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Murphy JP, Smart R, Schell TL, Nicosia N, Naimi TS. Relationships of State Alcohol Policy Environments With Homicides and Suicides. Am J Prev Med 2024:S0749-3797(24)00114-4. [PMID: 38604458 DOI: 10.1016/j.amepre.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Alcohol use is involved in a large proportion of homicides and suicides each year in the U.S., but there is limited evidence on how policies targeting alcohol influence violence in the U.S. CONTEXT Extant studies generally focus on individual policies in isolation of each other. This study examines the impacts of changes in states' alcohol policy restrictions on overall homicide and suicide rates and firearm-related homicide and suicide rates using a holistic measure of states' alcohol policy environments. METHODS Using a composite measure of state-level alcohol policies (Alcohol Policy Scale) and data from the National Vital Statistics System from 2002 to 2018, this study applied a Bayesian time series model to estimate the impacts of alcohol policy changes on overall and firearm-involved homicide and suicide rates. The analysis was performed in 2023 and 2024. RESULTS A 1 SD change in the Alcohol Policy Scale was associated with a 6% decline in homicide rates both overall (incident rate ratio=0.94; 95% credible interval = 0.89, 1.00) and for firearm homicides specifically (incident rate ratio=0.94, 95% CI=0.88, 1.01). There was no clear association of alcohol policy with suicides. The model predicts that a nationwide increase in alcohol restrictions equivalent to a shift from the 25th to 75th percentile of the scale's distribution would result in almost 1,200 fewer homicides annually. CONCLUSIONS Increases in the restrictiveness of state-level alcohol policies are associated with reductions in homicides. More restrictive alcohol policy environments may offer an opportunity to reduce homicides.
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Affiliation(s)
| | | | | | | | - Timothy S Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Dodig Hundric D, Lotar Rihtaric M, Mandić S, Ricijaš N. The Mediating Effect of Danger Invulnerability in the Relationship Between Sensation Seeking and Gambling Among University Students. J Gambl Stud 2024; 40:219-235. [PMID: 36593423 DOI: 10.1007/s10899-022-10179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 01/04/2023]
Abstract
The association between sensation-seeking and gambling is well established, yet the research on mediators of this relationship is limited. The proposed model of the present study includes sensation seeking as an antecedent variable, danger invulnerability as a mediator, and gambling frequency as an outcome variable.Self-report data obtained from a convenient sample of 641 university students aged 18-40 years (Mage = 21.25; F = 52.7%, M = 47.3%) were analysed. This study supported proposed hypothesis that both sensation seeking and danger invulnerability are in significant positive relation with the frequency of gambling. Moreover, the results show that tested mediation model fit the data well, and that danger invulnerability completely mediates the relationship between sensation seeking and gambling frequency, such that higher sensation seeking is related to higher danger invulnerability and higher danger invulnerability is related to higher gambling frequency. The model explained 42.4% of the variance in danger invulnerability and 32.7% of the variance in gambling frequency. This study underscores the importance of examining both the direct and indirect effects of different variables on gambling behaviour.
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Affiliation(s)
- Dora Dodig Hundric
- Department of Behavioural Disorders, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia.
| | - Martina Lotar Rihtaric
- Department of Criminology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
| | - Sabina Mandić
- Department of Behavioural Disorders, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
| | - Neven Ricijaš
- Department of Behavioural Disorders, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
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Naimi TS, Lira MC, Pessar SC, Smart R, Blanchette J, Pacula RL. Relationships Between Alcohol and Cannabis Policies in U.S. States, 1999-2019. J Stud Alcohol Drugs 2024; 85:254-260. [PMID: 38147075 PMCID: PMC10941819 DOI: 10.15288/jsad.23-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/02/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE A crucial question regarding the public health impacts of cannabis legalization is its impact on alcohol consumption and alcohol-related harm. However, little is known about whether these changing cannabis policies are occurring in liberal or in restrictive alcohol policy environments, either of which likely affect public health outcomes. We constructed comprehensive state-level alcohol and cannabis policy indices and explored relationships between them. METHOD We assessed relationships between the Alcohol Policy Scale (APS) and the Cannabis Policy Scale (CPS) from 1999 to 2019. The APS and CPS were based on 29 and 17 state-level policies, respectively, and each policy was weighted for its relative efficacy and degree of state-year implementation. RESULTS From 1999 to 2019, average state APS scores increased modestly (became more restrictive) by 4.11 points (2019 M = 43.23, range: 24.44-66.31) and average CPS scores decreased (became less restrictive) by 15.33 points (2019 M = 76.40, range: 29.40-95.74) on a 100-point scale. In 2019, average APS scores were similar among states that prohibited (criminalized) possession of cannabis (42.00), decriminalized possession (41.33), legalized medical cannabis (44.36), and legalized recreational cannabis (43.32). Across states, there was no correlation between the restrictiveness of state-level alcohol and cannabis policies (r = .03, p = .37) in unadjusted models, although there was some variation by time, geographic region, and political party, with a weak negative correlation in state fixed-effects models. CONCLUSIONS Although cannabis policies liberalized rapidly from 1999 to 2019, alcohol policies stayed relatively stable and did not differ by degree of cannabis policy liberalization. In general, there were weak associations between cannabis and alcohol policies among states; however, there was some temporal, regional, and political variation.
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Affiliation(s)
- Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Marlene C. Lira
- Clinical Addiction Research and Education (CARE) Unit, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Seema Choksy Pessar
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | | | - Jason Blanchette
- Department of Health Policy, Law, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Rosalie Liccardo Pacula
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
- Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles, California
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Almatar H, Alamri S, Alduhayan R, Alabdulkader B, Albdah B, Stalin A, Alsomaie B, Almazroa A. Visual Functions, Seatbelt Usage, Speed, and Alcohol Consumption Standards for Driving and Their Impact on Road Traffic Accidents. CLINICAL OPTOMETRY 2023; 15:225-246. [PMID: 37814654 PMCID: PMC10560477 DOI: 10.2147/opto.s422635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
Purpose The incidence of road traffic accidents (RTAs) is dramatically increasing worldwide. Consequently, driving and licensing authorities have instituted strict rules and regulations, such as vision standards, restrictions on drunk driving, seat belt usage, and speeding, for driving safety. This study aimed to summarize the global visual standards for driving license issuing and renewal and investigate the effect of driving safety laws on RTA-related death rates in different countries. Methods The study gathered data on visual standards for driving licenses from reliable sources and extracted enforcement scores (drunk driving, seat belt usage, and speeding) and RTA-related death rates from the World Health Organization status report on road safety. The Wilcoxon test explored the association between visual standards and RTA-related death rates, while the Kruskal-Wallis test analyzed the relationship between visual functions and death rates, as well as driving safety enforcement scores and RTA-related death rates. Results The analysis was conducted on 71 countries and 50 states within the United States out of the 193 countries listed by the United Nations. It was found that 116 countries and states required a minimum VA range of 6/6-6/18, while 91 countries and states mandated a similar range for one-eyed drivers. VF testing for driving licenses was necessary in 77 countries and states. No significant association was observed between VA or VF testing and RTA-related death rates. However, countries that conducted more visual function tests demonstrated lower rates of RTA-related fatalities. Furthermore, RTA-related death rates were significantly associated with speeding, drunk driving, and seat belt laws. Conclusion Implementing clear policies regarding vision requirements, maintaining strict rules, and promoting law enforcement on speeding, drunk driving, and seat belt usage are crucial for improving road safety. These measures should be prioritized by driving and licensing authorities worldwide to mitigate the escalating incidence of RTAs.
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Affiliation(s)
- Hessa Almatar
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia
| | - Suhailah Alamri
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia
| | - Reema Alduhayan
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia
| | - Balsam Alabdulkader
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 12372, Saudi Arabia
| | - Bayan Albdah
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research center, Riyadh, 11481, Saudi Arabia
| | - Amritha Stalin
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Barrak Alsomaie
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia
| | - Ahmed Almazroa
- Department of Imaging Research, King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia
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Udesen CH, Hviid SS, Becker U, Tolstrup JS. Alcohol-related mortality in 15–24-year-olds in Denmark (2010–2019): a nationwide exploratory study of circumstances and socioeconomic predictors. Lancet Reg Health Eur 2023; 29:100620. [PMID: 37025107 PMCID: PMC10070885 DOI: 10.1016/j.lanepe.2023.100620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Background Adolescents and young adults aged 15-24 years are disproportionately affected by unnatural deaths, including accidents, suicide and interpersonal violence for which alcohol is a leading risk factor. We aimed to explore the extent of and circumstances surrounding alcohol-related deaths in young people aged 15-24 years and whether socioeconomic background and ethnicity differ in those who died due to alcohol-related causes as compared to the background population. Methods All deaths of 15-24-year-olds occurring in Denmark from 2010 to 2019 were investigated. We manually reviewed death certificates containing information on circumstances, results from autopsies and blood tests, and statements from witnesses. Relevant information published in the media (most often newspaper articles) was included. Our main outcome measures were alcohol-related death and manner of death (accidents (transport accidents, drownings, falls, poisonings), suicide and violence). Further, we designed a population-based case-control study including 10 age- and sex-matched controls per case to test whether there was a socioeconomic gradient in alcohol-related deaths. We used parents' educational level and employment status to define socioeconomic position. Immigration status was used to assess ethnicity. Findings Over the 10-year period, 1783 deaths occurred among 15-24-year-olds. Of those, 1067 (60%) were due to unnatural causes, corresponding to a mortality rate of 14.8 (95% confidence interval: 13.9-15.7) per 100,000. Twelve percent of unnatural deaths (n = 125) were alcohol related, corresponding to a rate of 1.7 (1.4-2.0) per 100,000, and were higher in males (2.9 [2.3-3.4]) than in females (0.6 [0.3-0.8]); thus, males accounted for 105 (84%) of alcohol-related deaths. The majority of alcohol-related deaths occurred on Fridays, Saturdays and Sundays (n = 77, 62%). Accidents accounted for 82% (n = 102) of alcohol-related deaths, followed by suicide (n = 19, 15%) and interpersonal violence (n = 4, 3%). Of all fatal accidents, 102 of 636 (16%) were alcohol related. Of all deaths caused by drownings and falls, 14 of 26 (54%) and 10 of 25 (40%), respectively, were alcohol related. Alcohol-related drownings most often occurred while the deceased was alone, whereas alcohol-related falls most often occurred in relation to parties, involving falls from a window or balcony. Those who died from alcohol-related causes more often had parents with a short education or who were unemployed, as compared to the general population. For example, odds ratios were 3.9 (2.2-7.0) and 1.8 (1.2-2.9) for having parents with short and medium as compared to long educations. The odds ratio for being of Danish origin was 4.0 (1.7-9.5) compared to being first- or second-generation immigrants. Interpretation In 15-24-year-olds, alcohol-related deaths accounted for a substantial proportion of all unnatural deaths. There was substantial socioeconomic inequality in alcohol-related deaths, as has repeatedly been shown for chronic alcohol-related mortality in older adults. Funding Trygfonden.
