Perspectives on limiting tobacco access and supporting access to nicotine vaping products among clients of residential drug and alcohol treatment services in Australia.

INTRODUCTION: Tobacco endgame strategies aim to drive down population smoking rates, the success of which can be improved with public buy-in, including from populations with high smoking rates such as alcohol and other drug (AOD) service clients. This study aimed to explore acceptability of tobacco retail and nicotine reduction, and subsidised nicotine vaping to support AOD service clients following a smoking cessation attempt. METHODS: We interviewed 31 Australian AOD service clients who currently or previously smoked, following a 12-week randomised trial comparing nicotine replacement therapy with nicotine vaping product (NVP) for smoking cessation. Participants were asked how effectively three scenarios would support tobacco cessation: tobacco retailer reduction, very low-nicotine cigarette standard and subsidised NVP access. We thematically analysed participant views on how each approach would support tobacco abstinence. RESULTS: Tobacco retailer reduction raised concerns about increasing travel and accessing cigarettes from alternate sources, with generally lower acceptability, though a range of perspectives were provided. Reducing nicotine in tobacco products was described as reducing appeal of smoking and potentially increasing illicit purchases of non-reduced nicotine products. Clients of AOD services were highly accepting of subsidised NVP access for tobacco cessation, as this would partly address financial and socioeconomic barriers. CONCLUSIONS: Australian tobacco control policy should consider how these approaches impact ease and likelihood of tobacco access by AOD service clients in relation to the general population. Understanding clients' acceptability of tobacco control and endgame measures can inform how to avoid potential unintended consequences for these clients.

Trends and disparities in American Indian/Alaska Native unintentional injury mortality from 1999 to 2016.

INTRODUCTION: Alcohol and drug use are significant problems in the US, and American Indian/Alaska Native (AI/AN) communities and individuals are known to be among the most affected. This study evaluates disparities in unintentional injury mortality causes since 1999. METHODS: Analyses in 2020 of unintentional injury mortality rate disparities between AI/ANs and white population over the 1999-2016 period with attention to motor vehicle crashes, alcohol poisoning, drug poisoning and all other cause types. Rates in each of the 10 states with the largest AI/AN populations were also investigated to account for geographical concentration. RESULTS: Motor vehicle mortality rates declined for both AI/AN and white groups, but a large racial disparity was maintained. Conversely, poisoning mortality rates rose substantially in both groups, with a jump in rates in 2007 due to a coding change, resulting in a large disparity that was maintained through 2016. Comparison of alcohol and drug poisonings showed that the AI/AN alcohol poisoning rate was about eight times the white rate, whereas drug poisoning rates were similar. For 'all other' unintentional injuries, the highest rates were seen for AI/AN men, with rates generally rising over the study period. State-specific analyses found substantial variation in AI/AN rates, with few or no disparities in New York and Texas. CONCLUSIONS: Results indicate substantial and persisting disparities in unintentional injury mortality, with especially large differences in alcohol poisoning. The absence of disparities in New York and Texas suggest the importance of situational factors.

Price Changes in Washington Following the 2012 Liquor Privatization: An Update Through 2016 With Comparisons to California, Idaho, and Oregon.

BACKGROUND: Washington State ended their wholesale and retail monopoly on liquor on June 1, 2012, resulting in a 5-fold increase in liquor outlets in diverse store types. The legislation also included taxes at the wholesale and retail levels. This study seeks to investigate whether prices have changed from 2014 through 2016, as a follow-up to a previous study finding increases in prices from 2012 to 2014, compared to prices in other states. METHODS: We developed an index of 68 brands that were popular in Washington in early 2012. Data on final liquor prices (including taxes) in Washington and California were obtained through store visits and online sources between November 2013 and March 2014, and again between April and May 2016 for Washington only. Pricing data for Idaho and Oregon were obtained from the Statistics for Alcohol Management Database over both sampling periods. Primary analyses were conducted on the utmost brands available in the majority of the stores sampled. RESULTS: Liquor prices in Washington rose an average of 3.9% for 750 ml and 6.5% for 1.75-l containers overall from 2014 to 2016, while bordering states Idaho (+2.9%) and Oregon (+1.5%) experienced smaller increases for 750-ml and declines for 1.75-l containers (Idaho: -2.9%, Oregon: -4.9%). In the analyses of spirits prices in Washington compared to California, prices in California were 24.1% lower for 750-ml containers and 29.6% lower for 1.75-l containers. CONCLUSIONS: Our findings indicate liquor prices in Washington have increased since our 2014 assessment at a larger percentage than prices in the neighboring control states Oregon and Idaho, with varying effects on brands, container sizes, and store types. We demonstrate privatization is associated with a different pattern of prices across store types than seen in California.

