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Alcohol Outlet Density and Young Women’s Perpetration ofViolence Toward Male Intimate Partners
Bonita J. Iritani ,
Pacific Institute for Research and Evaluation, Chapel Hill, NC
Martha W. Waller ,
Pacific Institute for Research and Evaluation, Chapel Hill, NC
Carolyn Tucker Halpern ,
Carolina Population Center and Department of Maternal & Child Health, UNC Gillings School of
Global Public Health, University of North Carolina at Chapel Hill
Kathryn E. Moracco ,
Department of Health Behavior and Health Education, UNC Gillings School of Global Public
Health, University of North Carolina at Chapel Hill
Sharon L. Christ , and
Department of Human Development and Family Studies and Department of Statistics, Purdue
University
Robert L. Flewelling
Pacific Institute for Research and Evaluation, Chapel Hill, NC
Abstract This paper examines the relationships between alcohol outlet density, alcohol use, and
perpetration of intimate partner violence (IPV) among young adult women in the US. Data were
from Wave III of the National Longitudinal Study of Adolescent Health (Add Health;
N = 4,430 in
present analyses). Multinomial logistic regression was used to examine occurrence of past year
IPV perpetration toward a male partner based on tract-level on-premise and off-premise alcohol
outlet density, controlling for individuals’ demographic, alcohol use, and childhood abuse
characteristics and neighborhood socio-demographic factors. Higher off-premise alcohol outlet
density was found to be associated with young women’s perpetration of physical only IPV,
controlling for individual-level and ecological factors. Alcohol use had an independent association
with IPV perpetration but was not a mediator of the outlet density-IPV relationship. Findings
suggest that considering alcohol-related environmental factors may help efforts aimed at
preventing young women’s use of physical violence toward partners.
Keywords domestic violence; female perpetration; off-premise outlet density; alcohol use; young adults;
neighborhoods; drinking
Intimate partner violence (IPV) is a widespread problem that has been linked to deleterious
physical and mental health consequences for both male and female victims (Coker, Weston,
Creson, Justice, & Blakeney, 2005; Fletcher, 2010). Women, as well as men, perpetrate IPV,
Correspondence concerning this article should be addressed to B. J. Iritani, PIRE, 1516 E. Franklin Street, Suite 200, Chapel Hi\
ll, NC
27514-2812. [email protected]. NIH Public Access
Author Manuscript
J Fam Violence . Author manuscript; available in PMC 2014 July 01.
Published in final edited form as:
J Fam Violence . 2013 July 1; 28(5): 459–470. doi:10.1007/s10896-013-9516-y.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript and female perpetration is common from adolescence through adulthood (Williams,
Ghandour, & Kub, 2008). In studies of college students, prevalence of female-perpetrated
physical IPV was found to have ranged from 12 to 39% (Williams et al., 2008). Few of the
studies reported on college women’s sexual IPV perpetration, but the four that did estimated
prevalence at 2 to 46%. In a national study sample, 35.5% of the young adult women
reporting a heterosexual relationship in the past 5 years reported ever perpetrating physical
violence in a relationship (Whitaker, Haileyesus, Swahn, & Saltzman, 2007). Much or most
IPV among college students (Testa, Hoffman, & Leonard, 2011) and young adults in general
(Renner & Whitney, 2010) is bidirectional (both partners perpetrating). Male young adult
perpetrators are more likely to inflict injury on their partner (Whitaker et al., 2007). Given
the high prevalence of IPV in young adulthood and the tendency of women especially to
perpetrate, it is important to examine young women’s perpetration. In particular, examining
individual level and environmental level conditions that may lead to IPV perpetration is
necessary to develop effective prevention strategies. Women’s alcohol use is one promising
area for understanding female-perpetrated IPV (Langhinrichsen-Rohling, 2010).
Alcohol Use and IPV Perpetration Young adulthood (ages 18–25) includes peak years of alcohol use, binge drinking, and
heavy drinking (Substance Abuse and Mental Health Services Administration [SAMHSA],
2008). Over half (57%) of young adult women are current drinkers (SAMHSA, 2008); 30%
of 18 to 20-year-old women and 39% of 21 to 23-year-old women report binge drinking in
the past 30 days (Grucza, Norberg, & Bierut, 2009). Studies of young adults have yielded
mixed findings regarding whether or not there is an association between alcohol use and
IPV, and these studies have had limitations, including: using a college sample from a limited
area (Stappenbeck & Fromme, 2010; Testa et al., 2011), not reporting results specifically for
young women, and not specifically assessing perpetration as opposed to any violence in the
relationship (Stappenbeck & Fromme, 2010). An exception is a national study that used a
young adult couples sample and reported higher values of female-to-male violence among
the group of couples characterized by heavy female drinking (Wiersma, Cleveland, Herrera,
& Fischer, 2010).
Studies of adults generally have suggested that alcohol use and alcohol problems are
positively associated with female IPV (Caetano, Ramisetty-Mikler, & Field, 2005; Cunradi,
2007; Foran & O’Leary, 2008). Although these adult samples typically include individuals
18 years and older (e.g., Caetano et al., 2005; Cunradi, 2007) and therefore include young
adults, further research specifically on young adult women is needed given differences in
young adults’ versus older adults’ behaviors, relationships, and environments.
Alcohol Outlet Density and IPV Alcohol outlet density refers to the level of concentration of establishments in which alcohol
is sold in a defined area. It is typically measured as number of retail outlets either per area
unit or roadway miles or per capita. On-premise alcohol outlets, such as bars and restaurants,
sell alcohol for consumption on the premises; off-premise outlets, such as liquor stores and
grocery stores, sell alcohol for consumption off the premises. Outlet densities have been
implicated in a variety of problem behaviors, including excessive alcohol consumption,
crime, and medical harms (Campbell et al., 2009); violent assaults (Gorman, Speer,
Gruenewald, & Labouvie, 2001; Gruenewald & Remer, 2006); child maltreatment
(Freisthler, Midanik, & Gruenewald, 2004); campus sexual violence offenses (Scribner et
al., 2010); and young adults’ injuries (Gruenewald et al., 2010). Outlet density has been
found to be correlated with frequent drinking and problem drinking among college students
(Scribner et al., 2010), including women specifically (Weitzman, Folkman, Folkman, & Iritani et al. Page 2
J Fam Violence . Author manuscript; available in PMC 2014 July 01.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Wechsler, 2003). As with other forms of violence, greater alcohol availability in locales with
higher outlet density (both on- and off-premise) could foster IPV through increased drinking
occurring either in the home or elsewhere, by either a potential perpetrator or a potential
victim. This process suggests an indirect link between outlet density and IPV with more
frequent or heavier drinking as a mediator.
