RESEARCH REPORT

doi:10.1111/j.1360-0443.2006.01701.x

Alcohol and violence: use of possible confounders in a time-series analysis

Elin K. Bye
Norwegian Institute for Alcohol and Drug Research, Oslo, Norway

ABSTRACT Aims To assess the aggregate association between alcohol consumption and violence, while controlling for potential confounders. Design and measurements The data comprise aggregate time-series for Norway in the period 1880 2003 and 19112003 on criminal violence rates and per capita alcohol consumption. Possible confounders comprise annual rates of unemployment, divorce, marriage, total fertility rate, gross national product, public assistance/social care and the proportion of the population aged between 15 and 25. Autoregressive integrated moving average (ARIMA) analyses were performed on differenced data. Both semilogarithmic and linear models were estimated. Findings Alcohol consumption was associated signicantly with violence, and an increase in alcohol consumption of 1 litre per year per inhabitant predicted a change of approximately 8% in the violence rate. The parameter estimate for the alcohol variable remained unaltered after including the covariates both in the semilogarithmic and the linear models. Of the seven covariates included in the models, only divorce was associated signicantly with violence rate. Conclusions The results suggest that alcohol consumption has an independent effect on violence rates when other factors are controlled for. The results support the assumption of a causal effect of alcohol consumption on violence, and it appears that alcohol consumption is an important factor when we wish to explain changes in violence rates over time.

Keywords

Alcohol, time-series, violence.

Correspondence to: Elin K. Bye, Norwegian Institute for Alcohol and Drug Research, POB 565 Sentrum, N-0105 Oslo, Norway. E-mail: ekb@sirus.no Submitted 20 February 2006; initial review completed 21 April 2006; nal version accepted 9 October 2006

INTRODUCTION Alcohol consumption is a common factor in violent incidents, and an important risk factor for committing violent acts and for victimization [1,2]. Given that violence is a severe social problem, the extent to which changes in alcohol consumption may inuence violence rates in society is of considerable interest to public policy. Previous studies of alcohol and violence are mainly at the individual level. Emergency room studies and general population surveys show that violent incidents are associated frequently with alcohol use by the perpetrator, the victim, or both, and that the risk for being involved in violence increases with alcohol intake and number of heavy drinking episodes (for reviews see [35]). Experimental studies also indicate an increased risk of aggressive behaviour with increasing alcohol intake, but these studies are somewhat inconclusive and do not support the hypothesis that the pharmacolo-

