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This study examined the association between discrimination, peer connectedness, and mental health symptoms among Black medical students. Data were collected from a convenience sample of Black medical students via an anonymous electronic questionnaire (n = 733) in year 2020. The Patient-Reported Outcomes Measurement Information System Depression and Anxiety forms were used to measure depression and anxiety symptoms. Structural equation modeling was used to examine the association between discrimination, peer connectedness, and mental health symptoms (Mplus 7.3). The majority of the participants were female (80%), approximately 40% were third or fourth year medical school students, and 13% had a clinical diagnosis of depression/anxiety before medical school. About half of the students reported being watched more closely than their classmates, and 66% reported feeling the need to work twice as hard as others to get the same treatment or evaluation. The majority of students reported that their peers were supportive of their academic success (60.7%), and 53% reported that students often or always invited them to social outings. The mean T-score for depressive symptoms was 53.6 (SD = 7.8), and the mean T-score for anxiety symptoms was 58.6 (SD = 8.4). Overall, findings indicated a high prevalence of anxiety and depression symptoms among Black medical students, and increased discrimination was associated with more mental health symptoms among males. Additionally, increased peer connectedness was associated with fewer symptoms of anxiety among males and females and fewer depressive symptoms among females. Addressing discrimination among medical students may improve mental health among Black medical students. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01157-7.

BACKGROUND: The availability of local, state, and national data on alcohol outlet density have important implications for policies and interventions aiming to reduce alcohol-related problems. High-quality data on locations of alcohol outlets is important to accurately inform community interventions and public health initiatives, but such data is often not maintained, readily available, or of sufficient quality. OBJECTIVES: This study aims to examine the discrepancies between alcohol outlet databases and how neighborhood characteristics (i.e., income, majority racial population, urbanicity) are associated with the discrepancies between databases. METHODS: Data was collected from national (n=1), local (n=2), and state databases (n=3). Negative binomial regression modes were used to assess discrepancies in alcohol outlet count at the ZIP code level based on the data source. RESULTS: The average density of alcohol outlets (per 1000 residents) ranged from 0.71 to 2.17 in Maryland, 1.65 to 5.17 in Wisconsin, and 1.09 to 1.22 in Oregon based on different sources of data. Findings suggest high income areas (>200% poverty level) have fewer discrepancies (IR = 0.775, p < 0.01), low income areas (below poverty level) have greater discrepancies (IR = 4.990, p < 0.01), and urban areas tend to have fewer discrepancies (IR = 0.378, p < 0.01) between datasets. CONCLUSION: Interventions and policies depend on valid and reliable data; researchers, policymakers, and local agencies need to collaborate to develop methods to maintain accurate and accessible data.

Alcohol outlet oversaturation often exacerbates negative public health outcomes. Recently, Baltimore City passed an extensive zoning rewrite (“TransForm Baltimore”) that sought to give local government and residents a tool to reduce alcohol outlet oversaturation through land use regulation. The present investigation evaluated the outlet and neighborhood characteristics of stores impacted by two components of TransForm Baltimore: (1) a requirement that taverns licensed for on-premise consumption in addition to off-premise, carryout sales generate at least 50% of their business from on-premise sales, and (2) a requirement to close, repurpose, or relocate all package stores (i.e., off-premise alcohol outlets) that have been operating as “non-conforming” in residential zones since 1971. Research assistants visited every off-premise alcohol outlet in the city (n = 685) to complete an observational assessment. Approximately 77% (n = 530) of these off-premise alcohol outlets were open, including 292 taverns and 238 package stores. t tests and chi-square tests were used to compare neighborhood characteristics (neighborhood disadvantage, median household income, and racial segregation) of sham taverns (i.e., taverns with less than 50% space dedicated for on-premise sales that were primarily operating as a package store) and non-conforming package stores. Of the 292 taverns accessible during the study, the remainder were chronically closed (n = 130); 24 (8.2%) were deemed sham taverns. Sham taverns were more likely to be located in communities with more economic disadvantage and lower median household income (t test; p

Small-area ecological research is critical to inform place-based interventions at the neighborhood level; however, objective measurement of the social context has been limited. The current study extends the application of the Neighborhood Inventory for Environmental Typology (NIfETy) through the development and evaluation of measures of social context for a longer period of observation (3 years) and at a larger area of aggregation (census tract clusters) compared to previous studies using measures at the block-face level from a single observation. Observations from the 172-item inventory were collected from a random sample of block faces (n = 793) in Baltimore City annually over a three-year period. Through a multistep process including replication of previous measures, data reduction, and factor analysis, six unique neighborhood-level indices were generated to describe the environmental context: drug and alcohol use, violence, physical disorder, epicenter, youth activity, and improvements. An assessment of measurement consistency and validity provided support for some indices, while others had notable limitations. These indices can assist local policymakers and public health practitioners assessing the needs of individual neighborhoods and evaluating the effectiveness of place-based interventions designed to improve the neighborhood environment and population health outcomes.

A growing body of evidence suggests that characteristics of the neighborhood environment in urban areas significantly impact risk for drug use behavior and exposure to violent crime. Identifying areas of community need, prioritizing planning projects, and developing strategies for community improvement require inexpensive, easy to use, evidence-based tools to assess neighborhood disorder that can be used for a variety of research, urban planning, and community needs with an environmental justice frame. This study describes validation of the Neighborhood Inventory for Environmental Typology (NIfETy), a neighborhood environmental observational assessment tool designed to assess characteristics of the neighborhood environment related to violence, alcohol, and other drugs, for use with Google Street View (GSV). GSV data collection took place on a random sample of 350 blocks located throughout Baltimore City, Maryland, which had previously been assessed through in-person data collection. Inter-rater reliability metrics were strong for the majority of items (ICC ≥ 0.7), and items were highly correlated with in-person observations (r ≥ 0.6). Exploratory factor analysis and constrained factor analysis resulted in one, 14-item disorder scale with high internal consistency (alpha = 0.825) and acceptable fit indices (CFI = 0.982; RMSEA = 0.051). We further validated this disorder scale against locations of violent crimes, and we found that disorder score was significantly and positively associated with neighborhood crime (IRR = 1.221, 95% CI = (1.157, 1.288), p