At the same time, there may be other pathways not involving increased alcohol use by either
partner through which outlet density influences the likelihood of IPV. Alcohol outlets may
signal loosened social controls on violence and thereby facilitate violence, and they may
offer places where people at risk for IPV may form and mutually reinforce IPV-promoting
behaviors or attitudes (Cunradi, 2010). Furthermore, plentiful alcohol outlets in one’s
neighborhood may influence a person’s routine activities, affecting the timing or location of
one’s drinking in ways that could promote violence in the home (Freisthler et al., 2004;
Livingston, 2010).
Extant studies examining alcohol outlets and IPV often have been ecological studies
(Cunradi, Mair, Ponicki, & Remer, 2011; Gorman, Labouvie, Speer, & Subaiya, 1998;
Livingston, 2010, 2011) that lacked key individual-level data, including the perpetrator’s
gender, measures of alcohol use, and measures of intimate partner violence (Cunradi, 2010).
A national population-based survey of married and cohabitating couples examined alcohol
outlets by zip code in relation to partner violence and did not find outlet density to be
significantly associated with female-to-male IPV, but the sample was of adults 18 years and
older (McKinney, Caetano, Harris, & Ebama, 2009). Recent studies have examined outlet
density, drinking, and IPV victimization among young adult men (Waller, Iritani, Flewelling
et al., 2012) and women (Waller, Iritani, Christ et al., 2012), but research on alcohol outlets
and young adult women’s IPV perpetration is lacking.
Purpose of the Present Study The present study uses data from the National Longitudinal Study of Adolescent Health
(Add Health) to examine on-premise and off-premise alcohol outlet density as predictors of
young women’s perpetration of IPV toward an other-sex partner, controlling for individual-
and neighborhood-level characteristics, such as neighborhood social disorganization and
disadvantage (Gorman et al., 1998). We hypothesize that: (1) higher outlet density of both
types will be associated with greater likelihood of women perpetrating IPV, and (2) there
will be both direct links and indirect links (through alcohol use as a mediator) from outlet
density to IPV perpetration. Strengths of the present study include: (1) measuring outlet
density at the census tract level rather than the larger zip code level; (2) including dating and
other nonmarital and noncohabiting relationships to better understand female perpetration by
type of relationship; and (3) distinguishing between physical only violence from IPV that
includes sexual violence in order to address the paucity of literature on female perpetration
of sexual aggression against partners (Williams et al., 2008).
Method
Data and Sample Data were from Wave III of Add Health, a prospective cohort study that has followed a
nationally representative sample of U.S. adolescents into young adulthood. Wave III
respondents were young adults who were approximately 18 to 26 years old when they were
interviewed in 2001 to 2002 (
N = 14,322 in the national probability sample). Add Health’s
original sample was drawn from 7 th
- to 12 th
-grade students on school enrollment rosters in
1994 to 1995. A sample of 80 high schools and 52 middle schools was selected with unequal
probability of selection. Incorporating systematic sampling methods and implicit
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript stratification into the study design ensured that selected schools were representative of U.S.
schools with respect to region of the country, urbanicity, school size, school type, and
ethnicity. At Wave III, Add Health researchers sought to interview all original study
participants living in the U.S., including homeless and incarcerated individuals. The Wave
III response rate was 77.4% (Harris et al., 2009). The survey was administered using laptop
computers; computer-assisted self-interviewing technology was used for sensitive topics,
including sexual, substance use, and violence self-reports. Further information about Add
Health is available elsewhere (Harris et al., 2009). Participants provided written informed
consent. Add Health procedures were approved by the institutional review board (IRB) of
the University of North Carolina at Chapel Hill. The IRB of the Pacific Institute for
Research and Evaluation deemed protocols of the present study exempt from review.
At Wave III, Add Health participants were asked to list all romantic and sexual relationships
since summer 1995 and were asked if they were currently involved with each person. One
current sexual or romantic relationship per respondent was examined for present analyses.
For participants who reported more than one current partner, a single current relationship
was selected using the relationship, which happened to have the lowest relationship
identified number. Respondents whose identified relationship was with a same-sex partner
were sparse (1.4%) and excluded from analyses. A total of 8,463 Wave III respondents
reported at least one current relationship and had the appropriate sampling weight.
Respondents used in present analyses were female, had an index relationship partner not of
the same sex, and had non-missing data on IPV perpetration and alcohol use variables (
N =
4,430).
Measures Perpetration of IPV— IPV perpetration was based on the survey items: “How often in the
past year have you threatened with violence, pushed or shoved [HIM/HER],
or thrown something at [HIM/HER] that could hurt?;” “How often in the past year have you
slapped, hit, or kicked ?;” and “How often in the past year have you insisted
on or made have sexual relations with you when [HE/SHE] didn’t want to?”
Responses to each of those three survey questions were dichotomized as no IPV in the past
year (which included replies of “never” and “hasn’t happened in past year”) versus
happened 1 or more times in the past year. Physical IPV was indicated by having engaged in
threatened/pushed/thrown or slapped/hit/kicked in the past year. A 3-category nominal
variable was then created to represent type of IPV respondents reported perpetrating in the
past year in their relationship: (0) no IPV (referent category), (1) physical IPV only, or (2)
either sexual IPV only or both physical and sexual IPV (i.e., sexual with and without [w/wo]
physical IPV). Due to the way the threatened/pushed/thrown item was worded, it is possible
that a participant may have been coded as having perpetrated physical IPV who had only
threated their partner with violence (psychological aggression). However, prior research has
found the threatened/pushed/thrown item to be highly correlated with the slapped/hit/kicked
item (Cronbach alpha = 0.77 cited in Brown & Bulanda, 2008).
