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Blanchette JG, Pacula RL, Smart R, Lira MC, Boustead AE, Caulkins JP, Kilmer B, Kerr WC, Treffers R, Naimi TS. Rating the comparative efficacy of state-level cannabis policies on recreational cannabis markets in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103744. [DOI: 10.1016/j.drugpo.2022.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
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Kerr WC, Ye Y. Characteristics of the Washington cannabis market from 2014 to 2016. J Cannabis Res 2022; 4:35. [PMID: 35788247 PMCID: PMC9251922 DOI: 10.1186/s42238-022-00147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The state of Washington legalized cannabis for adult use in 2012 and retail stores began to open in 2014. While details of the legal market have been tracked by the state, the total market for cannabis and characteristics of purchasers can only be identified through surveys. METHODS Six cross-sectional samples of the Privatization of Spirits in Washington (PSW) surveys were collected between January 2014 and October 2016 with two in each year. Random digit dial procedures were used to recruit a sample aged 18 and older, with 40% of cases from mobile phones. A total of 5492 respondents participated. Analyses of the population-weighted sample utilized purchasing amounts and frequencies, use frequency and related measures to estimate total and mean amounts and expenditures. Sensitivity analyses were conducted for key assumptions. RESULTS The market for cannabis flower is estimated to have increased from 158 metric tons and $1.23 billion in 2014 to 222 metric tons and $1.7 billion in 2016, with little change from 2014 to 2015. Purchases from legal sources, retail and dispensaries, were estimated at 69% of the total market. Daily or near daily (DND) users accounted for about 83% of sales in 2014, rising to 91% in 2016. The prevalence of past year use rose substantially from 25% in 2014 to 32% in 2016, with DND use rising from 10.2 to 11.3%. Average purchase amounts for DND users rose from 291 g in 2014 to 374 g in 2016, while mean amounts among non-DND users declined from 78 to 28.6 g. CONCLUSIONS The expansion of retail cannabis stores in Washington appears to have led to increased market size in 2016 with all of the increase attributed to DND users. Frequent users may be important to consider in legalization evaluations.
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Kerr WC, Ye Y, Martinez P, Karriker-Jaffe KJ, Patterson D, Greenfield TK, Mulia N. Longitudinal assessment of drinking changes during the pandemic: The 2021 COVID-19 follow-up study to the 2019 to 2020 National Alcohol Survey. Alcohol Clin Exp Res 2022; 46:1050-1061. [PMID: 35753040 PMCID: PMC9350305 DOI: 10.1111/acer.14839] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
Background Surveys of changes in drinking during the COVID‐19 pandemic have primarily relied on retrospective self‐report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage‐specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use. Methods Data from 1819 completed interviews from the N14C follow‐up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage‐specific quantity and frequency, and DSM‐5 AUD items were asked in both surveys and used to estimate changes from pre‐pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age. Results Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits. Conclusions Results confirm prior findings of overall increases and subgroup‐specific changes, and importantly, provide detailed information on the patterns of change across major socio‐demographic subgroups. Substantial increases in the prevalence of DSM‐5 moderate to severe AUDs are a novel finding that is of particular concern.
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Martinez P, Karriker-Jaffe KJ, Ye Y, Patterson D, Greenfield TK, Mulia N, Kerr WC. Mental health and drinking to cope in the early COVID period: Data from the 2019-2020 US National Alcohol Survey. Addict Behav 2022; 128:107247. [PMID: 35074636 PMCID: PMC8760097 DOI: 10.1016/j.addbeh.2022.107247] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/17/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies show drinking to cope and mental health problems have increased during the COVID-19 pandemic, however, their samples have been limited by convenience sampling or lack of a pre-pandemic measure. We examined the early impact of the COVID-19 pandemic on mental health, drinking to cope and their association using a probability-based sample of the US adult population. METHODS Data was drawn from the probability samples of the 2019-2020 National Alcohol Survey (N = 7,233) to examine differences in drinking to cope and symptoms of depression and anxiety. Analyses compared participants who responded to the survey just prior to the widespread onset of the pandemic to those who responded after March 2020, in the total sample and by sex. RESULTS Respondents in the early- vs. pre-COVID-19 period had a 1.48 higher odds (p = 0.03) of higher agreement with drinking to forget one's worries and problems, with a significant association observed among women only. Respondents with symptoms of depression and anxiety had a 2.94 and 1.56 higher odds, respectively, of higher agreement with drinking to forget one's worries. We observed significant associations between early- vs. pre-COVID-19 period, depression and anxiety symptoms, and drinking to forget one's worries among women only; however, moderation by sex in the total sample was not statistically significant. CONCLUSIONS We observed higher prevalence of depression and anxiety symptoms and greater drinking to forget worries in the early months of COVID restrictions relative to the period just prior, with some effects more prominent among women. These observations call for sustained monitoring of and support for the mental health of the general population, and of women in particular during the course of the pandemic.
