Insurance-Based Discrimination Reports and Access to Care Among Nonelderly US Adults, 2011-2019.

Objectives. To report insurance-based discrimination rates for nonelderly adults with private, public, or no insurance between 2011 and 2019, a period marked by passage and implementation of the Affordable Care Act (ACA) and threats to it. Methods. We used 2011-2019 data from the biennial Minnesota Health Access Survey. Each year, about 4000 adults aged 18 to 64 years report experiences with insurance-based discrimination. Using logistic regressions, we examined associations between insurance-based discrimination and (1) sociodemographic factors and (2) indicators of access. Results. Insurance-based discrimination was stable over time and consistently related to insurance type: approximately 4% for adults with private insurance compared with adults with public insurance (21%) and no insurance (27%). Insurance-based discrimination persistently interfered with confidence in getting needed care and forgoing care. Conclusions. Policy changes from 2011 to 2019 affected access to health insurance, but high rates of insurance-based discrimination among adults with public insurance or no insurance were impervious to such changes. Public Health Implications. Stable rates of insurance-based discrimination during a time of increased access to health insurance via the ACA suggest deeper structural roots of health care inequities. We recommend several policy and system solutions. (Am J Public Health. 2023;113(2):213-223. https://doi.org/10.2105/AJPH.2022.307126).

Strategies Used by Local Law Enforcement Agencies to Prevent Overservice of Alcohol in the United States.

Overservice of alcohol, defined as commercial provision of alcohol to an individual who is obviously intoxicated, is illegal in most states and contributes to motor vehicle crashes and violence. Law enforcement agencies use various strategies that aim to reduce overservice at licensed alcohol establishments (e.g., bars, restaurants). Place of Last Drink (POLD) data collection is an emerging overservice enforcement strategy. POLD identifies patterns of overservice, which can provide support for targeted interventions to prevent overservice at offending establishments. We describe the prevalence of POLD and other overservice enforcement strategies and associations with agency characteristics, which has important implications for public health and safety. We conducted a national survey of 1024 municipal (e.g., town, city) and county law enforcement agencies in 2019 (response rate = 73%). We assessed the use of overservice enforcement strategies conducted by the agencies over the past year. We examined associations of each type of overservice enforcement strategy with agency and jurisdiction characteristics using regression models. 27% of responding agencies reported conducting overservice enforcement and 7% conducted POLD data collection specifically. Municipal (vs. county) agencies and agencies with an officer assigned primarily to alcohol enforcement activities were significantly more likely to conduct overservice enforcement generally but not POLD data collection specifically. Overservice enforcement in general, and POLD data collection specifically, are not widely conducted. Prevention of overservice has the potential to reduce harms related to excessive alcohol consumption. Increased evaluation of overservice enforcement strategies should be prioritized.

Effects of Sunday Liquor Sales Legalization on Alcohol Policy Attitudes and Alcohol Purchasing Behavior.

We examined how legalization of Sunday alcohol sales relates to attitudes towards Sunday sales, and how both attitudes and alcohol consumption patterns relate to Sunday alcohol purchasing. A total of 1,384 adults of legal drinking age completed a survey one year post-legalization of Sunday sales. A majority of respondents (51%) were supportive of Sunday sales legalization both before and after legalization. People were more likely to support Sunday sales legalization if they reported binge drinking (PR: 2.19; CI: 1.51 3.18). Following Sunday sales legalization, 59% of participants reported purchasing alcohol in Minnesota on Sunday. Binge drinking (PR: 1.39; CI: 1.27, 1.52) or supporting Sunday sales legalization (PR: 1.85; CI: 1.56, 2.17) were associated with higher likelihood of purchasing alcohol on Sunday. Legalizing Sunday sales may have increased access to alcohol for people with more unhealthy drinking behaviors.

The Effectiveness of Alcohol Impact Areas in Reducing Crime in Washington Neighborhoods.

