Neighborhood income and income distribution and the use of cigarettes, alcohol, and marijuana

IQ in high school as a predictor of midlife alcohol drinking patterns

AIMS

The aim of the present study was to assess the relationship between adolescent IQ and midlife alcohol use and to explore possible mediators of this relationship.

METHODS

Study data were from 6300 men and women who participated in the Wisconsin Longitudinal Study of high-school students graduating in 1957. IQ scores were collected during the participants' junior year of high school. In 2004, participants reported the number of alcoholic beverages consumed (past 30 days) and the number of binge-drinking episodes. A multinomial logistic regression was conducted to determine the relationship between adolescent IQ and future drinking pattern (abstainer, moderate drinker, or heavy drinker), and Poisson regression was used to examine the number of binge-drinking episodes. Two mediators-income and education-were also explored.

RESULTS

Every one-point increase in IQ score was associated with a 1.6% increase in the likelihood of reporting moderate or heavy drinking as compared to abstinence. Those with higher IQ scores also had significantly fewer binge-drinking episodes. Household income, but not education, partially mediated the relationship between IQ and drinking pattern.

CONCLUSIONS

The present study suggests that higher adolescent IQ may predict a higher likelihood of moderate or heavy drinking in midlife, but fewer binge-drinking episodes. The study also suggests that this relationship is mediated by other psychosocial factors, specifically income, prompting future exploration of mediators in subsequent studies.

Perceived Neighbourhood Disorder, Alcohol Consumption and Alcohol-Related Problems in Chile

Background: Alcohol misuse is one of the most important preventable public health risk factors. Empirical research shows that alcohol misuse is related to social and economic losses. Both theoretical and empirical evidence suggests that neighborhood disorder impacts alcohol-related behavior. However, there is limited literature in the context of developing countries. Objectives: The aim of this research is to estimate the association between perceived neighborhood disorder and (1) alcohol-related behavior and (2) alcohol-related problems in the context of the Chilean population. Our contribution focuses on the examination of the perception of disorder in urban neighborhoods and alcohol use patterns in a wide age range and sample of Chilean cities. Results: High levels of neighbor disorder perception are associated with higher levels of drinking and hazardous alcohol use. In addition, perceived neighborhood disorder is directly associated with probability of alcohol-related problems (ranging from 2% to 11%). Conclusions/Importance: The results are consistent with empirical and theoretical frameworks. This research could be used to better guide place-based policies in emerging countries with high levels of alcohol consumption to prevent alcohol risk behaviors and alcohol-related problems.

Social and economic determinants of drug overdose deaths: a systematic review of spatial relationships

PURPOSE

To synthesize the available evidence on the extent to which area-level socioeconomic conditions are associated with drug overdose deaths in the United States.

METHODS

We performed a systematic review (in MEDLINE, EMBASE, PsychINFO, Web of Science, EconLit) for papers published prior to July 2022. Eligible studies quantitatively estimated the association between an area-level measure of socioeconomic conditions and drug overdose deaths in the US, and were published in English. We assessed study quality using the Effective Public Health Practice Project Quality Assessment Tool. The protocol was preregistered at Prospero (CRD42019121317).

RESULTS

We identified 28 studies that estimated area-level effects of socioeconomic conditions on drug overdose deaths in the US. Studies were scored as having moderate to serious risk of bias attributed to both confounding and in analysis. Socioeconomic conditions and drug overdose death rates were moderately associated, and this was a consistent finding across a large number of measures and differences in study designs (e.g., cross-sectional versus longitudinal), years of data analyzed, and primary unit of analysis (e.g., ZIP code, county, state).

CONCLUSIONS

This review highlights the evidence for area-level socioeconomic conditions are an important factor underlying the geospatial distribution of drug overdose deaths in the US and the need to understand the mechanisms underlying these associations to inform future policy recommendations. The current evidence base suggests that, at least in the United States, employment, income, and poverty interventions may be effective targets for preventing drug overdose mortality rates.

Understanding predictors of mental health and substance use treatment utilization among US adults: A repeated cross-sectional study

Background

Understanding discrepancies in mental health and substance use treatment utilization can help identify inequities in access to health services. We investigate mental health and substance use treatment utilization as function of demographic and social determinants, as well as pre-existing mental health and substance use disorders.

Methods

In this repeated cross-sectional study, we used the 2017-2019 National Survey on Drug Use and Health data on US adults above age 18. Two logistic regression models were conducted, using predictors of age, gender, race/Hispanicity, sexual identity, education, insurance, family income, and past year mental health and substance use disorders, with outcomes of mental health or substance use treatment utilization. Weighted estimates of substance use disorders and insurance types and Pearson's correlation tests of vulnerability among age, gender, and treatment type were reported.

Findings

Racial minorities, uninsured populations, sexual minorities, and females had lower odds of receiving mental health treatment, while older populations, lower income groups, and dual eligible enrollees had higher odds. Individuals with substance use disorders but no mental illness had higher odds of receiving mental health treatment. Those utilizing mental health treatment were mostly of high income, privately insured, and using cannabis, cocaine, and opioids. Older populations, men, and Medicaid only enrollees had higher odds of receiving substance use disorder treatment, whereas racial minorities had lower odds. Distribution of income, insurance type, and substance use were more widespread than mental health treatment.

Interpretation

Mental health treatment can be used as an avenue for substance use treatment, particularly opioid use disorders. It is important to target vulnerable populations, like racial minorities and uninsured populations to improve access to mental health and substance use treatment.

Inequality's on Tap: A Longitudinal Study of Area-Level Income Inequality and Alcohol Consumption Among Canadian Adolescents

PURPOSE

To determine if income inequality at the census division level is associated with alcohol consumption and abuse among junior high and high school students.

METHODS

Data on adolescents are from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study. Participant data (n = 19,759) were collected during three survey waves (2016-2017, 2017-2018, and 2018-2019) and linked to 30 census divisions within four Canadian provinces. Data on income inequality and other area-level factors were derived from the 2016 Canadian census. Multilevel logistic regression modelling was used to quantify the associations between income inequality, monthly alcohol consumption, and binge drinking.

RESULTS

After adjusting for covariates, students living in census divisions within the second and third quintiles of income inequality experienced an average 80% (OR = 1.80, 95% CI = 1.08-3.02) and 92% (OR = 1.92, 95% CI = 1.05-3.51) increased odds of engaging in monthly binge drinking, respectively, compared to those living in the first quintile. Similarly, adolescents living in census divisions within the second inequality quintile experienced an average 169% (OR = 2.69, 95% CI = 1.45, 4.99) increased odds of engaging in weekly binge drinking, compared to those living in the first quintile. There was no significant association between higher income inequality and current monthly alcohol consumption.

DISCUSSION

Moderate area-level income inequality within census divisions was adversely associated with alcohol consumption among adolescents. Future work should investigate the potential mechanisms that mediate this relationship.

COVID-19 pandemic-related trauma symptoms are associated with postpartum alcohol consumption

OBJECTIVE

The COVID-19 pandemic has led to escalations in substance use, including alcohol consumption. Of particular concern are the potential impacts during the postpartum period, a time of heightened vulnerability to stress and potential transmission of the negative sequelae of substance use to offspring. However, postpartum alcohol consumption during the COVID-19 pandemic has not been well characterized.

METHOD

Postpartum drinking habits and COVID-19-related stress were repeatedly assessed (every two weeks for 12 weeks, and at one-, six-, and 12-months postpartum) from N = 378 individuals during the COVID-19 pandemic. Average alcohol use trajectories as well as heterogeneity in trajectories were characterized. COVID-19-related trauma symptoms and coping were examined in relation to alcohol use over time.

RESULTS

Average postpartum alcohol use included an initial quadratic increase from one-to-four-months postpartum, followed by a plateau between four-to-12-months. Higher (15.08%), moderate (26.90%), and lower consumption (57.90%) subgroups were identified. Endorsement of COVID-19-related trauma symptoms and using alcohol to cope with stress predicted higher consumption.

CONCLUSIONS

Findings suggest a potential sensitive period in establishing postpartum alcohol use patterns from one-to-four-months postpartum. Findings further suggest that postpartum alcohol use is heterogenous and that individual response to major traumatic stressors, like the COVID-19 pandemic, may influence emerging patterns of postpartum alcohol use.

