Defining Spatial Epidemiology: A Systematic Review and Re-Orientation.

BACKGROUND: Spatial epidemiology has emerged as an important subfield of epidemiology over the past quarter century. We trace the origins of spatial epidemiology and note that its emergence coincided with technological developments in spatial statistics and geography. We hypothesize that spatial epidemiology makes important contributions to descriptive epidemiology and analytic risk factor studies, but is not yet aligned with epidemiology's current focus on causal inference and intervention. METHODS: We conducted a systematic review of studies indexed in PubMed that used the term "spatial epidemiolog*" in the title, abstract, or keywords. Excluded papers were not written in English, examined disease in animals, or reported biologic pathogen distribution only. We coded the included papers into five categories (review, demonstration of method, descriptive, analytic, intervention) and recorded the unit of analysis (i.e., individual vs. ecological). We additionally examined papers coded as analytic ecologic studies using scales for lexical content. RESULTS: A total of 482 papers met the inclusion criteria, including 76 reviews, 117 demonstrations of methods, 122 descriptive studies, 167 analytic studies, and 0 intervention studies. Demonstration studies were most common from 2006 to 2014, and analytic studies were most common after 2015. Among the analytic ecologic studies, those published in later years used more terms relevant to spatial statistics (IRR =1.3, 95%CI: 1.1, 1.5) and causal inference (IRR =1.1, 95%CI: 1.1, 1.2). CONCLUSIONS: Spatial epidemiology is an important and growing subfield of epidemiology. We suggest a re-orientation to help align its practice with the goals of contemporary epidemiology.

Changes in six categories of alcohol-attributable mortality from before to during the early phases of the COVID-19 pandemic.

OBJECTIVE: The shelter-in-place mandates enacted early in the COVID-19 pandemic resulted in changes in alcohol use and consequent outcomes. We assessed changes in six categories of season-specific alcohol-attributable mortality from before to during the early phases of the COVID-19 pandemic in the U.S. METHODS: We used logistic regression models to assess alcohol-attributable mortality in the U.S. from 2017 through 2020 (n=11,632,725 decedents ages 18 and older). Outcomes included chronic fully alcohol-attributable deaths, poisonings, motor vehicle accidents, suicides, homicides, and falls. Exposure variables included year, season, the interaction between the year 2020 and season, rurality, the interaction between the year 2020 and rurality, decedent age, sex, race, ethnicity, marital status, and education. RESULTS: Compared to 2019, season-specific mortality age-adjusted rates of chronic fully alcohol-attributable deaths, homicides, poisonings, and falls increased during the COVID-19 pandemic. Suicide rates decreased in most 2020 seasons relative to the same seasons in 2019. Motor vehicle deaths decreased in the spring of 2020 vs. 2019. Relative to dying by any other cause, the odds of death by chronic fully alcohol-attributable causes and poisonings were higher across seasons in 2020 vs. 2019. The odds of death by suicide were higher among residents of rural counties in the spring of 2020 vs. 2019. CONCLUSIONS: There were distinct temporal changes in six types of alcohol-attributable deaths during the early phases of the COVID-19 pandemic.

Longitudinal profiles of neighborhood socioeconomic vulnerability influence blood pressure changes across the female midlife period.

PURPOSE: To examine whether longitudinal exposure to neighborhood socioeconomic vulnerability influences blood pressure changes throughout midlife in a racially, ethnically, and geographically-diverse cohort of women transitioning through menopause. METHODS: We used longitudinal data on 2738 women (age 42-52 at baseline) living in six United States cities from The Study of Women's Health Across the Nation. Residential histories, systolic blood pressures (SBP), and diastolic blood pressures (DBP) were collected annually for ten years. We used longitudinal latent profile analysis to identify patterns of neighborhood socioeconomic vulnerability occurring from 1996 to 2007 in participant neighborhoods. We used linear mixed-effect models to determine if a woman's neighborhood profile throughout midlife was associated with blood pressure changes. RESULTS: We identified four unique profiles of neighborhood socioeconomic vulnerability - differentiated by residential socioeconomic status, population density, and vacant housing conditions - which remained stable across time. Women residing in the most socioeconomically vulnerable neighborhoods experienced the steepest increase in annual SBP growth by 0.93 mmHg/year (95% CI: 0.65-1.21) across ten-year follow-up. CONCLUSIONS: Neighborhood socioeconomic vulnerability was significantly associated with accelerated SBP increases throughout midlife among women.