BACKGROUND: We evaluated the effectiveness of Alcohol Impact Areas (AIA) in reducing crime around off-premise alcohol outlets in 3 AIAs in Spokane and Tacoma, Washington, using an interrupted time series design with comparison groups. AIAs only exist in Washington and include designated areas in a city where specific brands of malt liquor are restricted. We hypothesized that mandatory restrictions on malt liquor sales in AIAs would be significantly associated with decreases in crime, especially less-serious crime. METHODS: In Spokane and Tacoma, targets were 3 AIAs and 3 comparison areas with demographically similar neighborhoods without malt liquor restrictions in the same respective city. Nine different crime outcomes were evaluated: Part I selected crimes, Part II selected crimes (further split into nuisance crimes and other Part II crimes), assaults, vandalism, narcotics, disorderly conduct, and all selected crimes combined. Crime was typically compared 3 years prior to and 3 years following policy adoption using time series and negative-binomial modeling. Separate models were run for each area and each crime. RESULTS: Study hypotheses were partially supported. Malt liquor restrictions in AIAs were associated with significant decreases in crime, particularly certain Part II crimes and assaults (simple and aggravated) in 12 of the 23 models. The strength of the observed associations varied by AIA. Average monthly crime counts across all crime categories decreased more in the Tacoma AIA than in Spokane AIAs, and average monthly crime decreased more in Spokane AIA 2 (East Central) than in AIA 1 (Downtown Core). Malt liquor restrictions were significantly associated with increases in disorderly conduct in the Tacoma AIA; the increase, however, was small. CONCLUSIONS: Findings suggest that malt liquor policies such as AIAs may be one of a number of tools local officials can use to reduce alcohol-related crime in cities, especially less-serious crime.

Support for Alcohol Policies in Marginalized Populations.

AIM: Kingdon [(2014) Agendas, Alternatives, and Public Policies. Essex. United Kingdom: Pearson Education Limited] argues that windows of opportunity to pass policies emerge when problems, solutions and policy support co-occur. This study aims to identify a set of alcohol policies with the potential to reduce alcohol-related disparities given high levels of support from marginalized groups, such as racial/ethnic minorities and lower-income groups. METHODS: This study used data from five US National Alcohol Surveys, which were based on household probability samples of adults in 1995 (n = 4243), 2000 (n = 5736), 2005 (n = 1445), 2010 (n = 4164) and 2015 (n = 4041). We used multiple logistic regression to determine the odds of policy support by racial/ethnic group and income level, considering price, place and marketing policies as well as individual-level interventions. RESULTS: Overall a majority of Americans supported banning alcohol sales in corner stores (59.4%), banning alcohol advertisements on television (55.5%), and establishing universal health coverage for alcohol treatment (80.0%). Support was particularly high among Blacks, Hispanics/Latinos and lower-income persons. Multivariate models showed that compared with White people, foreign-born Hispanics/Latinos had the most robust levels of support, including raising alcohol taxes (aOR = 2.40, 95% CI: 2.00, 2.88, P < 0.0001), banning alcohol sales in corner stores (aOR = 2.85, 95% CI: 2.22, 3.65, P < 0.0001) and reducing retail sales hours (aOR = 2.91, 95% CI: 2.38, 3.55, P < 0.0001). CONCLUSION: Of the policies examined, banning alcohol sales at corner stores is most likely to be in a "window of opportunity" for reducing alcohol-related disparities. By simultaneously reducing population-level consumption and harms from others' drinking, place-based policies have the potential to reduce harms experienced by marginalized groups.

Are people aware of the link between alcohol and different types of Cancer?