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Kerr WC, Ye Y. Estimating Usual Grams per Day of Marijuana Use from Purchases. ADDICTION RESEARCH & THEORY 2022; 30:360-367. [PMID: 36189378 PMCID: PMC9523691 DOI: 10.1080/16066359.2022.2049255] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Quantifying average amounts of marijuana used per day or per occasion of use helps inform understanding population-level patterns of use and use-related harm, but better estimates and estimation methods are needed. Users have difficulty in reporting use amounts, but purchase amounts may be more clearly recalled. METHODS Measures of individual's use and purchasing frequency and details of purchases such as the amounts and products bought and the cost of these were collected in six cross-sectional representative surveys of the population 18 and older in the state of Washington from 2014 to 2016. Analyses utilize purchase information on both flower and other marijuana products to estimate mean amounts per use day and predict use amounts for non-purchasers. RESULTS Mean marijuana use per use day among purchasers was 1.35 grams and non-purchasers estimated mean use amount per day was 0.71 grams. Lower mean use per day was a found for women and the most frequent users. Based on these estimates, total past year marijuana use for purchasers had a mean of 184.8 grams and the mean for non-purchasers was 28 grams. CONCLUSIONS Methods based on purchasing details can be used to estimate individual's marijuana quantity per occasion and total use amount per year, providing additional outcome measures for analyses of predictors of individual marijuana consumption and facilitating more detailed analyses of risks for marijuana harms.
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Cherpitel CJ, Ye Y, Kerr WC. Racial/Ethnic and Gender Differences in Risk of Injury and Life-Course Drinking Patterns: Data from US National Alcohol Surveys. Alcohol Alcohol 2022; 57:340-346. [PMID: 35037021 PMCID: PMC9086744 DOI: 10.1093/alcalc/agab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/10/2021] [Accepted: 11/26/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS To estimate risk of injury associated with frequency of drinking and heavy drinking (5+ drinks on occasion) by gender and race/ethnicity in the US population. METHODS Data were from a merged sample of two National Alcohol Surveys (telephone and web-based) (2014-2015 and 2019-2020) on 16,639 respondents, and analyzed using Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking was determined by age of onset and questions on any drinking and heavy drinking by decade of life. The outcome measure was having had an injury from a serious accident at a certainage. RESULTS Frequent heavy drinking (5+ daily, weekly and monthly) was significantly predictive of injury with hazard ratios (HRs) of 2.40, 1.81 and 1.50, respectively, while frequent light drinking (alcohol at least weekly and 5+ yearly or less) was also significant for women (HR = 1.73). For White respondents, 5+ at least weekly was significant for both men (HR = 1.74) and women (HR = 2.42). Among Hispanic respondents, 5+ at least weekly and 5+ monthly were both significant for men (HR = 2.81 and 2.49, respectively) and women (HR = 2.81 and 3.48, respectively). Among Black women, risk was significant for 5+ monthly (HR = 2.90) and for any alcohol ≥ weekly (HR = 2.72), but neither frequency of any drinking or 5+ was significant for Blackmen. CONCLUSIONS Data suggest a greater risk of injury from a serious accident for frequent heavy drinkers among all White and Hispanic respondents, and Black women, but not for Blackmen.
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Phillips AZ, Ahern JA, Kerr WC, Rodriguez HP. Cigarettes smoked among daily and non-daily smokers following CVS Health's tobacco-free pharmacy policy. Tob Control 2022; 31:25-31. [PMID: 33082285 PMCID: PMC8499493 DOI: 10.1136/tobaccocontrol-2020-055976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In September 2014, CVS Health ceased tobacco sales in all of its 7700 pharmacies nationwide. We investigate the impact of the CVS policy on the number of cigarettes smoked per day among metropolitan daily and non-daily smokers, who may respond to the availability of smoking cues in different manners. METHODS Data are from the US Census Bureau Tobacco Use Supplement to the Current Population Survey 2014-2015 and the Blue Cross and Blue Shield Institute Community Health Management Hub. Adjusted difference-in-difference (DID) regressions assess changes in the number of cigarettes smoked per day among daily smokers (n=10 759) and non-daily smokers (n=3055), modelling core-based statistical area (CBSA) level CVS pharmacy market share continuously. To assess whether the policy had non-linear effects across the distribution of CVS market share, we also examine market share using tertiles. RESULTS CVS's tobacco-free pharmacy policy was associated with a significant reduction in the number of cigarettes smoked by non-daily smokers in the continuous DID (rate ratio=0.985, p=0.022), with a larger reduction observed among non-daily smokers in CBSAs in the highest third of CVS market share compared with those living in CBSAs with no CVS presence (rate ratio=0.706, p=0.027). The policy, however, was not significantly associated with differential changes in the number of cigarettes by daily smokers. CONCLUSION The removal of tobacco products from CVS pharmacies was associated with a reduction in the number of cigarettes smoked per day among non-daily smokers in metropolitan CBSAs, particularly those in which CVS had a large pharmacy market share.