Micro-temporal analyses of crime related to alcohol outlets: A comparison of outcomes over weekday, weekend, daytime and nighttime hours.

INTRODUCTION: Causal relationships between alcohol outlets and crime are inferred from their statistical associations across neighbourhoods. However, many unobserved covariates may confound these effects. Recognising that outlet sales vary by time of day and day of week, we assess whether areas with more bars/pubs, restaurants or off-premise outlets have more crime during days and times when alcohol sales are greatest. METHODS: Annual administrative crime counts, sociodemographic data and other area characteristics of 336 Census block groups in Oakland, California, USA, were related to outlet densities from 2000 to 2015. Bayesian space-time Poisson models were used to measure associations between outlet densities and crime during: (i) weekday daytime; (ii) weekday nighttime; (iii) weekend daytime; and (iv) weekend nighttime periods (four seemingly unrelated equations). Comparisons of parameter estimates across equations provided an assessment of outlet effects on crime across days and times within the same analysis units using the same constellation of confounding covariates. RESULTS: Assault and driving under the influence crime incidents during weekend evening hours were more frequent in Census block group areas with greater numbers of bar/pubs. Burglaries were consistently greater in areas with greater densities of restaurants. DISCUSSION AND CONCLUSIONS: The spatiotemporal signature relating densities of bars/pubs over weekend evening hours to assault and driving under the influence incidents suggests that these outlets are a critical source of these crimes across neighbourhoods. Prevention programs and policies that focus upon specific drinking establishments, days and times may be most effective in reducing assault and impaired driving incidents in neighbourhoods.

Opioid Use Disorder and Overdose in the First Year Postpartum: A Rapid Scoping Review and Implications for Future Research.

OBJECTIVE: Opioid overdose is a leading cause of maternal mortality, yet limited attention has been given to the consequences of opioid use disorder (OUD) in the year following delivery when most drug-related deaths occur. This article provides an overview of the literature on OUD and overdose in the first year postpartum and provides recommendations to advance maternal opioid research. APPROACH: A rapid scoping review of peer-reviewed research (2010-2021) on OUD and overdose in the year following delivery was conducted in PubMed, PsycINFO, and Web of Science databases. This article discusses existing research, remaining knowledge gaps, and methodological considerations needed. RESULTS: Seven studies were included. Medication for OUD (MOUD) was the only identified factor associated with a reduction in overdose rates. Key literature gaps include the role of mental health disorders and co-occurring substance use, as well as interpersonal, social, and environmental contexts that may contribute to postpartum opioid problems and overdose. CONCLUSION: There remains a limited understanding of why women in the first year postpartum are particularly vulnerable to opioid overdose. Recommendations include: (1) identifying subgroups of women with OUD at highest risk for postpartum overdose, (2) assessing opioid use, overdose, and risks throughout the first year postpartum, (3) evaluating the effect of co-occurring physical and mental health conditions and substance use disorders, (4) investigating the social and contextual determinants of opioid use and overdose after delivery, (5) increasing MOUD retention and treatment engagement postpartum, and (6) utilizing rigorous and multidisciplinary research methods to understand and prevent postpartum overdose.

What is already known on this subject: Opioid overdose is a leading cause of maternal death within one year of delivery. Factors that increase susceptibility to or protect against opioid problems and overdose after delivery are not well understood.What this study adds: Seven articles were identified in a rapid scoping review of opioid use disorder (OUD) and overdose in the year following delivery. Medication for OUD (MOUD) was the only identified factor associated with a decreased risk of postpartum overdose. Literature gaps include co-morbid conditions, interpersonal factors, and social and environmental contexts that contribute to opioid-related morbidity and mortality after delivery.