Racial/Ethnic Disparities in the Relationship of Alcohol-Related Injury and Perceived Driving Under the Influence from Hours of Exposure to High Blood Alcohol Concentration: Data From Four US National Alcohol Surveys (2000-2015).

AIMS: To analyze racial/ethnic disparities in risk of two alcohol-related events, alcohol-related injury and self-reported perceived driving under the influence (DUI) from hours of exposure to an elevated blood alcohol concentration (BAC). METHODS: Risk curves for the predicted probability of these two outcomes from the number of hours of exposure to a BAC ≥ 0.08 mg% in the past year were analyzed separately for whites, blacks and Hispanics in a merged sample of respondents from four US National Alcohol Surveys (2000-2015). RESULTS: Hours of exposure to a BAC ≥ 0.08 showed a stronger association with perceived DUI than with alcohol-related injury for all racial/ethnic groups. Greater risk was found for whites than blacks or Hispanics for outcomes at nearly all BAC exposure levels, and most marked at the highest level of exposure. Risk of both outcomes was significant for whites at all exposure levels, but small for alcohol-related injury. Little association was found for alcohol-related injury for blacks or Hispanics. For perceived DUI, risk for blacks was significantly elevated at lower levels of exposure, while risk for Hispanics was significantly elevated beginning at 30 h of exposure. CONCLUSIONS: Findings showed racial/ethnic differences in risk of alcohol-related injury and perceived DUI from hours of exposure to elevated BAC. Risk increased at relatively low levels of exposure to a BAC ≥ 0.08, especially for whites, highlighting the importance of preventive efforts to reduce harmful outcomes for moderate drinkers.

Lifetime Alcohol Use Patterns and Risk of Diabetes Onset in the National Alcohol Survey.

BACKGROUND: Studies of the role of alcohol use in diabetes risk have rarely included lifetime alcohol use measures, including the frequency of heavy occasions, or evaluated risks among Black or Hispanic respondents in US samples. METHODS: Data from the 2014 to 2015 National Alcohol Survey of the U.S. population were used to estimate diabetes risk from drinking patterns at the time of onset in Cox proportional hazards models in a retrospective cohort design. Models for the population, males and females, and for White, Black, and Hispanic respondents of both genders were estimated using 2 versions of drinking pattern groupings at each age. RESULTS: While a number of significant results were found with the first version of the drinking measures, we focus on those confirmed with measures from responses strictly prior to the age of risk estimation. Compared to the lifetime abstainer group, the "drinking at least weekly with less than monthly 5+" group had a significantly lower hazard ratio (HR) for the total sample (HR = 0.64) and among Whites (HR = 0.42). Significantly reduced risks were found in the same models for those who drank 5+ at least monthly but not weekly. No significantly elevated risks were found for either current or prior heavy occasion drinking. CONCLUSIONS: These results are consistent with some prior studies in finding reduced risks for regular light-to-moderate drinkers, but not consistent with findings from other studies showing increased risk from heavy occasion drinking, particularly among women. New and larger studies with well-defined drinking pattern measures are needed, particularly for U.S. Blacks and Hispanics, to address varying results in this literature.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort.

BACKGROUND: Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset. METHODS: Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes. RESULTS: T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2-3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (ORadj = 1.14; 95% CI 1.02-1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI). CONCLUSION: ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.

Changing Racial/Ethnic Disparities in Heavy Drinking Trajectories Through Young Adulthood: A Comparative Cohort Study.

