Derived psychoactive cannabis products and 4/20 specials: An assessment of popular brands and retail price discounts in Fort Worth, Texas, 2023.

BACKGROUND: Retail sales of derived psychoactive cannabis products (DPCPs) have increased in the U.S. since passing the 2018 Farm Bill and is unregulated in most states. This study investigated the types and commonly sold brands of DPCPs as well as promotional pricing on April 20th, a day associated with cannabis use. METHODS: On April 19-20, 2023, investigators conducted telephone surveys with 98 retail stores that sold DPCPs in Fort Worth, Texas (where the market was largely unregulated). RESULTS: Delta-8, Delta-9, and Delta-10 THC products were widely available, with 97%, 72%, and 82% of stores selling each type, respectively. Fifteen additional DPCPs were identified, and selling blends containing multiple types of THC was common. Frequently sold brands included Cake, Medusa/Modus, Torch, Urb, Kik, Tyson, 3Chi, Casper, Hidden Hills, Esco Bars, Happi, Hometown Hero, STNR, Bomb Bars, Baked, Hi On Nature, Looper, and Space God. Overall, 45% reported having 4/20 specials discounting prices on DPCPs, smoking devices/accessories, or everything in the store. Several stores also sponsored 4/20 promotional events including free THC gummies and "live delta demos where people can test cartridges and try smoking flower in the store." CONCLUSIONS: Findings highlight the growing complexity of the DPCP market, including numerous different intoxicating compounds and blends. Policymakers, researchers, and public health professionals should consider these complexities, as well as the commonly sold brands, when developing strategies to regulate DPCPs and protect consumer safety. Pricing policies may be an especially important form of harm reduction during events associated with heavy cannabis use, including 4/20.

Types and Brands of Derived Psychoactive Cannabis Products: An Online Retail Assessment, 2023.

Background: The 2018 Farm Bill led to new types of derived psychoactive cannabis products (DPCPs) being sold throughout the United States. This study describes the new types and brands of DPCPs sold online. Materials and Methods: In May 2023, data were recorded from three top-trafficked U.S.-based DPCP retail websites, including information about each product (N=804). Results: DPCP modalities included disposable vapes (43%), edibles (29%), vape carts (18%), pre-rolls (7%), flower (2%), dabs (1%), and vape pods (<1%). Among the 118 brands, the most common were Exhale, Delta Extrax, Cake, URB, Looper, and TRE House. There were 26 different intoxicating compounds overall, the most prevalent being: Delta-8 tetrahydrocannabinol (THC), THC-P, Delta-9 THC, HHC, THC-A, Delta-10 THC, THC-H, THC-B, THC-JD, THC-X, HHC-P, and Delta-11 THC. Overall, 54% of products were blends, containing two to eight different intoxicating compounds in a single product. Discussion: This is the first study to systematically assess DPCPs sold online. Most of the DPCP market is comprised of vapes and edibles, but these products contain a wide array of compounds and blends. Data from this diverse, rapidly evolving market are needed to examine its consumer impact and inform public health policies and programs.

Tobacco and Alcohol Retailer Availability and Neighborhood Racialized, Economic, and Racialized Economic Segregation in North Carolina.

