Alcohol and cannabis use and co-use among Whites and Hispanics on and off the U.S./Mexico border in California.

This paper examines self-reported rates of drinking and cannabis use and co-use among White and Hispanic adults randomly selected in four counties in California: Imperial on the border; and Kern, Tulare, and Madera in California's Central Valley. Co-use was significantly higher among the U.S. born than among those born abroad, and in the Central Valley than on the border. Co-users were heavier drinkers, had higher rates of alcohol use disorder, other alcohol problems, and a positive history of illicit drug use than drinkers only.

Drinking in Mexico by Whites and Hispanics on and off the US/Mexico border in California.

This paper compares drinking patterns of Whites and Hispanics who after crossing the U.S./Mexico border drink and do not drink in Mexico. Data came from a household survey of 1,209 adults 18 to 39 years of age in California. Residence near the US/Mexico border increases the likelihood of drinking in Mexico (AOR = 4.57; 95%CI = 2.45-8.52; p < .001). Hispanics (AOR = 1.91; 95%CI = 1.26-2.90; p < .01), those who drink more frequently (AOR = 1.05; 95%CI = 1.02-1.09; p < .01) and those who drink six or more drinks in day (AOR = 1.91; 95%CI = 1.26-2.29; p < .01) are more likely than Whites and lighter drinkers to report this behavior. Crossing the U.S./Mexico border to drink is influenced by living close to the border, Hispanic ethnicity, and drinking many drinks in a day.

A Spatiotemporal Analysis of the Association of California City and County Cannabis Policies with Cannabis Outlet Densities.

BACKGROUND: Cannabis outlets may affect health and health disparities. Local governments can regulate outlets, but little is known about the effectiveness of local policies in limiting outlet densities and discouraging disproportionate placement of outlets in vulnerable neighborhoods. METHODS: For 241 localities in California, we measured seven policies pertaining to density or location of recreational cannabis outlets. We geocoded outlets using web-scraped data from the online finder Weedmaps between 2018 and 2020. We applied Bayesian spatiotemporal models to evaluate associations of local cannabis policies with Census block group-level outlet counts, accounting for confounders and spatial autocorrelation. We assessed whether associations differed by block group median income or racial-ethnic composition. RESULTS: Seventy-six percent of localities banned recreational cannabis outlets. Bans were associated with fewer outlets, particularly in block groups with higher median income, fewer Hispanic residents, and more White and Asian residents. Outlets were disproportionately located in block groups with lower median income [posterior RR (95% credible interval): 0.76 (0.70, 0.82) per $10,000], more Hispanic residents [1.05 (1.02, 1.09) per 5%], and fewer Black residents [0.91 (0.83, 0.98) per 5%]. For the six policies in jurisdictions permitting outlets, two policies were associated with fewer outlets and two with more; two policy associations were uninformative. For these policies, we observed no consistent heterogeneity in associations by median income or racial-ethnic composition. CONCLUSIONS: Some local cannabis policies in California are associated with lower cannabis outlet densities, but are unlikely to deter disproportionate placement of outlets in racial-ethnic minority and low-income neighborhoods.

Equity in Coverage of Local Cannabis Control Policies in California, 2020‒2021.

Objectives. To assess whether cannabis control policies that may protect public health were adopted evenly across California localities with differing sociodemographic compositions. Methods. From November 2020 to January 2021, we measured cannabis control policies for 241 localities across California and linked them to data on the characteristics of the communities affected by these policies. We evaluated whether disadvantaged communities were more likely to allow cannabis businesses and less likely to be covered by policies designed to protect public health. Results. Localities with all-out bans on cannabis businesses (65% of localities) were disproportionately high-education (55.8% vs 50.5% with any college) and low-poverty (24.3% vs 34.2%), with fewer Black (4.4% vs 6.9%) and Latinx (45.6% vs 50.3%) residents. Among localities that allowed retail cannabis businesses (28%), there were more cannabis control policies in localities with more high-income and Black residents, although the specific policies varied. Conclusions. Cannabis control policies are unequally distributed across California localities. If these policies protect health, inequities may be exacerbated. Public Health Implications. Uniform adoption of recommended cannabis control policies may help limit any inequitable health impacts of cannabis legalization. (Am J Public Health. 2022;112(11):1640-1650. https://doi.org/10.2105/AJPH.2022.307041).

Trends and correlates of spatially aggregated alcohol-involved crashes among Whites and Hispanics in California.

