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

KnowledgeDissemination

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; vol31(1): 66-68

1. Introduction

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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

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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

3. Methods

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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: SecondaryDatabases (Madrid city hall open databases)

3. Methods

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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)

http://hhhproject.eu

53,7% with promotionassociated to the outlet

We collected information in 92 on-premises and 24 off-premises alcohol in 7 censussections selected to validate the OHCITIES instrument in the city of Madrid.

88,2% with promotionassociated to the outlet

OHCITIES instrument

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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

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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

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GIS now represent an excellent methodology for advancedgeospatial 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)

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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

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• 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

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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

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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

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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, PhDAssociate Professor

School of Medicine, University of Alcala, Spain

Adjunct Associate Professor

Department of Epidemiology

Johns Hopkins Bloomberg School of Public Health

A Participatory Action Research project to

study and improve the food environment

in Madrid

PHOTOVOICE VILLAVERDE PROJECT

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Methods: Study setting

• Two administrative

low-income

neighborhoods

(Los Rosales and

San Cristobal)

• Collaboration with

Villaverde Health

Promotion Centre

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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.

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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

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• 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 1: Eating in Moderation

Theme 2: Cultural Diversity

Theme 3: Food Stores

Theme 4: Social Relationships

Theme 5: Economic crisis and poverty

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Translation into food policy

recommendations: Methods

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Translation into food policy

recommendations: Methods

Participants and co-facilitators met twice to translate

photovoice results into policy recommendations

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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

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Dissemination and communicationPhotovoice results

• Residents participated in dissemination and communication

strategies to promote social action:

• Photobook

• Exhibition

• Video

• Citizen Science meetings

• Interactive Cartography

• Media collaboration

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Dissemination and communicationPhotovoice results

• Free- downloadable Photobook: hhhproject.eu/photovoice

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Dissemination and communicationPhotovoice results

• Photography exhibition in three different venues in Madrid

• 6 months at the third most visited cultural center un Madrid

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Dissemination and communicationPhotovoice results

• Two citizen science meetings. Participants presented

results and policy recommendations to local policymakers

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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

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• 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

A Participatory Action Research project to

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