1. Introduction
The relationship between alcohol abuse and different public health problems has been well established [
1,
2]. Alcohol consumption was the responsible for 5.9% of global deaths in 2012, which translates to about 3.3 million alcohol-related deaths, and it is a public health priority for the World Health Organization (WHO) [
2].
Alcohol availability has become an important field of study because it is the major point of access for alcohol consumption [
3]. Variation in price and density of alcohol outlets are the most commonly used measures of alcohol availability [
4]. Alcohol outlet density, specifically, has been associated with different social problems, such as a violent crime [
1,
5,
6,
7,
8], traffic incidents [
9,
10,
11], alcohol-related problems [
12,
13,
14,
15], child maltreatment [
16,
17,
18], and intimate partner violence [
19,
20].
In order to assess alcohol outlet influences, some studies have analyzed the link between neighborhood-level characteristics and the spatial and temporal distribution of alcohol outlets in different cities [
21,
22,
23]. These studies have shown that alcohol outlets (usually represented as off-premise and on-premise establishments) are not randomly distributed in space and time, but they differ by neighborhood characteristics. Drawing from the social disorganization theory [
24,
25,
26], these studies have found associations between alcohol outlet density and a number of neighborhood characteristics such as neighborhood deprivation, residential instability and ethnic composition. In this body of research, most studies have focused on neighborhood deprivation, showing that areas with higher socioeconomic disadvantage tend to have higher alcohol outlet density [
12,
22,
27,
28,
29]. Residential instability has also shown a positive relationship with alcohol outlet density [
30]. However, the study of the influence of ethnic composition on alcohol outlet density, has yielded mixed results, with some studies supporting this link [
31,
32], while other studies showing no association [
29,
30].
Most of these studies have been conducted in the U.S. and north European countries [
21,
22,
30,
33,
34]. These countries are usually defined as “dry countries”, as opposed to “wet countries”. This classification is based on the average amount of alcohol consumed per capita in order to distinguish between “drinking” and ”not drinking” cultures [
35,
36]. United States, as well as northern Europe, would exemplify the “dry” end of this classification, which is characterized by low levels of alcohol consumption, many people who abstain, restrictive controls on drinking and selling alcohol, as well as less of a tradition of alcohol consumption in social contexts. On the other hand, Mediterranean countries (France, Italy, Portugal, Greece, or Spain) would be at the “wet” end of this classification, as they are characterized by higher rates of alcohol consumption and less restrictive control of alcohol-related behavior [
36,
37]. In these countries, alcohol is part of the social life and it is usually present in social meetings [
38,
39]. Also, in wet countries people drink more frequently during daily life (e.g., it is consumed at meals), unlike dry countries [
40,
41]. Despite these relevant differences in alcohol consumption and drinking culture, research suggests that people from wet countries are less likely to drink to intoxication than people from dry countries [
41].
These cultural differences in drinking patterns are also reflected in the availability of and access to alcohol establishments. For example, according to 2014 data, New York had a density of 88 bars per 100,000 people, while Madrid, Spain, had 186 bars per 100,000, which is almost double [
42]. On the other hand, in wet countries, the social acceptance of alcohol consumption behavior translates to a higher permissiveness in the sale of alcohol. This is also reflected in differences in the legal drinking age, which is 21 years old for the U.S. and 18 for the most European countries.
These differences in drinking culture may also be reflected on the distribution of alcohol outlets across city areas, as well as on the relationship between alcohol outlets and social problems. Thus, the space-time trajectories of alcohol outlets, the neighborhood variables that can influence this spatiotemporal distribution, and the relationship between alcohol outlet density and alcohol-related social problems, may differ between countries where the drinking behavior and culture is different. However, so far, no studies have analyzed these issues from a spatiotemporal perspective in wet countries.
The present study was conducted in the city of Valencia, Spain, which has been defined as a wet country [
41]. The aim of the study was to analyze the influence of neighborhood-level characteristics on the spatiotemporal distribution of alcohol outlets, and to examine the influence of alcohol-outlet density on alcohol-related police calls-for-service. To this end, we consider three categories of alcohol outlets (i.e., off-premise, restaurants/cafes, and bars), three neighborhood-level characteristics (i.e., socioeconomic status, residential instability, and immigrant population), and all alcohol-related police calls-for-service in the city of Valencia during a six-year period.