BACKGROUND: Despite evidence of racialized and socioeconomic inequities in tobacco and alcohol outlet availability, few studies have investigated spatial inequities in areas experiencing both concentrated residential racialized segregation and socioeconomic disadvantage. This study examined whether segregation-racialized, economic or both-was associated with alcohol and tobacco retailer counts in North Carolina (NC). METHODS: The NC Alcoholic Beverage Control Commission provided lists of 2021 off-premise alcohol retailers. We created a list of 2018 probable tobacco retailers using ReferenceUSA. We calculated three census tract-level measures of the Index of Concentrations at the Extremes (ICE), indicating racialized segregation between non-Hispanic White and Black residents and economic segregation based on household income. We used negative binomial regression to test associations between quintiles of each ICE measure and tobacco and, separately, alcohol retailer counts. RESULTS: Tracts with the greatest racialized disadvantage had 38% (IRR, 1.38; 95% CI, 1.15-1.66) and 65% (IRR, 1.65; 95% CI, 1.34-2.04) more tobacco and alcohol outlets, respectively, as tracts with the lowest. Tracts with the highest racialized economic disadvantage had a predicted count of 1.51 tobacco outlets per 1000 people while those in the lowest had nearly one fewer predicted outlet. Similar inequities existed in the predicted count of alcohol outlets. DISCUSSION: Tobacco and alcohol outlet availability are higher in NC places experiencing concentrated racialized and economic segregation. A centralized agency overseeing tobacco and alcohol outlet permits and strategies to reduce the retail availability of these harmful products (e.g., capping the number of permits) are needed to intervene upon these inequities.

Delta-8 THC Retail Availability, Price, and Minimum Purchase Age.

Background: Retail sales of Delta-8 tetrahydrocannabinol (THC) products have increased in the U.S. market since the passing of the 2018 Farm Bill, and there is currently little regulation of marketing/sales and limited related safety standards in many states. After thousands of calls to poison control centers (40% for individuals under 18 years old and 70% requiring health care facility evaluation), the Food and Drug Administration issued warnings on Delta-8 THC products, stating their psychoactive effects and that some manufacturers may synthesize Delta-8 using unsafe household chemicals. The current study describes the Delta-8 THC retail sales environment in Fort Worth, Texas. Given its relatively inexpensive manufacturing and that low prices are a major determinant of cannabis use, the price of Delta-8 THC products was examined. This study also examined whether retail outlets in areas with greater socioeconomic deprivation had higher odds of selling Delta-8 THC products. This is important because if Delta-8 THC retailers are disproportionately located in more socioeconomically deprived communities, residents of these communities can more easily access these products and may have higher risk of adverse consequences. Methods: Potential Delta-8 THC retailers were selected by identifying lists of current retail locations with alcohol, cannabidiol, and/or tobacco licenses in Fort Worth. Trained research assistants called outlets in September and October 2021 to query about sales of products containing Delta-8 THC. The response rate was 69% (n=1,223). Outlets' 9-digit zip codes were merged with Area Deprivation Index scores. Products and purported minimum age were described. Chi-squared and Student's t-tests were used. Results: Eleven percent of outlets (n=133) reported selling Delta-8 THC. Ninety-six percent sold vapes and/or "flower" (i.e., hemp leaves coated with Delta-8 THC distillate) and 76% sold edibles. Among the least expensive products available, edibles cost, on average, $8.58 less than flower/vapes (p<0.001). Outlets that sold Delta-8 THC were located in areas with greater deprivation (p=0.02). Most reported a minimum purchase age of 21; however, 4% reported 18 years or no minimum age. Conclusions: Delta-8 THC retail outlets were disproportionately located in areas with more socioeconomic deprivation. Legal intervention such as zoning, minimum age, and tax laws may help reduce Delta-8 THC-related disparities.

Gender and sexual identity and harms from others' drinking among U.S. college students: Results from a multi-campus survey.

BACKGROUND: College is a critical life stage for alcohol-related harms to others (AHTOs), gender, and sexual identity. We tested associations between inclusively-defined gender and sexual identities (separately) and AHTOs among college students. METHODS: The Healthy Minds Study (n = 8,308) provided data about three AHTOs: (1) babysitting a drunk student, (2) alcohol-related unwanted sexual advance, and (3) alcohol-related sexual assault. Independent variables included gender and sexual identity. RESULTS: One in four students (25.5%) reported babysitting, 6.2% reported unwanted advances, and 1.2% reported sexual assaults. Compared to cisgender males, cisgender females had higher odds of reporting babysitting (aOR = 1.36, p < 0.001) and unwanted advances (aOR = 2.59, p < 0.001); trans masculine students had higher odds of reporting sexual assaults (aOR = 4.49, p = 0.04). CONCLUSIONS: AHTOs are prevalent on college campuses, and cisgender female and trans masculine students have higher odds of experiencing them. Alcohol interventions may protect cisgender female and gender minority students from the drinkers around them.

