Alcohol outlets availability in school neighborhoods and alcohol use among adolescents

Cardoza, Loren Salazar; Machado, Christiane Opuszka; Santos, Clara Telles dos; Höfelmann, Doroteia Aparecida

doi:10.1590/0102-311X00062919

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ARTICLE • Cad. Saúde Pública 36 (10) • 2020 • https://doi.org/10.1590/0102-311X00062919 copy

Alcohol outlets availability in school neighborhoods and alcohol use among adolescents

Disponibilidade de locais de venda de álcool na vizinhança de escolas e consumo de álcool entre adolescentes

Disponibilidad de establecimientos para la venta de alcohol en las cercanías de las escuelas y consumo de alcohol entre adolescentes

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This cross-sectional study investigated the association between alcohol use by adolescents and the availability of alcohol outlets in the neighborhood of public schools. We collected primary data including variables at individual and school neighborhood level. Multilevel logistic regression was used to estimate odds ratio (OR) with a 95% confidence interval (95%CI) for alcohol use with the exposure variables. A total of 18.4% (95%CI: 13.2; 24.1) of adolescents reported using alcohol, which was associated with variables on the individual level such as being 18 years or older, working, and having previously smoked. Lower alcohol use was observed among adolescents from schools that were located 250m or more from alcohol outlets (OR = 0.29; 95%CI: 0.17; 0.48). Actions to reduce the use of alcohol among adolescents should take student’s and school neighborhood’s characteristics into account.

Keywords:
Underage Drinking; Neighborhood; Multilevel Analysis

Variables	n	%
Adolescents level (n = 1.146) *
Gender
Male	589	50.8
Female	557	49.2
Age (years)
10-14	691	61.3
15-17	431	36.7
18 and older	24	2.0
Work
No	998	87.6
Yes	148	12.4
Period
Morning	684	57.4
Afternoon	355	34.4
Full-time	107	8.2
Supervised physical activity
Yes	319	27.1
No	827	72.9
Smoking
No	1076	94.3
Yes	70	5.7
Alcohol use **
No	942	81.6
Yes	204	18.4
School neighborhood level (socioeconomic indexes) (n = 30) ***
Demographic density (inhabitants/km²)
163.8-3,577.8	9	30.0
3,577.9-4,556.6	10	33.3
4,556.7-11,579.1	11	36.7
Per capita income in 2010 (BRL)
439.7-853.0	10	33.3
854.0-2,104.6	12	40.0
2,104.7-4,645.6	8	26.7
Alcohol outlet density
0	5	16.7
1	2	6.7
2-7	23	76.6
Cigarette outlet density
0-1	14	46.7
2-3	12	40.0
4-7	4	13.3
Alcohol and cigarette outlet density
0	15	50.0
1	11	36.7
2-4	4	13.3
On-premise alcohol outlets
0	12	40.0
1-2	9	30.0
3-10	9	30.0
Off-premises alcohol outlets
0-1	12	40.0
2-3	9	30.0
4-8	9	30.0
Outlets with alcohol advertisement
0	12	40.0
1	10	33.3
2-7	8	26.7
Outlets with warning sign forbidding sale for minors
1	8	26.7
2	1	3.3
3	1	3.3
Closest alcohol outlet (m)
0-100	11	36.7
101-250	10	33.3
251 or more	9	30.0
School size (number of students)
Less than 499	5	16.7
500-999	13	43.3
1,000 or more	12	40.0
Distance from city ground zero (km)
1.6-5.6	11	36.7
5.7-8.2	9	30.0
8.3 or more	10	33.3