gical effects of alcohol alone increase aggressive acts [2,6,7]. The mechanisms underlying the observed alcohol violence relationship are complex, and causes of violence are probably multiple, conditional and interactive. Alcohol use, and particularly intoxication, may not only enhance or trigger aggressive behaviour and increase the risk of violent victimization, but may also reduce the likelihood of any bystanders intervening when a violent incident occurs. Such complexity may be difcult to assess in studies at the individual level. Moreover, inferences of causality from the alcoholviolence association at the individual level may well be hampered by methodological problems, such as selection effects and failure to control for potentially confounding factors. The complexity of underlying mechanisms and selection effects can be less of a problem when applying studies at the aggregate level. However, aggregate studies do not solve the inference problem completely, and the risks related to the ecological
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Elin K. Bye explores how social structure causes strain in individuals who fail in terms of prevailing social expectations, and this strain could result in violence. According to this view, lack of social integration could increase the risk of both heavy drinking and alcoholism and then violence. The social bonds theory, as outlined by Hirschi [28], has also played a key role in understanding violence, and the theory emphasizes the magnitude of attachment to traditional institutes such as home, school and the workplace. This attachment is presumed to control the assumed tendency to commit deviant acts such as violence. In this view, the role of alcohol is that the social bonds would be impaired in the presence of heavy alcohol consumption [28]. Another factor found to be important in a number of studies of homicide is economic deprivation. Severe deprivation might lead to both increased alcohol consumption and increased violence [25]. With regard to the relationship between economic deprivation, homicide and alcohol, the essence is that individuals who lack desired social and economic resources become frustrated. As frustration grows, it may trigger violent behaviour among friends, towards ones spouse or to anyone in the vicinity. Poverty has also long been acknowledged as a major correlate of homicide [25,32]. Alcohol may enhance the immediate gratication focus, while reducing inhibitory considerations of the probable consequences of current actions. A variety of measures have been used for economic deprivation at the aggregate level, such as the ofcial poverty line measure, infant mortality, median income and proportion of children living with one parent [33]. A meta-analysis of studies at the aggregate level that have used poverty and inequality as indicators of resource deprivation have shown that resource deprivation is associated more closely with homicide and assault than with robbery and rape [34]. A review of the literature also supports an association between unemployment and violence at the aggregate level [35]. In this perspective, alcohol might play an intervening role in addition to having a direct effect, i.e. inequality leads to higher consumption which leads in turn to violence. Divorce is another variable that has been linked to homicide in a number of previous studies [36]. Divorce can be viewed as a primary indicator of the breakdown of traditional social ties, and when divorce rates increase everyonenot only divorceesis at greater risk of being involved in violent incidents [24]. Parker [26] offers other indicators of social bonds for studies at the aggregate level, such as the percentage employed and the proportion of single-person households. It is well documented in the literature that alcoholics and excessive drinkers are poorly integrated and that their social networks are inadequate. Alcoholics may have lacked social skills prior to the onset of heavy
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fallacy must be considered. Confounding factors may also be a problem in aggregate studies. Hence, the possibility that a bivariate alcoholviolence covariation is the result of some other common factor must be ruled out (see [8] for discussion). However, when addressing questions that concern the health consequences of changes in population drinking, it has been argued that aggregate timeseries data is the most feasible approach, and that this approach also might be useful for assessing the plausibility of individual-level relationships, particularly those prone to be confounded by selection effects [9]. Several time-series analyses of aggregate-level data have demonstrated that an increase in alcohol consumption is followed by an increase in rates of violence and vice versa [1012]. This has also been shown in studies of natural experiments, for example sudden and large changes in alcohol consumption due to rationing, antialcohol campaigns and strikes [11,13,14]. However, previous studies have so far been conned to the bivariate relationship, with analysis performed on the yearly changes, together with a modelling of the noise term. Critical questions have been raised concerning the lack of possible confounders in these analyses, and furthermore whether the time-series have been too short to establish an appropriate model [1518]. Although the differencing technique may reduce the risk for certain types of omitted variables bias, the risk is not eliminated if covariates of importance for the alcoholviolence association still exist after differencing. Inclusion of possible confounders is therefore highly relevant. Thus, the present study will focus on this matter by including covariates from relevant theory in the analysis of alcohol and violence, so as to assess whether these may confound the alcoholviolence association. What, then, are the relevant covariates? A number of theories have been proposed to explain the relationship between alcohol and violence, and a large number of empirical studies have addressed various aspects of violence and alcohol (for reviews see [11,1923]). The importance of including additional variables when considering the relationship between alcohol and violence, and specically homicide, is outlined in several studies by Parker [2426]. Results from these studies indicate that control variables suggested from strain and social disorganization theories [27], social bonds theory [28] and routine activities [29] are of importance for the ways in which alcohol consumption and violence rates might be related at the aggregate level. The structural/strain perspective stresses conict, oppression, inequality and marginalization as explanatory factors. Versions of the strain approach have gured in sociological thinking for more than a century, since Durkheim in 1897, via Merton [27] to Robert Agnew [30] and Messner & Rosenfeld [31]. This perspective

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Alcohol and violence, a multivariate analysis

Table 1 Descriptive statistics of indicators of violence and covariates, 19112003. Mean Violence Alcohol Divorce Marriage Fertility Unemployment GNP Social care Percentage of population aged 1525 35.1 3.8 1.0 6.6 2.4 3.1 124.7 25.3 17.0 SD 21.4 1.3 0.8 1.3 0.6 2.6 93.6 13.8 3.0 Minimum 12.0 0.6 0.2 4.4 1.7 0.5 29.3 8.0 13.0 Maximum 115.6 6.0 2.6 9.5 3.8 10.4 338.2 55.0 21.0