AIMS: This paper examines trends and correlates of alcohol-involved motor vehicle crashes (AMVCs) in California between 2005 and 2016 among Hispanic and non-Hispanic Whites (Whites hereafter). Together these two groups comprise 76% of the state population. The paper also examines whether alcohol outlet density, percentage of Hispanics in census tract populations, and distance to the U.S./Mexico border are related to greater risks for AMVCs. The border is of interest given the greater availability of alcohol in the area. METHODS: Crash data come from Statewide Integrated Traffic Records System maintained by the California Highway Patrol. Sociodemographic and community characteristics data from the U.S. Census and alcohol outlet density were aggregated to census tracts. Total motor vehicle crashes and AMVCs were related to these characteristics using hierarchical Bayesian Poisson space-time models. RESULTS: There were over two million injury and fatality crashes during the period of analysis, of which 11% were AMVCs. About 1.7% of these crashes had fatalities. The rate of AMVCs increased among both Whites and Hispanics until 2008. After 2008, the rate among Whites declined through 2016 while the rate among Hispanics declined for 2 years (2009 and 2010) and increased thereafter. Crash distance from the border (RR = 1.016, 95% CI = 1.010 to 1.022) and percent Hispanic population (RR = 1.006; 95% CI = 1.003 to 1.009) were well-supported results with 95% credible intervals that did not include 1. The percentages of the following: bars/pubs, males, individuals aged 18 to 29 and 40 to 49 years, U.S. born population, individuals below the 150% poverty level, unemployed, housing vacant, and housing owner-occupied were all positively associated with AMVCs and well supported. CONCLUSIONS: Between 2005 and 2016 the rate of AMVCs in California declined among Whites but not among Hispanics. Population-level indicators of percent Hispanic population, distance to the U.S. Mexico border, gender, age distribution, and socioeconomic stability were positively associated with crash rates, indicating that important contextual characteristics help determine the level of AMVC rates in communities.

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample.

INTRODUCTION: Urban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use. METHODS: Cross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants' past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender. RESULTS: Rates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men's at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization. DISCUSSION: Brief screening of patients' at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.

Alcohol use disorder among Whites and Hispanics on and off the U.S./Mexico border in California.

This paper examines whether U.S./Mexico border residence in California is related to the prevalence of DSM-5 alcohol use disorder (AUD) among Whites and Hispanics. Household survey data were obtained from 1,209 adults (59.7% female) 18 to 39 years of age resident in four counties in California: Imperial on the U.S./Mexico border; and Kern, Tulare, and Madera in California's Central Valley. Households were selected using a list assisted sample, with data collected on the phone or online. Results show that AUD rates were not different between border and non-border location and between Whites and Hispanics. AUD was negatively associated with higher income ($20,000 to $60,000: AOR=.38; 95%CI=.17-.86; p<.01-more than $60,000: AOR=.27; 95%CI: .09-.81; p<.01) and poor risk perception (AOR=.86; 95%CI=.78-.94; p<.01). AUD was positively associated with continued volume of drinking (AOR = 1.05; 95%CI = 1.01-1.09; p<.01), drinking in Mexico (AOR = 4.28; 95%CI = 1.61-11.36; p<.01), marijuana use (AOR = 4.11; 95%CI = 1.73-9.77; p<.01), and impulsivity (AOR = 1.55; 95%CI = 1.23-1.94). Efforts to prevent AUD in the population in California, and especially among those who live close to the border with Mexico, should take into consideration factors such as impulsivity, marijuana use, border crossing to drink in Mexico, all of which increased risk of AUD.

Multiresolution Analyses of Neighborhood Correlates of Crime: Smaller Is Not Better.

Population analyses of the correlates of neighborhood crime implicitly assume that a single spatial unit can be used to assess neighborhood effects. However, no single spatial unit may be suitable for analyses of the many social determinants of crime. Instead, effects may appear at multiple spatial resolutions, with some determinants acting broadly, others locally, and still others as some function of both global and local conditions. We provide a multiresolution spatial analysis that simultaneously examines US Census block, block group, and tract effects of alcohol outlets and drug markets on violent crimes in Oakland, California, incorporating spatial lag effects at the 2 smaller spatial resolutions. Using call data from the Oakland Police Department from 2010-2015, we examine associations of assaults, burglaries, and robberies with multiple resolutions of alcohol outlet types and compare the performance of single (block-level) models with that of multiresolution models. Multiresolution models performed better than the block models, reflected in improved deviance and Watanabe-Akaike information criteria and well-supported multiresolution associations. By considering multiple spatial scales and spatial lags in a Bayesian framework, researchers can explore multiresolution processes, providing more detailed tests of expectations from theoretical models and leading the way to more effective intervention efforts.

