development and evaluation of the ohcities instrument: assessing alcohol urban environments in the heart healthy hoods project

by:YEROO     2019-09-20
Abstract objective to describe the development and retest reliability of OHCITIES, a tool to describe the alcohol urban environment in terms of availability, promotion and signs of consumption.
The design involved in this study :(1)
Through literature review and previous experience in alcohol environmental research, the conceptual framework of alcohol urban environment is formulated; (2)
Pilot and redesign of the instrument; (3)
Digital instrument; (4)
Instrument evaluation using retest reliability.
On 2016, two observers collected set data for testing instrument reliability in seven census areas in Madrid.
Primary and secondary outcome measures we calculated the percentage consistency and the kappa coefficient of Cohen to estimate the mutual
Evaluation of environmental measures for alcohol export and reliability of retest.
We calculate the inter-class coefficients and their 95% CIs to provide a metric of the inter-class coefficients
Reliability of reviewers of alcohol consumption indicators.
As a result, we collected information on 92.
Premise and 24
The premise alcohol store on availability, accessibility and promotion of alcohol identified in the study area. Most per cent-
Protocol values for alcohol measurement in On-Premise and off-site
If the export of alcohol is greater than 80%, and
The reliability value of the evaluator and the retest is generally above 0. 80.
Observers noted that there were 26 streets and 3 public squares with signs of drinking.
For any type of sign of drinking, the intra-class correlation coefficient between observers is 0. 50 (95% CI −0. 09 to 0. 77).
There are few items in public places that have nothing to do with the export of alcohol to promote alcohol.
Conclusion OHCITIES instrument is a reliable instrument to characterize the alcohol city environment.
The tool can be used to understand how the alcohol environment is associated with alcohol behavior and its associated health outcomes, and to help design and evaluate policies to reduce alcohol hazards.
Objective to describe the development and retest reliability of OHCITIES, a tool to describe the alcohol urban environment in terms of availability, promotion and signs of consumption.
The design involved in this study :(1)
Through literature review and previous experience in alcohol environmental research, the conceptual framework of alcohol urban environment is formulated; (2)
Pilot and redesign of the instrument; (3)
Digital instrument; (4)
Instrument evaluation using retest reliability.
On 2016, two observers collected set data for testing instrument reliability in seven census areas in Madrid.
Primary and secondary outcome measures we calculated the percentage consistency and the kappa coefficient of Cohen to estimate the mutual
Evaluation of environmental measures for alcohol export and reliability of retest.
We calculate the inter-class coefficients and their 95% CIs to provide a metric of the inter-class coefficients
Reliability of reviewers of alcohol consumption indicators.
As a result, we collected information on 92.
Premise and 24
The premise alcohol store on availability, accessibility and promotion of alcohol identified in the study area. Most per cent-
Protocol values for alcohol measurement in On-Premise and off-site
If the export of alcohol is greater than 80%, and
The reliability value of the evaluator and the retest is generally above 0. 80.
Observers noted that there were 26 streets and 3 public squares with signs of drinking.
For any type of sign of drinking, the intra-class correlation coefficient between observers is 0. 50 (95% CI −0. 09 to 0. 77).
There are few items in public places that have nothing to do with the export of alcohol to promote alcohol.
Conclusion OHCITIES instrument is a reliable instrument to characterize the alcohol city environment.
The tool can be used to understand how the alcohol environment is associated with alcohol behavior and its associated health outcomes, and to help design and evaluate policies to reduce alcohol hazards.
Harmful drinking is one of the major contributors to the global burden of disease and a major contributor to global premature deaths and disability in the 15-59 age group.
Worldwide, harmful alcohol consumption accounts for 4% of all deaths.
In recent years, more and more attention has been paid to how the features of places of life, work and entertainment affect the health-related behavior of individuals.
3-5 physical and social environments are related to personal drinking behavior.
In the physical features of the environment, the availability and accessibility of alcoholic beverages is related to alcohol consumption and its impact on health.
Improving the availability and accessibility of liquor stores may increase the consumption of local residents through three different channels.
First, the price of alcohol products can be reduced by providing a more competitive local market;
Lower prices are closely related to higher consumption patterns.
Second, there are more opportunities for alcohol promotion, because the alcohol store is a place where alcohol drinks can be promoted, offering drinks and advertising beverage brands with discounted prices.
11 13 14 international evidence suggests that the presence of alcohol promotion in alcohol stores may be related to an increase in alcohol use.
15-17 third, by affecting alcohol
Relevant local social norms have made alcohol consumption a more acceptable practice.
The popularity of alcohol products and their promotional activities in the local area, as well as those who drink alcohol in public places, normalizes and encourages drinking behavior, especially among young people.