Variables	Yes [n (%)]	OR not adjusted (95%CI)	p-value *	OR adjusted (95%CI)	p-value *	ICC (95%CI)	AIC
Empty model						0.18 (0.09; 0.30)
Adolescent level (n = 1.146)							1,062.45
Demographics						0.06 (0.02; 0.17) **
Gender			0.789		0.350		1,040.69
Male		1.00		1.00
Female		1.05 (0.73; 1.51)		1.20 (0.82; 1.76) **
Age (years)			0.000		0.000
10-14	67 (9.8)	1.00		1.00
15-17	126 (31.3)	3.18 (1.70; 5.95)		2.93 (1.66; 5.17) **
18 and older	11 (47.5)	6.35 (2.17; 18.54)		5.27 (1.74; 15.98) **
Period			0.004		0.014	0.03 (0.01; 0.13) ***	1,011.27
Morning	161 (25.7)	1.00		1.00
Afternoon	39 (10.1)	0.38 (0.21; 0.68)		0.64 (0.39; 1.03) ***
Full-time	4 (3.0)	0.10 (0.02; 0.66)		0.25 (0.07; 0.88) ***
Work			0.013		0.010
No	151 (15.7)	1.00		1.00
Yes	53 (37.7)	2.12 (1.18; 3.79)		2.10 (1.20; 3.61) ***
Health related behaviors
Smoke			0.000		0.000	0.03 (0.01; 0.15) ^#	927.15
No	161 (15.7)	1.00		1.00
Yes	43 (63.8)	8.32 (4.37; 14.84)		7.50 (4.12; 13.63) ^#
Supervised physical activity			0.087		0.057
Yes	134 (16.8)	1.00		1.00
No	70 (23.0)	1.57 (0.93; 2.65)		1.63 (0.99; 2.71) ^#
School neighborhood level (socioeconomic indexes) (n = 30)
Demographic density (inhabitants/km²)			0.022			0.01 (0.00; 0.30)	927.43
163.8-3,577.8	44 (14.0)	1.00		1.00
3,577.9-4,556.6	70 (16.2)	1.64 (0.63; 4.28)		1.09 (0.60; 1.90) ^##
4,556.7-11,579.1	90 (23.6)	2.91 (1.16; 7.32)		1.73 (1.00; 2.90)^##
Per capita income in 2010 (BRL)			0.017
439.7-853.0	54 (13.2)	1.00		1.00
854.0-2,104.6	62 (14.5)	1.13 (0.49; 2.59)		1.23 (0.70; 2.04) ^##
2,104.7-4,645.6	88 (18.4)	2.79 (1.27; 6.10)		1.54 (0.80; 2.74) ^##
School size (number of students)			0.175		0.003	^§	918.98
Less than 499	26 (16.3)	1.00		1.00
500-999	68 (14.8)	0.87 (0.33; 2.30)		1.29 (0.75; 2.23) ^###
1,000 or more	110 (21.2)	1.69 (0.33; 2.30)		1.87 (1.10; 3.18) ^###
Alcohol outlet density			0.619
0	75 (17.8)	1.00
1	81 (22.0)	1.71 (0.66; 4.43)
2-7	48 (15.9)	1.20 (0.47; 3.07)
Cigarette outlet density			0.760
0-1	89 (16.0)	1.00
2-3	95 (23.7)	1.71 (0.73; 3.82)
4-7	20 (13.2)	0.82 (0.22; 3.09)
Alcohol and cigarette outlet density			0.758
0	117 (19.6)	1.00
1	64 (16.3)	0.90 (0.42; 1.96)
2-4	23 (18.5)	1.43 (0.49; 4.18)
On-premise alcohol outlets			0.048
0	66 (12.5)	1.00
1-2	57 (18.7)	1.79 (0.73; 4.36)
2-7	81 (24.0)	2.48 (1.00; 6.15)
3-10	48 (15.9)	1.20 (0.47; 3.07)
Off-premises alcohol outlets
0-1	70 (17.6)	1.00
2-3	75 (23.6)	1.95 (0.77; 4.95)
4-8	59 (15.3)	1.22 (0.45; 3.29)
Outlets with alcohol advertisement			0.619
0	75 (17.8)	1.00
1	81 (22.0)	1.71 (0.66; 4.43)
2-7	48 (15.9)	1.20 (0.47; 3.07)
Outlets with warning sign forbidding sale for minors			0.314		0.013	^§	910.75
1	120 (17.6)	1.00		1.00
2	64 (21.4)	1.55 (0.69; 3.48)		0.86 (0.63; 1.18)
3	20 (16.6)	1.37 (0.56; 3.34)		0.59 (0.32; 1.09)
Closest alcohol outlet (m)			0.003		0.000
0-100	99 (21.5)	1.00		1.00
101-250	93 (21.4)	0.85 (0.44; 1.65)		0.83 (0.62; 1.11) ^§§
251 or more	12 (3.4)	0.15 (0.05; 0.45)		0.29 (0.17; 0.48) ^§§
Distance from city ground zero (km)
1.6-5.6	104 (26.5)	1.00
5.7-8.2	54 (18.5)	0.62 (0.25; 1.57)
8.3 or more	46 (12.1)	0.39 (0.17; 0.90)

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[1] Correspondence
L. S. Cardoza Universidade Federal do Paraná. Rua Padre Camargo 280, 3º andar, Curitiba, PR 80060-240, Brasil. loren.scardoza@gmail.com