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Blanchette JG, Pacula RL, Smart R, Lira MC, Pessar SC, Naimi TS. The Cannabis Policy Scale: A New Research and Surveillance Tool for U.S. States. J Stud Alcohol Drugs 2022; 83:829-838. [PMID: 36484580 PMCID: PMC9756403 DOI: 10.15288/jsad.21-00462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/03/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rapid shifts toward cannabis liberalization in the United States have created immense policy variability that is challenging to measure. We developed composite measures to characterize the restrictiveness of U.S. state cannabis policy environments. METHOD Nine panelists, consisting of four research team members and five expert policy consultants, nominated distinct cannabis policies pertaining to cannabis prohibition, medicalization, and legalization for recreational use. For each of the 17 nominated policies, panelists developed implementation ratings and rated each policy's relative efficacy for reducing excessive cannabis use by adults, youth use, and impaired driving. Cannabis Policy Scale scores were then calculated for each state-year for all 50 states from 1999 to 2019 by weighting policies by their efficacy and implementation ratings, and then summing over policies. RESULTS Median Cannabis Policy Scale scores remained stable until 2008, when they started declining (representing policy liberalization), with steeper declines after 2012. In 2019, state Cannabis Policy Scale scores targeting excessive use among the general population ranged from 29.6 to 66.7 for recreational cannabis legalization states, and from 72.4 to 93.4 for medical cannabis legalization states. Cannabis Policy Scale scores using youth-specific and driving-specific efficacy ratings showed similar trends. CONCLUSIONS The Cannabis Policy Scale reflects trends toward liberalization of cannabis policy in many U.S. states. Even within crude policy phenotypes (e.g., medical cannabis programs), Cannabis Policy Scale scores varied considerably between states and over time. The Cannabis Policy Scale is a new measure that can add nuance to cannabis policy research and help assess cannabis policy-outcome relationships.
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Affiliation(s)
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | | | | | - Seema Choksy Pessar
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | - Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
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Hoch AM, Schoenberger SF, Boyle TP, Hadland SE, Gai MJ, Bagley SM. Attitudes and training related to substance use in pediatric emergency departments. Addict Sci Clin Pract 2022; 17:59. [PMID: 36274146 PMCID: PMC9590142 DOI: 10.1186/s13722-022-00339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background In recent years, pediatric emergency departments (PED) have seen an increase in presentations related to substance use among their adolescent patient population. We aimed to examine pediatric emergency medicine (PEM) physicians’ knowledge, attitudes, and beliefs on caring for adolescents with substance use. Methods We conducted a cross-sectional online survey of PEM physicians through the American Academy of Pediatrics Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC) listserv. The 41-item survey contained the following domains: demographics, current protocols and education for managing adolescent substance use, and attitudes about treatment of substance use. We calculated descriptive statistics for each variable within the domains. Results Of 177 respondents (38.2% response rate), 55.4% were female, 45.2% aged ≥ 50 years, 78% worked in a children’s hospital, and 50.8% had > 15 years clinical practice. Overall, 77.8% reported caring for adolescents with a chief complaint related to non-opioid substance use and 26.0% opioid use at least once a month. Most (80.9%) reported feeling comfortable treating major medical complications of substance use, while less than half were comfortable treating withdrawal symptoms. 73% said that they were not interested in prescribing buprenorphine. Conclusions Among this national sample of PEM physicians, 3 of 4 physicians managed substance-related visits monthly, but 52% lacked comfort in managing withdrawal symptoms and 73.1% were not interested in prescribing buprenorphine. Almost all PEM physician identified substance use-related education is important but lacked access to faculty expertise or educational content. Expanded access to education and training for PEM physicians related to substance use is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00339-w.
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Hosseinichimeh N, Williams R, MacDonald R, Li K, Vaca FE. What determines the success of states in reducing alcohol related crash fatalities? A longitudinal analysis of alcohol related crashes in the U.S. from 1985 to 2019. ACCIDENT; ANALYSIS AND PREVENTION 2022; 174:106730. [PMID: 35709595 PMCID: PMC10756063 DOI: 10.1016/j.aap.2022.106730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/03/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
In the United States, nearly 28 people die in alcohol-related motor vehicle crashes every day (1 fatality every 52 min). Over decades, states have enacted multiple laws to reduce such fatalities. From 1982 to 2019, the proportion of drivers in fatal crashes with a blood alcohol concentration (BAC) above 0.01 g/dl declined from 41% to 22%. States vary in terms of their success in reducing alcohol-related crash fatalities. The purpose of this study was to examine factors associated with changes in fatalities related to alcohol-impaired driving at the state level. We created a panel dataset of 50 states from 1985 to 2019 by merging different data sources and used fixed-effect linear regression models to analyze the data. Our two outcome variables were the ratio of drivers in fatal crashes with BAC ≥ 0.01 g/dl to those with BAC = 0.00, and the ratio of those with BAC ≥ 0.08 g/dl to those with BAC < 0.08 g/dl. Our independent variables included four laws (0.08 g/dl BAC per se law, administrative license revocation law, minimum legal drinking age law, and zero tolerance law), number of arrests due to impaired driving, alcohol consumption per capita, unemployment rate, and vehicle miles traveled. We found that the 0.08 g/dl per se law was significantly associated with lower alcohol-related crash fatalities while alcohol consumption per capita was significantly and positively associated with crash-related fatalities. Arrests due to driving under the influence (DUI) and crash fatalities were nonlinearly correlated. In addition, interaction of DUI arrests and two laws (0.08 g/dl BAC per se law, and zero tolerance) were significantly associated with lower crash-related fatalities. Our findings suggest that states which have more restrictive laws and enforce them are more likely to significantly reduce alcohol-related crash fatalities.
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Affiliation(s)
- Niyousha Hosseinichimeh
- Department of Industrial and Systems Engineering, Virginia Tech, 7054 Haycock Road, Falls Church, VA 22043, USA.
| | - Ross Williams
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Rod MacDonald
- School of Integrated Sciences, James Madison University, Harrisonburg, VA, USA
| | - Kaigang Li
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Federico E Vaca
- Department of Emergency Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
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Romm KF, Patterson B, Wang Y, Wysota CN, Bar-Zeev Y, Levine H, Berg CJ. Drivers and Passengers in Vehicles Driven Under the Influence of Alcohol or Marijuana: Behavior Profiles and Risk Factors Among Young Adults in a Longitudinal Study. J Stud Alcohol Drugs 2022; 83:342-351. [PMID: 35590174 PMCID: PMC9135000 DOI: 10.15288/jsad.2022.83.342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/29/2021] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE Little research has examined psychosocial influences differentially associated with driving under the influence of alcohol and marijuana (DUIA/DUIM) or of being a passenger in a vehicle driven by someone under the influence of alcohol or marijuana (PVA/PVM). METHOD Using 2019 survey data among 2,375 young adults (M age = 24.66, 57.7% female, 51.2% in states with legal marijuana retail) in a longitudinal study examining vaping retail, we conducted latent class analysis (LCA) to identify classes of DUI-related behaviors and multinomial logistic regression to identify correlates of classes (e.g., individual, interpersonal, policy related). RESULTS A total of 22.6% reported past-month DUIA, 24.1% DUIM, 29.7% PVA, and 27.7% PVM. Of those reporting DUIA, 41.4% reported DUIM, 71.8% PVA, and 40.7% PVM. Of those reporting DUIM, 47.7% reported DUIA, 49.6% PVA, and 83.8% PVM. LCA indicated four classes: alcohol and marijuana risk takers (5.9%), all of whom reported DUIA and DUIM, 81.2% PVA, and 89.2% PVM; marijuana risk takers (14.2%), 45.1% DUIM, 100% PVM, 7.8% PVA, and 0% DUIA; alcohol risk takers (24.1%), 40.1% DUIA, 98.6% PVA, 2.6% DUIM, and 33.8% PVM; and low risk takers (55.8%), 8.7% DUIA, 4.5% DUIM, and 0% PVA/PVM. Relative to the other classes, alcohol and marijuana risk takers were more likely male, heterosexual, and White, and alcohol and marijuana risk takers reported greater depressive symptoms. Influences of parent/peer alcohol versus marijuana use were specific to the respective DUI risk behaviors. No differences emerged for legal marijuana retail. CONCLUSIONS Findings regarding those at particular risk, social influences, and situations under which DUI-related behaviors occur should inform future interventions and research.