Alcohol outlet density in neighborhood— Data were obtained for number of alcohol
outlets (establishments possessing on-premise or off-premise alcohol licenses) per square
kilometer in the communities of Add Health Wave III respondents. These outlet licensing
data were collected from individual states during 2006 to 2007, which was 5 to 6 years after
Wave III interviews. However, alcohol outlet density in small geographic areas is relatively
stable over time (Gruenewald & Remer, 2006). Outlet addresses were geocoded to the
census tract level. Separate variables were created for on-premise and off-premise alcohol
outlet density. These variables were dichotomized to indicate respondents’ neighborhoods
(tracts) as having higher or lower alcohol outlet density (defined here as one or more outlets
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript per square kilometer or not). The cutoff of one outlet was used because it fell between the
50 th
and 75 th
percentile of both on-premise and off-premise outlet density and therefore
indicates medium or greater outlet density. Preliminary analyses indicated that the
dichotomized on-premise and off-premise variables were highly correlated (Cramer’s V =
0.65; Rao-Scott Chi-Square = 933.72,
df = 1, p < .001). However, we decided against
combining the two types of outlets into a single variable because different forms of alcohol
availability may operate through different mechanisms and have different effects on young
adult drinking and injuries (Gruenewald et al., 2010; Scribner et al., 2008), and they can
have different relationships with IPV (Cunradi et al., 2011; Livingston, 2010; McKinney et
al., 2009). Analyses were conducted examining on-premise and off-premise outlet density in
separate models.
Alcohol use— Prior literature review has suggested the importance of accounting for more
in depth aspects of alcohol consumption than simple frequencies or quantities of drinking in
relation to IPV (Foran & O’Leary, 2008). Like other researchers (Cunradi, 2007; Lipton,
1994), we developed a complex, categorical variable in order to capture multiple dimensions
of alcohol use. Specifically, we incorporated ever drinking alcohol, ever drinking in the past
12 months, frequency and quantity of drinking in the past 12 months, heavy episodic (binge)
drinking (4 or more drinks on a single occasion in the past 2 weeks), and having ever been
drunk in the past 12 months. The final 6-category nominal variable was coded: (1) lifetime
abstainer or former (but not current) drinker (reference category), (2) light drinker, (3)
moderate drinker (4) infrequent heavy drinker, (5) occasional heavy drinker, and (6)
frequent heavy drinker (see Table 1).
Control variables— Age was measured in years. Race/ethnicity, based on respondent self-
report, was Hispanic (any race) and non-Hispanic categories of white (reference category),
black, Asian/Pacific Islander, and American Indian/Native American. Race for multiracial
participants was based on the category they said best described their racial background.
Marital status of the reference relationship was represented by never married nor ever lived
with this partner (reference category), lived with this partner but never married to him or
her, or ever married to this partner. Because only current relationships were selected for
present analyses, nearly all (99%) of those who had ever been married to their partner were
currently married to the person.
Measures of child abuse and neglect were controlled for in analyses because individuals who
have been maltreated as children have been found to be more likely to perpetrate IPV in
young adulthood (Gover, Kaukinen, & Fox, 2008; Melander, Noel, & Tyler, 2010),
especially women (Fang & Corso, 2007). Three variables indicated the respondent’s
recollection of a parent or other adult caregiver’s behavior before the respondent was in 6 th
grade pertaining to: (1) neglect (left the respondent home alone when an adult should have
been present or did not take care of the respondent’s basic needs), (2) “slapped, hit or
kicked” the respondent, and (3) sexually abused the respondent, defined as the adult
touching the child in a sexual way, forcing the child to touch the adult in a sexual way, or
forcing the child to have sexual relations. Each neglect/abuse measure was dichotomized to
indicate the event had occurred or not.
Several neighborhood-level sociodemographic characteristics indicating social
disorganization in the community were included as control variables. These measures
included ones pertaining to concentrated disadvantage, immigrant concentration, and
residential stability (Sampson & Groves, 1989; Sampson, Raudenbush, & Earls, 1997) and
have been used in prior outlet density and social disorganization research (Freisthler, 2004).
Using tract-level census data (as cited in Swisher, 2008), measures were prepared pertaining
to (1) poverty (the average of the standardized estimates for the proportion of persons in the
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript tract below the poverty level, proportion of families with a child in a female-headed
household, and unemployment rate; Cronbach’s alpha = .72), (2) transience (average of the
standardized estimates for the proportion of the population in the tract who had moved in the
past 5 years and the proportion of occupied units that were renter-occupied; Cronbach’s
alpha = .82), (3) proportion of residents who were foreign born, and (4) proportion of
housing units vacant (Swisher, 2008). Factor analyses were used to guide selection of items
for indices. An additional tract-level census variable that was included as a control was
population density because both on- and off-premise alcohol outlets may be more
concentrated in urban than rural or suburban areas. Population density was measured as
persons per square kilometer divided by 1000.
Data Analyses Using multinomial logistic regression, bivariate associations were examined of each control
variable and the dependent variable (IPV perpetration). In addition, the following key
posited relationships were examined in bivariate analyses: (1) alcohol outlet density (on-
premise and off-premise) and IPV perpetration, (2) outlet density and alcohol use, and (3)
alcohol use and IPV perpetration.
Multiple variable analyses were conducted using a set of two multinomial logistic regression
models to examine the effects of on-premise alcohol outlet density and off-premise outlet
density on female-perpetrated IPV. Each regression model used IPV perpetration as the
dependent variable with the reference category being not having perpetrated IPV in the
relationship. In Model 1, the predictors assessed were alcohol outlet density and alcohol use.
