Alchohol in the cities: Edinburgh, Barcelona and Madrid

Escuela Nacional de Sanidad
January 24th 2017
Alcohol in the cities: Edinburgh,
Barcelona and Madrid
@HHHproject
Xisca Sureda BPharm, MPH, PhD
Manuel Franco MD, PhD
Universidad de Alcalá
Facultad de Medicina
Departamento de Cirugía, Ciencias Médicas y Sociales

Alcohol urban environment, and the
implementation of regulatory
policies: Heart Healthy Hoods
mixed methods (mapping, cohort
study, and Photovoice)
PI: Xisca Sureda
Co-investigators: M. Franco, J Pearce, M. Lazo-Elizondo, FJ Escobar,
MV. Sandín
Alcalá University, Johns Hopkins Bloomberg School of Public Health,
University of Edinburgh
Funding: European Research Council Starting Grant 2013 HeartHealthyHoods
Agreement n. 336893 and Plan Nacional sobre Drogas (2016I047)

http://hhhproject.eu
Photography
Knowledge
Dissemination
Citizen Science
Epidemiology
Health Sociology
Johns Hopkins School of Public Health
Geography
University of Alcalá
CRESH Edinburgh
Interdisciplinary team
University of Alcalá
Johns Hopkins School of Public Health

1. Introduction
Urban determinants of alcohol behaviour
Sureda X, Villalbí JR, Espelt A, Franco M. Living under the influence: Normalization of alcohol consumption in our cities. Gac Sanit. 2017; vol
31(1): 66-68

1. Introduction
Alcohol in the city: wherever and whenever
Sureda X, Espelt A, Villalbí JR, Pearce J, Franco M. Alcohol in the city: wherever and whenever. (research in progress)
In Spain the availability of alcoholic
beverages at a relatively low cost is
the common norm in our
environment
The constant presence of alcohol
outlets ensures, through different
opening times, an extensive supply of
alcohol products

1. Introduction
Alcohol in the city: wherever and whenever
Sureda X, Espelt A, Villalbí JR, Pearce J, Franco M. Alcohol in the city: wherever and whenever. (research in progress)
The pressure of alcohol industry is
evident and they use different
strategies to circumvent the
legislation
Bars and restaurants use their
storefronts to promote alcohol
products offering drinks at discount
prices and advertising beverage
brands.

2. Objectives
1. To describe alcohol environment in in terms of availability,
promotion and signs of consumption.
1.1 To determine possible differences between alcohol
urban environment and alcohol drinking behaviour.
2. To conduct a participatory-action research strategy
(Photovoice) to better understand the attitudes and practices
in relation to alcohol consumption from a cultural and social
perspective.
3. To compare the regulation of the alcohol urban
environment and its implementation in Madrid and Barcelona
and how these policies determine possible differences

21 Districts
128 Neighborhoods
2.412 Census Sections
(≅1.500 ps)
3,2 Mill. Residents
Neighborhood SE status:
Secondary data bases (Madrid
Regional Government open
databases)
Alcohol outlets: Secondary
Databases (Madrid city hall
open databases)
3. Methods

42 neighborhoods in Madrid (2
neighborhoods per district selected
according different SE charactersitics)
In each neighborhood we select the
“median” census track in terms of
educational level, immigration, density of
business and age.
Representative area of the municipality of
Madrid in terms of SE characteristics
3. Methods

OHCITIES instrument
Sureda X, Espelt A, Villalbí JR, Cebrecos A, Baranda L, Pearce J, Franco M. Development and validation of the OHCITIES instrument: Assessing
alcohol urban environments in the Heart Healthy Hoods project. (submitted)

53,7% with promotion
associated to the outlet
We collected information in 92 on-premises and 24 off-premises alcohol in 7 census
sections selected to validate the OHCITIES instrument in the city of Madrid.
88,2% with promotion
associated to the outlet
OHCITIES instrument

Time to complete a whole census section: between 225 and 87 minutes depending on the
total number of alcohol-related elements in the urban environment.
Time to complete each item: on and off-premises aprox. 5-10 min; promotion and signs of
alcohol consumption in public spaces aprox. 3 min
We found 26 streets and 3 squares within the 7 census sections with signs of alcohol
consumption. We registered 7 alcohol promotion in public spaces, not associated to
alcohol outlets.
OHCITIES instrument

Individual data: cohort HHH
2500 men and women aged 40 - 75 years. Residents in the study area and
asigned to one of the Primary Health Care Centres selected for the study.
All the participants live and/or work in the area of their health care centre and
have been living in the same area for at least 3 years.
3. Methods
Measurements and variables: Questionnaire (administred by telephone)
- Total volume of alcohol consumed
- Type of alcohol consumed
- Frequency of alcohol consumption
- Drinking patterns
- Sociodemographic characteristics

