Reported exposures to derived cannabis products in California before and after the 2018 federal reclassification of hemp.

BACKGROUND: As of June 2023, a majority of states had legalized the sale of cannabis, which past research has found to be associated with increased exposures. In 2018, a change in federal policy increased access to cannabidiol (CBD) and derived psychoactive cannabis products, but there has been limited study of reported exposures following this change. METHODS: This observational retrospective study analyzed exposures involving synthetic cannabinoid receptor agonists (SCRAs) and derived cannabis products, including CBD, reported to the California Poison Control System (CPCS) from 2010 to 2022. We focused primarily on potential shifts in reported exposures before and after the implementation of the 2018 Farm Bill, which removed products derived from hemp from the Controlled Substances Act. We reviewed and hand-coded individual call records to assess reported exposures over time and their characteristics, and conducted interrupted time series analysis to assess whether exposure counts changed after policy interventions. RESULTS: Reported CBD exposures significantly increased following the federal reclassification of hemp products. Exposure reports were most common among young children and for edibles. Exposure reports provided limited information about derived psychoactive cannabis products. CONCLUSIONS: Our findings suggest a need for improved data collection regarding derived psychoactive cannabis products, as well as potential public health value in modifying packaging regulations and in providing additional guidance to parents to help prevent CBD exposures.

Pharmacist furnishing of hormonal contraception in California's Central Valley.

BACKGROUND: In the United States, more than 19 million people of reproductive age need access to publicly funded hormonal contraception or live in areas where it is not readily available. These include rural areas of the country, commonly known as contraception deserts. Pharmacist prescribing has been proposed to increase access, but little is known about its implementation in such areas. OBJECTIVE: This study quantified the extent of pharmacists' furnishing (prescribing) of hormonal contraception in California's Central Valley community pharmacies and identified barriers and facilitators to implementation. METHODS: The researchers conducted a cross-sectional, mixed methods, observational study by (1) contacting all community pharmacies in the 11 counties of the Central Valley to determine furnishing rates and (2) surveying and interviewing pharmacies that indicated they furnished hormonal contraception. RESULTS: Overall, 13% of pharmacies within the Central Valley reported that they furnished hormonal contraception. Pharmacists reported that barriers to furnishing included costs to patients and the pharmacy, lack of time and staff, lack of training and certifications, limited patient awareness of pharmacists' ability to furnish, pharmacists' limited confidence in furnishing, and patient use of emergency contraception as an alternative to hormonal contraception. Pharmacists reported that patients often sought hormonal contraception from pharmacists owing to ease of accessibility to a pharmacist; some other facilitators included advertising, confidentiality, low cost to patients, and referrals from other providers. CONCLUSIONS: Common barriers were identified across pharmacies that furnished hormonal contraception, indicating the need for strategies that reduce these barriers to help expand patient's access to these services and to increase pharmacists' ability and confidence to prescribe.

Exposures to Bleach, Peroxide, Disinfectants, Antimalarials, and Ivermectin Reported to the California Poison Control System Before and During the COVID-19 Pandemic, 2015-2021.

OBJECTIVES: The COVID-19 pandemic led to widespread fear of infection, with many people expanding their use of cleaning products and trying unproven prevention and treatment strategies. We described shifts in reported exposures related to COVID-19 home interventions. METHODS: This study considered suspected toxicity exposures involving household cleaning products (bleach, peroxide, disinfectants), antimalarials (hydroxychloroquine and chloroquine), and ivermectin reported to the California Poison Control System from 2015 through 2021 and assessed trends in exposures by using interrupted time-series analyses. RESULTS: We found a significant increase in exposures reported to the California Poison Control System related to household cleaning products and ivermectin during the COVID-19 pandemic. As of January 1, 2015, the baseline level of reported exposures to household cleaning products was 707.33 per month and was declining at a rate of 1.71 (95% CI, -2.87 to -0.56) per month through February 29, 2020. In March 2020, an increase of 466.57 (95% CI, 328.08-605.07) reported exposures above baseline occurred, after which exposures to cleaning products decreased at a rate of 23.40 (95% CI, -32.48 to -14.32) per month. The number of reported exposures to antimalarials did not change significantly before or during the pandemic. The number of reported ivermectin exposures before December 2020 was initially stable at 14.50 per month and then increased by 2.05 per month through December 2021. CONCLUSIONS: Our observations suggest that while some dangerous home prevention and treatment efforts resolve over time, further interventions may be needed to reduce the public health effects related to attempts to self-treat COVID-19 with ivermectin.

