Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Steven L. Bernstein

Subject Area(s)

Medicine, Public health

Abstract

This study examines whether proximity and density of alcohol outlets is associated with number of emergency department (ED) visits in a year, and whether any such relationship is mediated by alcohol consumption or alcohol-related injury. The population sample consists of ED patients identified as heavy drinkers during random screening. Weekly alcohol consumption, frequency of binge drinking, number of injuries sustained within two hours of alcohol consumption, and number of ED visits in the past year were obtained by an ED patient screening survey. ED visit data were obtained from electronic medical records (EMR). Alcohol license data from the Connecticut Department of Consumer Protection were separated by outlet type (off-premises, restaurant, bar) and geocoded along with home addresses of participants to measure density and proximity. Poisson and negative binomial regression models were used to individually examine the association between alcohol availability and consumption, injury, and ED visits, and then the association of consumption and injury with ED visits, controlling for age, sex, race/ethnicity, education, and insurance. The models showed a positive association of off-premises outlet density with self-reported ED visits (IRR 1.067, 95% CI: 1.005-1.132) and a negative association of distance to nearest restaurant with ED visits in EMR (IRR 0.505, 95% CI: 0.323-0.789). No associations were found between proximity or density and alcohol consumption for any outlet type. Alcohol-related injury was positively associated with distance to nearest off-premises outlet (IRR 1.764, 95% CI: 1.114-2.794). Results support the conclusion that there is an association between some types of alcohol outlets and ED visits, but the mechanisms behind this relationship are unclear. The lack of association between alcohol availability and consumption, and the increase in injuries associated with increased distance to off-premises outlets was unexpected, and might indicate that alcohol availability influences heavy drinkers differentially than the general population. These findings should be further investigated because current policy recommendations to decrease alcohol outlet density may have unintentional harmful effects on heavy drinkers.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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