Serving Alcohol to an "Obviously Intoxicated" Patron

OBJECTIVE

Alcohol overservice at on-premises establishments is associated with driving while intoxicated, violence, and other harms. This study examined rates of alcohol overservice and service refusal among licensed on-premises establishments in northern California and characteristics of establishments, servers, and pseudo-patrons (PPs) that may be associated with service refusal.

METHOD

In 2022, 300 licensed on-premises establishments were sampled in nine counties representing the San Francisco Bay Area. From July 2022 to January 2023, PP and observer teams visited each establishment, and PPs attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt; characteristics of establishments, servers, and PPs; and month, day, and time were recorded. Descriptive and regression analyses were conducted to address study objectives.

RESULTS

Twenty-one percent of the establishments refused alcohol service to PPs. No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis, nor were month, day, or time. However, service refusal was significantly more likely among female PPs (odds ratio = 3.71, 95% CI [1.67, 8.24], p < .01) and PPs displaying obvious or very obvious signs of intoxication (odds ratio = 9.28, 95% CI [1.99, 43.40], p < .01). There was no significant interaction effect of PP × Server Gender on the likelihood of service refusal.

CONCLUSIONS

This study indicates that alcohol overservice to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol overservice laws are needed to reduce overservice and related harms.

Did the association between alcohol outlet density and crime change during COVID shelter-in-place orders?

INTRODUCTION

We investigated whether greater concentrations of on- and off-sale alcohol outlets were associated with crime and whether this association was moderated by COVID-19 shelter-in-place orders (SIP) that restricted on-premises consumption of alcohol.

METHODS

Crimes (2019-2020) and addresses of licenced alcohol outlets in a medium-sized California city were geocoded within census block groups (N = 61). On- and off-sale alcohol outlet density was calculated as licenced outlets/2.59 km2 (1 square mile). Multilevel negative binomial regression analyses were conducted to examine associations between alcohol outlet density and crime, and possible moderating effects of SIP, controlling for block group demographic characteristics and density of other retail businesses.

RESULTS

On-sale outlet density was positively associated with total crimes and Part 2 crimes, while off-sale outlet density was inversely associated with total crime and Part 2 crimes. Overall, SIP was not significantly associated with crime, but moderated the associations of on-sale density with total crime and Part 1 crimes such that reductions in crime during SIP were observed in higher density areas. The association of off-sale outlets with crime was not moderated by SIP policies.

DISCUSSION AND CONCLUSION

On-sale outlet density, but not off-sale density, appears to be associated with increased crime. The results further indicate that restrictions in hours and service imposed by SIP policies reduced crime in high on-sale outlet density areas. These findings reinforce the importance of regulating alcohol outlet density and hours of service, especially for on-sale outlets, as a crime reduction strategy.

Recreational marijuana legalization and marijuana and alcohol co-use among adolescents: Differential associations among racial and ethnic groups

We examined associations of the 2016 legalization of recreational marijuana (RML) in California with marijuana and alcohol co-use among race/ethnic groups using successive cross-sections from 7th, 9th, and 11th graders (N = 3,319,329) in the 2010-11 to 2018-19 California Healthy Kids Surveys. Multilevel logistic regressions indicated a stronger positive association between RML and co-use among non-Hispanic/Latine White youth (OR = 1.21) relative to Hispanic/Latine (OR = 1.02) or Black youth (OR = 0.85). Among drinkers who had not consumed five or more drinks on any occasion in the past 30-days (non-heavy drinkers), the positive association between RML and co-use was stronger among American Indian/Alaska Native youth (OR = 2.19) compared to non-Hispanic/Latine Whites (OR = 1.56). For heavier drinkers it was stronger for Native Hawaiian/Pacific Islanders (OR = 1.47). Among marijuana users, there was a stronger inverse association between RML and co-use among Black youth (OR = 0.72) compared to non-Hispanic/Latine White youth (OR = 0.84). RML may increase the risk of co-use to a greater extent among non-Hispanic/Latine White youth than other race/ethnic groups in California, but broadly increases the risk among youth who engage in alcohol use or heavy drinking.

Obesity Prevalence and Dietary Factors Among Preschool-Aged Head Start Children in Remote Alaska Native Communities: Baseline Data from the "Got Neqpiaq?" Study

Background: American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska. Methods: The study used baseline data from "Got Neqpiaq?" a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3-5 years, enrolled in Head Start in 12 communities in southwest Alaska (n = 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured. Results: Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels. Conclusions: The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov #NCT03601299.

Recreational Marijuana Legalization, Local Retail Availability, and Alcohol and Marijuana Use and Co-Use Among California High School Students

OBJECTIVE

This study examined whether recreational marijuana legalization (RML) and local retail availability were associated with marijuana and alcohol use and co-use among adolescents.

METHOD

We investigated associations between RML and past-30-day marijuana and alcohol use and co-use, and moderating effects of retail availability of marijuana and alcohol, using data from the 2010-2011 to 2018-2019 California Healthy Kids Surveys (CHKS) of 9th and 11th grade students in 38 California cities. Multilevel mixed-effects logistic regression analyses were conducted, controlling for secular trends and student and city demographics. Additional analyses examined associations of RML and retail availability with co-use among subgroups of drinkers and marijuana users.

RESULTS

For the full sample, RML was inversely associated with alcohol use but was not significantly associated with marijuana use or co-use with alcohol. However, significant interactions between RML and marijuana outlet density showed that there were increases in marijuana and alcohol co-use and alcohol following legalization in cities with higher densities of marijuana outlets. RML was positively associated with co-use among non-heavy and heavy drinkers, but inversely related to co-use among occasional and frequent marijuana users. A significant positive interaction between RML and marijuana outlet density indicated that RML was associated with increases in co-use for occasional marijuana users in cities with higher densities of marijuana outlets.

CONCLUSIONS

RML was associated with increases in marijuana and alcohol co-use and alcohol use among California high school students, particularly those in cities with higher densities of retail cannabis stores, although this varied across alcohol and marijuana use subgroups.

Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework

Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."

Effects of the Universal Prevention Curriculum for Schools on Substance Use Among Peruvian Adolescents: A Randomized Trial

This group-randomized trial assessed the effects of a universal prevention training curriculum for school administrators and teachers that focused on effective strategies to prevent adolescent substance use and related problems. Twenty-eight schools in three regions of Peru were randomly assigned to either an intervention or control condition (14 schools per condition). Repeated cross-sectional samples of 11 to 19-year-old students participated in four surveys from May 2018 to November 2019 (N = 24,529). School administrators and teachers at intervention schools participated in a universal prevention training curriculum focusing on the development of a positive school climate as well as effective policies related to school substance use. All intervention and control schools were offered Unplugged, a classroom-based substance use prevention curriculum. Outcome measures included: lifetime drug use; past-year and past-month tobacco, alcohol, marijuana, and other drug use; awareness of school tobacco and alcohol use policies; perceived enforcement of school policies; school bonding; perceived friends' use of tobacco, alcohol, marijuana and other drugs; and personal problems in general and problems related to substance use. Multi-level analyses indicated significant reductions in past-year and past-month smoking, friends' substance use, and problems related to substance use and in general at intervention relative to control schools. Significant increases were found in intervention vs. control schools related to students' awareness of school substance use policies, perceived likelihood of getting caught for smoking, and school bonding. These findings suggest that the universal prevention training curriculum and the school policy and climate changes it promoted reduced substance use and related problems in the study population of Peruvian adolescents.