Retail chain pharmacy opioid dispensing practices from 1997 to 2020: A content analysis of internal industry documents.

Context: Lawsuits have determined that community pharmacy chains played a crucial role in the opioid epidemic. However, little research has assessed community pharmacy practices. This study sought to understand the contribution of pharmacies to the opioid epidemic through improper opioid prescription dispensing. Methods: We conducted an observational, retrospective content analysis that assessed the opioid dispensing practices of a retail community pharmacy chain, Walgreens, using pharmaceutical industry documents released in litigation between 1997 and 2020. The documents were retrieved from the Opioids Industry Document Archive (OIDA) at the University of California, San Francisco and reviewed to identify themes and identify organizational practices. Findings: We identified four primary factors that may have contributed to improper opioid dispensing practices: store-level procedures, management pressure, distribution center activities, and pharmaceutical company sponsorship. Stores dispensed opioid prescriptions without resolving red flags, management pressured pharmacists to fill more opioid prescriptions, distribution centers failed to investigate high volume orders, and pharmaceutical companies sponsored pharmacist continuing education advocating for opioid pain management. Conclusions: Our findings suggest that Walgreens may have contributed to the early prescription opioid epidemic through improper opioid dispensing and also identify key practices that could be reformed to reduce the risk of future inappropriate dispensing of addictive and potentially harmful medications.

Descriptive cross-sectional survey of tobacco and cannabis restrictions on state and local film incentives in the USA.

BACKGROUND: Reducing tobacco depictions in media has significant health benefits because tobacco placements in films normalise tobacco use and are linked to youth initiation. Cannabis depictions may have similar effects. Placing restrictions on film incentives has been suggested; however, it remains an unexplored strategy for reducing tobacco depictions. We investigated whether states and localities that offer film incentives have established funding restrictions to deter tobacco or cannabis depictions. METHODS: We conducted a descriptive cross-sectional survey of official state and local government websites in the USA that listed film incentives. We coded policy level (ie, state, local), incentive type (ie, tax credit, rebate), incentive amounts, programme qualifiers and presence and characteristics of tobacco and cannabis restrictions. RESULTS: Quantifiable tax incentives at the state level offered over $1.6 billion to producers. Among 50 US states and Washington, DC, 39 provided film incentives: 4 restricted tobacco and 0 restricted cannabis. Among the 238 local film offices we identified, 24 offered incentives; 5 restricted tobacco and 1 restricted cannabis. All the incentive restrictions excluded tobacco or cannabis purchases from reimbursement; there were no penalties for tobacco or cannabis depictions. CONCLUSIONS: Film incentives are large financial commitments that may undermine public health since they allow depictions of tobacco and cannabis that contribute to initiation and use. Few states or localities limit film incentives related to tobacco or cannabis, and the existing restrictions are unlikely to deter depictions or product placement. Restrictions on incentives are an underused tool for deterring tobacco and cannabis depictions in film.

Evaluation of a Pharmacist-Linked Smoking Cessation Intervention for Adults Experiencing Homelessness.