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Affiliation(s)
- Katelyn F. Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Brooke Patterson
- Global Health Design, Monitoring & Evaluation, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Christina N. Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
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11
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Romm KF, Patterson B, Wang Y, Wysota CN, Bar-Zeev Y, Levine H, Berg CJ. Drivers and Passengers in Vehicles Driven Under the Influence of Alcohol or Marijuana: Behavior Profiles and Risk Factors Among Young Adults in a Longitudinal Study. J Stud Alcohol Drugs 2022; 83:342-351. [PMID: 35590174 PMCID: PMC9135000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/29/2021] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE Little research has examined psychosocial influences differentially associated with driving under the influence of alcohol and marijuana (DUIA/DUIM) or of being a passenger in a vehicle driven by someone under the influence of alcohol or marijuana (PVA/PVM). METHOD Using 2019 survey data among 2,375 young adults (M age = 24.66, 57.7% female, 51.2% in states with legal marijuana retail) in a longitudinal study examining vaping retail, we conducted latent class analysis (LCA) to identify classes of DUI-related behaviors and multinomial logistic regression to identify correlates of classes (e.g., individual, interpersonal, policy related). RESULTS A total of 22.6% reported past-month DUIA, 24.1% DUIM, 29.7% PVA, and 27.7% PVM. Of those reporting DUIA, 41.4% reported DUIM, 71.8% PVA, and 40.7% PVM. Of those reporting DUIM, 47.7% reported DUIA, 49.6% PVA, and 83.8% PVM. LCA indicated four classes: alcohol and marijuana risk takers (5.9%), all of whom reported DUIA and DUIM, 81.2% PVA, and 89.2% PVM; marijuana risk takers (14.2%), 45.1% DUIM, 100% PVM, 7.8% PVA, and 0% DUIA; alcohol risk takers (24.1%), 40.1% DUIA, 98.6% PVA, 2.6% DUIM, and 33.8% PVM; and low risk takers (55.8%), 8.7% DUIA, 4.5% DUIM, and 0% PVA/PVM. Relative to the other classes, alcohol and marijuana risk takers were more likely male, heterosexual, and White, and alcohol and marijuana risk takers reported greater depressive symptoms. Influences of parent/peer alcohol versus marijuana use were specific to the respective DUI risk behaviors. No differences emerged for legal marijuana retail. CONCLUSIONS Findings regarding those at particular risk, social influences, and situations under which DUI-related behaviors occur should inform future interventions and research.
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Affiliation(s)
- Katelyn F. Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Brooke Patterson
- Global Health Design, Monitoring & Evaluation, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Christina N. Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem – Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington Cancer Center, George Washington University, Washington, DC
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12
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Hosseinichimeh N, MacDonald R, Li K, Fell JC, Haynie DL, Simons-Morton B, Banz BC, Camenga DR, Iannotti RJ, Curry L, Dziura J, Mayes LC, Andersen DF, Vaca FE. Mapping the complex causal mechanisms of drinking and driving behaviors among adolescents and young adults. Soc Sci Med 2022; 296:114732. [PMID: 35078103 PMCID: PMC8925313 DOI: 10.1016/j.socscimed.2022.114732] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/22/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S. METHODS We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review. RESULTS The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving. CONCLUSION This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.
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Affiliation(s)
| | - Rod MacDonald
- School of Integrated Sciences, James Madison University
| | - Kaigang Li
- Department of Health & Exercise Science, Colorado State University
| | | | - Denise L Haynie
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development
| | | | - Barbara C Banz
- Department of Emergency Medicine, Yale School of Medicine,Yale Developmental Neurocognitive Driving Simulation Research Center (DrivSim Lab), Yale School of Medicine
| | - Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine,Yale Developmental Neurocognitive Driving Simulation Research Center (DrivSim Lab), Yale School of Medicine
| | | | - Leslie Curry
- Department of Health Policy and Management, Yale School of Public Health
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine
| | - Linda C Mayes
- Yale Child Study Center, Yale University School of Medicine
| | - David F Andersen
- Rockefeller College of Public Affairs and Policy, University at Albany—SUNY
| | - Federico E. Vaca
- Department of Emergency Medicine, Yale School of Medicine,Yale Developmental Neurocognitive Driving Simulation Research Center (DrivSim Lab), Yale School of Medicine,Yale Child Study Center, Yale University School of Medicine
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13
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Borges G, García-Pacheco JÁ, Familiar-Lopez I. Global estimates of the attributable risk of alcohol consumption on road injuries. Alcohol Clin Exp Res 2021; 45:2080-2089. [PMID: 34748239 DOI: 10.1111/acer.14689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alcohol consumption is one of the main risk factors for death by road injuries, but little is known about the global distribution of the population-attributable risk (PAR) of alcohol use for death by road injuries. METHODS We used publicly available data from the 2019 Global Burden of Disease Study (GBD) to estimate the PAR of alcohol use for 5 types of road injury, globally and individually for available countries, by socio-demographic index (SDI), and by age, sex, and year from 1990 to 2019. RESULTS 6.6% of all road injuries in 2019 were attributable to alcohol consumption, with large variations worldwide; the highest burden was in Europe and among countries classified in the high-middle SDI. PAR was higher in men than in women, and among younger individuals. Important variations in PAR of alcohol were also observed by road injury type, with motorcyclist road injuries having the highest PAR. Overall, PAR showed a small increase during 1990-2019; younger (<39 years old) men showed an increasing trend during this period, while older women had a decreasing trend in PAR. CONCLUSIONS PAR for alcohol and road injuries is not homogenous. Large PAR for alcohol and road deaths was found in Europe, among men, young adults, and motorcyclists. These results could help public health agencies, law enforcement, and the public guide efforts to reduce these deaths.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Ciudad de México, Mexico
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14
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Lira MC, Heeren TC, Buczek M, Blanchette JG, Smart R, Pacula RL, Naimi TS. Trends in Cannabis Involvement and Risk of Alcohol Involvement in Motor Vehicle Crash Fatalities in the United States, 2000‒2018. Am J Public Health 2021; 111:1976-1985. [PMID: 34709858 PMCID: PMC8630490 DOI: 10.2105/ajph.2021.306466] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To assess cannabis and alcohol involvement among motor vehicle crash (MVC) fatalities in the United States. Methods. In this repeated cross-sectional analysis, we used data from the Fatality Analysis Reporting System from 2000 to 2018. Fatalities were cannabis-involved if an involved driver tested positive for a cannabinoid and alcohol-involved based on the highest blood alcohol concentration (BAC) of an involved driver. Multinomial mixed-effects logistic regression models assessed cannabis as a risk factor for alcohol by BAC level. Results. While trends in fatalities involving alcohol have remained stable, the percentage of fatalities involving cannabis and cannabis and alcohol increased from 9.0% in 2000 to 21.5% in 2018, and 4.8% in 2000 to 10.3% in 2018, respectively. In adjusted analyses, fatalities involving cannabis had 1.56 (95% confidence interval [CI] = 1.48, 1.65), 1.62 (95% CI = 1.52, 1.72), and 1.46 (95% CI = 1.42, 1.50) times the odds of involving BACs of 0.01% to 0.049%, 0.05% to 0.079%, and 0.08% or higher, respectively. Conclusions. The percentage of fatalities involving cannabis and coinvolving cannabis and alcohol doubled from 2000 to 2018, and cannabis was associated with alcohol coinvolvement. Further research is warranted to understand cannabis- and alcohol-involved MVC fatalities. (Am J Public Health. 2021;111(11):1976-1985. https://doi.org/10.2105/AJPH.2021.306466).
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Affiliation(s)
- Marlene C Lira
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Timothy C Heeren
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Magdalena Buczek
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Jason G Blanchette
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Rosanna Smart
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Rosalie Liccardo Pacula
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Timothy S Naimi
- Marlene C. Lira is with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA. Timothy C. Heeren is with the Department of Biostatistics, Boston University School of Public Health, Boston. Magdalena Buczek is with the Boston University School of Medicine, Boston. Jason G. Blanchette is with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Rosanna Smart is with RAND Corporation, Santa Monica, CA. Rosalie Liccardo Pacula is with the Department of Health Policy and Management, Sol Price School of Public Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. Timothy S. Naimi is with the Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
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Did "Conduce Sin Alcohol" a Program that Monitors Breath Alcohol Concentration Limits for Driving in Mexico City Have an Effect on Traffic-Related Deaths? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:979-984. [PMID: 32671671 DOI: 10.1007/s11121-020-01133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In September 2003, Mexico City introduced "Conduce sin Alcohol" (CSA)-drive without alcohol-a program that monitors breath alcohol concentration limits among drivers to reduce road traffic crashes. To our knowledge, no study has evaluated the impact of this program on mortality. We estimated the effect of CSA on the monthly rate of traffic-related deaths (deaths per one million people) in Mexico City. We applied interrupted time series analyses (ITSA) using monthly data from 1998 to 2016, adjusting for number of people covered by a public health insurance, monthly number of public health care facilities in the city, monthly average rain precipitation in milliliters, and number of vehicles registered. Our results show a statistically significant average reduction in the monthly trend of traffic-related deaths of 0.08 per 1 million people/per month after the program was implemented relative to the pre-intervention trend. The relative difference comparing pre- and post-intervention predicted values from the ITSA model shows that there was a 23.2% reduction in the fatality rate. Findings from this study can be used to scale up programs to monitor alcohol concentration limits among drivers in cities with high alcohol-related crashes and deaths where the program has not been implemented.