Patterns of problematic cannabis use in Canada pre- and post-legalisation: Differences by neighbourhood deprivation, individual socioeconomic factors and race/ethnicity

INTRODUCTION

The legalisation of cannabis in Canada in 2018, and subsequent increase in prevalence of use, has generated interest in understanding potential changes in problematic patterns of use, including by socio-demographic factors such as race/ethnicity and neighbourhood deprivation level.

METHODS

This study used repeat cross-sectional data from three waves of the International Cannabis Policy Study web-based survey. Data were collected from respondents aged 16-65 prior to cannabis legalisation in 2018 (n = 8704), and post-legalisation in 2019 (n = 12,236) and 2020 (n = 12,815). Respondents' postal codes were linked to the INSPQ neighbourhood deprivation index. Multinomial regression models examined differences in problematic use by socio-demographic and socio-economic factors and over time.

RESULTS

No evidence of a change in the proportion of those aged 16-65 in Canada whose cannabis use would be classified as 'high risk' was noted from before cannabis legalisation (2018 = 1.5%) to 12 or 24 months after legalisation (2019 = 1.5%, 2020 = 1.6%; F = 0.17, p = 0.96). Problematic use differed by socio-demographic factors. For example, consumers from the most materially deprived neighbourhoods were more likely to experience 'moderate' vs 'low risk' compared to those living outside deprived neighbourhoods (p < 0.01 for all). Results were mixed for race/ethnicity and comparisons for high risk were limited by small sample sizes for some groups. Differences across subgroups were consistent from 2018 to 2020.

DISCUSSION AND CONCLUSIONS

The risk of problematic cannabis use does not appear to have increased in the 2 years following cannabis legalisation in Canada. Disparities in problematic use persisted, with some racial minority and marginalised groups experiencing higher risk.

Worsening of alcohol abuse disorder in a Spanish population during the first twelve months of the COVID-19 pandemic and associated factors: retrospective, ecological and community study

PURPOSE

To analyse: (1) Changes in clinical parameters and in the use of social healthcare resources by patients with alcohol abuse disorder between the six months prior to the start of the pandemic and the first year of the pandemic. (2) The factors related to a worsening of clinical parameters among patients with alcohol abuse disorder.

METHODS

A retrospective and observational study of a population who have been diagnosed with alcohol abuse disorders according to their primary health care (PHC) electronic medical records was performed. The total sample was made up of 11,384 patients. The variables (sociodemographic variables, chronic comorbidities, analytical parameters related to alcohol abuse disorder, COVID-19 infection, and use of healthcare resources) were collected in three different time periods: (i) six months before the onset of the strict lockdown, (ii) six months following the end of lockdown and (iii) from six to twelve months after the end of lockdown. Paired Student's T-test and a multivariate logistic regression were performed.

RESULTS

Along the first year after the onset of the pandemic, between 44% and 54% of the patients suffered a decline in every clinical parameter. The number of PHC nursing, GP visits and social worker visits reduced significantly. As regards the associated factors related to deterioration of alcohol abuse disorder, being younger than 40 years old, having an income of over 18,000 euros/year and not having visited the social worker were associated with a worsening of the disorder.

CONCLUSIONS

These results suggest that the impact of COVID-19 on this group has been high, and the social care offered to these patients plays a significant role in minimising the repercussions of the pandemic.

DeepBiomarker2: Prediction of alcohol and substance use disorder risk in post-traumatic stress disorder patients using electronic medical records and multiple social determinants of health

Introduction

Prediction of high-risk events amongst patients with mental disorders is critical for personalized interventions. In our previous study, we developed a deep learning-based model, DeepBiomarker by utilizing electronic medical records (EMR) to predict the outcomes of patients with suicide-related events in post-traumatic stress disorder (PTSD) patients.

Methods

We improved our deep learning model to develop DeepBiomarker2 through data integration of multimodal information: lab tests, medication use, diagnosis, and social determinants of health (SDoH) parameters (both individual and neighborhood level) from EMR data for outcome prediction. We further refined our contribution analysis for identifying key factors. We applied DeepBiomarker2 to analyze EMR data of 38,807 patients from University of Pittsburgh Medical Center diagnosed with PTSD to determine their risk of developing alcohol and substance use disorder (ASUD).

Results

DeepBiomarker2 predicted whether a PTSD patient will have a diagnosis of ASUD within the following 3 months with a c-statistic (receiver operating characteristic AUC) of 0·93. We used contribution analysis technology to identify key lab tests, medication use and diagnosis for ASUD prediction. These identified factors imply that the regulation of the energy metabolism, blood circulation, inflammation, and microbiome is involved in shaping the pathophysiological pathways promoting ASUD risks in PTSD patients. Our study found protective medications such as oxybutynin, magnesium oxide, clindamycin, cetirizine, montelukast and venlafaxine all have a potential to reduce risk of ASUDs.

Discussion

DeepBiomarker2 can predict ASUD risk with high accuracy and can further identify potential risk factors along with medications with beneficial effects. We believe that our approach will help in personalized interventions of PTSD for a variety of clinical scenarios.

Explaining adult obesity, severe obesity, and BMI: Five decades of change

Obesity rates have increased across all segments of society since the late 1970s, but the reason behind population-level increases in body weight remains unclear. We used the 1971-2020 NHANES data to examine whether the observed trend in obesity prevalence is attributable to changing public health behaviors (i.e., intracohort change) or changing publics (i.e., cohort replacement). We partitioned total change in mean BMI, and rates of obesity and severe obesity, into its IC and CR components using linear and algebraic decomposition methods. We found that the IC mechanism (i.e., broad sectors of individuals changing) plays a dominant role in the overall increase in mean BMI, and obesity and severe obesity prevalence. Birth cohort membership (i.e., the CR mechanism) is also influencing mean BMI, and rates of obesity and severe obesity, but in differing ways. Specifically, the large positive IC and the small positive CR effects are amplifying one another, thus creating a steep increase in the observed rates of severe obesity. Conversely, the large positive IC effect is offset by a small negative CR effect, which created a more gradual rise in mean BMI and rates of obesity. Furthermore, we computed total change for models that entered separately sociodemographic, lifestyle, nutritional, and physical activity measures to estimate differences in mean BMI, and rates of obesity and severe obesity, among cohorts and time periods. Adjustment for all the compositional differences among the cohorts during the study period indicate that a combination of a more pronounced IC and a less pronounced CR drove the observed increase in mean BMI, and rates of obesity and severe obesity. Thus, "universal prevention" (i.e., entire community) strategies for healthy weight promotion may need to be combined with "selective prevention" (i.e., at-risk groups) and/or "targeted prevention" (i.e., at-risk individuals) approaches in order to reverse the obesity epidemic.

Associations between relative deprivation with opioid use among working-age adults during the great recession

Recessions, poverty, and unemployment have been associated with opioid use. However, these measures of financial hardship may be imprecise, limiting our ability to understand this relationship. We tested associations between relative deprivation and non-medical prescription opioid use (NMPOU) and heroin use among working-age adults (ages 18-64) during the Great Recession. Our sample included working-age adults in the 2005-2013 United States National Survey of Drug Use and Health (n = 320,186). Relative deprivation compared the lowest limit of participants' income category to the national 25th percentile individual income for people with similar socio-demographic characteristics (race and ethnicity, gender, year). We distinguished the period before (1/2005-11/2007), during (12/2007-06/2009), and after (07/2007-12/2013) the Great Recession. We estimated odds of past-year NMPOU and heroin use for each past-year exposure (i.e., relative deprivation, poverty, unemployment) using separate logistic regressions adjusting for individual-level covariates (gender, age, race/ethnicity, marital status, and education) and national-level annual Gini coefficient. Our results show that NMPOU was higher among people experiencing relative deprivation (aOR = 1.13, 95% CI = 1.06-1.20), poverty (aOR = 1.22, 95% CI = 1.16-1.29), and unemployment (aOR = 1.42, 95% CI = 1.32-1.53) between 2005 and 2013, as was heroin use (aORs = 2.54, 2.09, 3.55, respectively). The association between relative deprivation and NMPOU was modified by recession timing, and was significantly higher after the Recession (aOR = 1.21, 95% CI = 1.11-1.33). Relative deprivation was associated with higher odds of NMPOU and heroin use, and higher odds of NMPOU after the Great Recession. Our findings suggest contextual-level factors may modify the relationship between relative deprivation and opioid use, and support the need for new measures of financial hardship.

