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Myran DT, Friesen E, Talarico R, Gaudreault A, Taljaard M, Hobin E, Smith BT, Schwartz N, Giesbrecht N, Crépault JF, Tanuseputro P, Manuel DG. The association between alcohol retail access and health care visits attributable to alcohol for individuals with and without a history of alcohol-related health-care use. Addiction 2024; 119:1554-1563. [PMID: 38804474 DOI: 10.1111/add.16566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND AIMS Alcohol retail access is associated with alcohol use and related harms. This study measured whether this association differs for people with and without heavy and disordered patterns of alcohol use. DESIGN The study used a repeated cross-sectional analysis of health administrative databases. SETTING, PARTICIPANTS/CASES All residents of Ontario, Canada aged 10-105 years with universal health coverage (n = 10 677 604 in 2013) were included in the analysis. MEASUREMENTS Quarterly rates of emergency department (ED) and outpatient visits attributable to alcohol in 464 geographic regions between 2013 and 2019 were measured. Quarterly off-premises alcohol retail access scores were calculated (average drive to the closest seven stores) for each geographic region. Mixed-effect linear regression models adjusted for area-level socio-demographic covariates were used to examine associations between deciles of alcohol retail access and health-care visits attributable to alcohol. Stratified analyses were run for individuals with and without prior alcohol-attributable health-care use in the past 2 years. FINDINGS We included 437 707 ED visits and 505 271 outpatient visits attributable to alcohol. After adjustment, rates of ED visits were 39% higher [rate ratio (RR) = 1.39, 95% confidence interval (CI) = 1.20-1.61] and rates of outpatient visits were 49% higher (RR = 1.49, 95% CI = 1.26-1.75) in the highest versus lowest decile of alcohol access. There was a positive association between alcohol access and outpatient visits attributable to alcohol for individuals without prior health-care attributable to alcohol (RR = 1.65, 95% CI = 1.39-1.95 for the highest to lowest decile of alcohol access) but not for individuals with prior health-care attributable to alcohol (RR = 1.08, 95% CI = 0.90-1.30). There was a positive association between alcohol access and ED visits attributable to alcohol for individuals with and without prior health-care for alcohol for ED visits. CONCLUSION In Ontario, Canada, greater alcohol retail access appears to be associated with higher rates of emergency department (ED) and outpatient health-care visits attributable to alcohol. Individuals without prior health-care for alcohol may be more susceptible to greater alcohol retail access for outpatient but not ED visits attributable to alcohol.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Erik Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Talarico
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Schwartz
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Norman Giesbrecht
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jean-François Crépault
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Forbes SM, Schwartz N, Fu SH, Hobin E, Smith BT. The association between off- and on-premise alcohol outlet density and 100% alcohol-attributable emergency department visits by neighbourhood-level socioeconomic status in Ontario, Canada. Health Place 2024; 89:103284. [PMID: 38875963 DOI: 10.1016/j.healthplace.2024.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/17/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
Alcohol availability is positively associated with alcohol use and harms, but the influence of socioeconomic status (SES) on these associations is not well established. This population-based cross-sectional study examined neighbourhood-level associations between physical alcohol availability (measured as off- and on-premise alcohol outlet density) and 100% alcohol-attributable emergency department (ED) visits by neighbourhood SES in Ontario, Canada from 2017 to 2019 (n = 19,740). A Bayesian spatial modelling approach was used to assess associations and account for spatial autocorrelation, which produced risk ratios (RRs) and 95% credible intervals (95% CrI). Each additional off-premise alcohol outlet in a neighbourhood was associated with a 3% increased risk of alcohol-attributable ED visits in both men (RR = 1.03, 95%CrI: 1.02-1.04) and women (RR = 1.03, 95% CrI: 1.02-1.04). Positive associations were also observed between on-premise alcohol outlet density and alcohol-attributable ED visits, although effect sizes were small. A disproportionately greater association with ED visits was observed with increasing alcohol outlet density in the lowest compared to higher SES neighbourhoods. Reducing physical alcohol availability may be an important policy lever for reducing alcohol harm and alcohol-attributable health inequities.
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Affiliation(s)
- Samantha M Forbes
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Naomi Schwartz
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Sze Hang Fu
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1.
| | - Erin Hobin
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
| | - Brendan T Smith
- Public Health Ontario, 661 University Ave, Toronto, Ontario, Canada, M5G 1M1; Dalla Lana School of Public Health, University of Toronto, 1 55 College St, Toronto, Canada, M5T 3M7.