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Buckley C, Brennan A, Kerr WC, Probst C, Puka K, Purshouse RC, Rehm J. Improved estimates for individual and population-level alcohol use in the United States, 1984-2020. INTERNATIONAL JOURNAL OF ALCOHOL AND DRUG RESEARCH 2022; 10:24-33. [PMID: 37090902 PMCID: PMC10117538 DOI: 10.7895/ijadr.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Aims While nationally representative alcohol surveys are a mainstay of public health monitoring, they underestimate consumption at the population level. This paper demonstrates how to adjust individual-level survey data using aggregated alcohol per capita (APC) data for improved individual- and population-level consumption estimates. Design and Methods For the period 1984-2020, data on self-reported alcohol consumption in the past 30 days were taken from the Behavioral Risk Factor Surveillance System (BRFSS) involving participants (18+ years) in the United States (US). Monthly abstainers were reallocated into lifetime abstainers, former drinkers, and 12-month drinkers using the 2005 National Alcohol Survey data. To correct for under-coverage of alcohol use, we triangulated APC and survey data by upshifting quantity (average grams/day) and frequency (drinking days/week) of alcohol use based on national- and state-level APC data. Results were provided for the US as a whole and for selected states to represent different drinking patterns. Findings The corrections described above resulted in improved correspondence between survey and APC data. Following our procedure, national estimates of alcohol quantity increased from 45% to 77% of APC estimates. Both quantity and frequency of alcohol use were upshifted; by upshifting to 90% of APC, we were able to fit trends and distributions in APC patterns for individual states and the US. Conclusions An individual-level dataset which more accurately reflects the alcohol use of US citizens was achieved. This dataset will be invaluable as a research tool and for the planning and evaluation of alcohol control policies for the US. The methodology described can also be used to adjust individual-level alcohol survey data in other geographical settings.
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Kerr WC, Ye Y, Williams E, Mulia N, Cherpitel CJ. Trends and disparities in American Indian/Alaska Native unintentional injury mortality from 1999 to 2016. Inj Prev 2021; 27:435-441. [PMID: 33093126 PMCID: PMC8519032 DOI: 10.1136/injuryprev-2020-043951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Alcohol and drug use are significant problems in the US, and American Indian/Alaska Native (AI/AN) communities and individuals are known to be among the most affected. This study evaluates disparities in unintentional injury mortality causes since 1999. METHODS Analyses in 2020 of unintentional injury mortality rate disparities between AI/ANs and white population over the 1999-2016 period with attention to motor vehicle crashes, alcohol poisoning, drug poisoning and all other cause types. Rates in each of the 10 states with the largest AI/AN populations were also investigated to account for geographical concentration. RESULTS Motor vehicle mortality rates declined for both AI/AN and white groups, but a large racial disparity was maintained. Conversely, poisoning mortality rates rose substantially in both groups, with a jump in rates in 2007 due to a coding change, resulting in a large disparity that was maintained through 2016. Comparison of alcohol and drug poisonings showed that the AI/AN alcohol poisoning rate was about eight times the white rate, whereas drug poisoning rates were similar. For 'all other' unintentional injuries, the highest rates were seen for AI/AN men, with rates generally rising over the study period. State-specific analyses found substantial variation in AI/AN rates, with few or no disparities in New York and Texas. CONCLUSIONS Results indicate substantial and persisting disparities in unintentional injury mortality, with especially large differences in alcohol poisoning. The absence of disparities in New York and Texas suggest the importance of situational factors.