In recent years, several studies have used different methods to measure exposure to alcohol.
Most of the published works depend on the secondary database.
Some studies also use GIS for Advanced Spatial analysis and mapping.
At 21 26, there may be problems with the use of secondary databases because they are not verified and they do not provide a comprehensive assessment of the alcohol environment, including important information such as retailer alcohol promotions, or visibility into drinking in public places.
Subjective measurement including self
The report\'s view also used28-32 with self-limitationreport or non-response bias.
Only a few studies have been used-
Street observations that take images of alcohol, including alcohol ads and venues in city street views.
18 33-35 more effective and reliable measures are needed to fully assess a wide range of alcohol
The related stimuli we are exposed to in the city.
OHCITIES instruments are designed to describe the alcohol environment in the cities of Madrid and Barcelona as part of the \"heart health hooligans\" study, which aims to identify environmental risk factors associated with cardiovascular outcomes in European cities (
36 37 drug programs in Barcelona.
38 This tool can be adapted and used in other cities to facilitate the estimation of the association between alcohol urban environment and alcohol behavior and to design and evaluate alcohol policy interventions.
The purpose of this study is to describe the development and retest reliability of OHCITIES, a tool for describing the alcohol urban environment in terms of availability and accessibility, promotion and signs of consumption.
Development of the conceptual framework: major alcohol city environmental areas and projects involved in each area. The co-authors formed a multi-disciplinary research group including alcohol and social epidemiology experts (
XS, AE, JRV, JP and MF), demography (LB)and geography (AC and JP).
The author previously published a conceptual framework to help understand the relationship between urban environment and drinking behavior.
To conceptualize this framework, the authors have previously reviewed the literature on social and physical features related to alcohol consumption in urban settings.
The authors conducted different research strategies, including and combining search terms, such as alcohol, alcohol consumption, drinking behavior, retail, store, sales, point of sale, store, availability, accessibility, advertising, promotion or marketing.
Three main areas of urban environmental assumptions that are conducive to drinking are considered :(A)
Supply and access of alcohol; (B)
Promotion of alcohol; and (C)
Signs of drinking.
The authors further searched the instrument project for the measurement concepts related to the three alcohol domains.
The author uses a peer-to-peer network
Research reviewed, existing
Street tools that describe the alcohol environment and published reports that have been reviewed to conceptualize the conceptual framework.
Finally, the author also conducted a field visit to observe alcohol
The relevant features in the physical environment, followed by the review of the research team and the consultation of experts.
All authors reviewed the list of items, including assessing whether they are relevant and useful to describe the alcohol environment.
The availability and accessibility of alcohol includes the location and type of purchase (off-premises)or consume (on-premises)
Geographical location and address of alcohol, outlets (
In order to calculate proximity and density analysis in other studies)
And sales time.
It also includes public space activities related to alcohol sales (street vendors).
Alcohol promotion is part of the alcohol city environment, including advertising and sponsorship.
We focus on any type of promotion related to on
Venues and off-site
Places that can be observed from the street, and any type of promotion in public space (
Including streets, squares, markets, etc)
Outside the export.
Finally, we also included signs of drinking in public places.
As a venue in another area, it is also part of the physical alcohol environment that affects alcohol behavior as a measure of local norms and social acceptability.
The Pilot test and redesign of the instrument entwe Pilot tested the instrument in four convenient urban communities in Madrid and two communities in Barcelona.
The researchers chose areas they knew were exposed to alcohol.
The associated features are more likely to capture different areas of alcohol, as well as related projects in each area, such as tourism.
The instrument was applied by four trained observers (on paper)
Madrid and Barcelona in October 2015.
Data collection takes place at different days of the week and at different times of the day to check if the instrument is suitable for capturing alcohol
Related environments under different conditions, and different time points at which alcohol behavior may change.
Results from on-
Field visits enable the research team to define and clarify the concept definition for each alcohol field.
The researchers redesigned the instrument, modified the variables that caused the differences between observers, and introduced new variables that had previously been ignored, which appeared repeatedly in the evaluation area.
An example of this is a variable related to alcohol promotion.
In the first version of the tool, we only include advertising and sponsorship in display or visible windows related to the store.
We then realized the importance of including whether each promotion is related to the alcohol brand, price and food, or whether the alcohol image was included.
We also realized that promotions can also be found on the terrace and structural elements (such as labels related to the store), so we incorporated all of these items.
Table 1 shows the final version of the instrument used for evaluation.
When the observer walks in the study area, data for each alcohol domain is collected at two alcohol point of sale (on-
Venues and off-sitepremises)
Also in public space (
Streets, squares, etc ). .