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Berlin H, Coughenour C, Pharr J, Bungum TJ, Manlove H, Shan G. The Impact of an Educational Intervention on Distracted Driving Knowledge, Attitudes, and Behaviors Among College Students. J Community Health 2021; 46:1236-1243. [PMID: 34215995 DOI: 10.1007/s10900-021-01014-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
Distracted driving indiscriminately kills nearly 3500 people each year with young adults having greater risks associated with this phenomenon. Prevention programs targeting the distracted driving habits of young adults are necessary to ameliorate the high costs, both in dollars and in lives, associated with this behavior. Few health education and prevention programs have been assessed for their effectiveness in changing knowledge, attitudes, and behaviors related to distracted driving. This study explores a distracted driving intervention among undergraduate students enrolled in an introductory public health course. A quasi-experimental study design was used to compare the pre- and post-data of the group receiving 5-weeks of a distracted driving intervention to a control group. Questionnaires were administered to both groups prior to and 2 weeks following the intervention to assess changes in knowledge, attitudes, and behaviors related to distracted driving. A Difference-in-Difference technique showed significant changes in knowledge (β = 0.40, p = 0.03) and total scores (β = 2.48, p = 0.04) in the intervention (n = 97) compared to the control (n = 131). T-tests examining pre- and post-scores for individual behaviors showed the intervention group displayed positive changes for some behaviors (talking, texting, cellphone use, grooming) compared to the control. The results support the impact that a classroom-based distracted driving intervention can have on undergraduate college students. Implications for this type of health education program may lead to improvements in distracted driving attitudes and behavior among this age-group.
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Affiliation(s)
- Helena Berlin
- School of Public Health, University of Nevada - Las Vegas, 4700 S. Maryland Parkway, Suite 335, Box 3063, Las Vegas, NV, 89119, USA
| | - Courtney Coughenour
- School of Public Health, University of Nevada - Las Vegas, 4700 S. Maryland Parkway, Suite 335, Box 3063, Las Vegas, NV, 89119, USA
| | - Jennifer Pharr
- School of Public Health, University of Nevada - Las Vegas, 4700 S. Maryland Parkway, Suite 335, Box 3063, Las Vegas, NV, 89119, USA
| | - Timothy J Bungum
- School of Public Health, University of Nevada - Las Vegas, 4700 S. Maryland Parkway, Suite 335, Box 3063, Las Vegas, NV, 89119, USA.
| | - Heidi Manlove
- Oregon Department of Transportation, Salem, OR, 97302, USA
| | - Guogan Shan
- School of Public Health, University of Nevada - Las Vegas, 4700 S. Maryland Parkway, Suite 335, Box 3063, Las Vegas, NV, 89119, USA
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17
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Turnbull PRK, Khanal S, Dakin SC. The effect of cellphone position on driving and gaze behaviour. Sci Rep 2021; 11:7692. [PMID: 33833300 PMCID: PMC8032768 DOI: 10.1038/s41598-021-87120-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/23/2021] [Indexed: 11/26/2022] Open
Abstract
Legislation frequently restricts the use of cellphones while driving. Despite this, many people continue to interact with cellphones covertly while driving, typically by concealing their device in their lap. This strategy leads to frequent diversion of the drivers' gaze from the road ahead, potentially reducing their driving performance. To evaluate the influence of cellphone use on driving, 30 participants took part in three randomly ordered 7-min virtual reality driving simulations. In each condition, drivers were presented with either (a) no cellphone, (b) a cellphone fixed to the windscreen, or (c) a cellphone positioned at lap level. Their task was to maintain road position and observe speed limits while answering maths problems (delivered intermittently via 'text message') and searching for external target objects. Outcome measures included speed, lane position standard deviation (LPSD), and fixation behaviour, which were compared between trials. In trials where a cellphone was present, participants shifted fixation more frequently, drove approximately 6 km/h faster, exhibited a lower LPSD and spent more time in the correct lane on the road (compared to the no-cellphone condition; all p < 0.001). Cellphone position influenced eye gaze behaviour, with drivers looking at the cellphone less frequently, and the speedometer more frequently. when the cellphone was in their lap compared to when the cellphone was positioned on the windscreen. Our results are consistent with participants driving more cautiously-checking speed and lane position more frequently-when they have a cellphone in the lap. Real-world driving data would be useful to determine whether this change in driving behaviour we observed is sufficient to offset the increased risk introduced by spending less time looking at the road ahead.
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Affiliation(s)
| | - Safal Khanal
- University of Alabama at Birmingham, 1716 University Blvd., Birmingham, AL, 35233, USA
| | - Steven C Dakin
- University of Auckland, 85 Park Rd., Grafton, Auckland, 1023, New Zealand
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
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18
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Duko B, Pereira G, Betts K, Tait RJ, Newnham J, Alati R. Associations of prenatal alcohol exposure and offspring harmful alcohol use: findings from the Raine Study. Drug Alcohol Depend 2020; 217:108305. [PMID: 33032247 DOI: 10.1016/j.drugalcdep.2020.108305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Epidemiological evidence suggests offspring exposed to prenatal alcohol are at increased risk of alcohol use disorders in adulthood. The evidence on the risk of developing harmful alcohol use in adolescence is less clear. METHODS We used data from the Raine Study, a multi-generational birth cohort study, to examine the association between prenatal alcohol exposure and the risk of harmful alcohol use in offspring at the age of 17 years. Log binomial regression was used to estimate the relative risks (RRs) of harmful alcohol use in offspring exposed to maternal alcohol use in the first (early) and third (late) trimesters of pregnancy. Maternal pre-pregnancy alcohol use was used as a negative control for intrauterine exposure for comparison. RESULTS Complete data were available for 1200 mother-offspring pairs. After adjustment for potential confounders, we found increased RRs of harmful alcohol use in offspring born to mothers who consumed four or more standard drinks of alcohol per week during the first trimester [RR 1.45(95% CI: 1.08-1.93)], third trimester [RR 1.34 (95% CI: 1.04-1.72)] and during both trimesters of pregnancy [RR 1.86 (95% CI: 1.16-2.96)]. Maternal pre-pregnancy alcohol use was not associated with an increased risk of harmful alcohol use in offspring [RR 1.15 (95% CI: 0.89-1.48)]. CONCLUSION Observed associations for maternal prenatal alcohol exposure but not maternal pre-pregnancy alcohol use suggests a biological mechanism for intrauterine alcohol exposure on the risk of harmful alcohol use in the offspring.
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Affiliation(s)
- Bereket Duko
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Gavin Pereira
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA 6009, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Kim Betts
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, 7 Parker Place Building 609, Level 2 Technology Park, Bentley, WA 6102, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, 17 Monash Ave, Nedlands, WA 6009, Australia
| | - Rosa Alati
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, Queensland 4068 Australia
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19
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Blanchette JG, Lira MC, Heeren TC, Naimi TS. Alcohol Policies in U.S. States, 1999-2018. J Stud Alcohol Drugs 2020. [PMID: 32048602 DOI: 10.15288/jsad.2020.81.58] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE U.S. policymakers and public health practitioners lack composite indicators (indices) to assess and compare the restrictiveness of state-level alcohol policy environments, conceptualized as the presence of multiple policies in effect in a particular place and time. The purposes of this study were to characterize the alcohol policy environment in each U.S. state and Washington, DC, in 2018, and to examine changes during the past 20 years. METHOD State-specific Alcohol Policy Scale (APS) scores from 1999 to 2018 were based on 29 policies, after weighting each present policy by its efficacy and degree of implementation. Modified APS scores were also calculated on the basis of two sets of mutually exclusive policy subgroups. RESULTS APS scores in 2018 varied considerably between states, ranging from 25.6 to 67.9 on a theoretical scale of 0 to 100; the median score was 43.5 (based on a 0-100 range), and 43 states had scores less than 50. The median change in state APS scores from 1999 to 2018 was positive (+4.9, range: -7.4 to +10.3), indicating increases in the restrictiveness of policy environments, with decreases in only five states. The increases in APS scores were primarily attributable to the implementation of stronger impaired-driving laws, whereas policies to reduce excessive drinking were unchanged. There was no correlation between states' excessive drinking policy scores and their impaired-driving scores (r = .05, p = .74). CONCLUSIONS Based on this policy scale, few states have restrictive policy environments. Although states adopted policies targeting impaired driving during the study period, there was no change in policies to reduce excessive drinking.
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Affiliation(s)
- Jason G Blanchette
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy S Naimi
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts.,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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Mauro KL, Goncalves SF, Sinha R, Ansell E, Chaplin TM. Does Alcohol Initiation in Early-To-Middle Adolescence Predict Changes in Reward Motivation? Evidence of Sex Differences. Alcohol Clin Exp Res 2020; 44:1420-1430. [PMID: 32463517 DOI: 10.1111/acer.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reward motivation has been cross-sectionally correlated with adolescent alcohol use, but the temporal nature of this relationship remains unclear. This project sought to determine whether adolescent alcohol initiation longitudinally predicted changes in reward motivation and behavioral inhibition from early to middle adolescence, and explored the role of adolescent sex in this prediction. METHODS A total of 180 11- to 14-year-olds were recruited and then followed for 3 years to age 14 to 17. Participants self-reported their alcohol use at all time points. We selected participants who were alcohol-naïve at Baseline (early adolescence) and then grouped them based on whether or not they reported alcohol initiation by Year 3 (Y3: middle adolescence). Adolescents completed self-report and experimental (delay discounting) measures of reward motivation and self-report measures of behavioral inhibition at Baseline and Y3. RESULTS Adolescents' alcohol initiation significantly predicted higher Y3 self-reported reward motivation on one measure. Additionally, a significant sex × alcohol initiation interaction was found predicting Y3 task-based reward motivation (delay discounting), with boys' alcohol initiation predicting increased bias toward immediate reward at Y3. There was also a sex × alcohol initiation interaction predicting behavioral inhibition, with girls' alcohol initiation predicting higher behavioral inhibition at Y3. CONCLUSIONS Results suggest that alcohol initiation among adolescents might precede changes in reward motivation, and the effects of alcohol on reward and behavioral inhibition may differ by adolescent sex.
