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College student drinking in on-premises establishments has been associated with heavy alcohol consumption and a range of problems including assault, fighting, risky sex, and drinking and driving. Although more strictly enforcing overservice laws might reduce heavy drinking in on-premises establishments, law enforcement agencies have few resource-efficient tools for doing so, resulting in these laws seldom being enforced. In this paper, we report the results of an evaluation of the Stop Service to Obviously-impaired Patrons (S-STOP) program that was implemented in 303 bars and restaurants in 18 university communities in California using a randomized cross-over design (early vs. delayed implementation). The S-STOP program: (a) deployed pseudo-intoxicated patrons who attempted to purchase a drink when showing obvious signs of intoxication; (b) provided feedback to owners and managers on staff performance; and (c) offered free online refresher training for staff. Overall, alcohol servers in bars and restaurants in these college communities were willing to serve a pseudo-intoxicated mystery shopper 90% of the time. The study found no evidence that S-STOP reduced the prevalence of alcohol sales to apparently impaired patrons during the two intervention stages of the study. The findings highlight the need for developing effective interventions to prevent overservice and should prompt college and university leaders to take the lead in addressing the problem of alcohol overservice at on-premises establishments by working with community leaders, law enforcement, and retailers. [ABSTRACT FROM AUTHOR]

Background. American Indian/Alaska Native (AIAN) adolescents have a higher prevalence of commercial tobacco, alcohol, and marijuana use than other racial/ethnic groups in the United States. It is unclear whether cultural factors such as ethnic identity, spirituality, and ceremonial use of traditional tobacco are associated with substance use, especially use of emerging tobacco products such as electronic cigarettes, among AIAN adolescents. Methods. This study investigated the association between hypothesized cultural protective factors (ethnic identity, spirituality, and ceremonial use of traditional tobacco) and past-month use of commercial cigarettes, e-cigarettes, marijuana, blunts, and alcohol among 156 AIAN adolescents in California (mean age = 15.3 years, 55% female). Adolescents from six AIAN schools and afterschool programs completed paper-and-pencil surveys. We used Logistic regression analyses to identify the significant cultural correlates of past-month substance use, controlling for demographic covariates. Results. As hypothesized, strong ethnic identity was protective against cigarette, marijuana, and alcohol use. However, it was not protective against e-cigarette or blunt use. Spirituality was associated with an increased risk of cigarette and marijuana use. Previous ceremonial use of traditional tobacco was not associated with past-month recreational substance use. Conclusions. Results indicate that the associations between cultural factors and substance use vary across substances. Future research should identify cultural factors that protect AIAN adolescents against use of newer products such as e-cigarettes and blunts. [ABSTRACT FROM AUTHOR]

Background: Black tar heroin is typically prepared for injection with heat which decreases the risk of HIV transmission by inactivating the virus. We received reports that persons who inject drugs (PWID) in Tijuana, Baja California, Mexico, a black tar heroin market, were using only water to dissolve heroin.Objectives: Because Tijuana abuts San Diego County, CA, United States, we undertook the present analyses to determine the prevalence of this practice among PWID in San Diego, California.Methods: PWID completed quarterly behavioral assessments and serological testing for blood-borne viruses. Bivariate and multivariable logistic regression models were constructed to assess for individual, social, and structural correlates of preparing heroin without heat within the preceding 6 months.Results: Nearly half of black tar heroin users (149/305) reported they had prepared heroin without heat within 6 months. In multivariable analysis, cold preparation was independently associated with younger age (10 year decrease; AOR = 1.25; 95% CI 1.03, 1.53), more drug injecting acquaintances (per 5 acquaintance increase; AOR = 1.05; 95% CI 1.01, 1.09) and prefilled syringe use (injecting drugs from syringes that are already filled with drugs before purchase; AOR = 1.86; 95% CI 1.14, 3.02).Conclusions/Importance: To our knowledge, this is the first paper to report that PWID living in a black tar heroin market are preparing heroin without heat. Additional research is needed to determine whether this is an endemic practice or PWID are engaging in new forms of drug preparation in response to changes in the environment. [ABSTRACT FROM PUBLISHER]