4. Discussion
This study used a spatial-temporal approach to assess the distribution of alcohol outlet density in the city of Valencia (Spain) from 2010 to 2015. Spain has been characterized as a wet drinking country, where alcohol consumption is less problematized. We used three different categories of alcohol outlet density (off-premise, restaurants-cafes, and bars) [
43,
44,
45] and we analyzed the spatial patterns and the temporal trends of each category, as well as the neighborhood-level variables influencing these patterns. After analyzing the spatiotemporal distribution of alcohol outlets, we used these categories to study their relationship with alcohol-related calls-for-service.
The results indicated different relationships between the categories of alcohol outlets and neighborhood characteristics. Specifically, off-premise density was higher in areas with lower economic status, higher rates of immigrant population, and lower residential instability. Restaurant/cafe density was higher in areas with lower economic status, and higher spatially lagged economic status. Bar density, however, was higher in areas with higher levels of economic status, and higher spatially lagged economic status.
Previous studies conducted in U.S. cities have shown that socioeconomic disadvantage and lower economic status were positively related to alcohol outlet density [
12,
22,
24,
25,
26,
30]. Our results suggest that, in Valencia, off-premise outlets are located in lower economic status neighborhoods, restaurants/cafes are located in areas with lower local economic status but higher lagged economic status, while bars appear to have a different spatial signature (i.e., in local and lagged areas with higher economic status). Particularly interesting are the results for restaurants-cafes, which suggest that neighborhoods with higher density of restaurants/cafes are more likely to have lower economic status, but their neighboring areas are more likely to have higher economic status. Future studies would benefit from exploring the mechanisms involved in this relationship between local and lagged economic status and the restaurant and cafe distribution.
On the other hand, the location of the bars presents clear differences compared to the U.S., where alcohol outlet density tends to be associated to lower economic status areas. In our study, bar density was higher in local and lagged areas with higher economic status. These differences may reflect the characteristics of those who frequent bars and the reasons why people go to bars. In Valencia (and other Spanish cities), areas with a high number of bars are often frequented by young people who have a job or are studying at the university, and going to bars is culturally seen as a social activity. In this regard, bars would be more a meeting space than just a place for alcohol consumption. These areas with a higher density of bars often become popular areas and the cost of alcohol consumption at bars in these trendy areas tend to be higher, attracting a more wealthy type of clientele. These differences in the use of bars could lead to the different spatial association with neighborhood characteristics that we found in our study.
In regard to immigrant concentration, areas with higher immigrant concentration showed higher off-premise density. However, immigrant concentration was not associated with restaurants/cafes or bar density. Previous studies have also shown mixed results regarding the influence of immigrant concentration on alcohol outlet density [
26,
27,
28,
29]. Similarly, residential instability was only relevant in the off-premise density model, however, in contrast to previous studies [
27], our results showed a negative relationship between residential instability and off-premise density. In other words, those areas with higher residential stability showed higher off-premise density. These results suggest that off-premise establishments in Valencia are more frequent in stable neighborhoods, with families that tend to live in the same areas for a long time.
Taken together, these results suggest that research on the spatial distribution of alcohol outlets and the neighborhood characteristics influencing this distribution conducted in “dry” countries cannot be directly extrapolated to “wet” drinking countries, where the drinking patterns and culture are different. Clearly, further cross-cultural research is needed to better understand the different spatial distribution of alcohol outlets in countries with different drinking cultures.
Our study also showed the spatiotemporal trends of alcohol outlets from 2010 to 2015. Off-premises and bars models showed a clear improvement in fit when introducing a spatiotemporal structure, and only restaurants/cafes showed a better fit using only a spatial model, suggesting different space-time patterns depending on the alcohol outlet category. For example, during this time period, off-premise density increased in the central and eastern part of the city, and decreased in the peripheral areas. On the other hand, bar density increased in the south-central part of the city. This area corresponds to one of the traditional neighborhoods of Valencia, which has become a trendy district for the city’s nightlife after a process of gentrification [
56], which may explain the significant increase in bars in the area. Restaurant/cafe density, however, did not show important changes over the years, suggesting stable density levels.
To examine whether alcohol outlets were associated with alcohol-related problems in the neighborhoods, we also analyzed the influence of alcohol outlet density on alcohol-related calls-for-service. Results showed that bar density was the only alcohol outlet category with a positive association with alcohol-related calls-for-service risks. Restaurant/cafe density showed a negative relationship. Off-premise establishments showed no association with alcohol-related calls-for-service. When comparing the spatial distribution of alcohol-related calls-for-service and alcohol outlets, we can observe that the spatial pattern of alcohol-related calls-for-service is similar to the spatial distribution of bars. Specifically, the centre of the city showed higher relative risk of alcohol-related calls-for-service, as well as higher bar density. In addition, the temporal trend for calls-for-service (increasing in the south areas and decreasing in the north areas) is more coincident with the temporal trend for bars, which shows the same change patterns.
