Can Alcohol Environmental Interventions Reduce Child Maltreatment? Using the Sacramento Neighborhood Alcohol Prevention Project As a Case Study

Background:

In February 2018, the Families First Prevention Services Act was signed into law. This law was notable in that it expanded opportunities for states to engage in activities to prevent child abuse and neglect from occurring. Lawmakers mandated the development of a clearinghouse of evidence-based practices that could receive funding for child welfare prevention activities. To date, the programs being examined for inclusion are primarily individual or family-based interventions. However, over the past two decades, a growing body of literature has examined how the geographic density of alcohol outlets is related to rates of child abuse and neglect. Thus, interventions that seek to change the larger environmental structure by reducing access to and availability of alcohol in neighborhoods might also prevent child abuse and neglect. Specifically, this project takes advantage of data from the Sacramento Neighborhood Alcohol Prevention Project (SNAPP), an environmental intervention designed to reduce alcohol-related problems in two neighborhood areas among young adults aged 15-29, and analyzes them in relation to changes in child maltreatment. The age group under study coincides with parents who have higher rates of child abuse and neglect.

Methods:

SNAPP was a quasi-experimental intervention implemented from 1999 through 2003. It was designed to reduce alcohol-related problems in two neighborhood areas (north and south). SNAPP took a "phased" approach to program implementation and statistical examination of outcome data where interventions were conducted in the first neighborhood, with interventions commencing in the second neighborhood two years later. We use 1999-2003 administrative child welfare data of parents aged 18 to 29 years, aggregated to Census block groups as our outcome variable. Covariates include measure of alcohol outlet density from California’s Department of Alcoholic Beverage Control and sociodemographics (e.g., % poverty) from Geolytics. Data were analyzed using Bayesian space-time conditionally autoregressive models.

Results:

Overall, rates of child maltreatment show a negative time trend during the study. Importantly, we found statistically significant reductions in rates of substantiated cases of child abuse and neglect per household among 18 to 29 year olds living in the north neighborhood area. These reductions were over and above the time trend reductions. We found no difference in rates of maltreatment in the south neighborhood area.

Conclusions:

Evidence from our study is mixed as to whether environmental alcohol prevention intervention reduces child abuse and neglect, as reductions occurred in one of the two neighborhood areas. These environmental interventions could be less expensive and more easily sustained than many individual-level primary prevention efforts to reduce child abuse. Further, these interventions may also have the added benefit of potentially positive effects on related social problems. Thus, future research should assess the intervention components that are most effective at reducing maltreatment and assess possible savings to public health for these types of environmental interventions.