The association between alcohol outlet density and alcohol use among urban and regional Australian adolescents

Does geographic availability of alcohol influence drinking in adolescents? A systematic review of literature associations

BACKGROUND

The role of alcohol geographic availability in influencing adolescent drinking has been debated. However, clear literature consensus has not been reached.

OBJECTIVE

To provide a systematic review of the associations between geographic availability of alcohol outlets measured through different methodologies and drinking outcomes in adolescents.

METHODS

We conducted a systematic search (PubMed/SCOPUS/Web of Science) for articles exploring associations between alcohol availability and adolescent drinking before 2023. Original articles written in English that evaluated adolescent populations (10-19 years old), included at least one quantitative alcohol consumption outcome and its relationship with geographic availability of alcohol, and declared no conflicts of interest were selected for the review. A quality assessment of the selected articles was made using the Newcastle-Ottawa Scale and descriptive analyses were carried out to summarize results.

RESULTS

Thirty-one articles were reviewed (19 cross-sectional and 12 longitudinal studies), which included a total of 507336 participants. Alcohol availability was positively related to drinking prevalence and risky patterns in 53.3% and 60.5% of associations, respectively. Individual-level covariates, the type of alcohol outlets measured and the different methodological approaches to measure outlet density were related to differences in the direction and magnitude of these associations.

CONCLUSION

Just over half of the studies in this review demonstrate a positive association between alcohol availability and adolescent alcohol consumption with no negative associations reported. The review highlights the mix of methodological approaches that are used, which made it difficult to conduct joint analyses. Additional research is needed to explore the appropriateness, effectiveness and reliability of these methods within various contexts.

Alcohol outlet density and adolescent drinking behaviors in Thailand, 2007-2017: A spatiotemporal mixed model analysis

This study aimed to explore the relationship between alcohol outlet density and the proportion of alcohol consumption among Thai adolescents. We utilized the alcohol consumption data from the 2007, 2011, and 2017 Tobacco and Alcohol Consumption Survey in Thailand. We analyzed the relationships between alcohol sales license figures and consumption behavior using a spatiotemporal mixed model. Our data had two levels. The upper (provincial) level featured alcohol sales license density (spatial effect), the years of survey (temporal effect), and the social deprivation index. The lower (individual) level included the demographic data of the adolescents. A total of 9,566 Thai adolescents participated in this study, based on surveys conducted in 2007 (n = 4,731), 2011 (n = 3,466), and 2017 (n = 1,369). The density of alcohol sales licenses increased the odds for the one-year current drinker category (odds ratio [OR] = 1.08, 95% confidence interval [CI], 1.04-1.45), especially in male adolescents (OR = 1.09, 95% CI, 1.04-1.14). Furthermore, it increased the odds for the heavy episodic drinker category for female adolescents (OR = 1.23, 95% CI, 1.05-1.44). Increased alcohol sales licenses are associated with higher alcohol consumption among Thai adolescents. This highlights the need for government organizations to develop and apply strategies to reduce the number of licenses for the sale of alcohol.

Alcohol Use Amongst Rural Adolescents and Young Adults: A Brief Review of the Literature

The sociodevelopmental periods of adolescence and young adulthood are rife with alcohol use. However, much of the literature demonstrating this comes from 'traditional' settings and college campuses (i.e., large suburban/urban campuses, or those containing their own infrastructure). Alcohol culture in rural areas has largely been understudied, which may be problematic given the unique stressors they face (e.g., economic hardship, lack of social activities, healthcare inequality). There has also been difficulty both within and across fields classifying rural versus urban geographical locations; no distinct system used broadly, making ittrea difficult to generalize and accurately collect data. The geographic categorizations are often viewed as homogenous identifiers; however, diversity occurs both within and outside of these classification systems. It appears that rurality may be a risk factor for increased drinking both earlier and later in life, but the research has failed to extend to the formative college years. This short review has two main focuses: attempting to disentangle the definition of rurality and reviewing the literature regarding alcohol use in rural areas, with a specific focus on adolescents and young adults. Identifying the mechanisms responsible for substance use in rural areas is a crucial component of prevention and treatment programs.

Lifestyle Behaviors of Childhood and Adolescence: Contributing Factors, Health Consequences, and Potential Interventions

In this narrative review, we summarized evidence from peer-reviewed articles, published before February 2024, that investigated lifestyle behaviors among children (≤12 years) and adolescents (13-18 years) representing different geographic descents. These behaviors included dietary patterns, screen time, physical activity, smoking, alcohol consumption, oral hygiene, unsafe sex, and sleep duration and quality. We documented the significant impacts of parental, school, and sociodemographic factors on the adoption of numerous lifestyle behaviors in this age category. Several health consequences could be attributed to unhealthy lifestyle behaviors during childhood and adolescence. For example, poor dietary habits can lead to a higher risk of obesity and cardiovascular disease. Physical inactivity contributes to the development of musculoskeletal and psychological disorders. Excessive screen time is associated with visual acuity problems, poor sleep, and psychological and behavioral problems. Tobacco use poses a significant risk for severe respiratory and cardiovascular diseases. Risky sexual behaviors are related to sexually transmitted infections and exposure to violence. Short sleep duration is associated with a lack of physical fitness and poor cognitive function. However, potential interventions, such as school-based health programs, community outreach initiatives, and national health policies and regulations, can improve lifestyle behaviors among children and adolescents.

A spatial examination of alcohol availability and the level of disadvantage of schools in Ireland

BACKGROUND

The availability of alcohol is a major factor in underage drinking and according to the alcohol harm paradox, those living in more deprived communities are more susceptible to the negative consequences of alcohol use, despite drinking the same or less than those from more affluent areas. Alcohol availability within the vicinity of the home or school normalises alcohol for schoolchildren. For the first time in the Republic of Ireland, this study examines the number of premises licensed to sell alcohol within 300 m of all schools in Ireland and differences in this number between disadvantaged and non-disadvantaged schools.