BACKGROUND: Alcohol consumption is causally linked to several different types of cancer, including breast, liver, and colorectal cancer. While prior studies have found low awareness of the overall alcohol-cancer link, few have examined how awareness differs for each type of cancer. Greater awareness of risks associated with alcohol use may be a key factor in reducing alcohol-related cancer incidence. METHODS: We surveyed 1759 people of legal drinking age at the 2019 Minnesota State Fair. We used multivariable generalized linear models and linear regression models with robust standard errors to investigate factors associated with alcohol-cancer risk awareness. Models were fit examining predictors of overall awareness of alcohol as a risk factor for cancer, and prevalence of awareness of alcohol as a risk factor for specific types of cancer. RESULTS: Prevalence of awareness varied by cancer type, with awareness of alcohol causing liver cancer having the highest prevalence (92%) and awareness of alcohol causing breast cancer having the lowest prevalence (38%). Factors associated with awareness of alcohol-cancer risk differed by type of cancer. CONCLUSIONS: In general, awareness of the risk of alcohol for certain types of cancer was low to moderate, reflecting a need to inform people not only that alcohol increases risk of cancer, but which types of cancer are most highly associated alcohol.

Perceptions of Violent Encounters between Police and Young Black Men across Stakeholder Groups.

Violence between police and young black men is a longstanding issue that has gained national attention in recent years due to high-profile violent encounters. We conducted 48 semi-structured interviews with key stakeholders from different groups (young black men aged 14-24 years, parents, educators, police officers, and staff in youth serving organizations). Stakeholders were asked to (1) identify causes of violent encounters between police and young black men; (2) describe police officers who serve in their communities; and (3) describe interactions between police and young black men. Data were collected and analyzed using thematic analysis and content analysis methods. All stakeholder groups except police felt that violent encounters between police and young black men were caused by officers lacking a connection with communities. Fear and distrust across stakeholder groups was also seen as a cause of violent encounters; youth feared police after having seen or heard of violent encounters, while officers feared youth due to the availability of firearms and previous assaults on officers. Several stakeholder groups recognized that racism and prejudice among police was another cause of violence between police and young black men. Positive interactions between police and youth were seen as the result of established, trusting relationships developed over time. Future efforts to prevent violent encounters between police and young black men should engage multiple stakeholder groups. One avenue for engagement is through community mobilization efforts that foster collaboration, build community trust, and encourage implementation of policies, programs, and practices that prevent future violent encounters.

Effects of Restricting High Alcohol Content Beverages on Crime in California.

Background: Policy restrictions on malt liquor sales have been adopted in several cities throughout the United States in an effort to reduce crime around off-premise alcohol outlets. Although California has implemented the most restrictions on malt liquor sales, no studies in the published literature have evaluated the effects of these policies on reducing crime. Objectives: We evaluated the effectiveness of malt liquor restrictions on reducing crime around off-premise alcohol outlets in six California cities. We hypothesized that adoption of malt liquor policies would be significantly associated with decreases in crime within areas surrounding targeted outlets. Methods: We used an interrupted time-series design with control areas to examine the relationship between malt liquor policies and crime reduction. We compared crime rates three years prior and following adoption of malt liquor policies. Results: Malt liquor policies were associated with modest decreases in crime, largely Part II or less serious crimes such as simple assaults. The effectiveness of malt liquor policies varied by city, with reductions in crime greatest in Sacramento where policies were more restrictive than in other cities. Malt liquor policies were also associated with small increases in nuisance crime, especially in San Francisco. Conclusion: Results suggest that malt liquor policies may have modest effects on reducing crime when they include strong restrictions on the sale of malt liquor products. Results may be informative to other cities considering whether to maintain or change their malt liquor policies as well as cities considering placing restrictions on other high content beverages.

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking.