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Median 29.6 3.6 0.7 6.5 2.3 2.0 86.9 26.0 17.0

drinking, but studies also suggest that alcoholism is accompanied by a deterioration of social ties and that alcoholics are prone to social isolation [37]. More recently the routine activity (or life-style) approach has been applied to understand violence (and homicide in particular), focusing on the daily routines in which individuals engage, and particularly night-time activities [29,38]. According to this theory, crime rates and risk of victimization increase as people spend more work and leisure time outside the home. Alcohol consumption places people into contexts where violence is much more likely to occur, and routine activities and lifestyles that involve going out in the evening seem to increase the risk of victimization [23,39,40]. In Parkers time-series studies [21,41] routine activities have been operationalized by proxy variables, such as the proportion of young people in the population, the proportion of women in the labour force and earned income as a proxy for the ow of goods and services. The latter is seen as an indicator of the availability of attractive and available targets for crime [41]. Treno et al. [42] found that changes in the population age structure and in daily life routines were associated with predicted changes in consumption, and economic variables were found to play a minor role. The availability of long time-series data in Norway provided the opportunity to assess whether inclusion of theory-driven potential confounders modies the association between alcohol consumption and violence. DATA AND METHOD Violence and alcohol The data on annual violence rates were obtained from the statistics on crime, 18802003, compiled by Statistics Norway. These comprise the number of people courtconvicted for assaults and aggravated assaults (including homicides) as a result of investigations and prosecution. Only physical assaults were included. The violence rate is given per 100 000 inhabitants above the minimum legal

age (14 years and over until 1990, then 15 years and over). Annual sales statistics in litres of pure alcohol per inhabitant aged 15 years and over were used as a proxy for alcohol consumption (linear interpolation is used to compensate for missing data for 1998). Norway has ofcial data for the period 18512003 on violent crimes and alcohol sales. However, alcohol sales data are not comparable until the period after 1870, due to a different basis for calculation [43]. Thus, in the rst study we performed one bivariate analysis for the whole period 18802003. The choice of variables other than alcohol is limited by the ofcial statistics that are available for such a long period of time, and the variables available for the multivariate analysis in this paper therefore cover the period 19112003. Social bonds/integration variables The variables chosen for this measure were annual rates of unemployment and divorce (disruption of social bonds) and marriage and total fertility rate (family integration). All variables are per 1000 inhabitants. Routine activity The proportion of the population between 15 and 25 years was used as an indicator of routine activity theory (following Parker & Cartmill [41]). Economic deprivation variables Gross national product (GNP) measured in xed prices per 1000 inhabitants was used as an indicator of changes in the economic climate (linear interpolation was used to compensate for missing data 194045). Public assistance/social care per 1000 inhabitants was used as an indicator of changes in private economy (linear interpolation was used here as well to compensate for missing data for 1965) (Table 1). Dummy variables These were included to adjust for particular events. One covers the period 191620 due to a major drop in alcohol
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140

120

80

60

40

20

Alcohol consumption

100 Violence rate

0 1880 1885 1890 1895 1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Figure 1 Annual gures for alcohol consumption per inhabitant aged 15 + () and violence rate per 100 000 inhabitants ( ) 18802003

sales as a result of partial prohibition. During this period sales data are not a good proxy for actual consumption, as there was a signicant storage of alcohol prior to the prohibition, the amount of liquor prescribed by doctors was considerable and smuggling and illicit distilling were extensive [44]. The second dummy variable covers the World War II (194045), because of outliers in this period when both alcohol consumption and violence rates fell. We also used dummy variables for 1965, because of missing data on social care and the uncertain nature of marriage statistics in that year, and for 1998, because of missing data on alcohol. With regard to changes in the enforcement levels over time, it must be assumed that there has been a gradual change over time both for the time separation between the violent act and the court conviction and the enforcement levels, but this is difcult to adjust for. However, from 2000 to 2001 the violence rate increased by 52% (Fig. 1). This was due mainly to the fact that the police were given more money to investigate violent crime, and the courts were told to speed up cases involving violent crime. Thus, a dummy variable was used for the year 2001. In addition to this, scatter plots between the differenced dependent and independent variables were studied, but no outliers were detected that suggested the need for additional dummy variables. All estimated effects are based on the technique for time-series analysis developed by Box & Jenkins [45], often referred to as autoregressive integrated moving average (ARIMA) models. The analyses were performed on the yearly changes rather than on the raw data, due to the series being non-stationary. Analyses of differenced data may imply that the risk of biased estimates due to omitted confounding variables is signicantly less, as an omitted variable is more likely to be correlated with alcohol sales due to common trends than to synchronization in the