BACKGROUND: There is evidence of racial/ethnic differences in the age at which young adults age out of heavy drinking. Some studies have found Black and Hispanic drinkers engage in more frequent heavy drinking than White people beyond adulthood. Yet, the alcohol-related disparities literature has produced contradictory findings on whether an age-crossover effect is evident among racial/ethnic groups; that is, whether racial/ethnic minorities' drinking levels or trajectories are lower than White people at young ages but later exceed (or crossover) those of White people. This study extends this scant literature by assessing whether racial/ethnic differences in heavy drinking have changed over time (possibly accounting for mixed findings from prior research); and tests for an age-crossover effect in heavy drinking using longitudinal data from 2 cohorts born 20 years apart. METHODS: Data are from the 1979 (n = 10,963) and 1997 (n = 8,852) cohorts of the National Longitudinal Survey of Youth (NLSY). Generalized estimating equations were used to model trajectories of heavy drinking frequency from ages 17 to 31. Racial/ethnic differences were determined using sex-stratified models and 3-way interactions of race/ethnicity with age, age-squared, and cohort. RESULTS: Racial/ethnic differences in heavy drinking trajectories have changed over time in men and women. In the older NLSY cohort, Hispanic men and Black women surpassed White men's and women's heavy drinking frequency by age 31. This crossover was absent in the younger cohort, where trajectories of all racial-sex groups converged by age 31. Normative trajectories have changed in Hispanics and White people of both sexes, with a delay in age of peak frequency, and greater levels of heavy drinking in the younger cohort of women. CONCLUSIONS: Changes in heavy drinking trajectories over time suggest the need for targeted interventions during young adulthood. While disparities in young adult heavy drinking were no longer apparent in the more recent birth cohort, continued monitoring is important.

Alcohol use patterns and risk of diabetes onset in the 1979 National Longitudinal Survey of Youth Cohort.

One of the major limitations in studying alcohol's effect on risk for diabetes is the issue of classifying drinking patterns across the life course prior to the onset of diabetes. Furthermore, this research often overlooks important life course risk factors such as obesity and early-life health problems that may complicate estimation of the relationship between alcohol and diabetes. This study used data from the US National Longitudinal Survey of Youth 1979 cohort of 14-21 year olds followed through 2012 (n = 8289). Alcohol use was captured through time-varying measures of past month volume and frequency of days with 6+ drinks. Discrete-time survival models controlling for demographics, early-life characteristics and time-varying risk factors of employment, smoking, and body mass index (BMI) group, stratified by sex and race/ethnicity, were estimated. Increased odds of diabetes onset was found among lifetime abstainers for women compared to the low volume reference group (odds ratio (OR) 1.57; 95% Confidence Interval (CI) 1.07-2.3). Increased odds of diabetes onset was also found among women who reported drinking 6+ drinks in a day on a weekly basis during the prior 10 years (OR 1.55; CI 1.04-2.31). Models interacting alcohol and BMI groups found increased odds of diabetes onset from lifetime abstention among overweight women only (OR 3.06; CI 1.67-5.60). This study confirms previous findings of protective effects from low volume drinking compared to lifetime abstention and harmful effects from regular heavy occasion drinking for women. Further, protective effects in this US sample were found to be limited to overweight women only.

Survey Estimates of Changes in Alcohol Use Patterns Following the 2012 Privatization of the Washington Liquor Monopoly.

AIMS: The US state of Washington's 333 state-run liquor stores were privatized on 1 June 2012 and purchases began in ~1500 licensed stores of a variety of types. A regime of taxes and fees was implemented to replace the revenues generated by the state stores and, 1 year later, the beer tax was reduced by two thirds. This study evaluates the impact of these changes on total alcohol and spirits consumption in a retrospective pre-test design. METHODS: The study sample consists of 2289 adults recruited in three cross-sectional surveys during 2014 and 2015. Retrospective typical past month quantity-frequency measures for before privatization drinking and current past month quantity-frequency measures were compared within subjects, for all alcohol and for spirits only. RESULTS: No change in alcohol volume was seen across privatization while spirits volume was found to decrease, suggesting a shift from spirits to beer. This decline in spirits volume came from a reduction in drinking days while overall drinking days were found to increase. This was offset by a reduction in drinks per drinking day and in heavy occasions. CONCLUSIONS: These findings accurately mirror the overall flat trend in per capita alcohol sales but seem to exaggerate the very small shift towards beer seen in sales data. Effects of increased spirits availability appear to have been countered by increased spirits prices and a decreased beer tax, leading to a shift to beer consumption. SHORT SUMMARY: Survey-based analyses of alcohol use across Washington's spirits privatization, beer tax reduction and marijuana legalization found no change in alcohol volume, a reduction in spirits volume and a shift to more moderate drinking patterns. Reductions in drinking occurred among marijuana users and those with lower educational attainment reduced spirits volume.

Washington State Spirits Privatization: How Satisfied were Liquor Purchasers Before and After, and by Type of Retail Store in 2014?

