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Development and evaluation of the OHCITIES instrument: assessing alcohol urban environments in the Heart Healthy Hoods project

05 Oct 2017


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.


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.


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.


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.


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.

Click here to view the full article which appeared in BMJ Open