Access to alcohol outlets and harmful alcohol consumption: a multi-level study in Melbourne, Australia

AIMS: To assess the association between access to off-premises alcohol outlets and harmful alcohol consumption. DESIGN, SETTING AND PARTICIPANTS: Multi-level study of 2334 adults aged 18-75 years from 49 census collector districts (the smallest spatial unit in Australia at the time of survey) in metropolitan Melbourne. MEASUREMENTS: Alcohol outlet density was defined as the number of outlets within a 1-km road network of respondents' homes and proximity was the shortest road network distance to the closest outlet from their home. Using multi-level logistic regression we estimated the association between outlet density and proximity and four measures of harmful alcohol consumption: drinking at levels associated with short-term harm at least weekly and monthly; drinking at levels associated with long-term harm and frequency of consumption. FINDINGS: Density of alcohol outlets was associated with increased risk of drinking alcohol at levels associated with harm. The strongest association was for short-term harm at least weekly [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04-1.16]. When density was fitted as a categorical variable, the highest risk of drinking at levels associated with short-term harm was when there were eight or more outlets (short-term harm weekly: OR 2.36, 95% CI 1.22-4.54 and short-term harm monthly: OR 1.80, 95% CI 1.07-3.04). We found no evidence to support an association between proximity and harmful alcohol consumption. CONCLUSIONS: The number of off-premises alcohol outlets in a locality is associated with the level of harmful alcohol consumption in that area. Reducing the number of off-premises alcohol outlets could reduce levels of harmful alcohol consumption