Environmental Strategies for Underage Drinking Prevention: Lessons from Baltimore

1. Environmental Strategies for Underage Drinking Prevention: Lessons from Baltimore Debra Furr-Holden, PhD

2. ACKNOWLEDGEMENTS Parent Grant Funded by the National Institute on Alcoholism and Alcohol Abuse (PI, D Furr-Holden; 1-R01-AA015196)Additional funding provided by Centers for Disease Control and Prevention Youth Violence Prevention Center (PI, P Leaf; 1U49CE000728) Baltimore City data provided by The Baltimore City Mayor’s Office of Information Technology And The Board of Liquor License Commissioners for Baltimore City An extraordinary field data collection team!

3. C. Debra Furr-Holden, PhDAssistant Professor and Director Drug Investigations, Violence & Environmental (DIVE) Studies Laboratory JHU Bloomberg School of Public Health Department of Mental Health 111 Market Place Baltimore, MD 21202 Suite 850 dholden@jhsph.edu www.divestudies.com

4. Overview DIVE Research • Conduct neighborhood-level research using the NIfETy Method (Furr-Holden, et al, 2008 in Prevention Science; Furr-Holden, et al., 2010 in Evaluation Review) to improve health outcomes for community residents • Work closely with local stakeholders and policy makers to drive public health initiatives

5. Alcohol Systems in Baltimore • Enforcement • Board of Liquor License Commissioners • BCPD • Maryland State Police

6. Alcohol Systems in Baltimore • Establishments • Zoning • Board of Liquor License Commissioners • Article 2B of the Maryland State Annotated Code

7. Alcohol Systems in Baltimore • Treatment • Maryland ADAA • BSAS • Treatment Providers

8. Baltimore City has 277 ecologically defined neighborhoods; 242 are residential

9. There are 1,277 licensed alcohol outlets in Baltimore City

10. The Homewood Campus is just north of Central Baltimore City

13. Put into Perspective….. • There are 97 alcohol outlets within the 1-mile buffer around the Homewood Campus • There are 41 alcohol outlets within the 1-mile buffer around the worse block in East Baltimore • There are 33 alcohol outlets within the 1-mile buffer around the worse block in West Baltimore • There are 25 alcohol outlets within the 1-mile buffer around Martin O’Malley’s former residence

14. Information on the 97 Licensed Alcohol Outlets around the Homewood Campus • Among these 97 licensed alcohol outlets: • One-third (30) sell packaged goods exclusively • The other two-thirds (67) sell alcohol on premises • Two-thirds (64) sell alcohol 7 days per week • Between Thanksgiving and New Year’s 95 of the 97 outlets sell alcohol 7 days a week

15. Calls for Service for ‘Intoxicated Person’ by Month in 2008 within 1-mile of the Homewood Campus

16. Potential Environmental Strategies •  Decrease the number of alcohol outlets in the surrounding area • Quote from Scribner et al (2009) Given the limited number of modifiable factors that affect college drinking, on-premise outlet density represents a potential modifiable means of addressing the problem. • Article 2b of the Maryland State Law has provisions for the distance alcohol outlets can be from a church or a school, perhaps similar legislation is needed to protect college students. •  Enforcement

17. The Origin of the Research • Presentation at 2007 EUDL Conference • Requested to conduct a process evaluation for the Board of Liquor License Commissioners for Baltimore City • Review of State Article 2b (states no alcohol outlet can be within 300 feet of church or a school) • Queried alcohol outlet database • Acquired school data from BC MOIT • Triangulated school, alcohol outlet, NIfETy, local (crime and violence), and youth self-report data

18. Alcohol Outlets Physical and Social Disorder Youth Exposure to VAOD Violent Behavior Youth Drug and Alcohol Use Alcohol Policy & Zoning Enforcement Conceptual Model

19. Liquor Outlets in Baltimore City

20. Liquor Outlets and All K-12 Schools

21. Liquor Outlets, K-12, & Drug Hot Spots

22. Targeting a Selected Area

23. A Closer Look

24. Multi-Variable Analysis Results among High School Youth • 9th -12th grade youth who attend schools that have at least one alcohol outlet within 300 feet of their school are • 4.5 times more likely to use drugs (OR 4.5; p=0.02) • 5 times more likely to report feeling unsafe on the walk to school (OR 5.3; p=0.03) • 8 times more likely to have witnessed a violent assault (OR 7.9, p=0.01)

25. Multi-Variable Analysis Results among 3rd-5th grade Youth • 3rd-5th grade youth who go to schools that have at least one alcohol outlet within 300 feet of their school are • 4 times more likely to walk to school (OR 4.3; p=0.04) (partly related to economics) • Almost 7 times more likely to report feeling unsafe on the walk to school (OR 6.8; p=0.03) • 4 times more likely to be depressed (OR 4.2; p=0.02) • 5 times more likely to report seeing people using drugs or getting drunk in their neighborhood (OR 5.2, p=0.01)

26. Results to Date • Presented data to Liquor Commissioners and City Council Resistance, but enforcement strategy in place • 11 outlets closed so far • Revision to the 300 foot rule – specification (e.g., parcel) and possible expansion • Unexpected  Now alcohol outlets are on the radar  new BD7 and Bottle Club laws • 11 alcohol bills on the floor, 8 directly related to DIVE research

27. Recent Alcohol Policy Work in Baltimore • AlcoPops Bill Passed in 2009 • Revision to the 300 foot rule – specification and possible expansion • BD7s • Bottle Clubs • Billboard Laws

28. Discussion • Association between alcohol outlet proximity to schools and youth outcomes • Unmeasured dimensions of collective efficacy most likely at play • Policy implications: enforcement and revision

29. Nest Steps • Evaluation of drinking rates and underage sales after closures • Coordination of policy enforcement efforts with underage drinking enforcement • Developing multiple models across the City • Having key stakeholders own the issue

30. Questions/Discussion