Covid-19 Shelter-in-Place, Modified Reopening Orders, and Order Compliance Impact on Adolescent Alcohol Use and Drinking Contexts in California: A Longitudinal Analysis

This study evaluated how Shelter-in-Place (SIP), modified reopening orders, and self-reported compliance with these orders have affected adolescent alcohol frequency and quantity of use across contexts during the COVID-19 pandemic. Materials and Methods: Differences-in-differences (DID) models and multi-level modeling analyses were conducted on longitudinal data collected as part of a larger study on alcohol among adolescents in California. 1,350 adolescents at baseline contributed 7,467 observations for a baseline and 5 six-month follow-up surveys. Analytic samples ranged from 3,577-6,245 participant observations based on models. Alcohol use outcomes included participant frequency (days) and quantity (number of whole drinks) of alcohol use in past 1-month and past 6-month periods. Context-specific alcohol use outcomes included past 6-month frequency and quantity of use at: restaurants, bars/nightclubs, outside, one’s own home, another’s home, and fraternities/sororities. Participant self-reported compliance with orders in essential business/retail spaces and at outdoor/social settings were also assessed. Results: Our DID results indicated that being under a modified reopening order was associated with decreases in past 6-month quantity of alcohol use (IRR=0.72, CI=0.56-0.93, p<0.05). Higher self-reported compliance with SIP orders related to social outdoor/social settings was associated with decreases in overall drinking frequency and quantity as well as decreased frequency and quantity of alcohol use in all contexts in the past six months. Compliance with SIP orders impacting essential businesses and retail spaces was associated with decreased frequency and quantity of use at other’s home and outdoors. Conclusions: Results suggest that SIP and modified reopening policies may not directly affect adolescent alcohol use or drinking contexts, and that individual compliance with such orders may be a protective factor for alcohol use.

California's tobacco 21 minimum sales age law and adolescents' tobacco and nicotine use: differential associations among racial and ethnic groups

OBJECTIVE

A California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents' use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups.

METHODS

Secondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010-11 to 2017-2018.

RESULTS

Multilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups.

CONCLUSIONS

Our findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.

Determining a dosage threshold of drink-driving enforcement operations: A systematic review

ISSUES

Policy enforcement is crucial to achieve impacts on alcohol-related harm. It is not clear what level of enforcement intensity or 'dosage' is necessary for addressing drink driving and related harms. Given competing enforcement demands and agencies' resource constraints, understanding how much enforcement is sufficient to deter drink driving is critical.

APPROACH

This systematic literature review followed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines to examine research about dosage effects of enforcement and related visibility on drink-driving outcomes, including motor vehicle crashes and fatalities. Risk of bias was assessed using the Cochrane Collaboration Effective Practice and Organization of Care tool and the JBI checklist.

KEY FINDINGS

The 21 studies that met the inclusion criteria for this review differed in measures of enforcement dosage and outcomes, making it difficult to synthesise results across studies and draw conclusions about a threshold or optimal level of enforcement. Although most included studies found that sustained enforcement was associated with reductions in drink driving or related harms, only two studies tested an optimal dosage. Due to study design limitations, a substantial percentage of these studies must be considered with caution.

IMPLICATIONS

Additional research with rigorous study designs with appropriate controls is needed to determine an optimal high visibility enforcement dosage level to help law enforcement agencies make realistic decisions about allocating enforcement resources to address drink driving.

CONCLUSION

Consistent evidence about a drink-driving enforcement dosage threshold is lacking, partly due to an insufficient number of well-designed studies. Addressing challenges of conducting rigorous studies in community settings is crucial.

Screening and brief intervention for alcohol use disorder risk in three middle-income countries

Background

This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI.

Methods

Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics.

Results

Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil.

Conclusion

Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14358-4.

Recreational Marijuana Legalization and Co-use With Alcohol Among Adolescents

INTRODUCTION

Little is known about the possible impacts of recreational marijuana legalization on alcohol and marijuana co-use among underage youth. This study examines the association between recreational marijuana legalization in California in 2016 and alcohol and marijuana co-use among adolescents. Additional analyses investigate the associations between recreational marijuana legalization and co-use among past 30-day drinkers and marijuana users and the frequency of alcohol and marijuana use among co-users.

METHODS

This study used annual cross-sectional data from 7th, 9th, and 11th graders (N=3,319,329) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Measures included past 30-day alcohol and marijuana use and student demographic characteristics, survey year, pre-post recreational marijuana legalization, and urbanicity. Multilevel regression analyses were conducted in 2021.

RESULTS

Recreational marijuana legalization was associated with greater odds of past 30-day alcohol and marijuana co-use in the total sample (OR=1.06, 95% CI=1.05, 1.07). Recreational marijuana legalization was more strongly associated with co-use among adolescents who reported past 30-day alcohol use (OR=1.58, 95% CI=1.52, 1.62) and heavy drinking (OR=1.25, 95% CI=1.21, 1.29) but was inversely related to co-use among past 30-day marijuana users (OR=0.76, 95% CI=0.74, 0.78). Among past 30-day co-users, there was a positive association with the frequency of marijuana use (β=0.36, SE=0.07).

CONCLUSIONS

Recreational marijuana legalization may increase the risk of alcohol and marijuana co-use among adolescents. Greater restrictions on the numbers of alcohol and marijuana retail outlets and hours of operation and advertising and higher taxes on alcohol and marijuana products may help reduce the availability of these substances to adolescents.

Relationships Between Social Host Policies, Youth Drinking Contexts, and Age

OBJECTIVE

We examined associations of city-level policies and enforcement operations (i.e., social host laws and party patrol operations) with youth drinking, heavy drinking, and drinking-related problems in private and public drinking contexts. We also examined whether these associations were modified by age.

METHOD

We surveyed 580 youth (ages 16-20 years; 53% male) living in 24 midsized California cities. We used mixed-effects negative binomial and logistic regression to calculate the frequency of youth drinking and heavy drinking and odds of drinking-related problems in each context (own home, friend's home, restaurant, bar, music venue, and outdoors).

RESULTS

There were positive associations between more comprehensive city-level social host policies and frequency of youth drinking and heavy drinking at music venues, and youth heavy drinking and drinking-related problems at restaurants. Younger youth who lived in cities with more comprehensive social host laws drank heavily less frequently in their own home than younger youth living in cities with less comprehensive social host laws. Youth ages 17 or under who lived in cities with more party patrol enforcement had higher odds of problems related to drinking outdoors in the past 12 months than those in cities with fewer party patrol operations.

CONCLUSIONS

City-level alcohol policies and enforcement targeting underage drinking may have differential effects depending on youth drinking contexts and age. Comprehensive social host policies, which aim to decrease drinking in private contexts, may displace or increase youth drinking in other contexts, such as restaurants and music venues. Comprehensive social host policies and party patrol operations may be more influential for younger youth drinking in their own home or outdoors.

Characterizing Vegetable and Fruit Intake in a Remote Alaska Native Community Using Reflection Spectroscopy and 24-Hour Recalls

OBJECTIVE

Characterize vegetable and fruit (VF) intake in a Yup'ik community using self-reported intake and skin carotenoid status (SCS) and evaluate the relationship between SCS and fish intake.

METHODS

Self-reported VF intake was measured using the 24-hour recall, SCS was measured by reflection spectroscopy via the Veggie Meter (Longevity Link Corporation), and fish intake was estimated by the nitrogen isotope ratio (NIR) for 80 participants in a remote community in Southwestern Alaska. Bivariate correlations were used to assess the relationship between self-reported VF intake, SCS, and NIR.

RESULTS

Intake of all VF subgroups was low. The SCS was higher for males (262.7 vs 185.3; P = 0.002) and participants consuming more than 1 VF serving (232.5 vs 183.0; P = 0.02). It was not associated with the NIR.

CONCLUSIONS AND IMPLICATIONS

Increasing VF intake is a way to improve diet in Yup'ik communities and the Veggie Meter is a simple and noninvasive tool to facilitate surveillance efforts.