Model 2 included outlet density; alcohol use; individual-level control variables of
respondent’s age; race/ethnicity; marital status; whether or not the respondent had been
neglected, sexually abused, or physically abused as a child; and community-level control
variables of neighborhood poverty, neighborhood transience, foreign-born residents, housing
vacancy, and population density. Although analyses incorporated community-level
variables, multilevel modeling was not used because the majority of tracts had only one
respondent, and, as others have noted, the data were not sufficiently nested (Cubbin, Brindis,
Jain, Santelli, & Braveman, 2010; Cubbin, Santelli, Brindis, & Braveman, 2005).
Models in which alcohol outlet density was found to be a significant predictor of IPV
perpetration were further examined for alcohol use as a mediator of this relationship by
using criteria based on examining the paths between the independent variable, potential
mediator, and dependent variable elements (Baron & Kenny, 1986). If it was determined
that support for mediation was not found, then exploration of alcohol use as a moderator
variable also would be considered through post-hoc analysis in order to better understand the
relationships among the constructs. Finally, in order to address the possibility that outlet
density effects would vary by whether or not a person was underage for legally purchasing
alcohol or entering bars (Gruenewald et al., 2010), moderator analyses were conducted that
removed the age in years variable and instead tested for an interaction of each type of outlet
density by age group (less than 21-years-old versus 21 years or older).
Post-stratification sampling weights were applied in order to yield estimates representative
of the national population. Data analyses were conducted using SAS (version 9.13), MPlus
(version 6), and Stata (version SE 11.1). Following Add Health user protocols, procedures
for survey data analysis in MPlus and Stata were used to account for Add Health’s complex
sampling design in the regression models, incorporating schools as the primary sampling
unit and region of the country as the strata. Weighted estimates and unweighted sample sizes
are reported in results. Iritani et al. Page 6
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript ResultsCharacteristics of the sample, as reflected in summary statistics for all of the variables used
in the analyses, are displayed in Table 2. As shown in Table 2, Table 22.6% of this female
young adult sample reported perpetrating physical IPV only in their index current
relationship in the past year, 3.5% reported perpetrating either sexual IPV only or both
physical and sexual IPV in the past year, and 73.9% reported no IPV perpetration in the past
year.
Bivariate Associations As shown in Table 3, there was no significant bivariate relationship between on-premise
alcohol outlet density and either physical only or sexual w/wo physical IPV perpetration
among women. Respondents in neighborhoods with medium or greater off-premise alcohol
outlet density, however, were significantly more likely to perpetrate physical only IPV.
There was no association between off-premise density and sexual w/wo physical IPV
perpetration. There was no significant bivariate relationship between the alcohol use
categories and IPV perpetration. Table 3 also shows that most of the control variables have a
significant bivariate association with IPV. Exceptions were neighborhood transience,
percent foreign-born, and vacant housing. These variables were kept in the final models
based on theory from the social disorganization literature (Freisthler, 2004; Sampson et al.,
1997). Table 4 indicates that there were no significant bivariate relationships between either
on-premise or off-premise alcohol outlet density and alcohol use.
Multivariable Models Results from the multinomial logistic regression models that include variables for on-
premise and off-premise alcohol outlet density are shown in Tables 5 and 6, respectively.
On-premise outlet density was not a significant predictor of female IPV perpetration in
either Model 1 (which controlled for alcohol use) or Model 2 (which controlled for alcohol
use, other individual-level characteristics, and neighborhood characteristics). However, off-
premise alcohol outlet density was significantly associated with physical only IPV
perpetration in both Model 1 (
OR = 1.30; 95% CI = 1.07–1.56) and Model 2 ( OR = 1.35;
95% CI = 1.07–1.70). Off-premise outlet density was not a significant predictor of sexual w/
wo physical IPV. Except for the outlet density and population density variables, results for
all other variables in the models were similar across Tables 5 and 6. In the full models
(Model 2) of both Table 5 and Table 6, occasional heavy drinking and frequent heavy
drinking both were associated with increased odds of physical IPV perpetration, and
frequent heavy drinking also was associated with greater odds of sexual w/wo physical IPV
perpetration. Age was significantly associated with physical IPV in a negative direction.
Hispanics, blacks, and Native Americans all had increased odds of physical only IPV
perpetration compared to non-Hispanic whites. Hispanics and blacks also had greater
likelihood of sexual IPV perpetration. Young women who cohabited with their partner were
more likely to report both physical and sexual IPV perpetration toward that partner; women
who were married to the partner had greater odds of physical only perpetration. Respondents
who reported physical abuse as a child were more likely to perpetrate physical and sexual
IPV. In addition, respondents in neighborhoods with more transience were less likely to
report physical IPV. Population density was significantly negatively correlated with physical
IPV perpetration in the model that included off-premise outlet density.
Assessment of Mediation and Moderation Although off-premise outlet density was found to have an effect on physical IPV (Table 6),
our findings did not meet criteria which would suggest alcohol use to be a mediator of this
relationship (Baron & Kenny, 1986). Namely, as the bivariate results indicated, significant
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript associations were not found between the independent variable (outlet density) and the
potential mediator (drinking; Table 4) nor between the mediator and the outcome variable
(IPV; Table 3).
Given the lack of support for alcohol use as a mediator, we conducted additional analyses
examining it as a possible moderator of the outlet density-IPV relationship in order to
explore further the nature of the causal mechanisms (Baron & Kenny, 1986). Specifically,
we conducted multinomial logistic regressions that tested for an interaction of outlet density
and alcohol use (dichotomized as heavy drinker or not). This post-hoc analysis did not
indicate there to be a significant interaction between either on-premise outlet density and
alcohol use (
OR = 1.03, 95% CI = 0.66–1.60 for physical IPV and OR = 0.57, 95% CI =
0.21–1.56 for sexual IPV) or between off-premise outlet density and alcohol use (
OR = 0.79,
95% CI = 0.52–1.21 for physical IPV and
OR = 0.91, 95% CI = 0.35–2.40 for sexual IPV)
in predicting IPV perpetration.