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Ye Y, Cherpitel CJ, Terza JV, Kerr WC. Quantifying risk of injury from usual alcohol consumption: An instrumental variable analysis. Alcohol Clin Exp Res 2021; 45:2029-2039. [PMID: 34342011 PMCID: PMC8602733 DOI: 10.1111/acer.14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/28/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Numerous studies of roadside accidents among emergency room patients show elevated risk of injury from acute alcohol consumption, i.e., recent drinking precedes the injury event. The observed effects are large and show a dose-response relationship. In contrast, studies quantifying the association between injury risk and chronic consumption, such as past-year average volume, show lower relative risk estimates than those from acute consumption. METHODS Combining data from 4 waves of US National Alcohol Surveys (NAS) for years 2000-2015 (N = 29,571, 53% overall cooperation rate), we estimated the risk of any past-year injury from past-year volume using logistic regression. This was contrasted with an instrumental variable (IV) analysis utilizing a 2-stage residual inclusion (2SRI) approach to estimate injury risk from volume, which adjusted for unobserved confounders using state beer and spirits tax rates, zip code-level outlet and bar density, and control state status as instruments. RESULTS Based on the combined US population surveys and controlling for sociodemographics, using conventional logistic regression, the odds ratios of injury from an average volume of 1, 2, and 5 drinks per day were 1.12 [95% confidence interval: 1.02, 1.24], 1.10 [1.00, 1.22], and 1.04 [0.88, 1.22], respectively. These compared with 1.67 [1.00, 2.78], 2.38 [0.87, 6.54], and 6.98 [0.57, 85.89] using the IV method. The proportion of injury attributed to alcohol also increased in magnitude, from 6.2% [0.3%, 11.9%] using the conventional approach to 17.9% [8.2%, 27.7%] using the IV method. CONCLUSIONS The association between injury and chronic alcohol consumption may be confounded by unobserved factors, resulting in a possible downward bias of the risk estimate.
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Greenfield TK, Patterson D, Karriker-Jaffe KJ, Kerr WC, Gilder DA, Ehlers CL. Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys. J Stud Alcohol Drugs 2021; 82:564-575. [PMID: 34546902 PMCID: PMC8819606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/06/2021] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434). METHOD Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous). RESULTS In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks. CONCLUSIONS AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.
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Greenfield TK, Patterson D, Karriker-Jaffe KJ, Kerr WC, Gilder DA, Ehlers CL. Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys. J Stud Alcohol Drugs 2021; 82:564-575. [PMID: 34546902 PMCID: PMC8819606 DOI: 10.15288/jsad.2021.82.564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/06/2021] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434). METHOD Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous). RESULTS In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks. CONCLUSIONS AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.
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Patra J, Buckley C, Kerr WC, Brennan A, Purshouse RC, Rehm J. Impact of body mass and alcohol consumption on all-cause and liver mortality in 240 000 adults in the United States. Drug Alcohol Rev 2021; 40:1061-1070. [PMID: 33682957 PMCID: PMC9383267 DOI: 10.1111/dar.13265] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Nationally representative studies of the combined impact of drinking and body mass (BMI) on mortality outcomes are unavailable. We investigate whether both act together to elevate risk of all-cause or liver mortality. METHODS We obtained self-reported histories of drinking and BMI from 129 098 women (mean age 47.2 years) and 102 568 men (mean age 45.6 years) ≥18 years interviewed from 1997 to 2004 in the National Health Interview Survey and related these data to the deaths that occurred by 31 December 2006 (women = 8486; men = 7819 deaths). Death hazards among current drinkers in different BMI groups were adjusted for age, education, race and smoking. RESULTS Obese (≥30 kg m-2 ) adults with consumption of >40 g day-1 (women) or >60 g day-1 (men) pure ethanol were at risk of increased mortality from all-cause and chronic liver disease (P trend <0.0001). For heavy drinkers with BMI ≥30 kg m-2 , each 5 kg m-2 higher BMI was associated with an elevated all-cause mortality in men (hazard ratios 1.27, 95% confidence interval [CI]: 1.16-1.40) and women (1.12, [1.02-1.24]). The excess risk due to interaction was more pronounced in men (7.30, [3.60-11.00]) than women (2.90, [0.50-5.30]). DISCUSSION AND CONCLUSIONS Obesity and excess alcohol are both related to all-cause and liver mortality-the latter with evidence of a supra-additive interaction between the risk factors. The presence of both factors in the same population and their impact should inform treatment, public health policies and research.
