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.

Does a Place of Last Drink (POLD) Initiative Affect Alcohol Serving Staff Attitudes and Perceptions Related to Overservice of Alcohol?

Background: One enforcement strategy used to address illegal sales of alcohol to intoxicated patrons (i.e., overservice) is Place of Last Drink (POLD). When law enforcement responds to an alcohol-related incident, they ask persons involved in the incident where they had their last drink; POLD data can then be used to track patterns of overservice.Methods: We evaluated potential effects of a POLD initiative in one state (USA) on the attitudes and perceptions of serving staff (i.e., bartenders and servers) about their experiences in refusing sales to intoxicated customers. We conducted interviews with 44 serving staff across 24 communities (14 communities that participated in the POLD initiative and 10 comparison communities). We analyzed the interview transcripts using a qualitative matrix to identify major themes.Results: We found few differences across the two study conditions, with interview participants having no apparent awareness of POLD and many stating that overservice occurs frequently without law enforcement getting involved. One difference we identified was serving staff from communities in the POLD initiative reporting generally positive experiences with their managers when refusing sales to intoxicated patrons, whereas serving staff in comparison communities more commonly saying they were overruled by their managers. It is possible that these differences are the result of the POLD initiative; however, more research is needed.Conclusions: In general, serving staff across communities share many similar perceptions and attitudes around overservice. These findings can inform future implementation of POLD and other strategies to reduce overservice of alcohol.

Trade-Offs Faced by 2-and 4-Year College Students Experiencing Food Insecurity: An Analysis of Qualitative Data.

PURPOSE: To understand the trade-offs, defined as compromises or decisions students must make to prioritize one important need over another, as a result of economic constraints, food insecure (FI) college students experience and the perceived impact of these challenges on health, well-being, and academic achievement. DESIGN: 8 Semi-structured focus groups. SETTING: Seven 2- and 4-year Minnesota colleges. PARTICIPANTS: 53 students initially screening positive for FI. METHOD: The focus groups were audio-recorded and transcribed verbatim. Thematic analysis, a systematic approach for identifying and analyzing patterns across qualitative data, was used through four analysis phases to identify themes and categories. RESULTS: We identified five themes within trade-offs: sacrificing food, missing out on relationships, sacrificing academic studies, choosing between basic needs, and maintaining physical and mental well-being. The trade-offs students described were multifaceted, caused notable stress and worry, and presented challenges to students' well-being. CONCLUSION: This study provides evidence on the complexities of FI among students and details on what students may be sacrificing as a result of making trade-offs. Understanding the trade-offs students are experiencing can help college staff to prioritize which issues to focus on to improve student health and academic performance.

Impact of delaying high school start times on weight and related behaviors - the START study.

In the US, few adolescents get adequate school night sleep, largely due to early school start times. In the START study we aimed to test the following hypothesis: That following the implementation of later high school start times students have lesser longitudinal increases in body mass index (BMI) and shift to more healthful weight-related behaviors relative to students attending schools that retain early start times. The study enrolled a cohort of students (n = 2426) in five high schools in the Twin Cities, MN metro. Heights and weights were measured objectively, and surveys were administered annually from 9th through 11th grades (2016-2018). All study schools started early (either 7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), two schools delayed their start times by 50-65 min, while three comparison schools started at 7:30 am throughout the observation period. Using a difference-in-differences natural experiment design, we estimated differences in changes in BMI and weight-related behaviors over time between policy change and comparison schools. Students' BMIs increased in parallel in both policy change and comparison schools over time. However relative to changes in comparison schools after the start time shift, students in policy change schools had a modestly more healthful profile of weight-related behaviors - for instance they had a relatively greater probability of eating breakfast, having supper with their family, getting more activity, eating fast food less frequently, and eating vegetables daily. Later start times could be a durable, population-wide strategy that promotes healthful weight behaviors.

Alcohol Enforcement in the United States From 2010 to 2019.