BACKGROUND: In 2012 Washington State ended a wholesale/retail monopoly on liquor, permitting sale of spirits in stores with > 10,000 square feet. Implementation resulted in average price increases, but also five times the stores selling liquor. OBJECTIVES: As part of a privatization evaluation, we studied pre-post and between-store-type purchase experiences. METHODS: A 2010 Washington State Liquor Control Board (LCB) survey of liquor purchasers (n = 599), and the 2014 baseline of a repeated telephone survey (1,202 residents; n = 465 purchasers), each included 10 LCB questions on satisfaction with purchase experiences, each attribute with graded response scale A = 4 to D = 1 and F (0 = fail). Analyses used t-tests for satisfaction differences by time and analysis of variance (ANOVA) for 2014 between-store satisfaction-level differences. RESULTS: Five purchase features were rated more favorably after privatization (ps < .05-.001), including product supply, staff professionalism, location convenience, store hours, and prices (though price rated lowest both times); selection offered, courtesy, and checkout speed were unaltered, and number of staff and staff knowledge declined (both p < .001). Eight consumer experiences differed by store type: five satisfaction aspects (supply, selection, number of staff, operating hours, and checkout speed) were highest for liquor superstores, while location convenience favored grocery and drug stores, and price satisfaction favored wholesale (Costco) stores, with staff knowledge highest at liquor stores. CONCLUSIONS: Satisfaction with liquor purchases increased after privatization for half the consumer experiences. Availability (location convenience and store hours) was important to liquor purchasers. Such results are relevant to sustained support for the policy of privatizing spirits retail monopolies.

Health Risk Factors Associated with Lifetime Abstinence from Alcohol in the 1979 National Longitudinal Survey of Youth Cohort.

BACKGROUND: The choice and definition of a comparison group in alcohol-related health studies remains a prominent issue in alcohol epidemiology due to potential biases in the risk estimates. The most commonly used comparison group has been current abstainers; however, this includes former drinkers who may have quit drinking due to health problems. Lifetime abstention could be the best option, but measurement issues, selection biases due to health and other risk factors, and small numbers in populations are important concerns. This study examines characteristics of lifetime abstention and occasional drinking that are relevant for alcohol-related health studies. METHODS: This study used data from the National Longitudinal Survey of Youth 1979 cohort of 14 to 21 year olds followed through 2012 (n = 7,515). Definitions of abstinence and occasional drinking were constructed based on multiple measurements. Descriptive analyses were used to compare the definitions, and in further analysis, lifetime abstainers (n = 718) and lifetime minimal drinkers (n = 1,027) were compared with drinkers across demographics and early-life characteristics (i.e., religion, poverty, parental education, and family alcohol problems) in logistic regression models. RESULTS: Using a strict measurement of zero drinks from adolescence to the 50s, only 1.7% of the sample was defined as lifetime abstainer compared to a broader definition allowing a total of 1 drink over the lifetime that included 9.5% and to lifetime minimal drinking (a total of 3 drinks or less a month), which accounted for 13.7%. Factors significantly associated with lifetime abstention and lifetime minimal drinking included religion, poverty, having no family alcohol problems, Hispanic ethnicity, foreign-born, and female gender. Importantly, work-related health limitations in early life were significantly associated, but not childhood physical and mental health problems. CONCLUSIONS: Alcohol-related health studies should utilize lifetime classifications of drinkers and abstainers, and, in doing so, should account for early-life socioeconomic adversity and childhood health factors or consider these as unmeasured confounders.

Changes in heavy drinking following onset of health problems in a U.S. general population sample.

Heavy episodic drinking is a well-established risk factor for heart disease, diabetes, certain cancers, stroke, hypertension and injuries, however, little is known about whether health problems precipitate changes in subsequent drinking patterns. Retrospective cohort analyses of heavy drinking by decade were conducted using data from the 2010 U.S. National Alcohol Survey (n=5240). Generalized estimating equations models were used to predict any, monthly, and weekly heavy (5+) drinking occasions across decades of life following a diagnosis of hypertension, heart problems, diabetes, stroke, cancer, or serious injury. Experiencing heart problems was associated with higher odds of reduced weekly heavy drinking (adjusted odds ratio (ORadj)=3.5; 95% confidence interval (CI); 1.7-7.4). The onset of diabetes was also associated with higher odds of reducing any heavy drinking over the decade (ORadj=1.7; 95% CI; 1.1-2.6). Cancer survivors were less likely to report no heavy drinking (ORadj=0.5; 95% CI; 0.3-0.8) or no weekly heavy drinking (ORadj=0.3; 95% CI; 0.2-0.7). Hypertension, stroke and injury were not found to have any significant associations. Reduced heavy drinking was more likely to be reported by Black drinkers following heart problems and Whites following a diabetes diagnosis. Increased heavy drinking following a cancer diagnosis was significant among women and Whites. Future studies on alcohol's heath and mortality risks should take into consideration effects of health problems on drinking patterns. Additionally, study results support increased prevention efforts targeting heavy drinking among cancer survivors, especially White women, and individuals with or being treated for hypertension.