OBJECTIVE: In June 2012, Baltimore City, MD, enacted legislation (commonly referred to as the Mosby Bill) prohibiting all liquor stores (outlets that primarily sell alcoholic beverages) from selling “any food, goods, wares, supplies, or other merchandise to any person under the age of 18.” Three years after enactment, we evaluated the impact of this legislation on non-alcohol product sales among youth. METHOD: Research assistants (RAs) ages 16–20 were trained in using a standardized observational tool to quantify and record characteristics of the outlets, including products sold. A trained pair comprising one RA age 16 to 20 and one RA exactly age 18 were sent into every liquor store (i.e., packaged goods stores and bar/taverns with packaged goods sales) in Baltimore to conduct the assessment and make a non-alcohol purchase. Since the research was not conducted in concert with the police, the 18-year-old RA made the purchase attempt while the other (age 16 to 20) RA completed the assessment. RESULTS: Purchase attempts were made at 502 liquor stores, and 352 of those attempts were successful (able to make purchase without being asked for identification or age; noncompliance rate = 68.1%). Noncompliance was highest among packaged goods stores compared with bar/taverns, and in neighborhoods with a lower median household income and a higher proportion of African American residents (p < .050). Noncompliant outlets were also located closer to public schools (p < .050). CONCLUSIONS: This evaluation demonstrates that, in the absence of enforcement, ordinances are neither likely to be honored nor to achieve the intended public health benefits.

African Americans and ethnic minorities experience racial discrimination in a variety of settings. Racial discrimination is a potent stressor that has been linked to psychosocial stress and poor physical health. To cope with discriminatory experiences and daily life event stressors, African Americans frequently use the concept of John Henryism (a high effort coping strategy with prolonged exposure to stress). This cross-sectional analysis explored the relationship between racism/discrimination, John Henryism, and health problems in a predominately African American sample. Data were collected through health care screenings for hypertension, diabetes, and obesity and a self-report survey to assess experiences of discrimination and use of John Henryism. Logistic and linear regression models were used to assess the relationship between the John Henryism score, racism/discrimination score, and health problems among 352 participants. John Henryism was associated with a decrease in systolic blood pressure (b = − 12.50, 95% CI = − 23.05, − 1.95) among men, after adjusting for experiences of racism/discrimination and demographic characteristics. Experiences of racism/discrimination were associated with an increase in systolic blood pressure (b = 11.23, 95% CI = 0.38, 22.09) among men, after adjusting for John Henryism and demographic characteristics. Among women, there was no association found between John Henryism and experiences of racism/discrimination with systolic blood pressure. No association was found between John Henryism and experiences of racism/discrimination with being overweight/obese in women nor men. The study found that John Henryism was positively associated with the health of men, while experiences of racism/discrimination were negatively associated with their health. Limitations of the study are discussed, and recommendations are made to guide future research exploring the concept of John Henryism as a relevant factor between stress, racial discrimination and poor health.

Tobacco outlet density research has evolved to require a more refined examination of socioeconomic status’ influence beyond median household income. This study investigates the effects of SES on Census-Tract level tobacco outlet density in five predominantly-White Maryland jurisdictions. Tobacco license addresses and demographic data were analyzed via t-tests and spatial lag modeling. Results showed that higher-SES jurisdictions had lower tobacco outlet density than lower-SES jurisdictions despite similar White populations, and that median household income had consistent associations with tobacco outlet density. This study corroborates findings that differences in SES correlate with differences in tobacco outlet density between racially similar areas.

Food access literature links disinvested communities with poor food access. Similarly, links are made between discriminatory housing practices and contemporary investment. Less work has examined the relationship between housing practices and food environment disparities. Our central premise is that these practices create distinctions in food environment quality, and that these disparities may have implications for food system advocacy and policymaking. In this paper, we link an objective food environment assessment with a spatial database highlighting redlining, blockbusting, and gentrification in Baltimore, Maryland, USA. Standard socioeconomic and housing characteristics are used to control for race, income, and housing composition in a multivariate regression analysis. Our findings highlight that blockbusting-rather than redlining-most strongly shapes poor food access. Redlining and gentrification, meanwhile, are associated with better food access. These findings raise important points about future policy discussions, which should instead be focused on ameliorating more contemporary patterns of housing inequality.

INTRODUCTION: Numerous studies have found associations between alcohol outlet density and violence, but it is unknown whether alcohol advertisements (ads) visible outside outlets are also associated with violent crime. Baltimore City, Maryland enacted restrictions on retail alcohol establishment advertising practices as of June 5, 2017. This study examines the association between alcohol ads visible outside off-premise alcohol outlets and violent crime prior to this restriction. METHODS: Outlet observations (n=653) were conducted in summer 2015, and violent crime data (n=24,085) were from June 5, 2015 through June 4, 2017. The number of violent crimes per square mile within 1,000 feet of outlets was summed using kernel density estimation. In 20182019, authors used mixed models with Simes-Benjamini-Hochberg correction for multiple testing. RESULTS: Roughly half (47%, n=267) of the outlets with complete data (n=572) had alcohol ads visible from the exterior. Outlets with alcohol ads had 15% more violent crimes per square mile within 1,000 feet (ê=1.15, 95% CI=1.07, 1.25, q

Background Identifying and intervening on health disparities requires representative community public health data. For cities with high vacancy and transient populations, traditional methods of population estimation for refining random samples are not feasible. The aim of this project was to develop a novel method for systematic observations to establish community epidemiologic samples. Results We devised a four-step population randomization observation process for Flint, Michigan, USA: (1) Use recent total population data for community areas (i.e., neighborhoods) to establish the proportional sample size for each area, (2) Randomly select street segments of each community area, (3) Deploy raters to conduct observations about habitation for each randomly selected segment, and (4) Complete observations for second and third street segments, depending on vacancy levels. We implemented this systematic observation process on 400 randomly selected street segments. Of these, 130 (32.5%) required assessment of secondary segments due to high vacancy. Among the 130 primary segments, 28 (21.5%) required assessment of tertiary (or more) segments. For 71.5% of the 400 primary street segments, there was consensus among raters on whether the dwelling inhabited or uninhabited. Conclusion Houses observed with this method could have easily been considered uninhabited via other methods. This could cause residents of ambiguous dwellings (likely to be the most marginalized residents with highest levels of unmet health needs) to be underrepresented in the resultant sample.