Background: Interventions are needed to increase access to tobacco treatment for people experiencing homelessness. We developed a community pharmacist-linked cessation program for adults experiencing homelessness that included one-time, pharmacist-delivered counseling and furnishing nicotine replacement therapy (NRT) for 3 months. Methods: We conducted a single-arm, uncontrolled trial of the pharmacist-linked intervention among adults experiencing homelessness recruited from three homeless shelters in San Francisco, CA. We asked participants to complete questionnaires at baseline and during 12 weekly follow-up visits. We obtained information on cigarette consumption, use of NRT, and quit attempts at each visit, and reported cumulative proportions during the study interval. We used Poisson regression and logistic regression, respectively, to examine factors associated with weekly cigarette consumption and quit attempts. We conducted in-depth interviews with residents to understand barriers to and facilitators of engagement. Results: Among 51 participants, average daily cigarette consumption reduced 55% from 10 cigarettes per day at baseline to 4.5 cigarettes at 13 wk follow-up, and 56.3% had CO-verified abstinence. Use of medications in the past week was associated with a 29% reduction in weekly consumption (IRR 0.71, 95% CI 0.67-0.74), and increased the odds of a quit attempt (adjusted odds ratio (AOR), 2.37, 95% CI 1.13-4.99). While residents benefited from engaging in the pharmacist-linked program to increase quit attempts, they felt that to sustain abstinence, longitudinal tobacco treatment was needed. Conclusions: A pharmacist-linked smoking cessation program at transitional homeless shelters can reduce structural barriers to cessation care and reduce tobacco use among people experiencing homelessness.

Alignment in local approaches to alcohol and cannabis control policy: A case study of California cities and counties.

BACKGROUND: Public health experts have urged governments around the world to regulate newly legalized cannabis as they do alcohol to effectively and efficiently protect health. However, research evaluating the alignment of alcohol and cannabis policies is sparse. We assessed similarities and differences in local alcohol and cannabis control policies across California, and characterized localities adopting distinct policy approaches. METHODS: Using standard legal epidemiologic techniques, we collected and coded local alcohol and cannabis control policies relevant to public health for 12 California counties and all incorporated cities within them (N=241). We assessed whether localities were equally stringent on alcohol and cannabis policies by comparing overall restrictiveness (summed policy scores) and 9 specific provisions that applied to both substances. We captured distinct local alcohol-cannabis policy approaches using latent class analysis, and examined this classification in relation to local demographic, socioeconomic, political, and retail market characteristics. RESULTS: All 241 localities permitted alcohol sales, while 71% banned cannabis sales. Among those that did not ban cannabis sales, more stringent alcohol policy scores were associated with more stringent cannabis policy scores (linear regression coefficient: 0.16 [95% CI: 0.07, 0.25]). Local governments rarely adopted the same provisions for alcohol and cannabis (e.g., limits on hours of sale, advertising restrictions), and only two regulated the co-location of cannabis and alcohol outlets. Localities that were restrictive on alcohol yet permissive on cannabis (12%) were more urban, politically progressive, and had more low-income and racial/ethnic minority residents. Localities that were more permissive on alcohol and restrictive on cannabis (51%) were more socioeconomically advantaged. CONCLUSION: We found few similarities between local alcohol and cannabis control policies. California's experience suggests that, as governments around the world legalize cannabis, lessons learned from regulating alcohol are not routinely applied to cannabis, particularly in communities distinguished by high social and economic advantages.

Clearing cannabis criminal records: A survey of criminal record expungement availability and accessibility among US States and Washington DC that decriminalized or legalized cannabis.