OBJECTIVE: Despite the important role of enforcement in reducing alcohol-related harms, few studies have assessed alcohol enforcement efforts, particularly over time. We assessed the prevalence of alcohol law enforcement strategies at two time points. METHOD: Of a random sample of U.S. local law enforcement agencies (i.e., police, sheriff) surveyed in 2010, 1,028 were resurveyed in 2019 (742/1,028 [72%] response rate). We assessed changes in alcohol enforcement strategies and priorities within three domains: (a) alcohol-impaired driving, (b) alcohol sales to obviously intoxicated patrons (i.e., overservice), and (c) underage drinking. RESULTS: Agencies reported placing higher priority on enforcement of alcohol-impaired driving and overservice in 2019 versus 2010. For alcohol-impaired driving enforcement strategies, we found increases over time in use of saturation patrols and in enforcing laws prohibiting open containers of alcohol in motor vehicles, but not in use of sobriety checkpoints. Approximately 25% of agencies conducted overservice enforcement in both years. For all strategies directed at underage drinking, enforcement decreased over time with more agencies using strategies aimed at underage drinkers versus alcohol suppliers (alcohol outlets, adults) in both years. CONCLUSIONS: Agencies reported continued low levels or declines in enforcement across most strategies despite reported increases in prioritizing alcohol enforcement. More agencies could adopt alcohol control enforcement strategies, including an increased focus on suppliers of alcohol to youth rather than on underage drinkers, and increased awareness and enforcement of selling alcohol to obviously intoxicated patrons. Use of these strategies has the potential to reduce health and safety consequences of excessive alcohol use.

Alcohol-impaired driving enforcement priorities and strategies in a nationwide sample of U.S. law enforcement agencies.

OBJECTIVE: Excessive alcohol consumption leads to a range of public health problems and social and financial burdens. Traffic crashes resulting from alcohol-involved driving are a major contributor to the overall health consequences of alcohol. Various laws and enforcement strategies aim to prevent alcohol-involved driving. The extent to which law enforcement agencies prioritize enforcement of alcohol-impaired driving laws can help to reduce alcohol-impaired driving. Among law enforcement agencies in the US, we examined prioritization of alcohol-impaired driving enforcement and how it is associated with use of specific enforcement strategies, as well as agency and community characteristics. METHODS: We conducted a survey of a national sample of 1,024 US police and sheriff agencies in 2019. We assessed prioritization of alcohol-impaired driving enforcement, use of specific enforcement strategies (saturation patrols, sobriety checkpoints, open container law enforcement, training field officers to identify driving impairment), and agency and jurisdiction characteristics. We assessed how priority of enforcement (high vs. low) was associated with use of specific strategies, and agency and jurisdiction characteristics using regression models that accounted for agencies nesting within states. RESULTS: A majority of agencies (68%) placed a high priority on alcohol-impaired driving enforcement. Almost all agencies (93%) reported performing at least one alcohol-impaired driving enforcement strategy and the most common strategy used was saturation patrols. Agencies that prioritized alcohol-impaired driving enforcement were more likely to use sobriety checkpoints and saturation patrols, conduct enforcement of open container laws and train field officers in identifying driving impairment (p < 0.05). They were also more likely to have an officer assigned primarily to alcohol enforcement, have an alcohol division, and serve jurisdictions that had fewer Black residents (p < 0.05). CONCLUSIONS: Many law enforcement agencies utilize strategies to address alcohol-impaired driving, however, some strategies are underutilized and an opportunity exists for agencies to incorporate additional strategies to help prevent alcohol-impaired driving. Agencies that made alcohol-impaired driving enforcement a priority were more likely to conduct related enforcement strategies. Encouraging police and sheriff agencies to prioritize alcohol-impaired driving enforcement may be an effective approach for preventing alcohol-related harms.

Place of last drink enforcement: Effects on alcohol-related traffic crashes.

BACKGROUND: Binge drinking can result in various types of harms including traffic crashes. Bars and restaurants that serve alcohol to patrons who are obviously intoxicated (i.e., overservice) contribute to these crashes. One strategy to address overservice is place of last drink (POLD) where law enforcement officers responding to alcohol-related incidents inquire about where the individuals last drank alcohol. This information may then be used to identify bars and restaurants that frequently overserve alcohol. There is limited evaluation of the effectiveness of POLD in reducing overservice, traffic crashes, and other harms. METHODS: We evaluated the effects of a POLD initiative, developed by some law enforcement agencies in Minnesota (USA), on alcohol-related traffic crashes from 2010 to 2019. Among 89 intervention (POLD) vs. comparison communities, we fit regression models with participation in POLD as the predictor. As secondary analyses, we fit models with POLD implementation level as the predictor (implementation levels were assessed via a survey of law enforcement agencies). We controlled for relevant community and agency characteristics. RESULTS: In the model with participation in POLD as a predictor, there was little difference in the rate of total alcohol-related crashes (rate ratio [RR] = 1.07, 95% CI: 0.85-1.34). In the model with level of implementation as a predictor, the rate of total alcohol-related crashes was comparable between communities with high implementation and those with no implementation (RR = 0.89; 95% CI: 0.71-1.10). Similar results were seen for alcohol-related crashes with nonfatal injury and property damage outcomes. CONCLUSIONS: This study found little evidence that the POLD initiative, as currently implemented, was associated with reductions in traffic crashes across communities in Minnesota. Further research could explore whether specific characteristics of POLD are particularly important and whether POLD could be combined with other strategies to reduce traffic crashes and other alcohol-related harms.

