriksen, Wang, Feighery, & Fortmann, 2007; Ellickson, Collins,
Hambarsoomians, & McCaffrey, 2005)

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Map: Homeless Transitional Housing Proximity to Alcohol Outlets

Our Maps Indicate

 88% of identified homeless transitional housing sites
have alcohol outlets within ¼ mile.

Why It Matters
 Alcoholism may be the most widespread of the
numerous health problems faced by homeless people.
(Committee on Health Care for Homeless People, 1988)

 45-57% of homeless people have been estimated to

suffer from alcohol use disorders.
(National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1991, p. 541)

 “…Environmental contingencies can play a powerful

role in encouraging or discouraging drinking” among
homeless people.
(Smith, Meyers, & Delaney, 1998, p. 541)

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Map: Esophageal Cancer & On-Premise Alcohol Outlets

Our Maps Indicate

 Ambiguous relationship between cases of esophageal
cancer and on-premise alcohol outlets.

Why It Matters
 Approximately 40% of cases of esophageal cancer in
males and 29% of cases in females are attributable to
alcohol ingestion.
(Rehm, Room, Graham, Monteiro, Gmel, & Sempos, 2003)

 Average cost per case for esophageal cancer is

approximately $35,000.
(Max, Stark, Wittman, & West, 2004)

Other Risk Factors

 African-American race (Steyerberg, Earle, Neville, & Weeks, 2005)
 Smoking (Veugelers, Porter, Guernsey, & Casson, 2006)
 Obesity (Veugelers, Porter, Guernsey, & Casson, 2006)
 Male sex (Veugelers, Porter, Guernsey, & Casson, 2006)

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Map: Liver Cirrhosis & On-Premise Alcohol Outlets

Our Maps Indicate

 Ambiguous relationship between cases of liver
cirrhosis and on-premise alcohol outlets.

Why It Matters
 Approximately 61% of cases of liver cirrhosis in males
and 35% of cases in females are attributable to alcohol
ingestion.
(Rehm, Room, Graham, Monteiro, Gmel, & Sempos, 2003)

 Average cost per case for liver cirrhosis is

approximately $17,000 - $21,000.
(Max, Stark, Wittman, & West, 2004)

Other Risk Factors

 African-American race (Hurwitz, Holman, Strine, & Chorba, 1995)
 Lower socioeconomic status (Najman, Williams, & Room, 2007)
 Hepatitis C (Freeman, Law, Kaldor, & Dore, 2003)

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Map: Gonorrhea & Off-Premise Alcohol Outlets

Our Maps Indicate

 Ambiguous relationship between cases of gonorrhea
and off-premise alcohol outlets.

Why It Matters
 Studies have shown a strong relationship between
alcohol outlets and gonorrhea rates.
(Scribner, Cohen, & Farley, 1998; Cohen, Ghosh-Dastidar, Scribner, Miu, Scott,
Robinson, et al., 2006)

 Average cost per case for gonorrhea is $343 in direct

medical costs and $47 in lost productivity for females;
$68 in direct medical costs and $10 in lost productivity
for males.
(Chesson, Collins, & Koski, 2008)

Other Risk Factors

 African-American race (Einwalter, Ritchie, Ault, & Smith, 2005)
 Lower socioeconomic status (Lacey, Merrick, Bensley, Fairley, 1997)
 Neighborhood deterioration (Cohen, Spear, Scribner, Kissinger, Mason, &
Wildgen, 2000)
 Age <20 (Shahmanesh, Gayed, Ashcroft, Smith, Roopnarainsingh, Dunn, et al., 2000)

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 Map: Chlamydia & Off-Premise Alcohol Outlets

Our Maps Indicate

 Ambiguous relationship between cases of chlamydia
and off-premise alcohol outlets.