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Hutchinson M, Swirski A, Giesbrecht N. Public health efforts to prevent expansion of alcohol retail availability in neighbourhoods with factors associated with high rates of alcohol-related harms: A case report. Drug Alcohol Rev 2024. [PMID: 38685677 DOI: 10.1111/dar.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
This commentary illustrates a recent case study within Ontario, Canada, in which the application of sociodemographic and health data was used by public health to support a legal case to oppose a retail licence application to consume liquor at a corner store located within a neighbourhood that has experienced low socio-economic factors, including low income, high unemployment and low educational attainment levels. Communities in a similar situation may draw from this situation to prevent expansion of alcohol retail availability in neighbourhoods that have low socio-economic status populations and high unemployment and other factors associated with high rates of alcohol-related harms.
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Affiliation(s)
| | | | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Giesbrecht N, Myran DT. Harms and costs of proposed changes in how alcohol is sold in Ontario. CMAJ 2024; 196:E447-E448. [PMID: 38589028 PMCID: PMC11001388 DOI: 10.1503/cmaj.240069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Norman Giesbrecht
- Dalla Lana School of Public Health (Giesbrecht), University of Toronto; Institute for Mental Health Policy Research (Giesbrecht), Centre for Addiction and Mental Health, Toronto, Ont.; Bruyère Research Institute (Myran); Department of Family Medicine (Myran), University of Ottawa; Clinical Epidemiology Program (Myran), Ottawa Hospital Research Institute; and ICES uOttawa (Myran), Ottawa, Ont.
| | - Daniel T Myran
- Dalla Lana School of Public Health (Giesbrecht), University of Toronto; Institute for Mental Health Policy Research (Giesbrecht), Centre for Addiction and Mental Health, Toronto, Ont.; Bruyère Research Institute (Myran); Department of Family Medicine (Myran), University of Ottawa; Clinical Epidemiology Program (Myran), Ottawa Hospital Research Institute; and ICES uOttawa (Myran), Ottawa, Ont
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Berasaluce M, Martín-Turrero I, Valiente R, Martínez-Manrique L, Sandín-Vázquez M, Sureda X. Urban and social determinants of alcohol and tobacco consumption among adolescents in Madrid. GACETA SANITARIA 2023; 37:102336. [PMID: 38006663 DOI: 10.1016/j.gaceta.2023.102336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/10/2023] [Accepted: 09/25/2023] [Indexed: 11/27/2023]
Abstract
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.
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Affiliation(s)
- Maitane Berasaluce
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Irene Martín-Turrero
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Roberto Valiente
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom; SPECTRUM Consortium, United Kingdom
| | - Lucía Martínez-Manrique
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Preventive Medicine, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - María Sandín-Vázquez
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, City University of New York, New York, United States of America
| | - Xisca Sureda
- 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, United States of America; Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain.
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Martín-Turrero I, Sureda X, Escobar F, Bilal U, Berasaluce M, Valiente R. How Can We Measure Alcohol Outlet Density Around Schools? A Comparison Between Two Buffer-Based Methods. J Urban Health 2023:10.1007/s11524-023-00740-z. [PMID: 37351726 DOI: 10.1007/s11524-023-00740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/24/2023]
Abstract
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.
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Affiliation(s)
- Irene Martín-Turrero
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain
| | - Xisca Sureda
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain.
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, 10027, USA.
- Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Francisco Escobar
- Department of Geology, Geography and Environmental Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Usama Bilal
- 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
| | - Maitane Berasaluce
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain
| | - Roberto Valiente
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Campus Universitario - Crta. de Madrid-Barcelona, Km. 33,600. Alcalá de Henares, 28871, Madrid, Spain
- Center for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, London, UK
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Friesen EL, Staykov E, Myran DT. Understanding the association between neighbourhood socioeconomic status and grocery store alcohol sales following market liberalization in Ontario, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:254-263. [PMID: 36214995 PMCID: PMC10036712 DOI: 10.17269/s41997-022-00694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/31/2022] [Indexed: 03/24/2023]
Abstract
OBJECTIVES In 2015, Ontario partially deregulated alcohol sales by allowing grocery stores to sell alcohol. The purpose of this study was to evaluate (1) whether neighbourhood-level socioeconomic status (SES) impacted the likelihood that a grocery store began selling alcohol, and (2) whether increases in alcohol retail availability following deregulation differed between neighbourhoods based on SES. METHODS This was a repeated cross-sectional analysis of 1062 grocery stores in 17,096 neighbourhoods in urban Ontario. The association between neighbourhood-level SES and whether a grocery store began selling alcohol was modeled using mixed effect logistic regression. The annual change in drive-distance from a neighbourhood to the closest off-premise alcohol outlet between 2015 and 2020 was modeled using mixed effect linear regression. An interaction between time and SES was included to evaluate whether this change differed between neighbourhoods based on SES. RESULTS Grocery stores in neighbourhoods in the lowest SES quintile were 39% less likely to start selling alcohol than grocery stores in neighbourhoods in the highest SES quintile (odds ratio (OR): 0.61, 95% confidence interval (CI): 0.39-0.94). As grocery store sales expanded, the distance to the closest off-premise alcohol outlet decreased by 51.8 m annually (95% CI: 48.8-54.9, p < 0.01). A significant interaction between year and SES was observed whereby this trend was more pronounced in high- versus low-SES neighbourhoods. CONCLUSION The expansion of grocery store alcohol sales increased alcohol availability, but this increase was proportionately larger in high- versus low-SES neighbourhoods. This reduced historic disparities in alcohol availability between low- and high-SES neighbourhoods.
