Wave 1 results of the INTerventions, Research, and Action in Cities Team (INTERACT) cohort study: Examining spatio-temporal measures for urban environments and health.

Built environment interventions have the potential to improve population health and reduce health inequities. The objective of this paper is to present the first wave of the INTErventions, Research, and Action in Cities Team (INTERACT) cohort studies in Victoria, Vancouver, Saskatoon, and Montreal, Canada. We examine how our cohorts compared to Canadian census data and present summary data for our outcomes of interest (physical activity, well-being, and social connectedness). We also compare location data and activity spaces from survey data, research-grade GPS and accelerometer devices, and a smartphone app, and compile measures of proximity to select built environment interventions.

Concentration of Cannabis and Tobacco Retailers in Los Angeles County, California: A Spatial Analysis of Potential Effects on Youth and Ethnic Minorities.

OBJECTIVE: Cannabis and tobacco retailers are believed to cluster in areas with more racial/ethnic minorities, which could account for the disproportionate use of blunts in Black and Hispanic communities. The current study examined the spatial relationship between cannabis and licensed tobacco retailers in Los Angeles County, California, and assessed whether various neighborhood and business factors influenced the spatial patterning. METHOD: Generalized additive models were used to test the association between the location of cannabis retailers (N = 429) and their accessibility potential (AP) to tobacco retailers (N = 8,033). The covariates included cannabis licensure status, median household income, population density, percentages of racial/ ethnic minorities and young adults (18-34), unemployment status, families living in poverty, minimum completion of high school/General Educational Development (GED) credential, and industrial businesses by census tract. RESULTS: The location of cannabis retailers was significantly associated with AP in all adjusted models (p < .005). The percentage of racial/ethnic minorities, age (18-34 years), and nonlicensure of cannabis retailers, which were positively correlated with AP (p < .05), confounded the association between AP and cannabis retailer location. CONCLUSIONS: The concentration of unlicensed cannabis retailers and tobacco retailers in young and racially/ethnically diverse neighborhoods may increase access to and use of cigarillos for blunt smoking. Jurisdictions within Los Angeles County should consider passing ordinances requiring minimum distances between cannabis and tobacco retailers.

Using combined Global Position System and accelerometer data points to examine how built environments and gentrification are associated with physical activity in four Canadian cities.

BACKGROUND: Built and social environments are associated with physical activity. Global Positioning Systems (GPS) and accelerometer data can capture how people move through their environments and provide promising tools to better understand associations between environmental characteristics and physical activity. The purpose of this study is to examine the associations between GPS-derived exposure to built environment and gentrification characteristics and accelerometer-measured physical activity in a sample of adults across four cities. METHODS: We used wave 1 data from the Interventions, Research, and Action in Cities Team, a cohort of adults living in the Canadian cities of Victoria, Vancouver, Saskatoon, and Montreal. A subsample of participants wore a SenseDoc device for 10 days during May 2017-January 2019 to record GPS and accelerometry data. Two physical activity outcomes were derived from SenseDoc data: time spent in light, moderate, and vigorous physical activity; and time spent in moderate or vigorous physical activity. Using corresponding GPS coordinates, we summarized physical activity outcomes by dissemination area-a Canadian census geography that represents areas where 400 to 700 people live- and joined to built (active living space, proximity to amenities, and urban compactness) and gentrification measures. We examined the associations between environmental measures and physical activity outcomes using multi-level negative binomial regression models that were stratified by city and adjusted for covariates (weekday/weekend), home dissemination area, precipitation, temperature) and participant-level characteristics obtained from a survey (age, gender, income, race). RESULTS: We found that adults spent more time being physically active near their homes, and in environments that were more walkable and near parks and less time in urban compact areas, regardless of where participants lived. Our analysis also highlighted how proximity to different amenities was linked to physical activity across different cities. CONCLUSIONS: Our study provides insights into how built environment and gentrification characteristics are associated with the amount of time adults spend being physically active in four Canadian cities. These findings enhance our understanding of the influence that environments have on physical activity over time and space, and can support policies to increase physical activity.

Neighborhood social environment change in late adolescence predicts substance use in emerging adulthood.

This study examines associations of changes in perceived and objective (census-based) neighborhood social environment variables during adolescence with alcohol and marijuana outcomes in emerging adulthood using two waves of data (2013-14 and 2019-20) from a cohort in Southern California (n = 1249). Increasing perceived disorganization predicted greater alcohol consequences and socialization with peers using marijuana. Decreasing objective neighborhood SES predicted fewer alcohol consequences and greater socialization with peers drinking alcohol. Unexpectedly, both decreasing and increasing perceived social cohesion predicted fewer alcohol consequences. Increasing perceived social cohesion predicted lower solitary alcohol use. Findings identify potential environmental targets to prevent substance use during the transition to emerging adulthood, but more research is warranted to understand the complex findings for alcohol consequences.