Compliance with a law to reduce alcoholic beverage sales and service in Zacatecas, Mexico

BACKGROUND

Research on the effects of restricting bar opening hours and alcohol sales in middle-income countries is very limited. We assessed compliance with and possible effects of a law enacted in Zacatecas, Mexico on December 30, 2017 and implemented in 2018 and 2019 that established a 2 AM bar closing time and 10 PM cut-off for alcohol sales by off-premises stores.

METHODS

Monthly observations of bars and off-premises stores and alcohol mystery shopping visits from 2018 to early 2020 were conducted to assess compliance with the law. Breath tests were conducted in 2018 and 2019 with samples of pedestrians in the nighttime entertainment districts of Zacatecas and a comparison city (Aguascalientes). Surveys of bar owners/managers and staff, emergency medical personnel (EMP), and police officers were conducted in Zacatecas in 2018 and 2019 to assess awareness and support of the law and possible effects of the law on alcohol-related problems such as violence and injuries.

RESULTS

Monthly observations indicated that a substantial percentage of bars and off-premises package stores did not comply with the law. Pedestrian breath tests in 2018 and 2019 indicated significant reductions in blood alcohol concentration and heavy drinking among pedestrians in Zacatecas from 11 PM to 2 AM compared to Aguascalientes, but not after 2 AM. Surveys of bar owners/managers indicated that most were aware and supportive of the law. EMP surveys indicated reductions in incidents of physical fighting and drunk or injured customers during the annual September fair in Zacatecas.

CONCLUSIONS

This study suggests that restricting bar opening hours and alcohol sales may not result in full compliance by bars and off-premises stores, but may help to reduce excessive alcohol use and related harms in a middle-income country. A more rigorous evaluation with pre-intervention data is needed, however, to fully address this latter question.

Recreational Marijuana Legalization and Use Among California Adolescents: Findings From a Statewide Survey

OBJECTIVE

The legalization of recreational marijuana use and retail sales raises concerns about possible effects on marijuana use among adolescents. We evaluated the effects of recreational marijuana legalization (RML) in California in November 2016 on use among adolescents and investigated subgroup differences in these effects.

METHOD

We analyzed data from successive cross-sectional samples of 7th, 9th, and 11th grade students (N = 3,330,912) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Participants reported grade, sex, ethnicity, race, and lifetime and past-30-day marijuana use.

RESULTS

Multilevel analyses showed that RML was associated with increases in the likelihood of lifetime (odds ratio = 1.18, 95% CI [1.15, 1.21], p < .01) and past-30-day marijuana use (odds ratio = 1.23, 95% CI [1.20, 1.26], p < .01) relative to previous downward trends. RML was more strongly associated with increases in prevalence of marijuana use among 7th versus 9th and 11th graders, females versus males, non-Hispanic versus Hispanic youth, and White versus African American, American Indian/Native Alaskan, and multiracial youth. Overall, RML was not significantly associated with frequency of past-30-day use among users, although stronger positive associations between RML and frequency of use were found for 11th graders, Asian Americans, and African Americans. The association was weaker for females.

CONCLUSIONS

RML in California was associated with an increase in adolescent marijuana use in 2017-2018 and 2018-2019. Demographic subgroup differences in these associations were observed. Evidence-based prevention programs and greater local control on retail marijuana sales may help to reduce marijuana availability and use among adolescents.

Retail Availability of Recreational Marijuana and Alcohol in Oregon Counties and Co-Use of Alcohol and Marijuana and Related Beliefs among Adolescents

Objective: We investigated whether recreational marijuana legalization (RML) in Oregon in 2015 and recreational marijuana and alcohol retail outlet density levels in Oregon counties were associated with increased alcohol and marijuana co-use and beliefs supportive of alcohol and marijuana use among adolescents. Method: We conducted secondary analyses of biennial data collected from 11th graders who participated in the Student Wellness Survey (SWS) in 36 Oregon counties from 2010 to 2018 (N = 71,870). Multi-level logistic regression analyses assessed changes in past-30-day co-use of alcohol and marijuana, and alcohol- and marijuana-related beliefs after RML in counties with low, medium, and high densities of licensed recreational marijuana and alcohol retail outlets. We used post-RML 2016 and 2018 SWS data to examine whether beliefs accounted for any relationship of recreational marijuana and alcohol outlet density with alcohol and marijuana co-use. Results: We found a significant post-RML increase in past-30-day alcohol and marijuana co-use in 2016 in counties with the highest density of recreational marijuana and alcohol retail outlets. There were significant post-RML increases in perceived risk and parent approval of alcohol and marijuana use. Analyses with 2016 and 2018 SWS data indicated that the relationship between level of recreational marijuana and alcohol retail outlet density and past-30-day alcohol and marijuana co-use was accounted for beliefs about marijuana and alcohol availability, approval by parents, and risk. Conclusion: RML and greater retail availability of recreational marijuana and alcohol were positively associated with alcohol and marijuana co-use among adolescents, and with beliefs favorable to alcohol and marijuana use.

The Contribution of Alcohol Beverage Types to Consumption, Heavy Drinking, and Alcohol-Related Harms: A Comparison across Five Countries

BACKGROUND

This study examined the relative contribution of alcoholic beverage types to overall alcohol consumption and associations with heavy alcohol use and alcohol-related harms among adults.

METHODS

Cross-sectional survey data were collected from adult samples in two cities involved in the Global Smart Drinking Goals (GSDG) initiative in each of five countries (Belgium, Brazil, China, South Africa, United States). Survey measures included past-30-day consumption of beer, wine, flavored alcoholic drinks, spirits, and homemade alcohol; past-30-day heavy drinking; 14 alcohol-related harms in the past 12 months; and demographic characteristics. Within in each country, we computed the proportion of total alcohol consumption for each beverage type. Regression analyses were conducted to estimate the relative associations between consumption of each alcoholic beverage type, heavy alcohol use, and alcohol-related harms, controlling for demographic characteristics.

RESULTS

Beer accounted for at least half of total alcohol consumption in GSDG cities in Belgium, Brazil, the U.S., and South Africa, and 35% in China. Regression analyses indicated that greater beer consumption was associated with heavy drinking episodes and with alcohol-related harms in the cities in Belgium, Brazil, South Africa, and the U.S. Significant increases in heavy drinking and alcohol-related harms were also consistently observed for spirits consumption.

CONCLUSIONS

Beer accounts for the greatest proportion of total alcohol consumption in most of the GSDG cities and was consistently associated with more heavy drinking episodes and alcohol-related harms. Reducing beer consumption through evidence-based interventions may therefore have the greatest impact on hazardous drinking and alcohol-related harms.

Effects of a Community-Level Intervention on Alcohol-Related Motor Vehicle Crashes in California Cities: A Randomized Trial

INTRODUCTION

This trial assesses the effects of a community-level alcohol prevention intervention in California on alcohol-related motor vehicle crashes.

STUDY DESIGN

The study is a group RCT with cities as the unit of assignment to condition and as the unit of analysis.

SETTING/PARTICIPANTS

A total of 24 California cities with populations between 50,000 and 450,000 were chosen at random and roughly matched into pairs before randomly assigning 12 each to the intervention and control conditions.

INTERVENTION

The intervention, aimed at reducing excessive drinking among adolescents and young adults, included driving under the influence sobriety checkpoints, saturation patrols, and undercover operations to reduce service of alcohol to intoxicated patrons in bars, all including high visibility so the public would be aware of them. A measure of overall intervention intensity or dosage was created.

MAIN OUTCOME MEASURES

The outcome was a monthly percentage of all motor vehicle crashes that were single vehicle nighttime crashes for drivers aged 15-30 years.

RESULTS

Multilevel analyses were conducted to examine intervention effects on alcohol-related crashes among drivers aged 15-30 years. Crash data were obtained in 2018 with data preparation and analysis conducted in 2019. Intent-to-treat analyses indicated a 17% reduction in the percentage of alcohol-involved crashes among drivers aged 15-30 years relative to controls, which translates to about 310 fewer crashes. Dosage was found to have a statistically significant effect on crashes among this age group, although not in the expected direction.