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Affiliation(s)
- Erik Loewen Friesen
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Emiliyan Staykov
- Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Thomas Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Azra KK, Nielsen A, Kim C, Dusing GJ, Chum A. Investigating suicide related behaviours across sexual orientation and neighbourhood deprivation levels: A cohort study using linked health administrative data. PLoS One 2023; 18:e0282910. [PMID: 36989270 PMCID: PMC10058080 DOI: 10.1371/journal.pone.0282910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND There have been no studies examining how neighbourhood deprivation modifies the effects of sexual minority status on suicide-related behaviours (SRB). Sexual minority individuals in deprived areas may face unique challenges and stressors that exacerbate their risk of SRB. This study aims to investigate the association between sexual minority status and clinical SRB, and examine whether the effect of neighbourhood deprivation differs across sexual orientation. METHODS A population-representative survey sample (169,090 respondents weighted to represent 8,778,120 individuals; overall participation rate 75%) was linked to administrative health data in Ontario, Canada to measure SRB-related events (emergency department visits, hospitalizations, and deaths) from 2007 to 2017. Neighbourhood-level deprivation was measured using the Ontario Marginalisation index measure of material deprivation at the dissemination area level. Discrete-time survival analysis models, stratified by sex, tested the effects of neighbourhood deprivation and sexual minority status, while controlling for individual-level covariates. RESULTS Sexual minority men had 2.79 times higher odds of SRB compared to their heterosexual counterparts (95% CI 1.66 to 4.71), while sexual minority women had 2.14 times higher odds (95% CI 1.54 to 2.98). Additionally, neighbourhood deprivation was associated with higher odds of SRB: men in the most deprived neighbourhoods (Q5) had 2.01 times higher odds (95% CI 1.38 to 2.92) of SRB compared to those in the least deprived (Q1), while women had 1.75 times higher odds (95% CI 1.28 to 2.40). No significant interactions were observed between sexual minority status and neighbourhood deprivation levels. CONCLUSION In both men and women, sexual minority status and neighbourhood deprivation are independent risk factors for SRB. Despite the lack of effect modification, sexual minorities living in the most deprived neighbourhoods have the highest chances of SRB. Future investigations should evaluate interventions and policies to improve sexual minority mental health and address neighbourhood deprivation.
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Affiliation(s)
- Karanpreet Kaur Azra
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Alcohol Use among High School Learners in the Peri-Urban Areas, South Africa: A Descriptive Study on Accessibility, Motivations and Effects. CHILDREN 2022; 9:children9091342. [PMID: 36138651 PMCID: PMC9498139 DOI: 10.3390/children9091342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022]
Abstract
Learners are vulnerable to alcohol use and its negative effects, largely due to accessibility of alcohol products, especially in the localities with poor socioeconomic status and infrastructure. This study aimed to determine the accessibility, motivations and effects of alcohol use among high school learners (n = 403) in Tshwane North and West, South Africa, using a descriptive, cross-sectional design. Data were collected using a validated questionnaire and analysed using STATA 17. Learners (16 ± 2 years) had poor demographic status and lifestyle behaviors. Availability of alcohol outlets (54%) near schools was reported, and learners indicated easy access (65%) to taverns and bottle stores (30%), and purchasing alcohol without a proof of identity document (70%). Motivations for alcohol use were self-pleasure (36%), coping with stress (24%) and increasing self-esteem (19%). Almost half of the learners (49%) introduced themselves to alcohol use, while others were influenced by friends (36%) and family (14%). Reported alcohol related effects were a negative impact on health (56%), brain function (25%) and school work (12%), in addition to social harms, including problems with friends (25%) and parents (17%), physical fights (19%) and engaging in risky sexual behaviour (11%). Effective strategies are necessary to address underage alcohol use and should include regulating the proximity of alcohol outlets to schools, life skills training to address learners’ drinking motives and constantly alerting parents about the relevance of modeling behaviour.