Licensed and unlicensed cannabis outlets in Los Angeles County: the potential implications of location for social equity.

BACKGROUND: Cannabis social equity programs intend to redress inequities experienced by low income and Black, Indigenous, and People of Color (BIPOC) during cannabis prohibition in the United States. In Los Angeles County (LA), the approach is to increase cannabis outlet licensure and employment for low income and BIPOC communities. Monitoring locations of both licensed and unlicensed outlets over time is critical to informing how local social equity programs may affect communities. METHODS: We identified locations of licensed and unlicensed cannabis outlets in LA, from February to April 2019 and again from March to April 2020, and calculated the number and type of outlets by socio-demographic characteristics of census tracts (race/ethnicity, poverty, education, unemployment) using the 2013-2017 American Community Survey 5-year estimates. RESULTS: Licensed outlets increased in LA from 162 in 2019 to 195 in 2020; unlicensed outlets decreased from 286 to 137 over the same time period. In 2020, more licensed outlets were in tracts with majority white residents and adults with at least a bachelor's degree; fewer licensed outlets were in tracts with larger Latinx or Black populations, whereas 71% of unlicensed outlets in 2020 were in low-income tracts, and more unlicensed outlets were in predominately Latinx tracts, high poverty and high unemployment tracts, and tracts with more single female-headed households. CONCLUSIONS: Neighborhood-level analyses are an important first step, but more data are needed for comprehensive evaluations of social equity programs-from individual businesses to the communities living nearby-to understand the impacts on low income and BIPOC populations.

Retail cannabis environment and adolescent use: The role of advertising and retailers near home and school.

Youth cannabis use is influenced by overlapping environmental contexts. We examined the associations between proximity to cannabis retailers and seeing cannabis advertisements and cannabis use behaviors in Oregon, a state with adult cannabis legalization. We used 2017 anonymous survey data from 24,154 Oregon 8th and 11th grade students. After adjustments for student and school district characteristics, advertising for 8th graders and presence of a retailer within a mile from school for 11th graders were associated with cannabis use and perceived harm. Additional policy efforts may further reduce youth exposure to cannabis.

Patterns and correlates of cannabidiol product and marijuana co-use in a sample of U.S. young adults.

OBJECTIVE: Cannabis-derived products containing cannabidiol with no or minimal levels of delta 9-tetrahydrocannabinol (CBD products) are widely available in the United States and use of these products is common among young adults and those who use marijuana. The purpose of this study was to examine patterns and correlates of CBD product use and co-use with marijuana in a sample of young adults. METHOD: The study used cross-sectional survey data collected in 2019-2020 from a cohort of young adults (n = 2534; mean age 23) based primarily in California. The survey assessed lifetime, past-year, and past-month frequency and type of CBD products used, frequency and amount of marijuana consumption and indicators of marijuana use-related problems. Linear, Poisson, and logistic regression models compared individuals reporting past month CBD-only use, marijuana-only use, concurrent CBD + marijuana use (co-use), and use of neither product. Among those reporting co-use, we examined associations between CBD use frequency and marijuana use frequency and heaviness of use (occasions per day) and indicators of problem marijuana use (e.g., Cannabis Use Disorder Identification Test Short-Form, solitary use, marijuana consequences). RESULTS: Approximately 13% of respondents endorsed past-month CBD use; of these, over three-quarters (79%) indicated past-month co-use of marijuana. Among individuals reporting co-use, more frequent CBD use was associated with more frequent and heavier marijuana use but was not associated with marijuana use-related problems. CONCLUSIONS: CBD use was common and associated with higher levels of marijuana consumption in this sample. Routinely assessing CBD use may provide a more comprehensive understanding of individuals' cannabis product consumption.

Gentrification, Urban Interventions and Equity (GENUINE): A map-based gentrification tool for Canadian metropolitan areas.