CONCLUSIONS

Enhanced alcohol enforcement operations involving both community health and law enforcement agencies can help to reduce alcohol-impaired driving and related consequences among young people. Including measures of intervention dosage raises interesting questions about the understanding of the impact of the community intervention. Future studies should continue to further develop implementation strategies that may more effectively and efficiently reduce community alcohol-related harm.

A Comparison of Chinese Adults Who Consume Homemade versus Commercial Alcohol

Little is known about adults in China who drink homemade alcohol, and whether they are at elevated risk of harms relative to those who drink alcohol from commercial sources. Purpose: We describe and contrast adults in China who regularly consume either homemade or commercially available alcohol, or both. Methods: Household-based in-person interviews were conducted in 2018 with adults in Jiangshan and Lanxi. We examined the characteristics of 833 adults who had consumed alcohol within the previous 30 days, comparing those who drank commercial alcohol only with those who drank homemade alcohol only and alcohol from both sources. Results: Regression analyses revealed that drinkers of both homemade and commercial alcohol consumed more drinks and were more likely to report heavy drinking than did drinkers of commercial or homemade alcohol only and were also more likely to meet criteria for alcohol use disorder. We also found that homemade-only alcohol drinkers were at elevated risk for this disorder. Conclusions: Drinkers of both homemade and commercial alcohol in China may be at risk for alcohol-related problems and constitute a little understood population for whom further research is needed. The AB InBev Foundation supported this study.

Sexual Orientation-Based Alcohol, Tobacco, and Other Drug Use Disparities: The Protective Role of School-Based Health Centers

This study investigated whether the presence of school-based health centers (SBHCs) was associated with six substance use behaviors among sexual minority youth (SMY) and their heterosexual peers. Data from the 2015 Oregon Healthy Teens Survey, including 13,608 11th graders in 137 schools (26 with SBHCs) were used in the current study. Multilevel logistic regression analyses were performed. Results revealed significant SBHC by SMY status interactions indicating a relatively lower likelihood of past 30-day alcohol use (23%), binge drinking (43%), use of e-cigarettes (22%), marijuana (44%), and unprescribed prescription drugs (28%) among SMY in SBHC schools compared with non-SMY at SBHC schools. Furthermore, SMY in SBHC schools reported lower likelihood of aforementioned substance use behaviors than SMY attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY in SBHC and non-SBHC schools. Findings from this study suggest SBHCs may help to mitigate substance use disparities among marginalized populations, such as SMY.

Evaluation of a Mystery Shopper Intervention to Reduce Sales of Alcohol to Minors in Zacatecas and Guadalupe, Mexico

We report the results of a quasi-experimental evaluation of a mystery shopper intervention in Zacatecas and Guadalupe, Mexico. Underage youth attempted to purchase beer at 50 Modelorama stores and 32 Oxxo stores (intervention groups), and at 19 comparison convenience stores in March, July, and August 2018. After each attempt, intervention store operators were informed if a sale was made. Modelorama operators also received training and were warned that repeated sales to minors could jeopardize their franchise. Average sales rates to minors were 63.8% at Modeloramas, 86.5% at Oxxo stores, and 98.2% at comparison stores. The findings suggest that mystery shopper interventions with training, feedback to store operators, and sanctions after repeated sales to underage youth may reduce sales to minors in low- and middle-income countries.

Alcohol Availability, Use, and Harms Among Adolescents in Three Mexican Cities

Alcohol remains readily available to youth in most countries. We examined the associations between both the on- and off-premises commercial availability of alcohol to youth and their alcohol use, heavy episodic drinking, and alcohol-related harms. We conducted the study using data from a survey of a sample of 594 students in central Mexico between 12 and 17 years of age in 2016. Both the perceived availability of alcohol and the purchasing of alcohol at an off-premises establishment were positively related to past-30-day alcohol use and heavy episodic drinking, as well as to alcohol-related harms in the past year. Consumption at on-premises establishments was also positively associated with alcohol-related harms. Preventive efforts to reduce the availability of alcohol at off- and on-premises establishments, by such strategies as mystery shopper and responsible beverage service programs, are imperative.

Recreational Marijuana Availability in Oregon and Use Among Adolescents

INTRODUCTION

This study investigated whether legalization of recreational marijuana sales and retail availability of marijuana in Oregon counties were associated with higher levels of marijuana use and related beliefs among adolescents.

METHODS

Biennial data for 6th, 8th, and 11th graders from the 2010-2018 Student Wellness Survey in 35 Oregon counties (n=247,403) were analyzed in 2019 to assess changes in past 30-day marijuana use and beliefs (e.g., perceived availability of marijuana) in counties that allowed recreational marijuana sales in unincorporated areas beginning in October 2015 versus counties that did not. Analyses were also conducted with 2016 and 2018 Student Wellness Survey data (n=101,419) to determine whether the association between allowing recreational marijuana sales and marijuana use could be accounted for by retail marijuana outlet density and beliefs.

RESULTS

Higher rates of past 30-day marijuana use and more favorable beliefs were observed in counties that allow recreational marijuana sales in unincorporated areas, both before and after legalization of recreational sales in 2015. The prevalence of past 30-day marijuana use increased, relative to the downward secular trend, after legalization both in counties that did and did not allow recreational marijuana sales. There were parallel changes in beliefs favorable to marijuana use. Analyses with 2016 and 2018 Student Wellness Survey data suggested that the association between allowing recreational marijuana sales and past 30-day marijuana use could be accounted for by retail marijuana outlet density and beliefs.

CONCLUSIONS

Legalization and greater retail availability of recreational marijuana are positively associated with marijuana use among adolescents.

Crash patterns in two Chinese secondary cities, with comparisons to crash patterns in the United States

Objective: Evaluations of drink-driving crash interventions and crash burden in middle-income countries often rely on assumptions supported by data from the United States. We described crashes using pooled survey data across 2 Chinese agricultural cities in the 600,000 population range and then assessed comparability of selected crash characteristics to those in the United States.Methods: We conducted household interviews on drinking and related harms with representative samples of 1,500 people aged 18 and over in both Jiangshan and Lanxi, China. Near the end of the survey, 2,962 people responded to questions about motor vehicle crashes during the past year. We report survey data weighted to match the population demographically.Results: Across the 2 cities, 28% of adults were licensed drivers and 24% drove a motorized vehicle. Fifty-three respondents (unweighted) reported that they personally were involved in at least one crash in the past year. Among these, 32% (weighted) were driving a car, truck, or bus; 7.5% were driving a motorcycle; 9.5% were pedalcyclists; 17% were pedestrians; and 34% were passengers. Of the crashes, 42% involved just one motorized vehicle. Most crashes (62%) occurred in broad daylight, followed by at dawn or dusk (19%) and at night (19%). Only 4% were single-vehicle nighttime crashes. Someone was injured or killed in 22% of crashes. Respondents thought it likely that at least one driver was drinking alcohol in 21% of the crashes and thought it unlikely in 51%; the remaining 28% were unsure whether anyone was drinking or refused this question. Alcohol involvement was similar in injury and no-injury crashes. Respondents thought a driver had been drinking in 24% of daytime crashes, 34% of crashes at dawn or dusk, and 36% of nighttime crashes. All 3 crashes involving an alcohol-involved pedestrian or pedalcyclist also included an alcohol-involved driver. Respondents said that 40% of the crashes were reported to the police and 40% were not reported; the remaining 20% of respondents did not know whether anyone reported their crash. Among crashes where reporting status was known, all crashes with injuries were reported.Conclusions: Compared to published data, crash rates are similar among licensed drivers in the United States and these Chinese cities. The percentage of crashes that involved injury did not differ significantly between the 2 countries. Injury crashes were well reported in both. Crashes involving property damage only were significantly less likely to be reported to the police in the Chinese cities. Alcohol involvement rates in crashes were similar. Although our crash sample was small, some crash parameters appear to be transferable between these 2 countries.