In recent years, there has been increasing concern about youthful 'binge' drinking and intoxication. Yet the meaning of intoxication remains under-theorized. This paper examines intoxication in a young adult nightlife scene, using data from a 2005-2008 National Institute on Drug Abuse-funded project on Asian American youth and nightlife. Analyzing in-depth qualitative interview data with 250 Asian American young adults in the San Francisco area, we examine their narratives about alcohol intoxication with respect to sociability, stress, and fun, and their navigation of the fine line between being 'buzzed' and being 'wasted.' Finally, limitations of the study and directions for future research are noted. [ABSTRACT FROM AUTHOR]

Little published information exists to guide health care institutions in establishing syringe exchange program (SEP) services. To address this gap, this article discusses organizational issues encountered in the implementation of a hospital-based SEP in San Francisco, California (USA). Investigators collaborated with a community organization in implementing a county hospital-based SEP. SEP services integrated into a public hospital presented unique challenges directly related to their status as a health care institution. In the course of introducing SEP services into a hospital setting as part of a clinical trial, various ethical, legal, and logistical issues were raised. Based on these experiences, this paper provides guidance on how to integrate an SEP into a traditional health care institution. [ABSTRACT FROM AUTHOR]

Qualitative data can be a powerful tool in developing interventions for substance use and other HIV-risk behaviors. Mixed methods design offers researchers the ability to obtain data that provides both breadth and depth to their research questions. However, the integration of qualitative data in mixed methods research has been limited. This paper describes the qualitative study design of the Healthy Young Men's Study, a longitudinal mixed method study with an ethnically diverse cohort of young men who have sex with men (YMSM) ( N = 526) in Los Angeles. Integral to this discussion is how a mixed methods study can address common challenges such as sampling, representation and integration of both datasets. [ABSTRACT FROM AUTHOR]

Many community-based intervention studies experience problems with collaboration between researchers and practitioners. A preferred strategy appears to be to form community coalitions to carry out the proposed interventions in the community, but doing so risks shifting the focus from intervention objectives to coalition process. As a by-product, coalitions often lack understanding of the project goals and are not given specific instructions on how to implement the intervention. In contrast to conventional wisdom, the Safer California Universities study implemented a very directive approach in collaboration with local liaisons on the participating campuses, even though this approach is seen to risk cooperation or commitment from collaborators. This paper reports on the findings of a qualitative study based on interviews with campus liaisons of how the directive approach was perceived on the participating campuses. Findings indicate that the strategy was successful in terms of ''getting things done'' but could have been improved in terms of liaison involvement in setting objectives, and in finding the optimal level of specificity. [ABSTRACT FROM AUTHOR]

Objective: Underage tobacco sales is considered a serious public health problem in Los Angeles. Anecdotally, rates have been thought to be quite high. In this paper, using spatial statistical techniques, we describe underage tobacco sales, identifying areas with high levels of sales and hot spots controlling for sociodemographic measures. Methods: Six hundred eighty-nine tobacco outlets were investigated throughout the city of Los Angeles in 2001. We consider the factors that explain vendor location of illegal sales of tobacco to underage youth and focus on those areas with especially high rates of illegal sales when controlling for other independent measures. Using data from the census, the LA City Attorney's Office, and public records on school locations in Los Angeles, we employ general least-squares (GLS) estimators in order to avoid biased estimates. Main outcome measure: vendor location of underage tobacco compliance checks, violators, and nonviolators. Results: Underage tobacco sales in Los Angeles were very high (33.5%) for the entire city in 2001. In many zip codes this rate is considerably higher (60%-100%). When conducting spatial modeling, lower income and ethnicity were strongly associated with increases in underage tobacco sales. Hotspot areas of underage tobacco sales also had much lower mean family income and a much higher percentage of foreign born and greater population density. Conclusions: Spatial techniques were used to better identify areas where vendors sell tobacco to underage youth. Lower income areas were much more likely to both have higher rates of underage tobacco sales and to be a hot spot for such sales. Population density is also significantly associated with underage tobacco sales. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Service delivery to dually diagnosed individuals is often impeded by the divergent treatment approaches used by mental health and substance misuse treatment providers. This paper describes findings from a survey of mental health and substance misuse treatment program administrators and staff in Los Angeles County (n=275) on their views about treating the dually diagnosed. All groups agreed about the challenges of treating dually diagnosed patients; however, there were differences both between and within providers in the two treatment systems on other aspects of treatment. The findings arc discussed within the context of clinical and programmatic efforts to improve service delivery to the dually diagnosed. Key Words: Dual diagnosis; Treatment approaches; Mental health treatment; Substance misuse treatment; Service delivery. [ABSTRACT FROM AUTHOR]