Youth Exposure to Marijuana Advertising in Oregon's Legal Retail Marijuana Market.

INTRODUCTION: Research from tobacco and alcohol markets suggests advertising exposure is associated with perceptions of lower risk and increased use among young people. Limiting marketing may be a regulatory approach to prevent potential negative effects of retail marijuana legalization on youth use. This study assessed marijuana advertising exposure reported by youths in Oregon after the start of retail marijuana sales in October 2015. METHODS: Data from a 2017 school-based survey of Oregon 8th (N = 14,852) and 11th (N = 11,895) graders were used to characterize marijuana advertising exposure. Subgroup differences in reported exposure were assessed by using Pearson χ2 tests and multiple logistic regression. RESULTS: About three-quarters of 8th (72.2%) and 11th graders (78.1%) in Oregon reported seeing marijuana advertising in the past month. Youths most frequently reported seeing advertising on storefronts and online, and odds of exposure were significantly higher for girls; lesbian, gay, or bisexual youths; current marijuana users; 8th graders living with an adult who uses marijuana; and youths in school districts with a closer average proximity to retail marijuana stores. CONCLUSION: Reporting exposure to marijuana advertising is common among youths in Oregon's legal retail market. Oregon and other states working to prevent youth marijuana use may want to examine how well their rules are working to prevent youth exposure. Although some sources of youth advertising exposure may be difficult to regulate and enforce (eg, online), others may be within the purview of state authority (eg, billboards, storefronts) depending on state-specific interpretation of free speech protections.

Implications of Cannabis Legalization on Juvenile Justice Outcomes and Racial Disparities.

INTRODUCTION: The objective of this study is to assess the changes in rates of juvenile cannabis criminal allegations and racial disparities in Oregon after legalization of cannabis (July 2015) for adults. METHODS: This study included all allegations for cannabis-related offenses that occurred from January 2012 to September 2018 in Oregon. Negative binomial regression models were used to examine monthly cannabis allegation rates over time, and tested differences between youth of color and white youth, adjusting for age, gender, and month the allegation occurred. Analysis was conducted in January-March 2019. RESULTS: Cannabis allegation rates increased 28% among all youth and 32% among cannabis-using youth after legalization. Rates of allegations were highest for American Indian/Alaska Native and black youth. Rates for black youth were double that of whites before legalization, and this disparity decreased after legalization. For American Indian/Alaska Native youth, rates were higher than whites before legalization, and this disparity remained unchanged. CONCLUSIONS: Adult cannabis legalization in Oregon was associated with increased juvenile cannabis allegations; increases are not explained by changes in underage cannabis use. Relative disparities decreased for black youth but remained unchanged for American Indian/Alaska Native youth. Changing regulations following adult cannabis legalization could have unintended negative impacts on youth.

Factors Associated With Increased Syphilis Screening Among People Living With Human Immunodeficiency Virus.

BACKGROUND: Antiretroviral therapy effectively reduces the risk of human immunodeficiency virus transmission, but in the context of undetectable equals untransmittable and decreased condom use, rates of syphilis are increasing. In Oregon, syphilis has risen over 20-fold in the past decade, from less than 30 to approximately 600 cases annually during 2016 and 2017. Although many cases are among people living with human immunodeficiency virus infection (PLWH), screening for syphilis among PLWH is often lacking. The objective of this study was to estimate the prevalence of past-year syphilis testing among PLWH in Oregon to identify facility-level and individual-level factors associated with testing. METHODS: We examined 2015 to 2016 Medical Monitoring Project interview and medical records data in Oregon and conducted supplemental interviews with participants' medical providers. We used generalized mixed effects models to identify factors associated with syphilis screening. RESULTS: Sixty-nine percent of Medical Monitoring Project participants had past-year syphilis screening. Patients receiving care from facilities with written sexually transmitted infection screening policies were far more likely to be screened than those receiving care from facilities without written policies (94% vs. 43%, P < 0.001). Participants who identified as male were more likely to have been tested, even after adjusting for facility-level characteristics. Clustering within facility accounted for about 15% of the unexplained variability in the adjusted mixed effects models. CONCLUSIONS: Written sexually transmitted infection screening policies at medical facilities appear to be an important tool for ensuring syphilis screening occurs as recommended to prevent the continued rise in syphilis.

Post-Legalization Opening of Retail Cannabis Stores and Adult Cannabis Use in Washington State, 2009-2016.