METHODS

Using publicly available data from the Department of Education and Revenue, the addresses of all schools (n = 3,958) and all premises with at least one liquor licence (n = 14,840) were geocoded and analysed using the Geographic Information System software, Quantum GIS (QGIS). Schools were identified by their disadvantaged classification using the HP Pobal Deprivation Index and the number of liquor licences within 300 m of each school type was examined. To test for significant differences between schools' level of disadvantage, a combination of Mann-Whitney U tests, Kruskal-Wallis tests and Dunn-Bonferroni tests were used.

RESULTS

There was a mean of two licenced premises within 300 m of all schools in Ireland, but when disadvantaged schools were compared to non-disadvantaged schools, there was a significantly higher number of licenced premises around disadvantaged schools (p < .001). Primary schools are further classified according to their level of disadvantage and the results indicated that those schools classified as the most disadvantaged had a significantly greater number of liquor licences within 300 meters (p < .001). There was no significant difference in density of licenced premises when comparing disadvantaged secondary schools with non-disadvantaged secondary schools (p = .705).

CONCLUSION

Ireland is considering increasing alcohol availability through the Sale of Alcohol Bill, 2022. However, this analysis indicates already problematic numbers of licenced premises within close proximity of schools in Ireland. It is essential that the harms associated with alcohol availability are considered, especially for those living and attending school in disadvantaged communities, where higher numbers of licenced premises were identified.

Effects of cannabis legalisation on patterns of cannabis consumption among adolescents in Ontario, Canada (2001-2019)

INTRODUCTION

Cannabis legalisation was enacted on 17 October 2018 in Canada. Accordingly, the effects of cannabis legalisation on patterns of cannabis consumption were examined among adolescents, including on cannabis initiation, any cannabis use, daily cannabis use and cannabis dependence.

METHODS

Data from a biennial population-based, cross-sectional survey of students in Ontario were pooled in a pre-post design (2001-2019; N = 89,238). Participants provided self-reports of cannabis initiation, any cannabis use, daily cannabis use and cannabis dependence. Long-term trends in these patterns of cannabis consumption over two decades of observation were characterised to provide a broader context of usage. The effects of cannabis legalisation on patterns of cannabis consumption were quantified using logistic regression analyses.

RESULTS

Long-term trends over the two decades of observation indicated that cannabis initiation decreased and then increased (p = 0.0220), any cannabis use decreased and daily cannabis use decreased (p < 0.0001 and p = 0.0001, respectively) and cannabis dependence remained unchanged (p = 0.1187). However, in comparisons between the pre-cannabis legalisation period (2001-2017) and the post-cannabis legalisation period (2019), cannabis legalisation was not associated with cannabis initiation (odds ratio; 95% confidence interval 1.00; 0.79-1.27), but it was associated with an increased likelihood of any cannabis use (1.31; 1.12-1.53), daily cannabis use (1.40; 1.09-1.80) and cannabis dependence (1.98; 1.29-3.04).

DISCUSSION AND CONCLUSIONS

Cannabis legalisation was not associated with cannabis initiation, but it was associated with an increased likelihood of any cannabis use, daily cannabis use and cannabis dependence.

The potential adverse effects of minors' exposure to alcohol-related stimuli via licenced venues: A narrative review

ISSUES

Young people are particularly impressionable when it comes to forming expectations and attitudes around alcohol consumption. Any stimuli that normalise and foster positive expectations around alcohol use may increase the risk of underage alcohol consumption. Alcohol venues that market themselves as being appropriate 'family friendly' establishments for children risk exposing minors to environments that are saturated with alcohol-related stimuli. However, research examining how exposure to licenced venues affects underage people is very limited. The aim of this narrative review was to identify and synthesise relevant evidence to better understand how attending these venues might affect minors.

APPROACH

A narrative review of research published between January 2016 and November 2022 was conducted to investigate the potential effects on underage people of exposure to licenced venues and stimuli encountered in/around these venues. Examined stimuli included alcohol advertising, people consuming alcohol and alcohol outlets.

KEY FINDINGS

The reviewed literature indicates that the risk of alcohol-related harm among minors is likely to increase with greater exposure to alcohol venues due to the associated exposure to alcohol advertising, exposure to others consuming alcohol and higher outlet density. In combination, these factors are likely to normalise alcohol consumption for minors and create positive alcohol expectancies.

IMPLICATIONS AND CONCLUSION

Venues serving alcohol should be discouraged from targeting families and parents should be warned about the risks associated with taking minors to venues where alcohol is sold and consumed.

Association of service facilities and amenities with adolescent birth rates in Mexican cities

BACKGROUND

The association of the built environment and the structural availability of services/amenities with adolescent birth rates (ABR) has been overlooked in Latin America. We investigated the association of the availability, and changes in the availability, of services/amenities with ABR in 92 Mexican cities.

METHODS

We estimated ABR using data on live birth registration linked to municipality of residence at the time of birth from 2008-2017. The number of services/amenities were obtained from the National Statistical Directory of Economic Units in 2010, 2015, and 2020 and grouped as follows: education, health care, pharmacies, recreation, and on- and off-premises alcohol outlets. Data were linearly interpolated to obtain yearly estimates. We estimated densities per square km by municipality. We fitted negative binomial hybrid models, including a random intercept for municipality and city, and adjusted for other social environment variables.

RESULTS

After adjustment a 1-unit increase in the density of recreation facilities, pharmacies, and off-premises alcohol outlets within municipalities was associated with a 5%, 4% and 12% decrease in ABR, respectively. Municipalities with higher density of education, recreational and health care facilities had a lower ABR; in contrast, municipalities with a higher density of on-premises alcohol experienced a higher ABR.

CONCLUSION

Our findings highlight the importance of economic drivers and the need to invest in infrastructure, such as pharmacies, medical facilities, schools, and recreation areas and limit the availability of alcohol outlets to increase the impact of current adolescent pregnancy prevention programs.