At each liquor store, The Observer collects data on availability and accessibility --
Related projects and related projects to promote alcohol (table 1).
The Observer detected all items related to the export of alcohol from the outside, but did not enter.
We are-Premise and off-site
Export of alcohol.
View this table: View the inline View pop-up table 1 OHCITIES instruments: Included in-Premise and off-site
Type of socket (see table 1).
We recorded signs indicating the opening hours of the store and signs prohibiting the sale of alcohol products to minors. For off-
We also registered a ban on alcohol sales after 22: 00 (
According to Spanish regulations).
Alcohol promotions related to alcohol stores include information about the presence and quantity of advertisements and sponsorships in display or visible windows.
We also registered the presence and type of any furniture or structural elements related to alcohol products, and
The premise of direct selling promotional products on terraces (
See items included in Table 1).
For each item, we include which type of alcohol and brand to promote, if applicable, if alcohol promotion is related to price and food, and if they contain an image of alcohol.
We recorded sales and promotions of alcohol products and signs of drinking in public places outside the alcohol store.
Public spaces include streets, public squares, playgrounds, parks and any other open and green spaces.
Information on alcohol promotion in public places can be found on the advertising bulletin board (
Standards and figures)
Bus shelters, kiosks, corporate vehicles or any other element of the public domain.
We distinguish between advertising and sponsorship.
We also register anyone who conducts activities related to alcohol sales and promotions in public places, such as street vendors or pro motion that offers discounts on alcohol.
Signs of drinking include the presence and quantity of bottles, jars, glasses or similar items.
We also collect information about people who drink alcohol in public places (
Include quantity if they drink individually or collectively).
More detailed description of all alcohol-
The relevant major variables and items contained in the instrument can be seen in Table 1.
Instruments digital instruments are integrated in a digital application called an open data suite.
This app is via mobile phone (or tablets)
Operating system with Android (
The application allows data collection, including the possibility of taking photos and geo-location data using GPS (
Global Positioning System.
The application also records the date and time the data was collected.
A more detailed description of digital applications and instrument integration can be found in supplementary material 1 of the article.
Supplementary Materials 1 [SP1. pdf]
Final instrument evaluation: retest reliability research area and sample size data collection for instrument reliability evaluation were conducted in Madrid.
The city of Madrid is divided into 21 districts, and this is divided into 128 districts.
These communities are also divided into census areas, the smallest administrative region of the Spanish census (
Population = about 1000-1500 per census area).
We chose a census section in seven different communities to evaluate alcohol instruments.
The selection of census sections is based on changes in the urban export density register (
The density of outlets included in the census section is from 102 to 1812)
Ensure that there is a minimum channel for reliability analysis for each census and that there is sufficient variability in these measurements.
In May 2015, two different observers were trained to manage OHCITIES instruments.
The two observers tried the tool under the supervision of the chief researcher (XS)over a 5-hour period.
Field visit observers completed OHCITIES walking along both sides of the street in selected census areas.
The routes in each census section were previously defined using the map of the Observer after the day of data collection.
On 5 and June 2016, the two observers completed data collection, mostly between 17: 00 and 20: 00 working days.
Two observers completed OHCITIES in seven census areas at the same time (
Reduce the variability of alcohol environment over time)
But start their tasks in different locations (
Avoid interaction between them).
To determine internal reliability, one observer repeated these measures in the onecensus section for several consecutive days.
Observers simultaneously measure to minimize changes in the alcohol environment over time.
The route followed is the same as the previous day.
Collect data without informing or warning the owner, employee, customer or pedestrian to avoid bias.
Statistical analysis descriptive analysis of the variables of interest.
To estimate
For the assessors and retest reliability of environmental measurements for alcohol export, we used the percentage protocol and Cohen\'s kappa coefficient.
Provides a measure of mutual
We calculated the inter-class coefficient (ICCs)
And their 95% CIThe cut-
The deviation range of Kappa value and ICC value is as follows: 0. 0–0. 20 (weak agreement), 0. 21–0. 40 (poor agreement), 0. 41–0. 60 (
Mild agreement), 0. 61–0. 80 (
Substantive Agreement)and 0. 81–1. 00 (
Almost perfect agreement).
39 development of the conceptual framework: major alcohol urban environmental areas and projects involved in each area. The co-authors formed a multi-disciplinary research group including alcohol and social epidemiology experts (
XS, AE, JRV, JP and MF), demography (LB)and geography (AC and JP).
The author previously published a conceptual framework to help understand the relationship between urban environment and drinking behavior.
To conceptualize this framework, the authors have previously reviewed the literature on social and physical features related to alcohol consumption in urban settings.
