Looking back and moving forward: the evolution and potential opportunities for the future of alcohol outlet density measurement

Abstract

Background: The literature consistently finds that areas with greater density of alcohol outlets (places that sell alcohol) tend to have higher levels of public health harms. However, conflicting findings arise when researchers drill down to identify the type(s) of alcohol outlets with the strongest associations with harms and the mechanisms that explain these associations. These disagreements could be a result of the outdated methods commonly used to quantify the alcohol environment: counts of the number of outlets in an area.

Methods

This manuscript reviews the events and ideas that shaped the literature on the physical alcohol environment. It then defines the three main methods used to measure alcohol outlet density and conduct an exploratory factor analysis to explore the constructs underlying each method.

Results

We present a novel conceptual framework that summarizes the three most common measurement methods, their respective underlying constructs, and the setting(s) in which each may be most appropriate. The framework proposes that counts of alcohol outlets measure availability, proximity to the nearest outlet measures accessibility, and spatial access measures measure access, which comprises both availability and accessibility.

Discussion

Researchers should consider using proximity and spatial access measures when possible, because this may present opportunities to advance theory and the design and implementation of regulations. Researchers can also draw on innovations used in other areas of the built environment to suggest opportunities to use novel methods to overcome common hurdles (e.g., separating subtypes of outlets, ecologic designs) and a new challenge on the horizon: home delivery.

Keywords:

• Alcohol
• alcohol outlet density
• spatial access methods
• alcohol policy

Disclosure statement

The authors report no conflict of interest.

Data availability

The authors will make data available upon request.

Additional information

Funding

The project described was supported by Award Numbers T32AA007240, Graduate Research Training in Alcohol Problems: Alcohol-related Disparities and P50AA005595, Epidemiology of Alcohol Problems: Alcohol-Related Disparities from the National Institute on Alcohol Abuse and Alcoholism as well as from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health or National Institute on Minority Health and Health Disparities.