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.

Weekend night vs. school night sleep patterns, weight status, and weight-related behaviors among adolescents.

OBJECTIVE: In this study, we examine associations between objectively measured weekend night vs. school night sleep patterns, weight status, and weight-related behaviors among adolescents. DESIGN: Cross-sectional study. SETTING: Five Minnesota high schools that started early (7:30 or 7:45 AM) in Spring 2016. PARTICIPANTS: Ninth grade students, ages 14.5-16 years (n = 284). MEASUREMENTS: Students completed surveys, had body measurements taken, and wore sleep (wrist) actigraphs for 1 week (n = 284). We examined weekend night-school night differences in sleep duration and sleep timing. We then assessed whether these factors were related to weight status and weight-related behaviors (eating behaviors, food consumption, physical activity, beverage consumption) using generalized linear mixed models. RESULTS: On average, students slept 1.5 hours (95% confidence interval 1.3-1.7) more and had a sleep midpoint 1.9 hours (1.8-2.1) later on weekend nights compared to school nights. Female students had larger increases in sleep duration on weekend nights than males but similar timing differences. Sleep duration differences were uncorrelated with sleep timing differences (r = 0.01). Neither duration nor timing differences were associated with overweight, obesity, or any of the eating behaviors we examined. However, sleeping longer on weekend nights than on school nights was associated with lower probability of being active 6-7 days per week (p = .02). CONCLUSIONS: Adolescents have substantial sleep duration and sleep timing differences on weekend nights vs. school nights. While these differences may not be associated with weight status or weight-related behaviors, they reflect the reality that most adolescents have schedules that restrict their sleep.

An examination of how alcohol enforcement strategies by sheriff and police agencies are associated with alcohol-impaired-driving fatal traffic crashes.

Objective: Over 10,000 people die in alcohol-impaired-driving traffic crashes every year in the U.S. Approximately half of alcohol-impaired drivers report their last drink was at a bar or restaurant, and most bars and restaurants serve alcohol to patrons who are already intoxicated, known as overservice. Law enforcement agencies use various strategies to address alcohol-impaired driving and overservice but research on the effectiveness of these strategies is limited. Our objective was to assess whether law enforcement efforts focusing on alcohol-impaired driving and alcohol overservice were associated with alcohol-impaired-driving fatal traffic crashes.Methods: We conducted a survey of police and sheriff agencies in 1,082 communities across the U.S. in 2010 regarding their alcohol enforcement practices. We assessed whether the agency conducted: (1) alcohol overservice enforcement and (2) alcohol-impaired driving enforcement (sobriety checkpoints, saturation patrols, open container, overall alcohol-impaired driving enforcement). From the Fatality Analysis Reporting System (2009-2013), we obtained counts of alcohol-impaired-driving fatal traffic crashes (at least one driver had blood alcohol content ≥ 0.08) within the agency's jurisdiction boundary and within a 10-mile buffer. Using multi-level regression, we assessed whether each enforcement type was associated with alcohol-impaired-driving fatal crashes (per 100,000 population). For both the jurisdiction boundary and 10-mile buffer, we ran stratified models based on community/agency type: (1) small town/rural police; (2) urban/suburban police and (3) sheriffs.Results: In jurisdiction boundary models, urban/suburban communities where police conducted overservice enforcement (compared to those that did not) had fewer alcohol-impaired-driving fatal crashes (5.0 vs. 6.6; p = 0.01). For the 10-mile buffer, small town/rural communities where police agencies conducted overservice enforcement (compared to those that did not) had fewer alcohol-impaired-driving fatal crashes (16.9 vs. 21.2; p = 0.01); we found similar results for small town/rural communities where police used saturation patrols (18.7 vs. 22.1; p = 0.05) and had overall high alcohol-impaired driving enforcement (18.7 vs. 22.1; p = 0.05). The direction and the size of the effects for other types of enforcement and agencies were similar, but not statistically significant.Conclusions: Alcohol enforcement strategies among police agencies in small town/rural communities may be particularly effective in reducing alcohol-impaired fatal traffic crashes. Results varied by enforcement, agency and community type.