Medical Marijuana Legalization and Marijuana Use Among Youth in Oregon

While the legalization of marijuana for medical and recreational use has raised concerns about potential influences on marijuana use and beliefs among youth, few empirical studies have addressed this issue. We examined the association between medical marijuana patients and licensed growers per 1000 population in 32 Oregon counties from 2006 to 2015, and marijuana use among youth over the same period. We obtained data on registered medical marijuana patients and licensed growers from the Oregon Medical Marijuana Program and we obtained data on youth marijuana use, perceived parental disapproval, and demographic characteristics from the Oregon Healthy Teens Survey. Across 32 Oregon counties, the mean rate of marijuana patients per 1000 population increased from 2.9 in 2006 to 18.3 in 2015, whereas the grower rate increased from 3.8 to 11.9. Results of multi-level analyses indicated significant positive associations between rates of marijuana patients and growers per 1000 population and the prevalence of past 30-day marijuana use, controlling for youth demographic characteristics. The marijuana patient and grower rates were also inversely associated with parental disapproval of marijuana use, which decreased from 2006 to 2015 and acted as a mediator. These findings suggest that a greater number of registered marijuana patients and growers per 1000 population in Oregon counties was associated with a higher prevalence of marijuana use among youth from 2006 to 2015, and that this relationship was partially attributable to perceived norms favorable towards marijuana use.

Epidemiology of asphyxiation suicides in the United States, 2005-2014

BACKGROUND

From 2005 to 2014, the asphyxiation suicide rate in the United States (U.S.) increased by 45.7% from 2.45 to 3.57 per 100,000 population. The primary purpose of this cross-sectional study was to describe decedent and incident characteristics of asphyxiation suicides in the U.S. from 2005 to 2014. The secondary purpose of this study was to explore whether any demographic characteristics of asphyxia suicide decedents were associated with type of suicide incident.

METHODS

Data from the National Violent Death Reporting System (NVDRS) were used to describe asphyxiation suicide mechanisms and means in 16 states. Anchor points of hanging suicides were also described. Mechanisms, means, and anchor points were determined through a text search of cause of death, coroner/medical examiner narrative, and law enforcement narrative. Multivariable logistic regression was conducted separately for females and males to estimate beta coefficients to obtain adjusted odds ratios (AORs) and 95% confidence intervals (CIs) to compare hanging-related asphyxiation and other types of asphyxiation.

RESULTS

From 2005 to 2014, there were 25,270 asphyxiation suicides. Most decedents were male (79.9%) and white, non-Hispanic (76.8%). Most asphyxiation suicides involved hanging (90.7%, N = 22,931); 1717 (6.8%) involved smothering; 968 (3.8%) involved chemicals or gasses; and 145 (0.6%) involved strangulation. For hanging suicides, the three most commonly used means were power or extension cords (N = 1834), bedding (N = 873), and animal ropes (N = 578). The three most common anchor points for hanging suicides were trees (N = 2215), beams (N = 2014), and closets (N = 2009). Among females and males, odds of asphyxiation suicide were highest among those of Other, non-Hispanic race and black, non-Hispanic race, respectively [AOR (95% CI) = 3.73 (1.59, 8.79) and 2.72 (1.34, 5.50), respectively].

CONCLUSIONS

Commonly available objects are used in asphyxiation suicides. Modification of anchor points represents a potential solution for reducing hanging suicides. Changes in design and availability of grocery bags could help reduce smothering suicides. Strategies to reduce asphyxiation suicides need to be identified. Improving access to and utilization of mental health services can also reduce asphyxiation suicides. Future research should be conducted to better describe characteristics of asphyxiation suicide so that prevention efforts targeted by demographic subgroups can be implemented.

School-based mental health services, suicide risk and substance use among at-risk adolescents in Oregon

This study examined whether an increase in the availability of mental health services at school-based health centers (SBHCs) in Oregon public schools was associated with the likelihood of suicidal ideation, suicide attempts and substance use behaviors among adolescents who experienced a depressive episode in the past year. The study sample included 168 Oregon public middle and high schools and 9073 students who participated in the Oregon Healthy Teens Survey (OHT) in 2013 and 2015. Twenty-five schools had an SBHC, and 14 of those schools increased availability of mental health services from 2013 to 2015. The OHT included questions about having a depressive episode, suicidal ideation, attempting suicide in the past year, and substance use behaviors in the past 30days. Multi-level logistic regression analyses were conducted in 2017 to examine associations between increasing mental health services and the likelihood of these outcomes. Analysis results indicated that students at SBHC schools that increased mental health services were less likely to report any suicidal ideation [odds ratio (OR) (95% C.I.)=0.66 (0.55, 0.81)], suicide attempts [OR (95% C.I.)=0.71 (0.56, 0.89)] and cigarette smoking [OR (95% C.I.)=0.77 (0.63, 0.94)] from 2013 to 2015 compared to students in all other schools. Lower frequencies of cigarette, marijuana and unauthorized prescription drug use were also observed in SBHC schools that increased mental health services relative to other schools with SBHCs. This study suggests that mental health services provided by SBHCs may help reduce suicide risk and substance use behaviors among at-risk adolescents.

Increasing Parents' Awareness of Social Host Laws: A Pilot Study of Coalition Efforts

States and municipalities across the U.S. are adopting social host ordinances (SHOs) to reduce alcohol use by underage youth in private settings. SHOs are most likely to be effective if parents and other adults are aware of them and they are enforced. We examined the association between a multi-media SHO awareness campaign in northern California municipalities and parents' awareness of SHOs and SHO enforcement. We collected survey data from 1798 parents in a northern California county in fall 2014; all municipalities within the county had SHOs. We conducted descriptive and logistic regression analyses to determine whether parents living in municipalities with a SHO awareness campaign were more likely to be aware of SHOs and SHO enforcement than parents in municipalities without such a campaign. Findings showed that 55.6% of parents in municipalities with a SHO awareness campaign were aware of SHOs compared to 35.7% in municipalities without a campaign. Parents in municipalities with a SHO awareness campaign were also more likely to be aware of SHO enforcement activities (16.3 vs. 8.7%). Regression analyses indicated significant positive associations between the SHO awareness campaign and parental awareness of SHOs and SHO enforcement when controlling for parents' attitudes related to youth drinking, parenting characteristics, normative beliefs regarding other parents' awareness and youth drinking, and demographic characteristics. These findings suggest that a multi-media awareness campaign implemented by coalitions was positively associated with parental awareness of SHOs and perceived SHO enforcement, which may help to prevent or reduce underage drinking.

School-Based Health Centers and Adolescent Substance Use: Moderating Effects of Race/Ethnicity and Socioeconomic Status

BACKGROUND

School-based health centers (SBHCs) have been associated with many positive health and academic outcomes. The current study extends previous research and examines possible differences in the association between SBHC exposure and adolescent alcohol, tobacco, and other drug use by race/ethnicity, sex, and socioeconomic status (SES).

METHODS

California Healthy Kids Survey data from 504 traditional high schools in California were linked with publicly available data on SBHCs and school demographics. Multilevel logistic regression analyses were conducted controlling for school and individual characteristics.

RESULTS

Significant interactions suggest that SBHC exposure was inversely associated with past 30-day alcohol use, binge drinking, and cigarette and e-cigarette use among African American youth and negatively associated with cigarette and marijuana use among Asian youth, relative to whites. There was also a significant interaction between SBHC exposure and parent education for past 30-day alcohol use and binge drinking. No significant sex interactions were observed.