yearly changes [10,12]. No assumption of independent error terms is required with the Box & Jenkins method as the noise term is allowed to have a temporal structure, which is modelled and estimated in terms of autoregressive or moving average parameters. A rst-order differencing removed the stationarity in all models, and the annual changes uctuated as white noise. The model t was also evaluated with the aid of the BoxLjung portmanteau test (diagnostic test for residual correlation) of the rst 10 autocorrelations (Q 10), along with visual inspection, and normality test of the residuals. Regarding the choice of model, most studies on alcohol and various measures of violence have used a semilogarithmic model (multiplicative) [1012]. This multiplicative model assumes that the absolute effect of alcohol on violent behaviour may depend on other factors associated with violence. This would be the case if we assume, for instance, that the effect of alcohol consumption on violence in society depends on the level of informal social control. The model implies that the alcohol effect is relative, i.e. a nominal increase in the alcohol variable gives a relative change in the violence variable [12]. A few studies on alcohol and violence have, however, used a linear model (additive) [23,46]. The application of this model is based on the argument that the alcohol effect depends mainly on the number of events of acute intoxication in which violence may be triggered, and/or that the effect depends on the number of heavy drinkers who have an heighten risk of being involved in violent acts, more or less irrespective of the level of other factors that may affect the violence rate. Both of these hypothesized effects regarding the effect of alcohol on violence have some credibility, and in the present analyses both models were used for the multivariate analyses.
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Ln(Vt ) = ln() + i X it + Ln(N t ) Vt = + i X it + N t

Semi-logarithmic model:

Linear model:

Table 2 Estimated effect (ARIMA models) on the incidence of violence (per 100 000 inhabitants) of per capita alcohol consumption. Semi-logarithmic model, 18802003. B Alcohol Dummy WW II Dummy, 2001 Constant Diagnostics (Q 10)
1

Here denotes the difference operator, while b1 is the estimated regression parameters and Xit the set of explanatory variables (alcohol, unemployment, divorce, marriage, fertility rate, GNP, social care and the proportion of the population aged between 15 and 25 years). In the semilogarithmic model, the betas can be interpreted as follows: an increase in Xt of one unit produces a xed percentage increase in Vt, e.g. the parameter b for the alcohol variable will measure the relative increase in overall violence rates when alcohol increases by 1 litre of pure alcohol per inhabitant. In the linear model a 1-litre increase in alcohol sales is followed by an absolute increase in the violence rate corresponding to the value of the parameter b. N is the noise term, and represents the unexplained variation in the violence rate due to factors not included in the model. The constant a denotes the average annual increase (or decrease) in the violence rate due to other causes. Both theory and empirical studies suggest unanimously that the association between alcohol consumption and various forms of violence can only be expected to be positive, i.e. a xed increase in alcohol consumption is followed by an increase in violence rates. Consequently, a one-tailed signicance test was applied for the association between alcohol consumption and violence rates. Violent crimes are dealt with by the judiciary some time after the actual event. This could produce a time-lag, i.e. alcohol consumption during one year might affect criminal violence statistics the following year. However, weighting the alcohol variable in relation to this was problematic for such a long period, due to sparse and insufcient information of the actual time between the violent act and the conviction. Thus, a cross-correlation between the pre-whitened series for alcohol and violence was performed (a differencing was sufcient to prewhiten the consumption series, whereas in addition a second-order autoregressive parameter was required for the mortality series). This indicated no time-lag effect, and furthermore a 1-year lagged alcohol variable included in the analysis was not signicant. In addition to the estimated effect parameter, the alcohol effect is also expressed in terms of its attributable fraction (AF), which is possible to obtain from aggregate data by using the following expressions:
Semi-logarithmic model: AF = 1 e X Linear model: AF = *X Y

SE 0.031 0.079 0.076 0.010

AF1 23%

0.068* -0.439*** 0.325*** 0.011 9.86, P = 0.453

Attributable fraction. *P < 0.05, ***P < 0.001.