Excise Taxes as a Policy Lever for Reaching Healthy North Carolina 2030 Targets.

Excise taxes can raise the price of unhealthy products, reducing consumption and associated health risks and costs. Raising state excise taxes on tobacco, alcohol, and sugary drinks and allowing local governments to do the same are win-win strategies for achieving three Healthy North Carolina 2030 health behavior targets while increasing state revenues.

The Societal Cost of Excessive Drinking in North Carolina, 2017.

BACKGROUND Excessive drinking, including binge and heavy drinking, is a leading cause of morbidity and mortality in North Carolina. In 2010, excessive drinking cost North Carolina $7.03 billion, and this analysis aimed to update this figure for 2017.METHODS Following the methods of Sacks, et al. (2015), we obtained proxies for the 2010 and 2017 incidence and price for 26 alcohol-attributable cost components. We then multiplied each component's 2010 cost by the incidence trend (2017 incidence/2010 incidence) and price trend (2017 price/2010 price) to estimate the 2017 cost. Finally, we summed these cost components to calculate the total cost and allocated them by payer and county.RESULTS Excessive drinking cost $9.72 billion in North Carolina in 2017, which equals approximately $2.09 per standard drink. Government paid $4.43 billion (45.6%), drinkers paid $3.76 billion (38.7%), and persons other than the drinker paid $1.53 billion (15.7%).LIMITATIONS These methods relied on alcohol-attributable fractions, which were calculated using scientific literature and national data. If consumption patterns differ between the United States and North Carolina, these fractions may not generalize. Scaling processes may over- or underestimate individual cost components, so total state costs should be interpreted as estimates.CONCLUSIONS The societal costs from excessive drinking are high but spread across public sectors. This can make it difficult to attribute this burden to alcohol. While drinkers paid less than half of the costs of excessive drinking, a broad range of stakeholders bore the burden. Evidence-based strategies to reduce excessive drinking may decrease these costs.

Alcohol Policy Scores and Alcohol-Attributable Homicide Rates in 150 Countries.

INTRODUCTION: More comprehensive state-level alcohol policy environments are associated with lower alcohol-attributable homicide rates in the U.S., but few studies have explored this internationally. This study tests whether 3 national-level alcohol policy scores are associated with alcohol-attributable homicide rates. METHODS: Data were from the 2016 WHO Global Survey on Alcohol and Health and the 2017 Global Burden of Disease Study (N=150 countries). In 2020, the authors calculated domain-specific alcohol policy scores for physical availability, marketing, and pricing policies. Higher scores represented more comprehensive/restrictive alcohol policy environments. Negative binomial regressions with Benjamini-Simes-Hochberg multiple testing correction measured the associations between policies and alcohol-attributable homicide rates. Authors stratified countries by World Bank income group to determine whether the associations differed among low- and middle-income countries. RESULTS: A 10% increase in the alcohol policy score for pricing was associated with an 18% lower alcohol-attributable homicide rate among all the countries (incidence rate ratio=0.82, adjusted p-value or q<0.001) and with a 14% (incidence rate ratio=0.86, q=0.01) decrease among 107 low- and middle-income countries. More controls on days and times of retail sales (incidence rate ratio=0.96, q=0.01) and affordability of alcohol (incidence rate ratio=0.95, q=0.04) as well as adjusting excise taxes for inflation (incidence rate ratio=0.96, q<0.01) were associated with a 4%-5% lower alcohol-attributable homicide rate in the full sample. CONCLUSIONS: Countries with policies that reduce alcohol's affordability or days/hours of sales tend to have fewer alcohol-attributable homicides, regardless of their income level. Alcohol-attributable homicide rates are highest in low- and middle-income countries; policies that raise alcohol-relative prices may hold promise for curbing these harms.