Population and Neighborhood Correlates of Cannabis Dispensary Locations in Oklahoma

Background

Cannabis dispensaries have proliferated exponentially in Oklahoma since the state legalized medical cannabis in 2018. Oklahoma is unique from many other legalized states given its high number of lower income, rural, and uninsured residents, who may seek medical cannabis as an alternative to traditional medical treatment.

Methods

This study examined demographic and neighborhood characteristics associated with dispensary density (n = 1,046 census tracts) in Oklahoma.

Results

Compared to census tracts with no dispensaries, those with at least one dispensary had a higher proportion of uninsured individuals living below the poverty level and a greater number of hospitals and pharmacies. Almost half (42.35%) of census tracts with at least one dispensary were classified as a rural locale. In fully adjusted models, percent uninsured, percent of household rentals, and the number of schools and pharmacies were positively associated with greater number of cannabis dispensaries, while the number of hospitals was negatively associated. In the best fitting interaction models, dispensaries were predominant in areas with a higher percentage of uninsured residents and no pharmacies, suggesting that cannabis retailers may capitalize on the health needs of communities with limited healthcare outlets or access to medical treatment.

Conclusions

Policies and regulatory actions that seek to decrease disparities in dispensary locations should be considered. Future studies should examine whether people living in communities with a scarcity of health resources are more likely to associate cannabis with medical uses than those living in communities with more resources.

Addictive behavior as molar behavioral allocation: Distinguishing efficient and final causes in translational research and practice

OBJECTIVE

Translational research on addictive behaviors viewed as molar behavioral allocation is critically reviewed. This work relates rates of behavior to rates of reinforcement over time and has been fruitfully applied to addictive behaviors, which involve excessive allocation to short-term rewards with longer term costs.

METHOD

Narrative critical review.

RESULTS

This approach distinguishes between final and efficient causes of discrete behaviors. The former refers to temporally extended behavior patterns into which the act fits. The latter refers to environmental stimuli or internal psychological mechanisms immediately preceding the act. Final causes are most clear when addictive behaviors are studied over time as a function of changing environmental circumstances. Discrete acts of addictive behavior are part of an extended/molar behavior pattern when immediate constraints on engagement are low and few rewarding alternatives are available. Research framed by efficient causes often use behavioral economic simulation tasks as individual difference variables that precede discrete acts. Such measures show higher demand for addictive commodities and steeper discounting in various risk groups, but whether they predict molar addictive behavior patterning is understudied.

CONCLUSIONS

Although efficient cause analysis has dominated translational research, research supports viewing addictive behavior as molar behavioral allocation. Increasing concern with rate variables underpinning final cause analysis and considering how study methods and temporal units of analysis inform an efficient or final cause analysis may advance understanding of addictive behaviors that occur over time in dynamic environmental contexts. This approach provides linkages between behavioral science and disciplines that study social determinants of health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Census-Tract-Level Median Household Income and Median Family Income Estimates: A Unidimensional Measure of Neighborhood Socioeconomic Status?

Previous studies suggested either census-tract-level median household income (MHI) or median family income (MFI) estimates may be used as a unidimensional measure of neighborhood socioeconomic status (SES) in the United States (US). To better understand its general use, the purpose of this study was to assess the usefulness of MHI and MFI in a wide range of geographic areas. Area-based socioeconomic data at the census tract level were obtained from the 2000 Census as well as the 2005-2009, 2010-2014, and 2015-2019 American Community Survey. MHI and MFI were used as two simple measures of neighborhood SES. Based on the five area-based indexes developed in the US, several census-tract-level socioeconomic indicators were used to derive five composite measures of neighborhood SES. Then, a series of correlation analyses was conducted to assess the relationships between these seven measures in the State of California and its seven Metropolitan Statistical Areas. Two simple measures were very strongly and positively correlated with one another, and were also strongly or very strongly correlated, either positively or negatively, with five composite measures. Hence, the results of this study support an analytical thinking that simple measures and composite measures may capture the same dimension of neighborhood SES in different geographic areas.

Housing mobility protects against alcohol use for children with socioemotional health vulnerabilities: An experimental design

PURPOSE

Neighborhood context may influence alcohol use, but effects may be heterogeneous, and prior evidence is threatened by confounding. We leveraged a housing voucher experiment to test whether housing vouchers' effects on alcohol use differed for families of children with and without socioemotional health or socioeconomic vulnerabilities.

TRIAL DESIGN

In the Moving to Opportunity (MTO) study, low-income families in public housing in five US cities were randomized in 1994 to 1998 to receive one of three treatments: (1) a housing voucher redeemable in a low-poverty neighborhood plus housing counseling, (2) a housing voucher without locational restriction, or (3) no voucher (control). Alcohol use was assessed 10 to 15 years later (2008 to 2010) in youth ages 13 to 20, N = 4600, and their mothers, N = 3200.

METHODS

Using intention-to-treat covariate-adjusted regression models, we interacted MTO treatment with baseline socioemotional health vulnerabilities, testing modifiers of treatment on alcohol use.

RESULTS

We found treatment effect modification by socioemotional factors. For youth, MTO voucher treatment, compared with controls, reduced the odds of ever drinking alcohol if youth had behavior problems (OR = 0.26, 95% CI [0.09, 0.72]) or problems at school (OR = 0.46, [0.26, 0.82]). MTO low-poverty treatment (vs. controls) also reduced the number of drinks if their health required special medicine/equipment (OR = 0.50 [0.32, 0.80]). Yet treatment effects were nonsignificant among youth without socioemotional vulnerabilities. Among mothers of children with learning problems, MTO voucher treatment (vs. controls) reduced past-month drinking (OR = 0.69 [0.47, 0.99]), but was harmful otherwise (OR = 1.22 [0.99, 1.45]).

CONCLUSIONS

For low-income adolescents with special needs/socioemotional problems, housing vouchers protect against alcohol use.

What Prevention and Treatment of Substance Dependence Can Tell Us About Addressing Violent Extremism

In this article, the authors examine similarities between violent extremism and substance dependence. They review evidence from psychology, neuroscience, sociology, and public health that suggests that there are similarities in violent extremism and substance dependence in terms of the underlying neural pathways, social and psychological causes, behavioral patterns, and opportunities for prevention and intervention.

Risky Drinking Cultures Among Affluent Youth in Sweden

There is a growing scientific interest in drinking behavior among young people in affluent areas, who report higher levels of alcohol consumption compared to youth in less privileged areas. This phenomenon has been observed in several Western countries. The research has been dominated by variable-oriented analyses and has presented interesting explanations, but there has been little research into these young people's own experiences of and attitudes toward alcohol consumption. To develop interventions targeting this group, we need to understand their lifeworld. This study aims to develop an in-depth understanding of the high alcohol consumption among young people in affluent areas and how they themselves experience it. In the spring of 2019, we conducted 20 in-depth interviews with adolescents in upper secondary school (aged 15–19) in one of the most affluent area in Sweden. The empirical material was analyzed thematically. Theoretically, the phenomenon is understood by relating to social identity processes and considering the group's material, social and cultural means through Bourdieu's metaphors of capital. We found that affluent youth link their social identities to alcohol consumption. Alcohol is a social beverage that opens social networks and contributes to a sense of community. The consumption of alcohol gives experience capital leading to status in this context, with clear norms and expectations governing alcohol consumption. Parties are arranged in protected spaces where young people are free to drink out of the adults' sight. Affluent youths also have considerable purchasing power which contributes to drinking, and they are socialized into a pre-existing adult alcohol culture characterized by a liberal view on alcohol. Finally, when alcohol consumption escalates, the youths perceive that it is difficult to get adequate help from the adult world. The findings are important for future preventive interventions for subgroups of adolescents at high risk for heavy drinking.