BACKGROUND: In 2022, despite expanding state-level legalization, cannabis remained illegal at the federal level, driving drug offenses, and contact with the justice system. Cannabis criminalization disproportionately impacts minorities, and criminal records carry negative economic, health, and social consequences. Legalization prevents future criminalization but fails to assist existing record-holders. We surveyed 39 states and Washington DC where cannabis was decriminalized or legalized to determine record expungement availability and accessibility for cannabis offenders. METHODS: We performed a retrospective, qualitative survey of state expungement laws allowing record sealing or record destruction where cannabis use was decriminalized or legalized. Statutes were collected between February 25, 2021, and August 25, 2022, from state websites or NexisUni. We collected pardon information for two states from online state government resources. Materials were coded in Atlas.ti to determine if states had general, cannabis, and other drug conviction expungement regimes, petitions, or automated systems, waiting periods, and financial requirements. Codes were developed via inductive and iterative coding of materials. RESULTS: Among places surveyed, 36 provided any conviction expungement, 34 provided general relief, 21 offered cannabis-specific relief, and 11 offered general drug relief, nonexclusively. Most states used petitions. Thirty-three general and 7 cannabis-specific programs required waiting periods. Nineteen general and 4 cannabis programs imposed administrative fees, and 16 general and one cannabis-specific program required legal financial obligations to be paid. CONCLUSION: Among the 39 states and Washington DC that decriminalized or legalized cannabis and offered expungement, more states relied on general rather than cannabis-specific systems, and the majority of these required record holders to petition for relief and imposed waiting periods and financial requirements. Research is needed to determine if automating expungement, reducing or eliminating waiting periods, and eliminating financial requirements may expand record relief for former cannabis offenders.

Trends in concomitant and single opioid and benzodiazepine exposures reported to the California Poison Control System following the Centers for Disease Control and Prevention release of opioid guidelines in 2016.

INTRODUCTION: In March 2016, the Centers for Disease Control and Prevention released the Guideline for Prescribing Opioids for Chronic Pain, intended for primary care clinicians. One recommendation advised against concurrent prescription of opioids and benzodiazepines. Although existing research suggests a reduction in co-prescribing of these drug classes by clinicians after guideline release, there are limited data assessing its possible effect on patient medical outcomes, such as overdoses. METHODS: This retrospective observational study analyzed opioid and benzodiazepine exposures, alone or in combination, reported to the California Poison Control System from January 2012 to June 2021. Interrupted time series analyses identified the difference in monthly call volume between pre- and post-guideline release. For exposures resulting in serious medical outcomes, additional analyses assessed trends and identified associated variables. RESULTS: There was no significant change in concomitant opioid and benzodiazepine exposures reported to California Poison Control System between pre- and post-guideline release. Compared to pre-guideline release, exposures to a single opioid or to a single benzodiazepine significantly decreased by 1.07 (95% CI: -1.62, -0.51) and 1.82 (95% CI: -2.33, -1.31) calls per month, respectively, after the guideline release. For exposure calls associated with serious medical outcomes, there was a significant increase of 0.11 (95% CI: 0.04, 0.18) and 0.2 (95% CI: 0.05, 0.34) calls per month for concomitant opioid and benzodiazepine and single opioid exposures, respectively, following guideline release. DISCUSSION: The guideline release appeared to have a variable association with exposures to single opioid, single benzodiazepines, and concomitant opioid and benzodiazepine cases reported to California Poison Control System. Although exposures to opioids or benzodiazepines alone significantly decreased after guideline release, there was no significant change in concomitant exposures. Additionally, for exposures associated with serious medical outcomes, concomitant exposures, and single opioid exposures significantly increased following guideline release. CONCLUSION: Our results suggest that the guideline was not associated with a corresponding decrease in the number of concomitant poisoning exposures reported to California Poison Control System. Additional interventions may be needed to reduce concomitant exposures to opioids and benzodiazepines.

A review of policies on the involuntary use of psychotropic medications among persons experiencing incarceration in the United States.