Mental Health and Alcohol Use during and before the Early Phases of the COVID-19 Pandemic.

The early phases of the coronavirus 19 disease (COVID-19) pandemic were associated with changes in psychological well-being and alcohol use. However, it is unclear whether these changes are artifacts of psychological well-being and alcohol use prior to the pandemic across different sociodemographic groups. We received surveys from 247 adult residents of Allegheny County, Pennsylvania (United States), with an oversampling of sexual- and gender-minority individuals. Responses included measures of psychological well-being, substance use, and sociodemographic characteristics. Unadjusted mean depression scores, anxiety scores, and number of drinking days increased for all age and income groups during COVID-19, while average number of drinks per drinking day and days intoxicated differentially increased or decreased by age and income groups. Using Bayesian seemingly unrelated regression, we assessed depression and anxiety symptoms and alcohol use during the early stages of the pandemic and one month before COVID-19 was first identified in Allegheny County concurrently. Those in the youngest (18-24) group drank on more days during (but not before) the pandemic than those in the 25-44 age group. Compared to cisgender women, gender-minority adults had higher depression scores during the early stages of the pandemic. Employed adults had lower anxiety scores during (but not before) the pandemic than adults who were unemployed. Those with past-year annual incomes above $80,000 had fewer drinks on average drinking occasions than those in the $40,000 or below group before (but not during) the pandemic. Patterns of psychological distress and alcohol use associated with the COVID-19 pandemic differ by subgroup compared to patterns prior to the pandemic. Interventions addressing worsening mental health outcomes and shifting alcohol use patterns must be sensitive to the needs of vulnerable groups, such as younger adults and those experiencing poverty or unemployment.

Methadone prescribing by addiction specialists likely to leave communities without available methadone treatment.

Methadone treatment for opioid use disorder is not available in most suburban and rural US communities. We examined 2 options to expand methadone availability: (1) addiction specialty physician or (2) all clinician prescribing. Using 2022 Health Resources and Services Administration data, we used mental health professional shortage areas to indicate the potential of addiction specialty physician prescribing and the location of federally qualified health centers (ie, federally certified primary care clinics) to indicate the potential of all clinician prescribing. We examined how many census tracts without an available opioid treatment program (ie, methadone clinic) are (1) located within a mental health professional shortage area and (2) are also without an available federally qualified health center. Methadone was available in 49% of tracts under current regulations, 63% of tracts in the case of specialist physician prescribing, and 86% of tracts in the case of all clinician prescribing. Specialist physician prescribing would expand availability to an additional 12% of urban, 18% of suburban, and 16% of rural tracts, while clinician prescribing would expand to an additional 30% of urban, 53% of suburban, and 58% of rural tracts relative to current availability. Results support enabling broader methadone prescribing privileges to ensure equitable treatment access, particularly for rural communities.

Do Changes to the Alcohol Retail Environment Reduce Interpersonal Violence?

Purpose of Review: To summarize recent research on the alcohol retail environment (sales, policies, availability) and interpersonal violence (assault, intimate partner violence, sexual assault), including methods utilized, theoretical frameworks employed, and associations by types of alcohol environmental exposure and violence. Recent Findings: Studies continue to demonstrate that reducing alcohol availability directly and indirectly lowers rates of interpersonal violence. Many of the 30 studies used state-of-the-art analytic methods and study designs. Few studies examined heterogeneity by minoritized identities or between alcohol environments and violence by other contextual characteristics. There was a dearth of theoretical frameworks and mechanisms explicated. Summary: To increase impacts of alcohol control policies, specific, practical advice is needed about where, when, and for whom changes will reap the biggest effects. Methodological next steps include analyzing natural experiments, incorporating legal epidemiology, designing studies to examine heterogeneities, developing spatiotemporal simulations, and investigating how embodiment of historic injustices contributes to violence. Supplementary Information: The online version contains supplementary material available at 10.1007/s40471-022-00315-7.

Context-Specific Drinking Risks among Adolescents.

