While inappropriate gun use certainly contributes to gun violence, other contributing factors, such as alcohol, deserve greater scrutiny. New research has found that heavy drinking near off-premise alcohol outlets, such as take-out establishments and delis, is a risk factor for being shot in an assault.
The authors suggest that reducing the density of off-premise alcohol outlets and better training servers in these outlets may help to reduce gun violence.
"Strategies to reduce gun violence often focus on the guns themselves," said Charles C. Branas, associate professor of epidemiology at the University of Pennsylvania and corresponding author for the study. "While most Americans agree that gun violence is something we need to reduce, there is less certainty as to how we should intervene while striking a balance between gun owners' rights and public safety."
Yet the issue clearly needs to be addressed, according to Rose Cheney, executive director of the Firearm and Injury Center at the University of Pennsylvania.
"Firearm injury is a significant public health problem, in the US and globally," she said. "Annually, 100,000 Americans are killed or injured by firearms. Furthermore, families and communities are impacted by these interpersonal and self inflicted shootings; gun violence imposes an economic burden on individuals, businesses and communities far beyond the medical costs of treating injuries; and the brain sciences are beginning to identify how exposure to high levels of violence profoundly impacts many aspects of youth development."
Although there is no "single answer" on how to prevent gun violence, Cheney added, local communities need as much information and policy tools as possible in order to reduce risk. "Research findings such as these allow us to intervene earlier, more comprehensively interrupt pathways toward violence, and better document the impact of investments in prevention," she said. "In addition, while firearm homicides are most visible, focusing on the broader outcome of firearm injuries and their repercussions to individuals and communities will increase our chances of success."
Branas and his colleagues reviewed gun assault cases that occurred in the City of Philadelphia from 2003 to 2006: 677 cases of individuals shot during an assault, and 684 controls randomly sampled from the adult general population of Philadelphia. The relationships among individual alcohol consumption, alcohol outlets in the surrounding environment, and the outcome of being assaulted with a gun were then analyzed.
"This study found that the gun-assault risk to individuals who are near off-premise alcohol outlets was about the same as or statistically greater than the risk they incurred from heavy drinking," said Branas. "The combination of heavy drinking and being near off-premise outlets resulted in greater risk than either factor alone. Individuals in and around off-premise alcohol outlets were shot as the victims of predatory crimes, possibly because they had heavily consumed and were easier targets, or they were shot as the victims of otherwise tractable arguments that became violent because one or more of the combatants had consumed alcohol."
In contrast, he said, light drinking and being near on-premise alcohol outlets, such as bars and taverns, were not associated with increased risks for gun assault. "On-premise outlets were by comparison highly monitored, relatively safe havens, even in neighborhoods with high levels of gun violence," he said.
Cheney said that cities can use these findings to create interventions on at least three levels. "One, reduce risks associated with take-away alcohol outlets – such as their physical design, hours, service limits, or staff training – through a number of mechanisms, including zoning, ordinances, education, training, inspections and taxes," she noted. "Two, target enforcement to these high-risk hot spots and toward public drunkenness. And three, target individual interventions to reduce alcoholism, gun carrying or conflict-related behaviors by persons with a history of public drunkenness."
Branas agreed, and also suggested that off-premise alcohol outlets begin to function more like their on-premise counterparts in some aspects. "For example, training off-premise servers to cut off heavy drinkers as well as promptly report the outbreak of arguments to police could be effective gun-violence reduction strategies," he said.
At an individual level, Cheney recommended that people become more aware of not only the personal risk and responsibilities of heavy drinking and gun ownership, but also the risks of simply navigating near risky establishments such as off-premise alcohol outlets. "People can monitor and respond to high-risk establishments and behaviors in their neighborhoods and, furthermore, collect data that can be used to help improve local quality of life, and advocate for change that lowers both environmental and individual risks," she said.
Branas added that this study was designed to represent the entire city of Philadelphia, and be informative for US cities in general. "Perhaps strategies to reduce gun violence that focus on the involvement of alcohol are less politically volatile and as such may be more readily implemented with similar returns," he said.
Co-authors of the paper were: Michael R. Elliott of the Department of Biostatistics at the University of Michigan School of Public Health; Therese S. Richmond of the Division of Biobehavioral and Health Sciences at the University of Pennsylvania School of Nursing; Dennis P. Culhane of the Cartographic Modeling Laboratory at the University of Pennsylvania School of Social Policy and Practice; and Douglas J. Wiebe of the Department of Biostatistics and Epidemiology at the University of Pennsylvania School of Medicine. The study was funded by the National Institutes of Health, and the National Institute on Alcohol Abuse and Alcoholism.
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