Assessing Changes in Adolescents' Sleep Characteristics and Dietary Quality in the START Study, a Natural Experiment on Delayed School Start Time Policies.

BACKGROUND: Sleep duration, quality, and timing may influence dietary quality. In adults, poor dietary quality is a risk factor for numerous chronic diseases. It is unclear how these various sleep domains influence adolescents' diets because prior population-based studies have not effectively manipulated sleep, did not include objective sleep measures, and had short follow-up times. OBJECTIVES: The objectives of this study were to examine 1) how adolescent sleep characteristics relate to dietary quality; and 2) how delay in high school start times (which lengthened sleep duration) affects dietary quality over 2 y. METHODS: In the START study, adolescents (grades 9-11, n = 423) attending 5 high schools in the Minneapolis, Minnesota metropolitan area were annually assessed in 3 waves (2016-2018). At Baseline, all schools started "early" (07:30 or 07:45). From Follow-up 1 through Follow-up 2, 2 "policy change schools" shifted to later start times (to 08:20 and 08:50). Three "comparison schools" maintained their early start throughout. Sleep characteristics were measured with actigraphy. Mixed-effect regression models were used to examine cross-sectional and longitudinal associations of sleep characteristics with dietary quality, and school start time policy change with dietary quality change. RESULTS: Cross-sectionally, later sleep midpoint and onset were associated with dietary quality scores 1.6-1.7 lower (both P < 0.05). However, no prospective associations were observed between sleep characteristics and dietary quality in longitudinal models. Shifting to later school start time tended to be associated with a 2.4-point increase in dietary quality score (P = 0.09) at Follow-up 1, but was not associated with change in dietary quality scores at Follow-up 2 (P = 0.35). CONCLUSIONS: High school students attending delayed-start schools maintained better dietary quality than students in comparison schools; however, differences were not statistically significant. Overall study findings highlight the complexity of the relation between sleep behavior and diet in adolescence.

Small food store retailers' views on healthy food retail policy in response to a local staple foods ordinance.

OBJECTIVE: Our objectives were to explore attitudes regarding food retail policy and government regulation among managers of small food stores and examine whether manager views changed due to the 2014 Minneapolis Staple Foods Ordinance, a city policy requiring retailers to stock specific healthy products. DESIGN: Manager interviewer-administered surveys were used to assess views on food retail policy four times from 2014 to 2017. We examined baseline views across manager and store and neighbourhood characteristics using cross-sectional regression analyses and examined changes over time using mixed regression models. In 2017, open-ended survey questions asked about manager insights on the Minneapolis Staple Foods Ordinance. SETTING: Minneapolis, MN, where the ordinance was enacted, and St. Paul, MN, a control community, USA. PARTICIPANTS: Managers from 147 small food retail stores. RESULTS: At baseline, 48 % of managers were likely to support a policy requiring stores to stock healthy foods/beverages, 67·5 % of managers were likely to support voluntary programmes to help retailers stock healthy foods and 23·7 % agreed government regulation of business is good/necessary. There was a significant increase in overall support for food retail policies and voluntary programmes from 2014 to 2017 (P < 0·01); however, neither increase differed by city, suggesting no differential impact from the ordinance. Minneapolis store managers reported some challenges with ordinance compliance and offered suggestions for how local government could provide support. CONCLUSIONS: Findings suggest that managers of small food retail stores are becoming increasingly amenable to healthy food policies; yet, challenges need to be addressed to ensure healthy food is available to all customers.

Longitudinal Fruit and Vegetable Sales in Small Food Retailers: Response to a Novel Local Food Policy and Variation by Neighborhood Socioeconomic Status.

