Alcohol and cannabis use and co-use among Whites and Hispanics on and off the U.S./Mexico border in California.

This paper examines self-reported rates of drinking and cannabis use and co-use among White and Hispanic adults randomly selected in four counties in California: Imperial on the border; and Kern, Tulare, and Madera in California's Central Valley. Co-use was significantly higher among the U.S. born than among those born abroad, and in the Central Valley than on the border. Co-users were heavier drinkers, had higher rates of alcohol use disorder, other alcohol problems, and a positive history of illicit drug use than drinkers only.

Contexts of Drinking- and Alcohol-Related Problems Among Whites and Hispanics on and off the US/Mexico border in California.

BACKGROUND: This paper examines the association between drinking context use by Whites and Hispanics on and off the US/Mexico border and alcohol problems. METHODS: Data come from a household sample of 1209 adults 18 to 39 years of age resident in Imperial County on the California/Mexico border; and Kern, Tulare, and Madera in California's Central Valley. Data were collected on the phone or online and analyzed with an ordinal generalized linear model. RESULTS: The pattern of statistically significant associations between the frequency and the volume of drinking in different contexts varies across problem types. Furthermore, some contexts of drinking are associated with problems in more than one area. For instance, frequency of drinking at bars/pubs is associated with social problems, risky sex, and fights, but not with injuries. Injuries are associated with the frequency of drinking at home alone or with family and at restaurants. Volume of drinking at bars/pubs is also significantly associated with three different contexts: social problems, injury, and fights. But the volume of drinking at the home of friends or relatives is associated with fights only. Border location is an effect modifier, changing the effect of frequency of drinking at bars and pubs from protective to a factor of risk for social problems and fights. CONCLUSION: These results provide support for the social ecology of drinking and micro environmental factors or risk. The effect of border location on frequency of drinking in bars/pubs underlines the importance of the macro environment in problem generation.

Gender moderates the association between posttraumatic stress disorder and mutual intimate partner violence in an emergency department sample.

INTRODUCTION: Patients in emergency departments (EDs) constitute a diverse population with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines the interaction effect of depression, posttraumatic stress disorder (PTSD), impulsivity, drug use, adverse childhood experiences (ACEs), at-risk drinking, and having a hazardous drinker partner with gender on mutual physical IPV in an urban ED sample. METHODS: Research assistants surveyed 1037 married, cohabiting, or partnered patients in face-to-face interviews (87% response rate) regarding IPV exposure, alcohol and drug use, psychological distress, ACEs, and other sociodemographic features. IPV was measured with the Revised Conflict Tactics Scale. Interaction effects were examined in multinomial and logistic models. RESULTS: Results showed a significant interaction of gender and PTSD (odds ratio [OR] 3.06, 95% CI 1.21-7.23, p < 0.05) for mutual IPV. Regarding main effects, there were also statistically significant positive associations between mutual physical IPV and at-risk drinking (OR 1.73, 95% CI 1.07-2.77, p < 0.05), having a hazardous drinker partner (OR 2.19, 95% CI 1.35-3.55, p < 0.01), illicit drug use (OR 2.09, 95% CI 1.18-3.71, p < 0.01), ACEs (OR 1.23, 95% CI 1.06-1.42, p < 0.01), days of cannabis use past in the 12 months (OR 1.003, 95% CI 1.002-1.005, p < 0.001), and impulsivity (OR 2.04, 95% CI 1.29-3.22, p < 0.01). CONCLUSIONS: IPV risk assessment in EDs will be more effective if implemented with attention to patients' gender and the presence of various and diverse other risk factors, especially PTSD.

The Association between the Percentage of Female Law Enforcement Officers and Rape Report, Clearance, and Arrest Rates: A Spatiotemporal Analysis of California.

Rape is an underreported violent crime that frequently remains uncleared (open) in the legal system. Rape disproportionately affects women, with 91% of rape victim-survivors estimated to be female. However, law enforcement agencies, the entry point into the criminal justice system, are predominantly comprised of male officers. According to the theory of representative bureaucracy, groups with greater representation in a bureaucratic system are more likely to have their interests protected. This study aims to determine if California law enforcement agencies with a higher percentage of female officers are more likely to have higher rates of rape reporting, clearances, and arrests. No previous study has examined this relationship using statewide data. Crimes and Clearances, Monthly Arrest and Citation Register, and Uniform Crime Reporting data for California (2013-2016) were aggregated into 499 Law Enforcement Reporting Areas (LERA). Bayesian space-time Poisson regressions controlling for LERA demographics and crime produced scaled relative rates for three outcomes: (a) rape report rate: number of reports relative to population ages 18+; (b) rape clearance rate: number of clearances relative to reports; and (c) rape arrest rate: number of arrests for rape relative to reports. A 5% increase in the percentage of female officers within an agency was associated with a 6.2% increase in the rape report rate (ARR: 1.062, 95% credible interval (CI) [1.048, 1.077]), a 2.9% decrease in the clearance rate (ARR: 0.971 95% CI [0.950, 0.993]), and no change in the rape arrest rates (ARR: 1.010; 95% CI [0.981, 1.039]) across all LERA. Thus, increased female officer representation was associated with an increase in rape reporting rates but associated with a decrease in rape clearance rates. The theory of representative bureaucracy was only partially supported, and these relationships may not be causal. The quantity of rape reports received by an agency, employment and promotion practices of agencies, and victim-survivor's attitudes toward officer's gender should also be considered.