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Affiliation(s)
- Kelsey L Mauro
- From the, Youth Emotion Lab, (KLM, SFG, TMC), George Mason University, Fairfax, Virginia
| | - Stefanie F Goncalves
- From the, Youth Emotion Lab, (KLM, SFG, TMC), George Mason University, Fairfax, Virginia
| | - Rajita Sinha
- Yale Stress Center, (RS), Yale University School of Medicine, New Haven, Connecticut
| | - Emily Ansell
- Biobehavioral Health, (EA), Pennsylvania State University, University Park, Pennsylvania
| | - Tara M Chaplin
- From the, Youth Emotion Lab, (KLM, SFG, TMC), George Mason University, Fairfax, Virginia
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Lira MC, Sarda V, Heeren TC, Miller M, Naimi TS. Alcohol Policies and Motor Vehicle Crash Deaths Involving Blood Alcohol Concentrations Below 0.08. Am J Prev Med 2020; 58:622-629. [PMID: 32192802 PMCID: PMC7174083 DOI: 10.1016/j.amepre.2019.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Motor vehicle crashes are a leading cause of injury death in the U.S. Restrictive alcohol policies protect against crashes involving alcohol above the legal blood alcohol concentration of 0.08%. Characteristics of motor vehicle crash fatalities involving blood alcohol concentrations below the limit and their relationships to alcohol control policies have not been well characterized. METHODS Motor vehicle crash fatality data and crash and decedent characteristics from 2000 to 2015 came from the Fatality Analysis Reporting System and were analyzed in 2018-2019. Alcohol Policy Scale scores characterized alcohol policy environments by state-year. Generalized estimating equation alternating logistic regression models assessed these scores and the odds that a fatality involved alcohol below the legal threshold. RESULTS Of 612,030 motor vehicle crash fatalities, 223,471 (37%) died in alcohol-involved crashes, of which 33,965 (15% of alcohol-involved fatalities or 6% of all fatalities) had a blood alcohol concentration <0.08%. A 10 percentage point increase in Alcohol Policy Scale score, approximating the interquartile range among states, was associated with reduced odds of fatalities involving alcohol <0.08% vs 0.00% (AOR=0.91, 95% CI=0.89, 0.93). These findings held across multiple subgroup analyses by decedent and crash characteristics. Similar results were found for odds of alcohol involvement <0.05% vs 0.00% (AOR=0.90, 95% CI=0.88, 0.93), and ≥0.05% but <0.08% vs <0.05% (AOR=0.93, 95% CI=0.89, 0.96). CONCLUSIONS The number of lower blood alcohol concentration fatalities is substantial. States with more restrictive alcohol policies tend to have reduced odds of lower blood alcohol concentration motor vehicle crashes than states with weaker policies.
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Affiliation(s)
- Marlene C Lira
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vishnudas Sarda
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Matthew Miller
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Timothy S Naimi
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts; Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
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22
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Randle R, Bazargan-Hejazi S, Pen D, Diab S, Shaheen M. Racial and ethnic differences in patients involved in alcohol-impaired motor vehicle crashes and its related clinical outcomes among various age groups in the U.S. TRAFFIC INJURY PREVENTION 2020; 21:115-121. [PMID: 32023129 DOI: 10.1080/15389588.2019.1688312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
Objective(s): 1) to determine whether the proportion of alcohol-impaired patients involved in motor vehicle crashes (MVCs) varies by race/ethnicity within different age groups; 2) to explore the relationship between alcohol impairment, race/ethnicity and clinical outcomes among patients involved in MVCs across age groups.Methods: The 2012 National Trauma Data Bank (NTDB) queried for patients aged 16-55 involved in MVCs who received a blood ethanol test on admission.Results: Of the 44,216 patients involved in MVC, 68% were White, 14% Black, and 13% were Hispanic. About 36% were 16-25 years old, and 19% were 46-55 years old. Alcohol-impaired patients constituted 34% of the patients. The multiple logistic regression analysis of HLOS ≥ 2 days revealed that, when controlling for age, gender, race/ethnicity, insurance status, and the interaction between alcohol impairment and age as well as alcohol impairment and race/ethnicity, alcohol impairment positivity carried a 15% increase in probability of HLOS ≥ 2 days (OR 1.15, p < 0.0001). Additionally, using the 16-25 age group as reference, each of the older age groupings showed an increased probability of HLOS ≥ 2 days with ORs of 1.15, 1.32, and 1.51 for ages 26-35, 36-45, and 46-55, respectively (p-values < 0.0001). Blacks, Hispanics, and Asians/others were less likely than Whites to have HLOS ≥ 2 days with OR of 0.88, 0.89, and 0.88, respectively (p < 0.05). There was no statistically significant difference in the clinical outcome of mortality between races/ethnicities and alcohol-impaired driving.Conclusions: This study demonstrates that the proportions of alcohol-impaired driving and the associated clinical outcomes vary among race/ethnic groups in different age groups. More research is needed to determine the reasons for the observed differences in these vulnerable sub-groups.
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Affiliation(s)
- Ryan Randle
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- David Geffen School of Medicine, UCLA, Los Angeles, California
- Medical Education Program, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Deyu Pen
- Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Sara Diab
- Department of Public Health, University of California, Irvine, California
| | - Magda Shaheen
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- David Geffen School of Medicine, UCLA, Los Angeles, California
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Sheikh A. From Learning Healthcare Systems to Learning Health Systems. Learn Health Syst 2020; 4:e10216. [PMID: 32685684 PMCID: PMC7362675 DOI: 10.1002/lrh2.10216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/13/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Aziz Sheikh
- Primary Care Research and Development, Usher Institute The University of Edinburgh Edinburgh UK
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24
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Ray JG, Guttmann A, Silveira J, Park AL. Mortality in a cohort of 3.1 million children, adolescents and young adults. J Epidemiol Community Health 2020; 74:260-268. [PMID: 31915240 PMCID: PMC7035693 DOI: 10.1136/jech-2019-213365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Many youth deaths occur in the first year of life, from prematurity and anomalies. Detailing mortality after age 1 year may differentially guide preventive strategies in children, adolescents and young adults. METHODS A cohort study in Ontario, Canada comprised 3 139 698 children born from 1990 to 2016. Adjusted HR (aHR) for death between 1 and 24 years were generated, comparing demographic variables and parity. RESULTS After a median of 13.7 years of follow-up, 6930 deaths occurred between ages 1 and 24 years (incidence rate 17.0 per 100 000 person-years), peaking at age 23 years (43.7 per 100 000). The aHR for death was higher among males than females (1.44, 95% CI 1.37 to 1.51), rural versus urban areas (1.48, 95% CI 1.39 to 1.58), lowest versus highest income areas (1.39, 95% CI 1.29 to 1.51) and at parity 1 (1.16, 95% CI 1.10 to 1.23), parity 2 (1.34, 95% CI 1.23 to 1.45), parity 3+ (1.96, 95% CI 1.74 to 2.21), each relative to a child without an older sibling. Among males, the proportion of deaths due to injury jumped from 30% before age 15 years to 65% thereafter, and in females, from 28% to 51%. Intentional self-harm/assault explained 11% of injury-related deaths among males before age 15 years, and 20% thereafter, with respective figures of 18% and 17% for females. Deaths outside of hospital increased with age, from 35% at age 1 year, to 66% at age 22 years. CONCLUSION There is a heightened susceptibility of dying starting at age 15 years, especially among males, from injury, and arising outside of hospital.
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Affiliation(s)
- Joel G Ray
- Medicine, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada .,Psychiatry, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada.,Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jose Silveira
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Blanchette JG, Lira MC, Heeren TC, Naimi TS. Alcohol Policies in U.S. States, 1999-2018. J Stud Alcohol Drugs 2020; 81:58-67. [PMID: 32048602 PMCID: PMC7024811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/05/2019] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE U.S. policymakers and public health practitioners lack composite indicators (indices) to assess and compare the restrictiveness of state-level alcohol policy environments, conceptualized as the presence of multiple policies in effect in a particular place and time. The purposes of this study were to characterize the alcohol policy environment in each U.S. state and Washington, DC, in 2018, and to examine changes during the past 20 years. METHOD State-specific Alcohol Policy Scale (APS) scores from 1999 to 2018 were based on 29 policies, after weighting each present policy by its efficacy and degree of implementation. Modified APS scores were also calculated on the basis of two sets of mutually exclusive policy subgroups. RESULTS APS scores in 2018 varied considerably between states, ranging from 25.6 to 67.9 on a theoretical scale of 0 to 100; the median score was 43.5 (based on a 0-100 range), and 43 states had scores less than 50. The median change in state APS scores from 1999 to 2018 was positive (+4.9, range: -7.4 to +10.3), indicating increases in the restrictiveness of policy environments, with decreases in only five states. The increases in APS scores were primarily attributable to the implementation of stronger impaired-driving laws, whereas policies to reduce excessive drinking were unchanged. There was no correlation between states' excessive drinking policy scores and their impaired-driving scores (r = .05, p = .74). CONCLUSIONS Based on this policy scale, few states have restrictive policy environments. Although states adopted policies targeting impaired driving during the study period, there was no change in policies to reduce excessive drinking.