These findings show that police alcohol-related interventions are more common in neighborhoods with a higher density of bars. Despite the fact that these high bar-density areas are located in higher-income areas, police interventions are requested more often in these areas due to alcohol-related problems. This is similar to the context in the U.S., where bars are related to a variety of crimes [
6,
19]; although those studies did not measure only alcohol-related crimes. However, off-premise density was not related to alcohol-related calls-for-service. In the U.S., off-premise establishments are seen as an indicator of a “spiral of decay” that leads to more social problems, such as violent crime or injuries [
8,
57,
58,
59]. These differences between Spain and U.S. cities could be explained by the different meaning of off-premise establishments in Spain. In a wet country like Spain, the sale of alcohol does not require strict conditions, and alcohol is easily available in many establishments, including supermarkets, grocery stores, petrol stations, or small stores, where they are usually displayed along with nonalcoholic beverages. Spain, and by extension, wet drinking countries, would have the off-premise sale of alcohol more integrated into social life. These differences regarding off-premises may also be due to the fact that our study only assessed alcohol-related crimes. The U.S. studies tend to focus on all crimes within a specified area. As off-premise outlets do not allow alcohol use on premise, the number of alcohol-related crimes may actually be unaffected. In addition, wealthy neighborhoods may be more likely to call the police, because they may show greater trust in the police system, or because the police could be more likely to respond promptly in this type of neighborhoods than in deprived neighborhoods. However, we do not have available data to assess these possible relationships. Cross-cultural studies are needed to further analyze these differences and the implications of alcohol outlets in social problems.
This study has both strengths and limitations. Among the strengths, to the best of our knowledge, this is the first study on the spatial-temporal distribution of alcohol outlets in a city from a “wet” country. Most of the research in this field has been conducted in U.S. or northern European countries. Our results show that the influence of neighborhood-level variables on the distribution of alcohol outlets could be different in southern European cities, and that it is important to take into account the country’s drinking culture to make appropriate conclusions. In addition, this study uses a spatiotemporal perspective. This type of analysis presents major advantages because it reflects not only the spatial distribution, but it also accounts for changes over time. Studies that only consider spatial trends could bias the results and mask any relationship between variables [
49]. In addition, we use a Bayesian perspective, and we introduced different random-effects accounting for both spatial and temporal influences. Bayesian modelling has the advantage of addressing issues such as spatial autocorrelation or overdispersion, which can bias estimates if not taken into account [
60,
61,
62]. Finally, this study provides information about alcohol outlet distribution in small areas. Some studies have focused on larger areas such as zip codes, census tracks, or counties [
7,
26,
63]; we used census block groups, which were the smallest spatial unit available. This high-spatial resolution approach addressed potential issues in ecological studies due to aggregation effects [
62].
This study has also limitations. First, some traditional variables used for characterizing neighborhoods were not available for this study; for example, other socioeconomic indicators used in previous research that may reflect the better economic status of the census block groups (e.g., income, unemployment, or poverty indicators [
19,
25,
28,
29]), or variables related to neighborhood disorder [
64,
65]. In addition, we cannot discard that some endogeneity may exist in the relationship between bars, crime, and property values. For example, property values may be a product of overall crime rates in the area. Future research should address the possible nonrecursive relationship between these variables, and study the causality processes that would be explaining the results found in this study.
Regarding methodological aspects, a potential issue is the modifiable areal unit problem [
66]. In addition, our analysis may also be subjected to edge effect, where spillovers into surrounding rural areas around Valencia are not included in our model [
5,
67]. Another possible limitation is that, due to the short number of years available, we have used a linear time trend. However, other alternative and more complex models may be more appropriate and reveal more information about the problem when using longer time periods, such as an autoregressive structure or other nonlinear space-time models [
51,
52,
68].
In addition, it is important to note that alcohol-related calls refer only to those cases where police are required to intervene for alcohol-related problems, and they do not reflect other outcomes, such as hospital admissions, where the police do not intervene, or traffic crashes where alcohol is involved, which were not available for this study. Future research would benefit from focusing on other alcohol-related outcomes and explore their relationships with alcohol outlet density. In addition, more research is needed in the context of wet drinking countries, in order to analyze if they show the same sociospatial patterns, which differ from those found in dry drinking countries.