OBJECTIVE: This study A) assessed whether levels of alcohol-related disciplinary actions on college campuses changed among MD college students after the 2011 Maryland (MD) state alcohol tax increase from 6% to 9%, and B) determined which school-level factors impacted the magnitude of changes detected. METHOD: A quasi-experimental interrupted time series (ITS) analysis of panel data containing alcohol-related disciplinary actions on 33 MD college campuses in years 2006-2013. Negative binomial regression models were used to examine whether there was a statistically significant difference in counts of alcohol-related disciplinary actions comparing time before and after the tax increase. RESULTS: The ITS anaysis showed an insignificant relationship between alcohol-related disciplinary actions and tax implementation (β=−.27; p=.257) but indicated that alcohol-related disciplinary actions decreased significantly over the time under study (β=−.05; p=.022). DISCUSSION: Alcohol related disciplinary actions did decrease over time in the years of study, and this relationship was correlated with several school-level characteristics, including school price, school funding type, types of degrees awarded, and specialty. School price may serve as a proxy mediator or confounder of the effect of time on disciplinary actions.

This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.

BACKGROUND: Recent loosening of state and federal policy restrictions on marijuana, along with changes in social norms regarding marijuana use and decreases in prevalence of other types of substance use, may lead to increases in youth initiating marijuana before other types of substances such as alcohol and tobacco. We investigated predictors and potential consequences of initiating marijuana before other drugs for youth aged 12–21-years in the US. METHODS: Nationally-representative, cross-sectional survey data from the US National Survey on Drug Use and Health supplied self-reported age-of-first marijuana, cigarettes, alcohol, other tobacco, and other illegal drug use among 12–21-year-old samples from 2004 to 2014 (n=275,559). We first examined the degree to which initiating marijuana use first was associated with sex, age, race/ethnicity, and survey year. Then, we examined whether using marijuana first predicted heavy marijuana use, cannabis use disorder (CUD), alcohol use disorder (AUD), nicotine dependence (ND), or lifetime use of other illegal drugs. RESULTS: Among all survey youth (substance users and non-users) the proportion using marijuana first increased from 4.8% to 8.8% from 2004–2014. Those using marijuana first (versus alcohol or cigarettes first) were more likely to be male and older and Black, American Indian/Alaskan Native, multiracial, or Hispanic than White or Asian. Among substance users and adjusting for age of onset and the number of substances used, using marijuana first was associated higher odds of heavy current marijuana use and CUD. CONCLUSIONS: In recent years, youth have been increasingly likely to use marijuana as their first drug and sequence of initiation is associated with race/ethnicity, gender, and age. Using marijuana first might increase the chance of heavy use and CUD.

Recent loosening of state and federal policy restrictions on marijuana, along with changes in social norms regarding marijuana use and decreases in prevalence of other types of substance use, may lead to increases in youth initiating marijuana before other types of substances such as alcohol and tobacco. We investigated predictors and potential consequences of initiating marijuana before other drugs for youth aged 12-21-years in the USA. Nationally representative, cross-sectional survey data from the US National Survey on Drug Use and Health supplied self-reported age of first marijuana, cigarettes, alcohol, other tobacco, and other illegal drug use among 12-21-year-old samples from 2004 to 2014 (n = 275,559). We first examined the degree to which initiating marijuana use first was associated with sex, age, race/ethnicity, and survey year. Then, we examined whether using marijuana first predicted heavy marijuana use, cannabis use disorder (CUD), alcohol use disorder (AUD), nicotine dependence (ND), or lifetime use of other illegal drugs. Among all survey youth (substance users and non-users), the proportion using marijuana first increased from 4.8 to 8.8% from 2004 to 2014. Those using marijuana first (vs. alcohol or cigarettes first) were more likely to be male and older and Black, American Indian/Alaskan Native, multiracial, or Hispanic than White or Asian. Among substance users and adjusting for age of onset and the number of substances used, using marijuana first was associated higher odds of heavy current marijuana use and CUD. In recent years, youth have been increasingly likely to use marijuana as their first drug and sequence of initiation is associated with race/ethnicity, gender, and age. Using marijuana first might increase the chance of heavy use and CUD.

Background In emerging adulthood when many youth are maturing out of marijuana use, Blacks continue to have high rates of use and disorder. Theory suggests that factors tied to neighborhood disadvantage may partially explain this phenomenon but research is limited. Objectives This study examines the influence of neighborhood physical and social disorder on transitions in marijuana use during emerging adulthood in a low-income urban sample. Methods 379 primarily Black young adults residing in low-income neighborhoods in Baltimore City were followed-up annually from ages 18 to 21. Neighborhood environment was evaluated using a valid and reliable field-rater assessment of the residential block. Longitudinal latent class and latent transition analyses were performed. Results Fit indices supported three-classes of marijuana use: no use, infrequent use and frequent use. Between ages 18 and 21, young adults tended to transition toward lower levels of use. However, neighborhood physical disorder was associated with transitioning to increased marijuana use (no use to frequent use; AOR = 2.712; p = .023) while positive neighborhood social activity was associated with a decreased risk (AOR = 0.002; p = .013). Neighborhood social activity was also associated with decreases in use (frequent to infrequent use; AOR = 2.342; p = .020). Conclusions/Importance: These findings demonstrate that physical disorder within the context of a low-income urban neighborhood adversely impacts marijuana use. However, even in the presence of physical disorder, interventions that foster collective efficacy among residents through positive social activity may prevent initiation and progression of marijuana use.

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.

The oversaturation of alcohol outlets can have disastrous public health consequences. The goal of this study was to evaluate the potential impact of new zoning legislation, TransForm Baltimore on locations of alcohol outlets. More specifically, the study sought to determine the effect of the new zoning code on the potential re-distribution of alcohol outlets and also provide empirical support for the need to actively monitor redistribution of outlets to avoid further inequitable oversaturation in disadvantaged neighborhoods. METHODS: Data on off-premise alcohol outlets (e.g. packaged goods stores) were obtained from the Board of Liquor License Commissioners for Baltimore City. The alcohol outlets were geocoded and assigned to zoning parcels. Churches and schools were also geocoded. The alcohol outlets were also assigned to Census tracts to calculate socioeconomic statuses. RESULTS: 172 of the 263 off-premise packaged goods stores (PGS) were in violation of the new zoning law. TransForm will reduce the land parcels available to alcohol outlets by 27.2%. Areas containing non-conforming PGS were more likely to have a higher percentage of Black residents, single parent families, unemployment, household poverty, and vacancy compared to Baltimore City averages and areas without non-conforming PGS. CONCLUSIONS: Planning enforcement efforts need to accompany related laws to prevent/reduce overconcentration of PGS in disadvantaged neighborhoods.