Objectives. To assess the relationship between adult cannabis use and time-varying local measures of retail cannabis market presence before and after legalization (2012) and market opening (2014) in Washington State.Methods. We used 2009 to 2016 data on 85 135 adults' current (any) and frequent (20 or more days) past-month cannabis use from the Washington Behavioral Risk Factor Surveillance System linked to local retailer proximity and density. Multilevel models predicted use over time, accounting for nesting within communities.Results. Current and frequent cannabis use grew significantly between 2009 and 2016; use did not significantly change immediately after legalization but increased subsequently with greater access to cannabis retailers. Specifically, current use increased among adults living in areas within 18 miles of a retailer and, especially, within 0.8 miles (odds ratio [OR] = 1.45; 95% confidence interval [CI] = 1.24, 1.69). Frequent use increased among adults living within 0.8 miles of a retailer (OR = 1.43; 95% CI = 1.15, 1.77). Results related to geospatial retailer density were consistent.Conclusions. Increasing cannabis retail access was associated with increased current and frequent use.Public Health Implications. Policymakers might consider density limits as a strategy for preventing heavy cannabis use among adults.

Did marijuana legalization in Washington State reduce racial disparities in adult marijuana arrests?

Background: One justification for marijuana legalization has been to reduce existing disparities in marijuana-related arrests for African Americans. Objective: Describe changes in adult marijuana arrest rates and disparities in rates for African Americans in Washington State (WA) after legalization of possession of small amounts of marijuana for 21+ year olds in December 2012, and after marijuana retail market opening in July 2014. Methods: We used 2012-2015 National Incident Based Reporting System data to identify marijuana-related arrests. Negative binomial regression models were fit to examine monthly marijuana arrest rates over time, and to test for differences between African Americans and Whites, adjusting for age and sex. Results: Among those 21+ years old overall, marijuana arrest rates were dramatically lower after legalization of possession, and did not change significantly after the retail market opened. The marijuana arrest rates for African Americans did drop markedly and the absolute disparities decreased, but the relative disparities grew: from a rate 2.5 times higher than Whites to 5 times higher after the retail market opened. Among 18-20 year olds overall, marijuana arrest rates dropped, but not as dramatically as among older adults; the absolute disparities decreased, but the relative disparities did not change significantly. Conclusions: Marijuana arrest rates among both African American and White adults decreased significantly with legalization of possession, and stayed at a dramatically lower rate after the marijuana retail market opened. However, relative disparities in marijuana arrest rates for African Americans increased for those of legal age, and remained unchanged for younger adults.

Exposure to Marijuana Marketing After Legalization of Retail Sales: Oregonians' Experiences, 2015-2016.

OBJECTIVES: To assess exposure to marijuana advertising in Oregon after the start of retail marijuana sales in October 2015. METHODS: We conducted a repeated cross-sectional online survey of 4001 Oregon adults aged 18 years and older in November 2015 and April-May 2016. We assessed subgroup differences by using the Pearson χ2 test. RESULTS: More than half of adults (54.8%) statewide reported seeing marijuana advertising in the past month. These adults reported that they most frequently saw storefront (74.5%), streetside (66.5%), and billboard (55.8%) advertising. Exposure did not significantly differ by participant's age or marijuana use but was higher among those living in counties with retail sales (56.5%) than in counties without (32.5%). CONCLUSIONS: Most adults reported exposure to marijuana advertising following the start of retail marijuana sales in Oregon. People who do not use marijuana and those aged 18 to 24 years were as exposed to advertising as other groups. Public Health Implications. Advertising restrictions may be needed to protect youths and young adults from pro-use messages. Commercial free speech afforded by the First Amendment makes advertising restrictions challenging, but public policy experts note that restrictions aimed at protecting youths may be allowed.

Substance Use, Disordered Eating, and Weight Gain: Describing the Prevention and Treatment Needs of Incarcerated Women.

Weight-related concerns are associated with women's substance use and treatment relapse. The prevalence of overweight, obesity, disordered eating behavior, and substance abuse history was assessed among female inmates incarcerated for 6 to 24 months at an Oregon state prison, using a self-administered survey and physical measurements. Average weight gain was 20 pounds, 87% of women were overweight (39%) or obese (48%), and 24% reported using one or more unhealthy strategies to lose weight in the past 6 months. Women who used tobacco and illicit substances before incarceration gained more weight. Integrating nutrition and weight gain issues into substance abuse treatment could benefit incarcerated women--both soon after entering prison to prevent weight gain and close to release to prevent relapse into substance use.