Predicting the Future Course of Opioid Overdose Mortality: An Example From Two US States.

BACKGROUND: The rapid growth of opioid abuse and the related mortality across the United States has spurred the development of predictive models for the allocation of public health resources. These models should characterize heterogeneous growth across states using a drug epidemic framework that enables assessments of epidemic onset, rates of growth, and limited capacities for epidemic growth. METHODS: We used opioid overdose mortality data for 146 North and South Carolina counties from 2001 through 2014 to compare the retrodictive and predictive performance of a logistic growth model that parameterizes onsets, growth, and carrying capacity within a traditional Bayesian Poisson space-time model. RESULTS: In fitting the models to past data, the performance of the logistic growth model was superior to the standard Bayesian Poisson space-time model (deviance information criterion: 8,088 vs. 8,256), with reduced spatial and independent errors. Predictively, the logistic model more accurately estimated fatality rates 1, 2, and 3 years in the future (root mean squared error medians were lower for 95.7% of counties from 2012 to 2014). Capacity limits were higher in counties with greater population size, percent population age 45-64, and percent white population. Epidemic onset was associated with greater same-year and past-year incidence of overdose hospitalizations. CONCLUSION: Growth in annual rates of opioid fatalities was capacity limited, heterogeneous across counties, and spatially correlated, requiring spatial epidemic models for the accurate and reliable prediction of future outcomes related to opioid abuse. Indicators of risk are identifiable and can be used to predict future mortality outcomes.

Measuring Relationships Between Proactive Reporting State-level Prescription Drug Monitoring Programs and County-level Fatal Prescription Opioid Overdoses.

BACKGROUND: Prescription drug monitoring programs (PDMPs) that collect and distribute information on dispensed controlled substances have been adopted by nearly all US states. We know little about program characteristics that modify PDMP impact on prescription opioid (PO) overdose deaths. METHODS: We measured associations between adoption of any PDMP and changes in fatal PO overdoses in 2002-2016 across 3109 counties in 49 states and D.C. We then measured changes related to the adoption of "proactive PDMPs," which report outlying prescribing/dispensing patterns and provide broader access to PDMP data by law enforcement. Comparisons were made within 3 time intervals that broadly represent the evolution of PDMPs (2002-2004, 2005-2009, and 2010-2016). We modeled overdoses using Bayesian space-time models. RESULTS: Adoption of electronic PDMP access was associated with 9% lower rates of fatal PO overdoses after three years (rate ratio [RR] = 0.91, 95% credible interval [CI]: 0.88-0.93) with well-supported effects for methadone (RR = 0.86,95% CI: 0.82-0.90) and other synthetic opioids (RR = 0.82, 95% CI: 0.77-0.86). Compared with states with no/weak PDMPs, proactive PDMPs were associated with fewer deaths attributed to natural/semi-synthetic opioids (2002-2004: RR = 0.72 [0.66-0.78]; 2005-2009: RR = 0.93 [0.90-0.97]; 2010-2016: 0.89 [0.86-0.92]) and methadone (2002-2004: RR = 0.77 [0.69-0.85]; 2010-2016: RR = 0.90 [0.86-0.94]). Unintended effects were observed for synthetic opioids other than methadone (2005-2009: RR = 1.29 [1.21-1.38]; 2010-2016: RR = 1.22 [1.16-1.29]). CONCLUSIONS: State adoption of PDMPs was associated with fewer PO deaths overall while proactive PDMPs alone were associated with fewer deaths related to natural/semisynthetic opioids and methadone, the specific targets of these programs. See video abstract at, http://links.lww.com/EDE/B619.

Proximity to the Southern Border and Sociodemographic Correlates of Drinking and Driving Arrests in California.