AF is interpreted as the proportion of violence that, according to the estimates, is attributable to alcohol. However, it should be recognized that these calculations are based on extrapolations (see [48] for discussion). RESULTS The trends in alcohol sales and violence rates in Norway 18802003 are displayed in Fig. 1. We observed a relatively good correspondence between the series. The raw series for alcohol and violence for the whole period had a correlation of 0.57 (P < 0.01). Alcohol consumption and violent crime both fell during World War II, and in the late 1950s alcohol consumption started to increase rapidly. By the end of 1970 violent crime was also rising steeply; incidents of violent crime investigated by the police increased in real numbers from 4000 in 1980 to 15 000 in 2001, and the number of convictions for violent crime rose from 750 to 4200 in the same period. Assaults accounted for the majority of investigated violent crimes (61% in 2003). Before conducting the multivariate analysis for the period 19112003, an ARIMA model for the whole period 18802003 was estimated (Table 2). Consistent with previous research, annual changes in alcohol consumption signicantly predicted changes in violence. The results indicated that an increase in alcohol consumption of 1 litre per year per inhabitant will, on average, increase the rate of violence by approximately 7%. As shown in Fig. 1, the model estimates a reduction in violence rates due to World War II and an increase in 2001. The differenced noise term showed no temporal structure, thus no autoregressive or moving average parameters needed to be estimated in this model. The proportion of violence that can be attributed to alcohol in this estimated model (AF) is 23% (average for the period). With regard to the multivariate analysis of the period 19112003, the results from a correlation analysis of the differenced variables showed that none of the covariates were correlated with both alcohol and violence (not shown). Alcohol and divorce were correlated with
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Here b is the effect parameter estimated in the model; X and Y denote here the period average for alcohol sales and violence rates, respectively [47]. In the present context

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Table 3 Estimated effects (ARIMA models) on incidence of violence (per 100 000 inhabitants) of per capita alcohol consumption (model 1) and of per capita alcohol consumption and social bonds/integration variables (model 2), and of per capita alcohol consumption, social bonds/integration variables, economic deprivation variables and routine activity variable (model 3). Semi-logarithmic and linear models, 19112003. Model 1 B Semi-logarithmic models Alcohol1 Divorce Marriage Fertility Unemployment GNP Social care Percentage of population aged 1525 AF2 BoxLjung Q(10)3 Linear models Alcohol1 Divorce Marriage Fertility Unemployment GNP Social care Percentage of population aged 1525 AF2 BoxLjung (Q 10)3 SE Model 2 B SE Model 3 B SE

0.079**

0.031

0.089** 0.315(*) -0.041 0.135 0.014

0.032 0.163 0.026 0.100 0.010

0.084** 0.309(*) -0.043 0.148 0.020 0.003 -0.001 3.595 27% 2.19, P = 0.995

0.034 0.165 0.028 0.102 0.013 0.003 0.004 3.519

26% 4.32, P = 0.932 2.21* 1.23

29% 2.51, P = 0.991 2.66* 14.42* -1.98 6.35 0.67 1.26 6.39 1.03 3.93 0.40

2.42* 14.44* -1.92 6.47 0.83 0.11 -0.03 11.92 26% 10.35,

1.36 6.51 1.11 4.03 0.53 0.12 0.17 138.64

24% 17.87, P = 0.57

29% 14.56, P = 0.149

P = 0.411

1 One-tailed signicance test of the association between alcohol consumption and violence. 2Attributable fraction. 3BoxLjung portmanteau test of the rst 10 autocorrelations (Q 10). (*)P < 0.10; *P < 0.05; **P < 0.01.

violence (logarithmic) (P < 0.05), and GNP was correlated with alcohol (P < 0.01). Hence, this gives no reason to expect a great deal of change in the alcohol parameter due to the covariates. The analysis was conducted in three steps. The rst step included the alcohol variable (model 1); social bond/ integration variables were incorporated into model 2; model 3 included the economic variables and the one measure for routine activity. As for the results in Table 2, the differenced noise term showed no temporal structure for any of the models, thus no autoregressive or moving average parameters needed to be estimated. The results from the semilogarithmic model 1 (Table 3) are consistent with the ndings for the whole period 18802003. The parameter estimate indicates that an increase in alcohol consumption of 1 litre per year per inhabitant will, on average, be followed by an increase in the violence rate of approximately 8%. These results are mainly unchanged in models 2 and 3. The AF for this period was slightly higher than for the period 18802003. Hence, the alcohol variable remained unaltered after including

