Gender Matters: Identity, Risk Perception and Preventive Interventions for Alcohol Consumption among Adolescents Using a Qualitative Approach

The epidemiological information available in Spain and the Community of Madrid highlights two relevant facts regarding alcohol consumption: an increase in binge drinking in teenagers and a reduction/reversal of the gender gap, particularly at young ages. This article aims to describe some of the factors related to alcohol use in teenagers, especially those related to gender and risk perception. A qualitative study was designed with semi-structured interviews and a discussion group with students from the city of Madrid aged 14 to 18 years. A descriptive analysis of the content of the replies of 28 teenagers was conducted. The results show that alcohol consumption has an identity component, both in terms of transition to adulthood and gender role performance. Consumption is also associated with risks, especially those determined by gender inequality, which teenagers learn to manage as a means of survival in nightlife. Preventive campaigns typically lack a gender perspective and a focus on risk prevention. To reduce the prevalence of consumption and associated risks, these strategies need to be reformulated with a gender perspective

Exploring perceptions of alcohol consumption in unlicensed public places among individuals aged 40 and over: A qualitative study across socioeconomically diverse neighbourhoods in Madrid, Spain

Alcohol consumption in unlicensed public places has become a topic of intense debate in Spain due to its negative impact on health and social outcomes, and the inefficiency of current alcohol policies. This research aimed to explore the perceptions of individuals aged 40 and over regarding alcohol consumption in unlicensed public places in socioeconomically diverse neighbourhoods in Madrid. 37 semi-structured interviews and 29 focus groups were conducted in three neighbourhoods with different socioeconomic statuses. The analysis drew on Corbin and Strauss's grounded theory coding strategies. The findings of the study showed that people aged 40 and over problematised alcohol consumption in unlicensed public places, such as parks and squares. The problematisation followed a two-step process. Initially, non-compliance with current restrictions on alcohol sales during the night-time in convenience stores, including the sale of alcohol to minors, was identified as an issue. This, in turn, led to alcohol consumption in unlicensed public places, which was associated with negative outcomes such as alcohol-related litter, noise nuisance, and violence. These consequences were disproportionally perceived in the least affluent neighbourhood. To address the disproportionate impact of alcohol-related behaviours in the least affluent neighbourhoods, reinforcing existing alcohol sales policies is warranted. This may reduce alcohol consumption in unlicensed public places and its related negative outcomes

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

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, Lavapies 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

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

Qualitative examination of the perceived effects of a comprehensive smoke-free law according to neighborhood socioeconomic status in a large

Smoke-free legislations aim to protect non-smokers from second-hand smoke (SHS) exposure and improve population health outcomes. The aim of this study was to explore residents' perceptions to understand how people living in distinctive SES neighborhoods are differently affected by comprehensive smoke-free laws in a large city like Madrid, Spain. We conducted a qualitative project with 37 semi-structured interviews and 29 focus group discussions in three different SES neighborhoods within the city of Madrid. Constructivist grounded theory was used to analyze the transcripts. One core category arose in our analyses: Neighborhood inequalities in second-hand smoke (SHS) exposure in outdoor places. The enactment of the comprehensive smoke-free law resulted in unintended consequences that affected neighborhoods differently: relocation of smokers to outdoor setting, SHS exposure, noise disturbance and cigarette butt littering. Changes in the urban environment in the three neighborhoods resulted in the denormalization of smoking in outdoor public places, which was more clearly perceived in the high SES neighborhood. Changes in the built environment in outdoor areas of hospitality venues were reported to actually facilitate smoking. Comprehensive smoke-free laws resulted in denormalization of smoking, which might be effective in reducing SHS exposure. Extending smoking bans to outdoor areas like bus stops and hospitality venues is warranted and should include a public health inequalities perspective

Smoking behaviour, involuntary smoking, attitudes towards smoke-free legislations, and tobacco control activities in the European Union

The six most important cost-effective policies on tobacco control can be measured by the Tobacco Control Scale (TCS). The objective of our study was to describe the correlation between the TCS and smoking prevalence, self-reported exposure to secondhand smoke (SHS) and attitudes towards smoking restrictions in the 27 countries of the European Union (EU27)