BACKGROUND: Researchers, policy makers, and urban planners require tools to better understand the complex relationship between gentrification and health. The Gentrification, Urban Interventions and Equity (GENUINE) tool is an open-access, map-based tool that allows users to explore measures of gentrification for Canadian cities and incorporate them into their work. DATA AND METHODS: The phenomenon of gentrification has manifested differently across cities. The GENUINE tool was developed to include four distinct gentrification measures that have been used in the United States and Canada and that rely on different combinations of change in census indicators related to income, housing, occupation, education and age. The measures were computed for all census tracts within the 36 Canadian census metropolitan areas to identify gentrifiable areas in 2006 and those that gentrified between 2006 and 2016. RESULTS: Depending on the measure, by 2016, 2% to 20% of census tracts had experienced gentrification, corresponding to between 2% (418,065 people) and 17% (4,266,434) of the Canadian population living in gentrified areas. Generally, metropolitan areas with populations over 1 million people had a greater proportion of their population living in gentrified areas (2% to 18%) compared with metropolitan areas with fewer than 250,000 residents (1% to 14%). DISCUSSION: With attention on healthy cities only expanding, GENUINE provides pan-Canadian indicators of gentrification, which can be an integral part of solution-oriented research and advancing cities toward designing healthy and equitable communities.

Not quite a block party: COVID-19 street reallocation programs in Seattle, WA and Vancouver, BC.

The COVID-19 pandemic has exposed mobility inequities within cities. In response, cities are rapidly implementing street reallocation initiatives. These interventions provide space for walking and cycling, however, other mobility needs (e.g., essential workers, deliveries) may be impeded by these reallocation decisions. Informed by mobility justice frameworks, we examined socio-spatial differences in access to street reallocations in Seattle, Washington and Vancouver, British Columbia. In both cities, more interventions occurred in areas where people of color, particularly Black and Indigenous people, lived. In Seattle, more interventions occurred in areas where people with disabilities, on food stamps, and children lived. In Vancouver, more interventions occurred in areas where recent immigrants lived, or where people used public transit or cycled to work. Street reallocations could be opportunities for cities to redress inequities in mobility and access to public spaces. Going forward, it is imperative to monitor how cities use data and welcome communities to redesign these temporary spaces to be corridors for their own mobility.

Successes and failures of built environment interventions: Using concept mapping to assess stakeholder perspectives in four Canadian cities.

BACKGROUND: Healthy communities can be supported through built environment interventions that redesign cities for improved health outcomes. Understanding the context of these interventions is critical for assessing how an intervention impacts population health; such context is often poorly documented. This study uses concept mapping to capture stakeholders' perspectives on the factors that influence the success and failure of built environment interventions across cities. METHODS: The INTErventions, Research, and Action in Cities Team (INTERACT) research program undertook concept mapping exercises related to interventions in four Canadian cities: public bike share program (Vancouver); a cycling network (Victoria); a bus rapid transit program (Saskatoon); and interventions related to the Montreal Sustainability Plan (Montreal). Concept mapping synthesised stakeholder perceptions and Go zones were used to prioritise factors based on importance and feasibility. Resulting themes were integrated into implementation science frameworks. RESULTS: Across four cities, 95 stakeholders participated. An average of 38 factors were identified in each city, resulting in 5 emerging clusters in Victoria and Montreal and 6 clusters in Vancouver and Saskatoon. Clusters covered domains of economic and political context, intervention planning, equity considerations, user experience, and stakeholder engagement. Common across all cities was the importance of stakeholder engagement. Concerns for citizen safety were prominent in Victoria, Vancouver, and Saskatoon. Interventions in Saskatoon and Vancouver were related to programs, and reliability of service and ease of use emerged. Go zones highlighted 2-5 items in each city, which can inform priority actions. CONCLUSION: Our study provides stakeholders' collective thinking on the contextual factors that influence the success and failure of built environment interventions. Organising context within an implementation science framework can provide a common language to synthesise stakeholder perspectives across settings. Go zone items can inform city-specific priority actions to support a common vision around implementing built environment interventions in pursuit of designing equitable and healthy cities.

Examining Associations Between Licensed and Unlicensed Outlet Density and Cannabis Outcomes From Preopening to Postopening of Recreational Cannabis Outlets.

BACKGROUND AND OBJECTIVES: To expand on epidemiologic studies examining associations between the legalization of recreational cannabis and use among young adults, we examined the associations between licensed and unlicensed cannabis outlet density and cannabis outcomes. METHODS: A total of 1097 young adults aged 21 and older living in Los Angeles County were surveyed before licensed recreational cannabis outlets opened (Time 1: July to December 2017) and after (Time 2: July 2018 to June 2019). Using a database of open licensed and unlicensed cannabis retailers to calculate individual-level cannabis outlet density measures, we examined associations between outlet density within a 4-mile radius of participants' residences with Time 2 outcomes of any past-month use, daily use, intentions to use, quantity used, consequences, and cannabis use disorder (CUD) symptoms. RESULTS: After controlling for demographic factors and cannabis outcomes at a time point prior to their opening (Time 1), licensed cannabis outlets were associated with young adults' cannabis use, heavy use, and intentions, and unlicensed outlets were associated with young adults' heavy cannabis use and CUD symptoms. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: This study expands beyond studies of outlet prevalence to find that, after controlling for outcomes 1 year prior, licensed and unlicensed outlets were associated with young adults' cannabis outcomes. The current study is among the first to find associations between cannabis use outcomes and density of cannabis outlets among young adults using data from two time points: preopening and postopening of recreational cannabis retailers. Findings can inform policies around the density and placement of cannabis outlets. (Am J Addict 2020;00:00-00).

