ECPN poster contestant: The Neighborhood Alcohol Environment & Injury: a Spatial Analysis of Pedestrian Injury in Baltimore City

Introduction: Alcohol is an important risk factor for pedestrian injury on two levels. First, those under the influence of alcohol are at increased risk of being both the perpetrators and victims of pedestrian injury. Second, more pedestrian injuries occur in areas of greater alcohol outlet density independent of the intoxication status of drivers or pedestrians. Little research exists that explains the mechanisms by which outlet density impacts injury beyond alcohol consumption. 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.

Methods: 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 = 848). 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. Social environment observational measures and socioeconomic indicators from the 2010 U.S. Census were also explored, as were environmental observation measures of social and physical disorder.

Results: When controlling for established risk factors for pedestrian injury, including traffic volume, household income, and proximity to schools, presence of alcohol outlets significantly increased neighborhood risk of pedestrian injury. This effect was not attenuated when controlling for neighborhood social or physical disorder. 

Conclusions: Alcohol outlet density is an important risk factor for pedestrian injury, even when controlling for other established risk factors. 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 interventions addressing alcohol use and abuse, as well as injury prevention.