The authors conducted different research strategies, including and combining search terms, such as alcohol, alcohol consumption, drinking behavior, retail, store, sales, point of sale, store, availability, accessibility, advertising, promotion or marketing.
Three main areas of urban environmental assumptions that are conducive to drinking are considered :(A)
Supply and access of alcohol; (B)
Promotion of alcohol; and (C)
Signs of drinking.
The authors further searched the instrument project for the measurement concepts related to the three alcohol domains.
The author uses a peer-to-peer network
Research reviewed, existing
Street tools that describe the alcohol environment and published reports that have been reviewed to conceptualize the conceptual framework.
Finally, the author also conducted a field visit to observe alcohol
The relevant features in the physical environment, followed by the review of the research team and the consultation of experts.
All authors reviewed the list of items, including assessing whether they are relevant and useful to describe the alcohol environment.
The availability and accessibility of alcohol includes the location and type of purchase (off-premises)or consume (on-premises)
Geographical location and address of alcohol, outlets (
In order to calculate proximity and density analysis in other studies)
And sales time.
It also includes public space activities related to alcohol sales (street vendors).
Alcohol promotion is part of the alcohol city environment, including advertising and sponsorship.
We focus on any type of promotion related to on
Venues and off-site
Places that can be observed from the street, and any type of promotion in public space (
Including streets, squares, markets, etc)
Outside the export.
Finally, we also included signs of drinking in public places.
As a venue in another area, it is also part of the physical alcohol environment that affects alcohol behavior as a measure of local norms and social acceptability.
The Pilot test and redesign of the instrument entwe Pilot tested the instrument in four convenient urban communities in Madrid and two communities in Barcelona.
The researchers chose areas they knew were exposed to alcohol.
The associated features are more likely to capture different areas of alcohol, as well as related projects in each area, such as tourism.
The instrument was applied by four trained observers (on paper)
Madrid and Barcelona in October 2015.
Data collection takes place at different days of the week and at different times of the day to check if the instrument is suitable for capturing alcohol
Related environments under different conditions, and different time points at which alcohol behavior may change.
Results from on-
Field visits enable the research team to define and clarify the concept definition for each alcohol field.
The researchers redesigned the instrument, modified the variables that caused the differences between observers, and introduced new variables that had previously been ignored, which appeared repeatedly in the evaluation area.
An example of this is a variable related to alcohol promotion.
In the first version of the tool, we only include advertising and sponsorship in display or visible windows related to the store.
We then realized the importance of including whether each promotion is related to the alcohol brand, price and food, or whether the alcohol image was included.
We also realized that promotions can also be found on the terrace and structural elements (such as labels related to the store), so we incorporated all of these items.
Table 1 shows the final version of the instrument used for evaluation.
When the observer walks in the study area, data for each alcohol domain is collected at two alcohol point of sale (on-
Venues and off-sitepremises)
Also in public space (
Streets, squares, etc ). .
At each liquor store, The Observer collects data on availability and accessibility --
Related projects and related projects to promote alcohol (table 1).
The Observer detected all items related to the export of alcohol from the outside, but did not enter.
We are-Premise and off-site
Export of alcohol.
View this table: View the inline View pop-up table 1 OHCITIES instruments: Included in-Premise and off-site
Type of socket (see table 1).
We recorded signs indicating the opening hours of the store and signs prohibiting the sale of alcohol products to minors. For off-
We also registered a ban on alcohol sales after 22: 00 (
According to Spanish regulations).
Alcohol promotions related to alcohol stores include information about the presence and quantity of advertisements and sponsorships in display or visible windows.
We also registered the presence and type of any furniture or structural elements related to alcohol products, and
The premise of direct selling promotional products on terraces (
See items included in Table 1).
For each item, we include which type of alcohol and brand to promote, if applicable, if alcohol promotion is related to price and food, and if they contain an image of alcohol.
We recorded sales and promotions of alcohol products and signs of drinking in public places outside the alcohol store.
Public spaces include streets, public squares, playgrounds, parks and any other open and green spaces.
Information on alcohol promotion in public places can be found on the advertising bulletin board (
Standards and figures)
Bus shelters, kiosks, corporate vehicles or any other element of the public domain.
We distinguish between advertising and sponsorship.
We also register anyone who conducts activities related to alcohol sales and promotions in public places, such as street vendors or pro motion that offers discounts on alcohol.
Signs of drinking include the presence and quantity of bottles, jars, glasses or similar items.
We also collect information about people who drink alcohol in public places (
Include quantity if they drink individually or collectively).
More detailed description of all alcohol-
The relevant major variables and items contained in the instrument can be seen in Table 1.
Instruments digital instruments are integrated in a digital application called an open data suite.