Job loss and alcohol dependence among Blacks and Whites in a National Longitudinal Survey.

We used the 1979 National Longitudinal Survey of Youth to test whether the association between job loss and incidence of alcohol dependence differed across Blacks and Whites. Respondents were interviewed annually from 1979 to 1994; DSM-IV dependence was assessed in 1989 and 1994. Analyses included only those employed in 1989 and involved lagged logistic regressions predicting past-year dependence in 1994 from job loss during 1990-1993. Unexpectedly, results showed stronger and more robust associations between job loss and dependence among Whites (AOR = 1.93, p < .05) than among Blacks (AOR = 0.82, nonsignificant). Findings diverge from prior research, suggesting disparities may differ as a function of age and/or time.

Early Life Health, Trauma and Social Determinants of Lifetime Abstention from Alcohol.

AIMS: Factors influencing lifetime abstention from alcohol may be relevant to the validity of analyses of alcohol's impact on health outcomes. We evaluate relationships between early life experiences, social factors, and demographic characteristics on lifetime abstainer status in models disaggregating by gender and, among women, race/ethnicity. METHODS: Analyses use the landline sample (N = 5382) of the 2010 U.S. National Alcohol Survey. Surveyed participants who reported never drinking alcohol were defined as lifetime abstainers. Additional variables assessed included demographics, dispositions to risk taking and impulsivity, and indicators of early life stress like economic difficulty, childhood trauma and early onset of health conditions. Logistic regression models predicting lifetime abstention were estimated. RESULTS: Lifetime abstainers are more likely to be women and, among women, to be non-White and Latina. Those reporting that their religion discouraged drinking and that religion was very important to them were more likely to be lifetime abstainers. Higher education levels were associated with reduced rates of lifetime abstention among women. Also among women, family problem drinking was associated with lower rates of lifetime abstention. However, childhood economic difficulty significantly predicted lower abstention only for White women, and childhood sexual abuse was significantly related to lower lifetime abstention only for Black women. CONCLUSIONS: Understanding the characteristics and determinants of individuals who never drink alcohol is relevant to any analysis of alcohol-related health outcomes. Results point to specific factors related to lifetime abstention with potential to bias such analyses if not included as control measures. SHORT SUMMARY: Analyses evaluating relationships between early life experiences, social factors, and demographics with lifetime abstainer status identified characteristics associated with both poor health and with better health. These included lower risk taking and impulsivity scores and lower rates of family problem drinking, childhood economic difficulties and childhood sexual abuse.

Analysis of Price Changes in Washington Following the 2012 Liquor Privatization.

AIMS: In June, 2012 the state of Washington ended a wholesale and retail monopoly on liquor sales resulting in about five times as many stores selling liquor. Three-tier restrictions were also removed on liquor, while beer and wine availability did not increase. Substantial taxes at both the wholesale and retail levels were implemented and it was expected that prices would rise. METHODS: To evaluate price changes after privatization we developed an index of about 68 brands that were popular in Washington during early 2012. Data on final liquor prices (including all taxes) in Washington were obtained through store visits and on-line sources between November 2013 and March of 2014. Primary analyses were conducted on five or six brand indexes to allow the inclusion of most stores. RESULTS: Washington liquor prices rose by an average of 15.5% for the 750 ml size and by 4.7% for the 1.75 l size, while only small changes were seen in the bordering states of Oregon and Idaho. Prices were found to vary greatly by store type. Liquor Superstores had generally the lowest prices while drugstore, grocery and especially smaller Liquor Store prices were found to be substantially higher. CONCLUSION: Our findings indicate that liquor prices in Washington increased substantially after privatization and as compared to price changes in bordering states, with a much larger increase seen for the 750 ml size and with wide variation across store types. However, persistent drinkers looking for low prices will be able to find them in certain stores.

Life-course Accumulated Cannabis Use and Recent Cannabis-related Problems in the Washington Panel Survey.