Few studies have considered the potential role of the built environment in increasing adolescent substance use. The current study explored the relationship between alcohol outlets, a potential malleable component of the neighborhood environment, and adolescent behavioral outcomes. Specifically, we investigated the relationship between alcohol outlet density, perceived alcohol, tobacco, and other drugs (ATOD) availability, perception of substance use as a problem at the school, and self-reported ATOD use. Data come from Maryland Safe and Supportive Schools (MDS3) Initiative, a statewide project focused on measuring and improving school climate. The sample includes 25,308 adolescents from 58 high schools (Grades 9–12) across 12 counties. Multilevel path models indicated a positive relationship between the count of alcohol outlets and perceived availability of ATOD among girls but not boys. Perceived availability was associated with increased ATOD use at both individual and school levels as well as other students’ ATOD use. Findings provide support for the potential role of the built environment in adolescent risk for substance use, particularly among girls.

Substance use can occur as a result of coping with stress. Within the school context, youth are exposed to stressors related to school achievement and peer-relationships. Protective factors, such as spirituality, may moderate adolescents' engagement in substance use.The current study investigated the role of spirituality in the association between stress and substance use, in an effort to test the hypothesis that spirituality moderates the association between stress and substance use.This study used data from youth in grades 6-8 attending 40 parochial private schools. A total of 5,217 students participated in the web-based survey administered in Spring 2013. Multilevel structural equation models were used to examine the association between stress, spirituality, and substance use, while accounting for the nested nature of the data (i.e., students within schools).Higher stress was significantly associated with increased alcohol, tobacco, and other drug use among youth (b =.306, p.001). In addition, lower spiritual beliefs were associated with greater substance use (b =.349, p.001). Spiritual beliefs did not moderate the relationship between stress and substance use.Implications for increasing students' adaptive coping when confronted with school-related stressors and the role of school climate are discussed.

This research examined whether publicly funded drug treatment centers (DTCs) were associated with violent crime in excess of the violence happening around other commercial businesses.Violent crime data and locations of community entities were geocoded and mapped. DTCs and other retail outlets were matched based on a Neighborhood Disadvantage score at the census tract level. Street network buffers ranging from 100 to 1,400 feet were placed around each location. Negative binomial regression models were used to estimate the relationship between the count of violent crimes and the distance from each business type.Compared with the mean count of violent crime around drug treatment centers, the mean count of violent crime (M = 2.87) was significantly higher around liquor stores (M = 3.98; t test; p.01) and corner stores (M = 3.78; t test; p.01), and there was no statistically significant difference between the count around convenience stores (M = 2.65; t test; p = .32). In the adjusted negative binomial regression models, there was a negative and significant relationship between the count of violent crime and the distance from drug treatment centers (β = -.069, p.01), liquor stores (β = -.081, p.01), corner stores (β = -.116, p.01), and convenience stores (β = -.154, p.01).Violent crime associated with drug treatment centers is similar to that associated with liquor stores and is less frequent than that associated with convenience stores and corner stores.

BACKGROUND: The potential for increases in adolescent marijuana use is an important concern given recent changes in marijuana policy. The purpose of this study was to estimate trends in marijuana use from 1999 to 2013 among a national sample of US high school students. We examine changes over time by race/ethnicity and sex. METHODS: Data are from the National Youth Risk Behavior Survey (YRBS), which involves biennial, school-based surveys that generate nationally representative data about 9th-12th grade students in the United States. Students self-reported sex, race/ethnicity, and marijuana use (i.e., lifetime use, past 30-day use, any use before age 13). We generated national estimates of the prevalence of marijuana use for the time period, and also tested for linear and quadratic trends (n=115,379). RESULTS: The prevalence of lifetime marijuana use decreased modestly from 1999 to 2009 (44% to 37%), and has increased slightly since 2009 (41%). Other marijuana use variables (e.g., past 30-day use) followed a similar pattern over time. The prevalence of past 30-day use from 1999 to 2013 for all groups and both sexes was 22.5%, and it was lowest among Asians and highest among American Indian/Alaska Natives. Although boys have historically had a higher prevalence of marijuana use, results indicate that male-female differences in marijuana use decreased over time. CONCLUSION: Despite considerable changes in state marijuana policies over the past 15 years, marijuana use among high school students has largely declined. Continued surveillance is needed to assess the impact of policy changes on adolescent marijuana use. Language: en

Addressing health disparities requires both community engagement and an understanding of the social determinants of health. Although elements of the built environment can influence behavior change in public health interventions, such determinants have not been explicitly teased out via participatory mapping. An opportunity exists to integrate community voice in the development of such metrics. To fill this gap and inform the deployment of public health interventions in the Flint (USA) Center for Health Equity Solutions (FCHES), we created a means of assessing spatially-varying community needs and assets in a geographic information system (GIS), what we refer to as a healthfulness index. We engaged community and academic partners in their expert opinions on features of Flint's built environment that may promote or inhibit healthy behaviors via a multiple-criteria decision analysis framework. Experts selected from and ranked 29 variables in 6 categories (including amenities, environment, greenspace, housing, infrastructure, and social issues) using the analytic hierarchy process. The resulting matrices of expert opinions were aggregated and appended as weights for each variable's corresponding map layer. When combined through map algebra, composite scores yield spatially-varying healthfulness indices which signal any neighborhood's relative health promoting qualities (along a 0-100 scale). Results varied substantially across Flint, with the middle belt scoring highest and older neighborhoods in the northeast and north center of the city scoring lowest. Scores were aggregated to 38 Flint neighborhoods; for each of two project-specific indices, these ranged from lows of 38.7 (Hilborn Park) and 41.8 (Columbia Heights) to highs of 52.9 (College Cultural) and 58.0 (University Ave Corridor). We hypothesize that-even when controlling for individual-level factors-we will measure better and more sustained behavior change among participants living in neighborhoods with high healthfulness scores. Future work will examine this hypothesis and determine the importance of such indices in other similar communities.

