. 2022 Mar;204(Pt C):112323.

doi: 10.1016/j.envres.2021.112323. Epub 2021 Nov 10.

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

Irene Martín-Turrero¹, Roberto Valiente², Irene Molina-de la Fuente³, Usama Bilal⁴, Mariana Lazo⁵, Xisca Sureda⁶

Affiliations

¹ Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain.
² Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Geology, Geography and Environmental Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.
³ Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain; Malaria and NTDs Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain.
⁴ Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA.
⁵ Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Johns Hopkins, Center for Health Equity, Johns Hopkins University, Baltimore, MD, 21205, USA.
⁶ Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, 10027, United States; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; CIBER Respiratory Diseases (CIBERES), Madrid, Spain. Electronic address: francisca.sureda@uah.es.

PMID: 34774513
PMCID: PMC8875292
DOI: 10.1016/j.envres.2021.112323

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

Irene Martín-Turrero et al. Environ Res. 2022 Mar.

. 2022 Mar;204(Pt C):112323.

doi: 10.1016/j.envres.2021.112323. Epub 2021 Nov 10.

Authors

Irene Martín-Turrero¹, Roberto Valiente², Irene Molina-de la Fuente³, Usama Bilal⁴, Mariana Lazo⁵, Xisca Sureda⁶

Affiliations

¹ Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain.
² Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Geology, Geography and Environmental Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.
³ Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain; Malaria and NTDs Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain.
⁴ Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA.
⁵ Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Department of Community Health and Prevention, Drexel Dornsife School of Public Health, Philadelphia, PA, 19104, USA; Johns Hopkins, Center for Health Equity, Johns Hopkins University, Baltimore, MD, 21205, USA.
⁶ Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, 10027, United States; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; CIBER Respiratory Diseases (CIBERES), Madrid, Spain. Electronic address: francisca.sureda@uah.es.

PMID: 34774513
PMCID: PMC8875292
DOI: 10.1016/j.envres.2021.112323

Abstract

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.

Keywords: Accessibility; Adolescent health; Alcohol; Availability; GIS; Inequalities; Schools; Spain.

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Conflict of interest statement

Conflicts of interest: None declared.

Figures

**Figure 1.**
Spatial distribution of public schools, private schools and alcohol outlets in the city of Madrid, using kernel density estimations.

**Figure 2.**
Spatial distribution of socioeconomic status and schools according to their typology (public or private) and the availability of alcohol outlets within 200 meters around them in Madrid, 2017.

See this image and copyright information in PMC

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

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

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Conflict of interest statement

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