Smoking-related knowledge, attitudes, and behaviors among Alaska Native people: a population-based study.

BACKGROUND: Several studies have shown that Alaska Native people have higher smoking prevalence than non-Natives. However, no population-based studies have explored whether smoking-related knowledge, attitudes, and behaviors also differ among Alaska Native people and non-Natives. OBJECTIVE: We compared current smoking prevalence and smoking-related knowledge, attitudes, and behavior of Alaska Native adults living in the state of Alaska with non-Natives. METHODS: We used Alaska Behavioral Risk Factor Surveillance System data for 1996 to 2010 to compare smoking prevalence, consumption, and cessation- and second-hand smoke-related knowledge, attitudes, and behaviors among self-identified Alaska Native people and non-Natives. RESULTS: Current smoking prevalence was 41% (95% CI: 37.9%-44.4%) among Alaska Native people compared with 17.1% (95% CI: 15.9%-18.4%) among non-Natives. Among current every day smokers, Alaska Natives were much more likely to smoke less than 10 cigarettes per day (OR = 5.0, 95% CI: 2.6-9.6) than non-Natives. Compared with non-Native smokers, Alaska Native smokers were as likely to have made a past year quit attempt (OR = 1.4, 95% CI: 0.9-2.1), but the attempt was less likely to be successful (OR = 0.5, 95% CI: 0.2-0.9). Among current smokers, Alaska Natives were more likely to believe second-hand smoke (SHS) was very harmful (OR = 4.5, 95% CI: 2.8-7.2), to believe that smoking should not be allowed in indoor work areas (OR = 1.9, 95% CI: 1.1-3.1) or in restaurants (OR = 4.2, 95% CI: 2.5-6.9), to have a home smoking ban (OR = 2.5, 95% CI: 1.6-3.9), and to have no home exposure to SHS in the past 30 days (OR = 2.3, 95% CI: 1.5-3.6) than non-Natives. CONCLUSION: Although a disparity in current smoking exists, Alaska Native people have smoking-related knowledge, attitudes, and behaviors that are encouraging for reducing the burden of smoking in this population. Programs should support efforts to promote cessation, prevent relapse, and establish smoke-free environments.

Is smokeless tobacco use becoming more common among U.S. male smokers? Trends in Alaska.

INTRODUCTION: The tobacco industry has promoted the use of smokeless tobacco (SLT) to smokers as a substitution for cigarettes when smoking is not possible, and some smokers are using SLT this way. However, few publications have examined recent trends in dual cigarette and SLT use (dual use) over time in the U.S. MATERIALS AND METHODS: We examined trends in the use of SLT among current, former and never cigarette smokers using data on adult (aged 18+ years) males (n=16,590) from the 1996-2008 Alaska Behavioral Risk Factor Surveillance System (BRFSS). We also examined trends from 2004 to 2008 in cigarette consumption among dual users. RESULTS: Between 1996 and 2008, the overall prevalence of current SLT use and prevalence of current smoking among Alaskan men did not significantly change over time (p-value from age-adjusted models p=.63, p=.09, respectively). When we examined trends in SLT use by smoking status, we found that the prevalence of current SLT use remained unchanged between 1996 and 2008 among former and never smokers, but almost doubled among current smokers (age-adjusted p=.004). Between 2004 and 2008, cigarette consumption remained steady among current smokers who did not use SLT, but significantly decreased among dual users (age-adjusted p<.001). CONCLUSIONS: Our findings suggest that male smokers in Alaska are increasingly likely to use SLT, but do not appear to be switching to SLT use exclusively. We recommend that other state tobacco control programs examine trends in dual use to confirm our findings, and for programs to continue encouraging cessation of all tobacco products.

Implementation of a smoke-free policy in subsidized multiunit housing: effects on smoking cessation and secondhand smoke exposure.