School safety is of great concern for prevention researchers, school officials, parents, and students, yet there are a dearth of assessments that have operationalized school safety from an organizational framework using objective tools and measures. Such a tool would be important for deriving unbiased assessments of the school environment, which in turn could be used as an evaluative tool for school violence prevention efforts. The current paper presents a framework for conceptualizing school safety consistent with Crime Prevention through Environmental Design (CPTED) model and social disorganization theory, both of which highlight the importance of context as a driver for adolescents' risk for involvement in substance use and violence. This paper describes the development of a novel observational measure, called the School Assessment for Environmental Typology (SAfETy), which applies CPTED and social disorganizational frameworks to schools to measure eight indicators of school physical and social environment (i.e., disorder, trash, graffiti/vandalism, appearance, illumination, surveillance, ownership, and positive behavioral expectations). Drawing upon data from 58 high schools, we provide preliminary data regarding the validity and reliability of the SAfETy and describe patterns of the school safety indicators. Findings demonstrate the reliability and validity of the SAfETy and are discussed with regard to the prevention of violence in schools.

African American male high school students have the highest rates of marijuana use among all racial, ethnic, and gender groups, yet there is limited research examining contextual factors salient to the African American community. The purpose of this study was to examine how neighborhood environment measured in 8th grade is related to longitudinal transitions in marijuana use during high school (9th to 12th grades) in a sample of urban African Americans. Four hundred and fifty-two African American children were interviewed annually beginning in 1st grade as part of a longitudinal field study in Baltimore city. Latent transition analysis indicated early in high school posed the greatest risk for initiation and progression of marijuana use. Community violence exposure was associated with an increased likelihood of transitioning from no marijuana use to infrequent use (adjusted odds ratios (AOR) = 2.40, p

The current study examines differences in organizational characteristics and client posttreatment drug use abstinence in residential substance abuse treatment programs serving clients with high or low levels of legal coercion to participate in treatment. The findings show that low legal coercion programs have higher counselor caseloads (Z = 59, p < .05) than high coercion programs. Although the results showed that programs with a large proportion of African American clients (β = 14.26, p < .0001) and high legal coercion programs (β = 19.99, p < .05) predicted longer abstinence posttreatment, the final models suggest organizational factors are the key predictors of client posttreatment abstinence.

Recent years have witnessed an expansion of Internet- and mobile-phone-based interventions for health promotion, yet few studies have focused on the use of technology by individuals with mental illness. This study examined the extent to which patients at an inner-city community psychiatry clinic had access to information and communications technology (ICT) and how they used those resources.Patients of an outpatient, inner-city community psychiatry program (N=189) completed a survey that included questions about demographics and ICT use which were adapted from an existing local population-based health survey (community sample, N=968). Frequencies of ICT use were assessed for the clinic sample and questions common to both the surveys completed by the clinic and community samples were compared using logistic regression.Among clinic cases, 105 (55.6%) reported owning or using a computer, 162 (85.7%) reported owning or using a mobile phone, and 112 (59.3%) reportedf using the Internet. Among those who used mobile phones, the majority reported using them daily; 42% of those who used the Internet reported using it several times per day. Differences in frequency of Internet use between samples were not significant, but clinic participants used the Internet more intensively to email, instant message, access health information, and use social media sites.A majority of patients in this community psychiatry clinic sample use ICT. Greater access to and use of the Internet by those with mental illness has important implications for the feasibility and impact of technology-based interventions.

This research investigated the relationship between alcohol outlet density (AOD) and life expectancy, as mediated by community violence and community disadvantage. We used linear regression models to assess bivariate and multivariate relationships. There was a negative bivariate association between liquor store density and average life expectancy (β = -7.3370, p < 0.001). This relationship was partially attenuated when controlling for community disadvantage and fully attenuated when controlling for community violence. Bars/taverns (i.e., on-premise) were not associated with average life expectancy (β = -0.589, p = 0.220). Liquor store density is associated with higher levels of community disadvantage and higher rates of violence, both of which are associated with lower life expectancies. Future research, potential intervention, and current related policies are discussed.

Violent crime such as homicide causes significant excess morbidity and mortality in US urban areas. A health impact assessment (HIA) identified zoning policy related to alcohol outlets as one way to decrease violent crime. The objectives were to determine the relationship between alcohol outlets including off-premise alcohol outlets and violent crime in one urban area to provide local public health evidence to inform a zoning code rewrite. An ecologic analysis of census tracts in Baltimore City was conducted from 2011 to 2012. The data included violent crimes (n = 51,942) from 2006 to 2010, licensed alcohol outlets establishments (n = 1,327) from 2005 to 2006, and data on neighborhood disadvantage, percent minority, percent occupancy, and drug arrests from 2005 to 2009. Negative binomial regression models were used to determine the relationship between the counts of alcohol outlets and violent crimes controlling for other factors. Spatial correlation was assessed and regression inference adjusted accordingly. Each one-unit increase in the number of alcohol outlets was associated with a 2.2 % increase in the count of violent crimes adjusting for neighborhood disadvantage, percent minority, percent occupancy, drug arrests, and spatial dependence (IRR = 1.022, 95 % CI = 1.015, 1.028). Off-premise alcohol outlets were significantly associated with violent crime in the adjusted model (IRR = 1.048, 95 % CI = 1.035, 1.061). Generating Baltimore-specific estimates of the relationship between alcohol outlets and violent crime has been central to supporting the incorporation of alcohol outlet policies in the zoning code rewrite being conducted in Baltimore City.

This investigation examined the association between alcohol outlets and substance use during young adulthood in Baltimore, MD. Geospatial methods were used to determine the number of outlets within walking distance of the participant's home and distance to nearest outlet. Logistic regression models found that distance to the nearest alcohol outlet was associated with past year marijuana use after adjusting for community disadvantage and sociodemographic characteristics (OR = 0.77, p = .03); specifically, as distance to the nearest outlet increased the likelihood of marijuana use decreased. Findings suggest that distance to the nearest alcohol outlet was a better predictor of marijuana use than the density of alcohol outlets.