CONCLUSIONS

SBHC exposure appears to be inversely related to substance use among youth in some ethnic minority groups and youth of lower SES. This may have implications regarding SBHC placement and investment. Additional research is necessary to understand the mechanisms through which SBHCs may influence adolescent substance use and other health behaviors.

Places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults

INTRODUCTION AND AIMS

Little is known about social-ecological correlates of simultaneous use of alcohol with other substances. This study examined places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults.

DESIGN AND METHODS

We used survey data obtained from 1538 young adult recent alcohol drinkers (49% male; 18-30 years old) in 24 non-contiguous cities in California. Event-level measures included alcohol, tobacco and marijuana use, drinking places and social characteristics of the event. Individual-level measures included alcohol expectancies, depression and demographics.

RESULTS

Bars and restaurants had less alcohol and marijuana use (odds ratio = 0.34; 95% confidence interval 0.18, 0.62; P < 0.001) and alcohol, marijuana and tobacco use (odds ratio = 0.27; 95% confidence interval 0.14, 0.54; P < 0.001) compared with alcohol use only. Perceived percent of intoxicated people at an event was associated with greater likelihood of using alcohol with tobacco and marijuana at the event. At the individual level, greater age was generally associated with increased odds of simultaneous use. Participants who were male, less educated, more depressed and had positive alcohol expectancies were more likely to simultaneously co-use alcohol with tobacco and marijuana. Those with negative expectancies were less likely to simultaneously use these substances.

DISCUSSION AND CONCLUSIONS

Social events in private settings with a high percentage of people who are intoxicated had increased likelihood of simultaneous use of alcohol, tobacco and marijuana. Prevention efforts in these settings may reduce simultaneous use of these substances and related harms. [Lipperman-Kreda S, Paschall MJ, Saltz RF, Morrison CN. Places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults. Drug Alcohol Rev 2017;00:000-000].

Oregon School-Based Health Centers and Sexual and Contraceptive Behaviors Among Adolescents

This study investigated the association between school-based health centers (SBHCs) and sexual behavior and contraceptive use among 11th graders. The sample included 134 high schools (27 schools with SBHCs) and 11,840 students who participated in the 2015 Oregon Healthy Teens Survey. Multilevel logistic regressions found positive associations between SBHC presence and healthy sexual behavior ( OR = 1.23, p < .05) and contraceptive use ( OR = 1.31, p < .01). Associations were stronger at schools with at least 50% of students receiving free or reduced price lunch. Among SBHC schools, prescribing and dispensing contraceptives onsite was positively related to contraceptive use among students who had sex within the past 3 months ( OR = 1.77, p < .01). Findings suggest that exposure to SBHCs in general, and availability of specific reproductive health services, may be effective population-based strategies to support healthy sexual behaviors among youth.

Party Characteristics, Drinking Settings, and College Students' Risk of Intoxication: A Multi-Campus Study

We examined party characteristics across different college drinking settings, associations between party characteristics and likelihood of drinking to intoxication, and the mediating role of perceived prevalence of intoxicated partygoers. Students (N = 6903) attending 14 public universities in California during the 2010 and 2011 fall semesters completed surveys on individual and party characteristics in six unique settings (e.g., residence hall). We used descriptive statistics to examine party characteristics by setting. We estimated multilevel logistic regression models to identify party characteristics associated with drinking to intoxication, and we used RMediation to determine significance of mediating effects. Individual and party characteristics varied by drinking context. Greater time at a party was associated with drinking to intoxication at five of six settings, while larger party size was significant only for outdoor settings. Enforcing the legal drinking age and refusing to serve intoxicated patrons were associated with lower likelihood of intoxication at Greek and off-campus parties. The presence of a keg was associated with drinking to intoxication at Greek, off-campus and outdoor parties; at bars, cover charges and drink promotions were positively associated with drinking to intoxication. In four of six settings, we found evidence of significant mediating effects through perceived prevalence of intoxicated partygoers. Findings highlight risk and protective characteristics of parties by drinking setting, and have prevention implications.

Relationships between social host laws and underage drinking: findings from a study of 50 California cities

OBJECTIVE

Many states and local communities have enacted social host (SH) laws to reduce underage drinking in private settings. However, little is known about whether such laws are effective. This study examined relationships between city SH laws and underage drinking in general and at parties in private settings.

METHOD

SH policy data were collected for 50 California cities in 2009, and SH policies were rated for comprehensiveness and stringency. Annual telephone interviews were conducted with a cohort of 1,483 adolescents (ages 13-16 at Wave 1) from 2009 to 2011 to assess past-year alcohol use, heavy drinking, and drinking at parties. Multilevel analyses were first conducted for the total sample to examine relationships between SH laws and adolescents' past-year drinking, with other city and individual characteristics controlled for. Parallel analyses were then conducted for a subsample of 667 youth who had reported any past-year drinking.

RESULTS

SH policy ratings were unrelated to any of the past-year drinking outcomes for the total sample of adolescents. However, among past-year drinkers, a stronger SH policy was inversely related to drinking at parties (β = -.06, p < .05) but was unrelated to past-year alcohol use and heavy drinking in general. There were no moderating effects of SH policy on change in adolescents' past-year drinking over the 3-year period.

CONCLUSIONS

Local SH policies that include strict liability and civil penalties that are imposed administratively may be associated with less frequent underage drinking in private settings, particularly among adolescents who have already initiated alcohol use.

Effects of an online alcohol education course among college freshmen: an investigation of potential mediators

The authors investigated possible mediating effects of psychosocial variables (perceived drinking norms, positive and negative alcohol expectancies, personal approval of alcohol use, protective behavioral strategies) targeted by an online alcohol education course (AlcoholEdu for College) as part of a 30-campus randomized trial with 2,400 first-year students. Previous multilevel analyses have found significant effects of the AlcoholEdu course on the frequency of past-30-day alcohol use and binge drinking during the fall semester, and the most common types of alcohol-related problems. Exposure to the online AlcoholEdu course was inversely related to perceived drinking norms but was not related to any of the other psychosocial variables. Multilevel analyses indicated at least partial mediating effects of perceived drinking norms on behavioral outcomes. Findings of this study suggest that AlcoholEdu for College affects alcohol use and related consequences indirectly through its effect on student perceptions of drinking norms. Further research is needed to better understand why this online course did not appear to affect other targeted psychosocial variables.

Effects of the local alcohol environment on adolescents' drinking behaviors and beliefs

AIMS

To examine relationships between characteristics of the local alcohol environment and adolescent alcohol use and beliefs in 50 California cities.

DESIGN

The study used longitudinal survey data collected from adolescents; city-level measures of local alcohol policy comprehensiveness, policy enforcement, adult drinking and bar density; and multi-level modeling with three levels (city, individual, time), allowing for random effects. Models included interaction terms (time × alcohol environment characteristics) and main effects, controlling for city and youth demographic characteristics. Analyses also examined possible mediating effects of alcohol-related beliefs.

SETTING

Fifty California cities (50000-500000 population).

PARTICIPANTS

Random samples of 1478 adolescents and 8553 adults.

MEASUREMENTS

Past-year alcohol use and heavy drinking, and alcohol-related beliefs (e.g. perceived alcohol availability) among adolescents; past 28-day alcohol use among adults; ratings of local alcohol control policies; funding for enforcement activities; bars per roadway mile.

FINDINGS

Local alcohol policy comprehensiveness and enforcement were associated with lower levels of past-year alcohol use (betas=-0.003 and -0.085, P<0.05). Bar density was associated with a higher level of past-year alcohol use (beta=1.086, P<0.01). A greater increase in past-year alcohol use and heavy drinking over time was observed among adolescents living in cities with higher levels of adult drinking (betas=0.224 and 0.108, P<0.01). Effects of bar density appeared to be mediated through perceived alcohol availability and perceived approval of alcohol use.

