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Development and evaluation of the OHCITIES instrument: assessing alcohol urban environments in the Heart Healthy Hoods project
  1. Xisca Sureda1,
  2. Albert Espelt2,3,4,5,6,
  3. Joan R Villalbí2,3,5,7,8,
  4. Alba Cebrecos1,9,
  5. Lucía Baranda10,
  6. Jamie Pearce11,
  7. Manuel Franco1,12
  1. 1 Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
  2. 2 Agència de Salut Pública de Barcelona, Barcelona, Spain
  3. 3 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  4. 4 Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
  5. 5 Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
  6. 6 Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Manresa, Spain
  7. 7 Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
  8. 8 Grupo de Trabajo sobre Alcohol (GTOH), Sociedad Española de Epidemiología, Barcelona, Spain
  9. 9 Department of Geology, Geography and Environmental Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
  10. 10 Research Consultant, Barcelona, Spain
  11. 11 Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
  12. 12 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to and Dr Xisca Sureda; francisca.sureda{at}


Objectives To describe the development and test–retest reliability of OHCITIES, an instrument characterising alcohol urban environment in terms of availability, promotion and signs of consumption.

Design This study involved: (1) developing the conceptual framework for alcohol urban environment by means of literature reviewing and previous alcohol environment research experience; (2) pilot testing and redesigning the instrument; (3) instrument digitalisation; (4) instrument evaluation using test–retest reliability.

Setting Data for testing the reliability of the instrument were collected in seven census sections in Madrid in 2016 by two observers.

Primary and secondary outcome measures We computed per cent agreement and Cohen’s kappa coefficients to estimate inter-rater and test–retest reliability for alcohol outlet environment measures. We calculated interclass coefficients and their 95% CIs to provide a measure of inter-rater reliability for signs of alcohol consumption measures.

Results We collected information on 92 on-premise and 24 off-premise alcohol outlets identified in the studied areas about availability, accessibility and promotion of alcohol. Most per cent-agreement values for alcohol measures in on-premise and off-premise alcohol outlets were greater than 80%, and inter-rater and test–retest reliability values were generally above 0.80. Observers identified 26 streets and 3 public squares with signs of alcohol consumption. Intraclass correlation coefficient between observers for any type of signs of alcohol consumption was 0.50 (95% CI −0.09 to 0.77). Few items promoting alcohol unrelated to alcohol outlets were found on public spaces.

Conclusions The OHCITIES instrument is a reliable instrument to characterise alcohol urban environment. This instrument might be used to understand how alcohol environment associates with alcohol behaviours and its related health outcomes, and can help in the design and evaluation of policies to reduce the harm caused by alcohol.

  • alcohol
  • urban environment
  • cities
  • promotion
  • availability

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  • Contributors MF and XS conceived the study. XS, AE, JRV, LB and MF designed the instrument. AC coded and digitised the instrument. XS and LB supervised the fieldwork. XS and AE designed and supervised the analytical procedures. XS prepared the database and analysed the data with the advice of AE and JP. XS and MF drafted the manuscript. All authors contributed substantially to the interpretation of the data and manuscript review, and approved its final version. XS and MF are the guarantors.

  • Funding This study is part of the project Heart Healthy Hoods study funded by the European Research Council under the European Union’s Seventh Framework Programme (FP7/2007-2013/ERC Starting Grant HeartHealthyHoods Agreement No. 336893). This study is also funded by Delegación del Gobierno para el Plan Nacional sobre Drogas (DGPNSD) (2016I047 and 2016I029). The funding sources have no involvement in the study design; in the collection, analysis or interpretation of data; in the writing of this work; or in the decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

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