Purpose. Child and adolescent obesity is increasingly prevalent and predisposes risk for poor physical and psychosocial health. Physical and social factors in the environment, such as neighborhood disorder, may be associated with childhood obesity. This study examines the association between living in a disordered neighborhood and being overweight among a sample of urban schoolchildren. Design. Baseline interview data, including height, weight, and hip circumference, were obtained from 313 elementary school–aged participants in a community-based epidemiologic study. Setting. The setting was Baltimore, Maryland, a large metropolitan city. Subjects. Subjects were elementary school students ages 8 to 12 years. Measures. To assess neighborhood characteristics, independent evaluators conducted objective environmental assessments using the Neighborhood Inventory for Environmental Typology instrument on the block faces (defined as one side of a city block between two intersections) where the children resided. Analysis. Logistic regression models with generalized estimating equations were used to examine the association between neighborhood disorder and children being overweight. Results. Neighborhood disorder showed a trend toward a statistically significant association with being overweight during childhood (odds ratio [OR], 1.03; confidence interval [CI], .99–1.07; p = .07) in the unadjusted model. Gender was significantly associated with being overweight, with female gender increasing the odds of being overweight by 50% in the sample (OR, 1.50; CI, 1.18–1.92; p < .01). After controlling for race, age, and comparative time spent on a sport, multivariable analyses revealed that gender (adjusted odds ratio [AOR], 2.42; CI, 1.63–3.59; p < .01) and neighborhood disorder (AOR, 1.09; CI, 1.03–1.15; p < .01) were associated with being overweight. Further, an examination of interactions revealed girls (AOR, 2.40; CI, 1.65–3.49; p < .01) were more likely to be overweight compared with boys (AOR, 2.20; CI, 1.57–3.11; p < .01) living in neighborhoods with the same level of neighborhood disorder. Conclusion. Results suggest neighborhood hazards warrant additional consideration for their potential as obesogenic elements affecting gender-based disparities in weight among urban schoolchildren. Future studies in this area should include longitudinal examinations.

In the U.S., cigar use doubled from 5.0 to 10.6 billion cigars consumed annually between 1997 and 2007, driven in large part by increased sales of cigarette-sized "little cigars" and narrow, mid-sized "cigarillos." The present study examined prevalence of cigarillo use as well as attitudes, knowledge and behaviors related to cigarillo use among a sample of predominantly urban African American young adults 18-24 not in school and not employed. Survey data were collected from 131 young adults attending education and job training centers in Baltimore, Maryland and from 78 young adults attending education, job training, or recreational programs in Washington, D.C. In Baltimore, 22% of young adults had smoked a cigarillo in the past 30 days, compared with nearly 63% in D.C. Both populations were heavily exposed to cigarillo advertising and marketing. Cigarillo use in this urban young adult population is a growing public health problem and undermines the progress made in decreasing cigarette use.

Understanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic.Growth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N=1874 6th graders; 50.4% male, mean age 11.8 years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention.A two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR=1.17, p=0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR=1.22, p0.01 slow escalators; OR=1.54, p=0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR=1.02, p=0.98).This study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.

African American young adults ages 18-25 smoke less than their Caucasian peers, yet the burden of tobacco-related illness is significantly higher in African Americans than in Caucasians across the lifespan. Little is known about how clean indoor air laws affect tobacco smoking among African American young adults. We conducted a systematic observation of bars and clubs with events targeted to African American adults 18-25 in Baltimore City at two timepoints (October and November of 2008 and 2010) after enforcement of the Maryland Clean Indoor Air Act (CIAA). Twenty venues-selected on the basis of youth reports of popular venues-were rated during peak hours. All surveillance checklist items were restricted to what was observable in the public domain. There was a significant decrease in observed indoor smoking after CIAA enforcement. Observed outdoor smoking also decreased, but this change was not significant. Facilities for smoking outdoors increased significantly. The statewide smoking ban became effective February 1, 2008, yet measurable changes in smoking behavior in bars were not evident until the City engaged in stringent enforcement of the ban several months later.

The Problem : The prevalence of injection drug use (IDU) and incidence of human immunodeficiency virus (HIV) remain high in Baltimore, where IDU is a primary HIV risk factor. Substance use disorders and HIV are related syndemically—their causes and consequences interact synergistically. Baltimore is increasingly considering the syndemic relationship of substance use disorders, IDU, and HIV in making decisions about drug treatment funding and location. Purpose of Article : Our goal was to empirically identify the optimal location of new drug treatment programs through the development and application of a novel, practical tool. Key Points : Syndemic triangles were constructed to measure and visualize unmet need for drug treatment services. These data were used to determine priority zones for new treatment centers. Conclusions : The application of this tool helped inform strategies for locating drug treatment services in Baltimore, and its successful use suggests its potential value in other metropolitan areas.

Among youth 15 to 24years of age, homicide and nonfatal shootings are the leading causes of mortality and morbidity. Urban youth's attitudes and perceptions about the use of gun violence to resolve conflict present a major barrier to efforts to reduce gun homicides and nonfatal shootings. The current investigation extends the existing literature on attitudes toward guns and shootings among high-risk youth ages 18 to 24 by measuring perceived norms and viewpoints regarding gun violence in two analogous Baltimore City neighborhoods pre-implementation and 1-year post-implementation of the Safe Streets intervention (adapted from the CeaseFire/Cure Violence intervention). The Safe Streets intervention is designed for communities with high rates of gun violence and utilizes outreach workers to identify and build trusting relationships with youth ages 15 to 24 who are at greatest risk of being involved in gun violence. The outreach workers also position themselves in the community so that they can rapidly intervene in disputes that have the potential to lead to gun violence. Chi-squared tests and exploratory structural equation modeling (ESEM) were used to examine changes in attitudes toward gun violence 1year after the implementation of the Safe Streets intervention. There was a statistically significantly improvement in 43% of the attitudes assessed in the intervention community post-intervention compared to 13% of the attitudes in the control community. There was a statistically significant improvement in the violent attitudes toward personal conflict resolution scale after implementation of the intervention in both the intervention (b = -0.522, p

Management of daily stress can be greatly improved by delivering sensor-triggered just-in-time interventions (JITIs) on mobile devices. The success of such JITIs critically depends on being able to mine the time series of noisy sensor data to find the most opportune moments. In this paper, we propose a time series pattern mining method to detect significant stress episodes in a time series of discontinuous and rapidly varying stress data. We apply our model to 4 weeks of physiological, GPS, and activity data collected from 38 users in their natural environment to discover patterns of stress in real-life. We find that the duration of a prior stress episode predicts the duration of the next stress episode and stress in mornings and evenings is lower than during the day. We then analyze the relationship between stress and objectively rated disorder in the surrounding neighborhood and develop a model to predict stressful episodes.