CONCLUSIONS

Adolescent alcohol use and heavy drinking are related to characteristics of the local alcohol environment, including alcohol control policies, enforcement, adult drinking and bar density. Change in adolescents' drinking appears to be influenced by community-level adult drinking. Bar density effects appear to be mediated through perceived alcohol availability and approval of alcohol use.

The Role of Drinking Beliefs to Explain Ethnic Variation in Drinking Practices Among U.S. College Students

This study, funded by the National Institute on Alcohol Abuse and Alcoholism, examines psychosocial mediators to explain discrepancies in past-30-day drinking between African American and White college student drinkers in the United States. Between 2008 and 2010, 5,845 college drinkers completed an online survey about their alcohol use. Using latent variable structural equations modeling, we investigated the relationships between ethnicity, drinking beliefs, and students' past 30-day alcohol use. Drinking beliefs-i.e., positive expectancies, perceived norms, and disapproval of alcohol use-fully mediated the relationship between ethnicity and drinking behaviors. Study limitations and directions for future research are discussed.

Testing the results of municipal mixed-use zoning ordinances: a novel methodological approach

Municipal mixed-use zoning (MUZ) is one public health strategy to create more walkable neighborhoods by reducing the separation of daily activities. This study uses a novel data-gathering methodology to evaluate municipal zoning ordinances in twenty-two California cities in conjunction with the walkability potential of resulting mixed-use zones, to explore the extent to which variations in uses mandated by MUZ ordinances are correlated with variations in walking opportunities. We find that, after controlling for population, socioeconomic status, and zone size, significant relationships exist between the range and precision of uses mandated by MUZ ordinances and the mixture and breadth of walking destinations in these zones. The study also demonstrates that analysis of municipal zoning codes and a novel data-gathering methodology yield valid data. The analysis of MUZ ordinances is a significant complement to other approaches to measuring walkability and can be used across cities.

Reducing youth access to alcohol: findings from a community-based randomized trial

Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field. Community-based interventions designed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem, but studies designed to evaluate such interventions are sparse. To address this issue we conducted a randomized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components designed to reduce underage access to alcohol. The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers, but did not reduce underage drinking or the perceived availability of alcohol among high school students. Post hoc analyses, however, revealed significant associations between the level of underage drinking law enforcement in the intervention communities and reductions in both 30-day use of alcohol and binge drinking. The findings highlight the difficulty in reducing youth drinking even when efforts to curtail retail access are successful. Study findings also suggest that high intensity implementation of underage drinking law enforcement can reduce underage drinking. Any such effects of enhanced enforcement on underage drinking appear to be more directly attributable to an increase in perceived likelihood of enforcement and the resultant perceived inconveniences and/or sanctions to potential drinkers, than to a reduction in access to alcohol per se.

Effects of a multi-component responsible beverage service programme on violent assaults in Sweden

AIM

A multi-component Responsible Beverage Service (RBS) programme has been disseminated in Swedish municipalities. The aim of the programme is to reduce violence associated with consumption of alcohol at on-licensed premises. This study aimed to analyse the effect of the programme on police-recorded assaults after the dissemination of the programme in Swedish municipalities, 1996-2009.

DESIGN

This study is a natural experiment that uses variation in the level of implementation of the RBS programme to predict change in the rate of police-recorded assaults.

SETTING

Swedish municipalities.

PARTICIPANTS

The municipalities included in the study initiated the RBS programme no later than 2008. On-licensed premises open during the evenings must exist. Of 290 municipalities, 237 fulfilled these requirements.

MEASUREMENT

Programme fidelity was studied by means of several surveys. Yearly data on police-recorded assaults, per 100,000 inhabitants aged 15 and above, committed on weekend nights, were used as dependent variable. A fixed-effects panel data regression model was used to examine the effect of the programme.

FINDINGS

Each extension of the programme, by one component, was associated with a significant 3.1% reduction in assaults. However, this effect was seen mainly in smaller municipalities. Of the different components of the programme, the presence of a community coalition steering group had a significant effect on assaults. No significant effect was found regarding RBS training or supervision of on-licensed premises.

CONCLUSION

Multi-component Responsible Beverage Service programmes can have a significant effect on police-recorded assaults even when implemented on a large scale in many communities.

Relationships between local enforcement, alcohol availability, drinking norms, and adolescent alcohol use in 50 California cities

OBJECTIVE

This study investigated relationships between local alcohol policies, enforcement, alcohol outlet density, adult alcohol use, and underage drinking in 50 California cities.

METHOD

Eight local alcohol policies (e.g., conditional use permit, social host ordinance, window/billboard advertising) were rated for each city based on their comprehensiveness. Local alcohol enforcement was based on grants received from the California Alcoholic Beverage Control agency for enforcement of underage drinking laws. Outlet density was based on the number of on- and off-premise outlets per roadway mile. Level of adult alcohol use was ascertained from a survey of 8,553 adults and underage drinking (frequency of past-year alcohol use and heavy drinking) from surveys of 1,312 adolescents in 2009 and 2010. Multilevel regression analyses were conducted to examine the effects of policies, enforcement, and other community-level variables on adolescent drinking, controlling for youth demographic characteristics. Mediating effects of adolescents' perceived ease of obtaining alcohol, perceived enforcement, and perceived acceptability of alcohol use also were examined.

RESULTS

None of the eight local alcohol-policy ratings were associated with adolescent drinking. Funding for underage drinking enforcement activities was inversely related to frequency of past-year alcohol use, whereas outlet density and adult drinking were positively related to both past-year alcohol use and heavy drinking. These relationships were attenuated when controlling for perceived ease of obtaining alcohol, enforcement, and acceptability of alcohol use, providing evidence formediation.

CONCLUSIONS

Adolescent alcohol use and heavy drinking appear to be influenced by enforcement of underage drinking laws, alcohol outlet density, and adult alcohol use. These community-level influences may be at least partially mediated through adolescents' perceptions of alcohol availability, acceptability of alcohol use, and perceived likelihood of getting in trouble with local police.

Underage alcohol policies across 50 California cities: an assessment of best practices

BACKGROUND

We pursue two primary goals in this article: (1) to test a methodology and develop a dataset on U.S. local-level alcohol policy ordinances, and (2) to evaluate the presence, comprehensiveness, and stringency of eight local alcohol policies in 50 diverse California cities in relationship to recommended best practices in both public health literature and governmental recommendations to reduce underage drinking.

METHODS

Following best practice recommendations from a wide array of authoritative sources, we selected eight local alcohol policy topics (e.g., conditional use permits, responsible beverage service training, social host ordinances, window/billboard advertising ordinances), and determined the presence or absence as well as the stringency (restrictiveness) and comprehensiveness (number of provisions) of each ordinance in each of the 50 cities in 2009. Following the alcohol policy literature, we created scores for each city on each type of ordinance and its associated components. We used these data to evaluate the extent to which recommendations for best practices to reduce underage alcohol use are being followed.

RESULTS

(1) Compiling datasets of local-level alcohol policy laws and their comprehensiveness and stringency is achievable, even absent comprehensive, on-line, or other legal research tools. (2) We find that, with some exceptions, most of the 50 cities do not have high scores for presence, comprehensiveness, or stringency across the eight key policies. Critical policies such as responsible beverage service and deemed approved ordinances are uncommon, and, when present, they are generally neither comprehensive nor stringent. Even within policies that have higher adoption rates, central elements are missing across many or most cities' ordinances.

CONCLUSION

This study demonstrates the viability of original legal data collection in the U.S. pertaining to local ordinances and of creating quantitative scores for each policy type to reflect comprehensiveness and stringency. Analysis of the resulting dataset reveals that, although the 50 cities have taken important steps to improve public health with regard to underage alcohol use and abuse, there is a great deal more that needs to be done to bring these cities into compliance with best practice recommendations.