How Can We Measure Alcohol Outlet Density Around Schools? A Comparison Between Two Buffer-Based Methods

Measuring the density of alcohol outlets around schools is a critical step towards understanding the drivers of drinking among adolescents. Different methodologies have been used in the literature for this purpose, but the implications of using one methodology or another have not been clearly assessed. Our aim was to compare different methods to measure alcohol outlet density and highlight under which characteristics of the environment might be best using each approach. We used Geographic Information Systems to geolocate schools (n = 576) and alcohol outlets (n = 21,732) in Madrid. We defined the density of alcohol outlets as the number of establishments within an area of 400 m around schools measured using two buffering methods: crow flies' and street network distances. We evaluated the agreement between both methods visually and through regression models, including street connectivity, population density, and density of recreational venues as predictors of disagreement. The density of alcohol outlets around schools was higher using crow flies' distances compared to street network distances. The differences between methodologies were wider in areas of higher density of outlets, especially in the downtown areas, where there are higher population density and street connectivity. Our results suggest that the spatial characteristics and morphology of the study area (e.g., street connectivity and population density) should be considered when deciding the methodology to be used to measure alcohol outlet density. Future studies should explore the implications of different exposure measures in their association with drinking prevalence and consumption patterns among different geographical contexts.

Nutritional content and quality of processed foods and beverages advertised near schools in three cities in the north of Spain

The advertisement of food and beverages on television and social media has been widely assessed, evidencing its powerful influence on children's dietary patterns and the development of childhood obesity. However, there is a gap in the evidence about advertisements near schools. The aim of this study was to describe and classify the nutritional quality and information of processed foods and alcoholic and non-alcoholic beverages advertised near schools in three cities in the north of Spain. A descriptive analysis was performed from September to December 2021 in the cities of Oviedo, Gijón and Avilés in the Principality of Asturias (Spain). The nutritional quality and information of processed foods or beverages advertised within a 500 m radius of schools were assessed. The Nutri-Score system was used for the classification of the nutritional quality of products and nutritional information, calories, fat, saturated fat, carbohydrates, sugars, protein and salt in 100 g or ml of each product was calculated. A total of 73.5% of the products were classified as "foods to eat less often and in small amounts," and 22.6% and 46.3% were classified as D or E, respectively, according to the Nutri-Score system. Finally, 57.5%, 56.4% and 78.5% of the products showed a medium to high content of fat, saturated fat and sugar, respectively. In conclusion, the food and drink advertisements surrounding schools in the assessed cities promote many products of low nutritional value, rich in fat, saturated fat and sugars, which have high obesogenic potential.

Clarifying rural-urban disparities in alcohol-related emergency department visits and hospitalizations in Ontario, Canada: A spatial analysis

PURPOSE

Rates of alcohol-related harm are higher in rural versus urban Canada. This study characterized the spatial distribution and regional determinants of alcohol-related emergency department (ED) visits and hospitalizations in Ontario to better understand this rural-urban disparity.

METHODS

This was a cross-sectional spatial analysis of rates of alcohol-related ED visits and hospitalizations by Ministry of Health subregion (n = 76) in Ontario, Canada between 2016 and 2019. Regional hot- and cold-spots of alcohol-related harm were identified using spatial autocorrelation methods. Rurality was measured as the population weighted geographic remoteness of a subregion. The associations between rurality and rates of alcohol-related ED visits and hospitalizations were evaluated using hierarchical Bayesian spatial regression models.

FINDINGS

Rates of alcohol-related ED visits and hospitalizations varied substantially between subregions, with high rates clustering in Northern Ontario. Overall, increasing rurality was associated with higher subregion-level rates of alcohol-related ED visits (males adjusted relative rate [aRR]: 1.67, 95% credible interval [CI]: 1.49-1.87; females aRR: 1.78, 95% CI: 1.60-1.98) and hospitalizations (males aRR: 1.34, 95% CI: 1.24-1.45; females aRR: 1.59, 95% CI: 1.45-1.74). However, after the province was separated into Northern and Southern strata, this association only held in Northern subregions. In contrast, increasing rurality was associated with lower rates of alcohol-related ED visits in Southern subregions (males aRR: 0.87, 95% CI: 0.79-0.96; females aRR: 0.88, 95% CI: 0.81-0.97).

CONCLUSIONS

There are regional differences in the association between rurality and alcohol-related health service use. This regional variation should be considered when developing health policies to minimize geographic disparities in alcohol-related harm.

Inequalities in children's exposure to alcohol outlets in Scotland: a GPS study

BACKGROUND

Alcohol use is a leading cause of harm in young people and increases the risk of alcohol dependence in adulthood. Alcohol use is also a key driver of rising health inequalities. Quantifying inequalities in exposure to alcohol outlets within the activity spaces of pre-adolescent children-a vulnerable, formative development stage-may help understand alcohol use in later life.

METHODS

GPS data were collected from a nationally representative sample of 10-and-11-year-old children (n = 688, 55% female). The proportion of children, and the proportion of each child's GPS, exposed to alcohol outlets was compared across area-level income-deprivation quintiles, along with the relative proportion of exposure occurring within 500 m of each child's home and school.

RESULTS

Off-sales alcohol outlets accounted for 47% of children's exposure, which was higher than expected given their availability (31% of alcohol outlets). The proportion of children exposed to alcohol outlets did not differ by area deprivation. However, the proportion of time children were exposed showed stark inequalities. Children living in the most deprived areas were almost five times more likely to be exposed to off-sales alcohol outlets than children in the least deprived areas (OR 4.83, 3.04-7.66; P < 0.001), and almost three times more likely to be exposed to on-sales alcohol outlets (OR 2.86, 1.11-7.43; P = 0.03). Children in deprived areas experienced 31% of their exposure to off-sales outlets within 500 m of their homes compared to 7% for children from less deprived areas. Children from all areas received 22-32% of their exposure within 500 m of schools, but the proportion of this from off-sales outlets increased with area deprivation.