BACKGROUND: African Americans are generally known to have lower heavy drinking prevalence than Whites despite often greater individual and community risk factors. While it is supposed that their protective resources explain this "paradox," studies have not explicitly examined this. OBJECTIVE: Assess the contribution of protective resources to Black-White differences in heavy drinking, and (secondarily) whether protective resources operate by reducing heavy drinking and/or increasing abstinence. METHODS: Using data from the 2009-2010 U.S. National Alcohol Survey (N = 3,133 Whites and 1,040 Blacks ages 18+), we applied propensity score (PS) weighting to estimate racial differences in heavy drinking and abstinence under hypothetical conditions in which Whites are similar to Blacks in: (1) age and marital status; (2) socioeconomic position and unfair treatment; (3) neighborhood socioeconomic conditions and alcohol outlet density; and (4) protective resources (proscriptive religiosity, area-level religiosity, "drier" network drinking norms and patterns, and family social support). RESULTS: The Black-White gap in male and female drinkers' baseline heavy drinking increased after weighting adjustments for demographics. In women, this gap was reduced after weighting on disadvantage and eliminated after adjusting for protective resources. In men, adjustment for disadvantage increased the racial gap, and protective resources reduced it. Protective resources had a stronger effect on Black-White differences in men's abstinence than heavy drinking, but similar effects on these outcomes in women. CONCLUSION: Protective resources help explain Black-White differences in men's and particularly women's heavy drinking. Future research is needed to elucidate mechanisms of action and additional factors underlying racial differences in men's heavy drinking.

The Impact of Single-Container Malt Liquor Sales Restrictions on Urban Crime.

Many US cities have adopted legal restrictions on high-alcohol malt liquor sales in response to reports of crime and nuisance behaviors around retail alcohol outlets. We assessed whether these policies are effective in reducing crime in urban areas. We used a rigorous interrupted time-series design with comparison groups to examine monthly crime rates in areas surrounding alcohol outlets in the 3 years before and after adoption of malt liquor sales restrictions in two US cities. Crime rates in matched comparison areas not subject to restrictions served as covariates. Novel methods for matching target and comparison areas using virtual neighborhood audits conducted in Google Street View are described. In Minneapolis, Minnesota, sales of single containers of 16 oz or less were prohibited in individual liquor stores (n = 6). In Washington, D.C., the sale of single containers of any size were prohibited in all retail alcohol outlets within full or partial wards (n = 6). Policy adoption was associated with modest reductions in crime, particularly assaults and vandalism, in both cities. All significant outcomes were in the hypothesized direction. Our results provide evidence that retail malt liquor sales restrictions, even relatively weak ones, can have modest effects on a range of crimes. Policy success may depend on community support and concurrent restrictions on malt liquor substitutes.

Prenatal care: associations with prenatal depressive symptoms and social support in low-income urban women.

We examined associations of depressive symptoms and social support with late and inadequate prenatal care in a low-income urban population. The sample was prenatal care patients at five community health centers. Measures of depressive symptoms, social support, and covariates were collected at prenatal care entry. Prenatal care entry and adequacy came from birth certificates. We examined outcomes of late prenatal care and less than adequate care in multivariable models. Among 2341 study participants, 16% had elevated depressive symptoms, 70% had moderate/poor social support, 21% had no/low partner support, 37% had late prenatal care, and 29% had less than adequate prenatal care. Women with both no/low partner support and elevated depressive symptoms were at highest risk of late care (AOR 1.85, CI 1.31, 2.60, p < 0.001) compared to women with both good partner support and low depressive symptoms. Those with good partner support and elevated depressive symptoms were less likely to have late care (AOR 0.74, CI 0.54, 1.10, p = 0.051). Women with moderate/high depressive symptoms were less likely to experience less than adequate care compared to women with low symptoms (AOR 0.73, CI 0.56, 0.96, p = 0.022). Social support and partner support were negatively associated with indices of prenatal care use. Partner support was identified as protective for women with depressive symptoms with regard to late care. Study findings support public health initiatives focused on promoting models of care that address preconception and reproductive life planning. Practice-based implications include possible screening for social support and depression in preconception contexts.

Racial/Ethnic Differences in the Prevalence of Clinically Recognized Alcohol Use Disorders Among Patients from the U.S. Veterans Health Administration.