Another moderator of the outlet density-IPV relationship that was examined was being
underage for buying and drinking alcohol. When an interaction of age group (less than 21-
years-old versus 21-years or older) by alcohol outlet density was tested in the multinomial
logistic regression models, the interaction variable was not significant in the on-premise
model for either physical IPV (
OR = 1.22, 95% CI = 0.78–1.93) or sexual IPV compared to
no IPV (
OR = 1.25, 95% CI = 0.42–3.73), nor was the interaction significant in the off-
premise outlet density model (
OR = 1.16, 95% CI = 0.69–1.94 for physical IPV and OR =
0.82, 95% CI = 0.28–2.40 for sexual IPV ).
Discussion Using a nationally representative sample, we tested the hypotheses that both on- and off-
premise alcohol outlet density would be associated with greater likelihood of young women
perpetrating IPV and that there would be both direct and indirect links (through alcohol use
as a mediator) from outlet density to perpetration. We found that young women who lived in
a neighborhood having relatively higher density of off-premise alcohol outlets (one or more
outlets per square kilometer versus fewer) had significantly increased odds of reporting that
they had perpetrated physical only IPV against their male partner in the past year. Residing
in a neighborhood with higher on-premise alcohol outlet density was not similarly
associated with women’s IPV perpetration. These findings are consistent with ecological
studies linking off-premise alcohol outlets with domestic violence police calls (Cunradi et
al., 2011) and domestic violence rates (Livingston, 2011). However, unlike those studies, the
present research had information about perpetrators’ sex and age and was able to provide
results specifically about young adult female perpetration. A study using couples data of
adults had not found either off-premise or on-premise outlet density to be associated
significantly with female-to-male partner violence (FMPV; McKinney et al., 2009). It is
possible that off-premise density has an influence on young women’s perpetration but not
adults of all ages. It also is possible that the relatively large geographic unit of zip codes
may have limited the study’s ability to detect an outlet density effect (McKinney et al.,
2009).
McKinney et al.’s (2009) research on adults did find total and on-premise outlets to be
linked to increased risk of male-to-female partner violence (MFPV). It is possible that
different sources of alcohol affect men’s and women’s likelihood of IPV perpetration
differently. It may be that drinking in bars leads to risky, violence-promoting drinking
among men (McKinney et al., 2009). Among women, accessibility to buy alcohol at a
nearby liquor, grocery, or convenience store may result in the woman drinking at home
rather than elsewhere, and drinking in the home may increase the chance of being violent
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript toward their partner. Research on outlet density as a factor of young adult men’s IPV
perpetration is needed.
Importantly, and contrary to our expectation, our study did not find that the relationship
between off-premise outlet density and young women’s IPV perpetration was due to a
mediating effect of alcohol use. The result suggests that other mechanisms by which alcohol
outlets may influence IPV should be considered (Cunradi, 2010). Freisthler and colleagues’
(2004) examination of child maltreatment records in California may provide some relevant
findings and a conceptual analysis for the association. They found that the number of off-
premise alcohol outlets (but not of either bars or restaurants) per 1,000 of population was
associated with higher rates of child physical abuse and suggested that the presence of off-
premise outlets may affect the “routine activities” of parents who may buy the alcohol and
drink it at home, fostering greater child abuse. IPV may operate in a similar way among
young women in which nearby stores affect their drinking location (in particular, drinking at
home), timing, or other contextual factors in their drinking behavior that may lead to or
facilitate directing physical violence toward their partners. Alternatively, greater IPV might
occur because higher density of outlets may indicate to residents that social controls
proscribing violence are relaxed in their neighborhood or because neighborhoods with high
outlet density are places where people with a tendency toward IPV congregate and where
IPV behaviors and attitudes are reinforced (Cunradi, 2010). Further research is needed to
discern the processes by which the availability of off-premise outlets in particular may
influence women to perpetrate IPV.
Despite the lack of support for alcohol use as a mediator, the results did indicate an
independent association between young women’s drinking characteristics and IPV
perpetration in the fully controlled models. Women who were occasional heavy drinkers and
those who were frequent heavy drinkers were more likely to perpetrate physical IPV. In
addition, when compared to nondrinkers, frequent heavy drinkers had 3 times greater odds
of sexual IPV perpetration. As in a prior study of adults (McKinney et al., 2009), our
analyses did not find alcohol use to moderate the relationship between outlet density and
FMPV. Furthermore, we did not find being less than 21-years-old or not to moderate the
effects of outlet density. This result is congruent with an ecological study which found that
among both underage and of-age individuals, off-premise outlet density was positively
associated with number of injuries from assaults (Gruenewald et al., 2010). In the present
study, neither on-premise nor off-premise alcohol outlet density was found to be
significantly associated with sexual partner violence. These results add new information to
the alcohol outlet density literature which has not specifically examined sexual IPV.
Like previous studies, this research found that female-perpetrated IPV is common, given
that one-fourth of young women with current relationships in our sample reported having
perpetrated any violence toward their partner within just a 12-month span. As has been
reported elsewhere, young women who cohabit with their partner are especially likely to
perpetrate physical partner violence (Brown & Bulanda, 2008). Results of the present study
also indicate that cohabiting young women also are more likely than those not married or
cohabiting to perpetrate sexual IPV. Finally, it is of note that neighborhood poverty, which
has been a predictor of MFPV and FMPV in previous research (Cunradi, Caetano, Clark, &
Schafer, 2000), was not found to be a significant predictor in these analyses.
Our findings should be interpreted within the context of the study limitations. First, our
sample was of young adults ages 18 to 27, a period of high rates of drinking and IPV.