Background: Research has shown that specific contexts are associated with alcohol related problems in adults, but less is known about adolescents. Objectives: We examined how frequencies of drinking in different contexts and the amount of alcohol consumed in these contexts may be related to different alcohol-related problems among adolescent drinkers. Methods: Data were collected through a cross-sectional survey with 377 adolescents (13 to 18 years old) who reported past-6-month alcohol use, sampled from California households. Outcome measures included the breadth of alcohol-related problems participants experienced in the past 6-months overall and in 4 domains (physical, personal, social, and driving under the influence of alcohol or riding with a drunk driver [DUI/RDD]). We also assessed socio-demographics, the number of days adolescents drank alcohol in five contexts (restaurants, own homes, others' homes, outdoors, and fraternities/sororities) and the typical number of drinks they had in each context. Context-specific dose-response models were used to analyze data. Results: In adjusted models, drinking more frequently in outdoor venues was associated with greater number of alcohol-related problems. Drinking frequency in others' homes and in fraternities/sororities was positively associated with a greater number of physical problems. Drinking frequencies in outdoor venues and in others' homes were associated with greater number of personal problems. Finally, drinking more frequently in outdoor venues was associated with greater number of social problems and DUI/RDD. Conclusions/Importance: Results suggest the importance of considering drinking contexts independent of heavier drinking in the context, and they can be used to inform prevention interventions targeting specific risks in relation to alcohol use in specific contexts.KEY POINT SUMMARYThe associations between contexts and drinking problems among adolescents cannot be fully explained by heavier drinking in these contexts.Adolescents' drinking frequencies in specific contexts are uniquely associated with different types of alcohol-related problems.Results inform prevention interventions targeting specific risks in relation to alcohol use in specific contexts among adolescents.

Effect of HCV or HIV infection on mortality among hospitalized persons who used opioids, 2000-2010.

Mortality due to opioid misuse and overdose has increased substantially in the United States over the past two decades. The study objective was to describe the causes of death among persons with opioid-related hospitalizations and examine survival by Hepatitis C virus (HCV) or HIV. Opioid-related hospitalization records in Pennsylvania from 2000 to 2010 were linked to death registry files to assess cause of death, and survival from first hospital discharge date to death date, or December 31, 2010. Accelerated failure time models were used to compare survival between persons with and without HCV or HIV diagnoses. Among the 136,416 individuals with an opioid-related hospitalization, 13.0% died over a median of 56 months of follow-up; the most common causes of death were circulatory diseases (26.4%) and drug overdose (23.5%). There were 27,122 (19.9%) and 3662 (2.7%) persons who had an HCV and HIV diagnosis, respectively. Among patients aged ≥20 years, those with HCV had shorter survival time compared to those without HCV, with discrepancies more pronounced at older ages. Patients with HIV also had shorter survival time (time ratio: 0.29 [95% CI: 0.26, 0.34]) compared to without HIV. These findings show that in a cohort of patients with opioid-related hospitalizations, those with HCV or HIV diagnoses have shorter survival. This has public health implications, providing further evidence that medical providers should educate patients who use opioids about the risks of HCV and HIV infection and focus prevention and treatment to decrease mortality among patients hospitalized for opioid use.

Changes in activity locations during the COVID-19 pandemic and associations with depression, anxiety, loneliness, and alcohol use.

Introduction: Restrictions and guidelines to limit the spread of COVID-19 caused considerable and rapid changes to individuals' daily routines. This study examines how activity locations changed during the COVID-19 pandemic and associated social distancing restrictions, and whether these changes were associated with depression, anxiety, loneliness, and alcohol use. Methods: A web-based survey was conducted early in the COVID-19 pandemic (May-June 2020) in Allegheny County (Pittsburgh), Pennsylvania. Participants (n = 265) reported visits to activity locations in the last 30 days and retrospectively for February 2020 (pre-pandemic). A principal components analysis was conducted to assess change in utilization of activity locations. Component scores of changes to activity locations were compared by sociodemographics. Poisson and zero-inflated negative binomial models were used to examine the relationship between component scores and pandemic depression symptoms, anxiety symptoms, loneliness, and drinking days. Results: Five distinct principal components of activity location changes were identified. The first component, characterizing broad reductions in activity locations during the early phases of the pandemic, was associated with increased depression and loneliness. Conclusions: Results indicate non-uniform shifts in routine activities during the pandemic and highlight the importance of understanding how changes to the social environment affect individuals' psychological wellbeing and alcohol use.