This app is via mobile phone (or tablets)
Operating system with Android (
The application allows data collection, including the possibility of taking photos and geo-location data using GPS (
Global Positioning System.
The application also records the date and time the data was collected.
A more detailed description of digital applications and instrument integration can be found in supplementary material 1 of the article.
Supplementary Materials 1 [SP1. pdf]
Final instrument evaluation: retest reliability research area and sample size data collection for instrument reliability evaluation were conducted in Madrid.
The city of Madrid is divided into 21 districts, and this is divided into 128 districts.
These communities are also divided into census areas, the smallest administrative region of the Spanish census (
Population = about 1000-1500 per census area).
We chose a census section in seven different communities to evaluate alcohol instruments.
The selection of census sections is based on changes in the urban export density register (
The density of outlets included in the census section is from 102 to 1812)
Ensure that there is a minimum channel for reliability analysis for each census and that there is sufficient variability in these measurements.
In May 2015, two different observers were trained to manage OHCITIES instruments.
The two observers tried the tool under the supervision of the chief researcher (XS)over a 5-hour period.
Field visit observers completed OHCITIES walking along both sides of the street in selected census areas.
The routes in each census section were previously defined using the map of the Observer after the day of data collection.
On 5 and June 2016, the two observers completed data collection, mostly between 17: 00 and 20: 00 working days.
Two observers completed OHCITIES in seven census areas at the same time (
Reduce the variability of alcohol environment over time)
But start their tasks in different locations (
Avoid interaction between them).
To determine internal reliability, one observer repeated these measures in the onecensus section for several consecutive days.
Observers simultaneously measure to minimize changes in the alcohol environment over time.
The route followed is the same as the previous day.
Collect data without informing or warning the owner, employee, customer or pedestrian to avoid bias.
The study area and sample size data collection for instrument reliability assessment were conducted in Madrid.
The city of Madrid is divided into 21 districts, and this is divided into 128 districts.
These communities are also divided into census areas, the smallest administrative region of the Spanish census (
Population = about 1000-1500 per census area).
We chose a census section in seven different communities to evaluate alcohol instruments.
The selection of census sections is based on changes in the urban export density register (
The density of outlets included in the census section is from 102 to 1812)
Ensure that there is a minimum channel for reliability analysis for each census and that there is sufficient variability in these measurements.
In May 2015, two different observers were trained to manage OHCITIES instruments.
The two observers tried the tool under the supervision of the chief researcher (XS)over a 5-hour period.
Field visit observers completed OHCITIES walking along both sides of the street in selected census areas.
The routes in each census section were previously defined using the map of the Observer after the day of data collection.
On 5 and June 2016, the two observers completed data collection, mostly between 17: 00 and 20: 00 working days.
Two observers completed OHCITIES in seven census areas at the same time (
Reduce the variability of alcohol environment over time)
But start their tasks in different locations (
Avoid interaction between them).
To determine internal reliability, one observer repeated these measures in the onecensus section for several consecutive days.
Observers simultaneously measure to minimize changes in the alcohol environment over time.
The route followed is the same as the previous day.
Collect data without informing or warning the owner, employee, customer or pedestrian to avoid bias.
Statistical analysis descriptive analysis of the variables of interest.
To estimate
For the assessors and retest reliability of environmental measurements for alcohol export, we used the percentage protocol and Cohen\'s kappa coefficient.
Provides a measure of mutual
We calculated the inter-class coefficient (ICCs)
And their 95% CIThe cut-
The deviation range of Kappa value and ICC value is as follows: 0. 0–0. 20 (weak agreement), 0. 21–0. 40 (poor agreement), 0. 41–0. 60 (
Mild agreement), 0. 61–0. 80 (
Substantive Agreement)and 0. 81–1. 00 (
Almost perfect agreement).
39 The results describe sample observers measured in seven census areas, with a total of 97 people
They agree on the premise of alcohol outlets at 92 outlets; and 28 off-
They agree to the premise outlets at 24 outlets.
Number on-
The premise alcohol exports in each census department range from 2 to 37. Among the on-
Observers agreed to inspect 50 bars, 18 restaurants and 1 bar. Off-
The prerequisite alcohol exports in each community vary between 1 and 8.
Both observers found 1 supermarket, 13 convenience stores and 4 specialty stores.
67 people on site
Location and 17
According to observers and 53 observers, houses were open at the time of observation. 7% and 88.
2% is related to some alcohol promotion programs respectively.
There are 29 different public places (
26 streets and 3 squares)
At least one of the observers found signs of alcohol consumption.
Housing within seven census areas (
In 17 public places, both observers found signs of drinking, although the total number of signs registered may vary from observer to Observer).