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Martín-Turrero I, Valiente R, Molina-de la Fuente I, Bilal U, Lazo M, Sureda X. Accessibility and availability of alcohol outlets around schools: An ecological study in the city of Madrid, Spain, according to socioeconomic area-level. ENVIRONMENTAL RESEARCH 2022; 204:112323. [PMID: 34774513 PMCID: PMC8875292 DOI: 10.1016/j.envres.2021.112323] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
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.
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Affiliation(s)
- Irene Martín-Turrero
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Roberto Valiente
- 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
| | - Irene Molina-de la Fuente
- 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
| | - Usama Bilal
- 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
| | - Mariana Lazo
- 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
| | - Xisca Sureda
- 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.
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Bozic S, Vicendese D, Livingston M, Erbas B. Mapping Problematic Drinking Trends over Time in Urban, Semi-Urban, and Rural Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010589. [PMID: 35010847 PMCID: PMC8744560 DOI: 10.3390/ijerph19010589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 12/10/2022]
Abstract
Current alcohol public health policy in Australia is not uniform but is generally focused on restricting access and early prevention of problematic alcohol use. Semi-urban and rural populations are at greater risk of disease and other poor health outcomes due to a variety of factors. Little is known about problematic drinking patterns over time in semi-urban and rural populations. This study aims to assess patterns of problematic drinking defined as both long-term risky and heavy episodic drinking over time by age, sex, and mental health status among urban, semi-urban and rural populations). Four waves (2004 to 2016) of the Australian NDSHS (National Drug Strategy Household Survey) were analyzed to assess problematic drinking of participants over 18 years of age. We used regression models and predictive margins to identify trends in problematic drinking over time based on age, sex, and mental health status. Our results show young adults across all regions, males, and mentally well individuals in urban areas have reductions in the risk of problematic drinking over time. Middle-aged adults across all regions, females, and those with varying mental health presentations in rural areas have some increases in risk of problematic drinking over time. The general conclusion is that targeted alcohol-related public health policy may need to change and focus on females, middle-aged individuals, and those living in rural areas. Programs to support problematic drinking in people with mental health disorders may also need to be a priority.
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Affiliation(s)
- Stefan Bozic
- School of Psychology and Public Health, La Trobe University, Melbourne 3083, Australia;
| | - Don Vicendese
- The Department of Mathematics and Statistics, La Trobe University, Melbourne 3083, Australia;
- The Melbourne School of Population and Global Health, University of Melbourne, Carlton 3053, Australia
| | - Michael Livingston
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne 3083, Australia;
- National Drug Research Institute, Curtin University, Perth 6845, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne 3083, Australia;
- Correspondence:
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Matthay EC, Hagan E, Joshi S, Tan ML, Vlahov D, Adler N, Glymour MM. The Revolution Will Be Hard to Evaluate: How Co-Occurring Policy Changes Affect Research on the Health Effects of Social Policies. Epidemiol Rev 2021; 43:19-32. [PMID: 34622277 PMCID: PMC8763115 DOI: 10.1093/epirev/mxab009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022] Open
Abstract
Extensive empirical health research leverages variation in the timing and location of policy changes as quasi-experiments. Multiple social policies may be adopted simultaneously in the same locations, creating co-occurrence that must be addressed analytically for valid inferences. The pervasiveness and consequences of co-occurring policies have received limited attention. We analyzed a systematic sample of 13 social policy databases covering diverse domains including poverty, paid family leave, and tobacco use. We quantified policy co-occurrence in each database as the fraction of variation in each policy measure across different jurisdictions and times that could be explained by covariation with other policies. We used simulations to estimate the ratio of the variance of effect estimates under the observed policy co-occurrence to variance if policies were independent. Policy co-occurrence ranged from very high for state-level cannabis policies to low for country-level sexual minority-rights policies. For 65% of policies, greater than 90% of the place-time variation was explained by other policies. Policy co-occurrence increased the variance of effect estimates by a median of 57-fold. Co-occurring policies are common and pose a major methodological challenge to rigorously evaluating health effects of individual social policies. When uncontrolled, co-occurring policies confound one another, and when controlled, resulting positivity violations may substantially inflate the variance of estimated effects. Tools to enhance validity and precision for evaluating co-occurring policies are needed.