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Mulia N, Ye Y, Karriker-Jaffe KJ, Li L, Kerr WC, Greenfield TK. The Great Recession, behavioral health, and self-rated health: An examination of racial/ethnic differences in the US. Addict Behav 2021; 118:106873. [PMID: 33652334 PMCID: PMC8483811 DOI: 10.1016/j.addbeh.2021.106873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/14/2023]
Abstract
The Great Recession has been associated with racial/ethnic disparities in economic loss, alcohol-related problems and mental health in the US. In this study, we examine its effect on overall health, the role of heavy drinking and mental health, and whether these relationships vary by race/ethnicity. Using US National Alcohol Survey data collected from White, African American and Latino individuals between June 2009 and March 2010 (N = 4656), we conducted gender-stratified simultaneous path modeling to test racial/ethnic differences in hypothesized paths from recession-related hardships to overall self-rated health through current depressive symptoms and heavy drinking. Recession impacts were measured using an index of job-related, financial and housing hardships. Models accounted for demographic characteristics and heavy drinking, health conditions and alcohol-related health harms occurring prior to the Great Recession. We found that in men and women of each racial/ethnic group, more accumulated recession hardships were associated with greater depressive symptoms and more frequent heavy drinking, and depressive symptoms were associated with poorer self-rated health. Further, heavy drinking was related to poorer self-rated health in Black men and depressive symptoms in Latino men, and for Black and Latina women, prior heavy drinking was associated with current depressive symptoms. Findings highlight adverse, behavioral and overall health consequences of a severe recession for men and women of diverse racial/ethnic groups, as well as unique risks for Black and Latino men and women. Findings suggest the need for behavioral health interventions alongside multisector strategies to bolster the labor market and social safety net during severe economic downturns.
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Cherpitel CJ, Williams E, Ye Y, Kerr WC. Racial/Ethnic Disparities in the Relationship of Alcohol-Related Injury and Perceived Driving Under the Influence from Hours of Exposure to High Blood Alcohol Concentration: Data From Four US National Alcohol Surveys (2000-2015). Alcohol Alcohol 2021; 55:564-570. [PMID: 32518957 DOI: 10.1093/alcalc/agaa053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS To analyze racial/ethnic disparities in risk of two alcohol-related events, alcohol-related injury and self-reported perceived driving under the influence (DUI) from hours of exposure to an elevated blood alcohol concentration (BAC). METHODS Risk curves for the predicted probability of these two outcomes from the number of hours of exposure to a BAC ≥ 0.08 mg% in the past year were analyzed separately for whites, blacks and Hispanics in a merged sample of respondents from four US National Alcohol Surveys (2000-2015). RESULTS Hours of exposure to a BAC ≥ 0.08 showed a stronger association with perceived DUI than with alcohol-related injury for all racial/ethnic groups. Greater risk was found for whites than blacks or Hispanics for outcomes at nearly all BAC exposure levels, and most marked at the highest level of exposure. Risk of both outcomes was significant for whites at all exposure levels, but small for alcohol-related injury. Little association was found for alcohol-related injury for blacks or Hispanics. For perceived DUI, risk for blacks was significantly elevated at lower levels of exposure, while risk for Hispanics was significantly elevated beginning at 30 h of exposure. CONCLUSIONS Findings showed racial/ethnic differences in risk of alcohol-related injury and perceived DUI from hours of exposure to elevated BAC. Risk increased at relatively low levels of exposure to a BAC ≥ 0.08, especially for whites, highlighting the importance of preventive efforts to reduce harmful outcomes for moderate drinkers.
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Subbaraman MS, Kerr WC. Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state. J Cannabis Res 2021; 3:17. [PMID: 34082833 PMCID: PMC8176731 DOI: 10.1186/s42238-021-00071-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background The US national surveys and data from legal adult use cannabis states show increases in the prevalence of cannabis use among older adults, though little is known about their manner of cannabis consumption. Here, we examine cannabis use frequency, routes of cannabis administration, and co-use with alcohol, focusing on adults aged 50–64 and ≥65. Methods Data come from a general population survey conducted January 2014–October 2016 (N=5492) in Washington state. We first estimate prevalence and trends in cannabis frequency, routes of administration, and co-use with alcohol in gender by age groups (18–29, 30–49, 50–64, ≥ 65). To test associations between cannabis frequency, route of administration, and co-use with alcohol, we then use sample-weighted multinomial regression adjusted for gender, race/ethnicity, marital status, education, employment, and survey year. Sampling weights are used so results better represent the Washington state population. Regressions focus on the 50–64 and ≥65 age groups. Results Among men and women 50–64, the prevalence of no cannabis use in the past 12 months decreased significantly (84.2% in 2014 to 75.1% in 2016 for women, 76.8% in 2014 to 62.4% in 2016 for men). Among those who report past-year cannabis use, oral administration and vaping and other routes of administration increased by 70% and 94%, respectively each year. Almost one-third of women aged 50–64 and one-fifth of women aged ≥65 who use cannabis reported daily/near daily use, and more than one-third of men who use cannabis in all age groups reported daily/near daily use, including 41.9% of those ≥65. Among men, the prevalence of edibles, drinks, and other oral forms of cannabis administration went up significantly with age (6.6% among 18–29, 21.5% among ≥65). Vaping and other administration are more strongly related to regular and daily/near daily use than infrequent use among those ≥65. The pattern of associations between cannabis frequency and co-use with alcohol differed for women vs. men. Conclusions In a general population representative sample of adults living in a state with legal adult use cannabis, the prevalence of cannabis use increased among those aged 50–64 between 2014 and 2016, the prevalence of daily use is substantial, and oral administration and vaping are increasing.