CONCLUSIONS

Children have little control over what they are exposed to, so policies that reduce inequities in alcohol availability should be prioritised to ensure that all children have the opportunity to lead healthy lives.

Alcohol Accessibility and Family Violence-related Ambulance Attendances

There is substantial evidence supporting the association between alcohol license density and violent crime. However, the impact of different types of alcohol licenses on intimate partner and family violence is sparse. We explored the associations between access to alcohol outlets, and family and intimate partner violence using paramedic clinical records, given this service is often the first to respond to acute crises. Coded ambulance attendance data from 694 postcodes in Victoria, Australia, from July 1, 2016 to June 30, 2018 where alcohol or another drug, mental health or self-harm associated with family or intimate partner violence was indicated were examined. A hybrid model of spatial autoregressive and negative binomial zero-inflated Poisson-based count regression models was used to examine associations with alcohol outlet density and socioeconomic factors. We found that access to a liquor license outlet was significantly associated with family violence-related attendances across all types of outlets, including on-premise (late night) licenses (β = 1.73, SE: 0.18), restaurant licenses (β = 0.83, SE: 0.28), and packaged liquor licenses (β = 0.62, SE: 0.06). Our results demonstrate a significant relationship between alcohol-related harms in the context of family violence and provides evidence of the relationship between alcohol-related family violence in both victims and perpetrators. The findings of this study highlight the need for public health interventions such as licensing policy and town planning changes to reduce these harms by restricting alcohol availability.

Association of Neighborhood Alcohol Environment With Alcohol Intake and Cardiovascular Risk Factors in India: Cross-Sectional Evidence From APCAPS

There are more and more proofs about the impact of neighborhood alcohol environment on alcohol-associated events. The relationship between the neighborhood availability and accessibility of alcohol outlet with individual level of alcohol consumption along with 11 cardiovascular risk factors was explored for the first time in India using data from the 3rd follow-up of the Andhra Pradesh children and parents study (APCAPS) (n = 6156, for liquor intake and 5,641 for heart and blood vessel risk elements). In fully adjusted models, volunteers in the lowest tertile performed worse than volunteers in the highest tertile of distance to the closest alcohol outlet were more probably to exhibit less alcohol consumption (-14.40 g/day, 95% CI: -26.21, -2.59). A unit per km2 rise in alcohol outlet density in 400 m buffering area was related to a rise in waist circumference (1.45 mm, 95% CI: 0.13, 2.77), SBP (0.29 mmHg, 95% CI: 0.09, 0.49), and DBP (0.19 mmHg, 95% CI: 0.03, 0.35). A unit per 100 m rise in distance to the closest alcohol outlet was related to a rise in waist circumference (-2.39 mm, 95% CI: -4.18, -0.59), SBP (-0.41 mmHg, 95% CI: -0.68, -0.15), and DBP (-0.29 mmHg, 95% CI: -0.51, -0.07). Neighborhood availability of alcohol outlets within immediate locality of participants' households had a closer relationship with cardiovascular risk factors than that within the whole village. Public health policies designed to limit neighborhood availability and accessibility of alcohol outlets ought to be advocated in southern India.

Accessibility and availability of alcohol outlets around schools: An ecological study in the city of Madrid, Spain, according to socioeconomic area-level

Neighborhood accessibility and availability of alcohol products has been associated with increased alcohol consumption and harms among adolescents. This availability has been shown to be higher in neighborhoods with lower socio-economic status (SES). The aim of this study was to examine inequalities in alcohol outlet density and proximity around schools by area-level SES in Madrid, Spain. Data on schools, SES, alcohol outlets and population density at census tract level were obtained through public databases from the local government of Madrid. We examined (1) density as the number of alcohol outlets around schools within 3 buffers (i.e. 200 m, 400 m and 800 m) and (2) proximity as the distance from schools to their nearest alcohol outlet. We performed multilevel analyses to examine the associations between alcohol outlet density and proximity and SES, adjusted by population density. Secondary schools (n = 576) located in less deprived areas had lower densities of alcohol outlets at walking distances of 200 and 400 m (50% and 37% lower, respectively p < 0.05). No significant differences were found for the proximity measures. The socioeconomic level of the area in which adolescents go to school is a determinant of their exposure to alcohol, where those who study in high SES areas have lower exposure to alcohol outlets. This study highlights the need to prioritize equity in the design and implementation of policies to limit alcohol accessibility among adolescents, including establishing minimum distances between schools and alcohol outlets or limiting the number of outlets per inhabitant in neighborhoods.

Hazardous alcohol use and alcohol-related harm in rural and remote communities: a scoping review

Alcohol use is a major risk factor for death and disease worldwide and alcohol-related harms appear to be more prevalent in rural and remote, relative to urban, communities. This Review synthesised international research on rural-urban disparities in hazardous and harmful alcohol use and risk factors for these outcomes within rural and remote communities. 280 studies from 49 countries were included in the Scoping Review. Most studies (60%) found rural, relative to urban, residence to be associated with an increased likelihood of hazardous alcohol use or alcohol-related harm. This proportion increased between 1990 and 2019 and varied by country, age group, and outcome type, being highest in Australia, among young adults, and for more severe alcohol-related harms, such as drink driving and alcohol-related suicide. Improved public health strategies to reduce the burden of alcohol use in rural communities are required but their efficacy will depend on how well they are tailored to the unique needs of the region they are implemented in.

ESSE-RF study: epidemiology and public health promotion

The largest population-based study in Russian modern history the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) for 8 years has become a platform for public health research and projects, relevant for the whole country. Results of the ESSE-RF study were used to identify Demography National Project parameters, to model mortality and morbidity risk at the population level, to estimate the economic burden of risk factors, to predict the economic effect of population prevention measures, to assess the feasibility of using novel biomarkers for risk stratification, as well as for external evaluation of health care system. Further, results can be used to develop a novel cardiovascular risk score, to analyze COVID-19-related risk factors, and to study health protection environment. Epidemiological studies ESSE-RF1 and ESSE-RF2 have already become a significant component of public health system in Russia, and taking into account the scope of the ESSE-RF3 study (30 regions), the role of epidemiology will increase.