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Affiliation(s)
- Jason G. Blanchette
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Marlene C. Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy S. Naimi
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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26
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Weitzman ER, Magane KM, Chen PH, Amiri H, Naimi TS, Wisk LE. Online Searching and Social Media to Detect Alcohol Use Risk at Population Scale. Am J Prev Med 2020; 58:79-88. [PMID: 31806270 DOI: 10.1016/j.amepre.2019.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Harnessing engagement in online searching and social media may provide complementary information for monitoring alcohol use, informing prevention and policy evaluation, and extending knowledge available from national surveys. METHODS Relative search volumes for 7 alcohol-related keywords were estimated from Google Trends (data, 2014-2017), and the proportion of alcohol use-related Twitter posts (data, 2014-2015) was estimated using natural language processing. Searching/posting measures were created for all 50 U.S. states plus Washington, D.C. Survey reports of alcohol use and summaries of state alcohol policies were obtained from the Behavioral Risk Factor Surveillance System (data, 2014-2016) and the Alcohol Policy Scale. In 2018-2019, associations among searching/posting measures and same state/year Behavioral Risk Factor Surveillance System reports of recent (past-30-day) alcohol use and maximum number of drinks consumed on an occasion were estimated using logistic and linear regression, adjusting for sociodemographics and Internet use, with moderation tested in regressions that included interactions of select searching/posting measures and the Alcohol Policy Scale. RESULTS Recent alcohol use was reported by 52.93% of 1,297,168 Behavioral Risk Factor Surveillance System respondents, which was associated with all state-level searching/posting measures in unadjusted and adjusted models (p<0.0001). Among drinkers, most searching/posting measures were associated with maximum number of drinks consumed (p<0.0001). Associations varied with exposure to high versus low levels of state policy controls on alcohol. CONCLUSIONS Strong associations were found among individual alcohol use and state-level alcohol-related searching/posting measures, which were moderated by the strength of state alcohol policies. Findings support using novel personally generated data to monitor alcohol use and possibly evaluate effects of alcohol control policies.
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts.
| | - Kara M Magane
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Po-Hua Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hadi Amiri
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Timothy S Naimi
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Lauren E Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, California
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Geographic gender differences in traumatic unintentional injury hospitalization and youth drinking. Drug Alcohol Depend 2019; 205:107701. [PMID: 31726428 DOI: 10.1016/j.drugalcdep.2019.107701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Few studies have used both spatial and non-spatial techniques to the study of alcohol outcomes. The objectives of this study were to identify clusters of traumatic unintentional injury hospitalizations by gender and blood alcohol concentration (BAC), and to determine trends and correlates by BAC levels. METHODS State Trauma Registry data capturing unintentional injuries for those aged 10 to 24 hospitalized with negative and positive BAC levels (n = 6233) were analyzed from 2006 to 2015 for all Chicago block groups. Spatial clustering techniques were applied to detect spatial clusters and Generalized Estimating Equations to determine correlates and trends while controlling for correlation within block groups. RESULTS Regardless of BAC level, hospitalization rates decreased for all age groups between 2006 to 2010 and 2011 to 2015 from 94.41 to 67.69 per 100,000 population. The decline for males hospitalized with positive BAC was 1.4 times greater than the decline for their female counterparts. Risk factors included being male, black or of a minority race, having no private insurance and living in a disadvantaged neighborhood. Male hospitalization rates clustered among 33 census block groups located in three Chicago Community Areas. No clustering was detected for female patients. Motor vehicle accidents were the leading cause of hospitalization. CONCLUSIONS Hospitalizations are decreasing in Chicago, yet the risk is concentrated, with greater decreasing rates among males than females. Spatial approaches can be valuable tools in analyzing substance abuse outcomes, to identify high-risk areas and shifts in risk within a large geographic area.
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Probst J, Zahnd W, Breneman C. Declines In Pediatric Mortality Fall Short For Rural US Children. Health Aff (Millwood) 2019; 38:2069-2076. [DOI: 10.1377/hlthaff.2019.00892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Janice Probst
- Janice Probst is a distinguished professor emerita in the Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, in Columbia
| | - Whitney Zahnd
- Whitney Zahnd is a research assistant professor in the Rural and Minority Health Research Center of the University of South Carolina
| | - Charity Breneman
- Charity Breneman was a postdoctoral fellow in the Rural and Minority Health Research Center of the University of South Carolina at the time the study was performed
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Alcohol policies and alcohol-attributable cancer mortality in U.S. States. Chem Biol Interact 2019; 315:108885. [PMID: 31678112 DOI: 10.1016/j.cbi.2019.108885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although more restrictive alcohol control policies (e.g., higher alcohol taxes) are related to lower levels of alcohol consumption, little is known about the relationship between alcohol policies and rates of alcohol-attributable cancer. METHODS State alcohol policy restrictiveness, as measured by a validated policy scale, were related to state rates of six alcohol attributable cancers in the U.S. from 2006 to 2010 in a lagged, cross-sectional linear regression that controlled for a variety of state-level factors. Cancer mortality rates were from the Center for Disease Control and Prevention's Alcohol-Related Disease Impact application, which uses population-attributable fraction methodology to calculate mortality from cancers of the esophagus, larynx, liver, oropharynx, prostate (male only) and breast (female only). RESULTS More restrictive state alcohol policies were associated with lower cancer mortality rates for the six cancer types overall (beta [β] -0.33; 95% confidence interval [CI] -0.59, -0.07), and among men (β -0.45; 95% CI -0.81, -0.10) and women (β -0.21; 95% CI -0.40, -0.02). A 10% increase in the restrictiveness of alcohol policies (based on the mean APS among states) was associated with an 8.5% decrease in rates of combined alcohol-attributable cancers. In all analyses stratified by cancer subtype and sex, the associations were in the hypothesized direction (i.e., more restrictive state policy environments were associated with lower rates of alcohol-attributable cancers), with the exception of laryngeal cancer among women. CONCLUSION Strengthening alcohol policies is a promising prevention strategy for alcohol-related cancer.
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Asgarian FS, Namdari M, Soori H. Worldwide prevalence of alcohol in fatally injured motorcyclists: A meta-analysis. TRAFFIC INJURY PREVENTION 2019; 20:685-689. [PMID: 31389721 DOI: 10.1080/15389588.2019.1637519] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
Objective: The aim of this study was to estimate the prevalence of alcohol in fatally injured motorcyclists and to determine the factors that are related to the prevalence worldwide. Methods: A systematic review was conducted using PubMed/Medline, ISI Web of Knowledge, and Google Scholar until 2018. Point prevalence with 95% confidence intervals was estimated. The variances of each study were calculated using by binomial distribution formula. Heterogeneity among the studies was tested using Cochran's Q test with a significance level less than .1. The index of changes attributed to heterogeneity (I2) was assessed. Regarding the heterogeneity of the studies, a random effects model was employed to combine the results of the studies. All statistical analyses were performed using STATA Ver. 11 using the meta-analysis commands. Results: Of 916 articles from 2011 to 2018, 12 studies were examined and analyzed based on inclusion criteria. The prevalence of alcohol in fatally injured motorcyclists was 0.30 (95% confidence interval [CI], 0.25-0.35). Subgroup analysis based on the type of country showed that the prevalence of alcohol in fatally injured motorcyclists in developing countries was 34% (95% CI, 0.18-0.49), which was higher than that in developed countries (29%; 95% CI, 0.24-0.33). In addition, the prevalence of alcohol among fatally injured motorcyclists aged 25-35 years was greater than that of other age groups (0.34; 95% CI, 0. 27-0.4). Conclusions: Motorcyclists dominated the picture of fatal crashes and deserve more attention by the public and government. With the proper planning and adoption of health policies, increasing prevalence and complications of the disease will be prevented.
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Affiliation(s)
- Fatemeh Sadat Asgarian
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Mahshid Namdari
- Community Oral Health Department, School of Dentistry, Shahid Beheshti University of Medical Sciences , Tehran , Iran
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Hamid Soori
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Lira MC, Xuan Z, Coleman SM, Swahn MH, Heeren TC, Naimi TS. Alcohol Policies and Alcohol Involvement in Intimate Partner Homicide in the U.S. Am J Prev Med 2019; 57:172-179. [PMID: 31239088 PMCID: PMC6642831 DOI: 10.1016/j.amepre.2019.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intimate partner violence (IPV) results in deaths of both primary and corollary (i.e., nonintimate partner) victims. Alcohol use is a known risk factor for IPV, yet the relationship between alcohol policies and IPV homicides is unclear. This repeated cross-sectional study characterizes alcohol involvement, and the relationship between alcohol policies and alcohol involvement, among victims of IPV homicides in the U.S. METHODS Homicide victim data from 17 states in the National Violent Death Reporting System from 2003 to 2012 were analyzed in 2017-2018. Alcohol Policy Scale scores characterized alcohol policies by state year and were used in generalized estimating equation logistic regression models to predict the odds of alcohol involvement among victims of IPV homicide. RESULTS Among victims of IPV homicide, 36.5% of primary and 41.1% of corollary victims had a blood alcohol concentration (BAC) >0.00%. Of the victims with a positive BAC, 67.6% had a BAC ≥0.08%. In adjusted models, a 10-percentage point increase in Alcohol Policy Scale score was associated with reduced odds of having a positive BAC (AOR=0.77, 95% CI=0.64, 0.93) and having a BAC ≥0.08% (AOR=0.82, 95% CI=0.68, 0.99) among all victims, primary victims (AOR=0.78, 95% CI=0.63, 0.98; AOR=0.82, 95% CI=0.65, 1.04), and corollary victims (AOR=0.61, 95% CI=0.42, 0.89; AOR=0.68, 95% CI=0.48, 0.97). CONCLUSIONS Alcohol use was prevalent among victims of IPV homicide, and more-restrictive alcohol policies were associated with reduced odds of alcohol involvement. Strengthening alcohol policies is a promising strategy to reduce alcohol-involved IPV homicide victimization.