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Affiliation(s)
- Ellicott C Matthay
- Correspondence to Dr. Ellicott C. Matthay, Center for Health and Community, School of Medicine, University of California San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA 94143 (e-mail: )
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13
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Myran DT, Staykov E, Cantor N, Taljaard M, Quach BI, Hawken S, Tanuseputro P. How has access to legal cannabis changed over time? An analysis of the cannabis retail market in Canada 2 years following the legalisation of recreational cannabis. Drug Alcohol Rev 2021; 41:377-385. [PMID: 34250645 DOI: 10.1111/dar.13351] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study describes the legal recreational cannabis market across Canada over the 2 years following legalisation. We compared changes in access to the legal cannabis retail market for all provinces and territories (jurisdictions) in Canada and explored differences between jurisdictions. METHODS We collected data for all legal cannabis stores in Canada over five time periods following legalisation in October 2018. We examined the following measures by jurisdiction and retail model (public vs. private operation): absolute and per capita store numbers, hours of operation and store access across neighbourhoods. RESULTS Two years following legalisation, there were a total of 1183 legal cannabis stores open across Canada (3.7 stores per 100 000 individuals aged 15+). There was wide variation between jurisdictions in access to retail stores, with the lowest stores per capita in Quebec and Ontario (0.6 and 1.6 per 100 000), and the highest in Alberta and Yukon (14.3 per 100 000 in both). Jurisdictions with private retail models had more stores (4.8 vs. 1.0 per 100 000), held greater median weekly hours (80 vs. 69) and experienced greater store growth over time compared to public models. After adjusting for confounders, there were 1.96 times (95% confidence intervals: 1.84, 2.09) more cannabis stores within 1000 m of the lowest- compared to the highest-income quintile neighbourhoods. DISCUSSION AND CONCLUSIONS While access to the recreational cannabis retail market has increased following legalisation, there is substantial variation in access between jurisdictions and evidence of concentration in lower-income neighbourhoods. These differences may contribute to disparities in cannabis use and harms.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Emiliyan Staykov
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Nathan Cantor
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Bradley I Quach
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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14
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Matthay EC, Gottlieb LM, Rehkopf D, Tan ML, Vlahov D, Glymour MM. What to Do When Everything Happens at Once: Analytic Approaches to Estimate the Health Effects of Co-Occurring Social Policies. Epidemiol Rev 2021; 43:33-47. [PMID: 34215873 PMCID: PMC8763089 DOI: 10.1093/epirev/mxab005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
Social policies have great potential to improve population health and reduce health disparities. Increasingly, those doing empirical research have sought to quantify the health effects of social policies by exploiting variation in the timing of policy changes across places. Multiple social policies are often adopted simultaneously or in close succession in the same locations, creating co-occurrence that must be handled analytically for valid inferences. Although this is a substantial methodological challenge for researchers aiming to isolate social policy effects, only in a limited number of studies have researchers systematically considered analytic solutions within a causal framework or assessed whether these solutions are being adopted. We designated 7 analytic solutions to policy co-occurrence, including efforts to disentangle individual policy effects and efforts to estimate the combined effects of co-occurring policies. We used an existing systematic review of social policies and health to evaluate how often policy co-occurrence is identified as a threat to validity and how often each analytic solution is applied in practice. Of the 55 studies, only in 17 (31%) did authors report checking for any co-occurring policies, although in 36 studies (67%), at least 1 approach was used that helps address policy co-occurrence. The most common approaches were adjusting for measures of co-occurring policies; defining the outcome on subpopulations likely to be affected by the policy of interest (but not other co-occurring policies); and selecting a less-correlated measure of policy exposure. As health research increasingly focuses on policy changes, we must systematically assess policy co-occurrence and apply analytic solutions to strengthen studies on the health effects of social policies.
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Affiliation(s)
- Ellicott C Matthay
- Correspondence to Dr. Ellicott C. Matthay, Center for Health and Community, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143 (e-mail: )
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15
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Lardier DT, Opara I, Lin Y, Roach E, Herrera A, Garcia-Reid P, Reid RJ. A Spatial Analysis of Alcohol Outlet Density Type, Abandoned Properties, and Police Calls on Aggravated Assault Rates in a Northeastern U.S. City. Subst Use Misuse 2021; 56:1527-1535. [PMID: 34210249 PMCID: PMC8324007 DOI: 10.1080/10826084.2021.1942053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Community-based research and prevention scholarship has shown a growing interest in examining the impact of the ecological structure of neighborhoods on community violence. Ecological structures such as higher numbers of alcohol outlets and abandoned/vacant properties in geographically dense, poor, and socially isolated communities are critically important to consider. Further, disadvantaged urban communities are burdened by greater police presence with limited or no abatement in crime or violence. Purpose: Using Geographic Information Systems (GIS) mapping, spatial analysis techniques, and a negative binomial regression analyses, this study investigated the relationships between alcohol outlet density consisting of license C (i.e., combined on and off premises establishments) and license D (i.e., off premises establishments such as liquor stores), abandoned properties, and police calls to service on aggravated assault rates in a Northeastern United States urban city. Results: Negative binomial regression analysis results showed that license C alcohol outlet density count (IRR = 1.36, 95% CI = 1.08, 2.11), license D alcohol outlet density count (IRR = 1.13, 95% CI = 1.01, 1.30), abandoned property count (IRR = 1.28, 95% CI = 1.01, 2.01), and police call to service counts (IRR = 1.24, 95% CI = 1.01, 1.50) were positively associated with aggravated assault rates. Analyses controlled for census data characteristics. Conclusions: The link between alcohol outlet density and violent crime has been established in public health research. However, this study represents an important contribution in recognizing the unique relationships between license C and license D alcohol outlet density, abandoned properties, and police calls to service with aggravated assaults in an urban neighborhood. Conclusions are drawn for policy and practice.
