Geographical differences in the financial impacts of different forms of tobacco licence fees on small retailers in Scotland.

OBJECTIVE: Retailer licencing fees are a promising avenue to regulate tobacco availability. However, they face strong opposition from retailers and the tobacco industry, who argue significant financial impacts. This study compares the impacts of different forms of tobacco licence schemes on retailers' profits in Scotland. METHODS: We calculated gross profits from tobacco sales in 179 convenience stores across Scotland using 1 099 697 electronic point-of-sale records from 16 weeks between 2019 and 2022. We estimated different fees using universal, volumetric and separate urban/rural schemes. We identified the point at which 50% of retailers would no longer make a gross profit on tobacco sales for each scheme and modelled the financial impact of 10 incremental fee levels. The financial impact was assessed based on changes in retailers' tobacco gross profits. Differences by neighbourhood deprivation and urban/rural status were examined. RESULTS: The gross profit from tobacco per convenience store averaged £15 859/year. Profits were 2.29 times higher in urban (vs rural) areas and 1.59 times higher in high-deprivation (vs low-deprivation) areas, attributable to higher sales volumes. Tobacco gross profit decreased proportionally with increasing fee levels. Universal and urban/rural fees had greater gross profit reductions in rural and/or less deprived areas, where profits were lower, compared with volumetric fees. CONCLUSION: The introduction of tobacco licence fees offers a potential opportunity for reducing the availability of tobacco retailers. The likely impact of a tobacco licence fee is sensitive to the type of licence scheme implemented, the level at which fees are set and the retailers' location in relation to neighbourhood deprivation and rurality.

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.

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.

Availability and promotion of alcohol across different outlet typologies and under different area-level socioeconomic status. / Disponibilidad y promoción de alcohol según la tipología de los locales y las condiciones socioeconómicas del área.

We aimed to characterize the availability and promotion of alcohol at alcohol outlets in Madrid and to compare them according to type of outlet and area-level socioeconomic status. We used the OHCITIES instrument to characterise the alcohol outlets in 42 census tracts of Madrid in 2016. We specified alcohol availability as the density of alcohol outlets and the number of alcohol outlets with extended opening hours (12 or more). We registered any type of promotion associated to alcohol outlets that could be perceived from outside the outlet. We calculated and compared proportions of availability and promotion by alcohol outlet (on- and off-premise) using chi-squared and Fisher Exact tests. We estimated the availability and promotion of alcohol densities per census tract according to area-level socioeconomic status. To assess statistical significance, we used Kruskal-Wallis tests. We recorded 324 alcohol outlets, 241 on-premise and 83 off-premise. Most of the outlets had extended opening hours (73.77%) and at least one sign promoting alcohol (89.51%). More on-premise outlets had extended opening hours and higher presence of alcohol promotion than off-premise (p < 0.001). Higher density of alcohol outlets, extended opening hours and presence of alcohol promotion were found in higher socioeconomic areas (all p < 0.001). These results were also observed for on-premise alcohol outlets. Alcohol availability and promotion were associated with alcohol outlets in Madrid. Future alcohol policies regulating the availability and promotion of alcohol should consider outlet types and area-level socioeconomic status.

El objetivo fue caracterizar la disponibilidad y promoción de alcohol asociados a los locales de venta y consumo de alcohol en Madrid, así como explorar las diferencias en su distribución en función de la tipología del local y las características socioeconómicas del área. Se utilizó el instrumento OHCITIES para caracterizar locales situados en 42 secciones censales de Madrid durante 2016. Se registró la densidad de locales y el número de locales con amplios horarios de apertura (12 o más horas). Se registró cualquier tipo de promoción asociada al local visible desde el exterior. Se compararon los porcentajes de características de disponibilidad y promoción asociada a los locales de consumo y venta de alcohol utilizando el test de chi cuadrado y la prueba exacta de Fisher. Se estimó la densidad de disponibilidad y promoción por sección censal y se exploró su distribución en función de las características socioeconómicas del área mediante el test de Kruskal-Wallis. Se registraron 324 locales, 241 de consumo y 83 de venta. La mayoría tenía un horario amplio de apertura (73,77%) y algún elemento promocional (89,51%). Los locales de consumo tenían horarios más amplios de apertura y más elementos promocionales que los de venta (p < 0,001). Se encontraron mayor densidad de locales, amplitud de horarios y elementos promocionales en áreas de nivel socioeconómico alto (todos p < 0,001). La disponibilidad y promoción estuvieron asociadas con los locales de venta y consumo de alcohol en Madrid. Futuras políticas cuyo objetivo sea la prevención del consumo de alcohol deben tener en cuenta la influencia de los tipos de locales y las características socioeconómicas del área en la distribución de la disponibilidad y promoción de alcohol.