Interested constituents: identifying groups to mobilize in community organizing efforts to strengthen alcohol control policies.

Background: Policy support research identifies demographic profiles of those who support policies, but community organizers aim to mobilize groups with an existing structure. Thus, identifying established groups that support alcohol policies may aid organizing efforts.Objective: This paper calculates prevalence and odds of policy support among three potential constituency groups (i.e., religious affiliation, persons harmed by others' drinking, and persons in recovery from alcohol) for three policies: alcohol tax increases, banning alcohol in corner stores, and universal coverage for alcohol treatment.Methods: Using the 2014-15 National Alcohol Survey (n = 3,444; 1,457 male, 1,987 female) and logistic regression, this study explores associations between constituency groups and policy support.Results: Support was higher for the individual-level strategy of alcohol treatment (80.8%) than raising taxes (27.5%) and banning sales in corner stores (52.2%). Support for taxes was higher among persons who valued religion highly (vs not; aOR = 1.46, p < .01), persons harmed by others' drinking (vs not; aOR = 1.71, p < .001), and persons in recovery (vs. not; aOR = 1.76, p = .02); Catholics had lower odds of support for taxes (vs no denomination; aOR = 0.63, p = .01). Persons who valued religion highly (aOR = 1.53, p < .001), Protestants (aOR = 1.63, p < .01), Catholics (aOR = 1.46, p = .03), and persons with other religious denominations (aOR = 2.17, p = .02) had higher odds of supporting bans in corner stores. Only those in recovery showed greater support for treatment (aOR = 3.20, p < .001).Conclusion: Overall, support was lower for population-wide approaches, but results revealed constituency groups that supported these policies. These groups may be allies to organizers who seek to reduce population-level alcohol consumption and harms.

Association between state-level alcohol availability and taxation policies on the prevalence of alcohol-related harms to persons other than the drinker in the USA, 2000-2015.

INTRODUCTION AND AIMS: Alcohol-related harms to others (AHTO) are consequences of alcohol use borne by persons other than the drinker. This study assessed whether the odds of experiencing AHTO are associated with alcohol availability and taxation policies. DESIGN AND METHODS: This study pooled data from four waves of the National Alcohol Survey (n = 20656 adults). We measured past-year AHTO exposure using three binary variables: physical (pushed/hit/assaulted or property damage by someone who had been drinking), family or financial (family/marital problems or financial harms by someone who had been drinking) and driving AHTO (riding in a vehicle with a drink-driver or being in a drink-driving crash). Policies included bar and off-premise alcohol outlet density (separately), alcohol retail hours, beer and spirits taxes (separately) and monopoly on retail/wholesale alcohol purchases. RESULTS: Monopolies were associated with 41.2% lower odds of physical harms [adjusted odds ratio (aOR) = 0.59, 95% confidence interval (CI) 0.45, 0.77, q < 0.001 correcting for multiple analyses], and a 10% increase in bar density was associated with a 1.2% increase in odds of driving-related harms ( e ln(1.1) * ß =1.01, 95% CI 1.00, 1.02, q = 0.03). Among men, beer taxes were associated with lower odds of physical harms ( eln(1.1) * ß =0.93, 95% CI 0.88, 0.98 q = 0.03) and monopolies were associated with lower odds of physical (aOR = 0.45, 95% CI 0.35, 0.59, q < 0.001) and driving harms (aOR = 0.66, 95% CI 1.00, 1.02, q = 0.03). DISCUSSION AND CONCLUSIONS: Monopolies, taxes and outlet density are associated with odds of some AHTO. Future longitudinal research should test whether physical availability and taxation policies may be protective for bystanders as well as drinkers.

The Violence Prevention Potential of Reducing Alcohol Outlet Access in Baltimore, Maryland.