Employment Status and Alcohol-Attributable Mortality Risk-A Systematic Review and Meta-Analysis

Being unemployed has been linked to various health burdens. In particular, there appears to be an association between unemployment and alcohol-attributable deaths. However, risk estimates presented in a previous review were based on only two studies. Thus, we estimated updated sex-stratified alcohol-attributable mortality risks for unemployed compared with employed individuals. A systematic literature search was conducted in August 2020 using the following databases: Embase, MEDLINE, PsycINFO, and Web of Science. The relative risk (RR) of dying from an alcohol-attributable cause of death for unemployed compared with employed individuals was summarized using sex-stratified random-effects DerSimonian-Laird meta-analyses. A total of 10 studies were identified, comprising about 14.4 million women and 19.0 million men, among whom there were about 3147 and 17,815 alcohol-attributable deaths, respectively. The pooled RRs were 3.64 (95% confidence interval (CI): 2.04–6.66) and 4.93 (95% CI 3.45–7.05) for women and men, respectively. The findings of our quantitative synthesis provide evidence that being unemployed is associated with an over three-fold higher risk of alcohol-attributable mortality compared with being employed. Consequently, a global public health strategy connecting brief interventions and specialized care with social services assisting those currently unemployed is needed.

Psychiatric and substance use disorders in a predominately low-income, black sample in early midlife

Decades of research have documented elevated rates of psychopathology among individuals affected by poverty. However, many studies have relied on predominately White samples, and on brief symptom screening measures which may not fully capture the experiences of individuals of color (who are disproportionately affected by poverty in the United States.) The present study examines prevalence rates of probable major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, substance use disorder, and alcohol use disorder in a predominately Black sample that grew up in urban poverty, utilizing structured neuropsychiatric interview methods. Data are drawn from a subsample of the Chicago Longitudinal Study (CLS), which has followed a large cohort for over four decades. Outcomes were assessed using the Mini International Neuropsychiatric Interview (M.I.N.I.) 7.0.2. Results indicate high probable rates of all measured outcomes, with notably high rates of substance use and alcohol use disorder compared to rates reported in previous national studies. Differences by sex and childhood neighborhood poverty, as well as significant comorbidity among psychiatric, substance and alcohol use disorders were also detected. Findings underscore an urgent need for community-based, culturally tailored prevention and intervention initiatives to support the mental health of individuals living in poverty. The high prevalence of psychiatric, substance and alcohol use disorders in this study likely reflect systematic inequities faced by low-income people of color in the United States. Future directions for research and practice are discussed.

Piloting a spatial mixed method for understanding neighborhood tobacco use disparities

The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.

What Regional Living Conditions Affect Individual Smoking of Adults in Russia

Objectives: Our study evaluated the impact of a wide range of characteristics of large administrative regions on the individual level of cigarette smoking in the Russian adult population. Methods: The pool of participants included 20,303 individuals aged 25-64 years. We applied 64 characteristics of the 12 Russian regions under study for 2010-2014. Using principal component analysis, we deduced five evidence-based composite indices of the regions. We applied the generalized estimating equation to determine associations between the regional indices and the individual level of smoking. Results: The increased Industrial index in the region is associated with the probability of smoking (odds ratio = 1.15; 95% confidence interval = 1.06-1.24). The other indices show associations with smoking only in separate gender and educational groups. Surprisingly, it was found that the Economic index has no associations with the probability of smoking. Conclusion: We evaluated the key associations of the territorial indices with the individual probability of smoking, as well as the mutual influence between the territorial indices and individual factors.

Individual and Community Social Determinants of Health and Recovery from Alcohol Use Disorder Three Years following Treatment

Prior research on recovery from alcohol use disorder (AUD) has often focused on individual-level factors that promote recovery. Given systemic health inequities, it is also important to study community-level social determinants of health (SDOH) that may promote recovery from AUD. This study extended prior work examining individual profiles of recovery from AUD to assess how individual and community SDOH at the time of treatment entry were associated with recovery from AUD three years after treatment. Data were utilized from the COMBINE study (n = 664), a multisite randomized clinical trial evaluating pharmacological and behavioral treatments for AUD. Public community data sources associated with participants' study sites were used to measure community SDOH. Multilevel latent profile analyses with individual- and community-level variables as predictors of recovery profiles were estimated. Four profiles were identified based on participants' alcohol consumption and functioning. Individual SDOH variables, such as fewer years of education and lower income, and community SDOH, including lower rates of health insurance, lower income, and greater income inequality, were each associated with lower functioning profiles. The findings highlight the importance of community SDOH in AUD recovery and the value of including both individual and community SDOH variables in research on long-term recovery.

Changes in Rates of Hospitalizations due to Cannabis Harms in Ontario, Canada Before the Legalization of Nonmedical Cannabis: Retrospective Population-level Study Between 2003 and 2017

OBJECTIVES

To assess the burden of hospitalizations due to cannabis harms in Ontario, Canada before Canada's legalization of nonmedical cannabis.

METHODS

We conducted a retrospective population-level study that included all individuals living in Ontario between 2003 and 2017. We described patterns of hospitalizations due to cannabis harms in men and women by demographics, socioeconomic factors, and mental health comorbidities. We calculated annual crude rates of hospitalizations due to cannabis harms and assessed time trends using Poisson regression models.

RESULTS

There were 39,092 hospitalizations due to cannabis harms among 32,811 unique individuals. Annual hospitalizations due to a cannabis harm increased by 280% between 2003 and 2017 (1712 vs 4730), with increases noted for all age groups and sexes. Rates of hospitalizations due to cannabis harms were greater in young adults, low-income individuals, and those with mental health comorbidities. Overall, the rate of hospitalizations due to cannabis harms increased on average by 7.8% per year (95% CI 7.5-8.0). Women aged 15 to 24 experienced the largest average annual increase (12.2% per year, 95% CI 11.5 to 12.8).

CONCLUSIONS

There are distinct patterns of hospitalizations due to cannabis harms in different priority populations. Young women aged 15 to 24 are a key demographic that is disproportionately burdened with a rapid increase in hospitalizations due to cannabis harms. Jurisdictions considering new approaches to cannabis control policy and addiction services should consider the rising burden of harms faced by youth and young adults when planning interventions.

The association between internalizing and externalizing severity with current use of cigarettes, e-cigarettes, and alcohol in adults: Wave 1 of the Population Assessment of Tobacco and Health (PATH) study

INTRODUCTION

Concurrent tobacco/alcohol use is common in adults, and associated with the severity of symptoms experienced by those with mental health disorders. However, few studies have explored this relationship across different combinations of tobacco products [i.e., conventional cigarette (CC) and electronic cigarette (EC)] and alcohol.

METHODS

Data from the Wave 1 (2013-2014) Population Assessment of Tobacco and Health study were used. A total of 15,947 adults aged 18 years or older with complete study information were included. Multinomial logistic regression analyses were performed to determine the relationship between lifetime internalizing/externalizing severity and past 30-day use of tobacco and alcohol, adjusting for nicotine dependence (ND), sex, age, race, education, and income.

RESULTS

Internalizing severity was more strongly associated with CC and alcohol use (moderate AOR = 1.47, 95% CI = 1.22-1.77; high AOR = 1.29, 95% CI = 1.03-1.61) as well as alcohol-exclusive use (moderate AOR = 1.58, 95% CI = 1.27-1.96; high AOR = 1.31, 95% CI = 1.05-1.64) while externalizing severity was more strongly associated with EC and alcohol use (high AOR = 2.97, 95% CI = 1.84-4.81, moderate AOR = 2.29, 95% CI = 1.53-3.43) when accounting for ND compared to none. The relationship between externalizing severity with EC use was dependent on alcohol being used with EC.

CONCLUSIONS

The associations between psychopathology (internalizing vs. externalizing severity) varies by different combinations of alcohol, CC, and EC. Further, these relationships may be mediated through ND. Future investigations into the comorbidity between mental disorder symptoms with tobacco and alcohol use should consider use of specific substances as well as their combination.

Consumption of Alcohol, Cannabis, and Tobacco in a Cohort of Adolescents before and during COVID-19 Confinement

The aim of this study was to identify changes in the hazardous consumption of alcohol, tobacco, and cannabis, due to the COVID-19 lockdown in 2020 in a cohort of schooled adolescents from Central Catalonia. We also analyzed the effect of the individual and social factors on risky consumption during confinement. This longitudinal study involved a subsample of 303 adolescents aged 14-18 years, who were attending 4th year of compulsory secondary education (ESO), 2nd year of college preparation (baccalaureate), or Vocational and Educational Training (VET). We collected data before COVID-19 lockdown (October 2019-February 2020) and 2 months after the lockdown ended. We estimated the prevalence of risky substance use in the sample at baseline for each independent variable. We used Poisson regression models with robust variance to compute the Cumulative Incidence (CI) and Relative Risk (RR), with their respective 95% confidence interval. We found that VET students had a significantly (p < 0.05) higher risk of substance use: binge drinking (RR = 3.21 (95%CI: 1.00-10.34)); hazardous drinking of alcohol (RR = 3.75 (95%CI: 1.12-12.54)), hazardous consumption of cannabis (RR = 3.75 (95%CI: 0.65-21.59)) and daily smoking of tobacco (RR = 4.82 (95%CI: 1.74-13.39)). The results showed a general trend of reduction of consumption during COVID-19 confinement period. This study suggests that VET students were more likely to engage in hazardous drinking of alcohol and daily smoking of tobacco. No statistically significant differences were found for the other age groups and variables.