Differences between young adult and older adult rates of IPV, drinking, and utilization of
alcohol outlets all would be expected to affect the association between outlet density and
women’s perpetration of IPV. Further research is needed to determine if these findings are Iritani et al. Page 9
J Fam Violence . Author manuscript; available in PMC 2014 July 01.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript similar or different for women of other age groups. This study also is limited in that we have
not examined the frequency, seriousness, or harm incurred from the IPV incidents, nor have
we examined whether or not the incidents were mutual. Prior research has found a
substantial prevalence of bidirectional partner violence (Renner & Whitney, 2010). Further
examination of the context of violence and motivations for women’s IPV perpetration (Bair-
Merritt et al., 2010) as well as examining both the woman’s and male partner’s alcohol use
is important for understanding more fully how alcohol use and alcohol outlets fit into the
picture. Add Health did not ask about alcohol use by either the perpetrator or victim at the
time of the IPV incident. Thus, while an association between outlet density and IPV
perpetration was found in this sample, it does not necessarily mean that alcohol use was
involved during specific IPV events. In addition, the survey did not ask how often
respondents visited on-premise and off-premise alcohol outlets which could have helped to
understand further the mechanisms by which alcohol outlets may affect behavior.
Our analyses also did not control for pregnancy, which could have reduced the young
women’s alcohol use and also attenuated the link between outlet density and drinking. A
further limitation is that the measure of perpetration was self-reported and may have
underestimated the prevalence of female-perpetrated IPV. In addition, the low prevalence of
sexual aggression by women found in this study may have contributed to not finding a
significant association between outlet density and sexual violence. In this research, we do
not know if women with a tendency to perpetrate IPV are more likely to choose to live in
neighborhoods with high off-premise alcohol outlet density or whether presence of off-
premise outlets influences women’s violence behavior. Additionally, we recognize that all
neighborhood characteristics that might confound the relationship between outlet density
and IPV could not be perfectly measured and controlled, and therefore, the association
observed here could be in part due to these unmeasured confounding influences.
The outlet density data available in the data set did not allow us to separate restaurants that
served alcohol from bars. Thus, they were grouped together as on-premise outlets, but these
establishments may have different effects (Gruenewald & Remer, 2006). Therefore the
measurement used may have hindered the study’s ability to detect an association between
on-premise outlet density and IPV, as well as to assess for differences between restaurant
and bar outlets on young adult outcomes, as has been found in other research (Gruenewald
et al., 2010). Furthermore, we excluded same-sex relationships in these analyses. Nationally
representative data have indicated that individuals with a history of same-sex relationships
are more likely to experience IPV of all types (Messinger, 2011). It is important for future
research to examine alcohol outlets and alcohol use pertaining to same-sex partner violence.
Finally, we have not used spatial regression models designed to control for potential spatial
autocorrelation (correlation of IPV rates between neighboring geographic units; Freisthler et
al., 2004). It is reassuring, however, that our findings for outlet density are consistent with a
prior study that used spatial modeling procedures (Cunradi et al., 2011). In addition, we
would not expect substantial autocorrelation in our sample, given that there was usually not
more than one respondent in a tract.
Despite these limitations, the findings of this study offer important contributions to the
growing literature on alcohol outlet density and IPV. Although the underlying reasons have
yet to be determined, present findings indicate that density of off-premise alcohol outlets is a
risk factor for female-perpetrated violence. Recently reviewed evidence supports the
potential for regulation of alcohol outlet density through public policy to reduce alcohol-
related harms (Campbell et al., 2009). Building on that perspective, the findings from this
study suggest that policy-based interventions to control outlet density are a potentially
promising avenue for preventing female-perpetrated IPV. This study’s findings suggest that
considering the alcohol sales environment—and, in particular for women, how off-premise Iritani et al. Page 10
J Fam Violence . Author manuscript; available in PMC 2014 July 01.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript alcohol outlets may affect their use of violence—may better inform and strengthen efforts to
prevent and reduce partner violence.
Acknowledgments Funding for this study was from the National Institute for Alcohol and Alcohol Abuse (grant R03 AA016809,
M.W.W., principal investigator). This research uses data from Add Health, a program project directed by Kathleen
Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of
North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National
Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and
foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original
design. Information on how to obtain the Add Health data files is available on the Add Health website ( http://
www.cpc.unc.edu/addhealth ). No direct support was received from grant P01-HD31921 for this analysis.
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Alcohol Use Categories CategoryDescription1.Lifetime abstainers or
ex-drinkersLifetime abstainers were respondents who reported never drinking
alcohol during adolescence, never drinking alcohol as an adult, and
not drinking in the past 12 months. Ex-drinkers were respondents
who at Wave I and/or Wave III indicated they drank alcohol but
had not drunk any alcohol in the past 12 months.2.Light drinkersReported drinking in the past 12 months but having only 1 or 2
drinks at a time and not having been drunk in the past year nor
engaging in heavy episodic drinking in the past 2 weeks.3.Moderate drinkersReported drinking in the past 12 months (typically drinking 3 or
more drinks at a time), but not having been drunk in the past year
nor engaging in heavy episodic drinking in the past 2 weeks.4.Infrequent heavy
drinkersReported drinking infrequently (3 to 12 times) over the past 12
months but reported being drunk in the past year and/or heavy
episodic drinking in the past 2 weeks.5.Occasional heavy
drinkersReported drinking more frequently (2 or 3 days a month up to 1 to
2 days a week) over the past 12 months and having been drunk in
the past year and/or heavy episodic drinking in the past two weeks.6.Frequent heavy drinkersReported drinking frequently (3 to 7 days a week on average) over
the past 12 months and having been drunk in the past year and/or
heavy episodic drinking in the past 2 weeks.