Small food retailers, including corner/convenience stores, pharmacies, gas-marts, and dollar stores, have historically stocked limited fruits and vegetables, though this may be changing. We examined increases in sales, customer purchasing, and stocking of fresh and/or frozen fruits and vegetables in small food stores over time and in relation to: (a) a local food policy (the Minneapolis Staple Foods Ordinance) and (b) neighborhood socioeconomic status (SES). We used longitudinal data (2014-2017) from 147 randomly-sampled stores in Minneapolis/St. Paul, USA, collected using interviewer-administered manager surveys (measuring sales and stocking) and customer intercepts/observations (measuring purchasing, n = 3039). The local policy required Minneapolis stores to meet minimum stocking standards for fresh/frozen produce and other healthy foods. No ordinance existed in St. Paul. Mixed regression models examined overall change over time and change by city and neighborhood SES. We observed significant increases over time (p < 0.05) in sales and purchasing of fresh fruit and in stocking of fresh fruit, frozen fruit, and frozen vegetables. We did not identify consistent statistical evidence for differential change in sales, purchasing, or stocking by city or neighborhood SES. Key study findings suggest limited differential effects of the local ordinance and/or neighborhood SES. However, findings also indicate significant time trends for some products, including consistent improvements in sales, customer purchasing, and stocking of fresh fruit. Given the ready-to-eat convenience of many fresh fruits and their broad appeal, fresh fruit appears a promising target for advancing the healthfulness of small food retailers.

Store and neighborhood differences in retailer compliance with a local staple foods ordinance.

BACKGROUND: Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics. METHODS: In this natural experiment, audits were conducted annually pre- and post-ordinance (2014-2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018. RESULTS: All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p < 0.01). In Minneapolis, corporate (vs. independent) stores were generally more compliant. No differences were found by neighborhood characteristics. CONCLUSIONS: Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance. STUDY REGISTRATION: ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.

Food shopping, home food availability, and food insecurity among customers in small food stores: an exploratory study.

Customers who frequently shop in small food stores (e.g., convenience stores) may face numerous challenges to procuring healthful food for their household, and these may vary by food security status. The purpose of this study is to examine associations between food security and food shopping-related behaviors among frequent shoppers at small stores. Our sample included participants from customer intercept interviews at small food stores in an urban area. A follow-up in-home visit with a subset of customers who reported frequently shopping in these stores (≥1/week; n = 78) included a survey and researcher-administered home food inventory. Food security status was identified via the U.S. Household Food Security Survey Six-Item Short Form. Outcomes included shopping frequency and money spent by store type (e.g., small vs. large), home-to-store distance, and observed home availability of fruits, vegetables, and obesogenic foods. We estimated associations between food security status and each outcome, adjusting for demographic and poverty-related confounders. Participants were 56% female and 65% people of color; 45% received Supplemental Nutrition Assistance Program benefits and 54% experienced food insecurity in the past year. Unadjusted models indicated several significant associations: compared to those who were food secure, food-insecure participants shopped for food/beverages at small stores more times per month, spent more on food/beverages at dollar stores, and had less home availability of fruit and obesogenic foods. Associations remained significant (p = .04) between food insecurity and shopping frequency in adjusted models. Interventions requiring or incentivizing small food stores to stock healthful products could be important for improving access to nutritious food for food-insecure persons.

Correlates of short sleep duration among adolescents.

INTRODUCTION: Short sleep duration is exceedingly common among adolescents and has implications for healthy youth development. We sought to document associations between adolescents' sleep duration and characteristics of their schedules, behaviors, and wellbeing. METHODS: We used data from the baseline wave (9th grade year) of the START study, a cohort of 2134 students in five Minnesota high schools to assess how self-reported sleep duration was associated with the prevalence of time-use characteristics (i.e. activity schedules, screen use), sleep-wake problems (i.e. trouble waking in the morning, falling asleep in class, etc.), and risk of depression. RESULTS: Shorter sleep duration was associated with various behaviors including greater computer/screen time and screen use after bed, a lower probability of doing homework, participation in sports doing chores on school nights, and reporting that it takes at least 20 min to fall asleep on school days (p < 0.05). Suboptimal sleep duration was also associated with a higher probability of all reported sleep-wake problems as well as higher risk of depressive symptoms (p < 0.05). CONCLUSIONS: Given that getting an optimal amount of sleep can protect youth from risk and promote healthy youth development, it is critical that we gain a greater understanding of correlates and consequences of short sleep duration in order to develop a sleep-friendly culture for youth.

Sleep Duration and Weight-Related Behaviors among Adolescents.