Machine learning prediction of blood alcohol concentration: a digital signature of smart-breathalyzer behavior

Excess alcohol use is an important determinant of death and disability. Machine learning (ML)-driven interventions leveraging smart-breathalyzer data may help reduce these harms. We developed a digital phenotype of long-term smart-breathalyzer behavior to predict individuals' breath alcohol concentration (BrAC) levels trained on data from a smart breathalyzer. We analyzed roughly one million datapoints from 33,452 users of a commercial smart-breathalyzer device, collected between 2013 and 2017. For validation, we analyzed the associations between state-level observed smart-breathalyzer BrAC levels and impaired-driving motor vehicle death rates. Behavioral, geolocation-based, and time-series-derived features were fed to an ML algorithm using training (70% of the cohort), development (10% of the cohort), and test (20% of the cohort) sets to predict the likelihood of a BrAC exceeding the legal driving limit (0.08 g/dL). States with higher average BrAC levels had significantly higher alcohol-related driving death rates, adjusted for the number of users per state B (SE) = 91.38 (15.16), p < 0.01. In the independent test set, the ML algorithm predicted the likelihood of a given user-initiated BrAC sample exceeding BrAC ≥ 0.08 g/dL, with an area under the curve (AUC) of 85%. Highly predictive features included users' prior BrAC trends, subjective estimation of their BrAC (or AUC = 82% without the self-estimate), engagement and self-monitoring, time since the last measure, and hour of the day. In conclusion, an ML algorithm successfully quantified a digital phenotype of behavior, predicting naturalistic BrAC levels exceeding 0.08 g/dL (a threshold associated with alcohol-related harm) with good discrimination capability. This result establishes a foundation for future research on precision behavioral medicine digital health interventions using smart breathalyzers and passive monitoring approaches.

A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic

More than 750,000 people in the United States died from an overdose between 1999 and 2018; two-thirds of those deaths involved an opioid. In this review, we present trends in opioid overdose rates during this period and discuss how the proliferation of opioid prescribing to treat chronic pain, changes in the heroin and illegally manufactured opioid synthetics markets, and social factors, including deindustrialization and concentrated poverty, contributed to the rise of the overdose epidemic. We also examine how current policies implemented to address the overdose epidemic may have contributed to reducing prescription opioid overdoses but increased overdoses involving illegal opioids. Finally, we identify new directions for research to understand the causes and solutions to this critical public health problem, including research on heterogeneous policy effects across social groups, effective approaches to reduce overdoses of illegal opioids, and the role of social contexts in shaping policy implementation and impact.

Factors Associated with Women's Unwillingness to Decrease Alcohol Intake to Decrease Breast Cancer Risk

OBJECTIVE

Alcohol intake is a known risk factor for breast cancer. National organizations recommend that women consume no more than one serving of alcohol per day, if at all; however, many women exceed this recommendation, and some are unwilling to decrease consumption. Our study sought to identify factors associated with women's unwillingness to decrease their alcohol intake to decrease their breast cancer risk.

METHODS

942 women in a screening mammography cohort were asked questions about their demographics, personal and family health history, lifestyle factors, and willingness/unwillingness to decrease alcohol intake to decrease their breast cancer risk. Univariate and multivariate analyzes of their responses were performed.

RESULTS

13.2% of women in our cohort indicated they were unwilling to decrease their alcohol intake to reduce their breast cancer risk. After adjusting for potential confounders, women who were 60 years and older were more than twice as unwilling to decrease their alcohol intake compared to their younger counterparts (P = .0002). Women who had an annual household income of more than $200,000 were 1.75 times more unwilling to decrease their alcohol intake compared to their less affluent counterparts (P = .033). Unwillingness was not significantly associated with race/ethnicity, education, having a first-degree family member with cancer, health perception, breast cancer risk perception, or BMI.

CONCLUSIONS

Levels of unwillingness to decrease alcohol intake differed by age and household income. An opportunity is present to potentially decrease breast cancer risk in the community by educating women, especially older and more affluent women, about alcohol as a risk factor for breast cancer and the importance of limiting one's alcohol intake.

Local variation in cannabis use patterns among young adults in the San Francisco Bay Area

This study evaluated whether neighborhood-level disorder, social cohesion, and perceived safety, were associated with days of cannabis use in the prior month in a representative sample of young adults in Alameda and San Francisco Counties in California (N = 1272). We used multiscale geographically weighted regression, modeled by county, to measure associations between cannabis use days and neighborhood attributes, adjusting for sociodemographic characteristics and self-rated health. Positive associations were found between number of cannabis use days and neighborhood disorder, and greater perceived safety. Higher levels of social cohesion predicted fewer cannabis use days. Racial/ethnic, sex and, socioeconomic compositions of participants residing in areas with significant neighborhood-level associations varied substantially, suggesting that risk factors for young adult cannabis use may be highly localized. Public health efforts in cannabis education and intervention should be tailored to fit the culture and composition of local neighborhoods.

Resting-State Functional Connectivity between Putamen and Salience Network and Childhood Body Mass Index

Introduction: Although the putamen has a significant role in reward-seeking and motivated behaviors, including eating and food-seeking, minorities’ diminished returns (MDRs) suggest that individual-level risk and protective factors have weaker effects for Non-Hispanic Black than Non-Hispanic White individuals. However, limited research is available on the relevance of MDRs in terms of the role of putamen functional connectivity on body mass index (BMI). Purpose: Building on the MDRs framework and conceptualizing race and socioeconomic status (SES) indicators as social constructs, we explored racial and SES differences in the associations between putamen functional connectivity to the salience network and children’s BMI. Methods: For this cross-sectional study, we used functional magnetic resonance imaging (fMRI) data of 6473 9–10-year-old Non-Hispanic Black and Non-Hispanic White children from the Adolescent Brain Cognitive Development (ABCD) study. The primary independent variable was putamen functional connectivity to the salience network, measured by fMRI. The primary outcome was the children’s BMI. Age, sex, neighborhood income, and family structure were the covariates. Race, family structure, parental education, and household income were potential moderators. For data analysis, we used mixed-effect models in the overall sample and by race. Results: Higher right putamen functional connectivity to the salience network was associated with higher BMI in Non-Hispanic White children. The same association was missing for Non-Hispanic Black children. While there was no overall association in the pooled sample, a significant interaction was found, suggesting that the association between right putamen functional connectivity to the salience network and children’s BMI was modified by race. Compared to Non-Hispanic White children, Non-Hispanic Black children showed a weaker association between right putamen functional connectivity to the salience network and BMI. While parental education and household income did not moderate our association of interest, marital status altered the associations between putamen functional connectivity to the salience network and children’s BMI. These patterns were observed for right but not left putamen. Other/Mixed Race children also showed a pattern similar to Non-Hispanic Black children. Conclusions: The association between right putamen functional connectivity to the salience network and children’s BMI may depend on race and marital status but not parental education and household income. While right putamen functional connectivity to the salience network is associated with Non-Hispanic White children’s BMI, Non-Hispanic Black children’ BMI remains high regardless of their putamen functional connectivity to the salience network. This finding is in line with MDRs, which attributes diminished effects of individual-risk and protective factors for Non-Hispanic Black children to racism, stratification, and segregation.

National rates and trends of tobacco and substance use disorders among atrial fibrillation hospitalizations

BACKGROUND

Atrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substances abuse.

OBJECTIVE

The main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Also, this study identifies potential population who are more vulnerable to these substance abuse among AF hospitalizations.

METHODS

The National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification code. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD) and drug use disorder (DUD).

