Freisthler, B., Gruenewald, P. J., Remer, L. G., Lery, B., & Needell, B. (2007). Exploring the Spatial Dynamics of Alcohol Outlets and Child Protective Services Referrals, Substantiations, and Foster Care Entries. Child Maltreatment, 12(2), 114-125.
Drawing on the substantial literature that links alcohol consumption with child maltreatment, the authors examined the relationship between the density of alcohol retail outlets in neighborhoods (liquor stores, bars, and restaurants that serve alcohol) and the rate of child protective services referrals, substantiations, and foster care entries. All types of maltreatment were considered in this study, including physical abuse, sexual abuse, emotional abuse, and neglect. Zip codes were used as proxies for neighborhoods; data from 579 stable zip codes in California were analyzed over a period of five years (1998-2003). Sociodemographic data—child population size, median age, average household size, median household income, and racial composition (percentages of Whites, African-Americans, Hispanics and Asian/Pacific Islanders)—were also gathered for each zip code, to control for the effect of these variables on child maltreatment rates. Data were analyzed using spatial random effects panel models (REM). Two key methodological features of this study were: (1) the effects of changes over time in alcohol outlets were measured; and (2) the characteristics of adjacent neighborhoods were incorporated in the analysis.
For all three outcome measures—referrals, substantiations and foster care entries—zip codes with more off-premise alcohol outlets (e.g., liquor stores) reported significantly higher rates of child maltreatment. The number of bars in both local neighborhoods and adjacent neighborhoods was also positively related to rates of foster care entry. The authors concluded that “reductions in number of alcohol outlets per zip code . . . may result in lower rates of child maltreatment.” Specifically, they estimated that “an average decrease of one off-premise outlet per zip code would reduce total referrals to CPS in the 579 zip codes by 1,040 cases, substantiations by 180 cases, and foster care entries by 93 cases.” There were also other findings related to the demographic characteristics of neighborhoods; for example, all three outcome measures were positively associated with the percentage of African American residents and negatively associated with higher median household income.
There were inevitably a number of limitations in the methodology, many related to the nature and source of the data; in general, the authors did a good job of pointing these out. The statistical procedures were quite elaborate and not always well explained. No reason was given for the choice of control variables; it might also have been interesting to consider the possible effects of variables such as drug use, crime rates, education, employment status, and perhaps even religion. In an ecological study like this one it is difficult to determine the exact mechanisms through which increases in alcohol outlets can lead to increases in child maltreatment; the authors suggested a number of possible theories. This study is potentially valuable, in that it suggests specific population-level steps that could be taken to reduce child maltreatment, for example, regulating alcohol outlet densities, reducing the number of available alcohol licenses or limiting days and hours of alcohol sales. The authors pointed out that neighborhoods may also be viewed as potential locations for implementing programs that reduce health-related disparities.