Tobacco Retail Environment and Smoking: A Systematic Review of Geographic Exposure Measures and Implications for Future Studies.

INTRODUCTION: To review the geographic exposure measures used to characterize the tobacco environment in terms of density of tobacco outlets and proximity to tobacco outlets, and its association with smoking-related outcomes. METHODS: We used PubMed and Google Scholar to find articles published until December 2019. The search was restricted to studies that (1) measured the density of and/or proximity to tobacco outlets and (2) included associations with smoking outcomes. The extraction was coordinated by several observers. We gathered data on the place of exposure, methodological approaches, and smoking outcomes. RESULTS: Forty articles were eligible out of 3002 screened papers. Different density and proximity measures were described. 47.4% density calculations were based on simple counts (number of outlets within an area). Kernel density estimations and other measures weighted by the size of the area (outlets per square kilometer), population, and road length were identified. 81.3% of the articles which assessed proximity to tobacco outlets used length distances estimated through the street network. Higher density values were mostly associated with higher smoking prevalence (76.2%), greater tobacco use and smoking initiation (64.3%), and lower cessation outcomes (84.6%). Proximity measures were not associated with any smoking outcome except with cessation (62.5%). CONCLUSION: Associations between the density of tobacco outlets and smoking outcomes were found regardless of the exposure measure applied. Further research is warranted to better understand how proximity to tobacco outlets may influence the smoking outcomes. This systematic review discusses methodological gaps in the literature and provides insights for future studies exploring the tobacco environment. IMPLICATIONS: Our findings pose some methodological lessons to improve the exposure measures on the tobacco outlet environment. Solving these methodological gaps is crucial to understand the influence of the tobacco environment on the smoking outcomes. Activity spaces should be considered in further analyses because individuals are exposed to tobacco beyond their residence or school neighborhood. Further studies in this research area demand density estimations weighted by the size of the area, population, or road length, or measured using Kernel density estimations. Proximity calculations should be measured through the street network and should consider travel times apart from the length distance.

Mapping the visibility of smokers across a large capital city.

BACKGROUND: Smoking visibility may affect smoking norms with implications for tobacco initiation, particularly amongst youths. Understanding how smoking is distributed across urban environments would contribute to the design and implementation of tobacco control policies. Our objective is to estimate the visibility of smokers in a large urban area using a novel GIS-based methodological approach. METHODS: We used systematic social observation to gather information about the presence of smokers in the environment within a representative sample of census tracts in Madrid city in 2016. We designed a GIS-based methodology to estimate the visibility of smokers throughout the whole city using the data collected in the fieldwork. Last, we validated our results in a sample of 40 locations distributed across the city through direct observation. RESULTS: We mapped estimates of smokers' visibility across the entire city. The visibility was higher in the central districts and in streets with a high density of hospitality venues, public transportation stops, and retail shops. Peripheral districts, with larger green areas and residential or industrial land uses, showed lower visibility of smokers. Validation analyses found high agreement between the estimated and observed values of smokers' visibility (R = 0.845, p=<0.001). DISCUSSION: GIS-based methods enable the development of novel tools to study the distribution of smokers and their visibility in urban environments. We found differences in the visibility by population density and leisure, retail shops and business activities. The findings can support the development of policies to protect people from smoking.

Estimating and mapping cigarette butt littering in urban environments: A GIS approach.

BACKGROUND: Cigarette butts are some of the most common form of litter in the World, causing severe environmental damage. Analysing spatial distribution of cigarette butts in the urban environment may lead to useful insights for further interventions to reduce this form of litter. In this study, we present a GIS-based methodology to estimate the density of cigarette butts across a large urban area. METHODS: We collected information about discarded cigarette butts in outdoor public spaces by systematic social observation in a diverse sample of areas in Madrid, Spain. We used these data to estimate the density of cigarette butts in public spaces around the entire city by performing GIS analyses based on Kernel Density Estimations. Last, we validated these measures using on-field observations in a set of locations across the city. RESULTS: Hospitality venues and public transportation stops were the places with the highest concentrations of cigarette butts, followed by the entrances to educational venues and playgrounds. Central districts showed the highest amount of cigarette butts in contrast to peripheral ones. We found that our measure had good validity, with a correlation coefficient of 0.784. DISCUSSION: This is the first study estimating and mapping cigarette butt litter in a large urban area. We identified a set of outdoor public places with high concentrations of cigarette butts and found geographical unevenness in the distribution of this pervasive form of litter across the study area. Our findings demonstrate the ubiquitous nature of cigarette butts in the urban environment and the need for interventions to reduce its impact on both people's health and the environment.