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Affiliation(s)
- David T. Lardier
- Department of Individual, Family, and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Ijeoma Opara
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Yan Lin
- Department of Geography & Environmental Studies, College of Arts and Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Emily Roach
- Department of Individual, Family, and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, College of Arts and Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andriana Herrera
- Department of Public Health, College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Robert J. Reid
- Department of Family Science and Human Development, College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
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Stockwell T, Benoit C, Card K, Sherk A. Problematic substance use or problematic substance use policies? HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 40:135-142. [PMID: 32529972 DOI: 10.24095/hpcdp.40.5/6.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Cecilia Benoit
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Kiffer Card
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
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Vallance K, Stockwell T, Wettlaufer A, Chow C, Giesbrecht N, April N, Asbridge M, Callaghan R, Cukier S, Hynes G, Mann R, Solomon R, Thomas G, Thompson K. The Canadian Alcohol Policy Evaluation project: Findings from a review of provincial and territorial alcohol policies. Drug Alcohol Rev 2021; 40:937-945. [DOI: 10.1111/dar.13251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria Victoria Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria Victoria Canada
| | - Ashley Wettlaufer
- Centre for Addiction and Mental Health Institute for Mental Health Policy Research Toronto Canada
| | - Clifton Chow
- Canadian Institute for Substance Use Research, University of Victoria Victoria Canada
| | - Norman Giesbrecht
- Centre for Addiction and Mental Health Institute for Mental Health Policy Research Toronto Canada
| | - Nicole April
- Direction du développement des individus et des communautés Institut national de santé publique du Québec Québec City Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine Dalhousie University Halifax Canada
| | - Russell Callaghan
- Northern Medical Program University of Northern British Columbia Prince George Canada
| | - Samantha Cukier
- Centre for Journalogy Ottawa Hospital Research Institute Ottawa Canada
| | - Geoff Hynes
- Population Health, Canadian Institute for Health Information Ottawa Canada
| | - Robert Mann
- Centre for Addiction and Mental Health Institute for Mental Health Policy Research Toronto Canada
| | | | - Gerald Thomas
- Canadian Institute for Substance Use Research, University of Victoria Victoria Canada
| | - Kara Thompson
- Department of Psychology St. Francis Xavier University Antigonish Canada
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18
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Giesbrecht N, Wettlaufer A, Stockwell T, Vallance K, Chow C, April N, Asbridge M, Callaghan R, Cukier S, Hynes G, Mann RE, Solomon R, Thomas G, Thompson K. Alcohol retail privatisation in Canadian provinces between 2012 and 2017. Is decision making oriented to harm reduction? Drug Alcohol Rev 2020; 40:459-467. [PMID: 33319402 DOI: 10.1111/dar.13229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Policy changes may contribute to increased alcohol-related risks to populations. These include privatisation of alcohol retailing, which influences density of alcohol outlets, location of outlets, hours of sale and prevention of alcohol sales to minors or intoxicated customers. Meta-analyses, reviews and original research indicate enhanced access to alcohol is associated with elevated risk of and actual harm. We assess the 10 Canadian provinces on two alcohol policy domains-type of alcohol control system and physical availability of alcohol-in order to track changes over time, and document shifting changes in alcohol policy. METHODS Our information was based on government documents and websites, archival statistics and key informant interviews. Policy domains were selected and weighted for their degree of effectiveness and population reach based on systematic reviews and epidemiological evidence. Government representatives were asked to validate all the information for their jurisdiction. RESULTS The province-specific reports based on the 2012 results showed that 9 of 10 provinces had mixed retail systems-a combination of government-run and privately owned alcohol outlets. Recommendations in each provincial report were to not increase privatisation. However, by 2017 the percentage of off-premise private outlets had increased in four of these nine provinces, with new private outlet systems introduced in several. DISCUSSION AND CONCLUSIONS Decision-making protocols are oriented to commercial interests and perceived consumer convenience. If public health and safety considerations are not meaningfully included in decision-making protocols on alcohol policy, then it will be challenging to curtail or reduce harms.