Income disparities in driving distance to health care infrastructure in the United States: a geographic information systems analysis.

OBJECTIVE: Inequities in access to health care contribute to persisting disparities in health care outcomes. We constructed a geographic information systems analysis to test the association between income and access to the existing health care infrastructure in a nationally representative sample of US residents. Using income and household size data, we calculated the odds ratio of having a distance > 10 miles in nonmetropolitan counties or > 1 mile in metropolitan counties to the closest facility for low-income residents (i.e., < 200% Federal Poverty Level), compared to non-low-income residents. RESULTS: We identified that in 954 counties (207 metropolitan counties and 747 nonmetropolitan counties) representing over 14% of the US population, low-income residents have poorer access to health care facilities. Our analyses demonstrate the high prevalence of structural disparities in health care access across the entire US, which contribute to the perpetuation of disparities in health care outcomes.

Assessing the impacts of alcohol outlets on crime as a natural experiment: agglomeration, churning and spatial effects.

BACKGROUND AND AIMS: Retail alcohol outlets appear to open in neighborhoods with low land and structure rents near sources of demand; they may 'agglomerate', open near to one another or 'churn', replace one another, over time. We used the turnover in numbers of outlets over time to measure agglomeration and churning and the impacts of openings and closings of outlets on neighborhood crime. DESIGN: Interrupted quasi-experiments using spatial panel population data from 3768 synthetic block areas over 6 years. SETTING: City of Oakland, CA, USA. PARTICIPANTS: City population. MEASUREMENTS: Census-based socio-demographic estimates and counts of openings and closings of bars/pubs, restaurants and off-premises outlets related to assault, burglary and robbery crime incidents across synthetic Census blocks. Bayesian space-time models were used to assess agglomeration and churning and measure impacts of openings/closings on crime. FINDINGS: Churning was substantial; openings followed closings for all outlets [bars/pubs, relative risk (RR) = 50.9, 95% credible interval (CI) = 3.0-449.9; restaurants, RR = 3.1, CI = 1.5-6.1; off-premises, RR = 23.5, CI = 2.0-129.8]. Bars/pub and restaurant openings agglomerated with other outlets (e.g., RR = 1.02, CI = 1.00-1.03 and RR = 1.01, CI = 1.00-1.01), but off-premises outlets did not. Covarying out effects related to outlet densities, bar/pub openings were related to a 3.5% increase in assaults (RR = 1.04, CI = 1.01-1.06) and 6.9% increase in robberies (RR = 1.07, CI = 1.03-1.11). Restaurant openings were related to a 5.3% increase in burglaries (RR = 1.05, CI = 1.04-1.06). Openings and closings of off-premises outlets were unrelated to all three crime types. CONCLUSIONS: Retail alcohol outlets appear to follow a pattern of opening near to one another and replacing each other over time. Bar, pub and restaurant openings appear to be related to increases in neighborhood crime.

Air Quality Index and Emergency Department Visits and Hospitalizations for Childhood Asthma.