BACKGROUND: About 30% of all motor vehicle fatalities in the United States are associated with alcohol-impaired motor vehicle crashes. Arrests for drinking and driving (Driving under the influence [DUI]) are 1 of the most important deterrence actions to minimize DUI. This paper examines trends and population-level correlates of drinking driving arrests (DUI) from 2005 to 2017 in California. METHODS: Arrest data come from the Monthly Arrest and Citation Register compiled by the California Department of Justice. Sociodemographic and community characteristic data from the U.S. Census, alcohol outlet density, and distance to the U.S.-Mexico border from Law Enforcement Reporting Areas (LERA) centroids were aggregated at the level of 499 LERA contributing to the report. Reported arrest rates were related to area sociodemographic characteristics using hierarchical Bayesian Poisson space-time models. RESULTS: Both among men and women rates showed an upward trend until 2008, decreasing after that year. DUI arrest rates were greater among Hispanics than Whites for the 2 younger age groups, 18 to 29 (p < 0.001) and 30 to 39 years (p < 0.001). DUI arrest rates in LERA areas are positively related to proximity to the California/Mexico border; a higher percent of bar/pub outlets; a higher percent of Hispanic population; a higher percent of population 18 to 29, 30 to 39, and 40 to 49 years of age; a higher percent of US-born population; a higher percent of population with annual income of $100,000 or more; a higher percent of population 150% below the federal poverty line; and a higher level of law-enforcement activities. CONCLUSIONS: Results of this analysis of spatial correlates of DUI arrests overlap well with the literature on individual-level data and arrest rates. The decrease in arrest rates as distance to the California/Mexico border increases is potentially associated with the greater availability of alcohol in the border area.

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment. OBJECTIVES: To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males. METHODS: Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome. RESULTS: One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females' cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males' separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes. CONCLUSION: ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.

Assessing Individuals' Exposure to Environmental Conditions Using Residence-based Measures, Activity Location-based Measures, and Activity Path-based Measures.

BACKGROUND: Many approaches are available to researchers who wish to measure individuals' exposure to environmental conditions. Different approaches may yield different estimates of associations with health outcomes. Taking adolescents' exposure to alcohol outlets as an example, we aimed to (1) compare exposure measures and (2) assess whether exposure measures were differentially associated with alcohol consumption. METHODS: We tracked 231 adolescents 14-16 years of age from the San Francisco Bay Area for 4 weeks in 2015/2016 using global positioning systems (GPS). Participants were texted ecologic momentary assessment surveys six times per week, including assessment of alcohol consumption. We used GPS data to calculate exposure to alcohol outlets using three approach types: residence-based (e.g., within the home census tract), activity location-based (e.g., within buffer distances of frequently attended places), and activity path-based (e.g., average outlets per hour within buffer distances of GPS route lines). Spearman correlations compared exposure measures, and separate Tobit models assessed associations with the proportion of ecologic momentary assessment responses positive for alcohol consumption. RESULTS: Measures were mostly strongly correlated within approach types (ρ ≥ 0.7), but weakly (ρ < 0.3) to moderately (0.3 ≤ ρ < 0.7) correlated between approach types. Associations with alcohol consumption were mostly inconsistent within and between approach types. Some of the residence-based measures (e.g., census tract: ß = 8.3, 95% CI = 2.8, 13.8), none of the activity location-based approaches, and most of the activity path-based approaches (e.g., outlet-hours per hour, 100 m buffer: ß = 8.3, 95% CI = 3.3, 13.3) were associated with alcohol consumption. CONCLUSIONS: Methodologic decisions regarding measurement of exposure to environmental conditions may affect study results.

Prescription Drug Monitoring Programs and Opioid Overdoses: Exploring Sources of Heterogeneity.

BACKGROUND: Prescription drug monitoring program are designed to reduce harms from prescription opioids; however, little is known about what populations benefit the most from these programs. We investigated how the relation between implementation of online prescription drug monitoring programs and rates of hospitalizations related to prescription opioids and heroin overdose changed over time, and varied across county levels of poverty and unemployment, and levels of medical access to opioids. METHODS: Ecologic county-level, spatiotemporal study, including 990 counties within 16 states, in 2001-2014. We modeled overdose counts using Bayesian hierarchical Poisson models. We defined medical access to opioids as the county-level rate of hospital discharges for noncancer pain conditions. RESULTS: In 2010-2014, online prescription drug monitoring programs were associated with lower rates of prescription opioid-related hospitalizations (rate ratio 2014 = 0.74; 95% credible interval = 0.69, 0.80). The association between online prescription drug monitoring programs and heroin-related hospitalization was also negative but tended to increase in later years. Counties with lower rates of noncancer pain conditions experienced a lower decrease in prescription opioid overdose and a faster increase in heroin overdoses. No differences were observed across different county levels of poverty and unemployment. CONCLUSIONS: Areas with lower levels of noncancer pain conditions experienced the smallest decrease in prescription opioid overdose and the faster increase in heroin overdose following implementation of online prescription drug monitoring programs. Our results are consistent with the hypothesis that prescription drug monitoring programs are most effective in areas where people are likely to access opioids through medical providers.