BACKGROUND: Previous studies have only investigated the short-term association of recent cannabis use with cannabis-related problems, without accounting for the onset, duration, and variations in frequency of use in the life-course. METHODS: We obtained data from the Washington panel survey during 2014-2016. We constructed accumulated lifetime exposure to cannabis use, heavy drinking (5+ drinks on one occasion), and cigarette pack-years from age of onset based on a series of decades-based questions on cannabis use and heavy drinking, and tobacco use history. We used Generalized Estimating Equation with Poisson distribution to investigate the association between accumulated cannabis use and the past-6-month CUDIT score. We adjusted for accumulated heavy drinking and cigarette pack-years, substance co-use variables, demographics, and applied survey weights. RESULTS: We found strong and statistically significant correlations for the lifetime measures across the four panel surveys, indicating that the life-course measures of cannabis use and heavy drinking were largely reliable. We found a statistically significant relationship between the lifetime accumulated exposure to cannabis and CUDIT. The results were robust to the inconsistencies in reported frequencies and onset age across panel surveys. CONCLUSIONS: This study established the relationship between lifetime exposure to cannabis and cannabis-related problems in a representative sample of drinkers and marijuana users in Washington state. We have also provided test-retest validity and question details for the decades-based cannabis and heavy drinking measures to facilitate their use in future studies of cannabis and alcohol-related outcomes.

A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia.

INTRODUCTION: Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post-discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP). METHODS: We held semi-structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12-week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post-discharge from a smoke-free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data. RESULTS: cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP-facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP. DISCUSSION AND CONCLUSIONS: AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP.

Higher Concentration of Marijuana Dispensaries in Neighborhoods with More Disadvantage Following Legalization in Washington.

Washington is one of 21 states that have legalized recreational marijuana resulting in neighborhoods that have experienced a change in physical environment with the emergence of dispensaries. This study examines the selection of dispensaries into disadvantage area, incorporating local policies and neighborhood characteristics. Marijuana and alcohol sales data were from the Washington State Liquor and Cannabis Board; and neighborhood characteristics were drawn from the American Community Survey 2010-2016 5-year estimates. Using factor analysis we created a neighborhood disadvantage index where census tracts were stratified into disadvantaged tertiles; and counties were stratified by urban/rural status. We examined the association between dispensaries, neighborhood characteristics, and local marijuana policies using Negative Binomial Regression with a natural log of land area as an offset, separately for 2014-2016. Dispensaries opened in high-disadvantaged CTs in 2014 and then dispersed across the state while retaining higher concentrations in disadvantaged urban CTs. Marijuana-specific policies (allotted dispensaries and retail cap) were found to be predictors of marijuana dispensary density. This study provides evidence that marijuana dispensaries were disproportionately located in areas with greater disadvantage. State and local marijuana policies emerged as important predictors, underscoring the importance of designing thoughtful and equitable license allocation procedures and policies.

Associations between early childhood adversity and behavioral, substance use, and academic outcomes in childhood through adolescence in a U.S. longitudinal cohort.

BACKGROUND: Childhood adversity is strongly associated with adolescent substance use, but few epidemiologic studies have investigated early childhood adversity (ECA) before age 5. This study investigated pathways by which ECA is associated with adolescent alcohol and cannabis use and high school completion through childhood behavioral and academic mediators and their reciprocal effects. METHODS: Data were from the National Longitudinal Survey of Youth 1979-Child/Young Adult Cohort which surveyed children born 1984-1999 and followed through 2016 (n = 5521). Outcomes included alcohol and cannabis use frequency at ages 15-18, and high school completion by age 19. ECA at ages 0-4 was a cumulative score of maternal heavy drinking/drug use, low emotional support, low cognitive stimulation, and household poverty. Multilevel path models were conducted with ECA, childhood mediators (behavioral (externalizing and internalizing problems) and academics (reading and math scores), accounting for demographics and confounders. RESULTS: ECA was indirectly associated with adolescent cannabis frequency through mediators of externalizing/internalizing problems, low academics, and early cannabis onset before age 14. ECA was also indirectly associated with alcohol frequency via the same mediators, but not early alcohol onset. Greater behavioral problems elevated substance use risk; whereas, low academics reduced risk. Reciprocal effects were evident between childhood behavioral problems and cannabis frequency to high school completion. CONCLUSION: Adversity from birth to age 4 is associated with childhood behavioral problems and lower academics, which increased adolescent alcohol and cannabis use and lowered high school completion. Early childhood interventions with parents and preschools/daycare may reduce early onset and adolescent substance use.