Rationale: Outdoor air pollution causes emergency department visits and hospitalizations for childhood asthma. In the United States, the Air Quality Index (AQI) alerts the public to air quality and provides behavioral recommendations to reduce exposure and harm, yet little is known about the relationship between the AQI and childhood asthma exacerbations. Objectives: To test for association between the AQI and childhood asthma exacerbations resulting in emergency department visits and hospitalizations. Methods: This was a retrospective time-stratified case-crossover study, conducted using medical records data from 2010 through 2018 for children aged 6-17 years with a primary diagnosis of an asthma exacerbation (defined as an emergency department visit or hospitalization for asthma) at UPMC Children's Hospital of Pittsburgh. Daily AQI data was obtained for Allegheny County, Pennsylvania from the Environmental Protection Agency. Conditional logistic regression was used for analyses of the AQI (as both a continuous and categorical variable) and asthma exacerbations. Stratified analyses were conducted to explore modification of the AQI effects on asthma exacerbations by race and other covariates. Results: There were 6,573 events. Particulate matter <2.5 µm (PM2.5) was the primary pollutant responsible for the AQI, followed by ozone (62% and 29% of days with events, respectively). The overall AQI was associated with asthma exacerbations (e.g., as continuous, per 10-unit increase, Lag Day 2: odds ratio [OR], 1.014; 95% confidence interval [CI], 1.003-1.025; Lag Day 3: OR, 1.012; 95% CI, 1.001-1.023). By pollutant-specific AQI, the association was strongest for PM2.5. In stratified analyses, the AQI was associated with exacerbations in Black and younger children (6-11 yr) on Lag Day 4. Conclusions: The AQI is associated with asthma exacerbations among children in Allegheny County. This is driven primarily by PM2.5, with Black and younger children particularly affected. Healthcare providers should discuss the AQI in asthma management.

North to south gradient and local waves of influenza in Chile.

Influenza seasonality is caused by complex interactions between environmental factors, viral mutations, population crowding, and human travel. To date, no studies have estimated the seasonality and latitudinal patterns of seasonal influenza in Chile. We obtained influenza-like illness (ILI) surveillance data from 29 Chilean public health networks to evaluate seasonality using wavelet analysis. We assessed the relationship between the start, peak, and latitude of the ILI epidemics using linear and piecewise regression. To estimate the presence of incoming and outgoing traveling waves (timing vs distance) between networks and to assess the association with population size, we used linear and logistic regression. We found a north to south gradient of influenza and traveling waves that were present in the central, densely populated region of Chile. Our findings suggest that larger populations in central Chile drive seasonal influenza epidemics.

Alcohol Use Frequencies and Associated Problems Across Drinking Contexts.

OBJECTIVE: To better quantify the impact of specific on- and off-premise drinking contexts on population-level alcohol-related problems, we evaluated context-specific risks relative to frequency of use of each context. METHOD: We surveyed 860 adult (21-100 years) past-year drinkers in the California East Bay, sampled in areas of high versus low median household income and off-premise alcohol outlet densities. We examined associations of context-specific drinking frequencies in seven on- and off-premise drinking locations with individual and area characteristics using negative binomial regression. Next, we used heteroscedastic ordered logistic regression to relate context-specific drinking frequencies and continued volumes to five drinking-related problems (Alcohol Use Disorders Identification Test scores, physiological problems, risky sex, social problems, and driving after drinking too much). To estimate population-level effects, we assessed drinking frequencies relative to mean past-year use of each drinking context. RESULTS: Higher individual annual income (>$60,000) was associated with more frequent drinking in all on-premise drinking contexts (bars/clubs, restaurants, and stadiums). Heavier overall drinking was associated with drinking more frequently at bars. Drinking more frequently in respondents' own homes and heavier drinking at friends'/relatives' homes were associated with most drinking-related problems. The population-level effects of physiological problems and driving after drinking too much were highest for parties and friends'/relatives' homes, whereas that of risky sex outcomes was highest for bars. CONCLUSIONS: Assessing context-specific risks related to heavy and/or frequent drinking, in combination with scaling these risks to determine population-level impacts, can help tailor interventions to reduce alcohol-related problems across different on- and off-premise contexts.

Relationships Between Opioid-Related Hospitalizations and Intimate Partner Violence and Child Maltreatment Hospitalizations in Pennsylvania Across Space and Time.