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Affiliation(s)
- Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Ashley Wettlaufer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Clifton Chow
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Nicole April
- Direction du développement des individus et des communautés, Institut National de Santé Publique du Québec, Québec City, Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Russell Callaghan
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada
| | - Samantha Cukier
- Centre for Journalogy, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Geoff Hynes
- Population Health, Canadian Institute for Health Information, Ottawa, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Gerald Thomas
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Kara Thompson
- Department of Psychology, St. Francis Xavier University, Antigonish, Canada
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van der Maas M, Giesbrecht N, Stoduto G, Orpana H, Geneau R, Mann R. Drinking patterns, alcohol-related harm and views on policies: results from a pilot of the International Alcohol Control Study in Canada. Health Promot Chronic Dis Prev Can 2020; 40:165-175. [PMID: 32529976 PMCID: PMC7367431 DOI: 10.24095/hpcdp.40.5/6.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We conducted a pilot assessment of the feasibility of implementing the International Alcohol Control (IAC) Study in Ontario, Canada, to allow for future comparisons on the impacts of alcohol control policies with a number of countries. METHODS The IAC Study questionnaire was adapted for use in the province of Ontario, and a split-sample approach was used to collect data. Data were collected by computer-assisted telephone interviewing of 500 participants, with half the sample each answering a subset of the adapted IAC Study survey. RESULTS Just over half of the sample (53.6%) reported high frequency drinking (once a week or more frequently), while 6.5% reported heavy typical occasion drinking (8 drinks or more per session). Self-reported rates of alcohol-related harms from one's own and others' drinking were relatively low. Attitudes towards alcohol control varied. A substantial majority supported more police spot checks to detect drinking and driving, while restrictions on the number of alcohol outlets and increases in the price of alcohol were generally opposed. CONCLUSION This pilot study demonstrated that the IAC Study survey can be implemented in Canada with some modifications. Future research should assess how to improve participation rates and the feasibility of implementing the longitudinal aspect of the IAC Study. This survey provides additional insight into alcohol-related behaviours and attitudes towards alcohol control policies, which can be used to develop appropriate public health responses in the Canadian context.
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Affiliation(s)
- Mark van der Maas
- School of Social Work, Rutgers University, New Brunswick, New Jersey, United States of America
| | | | - Gina Stoduto
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Heather Orpana
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Geneau
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Robert Mann
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Ghanem L, Lee JP, Sumetsky N, Pagano A, Gruenewald P, Mair C. Place management in off-premise alcohol outlets: Results of a multi-methods study in a six-city California area. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 80:102735. [PMID: 32416539 DOI: 10.1016/j.drugpo.2020.102735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Associations between neighborhood crime and alcohol outlets are often theorized as resulting from poor place management. Barriers and supports to place management have been examined for on-premise (bars, restaurants) but not for off-premise alcohol outlets. Few studies have assessed place management issues across a range of off-premise outlet and neighborhood types, and none have included the perspectives of off-premise outlet managers themselves. Combining qualitative and quantitative methods within an ethnographic approach, we investigated barriers and supports to place management across off-premise outlets in a large urban area. METHODS We unobtrusively assessed outlet operating characteristics including crime prevention strategies at all 403 off-premise outlets in six contiguous California cities; interviewed managers in 40 outlets; and conducted extensive naturalistic observations in 15 of these 40 outlets. We analyzed data for frequencies and thematic content. RESULTS Small and independently operated off-premise outlets were the most common type of outlet in our study, but demonstrated fewer resources and more challenges to place management compared to large and chain establishments. Security guards were more observed in large and chain outlets. Small and independent outlets were more likely to post signs prohibiting loitering and to enable surveillance of interior spaces. Problems most commonly cited by managers were theft and loitering. Challenges to place management included physical and verbal threats from customers and intoxicated persons, and insufficient law enforcement. Managers evidenced some ability to assert authority over interior, private space, but less so over exterior, public space. CONCLUSIONS Although tasked with maintaining public health and safety, small and independent store managers reported challenges that are seldom acknowledged in policy or research literature. Managers may provide valuable insights on preventing and reducing neighborhood-level problems associated with off-premise alcohol outlets. Local communities should consider enhancing place management resources for managers of small and independent outlets.
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Affiliation(s)
- Lina Ghanem
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue #601, Berkeley CA 94704, United States.
| | - Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue #601, Berkeley CA 94704, United States.
| | - Natalie Sumetsky
- School of Public Health, University of Pittsburgh, 6136 Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, United States.