The number of signs of drinking found at each observation site varied between 1 and 19.
Only seven items promoting alcohol were reported by the observers (
3 Direct ads and 4 sponsors)
In public space, we are unable to calculate the reliability analysis due to insufficient samples.
Observers did not find anyone promoting or selling alcohol in public places.
The Observer found the data collection process simple and easy to understand and complete.
The time to complete the observation in the given census section varies between 87 and 225 min, depending on the total number of alcohol
Relevant elements existing in the census section.
The average time to complete these measures is about 8 min, and the average time to promote and drink signs in public places is about 3 min.
On-reliability
Alcohol output-
The scores of alcohol environmental measures are consistent with the percentage of retest
The location of all domains and projects in each domain is high (>80%)(table 2).
Availability and accessibility items have kappa values for interv
The rating reliability is 0.
Export type 67; 0.
72 signs of prohibition of selling alcohol to minors; and 0.
Signs of 82-hour sales.
Kappa value of Interv
The reliability of the judges is generally high (>0. 80)
Promotional activities-related items.
Most of the retest reliability values are also greater than 0.
80. in almost all cases, it is higher than that obtained for the international trade organization.
Reliability of judges.
Signs of prohibition of selling alcohol to minors and signs of sales time have lower retest reliability values.
View this table: View reliability of 92 on-medium alcohol environmental measurements
Export of alcohol. Madrid (Spain)
, Off-2015 reliability
Premise alcohol outletsTable 3 display room
Evaluation of Off-and retest reliability valuepremises.
In almost all cases, the percentage of agreements reached between observers is higher than 85%, except for the type of export (75%)
Advertising related to outlets (58. 82%).
Kappa value of Interv
The evaluator reliability of availability and accessibility items is between 0.
The export type is 49 to 0.
77. there are signs of a ban on the sale of alcohol to minors.
The existence of advertising (
Including sponsorship)
Low national rice related to export
Kappa value of the evaluator (0. 17). Inter-
Evaluator reliability kappa value for other promotional activities-
Related projects 1.
00, except for labels and/or awnings for alcohol promotion (0. 64).
The retest percentage of all cases was consistent with 100%, and the retest kappa value was 1.
They can calculate at 00.
View this table: View inline View pop-up table 3 24 off-reliability of medium alcohol Environmental Measurement
Export of alcohol. Madrid (Spain)
The reliability of drinking in public space is 2015. We identified 29 places (
26 streets and 3 squares)
There are signs of drinking (table 4).
The intra-class correlation coefficient for any type of drinking sign is 0. 50 (95% CI −0. 09to0. 77).
For glasses or similar items, and for people to drink, people\'s agreement is weak or poor.
We have reached a mild agreement on bottles or similar items.
Due to the characteristic of the collected data, we cannot calculate the retest reliability of the signs of alcohol consumption.
View this table: view the reliability of drinking signs found on 26 streets and 3 squares. Madrid (Spain)
, 2015 description of sample observers measured in seven census sections
They agree on the premise of alcohol outlets at 92 outlets; and 28 off-
They agree to the premise outlets at 24 outlets.
Number on-
The premise alcohol exports in each census department range from 2 to 37. Among the on-
Observers agreed to inspect 50 bars, 18 restaurants and 1 bar. Off-
The prerequisite alcohol exports in each community vary between 1 and 8.
Both observers found 1 supermarket, 13 convenience stores and 4 specialty stores.
67 people on site
Location and 17
According to observers and 53 observers, houses were open at the time of observation. 7% and 88.
2% is related to some alcohol promotion programs respectively.
There are 29 different public places (
26 streets and 3 squares)
At least one of the observers found signs of alcohol consumption.
Housing within seven census areas (
In 17 public places, both observers found signs of drinking, although the total number of signs registered may vary from observer to Observer).
The number of signs of drinking found at each observation site varied between 1 and 19.
Only seven items promoting alcohol were reported by the observers (
3 Direct ads and 4 sponsors)
In public space, we are unable to calculate the reliability analysis due to insufficient samples.
Observers did not find anyone promoting or selling alcohol in public places.
The Observer found the data collection process simple and easy to understand and complete.
The time to complete the observation in the given census section varies between 87 and 225 min, depending on the total number of alcohol
Relevant elements existing in the census section.
The average time to complete these measures is about 8 min, and the average time to promote and drink signs in public places is about 3 min.
On-reliability
Alcohol output-
The scores of alcohol environmental measures are consistent with the percentage of retest
The location of all domains and projects in each domain is high (>80%)(table 2).
Availability and accessibility items have kappa values for interv
The rating reliability is 0.
Export type 67; 0.
72 signs of prohibition of selling alcohol to minors; and 0.