RESULTS

Of 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1,851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD, SUD, AUD, and DUD. Among AF hospitalizations, the black race was associated with higher odds of SUD, and DUD. The younger age group (18-35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs.

CONCLUSION

TUD and SUD among AF hospitalizations in the United States mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands for the development of preventive strategies to address multilevel influences.

The effect of perceived interracial competition on psychological outcomes

There remains a dearth of research on causal roles of perceived interracial competition on psychological outcomes. Towards this end, this research experimentally manipulated perceptions of group-level competition between Black and White individuals in the U.S. and tested for effects on negative psychological outcomes. In Study 1 (N = 899), participants assigned to the high interracial competition condition (HRC) reported perceiving more discrimination, behavioral avoidance, intergroup anxiety, and interracial mistrust relative to low interracial competition (LRC) participants. Study 2 -a preregistered replication and extension-specifically recruited similar numbers of only Black and White participants (N = 1,823). Consistent with Study 1, Black and White participants in the HRC condition reported more discrimination, avoidance, anxiety, and mistrust. Main effects for race also emerged: Black participants perceived more interracial competition and negative outcomes. Racial income inequality moderated effects; competition effects were stronger in areas with higher levels of inequality. Implications for theory development are discussed.

Cannabis attitudes and patterns of use among followers of the Allergy & Asthma Network

BACKGROUND

Cannabis use in patients with allergy/asthma, a high-risk group for adverse effects to cannabis, is unknown.

OBJECTIVE

To determine the patterns of use and attitudes toward cannabis in patients with allergy/asthma.

METHODS

An anonymous online survey on cannabis attitudes and use was conducted through the Adult Allergy & Asthma Network. The Asthma Control Test assessed asthma burden. Cluster analyses determined group phenotypes and factor analyses condensed cannabis subjective effects into similar response patterns.

RESULTS

A total of 88 of 489 respondents (18.0%) currently use cannabis with most at the age of less than 50 years old, of female sex, and of White race. Of the noncannabis users (N = 401), 2.5% reported cannabis allergy. Cluster analysis revealed that a liberal attitude toward cannabis was associated with current cannabis use (P < .001). Among current cannabis users, 40.9% of their physicians inquired on cannabis use; only 37.5% of users wanted to discuss cannabis. In addition, 65.9% used cannabis for medical or medical/recreational purposes. Cannabinoids used were tetrahydrocannabinol (33.0%), cannabidiol (19.3%), or both (47.7%). Smoked and vaped cannabis were reported by 53.4% and 35.2%, respectively. Furthermore, 51 cannabis users (58.0%) reported current asthma with 39.2% uncontrolled; of these, 50% smoked cannabis. Compared with current participants with asthma not using cannabis, those currently using cannabis experienced similar levels of asthma control, quality of life, and frequency of asthma exacerbations. Positive effects were endorsed more than negative effects to cannabis (P < .001). Moreover, 19.3% of cannabis users reported coughing that was associated with smoking cannabis (P < .001).

CONCLUSION

Cannabis was used by less than 20% of the respondents with positive effects more frequent than negative effects. Half of cannabis users with uncontrolled asthma smoke cannabis, but only a minority of the physicians inquire about its use.

What explains the concentration of off-premise alcohol outlets in Black neighborhoods?

INTRODUCTION

Greater availability of commercial alcohol is associated with increased alcohol use and related public health problems. Greater alcohol outlet density, a marker of alcohol availability, is associated with poorer and predominantly minority neighborhoods. However, poorer populations, African Americans, and Latinxs report using less alcohol compared to Whites and wealthier groups. We consider the role of structural racism in the social ecology of alcohol availability. Specifically we examine racist urban land use practices in the USA which became codified in the 1930s through Federal Home Owner Lending Corporation (HOLC) designations for assigning parcel values, known as "redlining." Redlining demarcated low-density residential zones for wealthy Whites which excluded poor and non-White people as well as certain businesses, including alcohol retailers. We assessed the impacts of historic redlining on present day risks for exposure to retail alcohol availability in urban Northern California.

METHODS

For six contiguous and demographically diverse Northern California cities we obtained digital renderings of HOLC maps (1937) which demarcated exclusions of people and businesses for 119 neighborhood areas across four land valuation zones. We then identified the most prevalent HOLC rating for each of 520 current Census block groups in the six cities, including a residual category for areas not rated by HOLC. We geolocated all current (2016) off-premise alcohol sales outlets operating in the six cities (N = 401). We used Bayesian spatial Poisson models to relate current alcohol outlet densities and Census-based estimates of neighborhood characteristics to historic HOLC classifications.

RESULTS

Spatial Poisson analyses found far greater contemporary off-premise outlet densities in the lowest-valued HOLC zones than in the highest (median relative rate [RR] 9.6, 95% CI 4.8-22.1). The lowest-valued HOLC zones were also characterized by far higher current percentages of both Black residents (RR 30.4, 95% CI 17.0-54.6) and Hispanic residents (RR 9.7, 95% CI 7.2-12.9).

CONCLUSIONS

Present day risks for exposure to retail alcohol availability were delimited by historic exclusionary land use practices. Current inequitable health risks may be founded on racist spatial projects of past decades.

The Perceived Neighborhood Crime and Hazardous Alcohol Use Among Youth in University of the Northeastern Thailand Context

BACKGROUND

The residents' perceptions of the crime and lack of safety with their neighborhood environment, associated with stress that confers risk for drinking. While many studies have focused on adult drinking, less is known about how subjective neighborhood crime influences drinking during adolescent. We aimed to determine the association of perceived neighborhood crime and youth alcohol use.

STUDY DESIGN

A cross-sectional study.

METHODS

This study was conducted on 1087 university youths from 30 neighborhood clusters in Northeastern Thailand from May 2019 to Mar 2020. The data were collected by self-administered questionnaire. A multilevel logistic regression model was applied to examine the effect of perceived neighborhood crime on hazardous alcohol use.

RESULTS

Most of youths were female, approximately 60.7% reported hazardous alcohol use, and the average perceived neighborhood crime score was 65.1 (standard deviation, 2.1). The perceived neighborhood crime was associated with hazardous alcohol use; a 1-unit increase in the scores for perceived neighborhood crime corresponded to a 20% increase in hazardous alcohol use. The role of perceived neighborhood crime on alcohol use varied among males, but not females.

CONCLUSION

The perceived neighborhood crime plays a role in the increase likelihood of hazardous alcohol use. The consideration of neighborhood crime context is important to design the alcohol preventive and intervention strategies.

Microecological Relationships Between Area Income, Off-Premise Alcohol Outlet Density, Drinking Patterns, and Alcohol Use Disorders: The East Bay Neighborhoods Study

BACKGROUND

Distinguishing the impacts of neighborhood income and off-premise alcohol outlet density on alcohol use has proven difficult, particularly given the conflation of these measures across neighborhood areas. We explicitly test for differential effects related to individual and area income and outlet densities on alcohol use and alcohol use disorders (AUDs) by implementing a stratified microecological sample.

METHODS

The East Bay Neighborhoods Study included a survey of 984 residents of 72 microenvironments within a geographically contiguous 6-city area in California and Systematic social observations of each site. The sites included 18 areas in each of 4 strata (high/low median household income and off-premise outlet density). We assessed 4 outcomes: 28-day drinking frequency, average quantity of alcohol consumed per drinking occasion, 28-day drinking volume, and Alcohol Use Disorders Identification Test (AUDIT) score. We used zero-inflated negative binomial regression with standard errors adjusted for site clusters to relate drinking measures to individual-level age, race/ethnicity, gender, marital status, education, and income, and neighborhood indicators of site strata, physical disorder, and physical decay. An interaction term was tested representing site-level by individual-level income.

RESULTS

Living in a high-income site, regardless of off-premise alcohol outlet density, was associated with more frequent drinking and higher alcohol dependence/problems. Both individual-level income and site-level income were related to greater frequencies of use, but lower income drinkers in high-income areas drank more than comparable drinkers in low-income areas. Study participants living in high-density off-premise alcohol outlet sites drank less frequently but did not differ in terms of either AUDIT scores or heavy drinking from participants living in low-density sites.

CONCLUSIONS

Using a stratified microecological sampling design, we were able to directly assess statistical associations of off-premise outlet density and neighborhood median household income with patterns of drinking and AUDs. Caution should be used interpreting prior study findings linking off-premise outlet densities to drinking.