INTRODUCTION: We studied the impact of implementing a comprehensive smoke-free policy in multiunit housing in the Portland, Oregon metropolitan area. Among low-income tenants living in a subset of subsidized multiunit buildings, we evaluated cessation-related behaviors, policy knowledge and compliance, and secondhand smoke (SHS) exposure. METHODS: We mailed a self-administered questionnaire to a random sample of 839 current tenants of 17 subsidized buildings 4 months after policy implementation in January 2008 and sent another questionnaire to participants 1 year later. Results are based on 440 tenants who completed both surveys. RESULTS: We observed a self-reported annualized quit rate of 14.7% over the study period (95% CI = 7.9%-21.6%) compared with a historical quit rate in this population of 2.6% (95% CI = 0.6%-4.5%). Almost half of ongoing smokers reduced their cigarette consumption. More smokers correctly reported policy rules for indoor settings than for outdoor settings; self-reported indoor smoking decreased significantly from 59% to 17%. Among nonsmokers, frequent indoor SHS exposure (multiple times per week) decreased significantly from 41% prepolicy to 17% postpolicy. CONCLUSIONS: The implementation of a smoke-free policy was associated with positive changes in cessation-related behaviors and reduced SHS exposure in this population of low-income adults.

Smoke-free law associated with higher-than-expected taxable retail sales for bars and taverns in Washington State.

INTRODUCTION: Continued progress in implementing smoke-free laws throughout the United States would benefit from documenting positive economic effects, particularly for the hospitality industry. This study describes changes in sales revenue in bars and taverns since December 2005, when a statewide smoke-free law in Washington State went into effect. METHODS: Using 24 quarters of inflation-adjusted taxable retail sales data from 2002 through 2007, we fitted a regression model to estimate the effect of the smoke-free law on sales revenue, controlling for seasonality and other economic factors. RESULTS: We found no immediate change in bar revenues in the first quarter of 2006, but taxable retail sales grew significantly through the fourth quarter of 2007. In the 2 years after the smoke-free law was implemented, sales revenues were $105.5 million higher than expected for bars and taverns in Washington State. CONCLUSION: The higher-than-expected revenue from taxable sales in bars and taverns after the implementation of smoke-free laws in Washington State provided extra funds to the state general fund. Potential increases in revenue in other jurisdictions that implement smoke-free indoor air policies could provide funds to benefit residents of those jurisdictions.

Effectiveness of a tobacco quitline in an indigenous population: a comparison between Alaska Native people and other first-time quitline callers who set a quit date.

OBJECTIVES: To conduct a descriptive, comparative study of the acceptability and effectiveness of a tobacco cessation quitline (QL) among Alaska Native people and non-Alaska Native people. STUDY DESIGN: From January 2006 to January 2007, we conducted telephone surveys of first-time Alaska QL callers who set a quit date. We attempted to reach them by phone about 3 months after their call to the QL. METHODS: Analyses compared 7-day point prevalence quit rates, satisfaction measures, experiences and general perceptions of QLs by Alaska Native and non-Alaska Native callers. RESULTS: We surveyed 39.8% (n = 772) of the 1,941 adult tobacco users we attempted to contact. The 7-day point prevalence quit rate among Alaska Native survey participants at the 3-month follow-up was 22.2% (CI: 14.8% - 32.0%), compared to 40.7% (CI: 36.7% - 44.9%) for non-Alaska Native survey participants. Eighty-three percent (CI: 74.6% - 89.3%) were somewhat/very satisfied overall with the QL program compared to 90.3% (CI: 87.6% - 92.4%) for non-Alaska Native participants. CONCLUSIONS: Although the QL was less effective for Alaska Native callers than other QL callers, Alaska Native peoples' quit rates and satisfaction were still quite good. Despite this, more effort should be made to address specific Alaska Native values and social and cultural barriers to quitting tobacco.

Smoking-related knowledge, attitudes and behaviors in the lesbian, gay and bisexual community: a population-based study from the U.S. Pacific Northwest.

OBJECTIVE: Several studies have shown that lesbian, gay and bisexual (LGB) persons have higher smoking prevalence than heterosexuals. However, few population-based studies have explored whether smoking-related knowledge, attitudes and behaviors also differ between the communities. METHODS: We used Behavioral Risk Factor Surveillance System data for 2003 to 2005 from two states (Washington and Oregon) to compare smoking-related indicators between the self-identified LGB population and their heterosexual counterparts. RESULTS: Lesbians, gays and bisexuals were more likely to be current or ever smokers than their heterosexual counterparts. All except bisexual men and had lower quit ratios than heterosexuals. Among successful quitters, bisexual men were less likely to be long-term quitters than heterosexuals. For all groups, attitudes and behaviors regarding secondhand smoke (SHS) were similar to those of heterosexuals, except for bisexual women, who were more likely to be exposed to SHS. CONCLUSIONS: Despite a disparity in smoking prevalence, the LGB population in these two states appeared to have similar levels of knowledge and attitudes toward tobacco control as their heterosexual counterparts. Nevertheless, tobacco control programs should continue to focus on this population to prevent smoking initiation, promote cessation, and reduce secondhand smoke exposure.