BACKGROUND: In Harper v. Washington (1990), the United States Supreme Court established the right of states to involuntary medicate incarcerated individuals in emergency situations without a court order. The extent to which states have implemented this in correctional facilities has not been well characterized. This exploratory qualitative study sought to identify state and federal corrections policies relating to involuntary psychotropic medication for individuals who are incarcerated and classify them by scope. METHODS: State Department of Corrections (DOC) and Federal Bureau of Prisons (BOP) policies relating to mental health, health services, and security were collected between March and June 2021 and coded using Atlas.ti software. The primary outcome was whether states allowed emergency involuntary use of psychotropic medications; secondary outcomes pertained to use of restraint and "use of force" policies. RESULTS: Of the 35 states plus the Federal BOP that made policies publicly available, 35 out of 36 (97%) allowed the involuntary use of psychotropic medications in emergency situations. The extent of detail contained in these policies varied, with 11 states providing minimal information to guide use. One state (3%) did not allow public review of "use of restraint" policies, and 7 states (19%) did not allow public review of "use of force" policies. CONCLUSIONS: More explicit criteria for emergency involuntary use of psychotropic medications are needed to better protect individuals who are incarcerated, and states should provide more transparency regarding use of restraint and use of force in corrections.

An observational study of the extent of naloxone furnishing in California Central Valley community pharmacies.

BACKGROUND: California has sought to expand medication access and improve public health by authorizing pharmacists in California to prescribe certain medications since 2014. Medications with pharmacist-initiated prescribing, or furnishing, include naloxone, hormonal contraception, postexposure prophylaxis/preexposure prophylaxis, and nicotine replacement therapy. In light of the United States' opioid epidemic, naloxone, an opioid antagonist, this study considered furnishing rates in urban areas of California. Research from 2020 found 42.5% of pharmacies furnished naloxone. However, there has been limited study of furnishing outside of urban areas. OBJECTIVE: This study assessed pharmacist furnishing rates of naloxone in California's Central Valley and identified barriers and facilitators to implementation. METHODS: From April to May 2022, the researchers first conducted a cross-sectional, observational study of community and mail-order pharmacies in California's largely rural Central Valley, then collected interview data from a subset of pharmacists in stores that indicated they furnished naloxone. RESULTS: Forty-three percent of Central Valley pharmacies reported that they furnished naloxone. Interview respondents reported that barriers to furnishing included time restrictions, cost to patients, stigma, and language barriers. CONCLUSIONS: Furnishing rates in the Central Valley were slightly higher (43.4%) than those reported in previous research focusing on urban areas of California (42.5%). Identified barriers to furnishing were consistent with those identified in previous research. These findings suggest that further policy interventions may be needed to reduce out-of-pocket costs, establish stronger pharmacist-provider relationships, and provide education combatting stigma against opioid users to increase naloxone furnishing.

Industry strategies to market opioids to children and women in the USA: a content analysis of internal industry documents from 1999 to 2017 released in State of Oklahoma v. Purdue Pharma, L.P. et al.

OBJECTIVE: Identify advertising strategies used to market opioids to women and children. DESIGN: Qualitative content analysis of internal pharmaceutical industry documents released in litigation, dated between 1999 and 2017. SETTING: USA. PARTICIPANTS: Opioid manufacturers (Janssen, Ortho-McNeil, Purdue, Teva (Actavis), Janus, Cephalon); women; children. PRIMARY AND SECONDARY OUTCOME MEASURES: Advertising campaigns, industry executive statements regarding marketing goals METHODS: We examined ((DATASET) link: https://www.industrydocuments.ucsf.edu/drug/) documents released in State of Oklahoma v. Johnson & Johnson (2019) to identify marketing strategies and campaigns developed by opioid manufacturers that focused on children and women, as well as public records, including websites developed by manufacturers and their allies, to confirm whether marketing campaigns proposed in internal industry documents were implemented. Documents identified as relevant were coded for themes based on expectations drawn from previous research on marketing using internal industry documents, which included making emotional appeals and understating the risks of addiction. RESULTS: We found that opioid manufacturers sought to recruit coaches and school nurses to encourage opioid use by children, developed unbranded initiatives suggesting adolescents ask providers for pain care medications, suggested that opioid use could reduce health risks associated with untreated pain among women and advocated to policy makers that women faced unmet needs for pain medication. CONCLUSIONS: The USA strictly regulates direct marketing of medications but does not place the same restrictions on indirect marketing and unbranded campaigns, which encourage people to seek treatment without indicating the names of specific products. Opioid manufacturers in the early 21st century appear to have relied largely on unbranded campaigns for marketing, which they described externally as public health promotion and internally as a way to increase sales of opioids. The rapid increase in opioid use concomitant with these campaigns suggests that additional scrutiny of this kind of marketing may be needed in order to protect vulnerable groups.