Gun violence remains a pressing public health concern, especially in high-risk urban environments. Community-level violence intervention efforts are being mounted in cities across the United States to prevent and reduce the most severe forms of violence. There is growing evidence to suggest the effectiveness of the Safe Streets Program/ Cure Violence as a community-based intervention to reduce homicides and shootings. The mechanism underlying the reductions in community violence is theorized to be linked with changes in attitudes toward violence as well as shifts in social norms related to violence and retaliation, but there are few tools to assess these domains. This preliminary investigation sought to establish the metric properties of the Survey on Attitudes About Guns and Shootings (SAGAS) with the goal of providing an empirical measure of attitudes and community-level norms. Males aged 18 to 24 were surveyed using the SAGAS in two high-violence communities in Baltimore, Maryland, using street intercept methodology. We found acceptable reliability and validity metrics for the SAGAS. Reliability and validity of the SAGAS were assessed using internal consistency and a latent class analysis with violent behavior outcomes. The internal consistency of the total scale was in the extensive range (α = .70-.79) and the internal consistency of the factors was in the exemplary range (α ≥ .80). In addition, latent classes of attitudes were predictive of being arrested or being shot. Future studies will examine if rates of violence decrease in neighborhoods targeted by the Safe Streets Program and the mediating role of attitudes toward gun violence using the SAGAS.

Background The Czech Unplugged Study, inspired by the European Drug Addiction Prevention Trial, is a prospective, school-based, randomized controlled prevention trial designed to reduce the risk of alcohol, tobacco, inhalant, and illegal drug use in 6th graders in the Czech Republic. The intervention uses the comprehensive social influence model to affect alcohol and drug using norms among primary school students. Methods Descriptive statistics and chi-square analyses were used to assess differences between the experimental and control groups on demographic characteristics and study outcomes. Multilevel techniques were used to take the hierarchical structure of the data into account. Prevalence odds ratios using the Bonferroni correction were calculated to assess the differences between the experimental (N = 914) and control (N = 839) groups on each outcome 1, 3, 12, 15, and 24 months after the end of the intervention. Results Multilevel analysis using the Bonferroni correction showed statistically significant intervention effects at the final follow-up for any smoking (OR = 0.75, 99.2% CI 0.65–0.87), daily smoking (OR = 0.62, 99.2% CI 0.48–0.79), heavy smoking (OR = 0.48, 99.2% CI 0.28–0.81), any cannabis use (OR = 0.57 99.2% CI 0.42–0.77), frequent cannabis use (OR = 0.57, 99.2% CI 0.36–0.89), and any drug use (OR = 0.78, 99.2% CI 0.65–0.94). Conclusions This study adds new evidence on the effectiveness of the Unplugged school-based prevention program for primary school students in the Czech Republic.

Background: No one knows whether the temporality of nonfatal deliberate self-harm in the United States mirrors the temporality of suicide deaths. Aims: To analyze day- and month-specific variation in population rates for suicide fatalities and, separately, for hospital admissions for nonfatal deliberate self-harm. Methods: For 12 states, we extracted vital statistics data on all suicides (n = 11,429) and hospital discharge data on all nonfatal deliberate self-harm admissions (n = 60,870) occurring in 1997. We used multinomial logistic regression to analyze the significance of day-to-day and month-to-month variations in the occurrence of suicides and nonfatal deliberate self-harm admissions. Results: Both fatal and nonfatal events had a 6%–10% excess occurrence on Monday and Tuesday and were 5%–13% less likely to occur on Saturdays (p < .05). Males were more likely than females to act on Wednesdays and Saturdays. Nonfatal admission rates were 6% above the average in April and May (p < .05). In contrast, suicide rates were 6% above the average in February and March and 8% below it in November (p < .05). Conclusions: Suicides and nonfatal hospital admissions for deliberate self-harm have peaks and troughs on the same days in the United States. In contrast, the monthly patterns for these fatal and nonfatal events are not congruent.

While there are a growing number of observational instruments to assess the built and social dimensions of the neighborhood environment, there are few reliable and validated instruments; there are no instruments that assess the neighborhood environment during nighttime hours, a potential peak period of health and safety risk. The purpose of this investigation is to establish the metric properties of Neighborhood Inventory for Environmental Typology (NIfETy) Instrument nighttime ratings. Reliability of the scale was measured by internal consistency reliability and test re-test correlation. Validity was evaluated through correlation with the daytime NIfETy rating and regression models with local violent crime data. The nighttime items had good internal consistency (α = .81-82) for the total scale and acceptable internal consistency for a seven-item nighttime disorder scale (α = .66-.71). Future investigations will examine the nighttime NIfETy and its association with specific risk behaviors to evaluate changes in neighborhood environment.

Aims: The objective of this study was to establish the extent of alcohol use disorders (AUDs) among drivers at risk for alcohol-related crashes. The prevalence of drivers with AUDs on U.S. roads on weekend evenings when alcohol-related crashes are most frequent is unknown. This study will inform laws and programs designed to reduce alcohol-involved crashes. Design: Interviews using a 15-item AUD questionnaire with a stratified random sample of noncommercial drivers at 60 primary sampling locations in the 48 contiguous states on Fridays and Saturdays between 10 PM and 3 AM from July to November 2007. Setting: Off-road locations into which a police officer directed a random selection of motorist passing the site. Participants: 4614 drivers of noncommercial vehicles. Measurements: AUDs, including heavy drinking, alcohol abuse, and alcohol dependence. Findings: Seventy-four percent of the participating drivers were current drinkers (reported drinking in the last year). Among those drinkers, 14% were classifiable either as dependent drinkers or as abusive drinkers based on self-reports of drinking. Another 10% of the drivers were classified as heavy drinkers. Forty-six percent of the drivers in the survey who had BACs at or higher than the 0.08 grams per deciliter legal limit fell into one of those three AUD categories. Conclusions: Survey data suggest that the majority of high-BAC drivers on U.S. roads show no clinical signs of an alcohol use disorder, but they are categorized as heavy drinkers. This suggests that environmental programs directed at reducing heavy drinking and brief behavioral interventions aimed at reducing episodes of excessive consumption have promise for reducing alcohol-related crashes. Language: en

This study examines gender differences in the association between environment and internalizing problems in a sample of predominately African American schoolchildren. Internalizing problems was assessed using the Youth Self Report. Violence and alcohol and other drug (AOD) exposure subscales were created using observational assessments of neighborhood blocks. Logistic regression models were used to assess the relationship between neighborhood environment and internalizing problems. For each AOD item present on the block the odds of internalizing problems among girls increased by 17% (OR = 1.17, CI: 1.01, 1.35, P = 0.039). The relationship was not significant among boys. Violence exposure did not predict internalizing problems in boys or girls. These preliminary findings suggest that primary school-aged girls' emotional well-being is more negatively impacted by deleterious environments. Future investigations will examine the relationship between deleterious neighborhood environments and internalizing problems as the children age into adolescence. Language: en