Background: Insufficient sleep is widespread among adolescents and has consequences that extend far beyond hampering day-to-day functioning. It may influence eating and physical activity patterns and be an important determinant of adolescent overweight/obesity status. Methods: We assessed how self-reported sleep duration on school nights was associated with weight-related behaviors (eating, diet, and physical activity) and overweight/obesity at the baseline wave (ninth grade year) of the START study (n = 2134). Results: Fifteen percent of our sample reported optimal sleep duration (8.5-10.0 hours); nonwhites, participants of lower socioeconomic status, and girls were at greater risk for insufficient sleep. Suboptimal sleep was associated with various poor weight-related behaviors such as increased sugar-sweetened beverage consumption, decreased vegetable consumption, and decreased breakfast eating (p < 0.001). Fewer hours of sleep were also associated with less physical activity and an increased likelihood of obesity (p = 0.02 for both associations). Conclusions: The influence of adolescent sleep insufficiency on diet and activity could impact childhood obesity and following chronic disease risk especially if lack of sleep sets the stage for enduring, lifelong, poor, weight-related behavior patterns.

Variation in the food environment of small and non-traditional stores across racial segregation and corporate status.

OBJECTIVE: We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- v. independently owned). DESIGN: Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted. SETTING: Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.ParticipantsOne hundred and thirty-nine stores; seventy-eight managers. RESULTS: Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (P≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (<30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (P≤0·05). CONCLUSIONS: Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.

Law enforcement practices in the first two states in U.S. to legalize recreational marijuana.

BACKGROUND: There is a lack of research regarding law enforcement practices where recreational marijuana sales are legal. Given that legalization of recreational marijuana is expanding, lessons learned from areas with existing legalization can help inform future practices. This pilot study is an evaluation of enforcement of marijuana laws in the first two states in the U.S. to legalize sales of recreational marijuana, Colorado and Washington, several years post legalization. METHODS: We surveyed a random sample of local law enforcement agencies in the two states (25 agencies per state). We also attempted to survey the state-level marijuana enforcement agency but only Washington responded. Surveys focused on youth marijuana use, youth access to marijuana, and impaired driving but included other topics. Chi-square tests assessed differences between states (p < .05). RESULTS: All local agencies reported underage use was somewhat or very common in their jurisdictions. Thirty percent of local agencies conducted enforcement targeting underage use/possession. Twenty percent of agencies overall conducted underage compliance checks at licensed stores, with more agencies conducting checks in Colorado (32%) than Washington (8%; p = .03). Most agencies in both states reported marijuana-impaired driving was somewhat or very common in their jurisdictions. One local agency in each state specifically targeted marijuana-impaired driving. The state-level agency in Washington reported that their agency is the one primarily responsible for enforcing marijuana retail laws and they conducted routine underage compliance checks at all licensed marijuana stores three times per year. CONCLUSION: Our findings indicate that marijuana enforcement can be improved regarding sales/provision to underage youth and impaired driving in these states, particularly given that underage use and impaired driving are perceived to be common. Larger studies with additional jurisdictions and types of agencies (e.g., highway patrol) are warranted.

Customer Characteristics and Shopping Patterns Associated with Healthy and Unhealthy Purchases at Small and Non-traditional Food Stores.

Small and non-traditional food stores (e.g., corner stores) are often the most accessible source of food for residents of lower income urban neighborhoods in the U.S. Although healthy options are often limited at these stores, little is known about customers who purchase healthy, versus less healthy, foods/beverages in these venues. We conducted 661 customer intercept interviews at 105 stores (corner stores, gas marts, pharmacies, dollar stores) in Minneapolis/St. Paul, Minnesota, assessing all food and beverage items purchased. We defined three categories of "healthy" and four categories of "unhealthy" purchases. Interviews assessed customer characteristics [e.g., demographics, body-mass index (BMI)]. We examined associations between healthy versus unhealthy purchases categories and customer characteristics. Overall, 11% of customers purchased ≥1 serving of healthy foods/beverages in one or more of the three categories: 8% purchased fruits/vegetables, 2% whole grains, and 1% non-/low-fat dairy. Seventy-one percent of customers purchased ≥1 serving of unhealthy foods/beverages in one or more of four categories: 46% purchased sugar-sweetened beverages, 17% savory snacks, 15% candy, and 13% sweet baked goods. Male (vs. female) customers, those with a lower education levels, and those who reported shopping at the store for convenience (vs. other reasons) were less likely to purchase fruits/vegetables. Unhealthy purchases were more common among customers with a BMI ≥30 kg/m2 (vs. lower BMI). Results suggest intervention opportunities to increase healthy purchases at small and non-traditional food stores, particularly interventions aimed at male residents, those with lower education levels and residents living close to the store.