Marketing Antipsychotics to Correctional Facilities: A Review of Pharmaceutical Industry Documents.

This retrospective qualitative review describes the marketing of antipsychotics by pharmaceutical companies to prisons and jails to increase prescribing. This review relied on internal pharmaceutical industry documents released in litigation and stored in the Drug Industry Documents archive at the UCSF Industry Documents Library. At least two pharmaceutical companies directly marketed antipsychotics to correctional facilities to increase sales, using targeted promotions and indirect "educational" advertising and by seeking control of state advisory boards that made formulary decisions. Further research on how medications are marketed is needed, along with stronger conflict-of-interest policies to reduce industry involvement on advisory boards that approve medications. National regulations that restrict pharmaceutical manufacturers from involvement in formulary decisions and prescribing guidelines would likely improve the provision of health care to people who are incarcerated.

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).

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.

Content Analysis of the Corporate Social Responsibility Practices of 9 Major Cannabis Companies in Canada and the US.

Importance: The cannabis industry has sought to normalize itself and expand its markets in the 21st century. One strategy used by companies to generate positive public relations is corporate social responsibility (CSR). It is critical to understand these efforts to influence the public and politicians given the risks of increased cannabis use. Objectives: To analyze cannabis industry CSR behaviors, determine their characteristics, and compare their practices with those of the tobacco industry. Design, Setting, and Participants: This qualitative study of CSR activities conducted between January 1, 2012, and December 31, 2021, evaluated 9 of the 10 largest publicly traded cannabis companies in the US and Canada. Data were collected from August 1 to December 31, 2021. The 10th company was excluded because it engaged in cannabis-based pharmaceutical sales but not CSR. A systematic review of corporate websites and Nexis Uni was performed, resulting in collection of 153 news articles, press releases, and Web pages. Charitable and philanthropic actions were included. Themes were identified and interpreted using modified grounded theory. Main Outcomes and Measures: CSR activities and spending. Results: Nine major cannabis companies in the US and Canada engaged in CSR activities that encouraged increased consumption and targeted marginalized communities. Companies claimed these activities would mitigate the harms of cannabis prohibition, promote diversity, expand access to medical cannabis, and support charitable causes. They developed educational programs, sustainability initiatives, and voluntary marketing codes and used strategies similar to those used by tobacco companies to recruit public interest organizations as allies. Conclusions and Relevance: These findings suggest that cannabis companies developed CSR strategies comparable to those used by the tobacco industry to influence regulation, suggesting that cannabis companies should be included when addressing commercial determinants of health.

A Retrospective Global Assessment of Factors Associated With COVID-19 Policies and Health Outcomes.