Disentangling individual and neighborhood differences in the intention to quit smoking in Asian American male smokers

Numerous studies have assessed individual-level factors associated with intention to quit smoking. However, fewer studies have assessed how neighborhood and built environment also contribute towards individual-level behavior. We used baseline data of 340 Chinese and Vietnamese male daily smokers from August 2015 to November 2017 living in the San Francisco Bay Area, who enrolled in a lifestyle intervention trial. The outcome variable was intention to quit in 30 days. To understand the role of contextual factors participants' residential addresses were geocoded, and neighborhood median income, ethnic composition, and tobacco retail density were computed. Individual level analysis suggested that Vietnamese American men had greater intention to quit smoking (OR = 2.90 CI = 1.59, 5.26) in comparison to Chinese Americans. However, after adding neighborhood level factors to the model, no ethnic group difference was observed. Neighborhood household median income (OR = 0.74, CI = 0.64, 0.86) and tobacco retail counts (OR = 0.79, CI = 0.67, 0.94) were negatively associated with intention to quit. Years lived in the U.S. was the only individual level factor associated with intention to quit. By comparing two Asian American groups that live in heterogeneous neighborhoods, we identify key environmental and policy drivers that are associated with quit intention. Future studies aimed at influencing individual-level behavior should take into consideration the neighborhood context and built environment characteristics.

Substance use: Interplay between polygenic risk and neighborhood environment

BACKGROUND

Tobacco, alcohol, and cannabis use are prevalent behaviors that pose considerable health risks. Genetic vulnerability and characteristics of the neighborhood of residence form important risk factors for substance use. Possibly, these factors do not act in isolation. This study tested the interaction between neighborhood characteristics and genetic risk (gene-environment interaction, GxE) and the association between these classes of risk factors (gene-environment correlation, rGE) in substance use.

METHODS

Two polygenic scores (PGS) each (based on different discovery datasets) were created for smoking initiation, cigarettes per day, and glasses of alcohol per week based on summary statistics of different genome-wide association studies (GWAS). For cannabis initiation one PGS was created. These PGS were used to predict their respective phenotype in a large population-based sample from the Netherlands Twin Register (N = 6,567). Neighborhood characteristics as retrieved from governmental registration systems were factor analyzed and resulting measures of socioeconomic status (SES) and metropolitanism were used as predictors.

RESULTS

There were (small) main effects of neighborhood characteristics and PGS on substance use. One of the 14 tested GxE effects was significant, such that the PGS was more strongly associated with alcohol use in individuals with high SES. This was effect was only significant for one out of two PGS. There were weak indications of rGE, mainly with age and cohort covariates.

CONCLUSION

We conclude that both genetic and neighborhood-level factors are predictors for substance use. More research is needed to establish the robustness of the findings on the interplay between these factors.

Residential Socioeconomic Environments and Areca Nut Use in Taiwan: A Comparison with Alcohol and Tobacco Use in Multilevel Analysis

While the association between residential socioeconomic environments and the use of globally common substances such as alcohol and tobacco has been well documented in Western countries, it remains little known about regionally important substances, such as areca nut in Asia. Objective: This study was aimed to develop residential environmental indicators in the context of Taiwan and examine their associations with areca nut use, in comparison to alcohol and tobacco use. Methods: Data were drawn from 13,392 adults across 168 townships in the 2014 National Survey on Substance Use in Taiwan. Residential socioeconomic environment variables were derived from the census and analyzed using factor analysis. Multilevel logistic regression models were used to examine the association of individual- and residential-level factors with the use of areca nut (use/nonuse), alcohol (harmful use, low-risk use, or nonuse), and tobacco (nicotine dependence, regular active use, or nonuse). Results: A three-factor structure of socioeconomic environments derived from 16 residential-level variables consisted of Rural Disadvantage, Affluence, and Family Fragmentation. Multilevel analyses showed that areca nut use was associated with both individual-level (male sex, age group 35-44 years, being divorced/widowed/separated, low educational attainment, and the occupational group of labors) and residential-level (Rural Disadvantaged and Family Fragmented) variables; such a profile was most similar to that of nicotine dependence. Conclusions: A three-factor structure could be derived for the residential-level socioeconomic environments in the Taiwanese context. Rural Disadvantaged and Family Fragmented were associated with areca nut use, which have implications for interventions targeted at the community level.

Space and Place in Alcohol Research

Purpose of review

To summarize the recent literature on social and physical environments and their links to alcohol use and identify empirical research strategies that will lead to a better understanding of alcohol use in contexts.

Recent findings

Recent research has continued to describe the importance of neighborhood and regional contexts on alcohol use, while a smaller emerging scientific literature assesses the impacts of contexts on drinking.

Summary

The dynamic, longitudinal, and multiscale processes by which social and physical structures affect social interactions and substance use have not yet been uncovered or quantified. In order to understand and quantify these processes, assessments of exposures (e.g., how individuals use space) and risks within specific locations are essential. Methods to better assess these exposures and risks include model-based survey approaches, ecological momentary assessment (EMA) and other forms of ecologically- and temporally-specific analyses, affiliation network analyses, simulation models, and qualitative/multi-methods studies.

Neighborhood crime, disorder and substance use in the Caribbean context: Jamaica National Drug Use Prevalence Survey 2016

The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12–65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.

Social media photos of substance use and their relationship to attitudes and behaviors among ethnic and racial minority emerging adult men living in low-income areas

OBJECTIVES

Emerging adult minority males have inequitable negative consequences from substance abuse. They are also frequent users of social media, logging into popular sites up to 25 times per week on average, so there may be opportunities to use these technologies for better understanding and preventing substance use behaviors. Through mobile phone monitoring, this study examined how social media sites are used to post substance use-related images and how posting such images is related to behaviors and attitudes. It also explored how self-presentation of masculinity norms, such as coolness and toughness, was related to posting of substance use-related photos.

METHODS

Instagram and/or Twitter posts of 65 minority males aged 18-25 living in low-income areas were monitored for three months using phone tracking software. Over 2200 posted images were content analyzed to determine if they were related to alcohol or marijuana and if they displayed masculinity norms. Behavioral interviewing was also used to examine alcohol and marijuana attitudes, use, and problematic use. Analyses utilized t-tests and multiple and logistic regression.

RESULTS

Many participants posted at least one substance use-related photo and a strong majority were exposed to such images through their network. Individuals who posted substance use-related images had more "followers." Posting substance-use related photos was related to marijuana use attitudes, behaviors, and problem behaviors, as well as depictions of toughness in photos.

CONCLUSIONS

Social media monitoring has potential for use in identifying individuals at-risk for substance abuse and those who may be perpetuating unhealthy substance use norms.

Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study

OBJECTIVES

Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.

METHODS

The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.

RESULTS

There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.

CONCLUSIONS

This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.

Community social deprivation and availability of substance use treatment and mutual aid recovery groups

Background

The spatial distribution of substance use services impacts their use, with greater access to services associated with more positive outcomes. Findings from availability of primary healthcare indicate service shortages exist in areas characterized by social deprivation. This study investigated whether community social deprivation was associated with a lack of availability of substance use treatment or mutual aid recovery support services.

Methods

This is an ecological analysis investigating the availability of substance use services at a community level in the state of New Hampshire. Several public data sources were combined to represent community social deprivation and availability of substance treatment of mutual aid recovery support groups. Principal components analysis and negative binomial regression were used to test the relationship between community structure and the availability of substance use services.

Results

Community social deprivation was characterized by high rates of poverty, no access to motor vehicles, renter-occupied housing, less than a high school degree, and nonemployment. Communities high in measures of social deprivation were associated with increased availability of both substance use treatment and recovery support services.

Conclusions

Contrary to findings in access to primary healthcare services, social disadvantage was positively related to availability for both types of substance use services. This relationship may reflect the stigma associated with substance use where services associated with stigmatized conditions locate in areas with the least resistance to their presence or be a function of affordability of space. Future research could investigate the relationship between access to services and individual client outcomes.

Confirmed marijuana use and lymphocyte count in black people living with HIV

BACKGROUND

Marijuana is a commonly used recreational substance with purported analgesic and mood enhancing properties. Many people living with HIV identify marijuana as a palliative substance. However, through its main psychoactive component, tetrahydrocannabinol (THC), is known to influence the immune system. The effects of marijuana use in people with HIV are still controversial, with very scant literature in Black adults.