Space-Time Analyses of Alcohol Outlets and Related Motor Vehicle Crashes: Associations at City and Census Block-Group Levels.

BACKGROUND: Past research has linked alcohol outlet densities to drinking, drunken driving, and alcohol-related motor vehicle crashes (MVCs). Because impaired drivers travel some distances from drinking places to crash locations, spatial relationships between outlets and crashes are complex. We investigate these relationships at 3 geographic levels: census block groups (CBGs), adjacent (nearby) areas, and whole cities. METHODS: We examined risks of all injury MVCs as well as "had been drinking" (HBD) and single-vehicle-nighttime (SVN) subgroups using data from the Statewide Integrated Traffic Records System across CBGs among 50 California cities from 2001 to 2008. Relationships between outlet densities at the city level, within CBGs, and in adjacent CBGs and crashes were examined using Bayesian Poisson space-time analyses controlling for population size income and other demographics (all as covariates). RESULTS: All injury MVCs were positively related to adjacent CBG population size (relative rate [RR] = 1.008, 95% credible interval (CI) = 1.004, 1.012), and outlet densities at CBG (RR = 1.027, CI = 1.020, 1.035), nearby area (RR = 1.084, CI = 1.060, 1.106) and city levels (RR = 1.227, CI = 1.147, 1.315), and proportion of bars or pubs at the city level (RR = 2.257, CI = 1.187, 4.125). HBD and SVN crashes were comparatively less frequent in high outlet density CBG (RR = 0.993, CI = 0.987, 0.999; RR = 0.963, CI = 0.951, 0.975) and adjacent areas (RR = 0.979, CI = 0.962, 0.996; RR = 0.909, CI = 0.883, 0.936), but positively associated with city-level proportions of bars (RR = 3.373, CI = 0.736, 15.644; RR = 10.322, CI = 1.704, 81.215). Overall, a 10% increase in all outlets was related to 2.8% more injury crashes (CI = 2.3, 3.3) and 2.5% more HBDs (CI = 1.7, 3.3). A 10% increase in bars was related to 1.4% more crashes, 4.3% more HBDs, and 10.3% more SVNs. CONCLUSIONS: Population size and densities of bars or pubs were found to be associated with crash rates, with population effects appearing across cities and outlet effects appearing within dense downtown areas. Summary estimates of outlet and population impacts on MVCs must consider varying contributions at multiple spatial scales.

Spatial Epidemiology of Alcohol- and Drug-Related Health Problems Among Northern Plains American Indians: Nebraska and South Dakota, 2007 to 2012.

BACKGROUND: Despite high abstinence rates, American Indians experience elevated rates of many alcohol and other drug problems. American Indians also predominantly reside in poor and rural areas, which may explain some observed health disparities. We investigated whether geographic areas including reservations or large American Indian populations exhibited greater incidence of alcohol- and drug-related hospitalizations. METHODS: We obtained inpatient hospitalization records for 2 Northern Plain states (Nebraska and South Dakota) for the years 2007 to 2012. We constructed zip code counts for 10 categories of hospitalization with diagnoses or injury causation commonly associated with alcohol or drug use. We related these to community sociodemographic characteristics using Bayesian Poisson space-time regression models and examined associations with and without controls for whether each zip code was located within an American Indian reservation. RESULTS: Controlling for other demographic and economic characteristics, zip codes with greater percentage of American Indians exhibited greater incidence for all 10 substance abuse-related health outcomes (9 of 10 well supported); zip code areas within American Indian reservations had greater incidence of self-inflicted injury and drug dependence and abuse, and reduced incidence of alcohol cirrhosis and prescription opioid poisoning. However, the analyses generally demonstrated no well-supported differences in incidence associated with local residence percentages of American Indian versus African American. CONCLUSIONS: In our analyses, ethnicity or heredity alone did not account for alcohol- and drug-related hospitalizations among Native populations. Aspects of social, economic, and political dimensions of Native lives must be considered in the etiology of alcohol- and drug-related problems for rural-dwelling indigenous peoples.

Heterogeneous Costs of Alcohol and Drug Problems Across Cities and Counties in California.