[Community food environment and presence of food swamps around schools in a Brazilian metropolis]

The study aimed to assess the community food environment and the existence of food swamps around schools in a Brazilian metropolis. This was an ecological study in public and private schools in Belo Horizonte, Minas Gerais State, Brazil, with a 250-meter buffer as the analytical unit. The study included all preschool, elementary, and middle schools. In relation to the schools, the study evaluated administrative regimen (public versus private), type of teaching, and per capita income in the schools' census tracts. Information was also compiled on the retail food establishments inside the buffer zone around the schools. The food environment was characterized only according to the establishments around the schools that sold food for immediate consumption. Analysis of the buffers revealed that 97.4% of the schools had at least one establishment in the vicinity that sold food for immediate consumption. The most available establishments around schools were snack bars, restaurants, and bars. Schools located in higher-income census tracts showed higher mean numbers of all establishments in their vicinity, except for grocery stores and supermarkets. In addition, 54.6% of the schools were in neighborhoods classified as food swamps. The results that the among the target categories, there was a predominance of establishments that mainly sell ultra-processed foods such as bars and snack bars in the vicinity of schools in Belo Horizonte, which exposes children and adolescents to an unhealthy food environment.

Alcohol outlets availability in school neighborhoods and alcohol use among adolescents

This cross-sectional study investigated the association between alcohol use by adolescents and the availability of alcohol outlets in the neighborhood of public schools. We collected primary data including variables at individual and school neighborhood level. Multilevel logistic regression was used to estimate odds ratio (OR) with a 95% confidence interval (95%CI) for alcohol use with the exposure variables. A total of 18.4% (95%CI: 13.2; 24.1) of adolescents reported using alcohol, which was associated with variables on the individual level such as being 18 years or older, working, and having previously smoked. Lower alcohol use was observed among adolescents from schools that were located 250m or more from alcohol outlets (OR = 0.29; 95%CI: 0.17; 0.48). Actions to reduce the use of alcohol among adolescents should take student's and school neighborhood's characteristics into account.

What explains the concentration of off-premise alcohol outlets in Black neighborhoods?

INTRODUCTION

Greater availability of commercial alcohol is associated with increased alcohol use and related public health problems. Greater alcohol outlet density, a marker of alcohol availability, is associated with poorer and predominantly minority neighborhoods. However, poorer populations, African Americans, and Latinxs report using less alcohol compared to Whites and wealthier groups. We consider the role of structural racism in the social ecology of alcohol availability. Specifically we examine racist urban land use practices in the USA which became codified in the 1930s through Federal Home Owner Lending Corporation (HOLC) designations for assigning parcel values, known as "redlining." Redlining demarcated low-density residential zones for wealthy Whites which excluded poor and non-White people as well as certain businesses, including alcohol retailers. We assessed the impacts of historic redlining on present day risks for exposure to retail alcohol availability in urban Northern California.

METHODS

For six contiguous and demographically diverse Northern California cities we obtained digital renderings of HOLC maps (1937) which demarcated exclusions of people and businesses for 119 neighborhood areas across four land valuation zones. We then identified the most prevalent HOLC rating for each of 520 current Census block groups in the six cities, including a residual category for areas not rated by HOLC. We geolocated all current (2016) off-premise alcohol sales outlets operating in the six cities (N = 401). We used Bayesian spatial Poisson models to relate current alcohol outlet densities and Census-based estimates of neighborhood characteristics to historic HOLC classifications.

RESULTS

Spatial Poisson analyses found far greater contemporary off-premise outlet densities in the lowest-valued HOLC zones than in the highest (median relative rate [RR] 9.6, 95% CI 4.8-22.1). The lowest-valued HOLC zones were also characterized by far higher current percentages of both Black residents (RR 30.4, 95% CI 17.0-54.6) and Hispanic residents (RR 9.7, 95% CI 7.2-12.9).

CONCLUSIONS

Present day risks for exposure to retail alcohol availability were delimited by historic exclusionary land use practices. Current inequitable health risks may be founded on racist spatial projects of past decades.

Close proximity to alcohol outlets is associated with increased crime and hazardous drinking: Pooled nationally representative data from New Zealand

This nationwide study investigated the relationship between proximity to alcohol outlets (off-licence, on-licence, and other-licence) and two adverse outcomes; hazardous drinking and crime (common assault, non-aggravated sexual assault, aggravated sexual assault, and tobacco and liquor offences). After adjustment for important individual- and area-level factors, close proximity to alcohol outlets was associated with increased risk of hazardous drinking, with strong associations for on-licence outlets. Proximity alcohol outlets was also strongly associated with all crime outcomes, often with a dose-response relationship. Nationally representative New Zealand data showed that close proximity to alcohol outlets was associated with increased crime and hazardous drinking.

Comparison of drinking prevalence among Thai youth before and after implementation of the Alcoholic Beverage Control Act

BACKGROUND

Underage drinking contributes to numerous health and social problems among adolescents. The Alcoholic Beverage Control Act, issued in Thailand in 2008, contains several clauses aiming at preventing underage and novice drinking, such as raising the minimum legal purchasing age from 18 to 20, banning alcohol sale and consumption in places frequented by youth, and banning alcohol advertisements.

OBJECTIVES

To estimate the changes in the prevalence of alcohol consumption and perceptions of drinking norms among high-school students 8 years after the Act was implemented.

METHODS

Data from the Thai national high-school surveys in 2007 (N = 50,033; 49.9% female) and 2016 (N = 38,535; 49.8% female), using similar questionnaires, were analyzed. Prevalence rates and group norms toward drinking were compared between the two surveys, using weighted Poisson regression and prevalence ratios.