Intimate partner violence (IPV) and child maltreatment outcomes are markedly associated with substance abuse disorders. However, few studies have explored these serious family violence outcomes in connection to the opioid epidemic or population-level geographic connections between these variables. This study assesses associations of ZIP code-level IPV and child maltreatment hospitalization outcomes with opioid- and alcohol-related diagnoses as well as economic and demographic neighborhood characteristics. We used 11 years (2004-2014) of ZIP code-level Pennsylvania hospital discharge data and U.S. Census neighborhood characteristics data. As nearby ZIP codes are more likely to be similar than those that are distant, we incorporated spatial autocorrelation using conditionally autoregressive Bayesian hierarchical space-time models. There was a positive relationship between ZIP code-level opioid-related diagnoses and both IPV (relative risk 1.061; 95% credible interval [1.015, 1.106]) and child maltreatment (relative risk 1.055; 95% credible interval [1.035, 1.070]) hospitalizations. There was a positive relationship between alcohol-related diagnoses and IPV but not child maltreatment. Higher median household incomes were associated with lower counts of both IPV and child maltreatment hospitalizations. To illustrate geographic heterogeneity of model estimates, posterior distributions were used to compare variability of effects across ZIP codes. Our findings emphasize the secondary implications of the opioid epidemic in the form of family violence within communities.

Development of An Ecological Momentary Assessment of the Impact of Social Media Use Among Suicidal Adolescents.

OBJECTIVE: We aimed to develop an ecological momentary assessment (EMA) measure and sampling protocol to assess the near-term impact of experiences with social media use (SMU) that are associated with risk and protective factors for adolescent suicide. METHODS: To develop the EMA measure, we consulted literature reviews and conducted focus groups with the target population, adolescents at risk for suicide. Subsequently, we refined the measure through interviews with experts and cognitive interviews with adolescents, through which we explored adolescents' thought processes as they considered questions and response options. Data were recorded, transcribed, and analyzed using thematic analysis. RESULTS: The initial measure had 37 items assessing a range of harmful and beneficial aspects of SMU. Through expert and cognitive interviews, we refined the measure to 4 pathways assessing positive and negative experiences with SMU as well as positive and negative in-person interactions. Each pathway included a maximum of 11 items, as well as 2 items pertaining to SMU at nighttime to be assessed once daily. Acceptable targets the EMA measure's sampling protocol included a 10-day data collection window with text message-based prompts to complete the measure triggered 2-4 times daily. CONCLUSIONS: By assessing a range of risk and protective factors for youth suicide, while using methods to reduce participant burden, we established content validity for the EMA measure and acceptability for the sampling protocol among youth at high risk of suicide.HIGHLIGHTSDevelopment of an ecological momentary assessment measure and sampling protocolExploring brief momentary assessment of social media's impact on adolescent suicidal riskMulti-phase approach to establishing content validity and an acceptable sampling protocol.

Dual Use of Off-Premise Outlets for Alcohol and Grocery Purchases: Results From the East Bay Neighborhoods Study.

OBJECTIVE: Alcohol privatization efforts have enabled consumers in many states in the United States to purchase alcohol in a variety of off-premise outlets, including grocery stores. This study examines the dual use of outlets to purchase both alcohol and groceries and the extent to which dual use is related to individual income, neighborhood income, and local physical availability of alcohol. METHOD: The East Bay Neighborhoods Study surveyed residents from 72 microecological neighborhoods across six cities in Alameda County, California. Eligible respondents who purchased alcohol in the last year (n = 707) were asked about the off-premise outlet in which they most often purchase alcohol. Purchasing behaviors within this outlet, including purchasing groceries and frequency of visits to the outlet, were assessed. Multilevel logistic regression and negative binomial models assessed outcomes. RESULTS: Seventy-three percent of participants reported dual use of their most used outlet for groceries and alcohol. In adjusted models, dual use of the outlet was not associated with individual income, alcohol use, or neighborhood outlet density but was positively associated with neighborhood income and the number of outlet visits. After adjustment, dual use of the most used outlet was associated with 0.77 more visits per 28 days. CONCLUSIONS: Results suggest that convenience and reduced time costs for purchasing alcohol encourage the dual use of outlets, particularly in high-income neighborhoods. Differences in the dual use of outlets and frequency in outlet use by neighborhood environments highlight the importance of understanding the role of alcohol availability in distinct neighborhood income and outlet-level contexts.