BACKGROUND: Alcohol use disorders (AUDs) are common and have worse consequences for racial/ethnic minority groups than whites. AUDs are often underrecognized in clinical settings, but it is unknown whether the prevalence of clinically recognized AUD varies across racial/ethnic groups. We describe the overall and age- and gender-stratified prevalence of clinically documented AUD across 3 racial/ethnic groups in a national sample of Veterans Health Administration (VA) patients. METHODS: Data from VA's National Patient Care Database identified all patients who used VA care in Fiscal Year 2012 and were documented as black, Hispanic, or white race/ethnicity. The prevalence of clinically recognized AUD based on ICD-9 diagnoses was compared across racial/ethnic groups overall and within gender and age groups using chi-square tests of independence. RESULTS: Among 4,666,403 eligible patients, 810,902 (17.4%) were black, 302,331 (6.5%) were Hispanic, and 3,553,170 (76.1%) were white. The prevalence of clinically recognized AUD was 6.5% overall, and 9.8% (95% CI 9.8 to 9.9) among black, 7.1% (95% CI 7.0 to 7.2) among Hispanic, and 5.7% (95% CI 5.6 to 5.7) among white patients (p < 0.001). This pattern generally held for men, regardless of age group, with the exception of those 18 to 29 years old, for whom no difference was observed across race/ethnicity. Among women, the prevalence of AUD was generally lowest among Hispanic and highest among black patients, with the exception of those 30 to 44 years old, for whom the highest prevalence was among whites. CONCLUSIONS: In contrast to findings from the general population, the prevalence of clinically recognized AUD among VA patients is generally highest among black men and women and lowest among white men and Hispanic women. This is the first study to describe the prevalence of clinically recognized AUD across racial/ethnic groups in a large healthcare system. Future research comparing estimates to diagnoses based on structured gold-standard assessments is needed to understand whether AUDs are under- or overidentified.

Associations between Responsible Beverage Service Laws and Binge Drinking and Alcohol-Impaired Driving.

We explored potential associations between the strength of state Responsible Beverage Service (RBS) laws and self-reported binge drinking and alcohol-impaired driving in the U.S. A multilevel logistic mixed-effects model was used, adjusting for potential confounders. Analyses were conducted on the overall BRFSS sample and drinkers only. Seven percent of BRFSS respondents lived in states with the strongest RBS laws, 15% reported binge drinking and 2% reported driving after having too much to drink at least once in the past 30 days. There was no evidence of a significant association between RBS law strength and self-reported binge drinking or alcohol-impaired driving. Future studies should include additional information about RBS laws and use a prospective research design.

Targeting adults who provide alcohol to underage youth: results from a national survey of local law enforcement agencies.

We investigated what local enforcement agencies are doing to target adults who provide alcohol to underage youth; what types of enforcement activities are being conducted to target adult providers; and factors that encourage enforcement activities that target adult providers. We surveyed 1,056 local law enforcement agencies in the US and measured whether or not the agency conducted enforcement activities that target adults who provide alcohol to underage youth. We also measured whether certain agency and jurisdiction characteristics were associated with enforcement activities that target adults who provide alcohol to underage youth. Less than half (42%) of local enforcement agencies conducted enforcement efforts targeting adults who provide alcohol to underage youth. Agencies that conducted the enforcement activities targeting adult providers were significantly more likely to have a full time officer specific to alcohol enforcement, a division specific to alcohol enforcement, a social host law, and to perceive underage drinking was very common. Results suggest that targeting social providers (i.e., adults over 21 years of age) will require greater law enforcement resources, implementation of underage drinking laws (e.g., social host policies), and changing perceptions among law enforcement regarding underage drinking. Future studies are needed to identify the most effective enforcement efforts and to examine how enforcement efforts are prospectively linked to alcohol consumption.

Current use of underage alcohol compliance checks by enforcement agencies in the United States.