the covariates, indicating that alcohol consumption in fact has an independent effect on the incidence of violence, also when other factors are controlled for. This result was supported by the linear model, although these models showed a somewhat larger uncertainty around the point estimates. The alcohol parameter in model 1 can be interpreted as follows: a 1-litre increase in alcohol sales per capita (15 years and over) is followed by an increase in the violence rate of 2.2 per 100 000 inhabitants (corresponding to about 59 additional incidents of violence per year). DISCUSSION Previous studies at the aggregate level have demonstrated that an increase in alcohol consumption is followed by an increase in rates of violence. However, most of these studies deal only with bivariate relationships, and it has been questioned whether inclusion of theory-driven potential confounders may modify the parameter estimates in such analyses [1518]. Hitherto, to my
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Alcohol and violence, a multivariate analysis knowledge, this has not been studied empirically, and the present study has focused on this matter. The results of the present study showed that an increase in per capita alcohol sales of 1 litre was followed by an increase in violence rates of 8%. This estimate was not modied when relevant potential confounding variables were included in the analyses, but remained more or less of the same magnitude in all the models. Of the seven covariates included in the model, only divorce was statistically associated with violence rate. The results thus suggest that alcohol consumption has an independent effect on violence rates when other factors are controlled for. This supports the assumption of a causal effect of alcohol consumption on violence, and it appears that alcohol consumption is an important factor when we wish to explain changes in violence rates over time. There are good theoretical reasons to expect a relationship between alcohol and violence, and a temporal relationship has been demonstrated in several countries [11,12]. Studies by Lenke [11] in Sweden estimated an alcohol effect of 6% on assaults (195080) and 11% on homicide (192184). In an earlier analysis of the relationship between per capita consumption on assaults in Norway 193177, the estimated alcohol effect was 16% [10]. The difference between the estimate in the present study and that found for Norway, 193177, may reect that the association is not necessarily constant across various time periods, but may possibly differ with, for instance, the wetness or the violence-proneness of a society. Some limitations of the study should be noted. Both alcohol sales and recorded violence rates are proxy variables for total alcohol consumption and overall violence (of some severity), and both unrecorded consumption and unrecorded violent assaults may be of signicant magnitude. In more recent years it has been estimated that unrecorded consumption constitutes almost 20% of total consumption in Norway [49]. Thus, although we may want to assess how much a certain change in the overall consumption may affect the overall number of violent assaults, the estimates obtained here refer to the effect of changes in recorded alcohol sales on recorded violent assaults. If the measurement errors in both the alcohol and violence variables were correlated strongly in the differenced series this would lead to an inated parameter estimate, although this seems unlikely. Furthermore, it is possible that some relevant potential confounders have not been included in the present analyses and/or that some of the included variables were poor proxies. This may well be pursued in further studies, and use of other measurements or confounders, particularly confounders as suggested by routine activity theory, might be promising. On the other hand, it should also be noted that the present analyses were based on exception-

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ally long time-series, which has been warranted in previous criticisms of many time-series studies [15,18]. The ndings from this study are in line with a number of previous studies showing that violence rates systematically tend to change with changes in alcohol consumption at the population level. Hence, when alcohol consumption increases, violence rates will also tend to increase and vice versa.This may have implications for policy strategies, and indicates that there is a potential for preventing incidents of violence by implementing alcohol policy strategies to reduce population alcohol consumption and prevalence of heavy drinking episodes. Such strategies may comprise reduction of the availability of alcohol and an increase in alcohol prices. Parker [50] suggested that the distinction between alcohol control policy and crime control policy is articial, and that alcohol control policies should be added to the policies and approaches used by policy makers and communities wishing to reduce the damage caused by violence. He also proposed that with a combination of efforts to enforce already-existing statutes and regulations, for example limiting the outlet density by strictly enacting the regulations and policies for approval/change of ownership, the potential benets would be noticeable regarding the incidence of violence. The results reported here support this notion. Acknowledgements I am very grateful to Ingeborg Rossow and Ole-Jrgen Skog for valuable comments and discussions on earlier drafts of this paper, and to Anders Barstad in Statistic Norway for providing most of the covariates. I also obtained helpful and constructive comments and suggestions from two anonymous referees and one assistant editor of Addiction. References
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