BACKGROUND: Estimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between smaller geopolitical units like counties and cities. This study examines the ranges of these costs across counties and cities in California. METHODS: We used estimates of the incidence and prevalence of AOD use, abuse, and related problems to calculate costs in 2010 dollars for all 58 counties and an ecological sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public-use survey data collected at state, county, and city levels over the years from 2009 to 2010. RESULTS: Costs related to alcohol use and related problems exceeded those related to illegal drugs across all counties and most cities in the study. Substantial heterogeneities in costs were observed between cities within counties. CONCLUSIONS: AOD costs are heterogeneously distributed across counties and cities, reflecting the degree to which different populations are engaged in use and abuse across the state. These findings provide a strong argument for the distribution of treatment and prevention resources proportional to need.

From Medical to Recreational Marijuana Sales: Marijuana Outlets and Crime in an Era of Changing Marijuana Legislation.

A movement from medical to recreational marijuana use allows for a larger base of potential users who have easier access to marijuana, because they do not have to visit a physician before using marijuana. This study examines whether changes in the density of marijuana outlets were related to violent, property, and marijuana-specific crimes in Denver, CO during a time in which marijuana outlets began selling marijuana for recreational, and not just medical, use. We collected data on locations of crimes, marijuana outlets and covariates for 481 Census block groups over 34 months (N = 16,354 space-time units). A Bayesian Poisson space-time model assessed statistical relationships between independent measures and crime counts within "local" Census block groups. We examined spatial "lag" effects to assess whether crimes in Census block groups adjacent to locations of outlets were also affected. Independent of the effects of covariates, densities of marijuana outlets were unrelated to property and violent crimes in local areas. However, the density of marijuana outlets in spatially adjacent areas was positively related to property crime in spatially adjacent areas over time. Further, the density of marijuana outlets in local and spatially adjacent blocks groups was related to higher rates of marijuana-specific crime. This study suggests that the effects of the availability of marijuana outlets on crime do not necessarily occur within the specific areas within which these outlets are located, but may occur in adjacent areas. Thus studies assessing the effects of these outlets in local areas alone may risk underestimating their true effects.

Context-Specific Drinking Risks Among Young People.

BACKGROUND: Limited research suggests the context in which drinking occurs may contribute to specific alcohol-related consequences. Therefore the aims are to (i) determine whether the use of drinking contexts affects risks for several drinking consequences among young people in the general population and (ii) assess the degree to which additional risks are associated with greater levels of drinking in those contexts. METHODS: A New Zealand survey of 16- to 29-year-olds asked about context-specific drinking and incidence of alcohol-related consequences grouped as follows: total, alcohol-related disorderly behavior, symptoms of dependence, effects of heavier drinking, and felt effects the next day. A context-specific dose-response model separated the effects of frequency (i.e., how often someone consumes 1 drink in each context) and context-specific quantity (i.e., the count of each successive drink consumed above the first), and these were estimated as predictors of consequences. Demographic covariates were included. RESULTS: Exposure (number of visits): Increased exposure to drinking at bars/nightclubs, even at a very low level of consumption, that is, 1 drink, was independently related to the experience of greater consequences, including alcohol-related disorderly behavior. Risks for alcohol-related consequences were more strongly related to exposure to bars/nightclubs than they were to heavier drinking in that context. Greater use of private motor vehicles and outdoor public places was also associated with greater consequences (independently of the heavier drinking in these contexts). Quantity: Risk of consequences associated with others' home, restaurants, and own home depended primarily on quantity consumed. CONCLUSIONS: Bars/nightclubs are inherently risky contexts for drinking by young people and improved controls are required. Drinking at others' home, private motor vehicles, and outdoor public places were also associated with consequences; prevention efforts increasing the price and reducing the availability of takeaway alcohol should work to reduce consequences at these contexts. Innovative context-specific interventions may be useful.

Reducing Risky Sex Among College Students: Prospects for Context-Specific Interventions.

Better understanding the contribution of specific drinking contexts to alcohol use and risky sexual behaviors can help target effective prevention programs to specific locations and types of drinkers. We used a sample of college students to investigate whether more frequent and heavier drinking in specific drinking contexts was associated with unplanned sex, unprotected sex, and number of sexual contacts. Greater frequencies of drinking in almost all contexts (Greek parties, off-campus parties, campus events, dorms, and bars) were associated with greater numbers of sexual partners, unplanned sex and unprotected sex; heavier drinking at bars increased risks related to all outcomes. Risks related to frequencies of use of contexts were similar for men and women, but heavier drinking at bars was associated with more unprotected sex among males only. We discuss these observations in light of their implications for developing context-specific interventions to reduce community viral load in high-risk populations.