PROJECT SUMMARY/ABSTRACT Alcohol use and misuse is a leading cause of preventable death in the United States (US). Decades of research have identified individual-level and environmental characteristics that are associated with alcohol use and thus can be modified to reduce population alcohol consumption. Alcohol outlet density is one such environmental characteristic that has been a focus of substantial research in the US and around the world. While many agencies and organizations have used this research to promote policy advocating for modifications in alcohol outlet density, such as through changes in licensing and zoning, the science is far from settled. The findings of the relationship between outlet density and alcohol consumption are contradictory when examining individual-level and ecological level studies and the effect of every additional alcohol outlet on alcohol consumption also remains unclear. The lack of consensus on the true relationship between alcohol outlet density and alcohol consumption points to the need for rigorous individual-level studies that incorporate characteristics that impact an individual’s decision to travel to an alcohol outlet and the multiscale nature of alcohol consumption with risk factors lying on multiple levels. The objective of this study is to create a new measurement of the alcohol environment — a responsive buffer — that incorporates the decades of research identifying characteristics that impact alcohol use. The specific aims of this study are to (1) conduct an updated systematic review of research studying the impact of alcohol outlet density on alcohol consumption or related harm published from November 2014 to November 2023 to synthesize the findings of ecological and individual-level studies, alcohol outlet density measurements, methodological advances, scientific rigor, and methodological limitations, (2) compare the distance individuals travel to alcohol outlets using GPS travel data and use this information to develop responsive buffers for assessing exposure to alcohol outlets, and (3) characterize associations between alcohol outlet density of responsive buffers with individual-level alcohol consumption (i.e., number of drinking days, quantity consumed) and compare effect sizes to commonly used measurements of alcohol outlet density (e.g., census tracts, ZIP codes, 400 m buffer around residence). The proposed aims and training plan build upon my experience in alcohol research supplemented by focused training in alcohol epidemiology, spatial epidemiology and neighborhood research techniques for mobility studies and momentary assessments of exposure and analyses of hierarchically structured data. This research and development of a new method has important implications for environmental prevention efforts aimed to improve population health by decreasing alcohol consumption. By creating an innovative measurement of the alcohol environment, this research will improve the translation of evidence-based research to alcohol prevention policy and promote the NIAAA’s mission to inform regulatory efforts and policy that create environments for healthy lives and well-being for all.

PROJECT NARRATIVE Research on the impact of alcohol outlet density on alcohol consumption has recently remained stalled due to the mixed results of ecological and individual-level studies, in addition to the lack of clarity regarding the threshold effects of every additional alcohol outlet added to an area. We propose to create a responsive buffer — a new measurement of individuals’ exposure to the alcohol environment that is responsive to documented individual-level and neighborhood-level characteristics — to advance studies on alcohol outlet density. A new measurement of the alcohol environment has critical implications for establishment of the relationship of alcohol outlet density and alcohol consumption, which will therefore directly inform environmental prevention efforts, like licensing and zoning, to reduce alcohol consumption and improve population health.