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Affiliation(s)
- Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Ziming Xuan
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Sharon M Coleman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Monica H Swahn
- Department of Epidemiology & Biostatistics, Georgia State University School of Public Health, Atlanta, Georgia
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy S Naimi
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts; Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
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Cheng Z, Zu Z, Lu J, Li Y. Exploring the Effect of Driving Factors on Traffic Crash Risk among Intoxicated Drivers: A case Study in Wujiang. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142540. [PMID: 31315282 PMCID: PMC6678633 DOI: 10.3390/ijerph16142540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/30/2022]
Abstract
Intoxicated driving is a threat to both drivers and other road users. Exploring the association between intoxicated driving factors and traffic crashes is essential for taking effective countermeasures. Most previous works have studied the relation between intoxicated driving and traffic crash based on some large-sized cities. The current study aims to evaluate the effect of driving factors on traffic crashes among intoxicated drivers in a small-sized city in China. Descriptive statistics and binary logistic regression analysis are performed to guide the study, and the data (N = 1010) for the period 2016–2017 in Wujiang (i.e., a small-sized city in China) are employed as the target samples. The results demonstrate age, years of driving experience, road position, week, hour and blood alcohol concentration (BAC) are associated with traffic crashes in Wujiang. Specifically, the age of “18–25”, the years of driving experience of “≤2”, the “road intersection”, the “weekend”, the period of “0:00–6:59” and the BAC of “above 150 mg/100 mL” are more likely to cause traffic crashes among intoxicated drivers. The findings can be referred to make some targeted policies or measures to relieve Wujiang’s intoxicated driving situation and reduce the number of crashes caused by intoxicated driving.
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Affiliation(s)
- Zeyang Cheng
- Jiangsu Key Laboratory of Urban ITS, Southeast University, Nanjing, 211189, China
- Jiangsu Province Collaborative Innovation Center of Modern Urban Traffic Technologies, Southeast University, Nanjing, 211189, China
- School of Transportation, Southeast University, Nanjing, 211189, China
| | - Zhenshan Zu
- Traffic Police Brigade of Wujiang Public Security Bureau, Suzhou, 215200, China
| | - Jian Lu
- Jiangsu Key Laboratory of Urban ITS, Southeast University, Nanjing, 211189, China.
- Jiangsu Province Collaborative Innovation Center of Modern Urban Traffic Technologies, Southeast University, Nanjing, 211189, China.
- School of Transportation, Southeast University, Nanjing, 211189, China.
| | - Yunxuan Li
- Jiangsu Key Laboratory of Urban ITS, Southeast University, Nanjing, 211189, China
- Jiangsu Province Collaborative Innovation Center of Modern Urban Traffic Technologies, Southeast University, Nanjing, 211189, China
- School of Transportation, Southeast University, Nanjing, 211189, China
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Development and Validation of the Policies, Opportunities, Initiatives and Notable Topics (POINTS) Audit for Campuses and Worksites. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050778. [PMID: 30836633 PMCID: PMC6427413 DOI: 10.3390/ijerph16050778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 12/22/2022]
Abstract
Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions (administered, monitored, reviewed) were completed. Results: Cronbach's Alpha for the student-focused POINTS audit was α = 0.787 (34 items, possible points = 65), and for the employee-focused POINTS audit was α = 0.807 (26 items, possible points = 50). A total of 115 student-focused and 33 employee-focused audits were completed. Although there was little evidence of policy presence beyond stimulant standards (smoking and alcohol), there were extensive examples of health initiatives. The student-focused POINTS audit was validated using the Healthier Campus Initiative's survey. Conclusions: POINTS is a web-based audit tool that is valid and useful for pre-assessment, advocacy, benchmarking, and tracking policies for health and well-being for students (campus) and employees (worksite).
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Foster S, Gmel G, Mohler-Kuo M. Light and heavy drinking in jurisdictions with different alcohol policy environments. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 65:86-96. [PMID: 30711804 DOI: 10.1016/j.drugpo.2019.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND A basic, yet untested tenet underlying alcohol control policies is that they should affect both light and heavy drinking, thereby shifting the entire population in a favourable direction. The aim of this study was to test this assumption in young Swiss men. METHODS Cross-sectional self-reported data - from 5755 young Swiss men participating in the Cohort Study on Substance Use Risk Factors (C-SURF), a large cohort study on young men living within 21 jurisdictions across Switzerland - were analysed via nested logistic regression. With this approach, a set of increasingly-heavy drinking patterns was broken down into a set of nested regression models, each one estimating the probability of heavier drinking, conditional on the lighter drinking pattern. Drinking patterns relating to heavy episodic drinking (HED), heavy volume drinking (HVD) on weekends, and workweek drinking, as well as alcohol use disorder (AUD) were examined. The explanatory variable was a previously-used alcohol policy environment index (APEI) reflecting the number of alcohol control policies implemented in each jurisdiction. Conventional and multilevel logistic regression models were tested, adjusted for age, education, linguistic region, urban/rural status, attention-deficit/hyperactivity disorder, depression, sensation seeking, antisocial personality disorder, and unobserved heterogeneity between jurisdictions. RESULTS For HED, weekend HVD, and AUD, negative relationships with the APEI were found, such that with a higher APEI the probability of lighter drinking patterns was increased while the probability of heavier patterns was reduced, including a reduced probability of the heaviest patterns. These relationships were non-linear, however, and tapered off towards the heavy end of the drinking spectrum. No relationship was identified between the APEI and workweek drinking patterns. CONCLUSION Among young Swiss men, stricter alcohol policy environments were associated with a global shift towards lighter drinking, consistent with the basic tenet behind the universal prevention approach.
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Affiliation(s)
- Simon Foster
- Department of Child and Adolescent Psychiatry and Psychotherapy (KJPP), University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland; Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland.
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland; Addiction Switzerland, Lausanne, Switzerland; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of the West of England, Bristol, United Kingdom
| | - Meichun Mohler-Kuo
- Department of Child and Adolescent Psychiatry and Psychotherapy (KJPP), University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland; Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland; La Source, School of Nursing, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
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Soori H, Razzaghi A, Kavousi A, Abadi A, Khosravi A, Alipour A. Risk factors of deaths related to road traffic crashes in World Health Organization regions: A systematic review. ARCHIVES OF TRAUMA RESEARCH 2019. [DOI: 10.4103/atr.atr_59_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chadi N, Bagley SM, Hadland SE. Addressing Adolescents' and Young Adults' Substance Use Disorders. Med Clin North Am 2018; 102:603-620. [PMID: 29933818 DOI: 10.1016/j.mcna.2018.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adolescents and young adults (AYAs) have unique needs and important biopsychosocial differences when compared with older adults who use substances. As their brains continue to develop, youth are especially susceptible to the reinforcing effects of substances in the context of a still-developing capacity for executive control and decision making. In this article, the authors highlight key differences in the neurobiologic, epidemiologic, and relational aspects of substance use found in AYA. They also discuss how best to engage with youth who use substances and how prevention and intervention can be adapted for optimal effectiveness for this distinct and high-risk population.
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Affiliation(s)
- Nicholas Chadi
- Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sarah M Bagley
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA 02118, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Pediatrics, Boston Medical Center, Grayken Center for Addiction, 850 Harrison Avenue, Boston, MA 02118, USA; Department of Medicine, Boston Medical Center, Grayken Center for Addiction, 850 Harrison Avenue, Boston, MA 02118, USA
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA 02118, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
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Naimi TS, Xuan Z, Sarda V, Hadland SE, Lira MC, Swahn MH, Voas RB, Heeren TC. Association of State Alcohol Policies With Alcohol-Related Motor Vehicle Crash Fatalities Among US Adults. JAMA Intern Med 2018; 178:894-901. [PMID: 29813162 PMCID: PMC6145714 DOI: 10.1001/jamainternmed.2018.1406] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and alcohol-related crash fatalities has not been characterized previously to date. OBJECTIVE To examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States. DESIGN, SETTING, AND PARTICIPANTS This investigation was a repeated cross-sectional study in which state alcohol policies (operationalized by the Alcohol Policy Scale [APS]) from 1999 to 2014 were related to motor vehicle crash fatalities from 2000 to 2015 using data from the Fatality Analysis Reporting System (1-year lag). Alternating logistic regression models and generalized estimating equations were used to account for clustering of multiple deaths within a crash and of multiple crashes occurring within states. The study also examined independent associations of mutually exclusive subgroups of policies, including consumption-oriented policies vs driving-oriented policies. The study setting was the 50 US states. Participants were 505 614 decedents aged at least 21 years from motor vehicle crashes from 2000 to 2015. MAIN OUTCOMES AND MEASURES Odds that a crash fatality was alcohol related (fatality stemmed from a crash in which ≥1 driver had a blood alcohol concentration [BAC] ≥0.08%). RESULTS From 2000 to 2015, there were 505 614 adult motor vehicle crash fatalities in the United States, of which 178 795 (35.4%) were alcohol related. Each 10-percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality (adjusted odds ratio [aOR], 0.90; 95% CI, 0.89-0.91); results were consistent among most demographic and crash-type strata. More restrictive policies also had protective associations with alcohol involvement among crash fatalities associated with BACs from greater than 0.00% to less than 0.08%. After accounting for driving-oriented policies, consumption-oriented policies were independently protective for alcohol-related crash fatalities (aOR, 0.97; 95% CI, 0.96-0.98 based on a 10-percentage point increased APS score). CONCLUSIONS AND RELEVANCE Strengthening alcohol policies, including those that do not specifically target impaired driving, could reduce alcohol-related crash fatalities. Policies may also protect against crash fatalities involving BAC levels below the current legal limit for driving in the United States.
