Areas with an overabundance of alcohol outlets are potentially high-risk environments for violence.  This may be due in part to greater rates of alcohol consumption.  It may also be due to factors that are not directly related to consumption but that promote violence just the same.  Thus, although the vast majority of Americans either abstain or moderately consume alcohol in a responsible trouble-free manner, environments with an overabundance of alcohol outlets continue to experience high levels of violence.

The association of alcohol outlet density and violence has been well documented ecologically.  Rates of assaultive violence and alcohol outlet density have been shown to directly correlate at the city-level.  It has also been argued empirically that an overabundance of alcohol outlets most heavily exacts its influence on neighborhoods, as opposed to individual drinkers.  In this way, the density of alcohol outlets in a community has been shown to be a strong predictor of neighborhood-level violence, especially with respect to criminal victimization and homicide.  City blocks with more on-premise alcohol outlets (such as bars) are particularly risky settings because of the knowledge that patrons and proprietors have cash on hand and because potential offenders perceive drinkers as easier to victimize.  Neighborhoods with a high density of off-premise outlets (such as liquor stores) have also been strongly associated with violence.

However, alcohol consumption has not always been shown to be associated with an abundance of alcohol outlets.  Similarly, and in further contrast to the overwhelming balance of research work, a few studies have also failed to find a strong association between alcohol outlets and violence.  Violent behaviors and rates of violence have only been weakly associated in several studies of jurisdictions and municipalities at the State level.  These studies underscore the lack of a fully conclusive body of evidence regarding alcohol outlets and violence.  However, they also point to the need for neighborhood-level analyses using quantitative study designs other than the traditional ecological designs that have been exclusively used to date.

State alcohol distribution policies have become a patchwork quilt of different systems ranging from government-run monopolies to privatized license systems for different forms of alcohol.  Nevertheless, policies to control the availability of alcohol, including restricting the number and location of alcoholic beverage sales outlets, can be effective environmental interventions.  The presence of planning and zoning ordinances is a politically feasible, yet often overlooked, strategy for local communities to contend with problems that may be associated with alcohol outlets.  However, a barrier to implementing this strategy is the lack of convincing evidence that such an intervention can change the risk of injury.

The epidemiologic case-control study design that we are using is a valuable approach to the quantification of risk factors associated with relatively rare events and is intended to provide additional, and much needed, evidence regarding the relationship between alcohol outlets and firearm violence.