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue #601, Berkeley CA 94704, United States.
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, 2150 Shattuck Avenue #601, Berkeley CA 94704, United States.
| | - Christina Mair
- School of Public Health, University of Pittsburgh, 6136 Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, United States.
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Myran DT, Hsu AT, Smith G, Tanuseputro P. Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study. CMAJ 2020; 191:E804-E810. [PMID: 31332048 DOI: 10.1503/cmaj.181575] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Alcohol use causes a large burden on the health of Canadians, and alcohol-related harms appear to be increasing in many high-income countries. We sought to analyze changes in emergency department visits attributable to alcohol use, by sex, age and neighbourhood income over time. METHODS All individuals aged 10 to 105 years living in Ontario, Canada, between 2003 and 2016 were included in this study. The primary outcome was age-standardized rates of emergency department visits attributable to alcohol use, defined using diagnostic codes from the Canadian Institute for Health Information Health Indicator "hospitalizations entirely caused by alcohol." We compared rates of these visits using a retrospective population-level design. RESULTS Among 15 121 639 individuals, there were 765 346 emergency department visits attributable to alcohol use over the study period. Between 2003 and 2016, the age-standardized rates of these visits increased more in women (86.5%) than in men (53.2%), and the increase in rates of emergency department visits attributable to alcohol use was 4.4 times greater than the increases in the rates of overall emergency department visits. Individuals aged 25-29 years experienced the largest change in the rate of emergency department visits attributable to alcohol use (175%). We found evidence of age-cohort effects, whereby the rate of emergency department visits attributable to alcohol use at age 19 years increased on average by 4.07% (95% confidence interval [CI] 3.71%-4.44%) per year for each cohort born between 1986 and 1999. Individuals in the lowest neighbourhood income quintile had 2.37 (95% CI 2.27-2.49) times the rate of emergency department visits attributable to alcohol use than those in the highest income quintile. This disparity increased slightly over the study period. INTERPRETATION Although men and lower-income individuals have the highest burden of emergency department visits attributable to alcohol use, the largest increases in visits have been in women and younger adults. Further research should focus on potential causes of these trends to provide guidance on how to reduce alcohol-related harms.
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Affiliation(s)
- Daniel T Myran
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
| | - Amy T Hsu
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Glenys Smith
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- School of Epidemiology and Public Health (Myran), Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program (Hsu, Smith), The Ottawa Hospital, Ottawa Hospital Research Institute; ICES uOttawa (Smith); Bruyère Research Institute (Hsu, Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
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Myran DT, Brown CRL, Tanuseputro P. Access to cannabis retail stores across Canada 6 months following legalization: a descriptive study. CMAJ Open 2019; 7:E454-E461. [PMID: 31409593 PMCID: PMC6715107 DOI: 10.9778/cmajo.20190012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND On Oct. 17, 2018, Canada legalized recreational cannabis with the dual goals of reducing youth use and eliminating the illicit cannabis market. We examined factors associated with access to physical cannabis stores across Canada 6 months following legalization. METHODS We extracted the address and operating hours of all legal cannabis stores in Canada from online government and private listings. We conducted a descriptive study examining the association between private/hybrid (mixture of government and private stores) and government-only retail models with 4 measures of physical access to cannabis: store density, weekly hours of operation, median distance to the nearest school and relative availability of cannabis stores between low- and high-income neighbourhoods. RESULTS Six months after legalization, there were 260 cannabis retail stores across Canada: 181 privately run stores, 55 government-run stores and 24 stores in the hybrid retail system. Compared to jurisdictions with a government-run model, jurisdictions with a private/hybrid retail model had 49% (95% confidence interval 10%-200%) more stores per capita, retailers were open on average 9.2 more hours per week, and stores were located closer to schools (median 166.7 m). In both retail models, there was over twice the concentration of cannabis stores in neighbourhoods in the lowest income quintile compared to the highest income quintile. INTERPRETATION Marked differences in physical access to cannabis retail are emerging between jurisdictions with private/hybrid retail models and those with government-only retail models. Ongoing surveillance including monitoring differences in cannabis use and harms across jurisdictions is needed.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program (Myran, Brown, Tanuseputro), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Myran, Brown), University of Ottawa; Bruyère Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
| | - Catherine R L Brown
- Clinical Epidemiology Program (Myran, Brown, Tanuseputro), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Myran, Brown), University of Ottawa; Bruyère Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- Clinical Epidemiology Program (Myran, Brown, Tanuseputro), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Myran, Brown), University of Ottawa; Bruyère Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
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