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 15 Table 2
Characteristics of Analysis Sample of Young Women in the National Longitudinal Study of Adolescent
Health, 2001–2002 (N =4,430) CharacteristicWeighted %
or Mean ( SE)IPV perpetration No IPV 73.9 Physical IPV only 22.6 Sexual IPV only or physical and sexual IPV 3.5 Alcohol use Lifetime abstainer or ex-drinker 27.0 Light drinker 14.6 Moderate drinker 6.7 Infrequent heavy drinker 18.8 Occasional heavy drinker 28.2 Frequent heavy drinker 4.7 Higher on-premise alcohol outlet density in neighborhood (1 or
more outlets per square kilometer) 30.24 Higher off-premise alcohol outlet density in neighborhood (1 or
More outlets per square kilometer) 33.52 Age in years 18–20 29.0 21 16.1 22 18.2 23 15.3 24–27 21.5 Race/ethnicity Hispanic 10.6 White 70.9 Black 14.3 Asian 3.3 American Indian 1.0 Marital status Never married or lived with this partner 40.8 Ever lived with this partner but never married to him or her 31.2 Ever married to this partner 28.0 Neglected as a child (percent yes) 37.8 Sexually abused as a child (percent yes) 4.4 Physically abused as a child (percent yes) 26.3 Neighborhood characteristics control variables Proportion of population in poverty, standardized [mean ( SE)] −0.17 (0.95) Transience index , standardized [mean ( SE)] −0.01 (1.03) Proportion population foreign-born [mean ( SE)] 0.09 (0.01) Proportion housing units vacant [mean ( SE)] 0.08 (0.00)
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 16 CharacteristicWeighted %
or Mean ( SE) Population density [mean ( SE)] 1.75 (0.20)
Note . Based on the sample of young adult women at Wave III in the national probability sample with at least one reported current rel\
ationship, with
nonmissing data on the present study’s IPV perpetration and alcohol use variables, and whose index relationship was not a same-s\
ex relationship.
SE = linearized standard error.
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 17 Table 3
Bivariate Associations Between Each Predictor or Control Variable and IPV Perpetration Among Young
Women Predictor or control variablePhysical IPV only
vs. no IPV
RRR (95% CI)Sexual only or
physical & sexual
IPV vs. no IPV
RRR (95% CI)One or more on-premise alcohol outlets per sq.
kilometer in tract1.17 (0.95–1.44)1.21 (0.79−1.87)One or more off-premise alcohol outlets per sq.
kilometer in tract1.26 (1.04–1.52) * 1.18 (0.77−1.81)Alcohol use (reference = abstainer) Light drinker0.81 (0.61−1.08)0.67 (0.34−1.31) Moderate drinker1.42 (0.92−2.18)1.06 (0.49−2.33) Infrequent heavy drinker1.09 (0.82−1.44)1.13 (0.62−2.06) Occasional heavy drinker0.99 (0.76–1.28)0.72 (0.40–1.30) Frequent heavy drinker1.21 (0.75–1.95)1.69 (0.73–3.91)Age in years0.92 (0.87–0.97) ** 0.95 (0.84–1.08)Race/ethnicity (reference = Non-Hispanic white) Hispanic1.76 (1.31–2.36) *** 2.93 (1.79–4.79) *** Non-Hispanic black1.77 (1.43–2.20) *** 1.94 (1.17–3.23) * Non-Hispanic Asian1.34 (0.75–2.38)1.52 (0.74–3.12) Non-Hispanic Native American2.68 (1.18–6.08) * 4.92 (1.57–15.40) ** Marital status (reference=never married to
partner) Ever lived with this partner but never married
to him or her3.67 (2.89–4.66) *** 2.89 (1.77–4.73) *** Ever married to this partner2.09 (1.66–2.64) *** 1.59 (0.88–2.85)Neglect as a child (yes vs. no)1.52 (1.26–1.83) *** 2.42 (1.60–3.67) *** Sexually abused as a child (yes vs. no)1.97 (1.25–3.09) ** 2.03 (0.87–4.72)Physically abused as a child (yes vs. no)1.88 (1.53–2.32) *** 2.38 (1.54–3.68) *** Neighborhood poverty1.01 (1.00–1.01 a)* 1.01 (1.00–1.02)Neighborhood transience1.00 (0.99–1.00)0.99 (0.98–1.01)Neighborhood foreign-born1.25 (0.64–2.46)2.13 (0.70–6.47)Neighborhood vacant housing2.49 (0.71–8.70)2.29 (0.06–83.65)Neighborhood population density0.99 (0.97–1.01)1.03 (1.00–1.05 b)*
Note . Analyses were conducted using multinomial logistic regression unadjusted for any other variable and with IPV perpetration as t\
he dependent
variable. RRR = relative risk ratio; CI = confidence interval.
aCI was 1.001–1.010 before rounding.
bCI was 1.001–1.053 before rounding.
* p < .05.
** p < .01.
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 18 ***
p < .001.
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 19 Table 4
Bivariate Associations Between Neighborhood Alcohol Outlet Density and Alcohol Use Among Young Women Type of alcohol outlet densityLight drinker vs. abstainer
RRR (95% CI)Moderate drinker
vs. abstainer
RRR (95% CI)Infrequent
heavy drinker vs. abstainer
RRR (95% CI)Occasional
heavy drinker vs. abstainer
RRR (95% CI)Frequent heavy drinker
vs. abstainer
RRR (95% CI)One or more on-premise alcohol
outlets per sq. kilometer in tract0.94 (0.74–1.20)0.87 (0.62–1.22)0.96 (0.76–1.21)1.19 (0.91–1.56)1.46 (0.96–2.22)One or more off-premise alcohol
outlets per sq. kilometer in tract0.99 (0.77–1.27)1.09 (0.76–1.56)0.93 (0.72–1.21)1.01 (0.77–1.34)1.18 (0.78–1.80)
Note . The analysis was conducted using multinomial logistic regression unadjusted for any other variable and with alcohol use as the\
dependent variable. RRR = relative risk ratio; CI = confidence interval.
* p < .05.
