University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, 423 Guardian Dr, Philadelphia, PA, 19104, USA; Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA.
Michigan State University College of Human Medicine, Department of Epidemiology and Biostatics, 200 East First Street, Flint, MI, 48502, USA.
Int J Drug Policy. 2021 Sep;95:103289. doi: 10.1016/j.drugpo.2021.103289. Epub 2021 May 11.
Alcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association.
A cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly.
Each additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose.
This study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws.
酒精销售点与各种形式的伤害有关，可能导致药物过量的社区差异。很少有研究调查酒精销售点与药物过量之间的关联。本研究调查了酒精销售点是否与社区药物过量率有关，以及销售毒品用具是否会导致这种关联。
在巴尔的摩市的人口普查块组内进行了一项横断面的生态空间分析（n=653）。结果是 2015 年 EMS 对任何药物过量的呼叫次数（n=3856）。感兴趣的暴露是获得场外和场内消费许可证的酒精销售点数量，以及场外销售毒品用具（如钝器包装纸、小袋、烟斗）的比例。使用负二项回归来评估销售点数量与过量率之间的关系，如果用具销售改变了这种关系，则控制其他社区因素。评估了空间自相关，并相应地调整了回归推断。
在调整了其他社区变量后，每增加一个场外酒精销售点，社区药物过量率就会增加 16.6%（IRR=1.17，95%CI=（1.11, 1.23））。在调整场外酒精销售点后，场内酒精销售点与药物过量率没有显著相关性（IRR=1.01，95%CI=（0.97, 1.06））。销售毒品用具的场外销售点比例与过量率呈负相关（IRR=0.55，95%CI=（0.41, 0.74）），并且没有改变场外销售点与过量之间的关系。
本研究为制定关于酒精销售点许可和分区的政策决策提供了初步的公共卫生证据。酒精销售点可以成为减少伤害策略的潜在社区合作伙伴，例如在识别过量症状或善意撒玛利亚人法律方面的健康传播。