Effects of AlcoholEdu for college on alcohol-related problems among freshmen: a randomized multicampus trial

OBJECTIVE

AlcoholEdu for College is a 2- to 3-hour online course for incoming college freshmen. This study was the first multicampus trial to examine effects of AlcoholEdu for College on alcohol-related problems among freshmen.

METHOD

Thirty universities participated in the study. Fifteen were randomly assigned to receive AlcoholEdu, and the other 15 were assigned to the control condition. AlcoholEdu was implemented by intervention schools during the summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university beginning before the intervention in spring 2008/2009; post-intervention surveys were administered in fall 2008/2009 and spring 2009/2010. The surveys included questions about the past-30-day frequency of 28 alcohol-related problems, from which we created indices for the total number of problems and problems in seven domains: physiological, academic, social, driving under the influence/ riding with drinking drivers, aggression, sexual risk taking, and victimization. Multilevel Poisson regression analyses were conducted to examine intent-to-treat and dosage effects of AlcoholEdu for College on these outcomes.

RESULTS

Multilevel intent-to-treat analyses indicated significant reductions in the risk for past-30-day alcohol problems in general and problems in the physiological, social, and victimization domains during the fall semester immediately after completion of the course. However, these effects did not persist in the spring semester. Additional analyses suggested stronger AlcoholEdu effects on these outcomes at colleges with higher rates of student course completion. No AlcoholEdu effects were observed for alcohol-related problems in the other four domains.

CONCLUSIONS

AlcoholEdu for College appears to have beneficial short-term effects on victimization and the most common types of alcohol-related problems among freshmen. Universities may benefit the most by mandating AlcoholEdu for College for all incoming freshmen and by implementing this online course along with environmental prevention strategies.

Young adults and casual sex: the relevance of college drinking settings

This study investigated the relevance of college drinking settings on the likelihood of students having sexual intercourse with a stranger. A random sample of 7,414 undergraduates at 14 public California universities responded to questions regarding frequency of attendance at six different setting types since the beginning of the semester (e.g., Greek, residence-hall parties, and bars or restaurants), drinking behavior, and sexual activity. Multi-level modeling examined the association between each setting type and the occurrence of alcohol-related sexual intercourse with a stranger. Findings indicated strong, positive associations between frequency of attendance at Greek parties, residence-hall parties, off-campus parties, and the occurrence of alcohol-related sex with a stranger. Frequency of attending the six settings and proportion of times drunk at the settings were also positively associated with alcohol-related sex with a stranger. Efforts aimed at preventing outcomes associated with casual sex (e.g., pregnancy, sexually transmitted infections, or mental health) should target specific drinking settings where students might be at high risk for risky alcohol use and unsafe sex behaviors.

Students' experiences with web-based alcohol prevention: a qualitative evaluation of AlcoholEdu

AIM

To provide more in-depth information about students' experiences with AlcoholEdu and in particular to assess if students perceive that the course gives them tools to better control their drinking-related behavior.

METHODS

Focus group interviews with freshmen at three California universities.

FINDINGS

1) The course provides so much information that everyone can find some of it relevant; 2) participants prefer information presented in ways they can identify with; 3) participants report problems with surveys in the program pointing to redundancy and length; and 4) participants did not expect the course to impact their behavior relating to alcohol.

CONCLUSION

AlcoholEdu provides valuable information for freshmen in college about how to avoid problems with alcohol. However, the course could have much more impact if closer to college reality.

Evaluation of an Internet-based alcohol misuse prevention course for college freshmen: findings of a randomized multi-campus trial

BACKGROUND

Internet-based alcohol misuse prevention programs are now used by many universities. One popular 2- to 3-hour online course known as AlcoholEdu for College is typically required for all incoming freshmen and thus constitutes a campus-level strategy to reduce student alcohol misuse.

PURPOSE

Multi-campus study to evaluate the effectiveness of an Internet-based alcohol misuse prevention course.

DESIGN

RCT with 30 universities: 21 entered the study in Fall 2007, nine in Fall 2008. Fifteen were randomly assigned to receive the online course and the other 15 were assigned to the control condition. The course was implemented by intervention schools during the late summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university, beginning prior to the intervention in Spring 2008-2009; post-intervention surveys were administered in Fall 2008-2009 and Spring 2009-2010.

SETTING/PARTICIPANTS

Public and private universities of varying sizes across the U.S. Random samples of 200 freshmen per campus were invited to participate in online surveys for the evaluation. Overall survey response rates ranged from 44% to 48% (M ≈ 90 participants per campus).

INTERVENTION

The online course includes five modules; the first four (Part I) are typically offered in the late summer before matriculation, and the fifth (Part II) in early fall. Course content includes defining a standard drink, physiologic effects of alcohol, the need to monitor blood alcohol level, social influences on alcohol use, alcohol laws, personalized normative feedback, and alcohol harm-reduction strategies. Students must pass an exam after Part I to advance to Part II.

MAIN OUTCOME MEASURES

Past-30-day alcohol use, average number of drinks per occasion, and binge drinking.

RESULTS

Multilevel intent-to-treat analyses indicated significant reductions in the frequency of past-30-day alcohol use (beta = -0.64, p<0.05) and binge drinking (beta = -0.26, p<0.05) during the fall semester immediately after completion of the course. However, these effects did not persist when assessed in the spring semester. Post hoc comparisons suggested stronger course effects on these outcomes at colleges with higher rates of student course completion. No course effects were observed for average number of drinks per occasion or prevalence of binge drinking, regardless of the campus course completion rate.

CONCLUSIONS

This study provides initial evidence that the Internet-based alcohol misuse prevention course has beneficial short-term effects on hazardous drinking behavior among first-year college students, which should be reinforced through effective environmental prevention strategies.

Drinking behavior and sources of alcohol: differences between Native American and White youths

OBJECTIVE

We investigated drinking behavior and sources of alcohol among Native American and White youths, as well as how underage drinking behavior and sources of alcohol may be related to environmental factors.

METHOD

Survey data from a sample of 18,916 youths (8th, 10th, and 12th grades) from Montana were analyzed using hierarchical linear modeling. Survey data were supplemented with county-level economic and census data.

RESULTS

Native American youths were more likely than White youths to report drinking and heavy episodic drinking and initiate drinking at a younger age. Native Americans were less likely than Whites to get alcohol from home or from someone younger than age 21 but were more likely to get it from other social sources or through theft from a store. Living in a county with more Native Americans was inversely related to access to alcohol for both White and Native American youths, as well as reduced lifetime, 30-day, and heavy episodic drinking. Living in a county with more single-parent households was positively related to lifetime drinking, 30- day drinking, heavy episodic drinking, and increased access to alcohol through someone younger than age 21 or a stranger. Median income was negatively related to lifetime drinking and ease of access to alcohol and was positively related to accessing alcohol from home without permission, theft, or purchase with a fake ID.

CONCLUSIONS

Because Native American and White youths have different drinking patterns and obtain alcohol from different sources, strategies to prevent alcohol problems in these groups should take these differences into consideration.

Alcohol prevention strategies on college campuses and student alcohol abuse and related problems

This study examined the relationship between colleges' alcohol abuse prevention strategies and students' alcohol abuse and related problems. Alcohol prevention coordinators and first year students in 22 colleges reported whether their schools were implementing 48 strategies in six domains, and students (N = 2041) completed another survey concerning their use of alcohol and related consequences. Colleges were most likely to prevent alcohol use in public places on campus and the delivery and use of kegs. Four alcohol prevention domains were inversely associated with at least one of five outcomes related to student alcohol abuse or related consequences, and the alcohol policy and enforcement domain was inversely associated with all outcomes. Colleges should pay particular attention to strategies related to policy and enforcement.