** p < .01.
*** p < .001.
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 20 Table 5
On-Premise Alcohol Outlet Density: Odds Ratios from Multinomial Logistic Regression Models of IPV
Perpetration Among Young Women Predictor variableModel 1: Outlet density, alcohol useModel 2: Outlet density, alcohol use,
individual- and community-level control variables Physical IPV only
vs. no IPV
(95%CI)Sexual only or
physical &
sexual IPV vs.
no IPV (95% CI)Physical IPV only
vs. no IPV (95% CI)Sexual only or
physical & sexual
IPV vs. no IPV (95%
CI)One or more on-premise alcohol
outlets per sq. kilometer in tract1.16 (0.94–1.44)1.21 (0.78–1.88)1.26 (0.98–1.60)1.36 (0.75–2.46)Alcohol use (reference = abstainer) Light drinking0.88 (0.64–1.20)0.90 (0.46–1.76)0.99 (0.69–1.42)1.05 (0.51–2.16) Moderate drinking1.41 (0.88–2.24)0.90 (0.36–2.22)1.46 (0.94–2.25)1.01 (0.42–3.43) Infrequent heavy drinking1.11 (0.83–1.50)1.35 (0.72–2.54)1.33 (0.95–1.86)1.62 (0.82–3.20) Occasional heavy drinking0.99 (0.75–1.30)0.74 (0.39–1.43)1.46 (1.07–1.98) * 1.03 (0.52–2.04) Frequent heavy drinking1.13 (0.66–1.92)2.02 (0.87–4.72)1.79 (1.03–3.11) * 3.04 (1.19–7.78) * Age in years0.85 (0.80–0.90) *** 0.90 (0.78–1.04)Race/ethnicity (reference = Non-
Hispanic white) Hispanic1.81 (1.23–2.64) ** 2.80 (1.32–5.95) ** Non-Hispanic black2.48 (1.81–3.39) *** 2.07 (1.08–3.99) * Non-Hispanic Asian2.05 (0.98–4.29)1.98 (0.83–4.73) Non-Hispanic Native American2.64 (1.16–6.01) * 3.32 (0.93–11.82)Marital status (reference = never
married to partner) Cohabited with partner4.52 (3.48–5.88) *** 2.95 (1.64–5.32) *** Ever married to partner3.27 (2.47–4.33) *** 2.00 (0.98–4.11)Neglect as child (yes vs. no)1.09 (0.89–1.35)1.59 (0.98–2.58)Sexual abuse as child (yes vs. no)1.29 (0.78–2.15)0.91 (0.28–2.95)Physical abuse as child (yes vs. no)1.85 (1.44–2.36) *** 1.85 (1.08–3.17) * Neighborhood poverty1.00 (1.00–1.01)1.01 (1.00–1.02)Neighborhood transience0.99 (0.99–1.00 a)** 0.98 (0.97–1.00)Neighborhood foreign-born1.12 (0.37–3.40)0.86 (0.14–5.38)Neighborhood vacant housing0.78 (0.19–3.27)1.53 (0.03–88.88)Neighborhood population density0.97 (0.95–1.00)1.02 (0.98–1.05)
Note . CI = confidence interval.
aCI was 0.987–0.997 before rounding.
* p < .05.
** p < .01.
*** p < .001.
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 21 Table 6
Off-Premise Alcohol Outlet Density: Odds Ratios from Multinomial Logistic Regression Models of IPV
Perpetration Among Young Women Predictor variableModel 1: Outlet density, alcohol useModel 2: Outlet density, alcohol use,
individual- and community-level control variablesPhysical IPV only
vs. no IPV
(95% CI)Sexual only or
physical & sexual
IPV vs. no IPV
(95% CI)Physical IPV only
vs. no IPV (95% CI)Sexual only or
physical & sexual
IPV vs. no IPV
(95% CI)One or more off-premise alcohol
outlets per sq. kilometer in tract1.30 (1.07–1.56) ** 1.20 (0.78–1.84)1.35 (1.07–1.70) * 1.17 (0.71–1.93)Alcohol use (reference = abstainer) Light drinking0.87 (0.64–1.19)0.89 (0.45–1.75)0.98 (0.69–1.40)1.05 (0.51–2.15) Moderate drinking1.40 (0.88–2.22)0.89 (0.36–2.21)1.44 (0.93–2.23)1.00 (0.42–2.42) Infrequent heavy drinking1.12 (0.83–1.51)1.34 (0.71–2.54)1.31 (0.93–1.84)1.61 (0.82–3.16) Occasional heavy drinking0.99 (0.75–1.31)0.75 (0.39–1.43)1.45 (1.07–1.98) * 1.03 (0.52–2.03) Frequent heavy drinking1.13 (0.66–1.94)2.04 (0.88–4.76)1.79 (1.03–3.10) * 3.06 (1.20–7.82) * Age in years0.85 (0.80–0.90) *** 0.90 (0.78–1.04)Race/ethnicity (reference = Non-
Hispanic white) Hispanic1.79 (1.21–2.63) ** 2.77 (1.30–5.89) ** Non-Hispanic black2.49 (1.82–3.41) *** 2.09 (1.09–4.01) * Non-Hispanic Asian2.00 (0.96–4.17)1.96 (0.81–4.71) Non-Hispanic Native American2.65 (1.14–6.12) * 3.25 (0.91–11.64)Marital status (reference = never
married to partner) Cohabited with partner4.54 (3.49–5.90) *** 2.96 (1.65–5.34) *** Ever married to partner3.27 (2.48–4.32) *** 1.98 (0.97–4.05)Neglect as child (yes vs. no)1.09 (0.89–1.35)1.59 (0.98–2.58)Sexual abuse as child (yes vs. no)1.31 (0.79–2.17)0.91 (0.28–2.95)Physical abuse as child (yes vs. no)1.83 (1.43–2.35) *** 1.86 (1.09–3.19) * Neighborhood poverty1.00 (1.00–1.01)1.01 (1.00–1.02)Neighborhood transience0.99 (0.99–1.00 a)** 0.99 (0.97–1.00)Neighborhood foreign-born1.08 (0.36–3.29)0.99 (0.17–5.82)Neighborhood vacant housing0.86 (0.20–3.67)1.59 (0.03–91.19)Neighborhood population density0.97 (0.94–1.00 b)* 1.02 (0.98–1.05)
Note . CI=confidence interval.
aCI was 0.987–0.998 before rounding.
bCI was 0.942–0.997 before rounding.
* p < .05.
** p < .01.
J Fam Violence . Author manuscript; available in PMC 2014 July 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Iritani et al.Page 22 ***
p < .001.
J Fam Violence . Author manuscript; available in PMC 2014 July 01.