Regulating the local availability of tobacco retailing in Madrid, Spain: a GIS study to evaluate compliance.

BACKGROUND: In Spain, tobacco sales are limited to tobacco-exclusive stores and associated vending machines. A minimum of 150 m between stores is required, unless they exceed a legal sales threshold. Minimum distances to schools are recommended but not defined. We evaluated compliance with these regulations in Madrid, Spain. METHODS: Information about tobacco-exclusive stores and their sales volume was obtained in 2014. We used geographic information system to identify stores closer than 150 m between them and examine whether they exceeded the sales threshold. We estimated distances between stores and schools, considering different distance intervals (<150 m, 150-300 m and >300 m) and calculations (crow flies and street network). We assessed the association of area-level demographic and socioeconomic characteristics with the distribution of tobacco stores. RESULTS: 5.3% (34/638) of tobacco stores were within 150 m of each other. Among those, 76% (26/34) did not meet the regulation sales threshold. These stores were in areas with lower proportion of young population (<15 years) and higher proportion of people with university-level education. 75% (476/638) of stores were situated closer than 300 m to schools. No differences were identified in sociodemographic and economic characteristics by the store distance to schools. CONCLUSION: Most tobacco stores are compliant with the regulations in Spain. However, these regulations are insufficient to reduce tobacco availability. More restrictive regulations are needed to limit the geographic distribution of tobacco retailers, and health criteria should also be considered in the current legislation. The evaluation of the Spanish regulatory model may provide useful insights for other jurisdictions looking to decrease the tobacco retail availability.

Second-hand smoke exposure in outdoor hospitality venues: Smoking visibility and assessment of airborne markers.

INTRODUCTION: After the implementation of smoke-free policies in indoor hospitality venues (including bars, cafeterias, restaurants, and pubs), smokers may have been displaced to their outdoor areas. We aimed to study smoking visibility and second-hand smoke exposure in outdoor hospitality venues. METHODS: We collected information on signs of tobacco consumption on entrances and terraces of hospitality venues in 2016 in the city of Madrid, Spain. We further measured airborne nicotine concentrations and particulate matter of less than 2.5 µm in diameter (PM2.5) in terraces with monitors by active sampling during 30 min. We calculated the medians and the interquartile ranges (IQR) of nicotine and PM2.5 concentrations, and fitted multivariate models to characterize their determinants. RESULTS: We found 202 hospitality venues between May and September (summer), and 83 between October and December 2016 (fall) that were opened at the time of observation. We found signs of tobacco consumption on 78.2% of the outdoor main entrances and on 95.1% of outdoor terraces. We measured nicotine and PM2.5 concentrations in 92 outdoor terraces (out of the 123 terraces observed). Overall median nicotine concentration was 0.42 (IQR: 0.14-1.59) µg/m3, and overall PM2.5 concentration was 10.40 (IQR: 6.76-15.47) µg/m3 (statistically significantly higher than the background levels). Multivariable analyses showed that nicotine and PM2.5 concentrations increased when the terraces were completely closed, and when tobacco smell was noticed. Nicotine concentrations increased with the presence of cigarette butts, and when there were more than eight lit cigarettes at a time. CONCLUSIONS: Outdoor hospitality venues are areas where non-smokers, both employees and patrons, continue to be exposed to second-hand smoke. These spaces should be further studied and considered in future tobacco control interventions.

The mismatch between observational measures and residents' perspectives on the retail food environment: a mixed-methods approach in the Heart Healthy Hoods study.

