Abstract

Alcohol urban environment has been associated with individual alcohol behaviors. We are constantly exposed to a wide variety of alcohol products, its marketing and promotion and signs of alcohol consumption that may influence alcohol-drinking behaviors. In this photo-essay, we include photographs that visually explain the exposure to alcohol in the urban streetscape of Madrid. These photographs show the pervasiveness of alcohol products in this city, which can be found everywhere at any time.

Keywords:
Alcohol drinking; Alcohol promotion; Cities; Urban health; Photographs

Resumen

El entorno urbano del alcohol se ha asociado a su consumo individual. Estamos constantemente expuestos a una amplia variedad de productos con contenido de alcohol, su promoción y signos de consumo, que pueden influir en la normalización del mismo. En este ensayo fotográfico se incluyen imágenes que explican visualmente la exposición al alcohol en el paisaje urbano de Madrid. Estas fotografías muestran la omnipresencia de los productos con contenido de alcohol en esta ciudad, que se puede encontrar en todas partes y en cualquier momento.

Palabras clave:
Consumo de bebidas alcohólicas; Promoción del alcohol; Ciudades; Salud urbana; Fotografías

Globally, harmful use of alcohol is responsible for 5.9% of all deaths, and 5.1% of the global burden of disease.¹1. World Health Organization. Global status report on alcohol and health 2014. World Health Organization, (2014). In Europe, where consumption levels are the highest in the world, 13.3% of deaths can be attributed to alcohol.¹1. World Health Organization. Global status report on alcohol and health 2014. World Health Organization, (2014). Alcohol consumption has also been connected to a multitude of social issues including suicide, mental health problems, injuries and domestic violence.¹1. World Health Organization. Global status report on alcohol and health 2014. World Health Organization, (2014).

High levels of alcohol consumption and related harm in Europe can be explained by a multitude of environmental factors including the level and effectiveness of alcohol policies (e.g., taxation, promotion and marketing), cultural norms around consumption, and the availability of alcohol products.²2. M. Bosque-Prous,A. Espelt,A.M. Guitart. Association between stricter alcohol advertising regulations and lower hazardous drinking across European countries. Addiction., 109 (2014), pp. 1634-1643 http://dx.doi.org/10.1111/add.12562.
https://doi.org/10.1111/add.12562... ³3. A. Bryden,B. Roberts,M. Petticrew. A systematic review of the influence of community level social factors on alcohol use. Health & Place., 21 (2013), pp. 70-85. ⁴4. M. Kuo,H. Wechsler,P. Greenberg. The marketing of alcohol to college students: the role of low prices and special promotions. Am J Prev Med., 25 (2003), pp. 204-211. ⁵5. S. Popova,N. Giesbrecht,D. Bekmuradov. Hours and days of sale and density of alcohol outlets: impacts on alcohol consumption and damage: a systematic review. Alcohol Alcohol., 44 (2009), pp. 500-516 http://dx.doi.org/10.1093/alcalc/agp054.
https://doi.org/10.1093/alcalc/agp054... ⁶6. L.A. Smith,D.R. Foxcroft. The effect of alcohol advertising, marketing and portrayal on drinking behaviour in young people: systematic review of prospective cohort studies. BMC Public Health., 9(2009), pp. 51 http://dx.doi.org/10.1186/1471-2458-9-51
https://doi.org/10.1186/1471-2458-9-51... ⁷7. J.R. Villalbí, M. Bosque-Prous ,M. Gili-Miner. Políticas para prevenir los daños causados por el alcohol. Rev Esp Salud Pública., 88 (2014), pp. 515-528 http://dx.doi.org/10.4321/S1135-57272014000400006.
https://doi.org/10.4321/S1135-5727201400... In many urban environments in Europe, the marketing, consumption and availability of alcohol have become ubiquitous. The ‘alcogenic’ environments in which we live, study, work and play contribute to the normalization of alcohol drinking, significantly influencing consumption patterns.⁸8. X. Sureda, J.R. Villalbí , A. Espelt . Living under the influence: normalisation of alcohol consumption in our cities. Gac Sanit., 31 (2017), pp. 66-68 http://dx.doi.org/10.1016/j.gaceta.2016.07.018.
https://doi.org/10.1016/j.gaceta.2016.07... ⁹9. A. Murphy, B. Roberts ,G.B. Ploubidis. Using multi-level data to estimate the effect of an ‘alcogenic’ environment on hazardous alcohol consumption in the former Soviet Union. Health & Place., 27 (2014), pp. 205-211.

We propose a conceptual framework to help understand the ways in which alcohol urban environment relates to alcohol drinking behaviors⁸8. X. Sureda, J.R. Villalbí , A. Espelt . Living under the influence: normalisation of alcohol consumption in our cities. Gac Sanit., 31 (2017), pp. 66-68 http://dx.doi.org/10.1016/j.gaceta.2016.07.018.
https://doi.org/10.1016/j.gaceta.2016.07... (see online Appendix). The framework emphasizes that availability and accessibility of alcohol, promotion of alcohol, and signs of alcohol consumption would be associated with alcohol drinking behaviors. In this photo-essay, we capture these three domains and show how ubiquitous and normal alcohol is in our urban life (Figure 1 and Figure 2).

This work is part of the Heart Healthy Hoods Project (https://hhhproject.eu/) studying the associations between the social and physical features of the urban environment and cardiovascular health in the municipality of Madrid,¹⁰10. V. Carreño,M. Franco,P. Gullón. Studying city life, improving population health. Int J Epidemiol., 46 (2017), pp. 14-21 http://dx.doi.org/10.1093/ije/dyv207.
https://doi.org/10.1093/ije/dyv207... the most populated city in Spain, with approximately 3.2 million residents.¹¹11. Instituto Nacional de Estadística. Censos de población y viviendas 2011. España: Instituto Nacional de Estadística. (Accessed 04/02/2017.) Available at: Available at: http://www.ine.es/censos2011_datos/cen11_datos_inicio.htm
http://www.ine.es/censos2011_datos/cen11... Spain is a Southern European Country, with a yearly average consumption of 9.5 l of pure alcohol per capita, traditionally part of the wine growing culture, and a major tourist destination.¹²12. L. Sordo,G. Barrio,M.J. Bravo. Estimating average alcohol consumption in the population using multiple sources: the case of Spain. Popul Health Metr., 14 (2016), pp. 21 http://dx.doi.org/10.1186/s12963-016-0090-4.
https://doi.org/10.1186/s12963-016-0090-...

The photographs included in this photo-essay examine how alcohol has become entrenched in the urban streetscape of Madrid. We consider the presence of alcohol in different neighborhoods across the city including areas with a large tourist population and dependence on the night time economy. Photographs were taken during different times of the day and days of the week. The photographs depict the presence of alcohol related items within alcohol outlets (Figure 1) or other public spaces (Figure 2), including the sides of streets, public squares, playgrounds, parks, and any other open and green spaces. These photographs show the pervasiveness of alcohol products in a city like Madrid, which can be found everywhere at any time, and point to directions to follow for public policies oriented to preventing the harm done by alcohol. More photographs and its description can be found in the online Appendix.

This collection of photographs emphasizes the importance of raising awareness about the normalization and social acceptability of alcohol in our cities. Future studies conducted in different cities across the globe will help understand how the alcohol environment may affect the normalization and harmful use of alcohol. This work will be important in identifying new opportunities for environmental interventions designed to restrict the promotion and supply of alcohol products in our communities, and help to reduce alcohol-related harm in our cities.

Appendix A. Supplementary data

Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.gaceta.2017.06.008.

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