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Phillips AZ, Rodriguez HP, Kerr WC, Ahern JA. Washington's liquor license system and alcohol-related adverse health outcomes. Addiction 2021; 116:1043-1053. [PMID: 33058384 PMCID: PMC8043979 DOI: 10.1111/add.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS In June 2012, Washington state (USA) implemented Initiative 1183, privatizing liquor sales. As a result, off-premises outlets increased from 330 to over 1400 and trading hours lengthened. Increased availability of liquor may lead to increased consumption. This study examines the impact of Initiative 1183 on alcohol-related adverse health outcomes, measured by inpatient hospitalizations for alcohol-related disorders and accidental injuries. It further assesses heterogeneity by urbanicity, because outlets increased most in metropolitan-urban areas. DESIGN County-by-quarter difference-in-difference linear regression models, estimated statewide and within metropolitan/rural strata. SETTING AND PARTICIPANTS Data are from AHRQ Healthcare Cost and Utilization State Inpatient Database 2010-2014 and HHS Area Health Resource File 2010-2014. Changes in the rates of hospitalizations in the 2.5 years following Initiative 1183 in Washington (n = 39 counties) are compared with changes in Oregon (n = 36 counties). MEASUREMENTS County rates of hospitalizations per 1000 residents, including all records with any-listed ICD-9 Clinical Classification Software code denoting an alcohol-related disorder, and all records with any-listed external cause of injury code denoting an accidental injury. FINDINGS The increase in the rate of accidental injury hospitalizations in Washington's metropolitan-urban counties was on average 0.289 hospitalizations per 1000 county residents per quarter greater than the simultaneous increase observed in Oregon (P = 0.017). This result was robust to alternative specifications using a propensity score matched sample and synthetic control methods with data from other comparison states. The evidence did not suggest that Initiative 1183 was associated with differential changes in the rate of hospitalizations for alcohol-related disorders in metropolitan-urban (P = 0.941), non-metropolitan-urban (P = 0.162), or rural counties (P = 0.876). CONCLUSIONS Implementing Washington's Initiative 1183 (privatizing liquor sales) appears to have been associated with a significant increase in the rate of accidental injury hospitalizations in urban counties in that state but does not appear to be significantly associated with changes in the rate of hospitalizations specifically for alcohol-related disorders within 2.5 years.
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Bensley KMK, Kerr WC, Barnett SB, Mulia N. Postmortem screening of opioids, benzodiazepines, and alcohol among rural and urban suicide decedents. J Rural Health 2021; 38:77-86. [PMID: 33817837 DOI: 10.1111/jrh.12574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Fatal suicides involving opioids are increasingly common, particularly in rural areas. As co-use of opioids with other substances contributes significantly to mortality risk, we examined whether positive screens for opioids with other substances is more prevalent among rural versus urban suicide deaths, as this could have implications for public health strategies to reduce overdose suicides. METHODS Data from all states reporting opioid-related overdose suicides in the National Violent Death Reporting System from 2012 to 2015 were used. Relative risk ratios were obtained using multinomial logistic regression, comparing opioid-only to (1) opioid and alcohol, (2) opioid and benzodiazepines, and (3) opioid, alcohol, and benzodiazepines suicides across rurality. Models were fit using robust standard errors and fixed effects for year of death, adjusting for individual, county, and state-level covariates. FINDINGS There were 3,781 opioid-overdose suicide decedents (42% female) tested for all 3 substances during the study period. Unadjusted prevalence of positive screens in decedents varied across rurality (P = .022). Urban decedents were more likely to test positive for opioids alone, while rural decedents were more to likely test positive for opioids and benzodiazepines. CONCLUSIONS Rural suicides are associated with increased opioid and benzodiazepine positive screens. These findings suggest the need for rural-focused interventions to support appropriate co-prescribing, better health education for providers about risks associated with drug mixing, and more linkages with mental health services.