To determine whether drivers contacted at the roadside can be screened for alcohol use disorders (AUDs). Secondarily, to produce preliminary estimates of AUDs among drivers and estimate the relationship between AUD status and BAC measured at the roadside.A two-phase survey program was undertaken. In phase 1, 206 motorists were interviewed at the roadside using a 15-item AUD Survey derived from a condensed version of the AUDADIS and the AUDIT-C. One hundred sixty-seven of these motorists were invited, for a $25 incentive, to call the research team within 48 h of the roadside assessment to repeat the questionnaire and complete a more detailed AUD assessment. Phase 2 involved a 6-state pilot test of the AUD Survey as an add-on to the 2005 National Roadside Survey Pilot Program. The setting for both phases of the survey program was US roadways on weekends between 10 p.m. and 3 a.m.Ninety-seven percent of all eligible drivers completed the AUD questionnaire. The correlation between roadside and telephone interview results was 0.3 for alcohol abuse, 0.6 for alcohol dependence and heavy drinking, and 0.7 for binge drinking. Alcohol abuse and dependence diagnoses had 0.6 and 0.7 correlations with diagnoses derived from the full AUDADIS and the AUDIT-C had a 0.8 correlation with the full AUDIT. There was also a statistically significant and positive relationship between having a positive BAC at the roadside and meeting criteria for heavy drinking.AUD status can be effectively measured at the roadside. The poor reliability for alcohol abuse is related to underreporting of drinking and driving during roadside assessments, compared to telephone follow-up. Other measures of hazardous alcohol use should be used in the roadside context to measure alcohol abuse.

Portal survey techniques involve multimodal assessments (e.g., self-report, biologic, and observational) in high-risk drinking and drug-use settings. Our investigation expanded the portal survey methodology to include follow-up assessments of emerging adult women recruited at the border as they cross to and from Mexico south of San Diego, California. The feasibility of the follow-up procedure was established, and the limitations of the technique clarified. Follow-up participants and nonparticipants did not differ by age or reported victimization. Data indicated that 8% of women experience negative events on their return to the United States after a night of binge drinking. These experiences could only be captured in a follow-up survey, as they happened after participants left the border area.

Risk factors for marijuana use in older adolescents and young adults have focused primarily on family environment and peer affiliation. A growing body of work has examined the relationship between environmental context and young adult substance use. This study builds on previous research linking neighborhood environment to young adult marijuana use by exploring two distinct features of neighborhoods, namely the physical (e.g., broken windows) and social environment (e.g., adults watching youth). Data were obtained from a longitudinal sample of 398 predominately African American young adults living in an urban environment. The data also included observational measures of physical and social order and disorder collected on the young adult’s residential block. Exploratory structural equation modeling (ESEM) was utilized to test hypothesized relationships between these two features of the neighborhood environment and past year young adult marijuana use. A two-factor model of neighborhood environment with good fit indices was selected (CFI = 0.97, RMSEA = 0.037). There was a positive and significant direct effect from neighborhood physical disorder to marijuana use (0.219, p

The object of this study was to estimate the relative contribution of various classes of drinkers (including those with alcohol-use disorders) to alcohol-related fatal motor vehicle crashes.Using the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2000, the percentage of state residents falling into six nonoverlapping alcohol-user categories-dependent drinkers, abusive drinkers, dependent and abusive drinkers, heavy episodic drinkers, current normative drinkers, and current nondrinkers- was determined based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classifications. The percentage of residents in each state in each of these user categories and their relationships to the number of drinking drivers involved in fatal crashes in that state were determined through regression analysis using data from the Fatality Analysis Reporting System.The proportion of drinkers in a state in each of the six consumption categories was positively related to the number of drinking drivers in fatal crashes in that state. Conversely, the percentage of the state's population who were current nondrinkers was negatively related to the number of drinking road users in crashes.Although alcohol abusive and heavy episodic drinkers had substantially higher associations with impaired drivers in fatal crashes, half of such drivers were associated with the percentage of current nominative drinkers in the state. Despite the relevancy of these findings, they must be qualified by statistical limitations associated with the use of state as the unit of analysis.

This article explores the prevalence of drug and alcohol use and related risks by attendees at electronic music dance events (EMDEs) in club settings. From six events located on the East and West Coasts, anonymous data were collected via self-report questionnaires, drug bioassays, and alcohol breath tests prior to entry (N = 240) and upon exit from the venues (N = 219). EMDEs were locations for identifying young adults who were aged 18 to 25 (70%), not college students (54%), and at risk for substance use. Nearly half of the sample (45%) were positive for drug use, and 60% were positive for alcohol use at entrance. Slightly more than one third (38%) were positive for drug use, and 59% were positive for alcohol use at exit. Only a small percentage of the sample converted from no use to drug use on premises (5.4%). Future investigations need to explore targeted substance use prevention strategies within this context.

Prior investigations have linked behavioral competencies in primary school to a reduced risk of later drug involvement. In this randomized prevention trial, we sought to quantify the potential early impact of two developmentally inspired universal preventive interventions on the risk of early-onset alcohol, inhalant, tobacco, and illegal drug use through early adolescence. Participants were recruited as they entered first grade within nine schools of an urban public school system. Approximately, 80% of the sample was followed from first to eighth grades. Two theory-based preventive interventions, (1) a family-school partnership (FSP) intervention and (2) a classroom-centered (CC) intervention, were developed to improve early risk behaviors in primary school. Generalized estimating equations (GEE) multivariate response profile regressions were used to estimate the relative profiles of drug involvement for intervention youths versus controls, i.e. youth in the standard educational setting. Relative to control youths, intervention youths were less likely to use tobacco, with modestly stronger evidence of protection associated with the CC intervention (RR=0.5; P=0.008) as compared to protection associated with the FSP intervention (RR=0.6; P=0.042). Intervention status was not associated with risk of starting alcohol, inhalants, or marijuana use, but assignment to the CC intervention was associated with reduced risk of starting to use other illegal drugs by early adolescence, i.e. heroin, crack, and cocaine powder (RR=0.32, P=0.042). This study adds new evidence on intervention-associated reduced risk of starting illegal drug use. In the context of 'gateway' models, the null evidence on marijuana is intriguing and merits attention in future investigations.