OBJECTIVE: There are few cost-effectiveness analyses that model alcohol outlet zoning policies. This study determines the potential decreases in homicides, disability-adjusted life years (DALYs), and victim and criminal justice costs associated with four policy options that would reduce the alcohol outlet access in Baltimore. METHOD: This cost-effectiveness analysis used associations between on-premise (incidence rate ratio [IRR] = 1.41), off-premise (IRR = 1.76), and combined on- and off-premise outlet density (IRR = 1.07) and homicide in Baltimore. We determined the potential change in the level of homicide that could occur with changes in the density of alcohol outlets, assuming that 50% of the association was causal. RESULTS: Reducing alcohol outlet density in Baltimore City by one quintile was associated with decreases of 51 homicides per year, $63.7 million, and 764 DALYs. Removing liquor stores in residential zones was associated with 22 fewer homicides, which would cost $27.5 million and lead to 391 DALYs. Removing bars/taverns operating as liquor stores was associated with a decrease of one homicide, $1.2 million, and 17 DALYs. Removing both the liquor stores in residential zones and the bars/taverns operating as liquor stores was associated with 23 fewer homicides, which translated to $28.7 million and 409 DALYs. CONCLUSIONS: For preventing homicides, the strategy of removing liquor stores in residential zones was preferred because it was associated with substantial reductions in homicides without closing unacceptably high numbers of outlets. It is possible that policies that close the bars/taverns operating as liquor stores would be associated with decreases in other types of violent crime.

Alcohol Advertising and Violence.

INTRODUCTION: Numerous studies have found associations between alcohol outlet density and violence, but it is unknown whether alcohol advertisements visible outside outlets are also associated with violent crime. Baltimore City, MD enacted restrictions on retail alcohol establishment advertising practices as of June 5, 2017. This study examines the association between alcohol advertisements visible outside off-premise alcohol outlets and violent crime before this restriction. METHODS: Outlet observations (n=683) were conducted in summer 2015, and violent crime data (n=24,085) were from June 5, 2015, through June 4, 2017. The number of violent crimes per square mile within 1,000 feet of outlets was summed using kernel density estimation. In 2018-2019, authors used mixed models with a Simes-Benjamini-Hochberg correction for multiple testing. RESULTS: Roughly half (47%, n=267) of the outlets with complete data (n=572) had alcohol advertisements visible from the exterior. Outlets with alcohol advertisements had 15% more violent crimes per square mile within 1,000 feet (eß=1.15, 95% CI=1.07, 1.25, q<0.001) after adjusting for neighborhood context. All associations between alcohol advertisements and specific types of violent crime were significant, with the association strongest for homicides (eß=1.28, 95% CI=1.13, 1.46, q<0.001). There was no association between cigarette advertisements and violent crime (eB=1.08, 95% CI=0.92, 1.26, q=0.43). CONCLUSIONS: Alcohol advertisements visible outside off-premise outlets were associated with increased violent crime over and above the association between the outlets themselves and violent crime. Reducing alcohol advertising visible from the street may decrease risk of violent crime that is associated with alcohol outlets.

Alcohol Outlet Clusters and Population Disparities.

Alcohol outlet clusters are an important social determinant of health in cities, but little is known about the populations exposed to them. If outlets cluster in neighborhoods comprised of specific racial/ethnic or economic groups, then they may function as a root cause of urban health disparities. This study used 2016 liquor license data (n = 1204) from Baltimore City, Maryland, and demographic data from the American Community Survey. We defined alcohol outlet clusters by combining SaTScan moving window methods and distances between outlets. We used multiple logistic regression to compare census block groups (CBGs) (n = 537) inside and outside of four types of outlet clusters: total, on-premise, off-premise, and LBD-7 (combined on-/off-premise). The most robust predictor of alcohol outlet cluster membership was a history of redlining, i.e., racially discriminatory lending policies. CBGs that were redlined had 7.32 times the odds of being in an off-premise cluster, 8.07 times the odds of being in an on-premise cluster, and 8.60 times the odds of being in a LBD-7 cluster. In addition, level of economic investment (marked by vacant properties) appears to be a key characteristic that separates CBGs in on- and off-premise outlet clusters. CBGs with racial/ethnic or socioeconomic advantage had higher odds of being in on-premise clusters and CBGs marked by disinvestment had higher odds of being in off-premise clusters. Off-premise clusters deserve closer examination from a policy perspective, to mitigate their potential role in creating and perpetuating social and health disparities. In addition to addressing redlining and disinvestment, the current negative effects of alcohol outlet clusters that have grown up in redlined and disinvested areas must be addressed if inequities in these neighborhoods are to be reversed.