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Affiliation(s)
- Timothy S Naimi
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Vishnudas Sarda
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Scott E Hadland
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Marlene C Lira
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Monica H Swahn
- Division of Epidemiology and Biostatistics, Georgia State University School of Public Health, Atlanta
| | - Robert B Voas
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
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Rossheim ME, Greene KM, Stephenson CJ. Activities and Situations When Young Adults Drive Drunk in Rural Montana. Am J Health Behav 2018; 42:27-36. [PMID: 29663978 DOI: 10.5993/ajhb.42.3.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This qualitative study explored activities and situations that often result in young adults driving while under the influence of alcohol in rural Montana. METHODS Eleven focus groups were conducted in 8 rural counties across Montana, and 72 persons (50.7% female, 63.4% college students) aged 18 to 25 years old participated. Focus groups were audio-recorded, transcribed, and narrative text segments were coded independently by 2 researchers. RESULTS Participants noted a variety of situations specific to rural settings that promoted drunk driving by young adults. Drinking at several types of outdoor activities, such as branding events and festivals, facilitated alcohol consumption in underage youth; drunk driving often followed. Underage youth frequently drank while driving along back roads to avoid detection. Drinking while driving, ie, booze cruising, was thought of as a fun activity and sometimes involved firearms, ie, spotlighting. Driving after drinking was seen as necessary to get home or to other locations. CONCLUSIONS Our findings should be used to inform multifaceted community-wide programs aimed at reducing underage alcohol consumption as well as deterring driving after/while drinking. Interventions could include media campaigns, improving enforcement of DUI and underage drinking laws, providing alternative transportation, and passing additional alcohol control laws.
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Affiliation(s)
- Matthew E. Rossheim
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
| | - Kaylin M. Greene
- Department of Sociology and Anthropology, Montana State University, Bozeman, MT, USA
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Jongen S, van der Sluiszen NN, Brown D, Vuurman EF. Single- and dual-task performance during on-the-road driving at a low and moderate dose of alcohol: A comparison between young novice and more experienced drivers. Hum Psychopharmacol 2018; 33:e2661. [PMID: 29878502 PMCID: PMC6001797 DOI: 10.1002/hup.2661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/17/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022]
Abstract
Driving experience and alcohol are two factors associated with a higher risk of crash involvement in young novice drivers. Driving a car is a complex task involving multiple tasks leading to dividing attention. The aim of this study was to compare the single and combined effects of a low and moderate dose of alcohol on single- and dual-task performance between young novice and more experienced young drivers during actual driving. Nine healthy novice drivers were compared with 9 more experienced drivers in a three-way, placebo-controlled, cross-over study design. Driving performance was measured in actual traffic, with standard deviation of lateral position as the primary outcome variable. Secondary task performance was measured with an auditory word learning test during driving. Results showed that standard deviation of lateral position increased dose-dependently at a blood alcohol concentration (BAC) of 0.2 and 0.5 g/L in both novice and experienced drivers. Secondary task performance was impaired in both groups at a BAC of 0.5 g/L. Furthermore, it was found that driving performance in novice drivers was already impaired at a BAC of 0.2 g/L during dual-task performance. The findings suggest that young inexperienced drivers are especially vulnerable to increased mental load while under the influence of alcohol.
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Affiliation(s)
- Stefan Jongen
- Department of Neuropsychology and PsychopharmacologyMaastricht UniversityMaastrichtThe Netherlands
| | | | - Dennis Brown
- Department of Neuropsychology and PsychopharmacologyMaastricht UniversityMaastrichtThe Netherlands
| | - Eric F.P.M. Vuurman
- Department of Neuropsychology and PsychopharmacologyMaastricht UniversityMaastrichtThe Netherlands
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Li K, Ochoa E, Vaca FE, Simons-Morton B. Emerging Adults Riding With Marijuana-, Alcohol-, or Illicit Drug-Impaired Peer and Older Drivers. J Stud Alcohol Drugs 2018; 79:277-285. [PMID: 29553357 PMCID: PMC6019775 DOI: 10.15288/jsad.2018.79.277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the prevalence and covariates among emerging adults of riding with an impaired peer or older adult driver (RWI) because of marijuana (MJ), alcohol (ALC), or illicit drugs (ID). METHOD Data were from Waves 4 (W4, N = 2,085) and 5 (W5, N = 2,116) of the NEXT Generation Health Study, collected in 2013-2014, 1 and 2 years after high school. W5 RWI was specified for substance-specific impaired peer and older adult (peer/older adult) drivers. Multinomial logistic regressions estimated W5 association of substance-specific RWI with W4 RWI, and W5 heavy episodic drinking, MJ use, and school/residence/work status. RESULTS At W5, 33% of the participants reported RWI in the past year, including riding with ALC- (21%), MJ- (17%), and ID- (5%) impaired peer drivers and ALC- (2%), MJ- (4%), and ID- (0.7%) impaired older adult drivers. W4 RWI was associated with W5 RWI with impaired peer/older adult drivers for ALC- (adjusted odds ratio [AOR] = 4.28, 2.69) and MJ-RWI (AOR = 2.34, 3.56). W5 heavy episodic drinking was positively associated with W5 peer ALC-related RWI (AOR = 2.16) and peer/older adult MJ-related RWI (AOR = 2.38, 5.45). W5 MJ use was positively associated with W5 peer ALC-related RWI (AOR = 2.23), peer/older adult MJ-related (AOR = 10.89, 2.98), and peer/older adult ID-related (AOR = 9.34, 4.26) RWI. ID-related RWI was higher among those not attending 4-year college (AOR = 3.38), attending technology school (AOR = 16.23), living on their own (AOR = 6.85), or living on campus (AOR = 11.50). CONCLUSIONS The high prevalence of RWI among emerging adults occurred mostly with ALC- or MJ-impaired peer drivers. The findings support the need for precisely tailored programs to prevent impaired driving according to substance use and age.
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Affiliation(s)
- Kaigang Li
- Department of Health & Exercise Science, Colorado State University, Fort Collins, Colorado,Correspondence may be sent to Kaigang Li at the Department of Health & Exercise Science, Colorado State University, B 215E Moby Complex, Fort Collins, CO 80523, or via email at:
| | - Elizabeth Ochoa
- Department of Environmental and Occupational Health, Colorado School of Public Health, Fort Collins, Colorado
| | - Federico E. Vaca
- Department of Emergency Medicine and Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Bruce Simons-Morton
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Bethesda, Maryland
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Chadi N, Weitzman ER, Levy S. Understanding the Impact of National and State Medical Marijuana Policies on Adolescents. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0191-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Naimi TS, Xuan Z, Coleman SM, Lira MC, Hadland SE, Cooper SE, Heeren TC, Swahn MH. Alcohol Policies and Alcohol-Involved Homicide Victimization in the United States. J Stud Alcohol Drugs 2017; 78:781-788. [PMID: 28930066 PMCID: PMC5675429 DOI: 10.15288/jsad.2017.78.781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the associations between the alcohol policy environment and alcohol involvement in homicide victims in the United States, overall and by sociodemographic groups. METHOD To characterize the alcohol policy environment, the presence, efficacy, and degree of implementation of 29 alcohol policies were used to determine Alcohol Policy Scale (APS) scores by state and year. Data about homicide victims from 17 states from 2003 to 2012 were obtained from the National Violent Death Reporting System. APS scores were used as lagged exposure variables in generalized estimating equation logistic regression models to predict the individual-level odds of alcohol involvement (i.e., blood alcohol concentration [BAC] > 0.00% vs. = 0.00% and BAC ≥ 0.08% vs. ≤ 0.079%) among homicide victims. RESULTS A 10 percentage point increase in APS score (representing a more restrictive policy environment) was associated with reduced odds of alcohol-involved homicide with BAC greater than 0.00% (adjusted odds ratio [AOR] = 0.89, 95% CI [0.82, 0.99]) and BAC of 0.08% or more (AOR = 0.91, 95% CI [0.82, 1.02]). In stratified analyses of homicide victims, more restrictive policy environments were significantly protective of alcohol involvement at both BAC levels among those who were female, ages 21-29 years, Hispanic, unmarried, victims of firearm homicides, and victims of homicides related to intimate partner violence. CONCLUSIONS More restrictive alcohol policy environments were associated with reduced odds of alcohol-involved homicide victimization overall and among groups at high risk of homicide. Strengthening alcohol policies is a promising homicide prevention strategy.
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Affiliation(s)
- Timothy S. Naimi
- Section of General Internal Medicine, Boston
Medical Center, Boston, Massachusetts,Department of Community Health Sciences,
Boston University School of Public Health, Boston, Massachusetts,Correspondence may be sent to Timothy S. Naimi
at the Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts
Ave., 2nd Floor, Boston, MA 02118, or via email at:
| | - Ziming Xuan
- Department of Community Health Sciences,
Boston University School of Public Health, Boston, Massachusetts
| | - Sharon M. Coleman
- Data Coordinating Center, Boston University
School of Public Health, Boston, Massachusetts
| | - Marlene C. Lira
- Section of General Internal Medicine, Boston
Medical Center, Boston, Massachusetts
| | - Scott E. Hadland
- Department of Pediatrics, Boston University
School of Medicine, Boston, Massachusetts
| | - Susanna E. Cooper
- Section of General Internal Medicine, Boston
Medical Center, Boston, Massachusetts
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University
School of Public Health, Boston, Massachusetts
| | - Monica H. Swahn
- Department of Epidemiology and Biostatistics,
Georgia State University School of Public Health, Atlanta, Georgia
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