Sources of cannabis among young adults and associations with cannabis-related outcomes.

BACKGROUND: The ways in which young people learn about cannabis product availability and where they obtain cannabis products are important to understand for prevention and intervention efforts. METHODS: Young adults who reported past month cannabis use (N = 758) completed an online survey in 2018-2019 on how they obtained cannabis and the products they used in a newly legalized market in Los Angeles (mean age 21.6; 44% Hispanic, 27% white, 15% Asian). RESULTS: Overall, 59.1% obtained cannabis from recreational cannabis retailers (RCRs), 51.5% from family or friends, 39.1% from medical cannabis dispensaries (MCDs), and 5.5% from strangers or dealers in the past month. Compared to those getting cannabis from family or friends, those getting cannabis from MCDs or RCRs spent more money, used more cannabis products, were more likely to use alone, used greater quantities of bud/flower, and reported more consequences from use. Further, those obtaining cannabis from MCDs were more likely to screen positive for cannabis use disorder (CUD). For type of products, those obtaining cannabis from MCDs or RCRs were more likely to use joints, bongs, pipes, dabs, vape, and consume edibles relative to those obtaining from family or friends. Subgroup differences were found for both source patterns and cannabis-related outcomes. Males and those with a cannabis medical card reported spending more money on cannabis, using more types of products, and indicated more frequent use and greater CUD symptoms and consequences. Compared to Whites, Blacks spent more money on cannabis and used more products, and Hispanics reported using more products and greater quantities of cannabis bud/flower. CONCLUSIONS: Findings highlight the different ways that young adults obtain cannabis, and how young adults with a medical cannabis card may be at greater risk for problems compared to young adults who use cannabis recreationally.

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

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

Causally speaking: Challenges in measuring gentrification for population health research in the United States and Canada.

The planet is rapidly urbanizing, the need for actionable evidence to guide the design of cities that help (not hinder) our health has never felt more urgent. One essential component of healthy city design is improving neighborhood conditions in previously disinvested areas. To ensure equitable city design, policy makers, city planners, health practitioners, and researchers are interested in understanding the complex relationship between urban change, gentrification, and population health. Yet, the causal link between gentrification and health outcomes remain unclear. Without clear and consistent gentrification measures, researchers struggle to identify populations who are exposed to gentrification, and to compare health outcomes between exposed and unexposed populations. To move the science forward, this paper summarizes the challenges related to gentrification measurement in the United States and Canada when aspiring to conduct studies to analyze causal relationships between gentrification and health. The paper concludes with a series of recommendations for studies aimed at examining both causes and consequences of gentrification and health.

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

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

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

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

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

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

"Out of Care" HIV Case Investigations: A Collaborative Analysis Across 6 States in the Northwest US.

BACKGROUND: HIV care continuum estimates derived from laboratory surveillance typically assume that persons without recently reported CD4 count or viral load results are out of care. METHODS: We conducted a multistate project (Alaska, Idaho, Montana, Oregon, Washington, and Wyoming) to ascertain the status of HIV cases that appeared to be out of care during a 12-month period. We used laboratory surveillance to identify cases in all states but Idaho, where viral load reporting is not mandatory, requiring us to rely on clinic records. After complete investigation, we assigned each case one of the following dispositions: moved out of state, died, in HIV care, no evidence of HIV care, or data error. RESULTS: We identified 3866 cases with no CD4 count or viral load result in a ≥12-month period during 2012-2014, most (85%) of which were in Washington or Oregon. A median of 43% (range: 20%-67%) of cases investigated in each state had moved, 9% (0%-16%) had died, and 11% (8%-33%) were in care during the 12-month surveillance period. Only 28% of investigated cases in the region and a median of 30% (10%-57%) of investigated cases in each state had no evidence of care, migration, or death after investigation. CONCLUSIONS: Most persons living with HIV in the Northwest United States who appear to be out of care based on laboratory surveillance are not truly out of care. Our findings highlight the importance of improving state surveillance systems to ensure accurate care continuum estimates and guide Data to Care efforts.