Signs of 82-hour sales.
Kappa value of Interv
The reliability of the judges is generally high (>0. 80)
Promotional activities-related items.
Most of the retest reliability values are also greater than 0.
80. in almost all cases, it is higher than that obtained for the international trade organization.
Reliability of judges.
Signs of prohibition of selling alcohol to minors and signs of sales time have lower retest reliability values.
View this table: View reliability of 92 on-medium alcohol environmental measurements
Export of alcohol. Madrid (Spain)
, Off-2015 reliability
Premise alcohol outletsTable 3 display room
Evaluation of Off-and retest reliability valuepremises.
In almost all cases, the percentage of agreements reached between observers is higher than 85%, except for the type of export (75%)
Advertising related to outlets (58. 82%).
Kappa value of Interv
The evaluator reliability of availability and accessibility items is between 0.
The export type is 49 to 0.
77. there are signs of a ban on the sale of alcohol to minors.
The existence of advertising (
Including sponsorship)
Low national rice related to export
Kappa value of the evaluator (0. 17). Inter-
Evaluator reliability kappa value for other promotional activities-
Related projects 1.
00, except for labels and/or awnings for alcohol promotion (0. 64).
The retest percentage of all cases was consistent with 100%, and the retest kappa value was 1.
They can calculate at 00.
View this table: View inline View pop-up table 3 24 off-reliability of medium alcohol Environmental Measurement
Export of alcohol. Madrid (Spain)
The reliability of drinking in public space is 2015. We identified 29 places (
26 streets and 3 squares)
There are signs of drinking (table 4).
The intra-class correlation coefficient for any type of drinking sign is 0. 50 (95% CI −0. 09to0. 77).
For glasses or similar items, and for people to drink, people\'s agreement is weak or poor.
We have reached a mild agreement on bottles or similar items.
Due to the characteristic of the collected data, we cannot calculate the retest reliability of the signs of alcohol consumption.
View this table: view the reliability of drinking signs found on 26 streets and 3 squares. Madrid (Spain)
, 2015 the results of the discussion on OHCITIES development and assessment indicate that it is a reliable and useful tool for characterizing alcohol in urban settings.
All projects developed in each alcohol field are based on published literature and on-
On-site pilot experience.
The results also indicate that instructions to observers and
Field training is enough for observers to collect high
Quality and accurate data. Inter-
Assessors and retest reliability are high for the availability and accessibility measurements of alcohol stores and most of the items that describe store-related promotions.
The results show that the reliability value between the observer of the export type and the presence of the ad associated with off-is lowerpremises.
Future research should focus on defining and training different types of alcohol stores that exist in any particular city, as observers find it difficult to assign a given category.
The existence of off-site advertising
These factors do not seem obvious to the observer and are often difficult to classify.
In most cases, the reliability of signs of drinking is low.
Some items are hard to find, according to observers.
In addition, signs of drinking are temporarily affected and changed in a short period of time.
Although these variables are difficult to verify, it is important to capture them because they are part of the alcohol urban environment and contribute to the normalization of alcohol consumption.
OHCITIES have developed in Madrid and Barcelona.
Alcohol is very normal in these urban settings and is part of the food culture.
Spain is 36 and 65.
In 2011, 6% of adults drank alcohol in the past year (77.
5% of men and 54. 3% of women).
40 The same study showed that the prevalence of overdrinking was 19.
There are 6% men and 7. 1% for women.
Another study found that the prevalence of dangerous drinking among the population aged 15-64 in Spain was 6.
There are 7% men and three.
The number of women in 2013 was 5%.
41. policies governing alcohol sales and their promotion are currently not effective enough to protect people from excessive alcohol exposure in urban settings.
Offering alcohol products at a relatively low cost is still very common.
In addition, the European directive\'s deregulation of the retail environment allows night
Low-cost alcohol supplies are longer, especially in big cities.
7 11 similarly, the promotion of alcohol is partially regulated in public places and, in addition to some local jurisdictions, rarely regulates the sponsorship of alcohol products or promotions related to alcohol stores.
OHCITIES tools may help to establish evidence of exposure to the alcohol environment and assess the implementation of alcohol policy in different urban environments.
OHCITIES aims to collect objective data on alcohol exposure in urban settings and to understand its relationship with alcohol behavior.
The study is part of the \"heart health hooligans\" project to learn about the community in the city of Madrid (Spain)
It is related to cardiovascular health of residents.
The project included information on the drinking behavior of a group of adults.
We will use OHCITIES instruments to describe the alcohol environment in Madrid and explore how it affects alcohol consumption reported by local residents.
OHCITIES instruments will be further used to describe the alcohol environment in Barcelona (Spain).