Background: The 2019 Global Health Security (GHS) Index measured the capacities of countries to prepare for and respond to epidemics and pandemics. However, the COVID-19 pandemic revealed that GHS Index scores were poorly correlated with ability to respond to infectious disease threats. It is critical to understand how public health policies may reduce the negative impacts of pandemics. Objective: To identify non-pharmaceutical interventions (NPIs) that can minimize morbidity and mortality during the COVID-19 and future pandemics, this study examined associations between country characteristics, NPI public health policies, and COVID-19 outcomes during the first year of the pandemic, prior to the introduction of the COVID-19 vaccine. This global analysis describes worldwide trends in policy implementation and generates a stronger understanding of how NPIs contributed to improved health outcomes. Design: This cross-sectional, retrospective study relied on information drawn from publicly available datasets through December 31, 2020. Primary and Secondary Outcome Measures: We conducted multivariate regressions to examine associations between country characteristics and policies, and policies and health outcomes. Results: Countries with higher health service coverage prior to the pandemic implemented more policies and types of policies. Countries with more bordering countries implemented more border control policies (0.78**), and countries with denser populations implemented more masking policies (0.24*). Across all countries, fewer COVID-19 cases and deaths per million were associated with masking (-496.10*, -7.57), testing and tracing (-108.50**, -2.47**), and restriction of movement (-102.30*, -2.10*) policies, with stronger associations when these policies were mandatory rather than voluntary. Conclusions: Country characteristics, including health service coverage, number of bordering countries, and population density, may predict the frequency and nature of public health interventions. Countries with higher health service coverage may have the infrastructure to react more efficiently to a pandemic, leading them to implement a greater number of policies. Mandatory masking, testing and tracing, and restriction of movement policies were associated with more favorable COVID-19 population health outcomes. While these results are consistent with existing COVID-19 mathematical models, policy effectiveness depends on how well they are implemented. Our results suggest that social distancing policies were less effective in reducing infectious disease risk, which may reflect difficulties with enforcement and monitoring.

Cannabis use prevalence among Baby Boomers before and after implementation of recreational retail sales in California.

BACKGROUND: As of 2021, 21 US states and territories allowed recreational cannabis use. Although previous research has identified an overall increase in prevalence of cannabis use after legalization, it has been less clear how this change will affect different parts of the population, including older adults, and specifically Baby Boomers, born 1946-1964, given their historically higher rates of use and a higher prevalence of comorbid conditions that could be either exacerbated or addressed by cannabis use. In this study we assessed whether implementation of recreational retail sales in California was associated with increased prevalence of cannabis use among Baby Boomers. METHODS: We conducted a retrospective study of cannabis use prevalence one year before and after the implementation of recreational retail sales in California using the California Health Interview Survey (CHIS), a statewide public health surveillance dataset. RESULTS: We found that cannabis use prevalence did not change among Baby Boomers but increased among non-Baby Boomers. Most of the factors found to be predictive of cannabis use in past research did not predict cannabis use among Baby Boomers. CONCLUSIONS: Baby Boomers did not change their consumption of cannabis in the first year after opening the retail market, despite previous research suggesting that cannabis consumption increases with access, and most previously identified predictors of use did not identify people who use cannabis in this generation. Further research is needed to determine whether these effects persist over time.

A community-based tobacco cessation program for individuals experiencing homelessness.

BACKGROUND: Tobacco use is common among persons experiencing homelessness (PEH), and interventions are needed. We conducted a community-based, single-arm uncontrolled trial of a pharmacy-linked intervention for smoking cessation for PEH. METHODS: The intervention took place between September 2019 and June 2021 in homeless shelters in San Francisco, CA. We trained shelter staff on how to provide brief cessation counseling, then tested a program among PEH in two shelters that included one-time pharmacist-delivered cessation counseling and nicotine replacement therapy (NRT) for 3 months. We examined factors associated with cigarette consumption and quit attempts. RESULTS: We trained 69 staff from 8 shelters and selected 2 of those shelters as pilot sites for the program. Of the 52 participants, 71% were male and 49% were Black. The majority of participants reported making a quit attempt (70%) and using NRT (84%). Having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption (Incidence rate ratio (IRR) 0.61, 95% CI 0.57-0.67) and using medications in the past week was associated with a 23% reduction in weekly consumption (IRR 0.78, 95% CI 0.75-0.81). Using medications in the past week increased the odds of a quit attempt 2.89 times compared to not using medications (Adjusted odds ratio (AOR), 2.89, 95% CI 1.45-5.77). CONCLUSIONS: Our findings highlight a role for leveraging community-based pharmacists to expand smoking cessation services in homeless shelters to reduce tobacco use among PEH.