BACKGROUND: Compliance checks conducted by law enforcement agents can significantly reduce the likelihood of illegal alcohol sales to underage individuals, but these checks need to be conducted using optimal methods to maintain effectiveness. METHODS: We conducted a national survey of local and state enforcement agencies from 2010 to 2011 to assess: (i) how many agencies are currently conducting underage alcohol compliance checks, (ii) how many agencies that conduct compliance checks use optimal methods-including checking all establishments in the jurisdiction, conducting checks at least 3 to 4 times per year, conducting follow-up checks within 3 months, and penalizing the licensee (not only the server/clerk) for failing a compliance check, and (iii) characteristics of the agencies that conduct compliance checks. RESULTS: Just over one-third of local law enforcement agencies and over two-thirds of state agencies reported conducting compliance checks. However, only a small percentage of the agencies (4 to 6%) reported using all of the optimal methods to maximize effectiveness of these compliance checks. Local law enforcement agencies with an alcohol-related division, those with at least 1 full-time officer assigned to work on alcohol, and those in larger communities were significantly more likely to conduct compliance checks. State agencies with more full-time agents and those located in states where the state agency or both state and local enforcement agencies have primary responsibility (vs. only the local law agency) for enforcing alcohol retail laws were also more likely to conduct compliance checks; however, these agency characteristics did not remain statistically significant in the multivariate analyses. CONCLUSIONS: Continued effort is needed to increase the number of local and state agencies conducting compliance checks using optimal methods to reduce youth access to alcohol.

State and local law enforcement agency efforts to prevent sales to obviously intoxicated patrons.

Alcohol sales to intoxicated patrons are illegal and may lead to public health issues such as traffic crashes and violence. Over the past several decades, considerable effort has been made to reduce alcohol sales to underage persons but less attention has been given to the issue of sales to obviously intoxicated patrons. Studies have found a high likelihood of sales to obviously intoxicated patrons (i.e., overservice), but little is known about efforts by enforcement agencies to reduce these sales. We conducted a survey of statewide alcohol enforcement agencies and local law enforcement agencies across the US to assess their strategies for enforcing laws prohibiting alcohol sales to intoxicated patrons at licensed alcohol establishments. We randomly sampled 1,631 local agencies (1,082 participated), and surveyed all 49 statewide agencies that conduct alcohol enforcement. Sales to obviously intoxicated patrons were reported to be somewhat or very common in their jurisdiction by 55 % of local agencies and 90 % of state agencies. Twenty percent of local and 60 % of state agencies reported conducting enforcement efforts to reduce sales to obviously intoxicated patrons in the past year. Among these agencies, fewer than half used specific enforcement strategies on at least a monthly basis to prevent overservice of alcohol. Among local agencies, enforcement efforts were more common among agencies that had a full-time officer specifically assigned to carry out alcohol enforcement efforts. Enforcement of laws prohibiting alcohol sales to obviously intoxicated patrons is an underutilized strategy to reduce alcohol-related problems, especially among local law enforcement agencies.

The Interplay of Local- and State-Level Alcohol Policies in the US.

OBJECTIVE: Most research on alcohol control policies in the U.S. has focused on the state-level. In this study, we assessed both local and state policy prevalence and restrictiveness in a nationwide sample of cities. METHODS: We conducted original legal research to asses prevalence of local-level policies across 374 cities (48 states) in 2019 for seven policy areas: (1) Drink specials; (2) Beverage service training; (3) Minimum age for on-premise servers and bartenders; (4) Minimum age for off-premise sellers; (5) Prohibitions against hosting underage drinking parties (i.e., social host provisions); (6) Bans on off-premise Sunday sales; and (7) Keg registration. We obtained parallel state-level policies from the Alcohol Policy Information System. We assessed restrictiveness of existing policies and how these compared across local and state levels. RESULTS: We found that for six of the seven policy areas, the majority of cities (53% to 83%) had only a state-level policy. Few cities (0% to 8% across policy areas) had only a local-level policy. The percentage of cities that had an alcohol policy at both the local and state-level ranged from <1% to 19% across policy areas, and the policies were mostly equally restrictive at both levels. DISCUSSION: The lack of local policies may point to areas where these localities could strengthen their alcohol policy environments. More research is needed to understand how the prevalence and restrictiveness of local and state policies are associated with public health harms such as traffic crashes.