Price of Four Loko in Large U.S. Cities, 2018.

BACKGROUND: Supersized alcopops are flavored alcoholic beverages that contain up to 5.5 standard alcoholic drinks in a single can. Limited research suggests Four Loko-the most commonly consumed supersized alcopop by underage drinkers-is among the least expensive ready-to-drink alcohol products on the U.S. market. This is a public health concern because alcohol prices are inversely associated with consumption and related harms, particularly among youth. This study investigated Four Loko's retail price per volume of alcohol in large U.S. cities. METHODS: This study used multistage random sampling to collect data in the largest city of each state and Washington, DC. A simple random sample of 5 ZIP codes from each city was selected and entered into Four Loko's website product locator. Within ZIP codes, up to 4 stores were randomly selected and contacted by telephone. Retailers were interviewed about Four Loko in regard to: availability, volume, alcohol by volume (abv), price for 1 can, and discounts for purchasing more than 1 can. RESULTS: The sample included 344 retail stores with Four Loko in stock. Average price per standard alcoholic drink (i.e., 14 g of absolute alcohol) was $0.54 for Four Loko products. Taking into account volume, price, and discounts, an average of 17 standard alcoholic drinks could be purchased via Four Loko with $10. Adjusted analysis using linear regression showed that availability of bulk price discounts and higher abv (14% vs. 12%) were associated with lower price per drink. CONCLUSION: This study verifies that Four Loko is among the least expensive ready-to-drink alcohol available for purchase in the United States. Given that consuming a single supersized alcopop constitutes binge drinking and is therefore unsafe, regulatory agencies should consider a variety of steps to reduce the availability and abv of these products and increase their retail price in order to reduce and prevent unsafe alcohol consumption.

Outlet Type, Access to Alcohol, and Violent Crime.

BACKGROUND: While there are overwhelming data supporting the association between alcohol outlet density and violent crime, there remain conflicting findings about whether on- or off-premise outlets have a stronger association. This inconsistency may be in part a result of the methods used to calculate alcohol outlet density and violent crime. This analysis uses routine activity theory and spatial access methods to study the association between access to alcohol outlets and violent crime, including type of outlet and type of crime in Baltimore, MD. METHODS: The data in this analysis include alcohol outlets from 2016 (n = 1,204), violent crimes from 2012 to 2016 (n = 51,006), and markers of social disorganization, including owner-occupied housing, median annual household income, drug arrests, and population density. The analysis used linear regression to determine the association between access to alcohol outlets and violent crime exposure. RESULTS: Each 10% increase in alcohol outlet access was associated with a 4.2% increase in violent crime exposure (ß = 0.43, 95% CI 0.33, 0.52, p < 0.001). A 10% increase in access to off-premise outlets (4.4%, ß = 0.45, 95% CI 0.33, 0.57, p < 0.001) and LBD-7 outlets (combined off- and on-premise outlets; 4.2%, ß = 0.43, 95% CI 0.33, 0.52, p < 0.001) had a greater association with violent crime than on-premise outlets (3.0%, ß = 0.31, 95% CI 0.20, 0.41, p < 0.001). CONCLUSIONS: Access to outlets that allow for off-site consumption had a greater association with violent crime than outlets that only permit on-site consumption. The lack of effective measures to keep order in and around off-premise outlets could attract or multiply violent crime.