GIS now represent an excellent methodology for advanced
geospatial analysis and for mapping.
GIS will be present transversely throughout all the project.
Geospatial data integration and analysis using Geographic Information
Systems (GIS)
3. Methods

Acknowledgements
Sonsoles Fuentes, Lucía Moure, Roberto Valiente, & Gonzalo Ruiz for their
participation in the fieldwork.
Researchers at Agència Salut Pública de Barcelona (JR Villalbí, Albert Espelt &
Lucía Barada)
HHH team Alcohol team

Manuel Franco & Xisca Sureda
A Participatory Action Research project to
study and control alcohol environment in
Madrid
PHOTOVOICE ALCOHOL IN THE CITIES

• Understanding alcohol environment and
residents drinking patterns
• Need for participatory research to obtain “real”
data of use and meaning of alcohol environment
• Necessary information to design culturally
appropriate and effective interventions
Alcohol environment research
Participatory Project in Madrid

What is Photovoice?
• Photovoice is a participatory-action research method. Caroline
C. Wang and Mary Ann Burris (1994, 2000)
• Enables people to identify, capture, and reflect their
community´s strengths and concerns through photography
• Informs policy makers to promote health related public policies

Main objective
To conduct a photovoice project with
residents of two Madrid areas to understand
the local alcohol environment and its
influence on individuals’ drinking patterns

Specific Objectives
1. To describe photovoice participants’ main
themes relating local alcohol environment to
residents’ drinking patterns
2. To translate photovoice findings into urban
alcohol policy recommendations
3. To communicate Photovoice Alcohol results

Manuel Franco MD, PhD
Associate Professor
School of Medicine, University of Alcala, Spain
Adjunct Associate Professor
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
study and improve the food environment
in Madrid
PHOTOVOICE VILLAVERDE PROJECT

Methods: Study setting
• Two administrative
low-income
neighborhoods
(Los Rosales and
San Cristobal)
• Collaboration with
Villaverde Health
Promotion Centre

Methods: Participants
• We used a purposive sampling
strategy to engage participants.
• Participants completed informed
consents and image release forms.
• Villaverde Health Promotion Center
facilitated participants’ recruitment
and retention.
• 24 residents enrolled in the project.

Methods: Photovoice procedure
• Four Photovoice groups by gender/neighborhood
• During five group discussion sessions, participants:
• attended a Photography workshop
• critically discussed their photographs
• analyzed their photographs

• Participants took 163 photographs, and identified 30
categories emerging from the photographs and
discussions
• Final categories were then organized around five themes
of the food environment related to dietary behaviors :
1. Eating in moderation
2. Cultural diversity
3. Food stores
4. Social relationships
5. Economic crisis and poverty
Methods: Participatory data analysis
Diez. J. et al. 2016 Health and Place

Theme 5: Economic crisis and poverty

Translation into food policy
recommendations: Methods

Translation into food policy
recommendations: Methods
Participants and co-facilitators met twice to translate
photovoice results into policy recommendations

Food policy recommendations (ranked)
1. Offering local leisure time activities to avoid unhealthy behaviors
(e.g. snacking, alcohol, sodas)
2. Improving food banks management
3. Reactivating traditional markets and small retailers
4. Improving food hygiene conditions
5. Promoting the availability of organic foods and for patients
(e.g. diabetes and celiac disease)
6. Reducing food waste
7. Improving nutrition labeling
8. Offering healthier alternatives to workplace vending machines
9. Teaching food education at schools
10. Promoting healthy social networks for older people
11. Giving street vendors legal status

Dissemination and communication
Photovoice results
• Residents participated in dissemination and communication
strategies to promote social action:
• Photobook
• Exhibition
• Video
• Citizen Science meetings
• Interactive Cartography
• Media collaboration

Photovoice results
• Free- downloadable Photobook: hhhproject.eu/photovoice

Photovoice results
• Photography exhibition in three different venues in Madrid
• 6 months at the third most visited cultural center un Madrid

Photovoice results
• Two citizen science meetings. Participants presented
results and policy recommendations to local policymakers

Successful method to engage residents in a participatory
action research project collecting, analyzing, and
communicating
Participants identified five themes relating their local food
environment to residents’ diets
Results were translated into community generation food
policy recommendations may inform policies improving
population diet
Project communication included a photobook, a public
exhibit, a video and an interactive cartography
Photovoice Villaverde Conclusions

• Collaboration Madrid Public Health Institute and
• Funding:
• European Research Council
• PNSD
• Ayuntamiento de Madrid
• CRESH University of Edinburgh, Jamie Pearce
• Johns Hopkins School of Medicine, Mariana Lazo
Acknowledgements

study and control alcohol environment in
Madrid
¡ GRACIAS !

Escuela Nacional de Sanidad
January 24th 2017
¡ Thank You !
Manuel Franco & Xisca Sureda
(manuel.franco@uah.es & francisca.sureda@uah.es)
@HHHproject

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