Health considerations in regulating marijuana in Vermont.

This article delineates the current efforts of the Vermont Department of Health (VDH) to address the potential health impact of legalization and regulation of recreational marijuana for use by adults at least 21years of age. To this end, VDH and key stakeholders developed and published a Health Impact Assessment with specific recommendations should legislation that legalized and regulated marijuana be passed into law. Although the legalization legislation failed in 2016 and was vetoed by the Governor in 2017, it is unclear what will happen in the future.

Decline in alcohol consumption during two years of daily reporting.

OBJECTIVE: We conducted a formal analysis of the potential effects on alcohol consumption of daily reports to an Interactive Voice Response (IVR) system over a 2-year period. METHOD: Thirty-three white men who had been recruited from bars were invited to call a toll-free number daily to answer a 2-minute questionnaire regarding alcohol consumption the previous day, reasons for drinking or not drinking, mood and stress levels, and a few other relevant items. A recorded voice asked the questions and callers responded using the telephone keypad. During the 2-year study, all subjects were personally interviewed each quarter, including regular Timeline Follow Back (TLFB) assessments. We compared mean consumption levels reported for the first year with those reported the second year. RESULTS: Although there were consistent seasonal variations and holiday peaks, reported consumption declined over the 2 years of study. A comparison of average consumption across all subjects revealed significant declines in drinks per day, drinking days per week, and drinks per drinking day. Analysis of individuals showed at least some reduction in 82% of the subjects and statistically significant reductions in 45%. There was an estimated 19% reduction in consumption from Year I to Year 2 based on the IVR reports and a 21% reduction as ascertained by the TLFB. No significant changes were observed in nonalcohol-related measures. CONCLUSIONS: After exploring possible reasons for our results, we conclude that the most likely explanation of the decline in alcohol consumption is a reactivity effect due to reporting consumption regularly. The results suggest that IVR may have potential utility as an intervention for excessive alcohol consumption.

Concurrent and retrospective reports of alcohol consumption across 30, 90 and 366 days: interactive voice response compared with the timeline follow back.

OBJECTIVE: To compare near-concurrent and retrospective reports of alcohol consumption and to determine whether a simple adjustment function could be applied to the retrospective reports to correct any distortions in reporting. METHOD: Reports of daily alcohol consumption collected via an Interactive Voice Response (IVR) system were aggregated over 30, 90 and 366 days and compared with the corresponding retrospective reports gathered with the Timeline Follow Back (TLFB). Comparisons of the IVR and TLFB reports for five consumption variables were made for each time period for 33 men. RESULTS: Significant differences between reporting methods were found for four of the five variables tested. On average, the TLFB yielded an underestimate of alcohol consumption compared to the IVR. This underestimate associated with TLFB reports was not dependent on the length of the recall period. Regression analyses indicated that the relationship between the two modalities of reporting was dependent on the quantity of drinks reported, thus precluding the application of a simple, linear metric to the TLFB data to model near real-time daily data obtained through the IVR more accurately. CONCLUSIONS: The retrospective TLFB consistently and significantly underestimated alcohol consumption compared to the aggregated daily reports. This underestimate, however, was stable across the three reporting periods. With one exception, no simple linear function could be applied to the retrospective TLFB consumption reports to more accurately reflect the IVR data gathered daily. Evidence presented here also suggests that underreporting on the TLFB is not simply a matter of consciously attempting to conceal consumption.

Comparison of embedded and isolated administrations of the California Psychological Inventory's Socialization subscale.

Alternate administration methods were tested for the Socialization (So) subscale of the California Psychological Inventory (CPI; H. G. Gough, 1994; H. G. Gough & P. Bradley, 1996) in 437 young adult men. One method administered the 46 CPI-So items in isolation from the CPI, whereas the 2nd method administered the 46 items embedded in the CPI. External validity measures of antisociality were also administered over the 2 sessions. Isolated administration produced somewhat higher internal consistency and significantly better concurrent validity and demonstrated construct validity as a measure of antisociality. Additional factor analytic studies of the CPI-So and CPI revealed that the 2 CPI-So versions had different factorial structures and that the embedded CPI-So subscale did not retain factorial integrity or an appreciable amount of reliable and uniquely interpretable variance.

Using interactive voice response to enhance brief alcohol intervention in primary care settings.

OBJECTIVE: Self-monitoring is recommended following brief alcohol intervention (BI). We have previously demonstrated that self-monitoring with an automated telephone system (interactive voice response; IVR) is associated with a steady reduction in alcohol consumption in the absence of BI. In this study we explore the feasibility and efficacy of IVR as a possible therapeutic enhancement for BI. METHOD: We updated all providers (N= 112) in 15 primary care clinics about BI and encouraged them to do a BI with their patients whenever appropriate and to invite those patients to participate in the research project. Interested patients (N = 338) were randomized to one of four study conditions including no IVR and three groups who self-monitored for 6 months using an IVR: no feedback, feedback, and feedback plus a monetary calling incentive. RESULTS: The IVR proved to be a feasible method for self-monitoring. Of those invited to use the IVR, 90% initiated use and made 95% of the calls while they remained engaged with the system; more than half continued calling for the entire 6 months. Reported impact of the IVR and associated feedback on drinking awareness was high. Therapeutic results were mixed. Overall, the IVR groups reported higher consumption on the Timeline Followback (TLFB) at the 3- and 6-month follow-ups than did the no IVR group. However, because of a potential measurement confound, the TLFB may not have operated in an unbiased fashion across the four study conditions. A comparison of the feedback and no feedback IVR groups, which is independent of this confound, shows a significant therapeutic advantage of IVR with feedback. CONCLUSIONS: IVR is a feasible technology for behavioral self-monitoring in primary care clinics. IVR with regular feedback may be an effective therapeutic enhancement to BI.

Stress and alcohol consumption in heavily drinking men: 2 years of daily data using interactive voice response.

BACKGROUND: The relationship between stress and alcohol consumption has been shown in recent research to be more complex than originally thought. Cross-sectional and short-term longitudinal studies may not provide adequate data to address subtle but important relationships that impact consumption frequency and/or quantity. METHODS: Participants were 33 males recruited from local bars who reported their alcohol consumption, stress, and other related variables every day for 2 years. Reports were provided by automated telephone to a computer-based interactive voice response (IVR) system. By closely monitoring call completion, we were able to collect over 95% of the daily calls. RESULTS: Using hierarchical linear modeling, daily stress was found to be associated with daily alcohol consumption, but in the opposite direction than would be predicted by a "drinking to cope" hypothesis. That is, same-day stress was found to be inversely related to consumption levels. Prior day's stress was not significantly associated with subsequent day's consumption; however, prior day's consumption was predictive of subsequent stress for up to 2 days. Similar analyses using week, rather than day, as the unit of measure paralleled these findings. CONCLUSIONS: This study highlights the utility of using long-term daily process data to address important research and clinical questions in the alcohol field.