RESULTS

Drinking prevalence significantly increased in females, with prevalence ratios ranging from 1.2 for 30-day intoxication to 2.1 for 30-day binging. In males, the 12-month drinking prevalence increased in 2016, but a non-significant change for binge drinking and a 40% decrease for intoxication was seen. Higher proportions of students in 2016 perceived that most of their friends also drank alcohol compared to students in 2007 (16.8% vs. 11.2%; 49.8% increase). A significant effect of the year of survey on drinking patterns was seen across all school levels.

CONCLUSION

Drinking rates decreased among males, but increased in females. These changes may be somewhat due to the Act, or to changes in the social environment in Thailand over this 8-year period.

Densidade de estabelecimentos que comercializam bebidas alcoólicas na área residencial está associada ao consumo de álcool em adolescentes?

RESUMO: Objetivos: Investigar a associação entre a densidade de estabelecimentos de venda de bebidas alcoólicas no entorno da residência dos adolescentes e a prevalência de consumo de álcool na vida e atual, ajustado por fatores individuais e familiares. Métodos: As informações provêm da pesquisa domiciliar por amostragem probabilística estratificada e por conglomerados em três estágios (setor censitário, domicílio, adulto e adolescente), realizada em Belo Horizonte, Brasil (Saúde em Beagá, 2008-9) e de fontes oficiais de estabelecimentos que comercializam bebidas alcoólicas, devidamente georreferenciados. O desfecho foi o autorrelato de consumo de álcool na vida e atual pelos adolescentes. A variável de exposição foi a densidade de estabelecimentos definida como número de locais de venda de bebida dentro do buffer de 200 metros da residência dos adolescentes. A associação foi estimada pela regressão de Poisson ajustada por fatores individuais e familiares. Resultados: Participaram 601 adolescentes de 14-17 anos; 53,3% eram homens e 71% tinham renda familiar até cinco salários mínimos. A prevalência de consumo de álcool na vida foi de 57,0% (intervalo de confiança de 95% - IC95% 51,5 - 62,6) e o atual de 11,9% (IC95% 8,7 - 15,0). Na análise multivariada, verificou-se associação significativa entre o consumo atual de bebidas alcoólicas e a densidade de lanchonetes (razão de prevalência - RP = 1,13; IC95% 1,03 - 1,24), bares (RP = 1,21; IC95% 1,05 - 1,38) e restaurantes (RP = 1,11; IC95% 1,02 - 1,21). Interações significativas entre densidade de estabelecimentos com sexo e idade foram encontradas. Conclusão: O consumo atual de álcool pode ser potencializado pela presença de alguns tipos de estabelecimentos localizados no buffer de 200 metros da residência dos adolescentes.

Potential Causal Influence of Neighborhood Disadvantage on Disordered Gambling: Evidence From a Multilevel Discordant Twin Design

The quality of the neighborhood in which one lives has been linked to disordered gambling (DG), but whether this reflects a causal relation has not yet been empirically examined. Participants were 3,450 Australian twins who completed assessments of past-year DG and personality and for whom census-derived indicators of disadvantage were used to characterize their neighborhood. Multilevel models were employed to estimate within-twin-pair and betweentwin-pair effects of neighborhood disadvantage on DG, with the within-twin-pair effect representing a potentially causal association and the between-twin-pair effect representing a noncausal association. There was robust evidence for a potentially causal (as well as a non-causal) effect of neighborhood disadvantage on DG (in contrast, parallel analyses of past-year alcohol use disorder failed to find evidence of a potentially causal effect). These results support efforts focused on identifying the active ingredients contributing to the effect of neighborhood disadvantage on DG and developing interventions to limit their impact.

Leisure activity participation in relation to alcohol purchasing and consumption in adolescence

BACKGROUND

Building upon the socioecological perspective, this study examines prospective associations linking leisure activity participation with alcohol purchasing and consumption in early adolescence.

METHODS

A total of 1763 seventh graders (age 12-13 years) were recruited from middle schools in urban Taiwan via multi-stage sampling and followed-up 1.5 years later during ninth grade. Information about leisure activities, covariates (i.e., gender, puberty development, family structure, parental educational attainment, monthly allowance, peer drinking, and childhood alcohol experience), and two outcome variables (i.e., alcohol purchasing and drinking behaviors) was gathered via web-based self-administered questionnaires. Data concerning alcohol outlets and recreational resource for each community district were retrieved from official statistics and commercial sources. Two-level hierarchical generalized linear models were used to evaluate association estimates.

FINDINGS

Five percent of ninth graders ever purchased alcohol and nearly one in seven drank alcohol on three or more occasions (i.e., occasional drinking) in the past year. Sports, unstructured, and organized leisure activities were not linked with illegal alcohol purchasing when community contexts were statistically adjusted; a higher community on-premised alcohol outlet density increased alcohol purchasing by 94% (95% CI = 1.24-3.06). In contrast, unstructured leisure activity participation at 7th grade predicted occasional drinking (adjusted Odds Ratio [aOR] = 5.52; 95% CI = 3.13-9.74). Sports participation was associated with reduced risk of occasional drinking in the communities with high unregulated alcohol outlets (aOR for interaction = 0.58; P < .001).

CONCLUSION

Our research provides insights to differential roles of leisure activity participation in shaping adolescents' commercial alcohol access and occasional drinking. Macro-social contexts should be considered in the efforts to reduce underage drinking problems through leisure activities.

Surveying Alcohol Outlet Density in Four Neighborhoods of Beirut Lebanon: Implications for Future Research and National Policy

Underage drinking among youth in Lebanon is increasing. Regulating availability is one of the best buy policies recommended by the World Health Organization. To quantitatively document the current status of alcohol availability to youth in Lebanon, we used GPS technology to survey alcohol outlet density in four highly populated neighborhoods in Beirut, Lebanon, and to estimate their proximity to educational institutions. The density of alcohol outlets ranged from 18.30 to 80.95 per km² (average of 39.6 alcohol outlets/km²). The highest number of total alcohol outlets was in the “Hamra & Jamiaa” area, which includes one of the largest private universities in the country. Thirteen out of 109 (12%) alcohol outlets (on and off-premise) were located less 100 m away from educational institutions, in violation of the current licensing law. None of the off-premise and the majority (94%) of on-premise alcohol outlets displayed the “no sale for <18” sign. Findings were indicative of an environment conducive to increased access and availability of alcohol among youth in Lebanon probably attributed to the prevailing weak alcohol policies and their enforcement. Systematic collection and reporting of alcohol outlet densities is critical to understand the alcogenic environment and guide local harm reduction policies.