METHODS

The current study determined the differences in the lymphocyte count, specifically the number cluster differentiation 4 and 8 (CD4+ and CD8+), among patients who urine drug tested negative for THC (n = 70) and those who tested positive for THC (n = 25). The sample included 95 Black people living with HIV, 51% female, with a mean age of 46 ± 11 years. Participants provided a urine sample for substance use testing and a trained researcher extracted clinical data from clinical charts on the day of appointment.

RESULTS

After adjusting for demographic and HIV-related covariates, THC-positive patients had significantly higher CD4+ and CD8+ counts than their THC-negative counterparts.

CONCLUSION

These results extend previous HIV-related immunity findings in an underrepresented group, and suggest that THC use does not reduce immune function as measured by CD count. Further research is warranted on the overall effects of THC on immune function in HIV positive patients.

Exploring and visualizing the small-area-level socioeconomic factors, alcohol availability and built environment influences of alcohol expenditure for the City of Toronto: a spatial analysis approach

INTRODUCTION

Many Canadians continue to drink alcohol in excess of the recommended low-risk guidelines. In this study, we visualized the geographic variation of licensed premises alcohol expenditures in Toronto and examined the effects of area-level socioeconomic characteristics, alcohol availability and built environment influences on alcohol expenditures at the Dissemination Area (DA) level.

METHODS

Dissemination Area average total household expenditures on alcohol from licensed premises, from the 2010 Survey of Household Spending, was the main outcome variable. Moran's I and Local Moran's I were used to quantify geographic variation and determine hot spots and cold spots of expenditure. We used DA-level socioeconomic characteristics from the 2006 Census of Canada, and the density of licensed premises and other built environment characteristics from the 2008 DMTI Spatial and 2010 CanMap datasets to predict alcohol expenditures in multivariate spatial regression models.

RESULTS

The results indicated that the most significant area-level predictors of alcohol expenditure were the percentage of individuals in management or finance occupations and the percentage with postsecondary education (one-unit increases associated with 78.6% and 35.0% increases in expenditures respectively). Presence of subway lines in the immediate and neighbouring areas was also significant (one-unit increases resulted in 5% and 28% increases respectively). Alcohol outlet density was also positively associated with alcohol expenditures.

CONCLUSION

The associations identified between licensed premises alcohol expenditures and small-area-level characteristics highlight the potential importance of small-area-level factors in understanding alcohol use. Understanding the small-area-level characteristics of expenditures and geographic variation of alcohol expenditures may provide avenues for alcohol use reduction initiatives and policies.

The association of county-level socioeconomic factors with individual tobacco and alcohol use: a longitudinal study of U.S. adults

Background

Place-based factors have been implicated as root causes of socioeconomic disparities in risky health behaviors such as tobacco and alcohol use. Yet few studies examine the effects of county-level socioeconomic characteristics, despite the fact that social and public health policies are often implemented at the county level. In this study, we tested the hypothesis that county-level socioeconomic disadvantage was associated with individual tobacco and alcohol use.

Methods

The sample included a panel of participants from the National Longitudinal Survey of Youth (N = 9302). The primary predictors were three time-varying measures of socioeconomic disadvantage in an individual’s county of residence: educational attainment, percent unemployment, and per capita income. We first conducted traditional ordinary least squares (OLS) models, both unadjusted and adjusted for individual-level covariates. We then conducted fixed effects (FE) models to adjust for confounding by unmeasured time-invariant individual-level factors.

Results

OLS and FE models yielded contrasting results: higher county-level per capita income was associated with decreased drinking in OLS models and increased drinking in FE models, while decreased county-level educational attainment was associated with decreased smoking in OLS models and more cigarettes per day in FE models. The findings from FE models suggest that OLS models were confounded by unobserved time-invariant characteristics. Notably, the point estimates for the county-level measures were small, and in many cases they may not represent a clinically meaningful effect except at the population level.

Conclusions

These results suggest that county-level socioeconomic characteristics may modestly influence tobacco and alcohol use. Future work should examine the effects of specific county policies that might explain these findings.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6700-x) contains supplementary material, which is available to authorized users.

Do Drinking Motives Mediate the Relationship between Neighborhood Characteristics and Alcohol Use among Adolescents?

Adolescents not only vary in their alcohol use behavior but also in their motivations for drinking. Young people living in different neighborhoods may drink for different reasons. The aims of this study were to determine if neighborhood characteristics were associated with adolescent drinking motives, and whether drinking motives mediate the relationship between neighborhood context and regular alcohol use. Data from the Scottish Health Behaviours in School-aged Children 2010 survey of students in their 4th year of secondary school were used. The study included 1119 participants who had data on neighborhood characteristics and had used alcohol in the past year. Students were asked questions about the local area where they lived, their alcohol use, and their motives for drinking alcohol, based on the Drinking Motives Questionnaire Revised Short Form (DMQR-SF). Multilevel multivariable models and structural equation models were used in this study. Coping motives showed significant variation across neighborhoods. Structural equation models showed coping motives mediated the relationships between neighborhood deprivation, living in an accessible small-town, and neighborhood-level disorder with regular alcohol use. Public health policies that improve neighborhood conditions and develop adaptive strategies, aimed at improving alcohol-free methods for young people to cope better with life's stresses, may be particularly effective in reducing inequalities in adolescent alcohol use if targeted at small towns and areas of increased deprivation.

The Influence of Tobacco Retailer Density and Poverty on Tobacco Use in a Densely Populated Urban Environment

OBJECTIVES

Researchers have identified associations between neighborhood-level factors (eg, income level, tobacco retailer density) and smoking behavior, but few studies have assessed these factors in urban environments. We explored the effect of tobacco retailer density, neighborhood poverty, and housing type (multiunit and public) on smoking in a large urban environment (New York City).

METHODS

We used data on smoking prevalence and individual sociodemographic characteristics from the 2011-2013 New York City Community Health Survey, data on tobacco retailers from the 2012 New York City Department of Consumer Affairs, data on neighborhood sociodemographic characteristics and population density from the 2009-2013 American Community Survey, and data on multiunit and public housing from the 2012 New York City Primary Land Use Tax Lot Output data set. We used aggregate neighborhood-level variables and ordinary least squares regression, geographic weighted regression, and multilevel models to assess the effects of tobacco retailer density and neighborhood poverty on smoking prevalence, adjusting for sociodemographic characteristics (age, sex, race/ethnicity, and education) and neighborhood population density. We also assessed interactions between tobacco retailer density and poverty and each housing type on smoking.

RESULTS

Neighborhood poverty positively and significantly modified the association between tobacco retailer density and prevalence of neighborhood smoking ( β = 0.003, P = .01) when we controlled for population density, sociodemographic characteristics, and types of housing. Neighborhood poverty was positively associated with the prevalence of individual smoking ( β = 0.0099, P < .001) when we adjusted for population density, sociodemographic characteristics, and type of housing.

CONCLUSION

More research is needed to determine all the environmental factors associated with smoking prevalence in a densely populated urban environment.

Rural Incarcerated Women: HIV/HCV Knowledge and Correlates of Risky Behavior

Rural incarcerated women have an increased risk of acquiring the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) due to prevalent engagement in drug use and sexual behaviors. Limited research has investigated HIV and HCV knowledge in this high-risk population. Furthermore, the interplay of sociodemographic factors (i.e., education, age, income, and sexual orientation) and risky behavior is understudied in this population. The present study evaluated a sample of adult, predominately White women from rural Kentucky ( n = 387) who were recruited from local jails. The sample had high HIV and HCV knowledge but also reported extensive risk behaviors including 44% engaging in sex work and 75.5% reporting a history of drug injection. The results of multiple regression analysis for risky sexual behavior indicated that sexual minority women and those with less HIV knowledge were more likely to engage in high-risk sexual behaviors. The regression model identifying the significant correlates of risky drug behavior indicated that HIV knowledge, age, and income were negative correlates and that sexual minority women were more likely to engage in high-risk drug use. When HCV knowledge was added to the regression models already including HIV knowledge, the interaction was significant for drug risk. Interventions for rural imprisoned women should consider the varied impact of sociodemographic background and prioritize HIV education to more effectively deter risky sexual and drug behaviors.