Novel Methods for Environmental Assessment of Pedestrian Injury: A Spatial Analysis of Alcohol Outlets and Pedestrian Injury in Baltimore City

The aim of this study was to explore the extent of overlap between areas of concentrated pedestrian injuries and alcohol outlet density in Baltimore City. This study incorporated methods from Geographic Information Systems (GIS), spatial statistics, and environmental observation for integrating, visualizing and analyzing data with location information. Pedestrian injury incidence data were gathered in real-time through EMS records collected from January 1, 2014, to April 15, 2015 (n = 849). Alcohol outlet locations licensed in 2014 were obtained through the Board of Liquor License Commissioners for Baltimore City (n = 693). All alcohol outlet locations and pedestrian injury locations were geocoded and mapped using ArcGIS. The spatial intensity of both alcohol outlet density and pedestrian injuries were estimated and compared statistically using R. A novel, validated tool for conducting an environmental audit of traffic safety infrastructure for pedestrians was incorporated to investigate possible mediators of the outlet-injury risk relationship. Social environment observational measures and socioeconomic indicators from the 2010 U.S. Census were also explored. Study findings point to the built and social environment as possible mechanisms by which alcohol outlet density impacts pedestrian injury risk. Study findings have implications for understanding the impact of alcohol outlet density on unintentional injury, as well as increasing the evidence base to inform decisions about liquor store licensing and enforcement. These activities could have important implications for public health-based policy interventions and community-level behavioral health intervention addressing alcohol use and abuse, as well as injury prevention.