Smoking patterns in Oregon youth: effects of funding and defunding of a comprehensive state tobacco control program.

PURPOSE: Comprehensive tobacco control programs have included school-based prevention programs as a key strategy to reach adolescents. Unfortunately, these programs have undergone extensive budget reductions in recent years. In 2003, funding for the Oregon Tobacco Prevention and Education Program was reduced by about 70%, and the school component was entirely defunded. To assess the effects of program funding and subsequent defunding on smoking prevalence within targeted Oregon schools, we compared the change in 30-day smoking prevalence between grades 8 and 11 in school districts in two periods: namely, during funding and after funding was eliminated. METHODS: We used annual school-based survey data for grades 8 and 11 to describe district-level changes in smoking prevalence in five age cohorts: two during the funding period and three after defunding. Each cohort was comprised of districts whose 8th-graders completed the survey and participated again 3 years later. Using mixed models, we compared the change in 30-day adjusted smoking prevalence among cohorts in funded districts, defunded districts, and districts that never received funding. RESULTS: Smoking prevalence growth was significantly higher among cohorts from the defunded period than for cohorts from the funded period (p=.04) and was not significantly different from schools that were never-funded (p=.79). CONCLUSIONS: In Oregon, funding a school component of a comprehensive tobacco control strategy was associated with depressed uptake of smoking. Gains were quickly lost upon program defunding. School programs are an important strategy if they are long term, comprehensive, and reinforced in the larger environment.

Reducing HIV and partner violence risk among women with criminal justice system involvement: a randomized controlled trial of two motivational interviewing-based interventions.

Women with histories of incarceration show high levels of risk for HIV and intimate partner violence (IPV). This randomized controlled trial with women at risk for HIV who had recent criminal justice system involvement (n = 530) evaluated two interventions based on Motivational Interviewing to reduce either HIV risk or HIV and IPV risk. Baseline and 3, 6, and 9-month follow-up assessments measured unprotected intercourse, needle sharing, and IPV. Generalized estimating equations revealed that the intervention groups had significant decreases in unprotected intercourse and needle sharing, and significantly greater reductions in the odds and incidence rates of unprotected intercourse compared to the control group. No significant differences were found in changes in IPV over time between the HIV and IPV group and the control group. Motivational Interviewing-based HIV prevention interventions delivered by county health department staff appear helpful in reducing HIV risk behavior for this population.

Is a statewide tobacco quitline an appropriate service for specific populations?

OBJECTIVE: To assess whether smoking quit rates and satisfaction with the Washington State tobacco quitline (QL) services varied by race/ethnicity, socioeconomic status, area of residence (that is, urban versus non-urban), or sex of Washington QL callers. METHODS: From October 2004 into October 2005, we conducted telephone surveys of Washington QL callers about three months after their initial call to the QL. Analyses compared 7-day quit rates and satisfaction measures by race/ethnicity, education level, area of residence and sex (using alpha = 0.05). RESULTS: We surveyed half (n = 1312) of the 2638 adult smokers we attempted to contact. The 7-day quit rate among survey participants at the 3-month follow-up was 31% (CI: 27.1% to 34.2%), 92% (CI: 89.9% to 94.1%) were somewhat/very satisfied overall with the QL programme, 97% (CI: 95.5% to 98.2%) indicated that they would probably/for sure suggest the QL to others and 95% (CI: 92.9% to 96.4%) were somewhat/very satisfied with the QL specialist. Quit rate did not vary significantly by race/ethnicity, education level, area of residence or sex. Satisfaction levels were high across subpopulations. Almost all participants (99%) agreed that they were always treated respectfully during interactions with QL staff. CONCLUSIONS: The Washington QL appeared effective and well received by callers from the specific populations studied. States choosing to promote their QL more aggressively should feel confident that a tobacco QL can be an effective and well received cessation service for smokers who call from a broad range of communities.