Why It Matters
 Studies have shown relationship between alcohol
outlets and gonorrhea rates and HIV/AIDS rates.
(Scribner, Cohen, & Farley, 1998; Cohen, Ghosh-Dastidar, Scribner, Miu, Scott, Robinson,
et al., 2006; Scribner, Johnson, Cohen, Robinson, Farley, & Gruenewald, 2008)

By analogy, alcohol outlet density may affect other

STDs.
 Average cost per case for chlamydia is $315 in direct
medical costs and $47 in lost productivity for females;
$26 in direct medical costs and $10 in lost productivity
for males.
(Chesson, Collins, & Koski, 2008)

Other Risk Factors

 African-American race (Einwalter, Ritchie, Ault, & Smith, 2005)
 Lower socioeconomic status (Shahmanesh, Gayed, Ashcroft, Smith,
Roopnarainsingh, Dunn, et al., 2000)
 Age <20 (Shahmanesh, Gayed, Ashcroft, Smith, Roopnarainsingh, Dunn, et al., 2000)

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 Map: DWI Arrests & On-Premise Alcohol Outlets

Our Maps Indicate

 An apparent correlation between DWI arrests and on-
premise alcohol outlets.

Why It Matters
 Approximately 40% of motor vehicle accident injuries
are alcohol-involved.
(Rehm, Patra, & Popova, 2006)

 Each year about 1,900 youth die as the result of

alcohol-related motor vehicle crashes.
(National Institute on Alcohol Abuse and Alcoholism, 2006)

 Average cost per case for injured motor vehicle driver

is $33,731 - $50,583. Average cost per case for injured
pedestrian is $31,414 - $57,103. Two-thirds of those
expenditures are for teenagers.
(Pressley, Trieu, Kendig, & Barlow, 2007)

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Map: Aggravated Assault Arrests & Alcohol Outlets

Our Maps Indicate

 An apparent modest correlation between arrests for
aggravated assault and alcohol outlets.

Why It Matters
 Approximately 50% of those committing violent
crimes consumed alcohol prior to the act. About 40%
of state prisoners report being under the influence of
alcohol at the time of the crime.
(Martin, 2001)

 Average cost per case for a non-fatal assault is $23,353

in medical costs and $57,209 in lost productivity.
(Corso, Mercy, Simon, Finkelstein, & Miller, 2007)

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Map: Domestic Calls for Service & Off-Premise Alcohol Outlets

Our Maps Indicate

 Little apparent relationship between domestic calls for
service and off-premise alcohol outlets.

Why It Matters
 51% of victims of intimate partner violence (IPV)
perceived their attacker to be using alcohol.
(Greenfeld & Henneberg, 2001)

 Total mean medical and mental health care cost per IPV
victimization is $816, with additional costs in lost
productivity.
(National Center for Injury Prevention and Control, 2003)

Other Risk Factors

 Poverty and associated stress (Jewkes, 2002)
 Illicit drug use (Coker, Smith, McKeown, & King, 2000)

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 Map: Purchase of Preventive Services Cases & Alcohol Outlets

Our Maps Indicate

 An apparent correlation between alcohol outlets and
PPS cases.

Why It Matters
 Purchase of preventive services (PPS) cases represent
families at moderate to high risk for foster care
placement of children due to child abuse or neglect.
(Brian McKee, personal communication, February 6, 2009)

 The average cost per case for PPS in Onondaga County

is approximately $5,600 per case.
(Brian McKee, personal communication, February 6, 2009)

 Some studies have shown a positive correlation

between alcohol outlet density and substantiated rates
of child maltreatment; severe domestic violence
toward children; hospital discharges for child abuse
injuries; child neglect; and, foster care entries.
(Freisthler, 2004; Markowitz & Grossman, 1998; Freisthler, Gruenewald, Ring &
LaScala, 2008; Freisthler, Midanik, & Gruenewald, 2004; Freisthler, Gruenewald,
Remer, Lery, & Needell, 2007)

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Map: TANF Substance Abuse Screening & Alcohol Outlets

Our Maps Indicate

 Ambiguous relationship between alcohol outlet placement
and positive TANF substance abuse screens. (Note:
screening statistics did not separate alcohol from illicit drugs.)

Why It Matters
 One study found that 9% of welfare recipients were alcohol-
dependent, compared to 5% of nonrecipient single mothers.
(Jayakody, Danziger, & Pollack, 2000)

 A 2004 study suggested that a need for substance abuse

services was correlated with “going on and off welfare more
than once, leaving welfare for negative reasons, failing to find
employment, and a low trajectory of earned income.”
Furthermore, alcohol dependence was negatively related to
working >32 hours per week.
(Chandler, Meisel, Jordan, Rienzi, & Goodwin, 2004, p. 628)

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