Gentrification and binge drinking in California neighborhoods: It matters how long you've lived there

BACKGROUND

Neighborhood context plays a role in binge drinking, a behavior with major health and economic costs. Gentrification, the influx of capital and residents of higher socioeconomic status into historically-disinvested neighborhoods, is a growing trend with the potential to place urban communities under social and financial pressure. Hypothesizing that these pressures and other community changes resulting from gentrification could be tied to excessive alcohol consumption, we examined the relationship between gentrification and binge drinking in California neighborhoods.

METHODS

California census tracts were categorized as non-gentrifiable, stable (gentrifiable), or gentrifying from 2006 to 2015. Outcomes and covariates were obtained from the California Health Interview Survey using combined 2013-2015 data (n = 60,196). Survey-weighted logistic regression tested for associations between gentrification and any binge drinking in the prior 12 months. Additional models tested interactions between gentrification and other variables of interest, including housing tenure, federal poverty level, race/ethnicity, sex, and duration of neighborhood residence.

RESULTS

A third of respondents reported past-year binge drinking. Controlling for demographic covariates, gentrification was not associated with binge drinking in the population overall (AOR = 1.13, 95% CI = 0.95-1.34), but was associated with binge drinking among those living in the neighborhood <5 years (AOR = 1.49, 95% CI 1.15-1.93). No association was seen among those living in their neighborhood ≥5 years.

CONCLUSIONS

For those newer to their neighborhood, gentrification is associated with binge drinking. Further understanding the relationship between gentrification and high-risk alcohol use is important for policy and public health interventions mitigating the impact of this process.

Adolescents' alcohol use and strength of policy relating to youth access, trading hours and driving under the influence: findings from Australia

AIMS

To determine (i) whether the strength of Australian alcohol control policy in three domains (youth access, trading hours and drink driving) changed during the 2000s; and (ii) estimate associations between these policies and adolescent drinking after adjusting for television alcohol advertising exposures, alcohol outlet density, alcohol price changes, exposure to negative articles about alcohol in daily newspapers and adult drinking prevalence.

DESIGN

Repeated cross-sectional surveys conducted triennially from 2002 to 2011. Multi-level modelling examined the association between alcohol control policies and drinking prevalence after adjusting for covariates.

SETTING

Four Australian capital cities between 2002 and 2011.

PARTICIPANTS

Students aged 12-17 years participating in a triennial national representative school-based survey (sample size range/survey: 9805-13 119).

MEASUREMENTS

Outcome measures were: past month drinking and risky drinking (5+ drinks on a day) in the past 7 days. Policy strength in each of three domains (youth access, trading hours, drink-driving) were the key predictor variables. Covariates included: past 3-month television alcohol and alcohol-control advertising, alcohol outlet density, alcohol price change, negatively framed newspaper alcohol articles, adult drinking prevalence and student demographic characteristics.

FINDINGS

During the study period, the strength of youth access policies increased by 10%, trading hours policies by 14% and drink-driving policies by 58%. Past-month and risky drinking prevalence decreased (e.g. past-month: 2002: 47.4% to 2011: 26.3%). Multivariable analyses that included all policy variables and adjusted for year, student and other covariates showed past-month drinking to be associated inversely with stronger trading hours policies [odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.69, 0.94], but not youth access (OR = 0.92 95% CI = 0.81, 1.04) or drink-driving (OR = 1.00, 95% CI = 0.93, 1.09). Risky drinking was associated inversely with stronger youth access policies (OR = 0.82, 95% CI = 0.69, 0.98), but not trading hours (OR = 0.85, 95% CI = 0.66, 1.09) or drink-driving (OR = 1.02, 95% CI = 0.90, 1.14) policies.

CONCLUSIONS

Population-directed policies designed to reduce alcohol availability and promotion may reduce adolescents' alcohol use.

Does Industry-Driven Alcohol Marketing Influence Adolescent Drinking Behaviour? A Systematic Review

Aim

To systematically review evidence on the influence of specific marketing components (Price, Promotion, Product attributes and Place of sale/availability) on key drinking outcomes (initiation, continuation, frequency and intensity) in young people aged 9–17.

Methods

MEDLINE, EMBASE, SCOPUS, PsychINFO, CINAHL and ProQuest were searched from inception to July 2015, supplemented with searches of Google Scholar, hand searches of key journals and backward and forward citation searches of reference lists of identified papers.

Results

Forty-eight papers covering 35 unique studies met inclusion criteria. Authors tended to report that greater exposure to alcohol marketing impacted on drinking initiation, continuation, frequency and intensity during adolescence. Nevertheless, 23 (66%) studies reported null results or negative associations, often in combination with positive associations, resulting in mixed findings within and across studies. Heterogeneity in study design, content and outcomes prevented estimation of effect sizes or exploration of variation between countries or age subgroups. The strength of the evidence base differed according to type of marketing exposure and drinking outcome studied, with support for an association between alcohol promotion (mainly advertising) and drinking outcomes in adolescence, whilst only two studies examined the relationship between alcohol price and the drinking behaviour of those under the age of 18.

Conclusion

Despite the volume of work, evidence is inconclusive in all four areas of marketing but strongest for promotional activity. Future research with standardized measures is needed to build on this work and better inform interventions and policy responses.