Researchers in Barcelona will study the relationship between urban alcohol environmental data and drinking behavior among adolescents aged 12-18.
OHCITIES can also be used to evaluate policy interventions aimed at changing the alcohol environment and affecting consumption patterns.
In Europe, regulatory policies on alcohol sales and their promotion vary between countries, sometimes within the same country.
42 although the instrument was designed in Madrid and Barcelona, researchers working in Edinburgh (JP)and Baltimore (MF)
Participate in the design and evaluation of OHCITIES instruments.
This tool can be adjusted and used in other urban environments.
For example, some alcoholic drinks
Related items included in the OHCITIES tool may be modified and/or additional variables may need to be developed.
The reliability of these modifications should be further evaluated.
Most published literature uses Level 2 databases19-27 43 and self to describe the alcohol environment
Questionnaires were used to report environmental exposure to alcohol.
There are very few studies using 28-32-
Street observation.
Some of them only focus on the outdoor marketing fair 33-35 34;
Another study compared Google Street View with on-
Street observation of alcohol environment
Another measure includes the presence of alcohol exports (
Including 24-hour alcohol supply and alcohol export density)
And alcohol ads.
As far as we know, the 35 OHCITIES instrument is the first instrument to fully describe the alcohol city environment through direct observation and the use of digital applications through mobile phones, including availability and accessibility, promotion and labeling of drinking.
OHCITIES instruments will allow to capture important features of the alcohol environment that are difficult or even impossible to describe using other methods, or even to take pictures.
In addition, OHCITIES integrate the geographic location of the data collected.
This feature will enable advanced geospatial analysis and mapping of all collected data to understand the situation in which the alcohol environment and its distribution varies between regions depending on socio-economic and demographic features, and to study how the alcohol environment affects alcohol consumption at a personal level.
21 25-27 in future studies using OHCITIES instruments to determine the relationship between alcohol environment and alcohol behavior, an important challenge is to identify which areas have a contextual impact on the individuals studied.
People exposed to the \"niche environment\" will depend on the activity space of each person, including where they live, study, work and play.
Results from OHCITIES instruments can be combined with other qualitative and geographic research techniques to understand how the urban environment of personal contact is related to alcohol attitudes and practices.
One limitation of our approach is that data collection can be time consuming when describing the alcohol environment throughout the city.
However, observers have found OHCITIES simple and quick, and the instrument fully describes the alcohol environment, including some variables that cannot be captured in other ways.
Another possible limitation is the time to collect data.
Almost all data is collected between 17: 00 and 20: 00 on weekdays.
These times are chosen to ensure most alcohol exports (both on-
Venues and off-sitepremises)
Will open during data collection.
However, at these times, we are unable to capture people who are doing activities in public spaces related to alcohol sales and promotions (
That is, street vendors who offer discounts on alcohol or promote alcohol).
Perhaps the data collected at other times may have captured more drinking incidents.
Future research should take more measures at other times (
(Later in the evening)
Weekends and different seasons.
Conclusion through systematic observation, OHCITIES instruments can fully describe the alcohol city environment from the aspects of availability and accessibility, promotion and signs of alcohol consumption.
OHCITIES instruments may be important to further understand the geographical differences in the alcohol environment and how these spatial differences affect local normalization and association with alcohol behavior.
In addition, OHCITIES can be widely applied to assess the implementation of alcohol policies and to design and support future interventions to prevent harmful use of alcohol and its health
Related results.
The author is grateful to Sonsoles acknoughtstep Fuentes, lucia Moure, Mr. Roberto validate and Gonzalo Ruiz for their participation in the field. References1.
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The study of conceive 002 openurlfootnotescontriators MF and XS.
The instruments are designed by companies such as XS, AE, JRV, LB, MF, etc.
AC coding and digitization of instruments.
XS and LB are responsible for on-site work.
XS and AE design and supervise analytical procedures.
XS prepared the database and analyzed the data according to the suggestions of AE and JP.
The original draft was drafted by XS and MF.
All authors have made significant contributions to the interpretation of the data and manuscript comments and approved the final version.
The guarantors are XS and MF.
Funding this study is part of the heart health Hoods research project funded by the European Research Council under the European Union\'s Seventh Framework Programme (FP7/2007-
2013/ERC initiate Grant hearthealthy protocol number336893).
The study was also funded by the National Strategic Plan (DGPNSD)(
2016I047 and 2016I029).
Funding sources have nothing to do with research design;
Collection, analysis or interpretation of data;
In the writing of this work;
Or in the decision to submit the manuscript for publication.
No one declared a competitive interest.
Uncommissioned source and peer review;
External peer review.
There is no other data available for the data sharing statement.
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