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Subbaraman MS, Mulia N, Ye Y, Greenfield TK, Kerr WC. Alcohol policy effects on 100% chronic alcohol-attributable mortality across racial/ethnic subgroups. Prev Med 2021; 145:106450. [PMID: 33549683 PMCID: PMC8631687 DOI: 10.1016/j.ypmed.2021.106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
In the United States, some racial/ethnic minorities suffer from higher rates of chronic alcohol problems, and alcohol-related morbidity and mortality than Whites. Furthermore, state-level alcohol policies may affect racial/ethnic subgroups differentially. We investigate effects of beverage-specific taxes and government control of spirits retail on alcohol-related mortality among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic American Indians/Alaska Natives (AI/AN) and Hispanics using death certificate and state-level alcohol policy data for 1999-2016. Outcomes were analyzed as mortality rates (per 10,000) from 100% alcohol-attributable chronic conditions ("100% chronic AAD"). Statistical models regressed racial/ethnic-specific logged mortality rates on state-level, one-year lagged and logged beer tax, one-year lagged and logged spirits tax, and one-year lagged government-controlled spirits sales, adjusted for mortality trends, fixed effects for state, and clustering of standard errors. Government control was significantly (P < 0.05) related to 3% reductions in Overall and non-Hispanic White mortality rates, and 4% reductions in Hispanic mortality rates from 100% chronic AAD. Tax associations were not robust. Results support that government control of spirits retail is associated with significantly lower 100% AAD from chronic causes Overall and among non-Hispanic Whites and Hispanics. Government control of spirits retail may reduce both population-level 100% chronic AAD as well as racial/ethnic disparities in 100% chronic AAD.
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Rehm J, Patra J, Brennan A, Buckley C, Greenfield TK, Kerr WC, Manthey J, Purshouse RC, Rovira P, Shuper PA, Shield KD. The role of alcohol use in the aetiology and progression of liver disease: A narrative review and a quantification. Drug Alcohol Rev 2021; 40:1377-1386. [PMID: 33783063 PMCID: PMC9389623 DOI: 10.1111/dar.13286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/16/2020] [Accepted: 03/10/2021] [Indexed: 12/16/2022]
Abstract
Issues. Alcohol use has been shown to impact on various forms of liver disease, not restricted to alcoholic liver disease. Approach. We developed a conceptual framework based on a narrative review of the literature to identify causal associations between alcohol use and various forms of liver disease including the complex interactions of alcohol with other major risk factors. Based on this framework, we estimate the identified relations for 2017 for the USA. Key Findings. The following pathways were identified and modelled for the USA for the year 2017. Alcohol use caused 35 200 (95% uncertainty interval 32 800–37 800) incident cases of alcoholic liver cirrhosis. There were 1700 (uncertainty interval 1100–2500) acute hepatitis B and C virus (HBV and HCV) infections attributable to heavy-drinking occasions, and 14 000 (uncertainty interval 5900–19 500) chronic HBV and 1700 (uncertainty interval 700–2400) chronic HCV infections due to heavy alcohol use interfering with spontaneous clearance. Alcohol use and its interactions with other risk factors (HBV, HCV, obesity) led to 54 500 (uncertainty interval 50 900–58 400) new cases of liver cirrhosis. In addition, alcohol use caused 6600 (uncertainty interval 4200–9300) liver cancer deaths and 40 700 (uncertainty interval 36 600–44 600) liver cirrhosis deaths. Implications. Alcohol use causes a substantial number of incident cases and deaths from chronic liver disease, often in interaction with other risk factors. Conclusion. This additional disease burden is not reflected in the current alcoholic liver disease categories. Clinical work and prevention policies need to take this into consideration.
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Cherpitel CJ, Ye Y, Kerr WC. Shifting patterns of disparities in unintentional injury mortality rates in the United States, 1999-2016. Rev Panam Salud Publica 2021; 45:e36. [PMID: 33790956 PMCID: PMC7993239 DOI: 10.26633/rpsp.2021.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To analyze changes in racial/ethnic disparities for unintentional injury mortality from 1999-2016. METHODS Mortality data are from the National Center for Health Statistics (NCHS) for all unintentional injuries, analyzed separately by injury cause (motor vehicle accidents [MVA], poisonings, other unintentional) for white,black, and Hispanic populations within four age groups: 15-19, 20-34, 35-54, 55-74 for males and for females. RESULTS Rates across race/ethnic groups varied by gender, age and cause of injury. Unintentional injury mortality showed a recent increase for both males and females, which was more marked among males and for poisoning in all race/ethnic groups of both genders. Whites showed highest rates of poisoning mortality and the steepest increase for both genders, except for black males aged 55-74. MVA mortality also showed an increase for all race/ethnic groups, with a sharper rise among blacks, while Hispanics had lower rates than either whites or blacks. Rates for other unintentional injury mortality were similar across groups except for white women over 55, for whom rates were elevated. CONCLUSIONS Data suggest while mortality from unintentional injury related to MVA and poisoning is on the rise for both genders and in most age groups, blacks compared to whites and Hispanics may be suffering a disproportionate burden of mortality related to MVAs and to poisonings among those over 55, which may be related to substance use.
