Associations Between the Physical Availability of Alcohol and Alcohol Use: Regional Variation Across 15 Major Cities in Ontario, Canada

Objective: Rates of alcohol use and alcohol-related harms increase with greater alcohol availability. However, regional differences in sociodemographic characteristics and built environment may affect this association. This study evaluated the association between off-premise alcohol availability and alcohol use in Ontario, Canada, and the degree to which this association varies between cities. Method: This was a cross-sectional spatial analysis of urban neighborhoods in Ontario, Canada (n = 11,742). The primary exposure was off-premise alcohol availability, based on the drive time from a neighborhood to the closest off-premise outlets. The primary outcome was the neighborhood-level prevalence of high-volume alcohol use (>2 drinks/day [males], >1 drink/ day [females]) based on survey data from 2000 to 2014. The association between availability and use was assessed using Bayesian hierarchical spatial models to account for spatial autocorrelation. Results: There was an overall positive association between alcohol availability and high -volume alcohol use (male coefficient estimate (13) = 0.19, 95% credible interval [CI] [0.16, 0.22]; female 13 = 0.17, 95% CI [0.13, 0.21]). How-ever, the association was eliminated in models that allowed for this as-sociation to vary between cities via an interaction term (male 13 =-0.04, 95% CI [-0.26, 0.19]; female 13 =-0.04, 95% CI [-0.34, 0.26]). This was explained by variability in the association between cities, where some cities demonstrated a positive association between availability and use and others demonstrated a negative association. Conclusions: Although there is a province-wide positive association between off-premise alcohol availability and high-volume alcohol use, there is substantial regional variation in this association that may affect the local effectiveness of alcohol regulation policies.