OBJECTIVE: To gain a deeper understanding of the retail food environment by investigating similarities and differences between objective measures and residents' perspectives. DESIGN: The study incorporated Geographic Information System (GIS)-based measures, in-store surveys and the results from a larger photovoice project. We combined these data using a convergent parallel mixed-methods approach. SETTING: We conducted this study in a low-income neighbourhood in Madrid (Spain) in 2016. SUBJECTS: We assessed healthy food availability, accessibility and affordability using GIS-based measures and in-store audits. We also analysed the photographs and discussions from twelve participants who engaged in a photovoice project on their food environment. RESULTS: Quantitative results depicted a widely served and highly accessible retail food environment, in which supermarkets scored highest in terms of healthy food availability (36·5 out of 39) and 98·9 % of residents could access a healthy food store within a walking travel distance of less than 15 min. Qualitative results showed that participants preferred small local businesses over supermarkets, and revealed built environment obstacles for elderly residents. They also highlighted how the socio-economic context constrained residents' food choices. CONCLUSIONS: People's experienced retail food environment is different from the one quantitatively analysed. Results show the potential of using a mixed-methods approach to enrich food environment research and enhance public health interventions.

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.

Urban and social determinants of alcohol and tobacco consumption among adolescents in Madrid.

OBJECTIVE: This study aims to describe the accessibility to and promotion of alcohol and tobacco around secondary schools in Madrid and its distribution in relation with area-level socioeconomic deprivation; analyze the relationship between this exposure and individual consumption characteristics of students between 14 and 18 years old; and explore other facilitators of this consumption. METHOD: Mixed-methods study conducted in three phases: 1) we collected data on accessibility to and promotion of alcohol and tobacco in the environment using systematic social observation around 55 secondary schools; 2) we administered 2287 questionnaires among the students in these centers to gather information about characteristics and determinants of consumption; and 3) we conducted 20 semi-structured interviews and one discussion group to deepen in the results obtained in surveys and systematic social observation. We will use Geographic Information Systems to integrate and analyze the data from a spatial perspective.

An integrated approach to create a spatial database of parks for urban health research.

The role of urban parks has gained interest in urban health research. However, there are currently no clear definitions of these urban assets as exposure variable across the literature, which do have implications for the analysis. In this study, we exhibit an approach to design a comprehensive spatial database of urban parks in cities, using the example of Madrid. This approach consisted of the combination of different spatial databases containing information about parks and green spaces in the city of Madrid, and then a spatial processing to keep only those that met the selected criteria for urban park definition: accessible for pedestrians (to have at least one path around or through the area) and with the minimum size suitable (bigger than 0.50ha) for physical activity. This approach can be helpful to design spatial databases that enable conducting epidemiological studies on the relationship between urban parks and population health.

Using Geovisualization Tools to Examine Attitudes towards Alcohol Exposure in Urban Environments: A Pilot Study in Madrid, Spain.

Pervasiveness of alcohol products and their promotion in the urban landscape may normalize alcohol consumption. This study aims to utilize geovisualization-based methods to assess attitudes towards different levels of alcohol exposure in the urban environment. We selected a typical downtown location, Lavapiés Square in Madrid, Spain, to conduct our study. First, we designed and created realistic 3D models simulating three different urban scenes with varying degrees of exposure to alcohol in the environment. Second, we used a survey on 159 adults to explore the level of acceptance of, attitudes towards, and perceptions of alcohol exposure in each scene. Participants reported a higher level of comfort in the scene with null alcohol exposure compared with the other scenes (p < 0.001). Acceptance towards alcohol exposure decreased as the level of alcohol elements increased in the scenes (p < 0.01). Acceptance also decreased when children were present in the scenes (p < 0.01). This study demonstrated that geovisualization tools provide a useful and well-suited approach to analyze perceptions of the alcohol environment. The use of geovisualization can help understand attitudes and perceptions towards the alcohol environment and may offer a way to simulate different scenarios prior to development or retrofitting.

Influence of home/school environments on children's obesity, diet, and physical activity: the SUECO study protocol.

OBJECTIVE: The SUECO study examines the relationship between urban obesogenic environments and health outcomes among school-age children in the city of Madrid, Spain. We will study how features of the urban environment (related to the food- and the physical activity environment) associate with children's anthropometrics, eating habits, and physical activity levels. METHOD: We describe the study protocol of this multilevel study in a representative sample of school-age children in the city of Madrid (2017; n=5,961 children ages 3-12). Main outcome variables include anthropometrics (body mass index, waist circumference, and body fat), healthy and unhealthy consumption measures, and physical activity measures. The primary explanatory variables are grouped into food environment (e.g., unhealthy food retailers' density) and physical activity environment (e.g., walkability, physical activity opportunities) variable categories. Multilevel models will be used to calculate the associations between each indicator and obesity and physical inactivity.