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Cook WK, Tam CC, Luczak SE, Kerr WC, Mulia N, Lui C, Li L. Alcohol Consumption, Cardiovascular-Related Conditions, and ALDH2*2 Ethnic Group Prevalence in Asian Americans. Alcohol Clin Exp Res 2020; 45:418-428. [PMID: 33349921 DOI: 10.1111/acer.14539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the relationships between alcohol consumption and cardiovascular disease (CVD) and related chronic conditions in Asian Americans and how such risk relationships vary among their subgroups. We examine these relationships in Asian Americans and their moderation by ethnic prevalence of a variant the aldehyde dehydrogenase gene: ALDH2*2. METHODS Multiple logistic regression modeling was performed using a nationally representative sample of Asian-American adults aged 30 to 70 (n = 1,720) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 2 (2004 to 2005) and 3 (2012 to 2013). Outcomes considered were diabetes, hypertension, high cholesterol, CVD, any of the 3 conditions (i.e., diabetes, high cholesterol, and CVD) documented to have a J-shaped relationship with drinking (CVDRC3), and any of the CVD-related conditions (ANYCVD). Demographic and socioeconomic characteristics, health insurance coverage, and other lifestyle risk factors (smoking and obesity/overweight) were adjusted. Analyses were stratified by gender. RESULTS Alcohol consumption level was positively associated only with hypertension in Asian males, with consuming 7 to 14 drinks per week associated with more than double the risk of lifetime abstinence. For females, alcohol consumption had a dose-response relationship with high cholesterol and CVDRC3. Membership in the higher ALDH2*2 ethnic group overall was associated with lower risk of CVD-related conditions. However, compared to abstainers in lower ALDH2*2 group, females in the higher ALDH2*2 group who consumed more than 7 drinks per week had a higher risk of diabetes, hypertension, CVDRC3, and ANYCVD. CONCLUSIONS Asian Americans may have increased risk of CVD-related conditions at relatively low alcohol consumption levels. Among Asian-American females, in particular, any amount of drinking may increase risk for high cholesterol or any of the CVD-related conditions previously documented to have a curvilinear relationship with drinking. These risks may be particularly elevated for those in ethnic groups with a high prevalence of ALDH2*2.
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Kerr WC, Williams E, Patterson D, Karriker-Jaffe KJ, Greenfield TK. Extending the Harm to Others Paradigm: Comparing Marijuana- and Alcohol-Attributed Harms in Washington State. J Psychoactive Drugs 2020; 53:149-157. [PMID: 33269983 DOI: 10.1080/02791072.2020.1847364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Harms attributed to others' alcohol use have been extensively studied in the US and internationally, but no studies have measured harms from others' marijuana use. We utilize data from five cross-sectional waves of a survey series with representative samples of Washington state residents conducted every 6 months from 2014 to 2016, after the legalization of adult use marijuana. Harms attributed to others' drinking and to others' marijuana use included family and financial problems, assault, harassment, and vandalism experiences, and accidents due to impaired drivers. Past year harms attributed to others' marijuana use were reported by 8.4% of the sample, while 21.3% reported alcohol-attributed harms and 4.3% experienced both. Women were more likely to experience harms from either substance. While heavy drinkers were most likely to experience alcohol harms from others' use, frequent marijuana users reported the least harms from others. About three times as many individuals reported harassment, vandalism, or family problems attributed to someone's alcohol use compared to those harms attributed to someone's marijuana use, with a smaller ratio seen for financial trouble and a wider ratio for physical harm. Harms attributed to other's marijuana use in Washington were found to be substantial, but lower than harms from others' drinking.
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Kaplan MS, Kerr WC, McFarland BH, Bensley K, Caetano R, Giesbrecht N, Monnat SM, Nolte KB. A Reply to Monteiro et al.’s (2020) ‘Alcohol Policy and Coronavirus: An Open Research Agenda’. J Stud Alcohol Drugs 2020. [DOI: 10.15288/jsad.2020.81.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kaplan MS, Kerr WC, McFarland BH, Bensley K, Caetano R, Giesbrecht N, Monnat SM, Nolte KB. A Reply to Monteiro et al.'s (2020) 'Alcohol Policy and Coronavirus: An Open Research Agenda'. J Stud Alcohol Drugs 2020; 81:687-688. [PMID: 33028483 PMCID: PMC8076483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
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