Associations Between the Physical Availability of Alcohol and Alcohol Use: Regional Variation Across 15 Major Cities in Ontario, Canada.

Abstract

Rates of alcohol use and alcohol-related harms increase with greater alcohol availability. However, regional differences in sociodemographic characteristics and built environment may affect this association. This study evaluated the association between off-premise alcohol availability and alcohol use in Ontario, Canada, and the degree to which this association varies between cities. This was a cross-sectional spatial analysis of urban neighborhoods in Ontario, Canada (n = 11,742). The primary exposure was off-premise alcohol availability, based on the drive time from a neighborhood to the closest off-premise outlets. The primary outcome was the neighborhood-level prevalence of high-volume alcohol use (>2 drinks/day [males], >1 drink/ day [females]) based on survey data from 2000 to 2014. The association between availability and use was assessed using Bayesian hierarchical spatial models to account for spatial autocorrelation. There was an overall positive association between alcohol availability and high-volume alcohol use (male coefficient estimate (β) = 0.19, 95% credible interval [CI] [0.16, 0.22]; female β = 0.17, 95% CI [0.13, 0.21]). However, the association was eliminated in models that allowed for this association to vary between cities via an interaction term (male β = -0.04, 95% CI [-0.26, 0.19]; female β = -0.04, 95% CI [-0.34, 0.26]). This was explained by variability in the association between cities, where some cities demonstrated a positive association between availability and use and others demonstrated a negative association. Although there is a province-wide positive association between off-premise alcohol availability and high-volume alcohol use, there is substantial regional variation in this association that may affect the local effectiveness of alcohol regulation policies.