# Multilevel Associations Between Outlet Characteristics, Contextual Factors and Firearm Violence at On‐Premise Alcohol Outlets in the United States

## TL;DR

This study explores how alcohol outlet features and neighborhood conditions relate to firearm violence in the US.

## Contribution

It extends prior work by showing how firearm policies and neighborhood disadvantage intersect with local alcohol outlet environments.

## Key findings

- Non-bar on-premise outlets like restaurants had lower odds of shooting incidents compared to bars.
- Stronger firearm laws and higher neighborhood socioeconomic advantage were linked to fewer shootings.
- Multilevel prevention strategies could help reduce firearm violence at alcohol outlets.

## Abstract

Firearm violence is a major public health concern in the United States (US). Alcohol use and features of the alcohol environment, including outlet type and alcohol control policies, are factors known to increase the risk of firearm violence. On‐premise alcohol outlets, where alcohol is sold and consumed on site, may influence firearm violence risk through modifications in the physical environment, social processes and policy contexts.

We conducted a cross‐sectional study examining the association between multilevel characteristics of on‐premise alcohol outlets and other social ecological conditions and shooting incidents across 69 US cities from 2022–2023. Shooting incidents were spatially linked to outlets within a 10‐m buffer. A multivariable generalised linear mixed model with a logit link assessed associations between outlet, neighbourhood, and state factors and the odds of a shooting incident.

The 19,472 on‐premise outlets experienced 290 shooting incidents during the study period. Compared with bars, restaurants (OR = 0.58; 95% CI 0.42, 0.80) and other outlets (OR = 0.58; 95% CI 0.34, 1.00) had lower odds of experiencing a shooting. Greater neighbourhood socioeconomic advantage (per 1 SD increase: OR = 0.64; 95% CI 0.56, 0.74) and stronger state‐level firearm laws (per 1 SD increase: 0.72; 95% CI 0.53, 0.97) were also found to be negatively associated with shooting incidents.

Findings align with prior research linking stronger firearm laws, neighbourhood advantage and outlet type to reduced firearm violence risk. Multilevel prevention strategies addressing both structural and outlet‐specific factors may help reduce firearm violence in on‐premise alcohol outlets.

Non‐bar on‐premise alcohol outlets (restaurants and other types of on‐premise alcohol outlets), greater neighbourhood socioeconomic advantage and stronger firearm laws were associated with decreased odds of a shooting incident at on‐premise alcohol outlets.Findings align with prior evidence linking firearm policy strength and neighbourhood conditions to firearm violence risk.Extends prior work by showing how firearm policies and neighbourhood disadvantage intersect with local alcohol outlet environments.

Non‐bar on‐premise alcohol outlets (restaurants and other types of on‐premise alcohol outlets), greater neighbourhood socioeconomic advantage and stronger firearm laws were associated with decreased odds of a shooting incident at on‐premise alcohol outlets.

Findings align with prior evidence linking firearm policy strength and neighbourhood conditions to firearm violence risk.

Extends prior work by showing how firearm policies and neighbourhood disadvantage intersect with local alcohol outlet environments.