Alcohol availability around schools and adolescent consumption: A case study in Madrid, Spain

Evidence on the relationship between alcohol environment and adolescents' alcohol consumption remains inconsistent. This cross-sectional study explored the association between alcohol availability around schools and adolescent alcohol consumption in Madrid, a European city with high availability. We quantified alcohol availability as the number of alcohol outlets within 500m street network buffers around 49 schools located in areas with different Socioeconomic Position (SEP). Questionnaires were distributed to students aged 14-18 attending these schools, including sociodemographic and alcohol consumption measures (ever drunk, past 30 and 7 days and binge drinking in the past 30 days). Data were collected during 2021-2022. We designed a Directed Acyclic Graph to identify the minimal adjustment set for Robust Poisson regression models assessing the association between alcohol availability and consumption. The mean number of alcohol outlets around schools was 79. 67% of students reported ever drinking, with higher prevalences among females, older students, and those receiving more pocket money, with low-risk perception, or reporting higher parental alcohol consumption. Students from high SEP areas reported more drinking than those from low SEP areas. Consumption was not associated with alcohol availability around schools. This aligns with emerging evidence suggesting that in highly saturated urban environments, the relationship between outlet density and consumption may follow a threshold-effect, where additional outlets no longer increase use. Adolescent consumption was high overall, and the observed overprovision of outlets may contribute to the normalization of drinking. Future research should inform preventive strategies and public health policies that tackle the complex dynamics of alcohol consumption.