Neighborhood disadvantage, high alcohol content beverage consumption, drinking norms, and drinking consequences: a mediation analysis.

Alcohol use can cause significant harm. We examined the relationships between neighborhood disadvantage, consumption of high-alcohol-content beverages (HACB), drinking norms, and self-reported drinking consequences using data from the 2000 and 2005 National Alcohol Surveys (N = 9,971 current drinkers) and the 2000 Decennial Census. We hypothesized that (1) individuals living in disadvantaged neighborhoods would report more negative drinking consequences than individuals living in more affluent neighborhoods, and (2) this relationship would be mediated by HACB consumption and pro-drunkenness drinking norms. Neighborhood disadvantage was based on a composite measure of socioeconomic indicators from the 2000 Decennial Census (five-item composite, alpha = 0.89). We measured high alcohol content beverage consumption in terms of whether respondents engaged in frequent or heavy consumption of malt liquor, fortified wine, or distilled spirits/liquor. The outcome was a dichotomous indicator of two or more of 15 past-year social, legal, work, and health consequences. Simultaneous, multivariate path modeling tested direct and indirect effects of neighborhood disadvantage, HACB consumption, and pro-drunkenness norms on consequences. Individuals living in disadvantaged neighborhoods reported significantly more negative drinking consequences than individuals living in more affluent neighborhoods. Consumption of high-alcohol-content beverages and pro-drunkenness norms did not mediate this relationship. However, heavy distilled spirits/liquor use was a significant mediator of other neighborhood characteristics (i.e., percent African American). Living in an African American neighborhood was related to increased spirits/liquor consumption and, in turn, reporting more negative drinking consequences. Greater scrutiny of advertising and tax policies related to distilled spirits/liquor is needed to prevent future drinking problems, especially in minority neighborhoods.

Recruiting gay alcohol establishments for studies: lessons learned from the SILAS study.

We contacted gay bar/club managers in 16 metropolitan statistical areas (MSAs) in the US from 2008 to 2010 and invited them to participate in survey of gay bar/club identification and patronage. The annual response rates were 58%, 74%, and 71%, respectively. We convened two, 1-hr meetings with research staff to discuss lessons learned from recruitment efforts. Data were analyzed using qualitative techniques. Improved response rates appeared to be a function of developing a broader definition of gay bar/club, using multiple sources to identify gay bars/clubs, using passive data collection strategies with active follow-up, and offering multiple methods of completing surveys. Study limitations are discussed.

Cancer pain and alcohol self-medication.

BACKGROUND: Cancer survivors are at increased risk of pain due to their either cancer and/or treatments. Substances like alcohol may be used to self-medicate cancer pain; however, these substances pose their own health risks that may be more pronounced for cancer survivors. METHODS: We used cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) 2012-2019 to quantify the association between cancer pain and alcohol use. We used negative binomial regression, with interaction terms added to examine variations across age, sex, and race. We also examined whether alcohol use relates to cancer pain control status. RESULTS: Cancer survivors with cancer pain were more likely to be younger, female, Black, and to have been diagnosed with breast cancer. Cancer pain was associated with lower alcohol consumption (incidence rate ratio (IRR): 0.88, confidence interval (CI): 0.77, 0.99). This association was primarily among people 65 and older, women, and white and Hispanic people. Cancer pain control status was not related to alcohol use. CONCLUSIONS: Lower alcohol use among cancer survivors with pain has many possible explanations, including several alternative pain management strategies or a decrease in social engagement. Our findings of racial and gender disparities in cancer pain are consistent with the broader evidence on disparities in pain. IMPLICATIONS FOR CANCER SURVIVORS: Cancer pain management for marginalized groups should be improved. Healthcare providers should screen cancer survivors for both pain and substance use, to prevent unhealthy self-medication behaviors.