The role of neighborhood disadvantage, physical disorder, and collective efficacy in adolescent alcohol use: a multilevel path analysis

Research into the salient exposures which explain neighborhood variation in adolescent alcohol use remains inconclusive. The Social Disorganization Theory suggests that neighborhood-level disadvantage may reduce collective efficacy to control adolescent risky behavior. Collective perceptions of physical disorder are also implicated in this neighborhood pathway. Drawing on data from a nationally-representative survey of urban high school students in New Zealand, multilevel path analysis was used to estimate the direct and mediating effects of neighborhood disadvantage, physical disorder, and collective efficacy on current drinking, frequency of binge drinking, and typical quantity of alcohol consumed. The findings supported an indirect pathway from disadvantage to binge drinking and high typical quantities in young adolescents (<16 years), mediated by physical disorder and reduced collective efficacy. Collective efficacy was not associated with current drinking in young adolescents. An opposing indirect effect was evident among older adolescents (≥16 years), whereby collective efficacy was positively associated with drinking outcomes. Implications for future research are discussed.

Differential Effects of Neighborhood Type on Adolescent Alcohol Use in New Zealand

Identifying neighborhood typologies associated with adolescent alcohol use can inform the development of harm reduction strategies. Utilizing data from a nationally representative youth survey (n = 4267) in New Zealand, latent class analysis was used to categorize neighborhood types (defined by 10 demographic, social and environmental indicators) to investigate their association with alcohol consumption and related harm. Three neighborhood types were distinguished: (1) "high outlet density and economic deprivation" (30 % of all neighborhoods); (2) "high deprivation, social disorganization, and unsafe" (38 %); and (3) "higher income, safe, and socially organized" (32 %). Significant ethnic variation was evident between neighborhood types. There was an age-group interaction in the main effects with significant associations between neighborhood type and drinking measures and harm most apparent among younger adolescents (<16 years), as described next. Compared to students residing in "higher income, safe, and socially organized" neighborhoods, the frequency of binge drinking and high typical consumption was significantly higher in students residing in "high outlet density and economic deprivation" and "high deprivation, social disorganization, and unsafe", with students residing in "high outlet density and economic deprivation" also experiencing higher levels of alcohol-related harm. The findings that neighborhoods characterized by high deprivation and alcohol outlet density and low social organization and perceptions of safety were associated with risky drinking patterns and harm, specifically among young adolescents, underscores the importance of adopting a developmental approach to the study of contextual effects on adolescents.

Residential environments, alcohol advertising, and initiation and continuation of alcohol consumption among adolescents in urban Taiwan: A prospective multilevel study

Background

Research indicates that place characteristics and the media environment are important contextual determinants of underage drinking behaviors in Western countries, but it is unknown whether these exposures influence adolescent alcohol consumption outside Western contexts, including in Asia׳s emerging global alcohol markets. Guided by the social ecological framework, we prospectively investigated the influences of place characteristics and alcohol advertising on initiation and continuation of alcohol consumption among adolescents in Taipei, Taiwan.

Methods

Data on individual-level characteristics, including alcohol use behaviors and perceived exposure to alcohol advertising, were obtained from two waves of a longitudinal school-based study through a stratified probability sampling method in 2010 (Grade 7/Grade 8, aged 13-14 years old) and 2011-2012 (Grade 9, aged 15 years old) from 1795 adolescents residing in 22 of 41 districts in Taipei. Data on district-level characteristics were drawn from administrative sources and Google Street View virtual audit to describe districts where adolescents lived at baseline. Hierarchical generalized linear models tested hypotheses about the associations of place characteristics and perceived alcohol advertising with underage drinking, with stratification by baseline lifetime alcohol consumption.

Results

Among alcohol-naïve adolescents, lower district-level economic disadvantage, a higher proportion of betel nut kiosks (a relatively unregulated alcohol source) compared to off-premises alcohol outlets, and exposure to television-based alcohol advertising predicted increased likelihood of alcohol initiation at one-year follow-up. Among alcohol-experienced adolescents, greater spatial access to off-premises alcohol outlets, and lower access to metro rapid transportation (MRT) and to temples were found to predict a subsequent increased likelihood of continued alcohol use. Parental drinking moderated the relationship between district-level violent crime and initiation of alcohol consumption.

Conclusions

These findings suggest that local social economic status, alcohol access, and institutional resource and individual media exposure affect underage drinking behaviors in Taiwan. We discuss potential public health implications for place-based interventions. Future research on place, media, and adolescent alcohol consumption in Asian contexts is warranted.

Neighborhood Contextual Factors, Alcohol Use, and Alcohol Problems in the United States: Evidence From a Nationally Representative Study of Young Adults

BACKGROUND

There is considerable variation in alcohol use and problems across the United States, suggesting that systematic regional differences might contribute to alcohol involvement. Several neighborhood contextual factors may be important aspects of this "alcohol environment."

METHODS

Participants were 15,197 young adults (age 18 to 26) from Wave III of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative U.S. survey. Measures of past-year alcohol use and problems were obtained via structured in-home interviews. Tract-level neighborhood contextual factors (density of on- and off-premises alcohol outlets, neighborhood disadvantage, rural vs. urban residence) were derived from census indicators and geocoded state-level alcohol outlet licenses. Multivariate logistic regression, ordered logistic regression, or negative binomial regression models, including age, sex, race, and household income as covariates, were fit to examine the relation of the neighborhood contextual factors with alcohol use and problems.

RESULTS

The most consistent finding across 4 of the 5 measures of alcohol involvement was their association with neighborhood advantage; the active ingredient underlying this effect was primarily the proportion of educated residents in the neighborhood. The densities of alcohol outlets were associated with any alcohol use-they were not associated with binge drinking or alcohol problems, nor could they explain any of the neighborhood advantage effects. The influence of alcohol outlet densities on alcohol involvement did not differ for those above or below the legal age to purchase alcohol. Living in a rural versus an urban neighborhood was associated with a different alcohol use pattern characterized by a lower likelihood of any drinking, but among those who drank, consuming more alcohol per occasion.

CONCLUSIONS

Living in a more advantaged and educated urban neighborhood with greater densities of bars and restaurants is associated with greater alcohol involvement among 18- to 26-year-olds in the United States.