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.

Drinking and driving among Whites and Hispanics on and off the US/Mexico border in California.

OBJECTIVE: To examine self-reported rates of driving under the influence (DUI) with and without arrest among border and non-border residents in California. METHODS: Data were obtained from 1,209 adults 18 to 39 years of age resident in four counties in California: Imperial on the U.S./Mexico border; and Kern, Tulare, and Madera in California's Central Valley. Households were selected using a list assisted sample. Data were collected on the phone or online and analyzed with a heteroskedastic ordinal generalized linear model. RESULTS: Driving after drinking (11.1% vs. 6.5%; q = 0.04) and the lifetime DUI arrest rates were higher for men than women (10.7% vs. 4%; q = 0.001). In multivariable analysis driving after drinking and DUI arrests were not higher on the border, not higher among Hispanics than Whites, and among Hispanics, the rates were not higher among those located on the border. Income was positively associated with drinking and driving. Impulsivity was positively and significantly associated with both drinking and driving and lifetime DUI arrest. CONCLUSION: The null results suggest that DUI related risk behaviors may not be higher on the border than in other areas of California. There may be health related risk behaviors of higher prevalence in the border population than in other areas, but DUI related behavior may not be one of them.

Drinking in Mexico by Whites and Hispanics on and off the US/Mexico border in California.

This paper compares drinking patterns of Whites and Hispanics who after crossing the U.S./Mexico border drink and do not drink in Mexico. Data came from a household survey of 1,209 adults 18 to 39 years of age in California. Residence near the US/Mexico border increases the likelihood of drinking in Mexico (AOR = 4.57; 95%CI = 2.45-8.52; p < .001). Hispanics (AOR = 1.91; 95%CI = 1.26-2.90; p < .01), those who drink more frequently (AOR = 1.05; 95%CI = 1.02-1.09; p < .01) and those who drink six or more drinks in day (AOR = 1.91; 95%CI = 1.26-2.29; p < .01) are more likely than Whites and lighter drinkers to report this behavior. Crossing the U.S./Mexico border to drink is influenced by living close to the border, Hispanic ethnicity, and drinking many drinks in a day.

Development and Evaluation of a Measure of Drinking Behavior in Response to Acculturation Stressors for Latinx Adults Entering Alcohol Treatment.

Introduction: The current study presents the development of a scale to assess drinking behavior in response to acculturation and immigration stress. Methods: The 19-item Measure of Immigration and Acculturation Stressors (MIAS) and a parallel assessment, a Measure of Drinking in Response to Immigration and Acculturation Stressors (MDRIAS), were administered at baseline, 6 months, and 12 months in a completed randomized controlled trial testing culturally adapted motivational interviewing to reduce heavy drinking and related problems in Latinx individuals who met criteria for heavy drinking (n=149). Results: Exploratory factor analysis of the MIAS showed best fit for a four-factor solution (Relational Stress, Perceived Ethnic Discrimination, Attenuated Aspirations, and Sense of Alienation) with 15 items. The MIAS subscales and the four corresponding MDRIAS subscales were shown to have good reliability (i.e., internal consistency, intercorrelations, and test-retest) and criterion-related validity (i.e., concurrent, convergent, and predictive). Conclusions: These findings suggest that the MIAS can be used to assess different types of immigration and acculturation stressors for Latinx adults and the MDRIAS can be used to assess drinking in response to those experiences. The MIAS and MDRIAS could be used in the future to adapt alcohol interventions to relevant stressors that contribute to Latinx adults' alcohol use.

Norms about Alcohol Use among US Firefighters.

Background: Problem drinking is a perennial concern in the US fire service. A large literature has documented the importance of addressing alcohol norms in intervention research. The purpose of this study was to explore alcohol norms in a national cohort of firefighters (FFs) to inform intervention development in this occupational group. Methods: Data were from a national online survey of career and volunteer FFs (N = 674). Participants were recruited through national fire service listservs and a database of FFs who had agreed to be contacted for research. Results: When asked about "acceptable" levels of alcohol consumption, FFs on average suggested levels which exceeded public health guidelines. Further, approximately half of career and volunteer FFs believed that, at least under some circumstances, drinking until intoxicated was normative. When asked how long should elapse between a FFs last drink and reporting for duty, the average suggested lag was 11.2 hours (sd = 4.6). However, among male volunteer FFs who reported heavy drinking, the average was 6.68 hours (sd = 4.77). Conclusions: Given the high prevalence of heavy and binge drinking in the fire service, it is not surprising that the alcohol norms found in this study were consistent with a culture of drinking. Participants' reports of alcohol use among their peers were consistent with the actual prevalence of problem drinking. Thus, education and prevention efforts in this occupation should focus on changing norms about alcohol use, including linking heavy drinking to other health and safety issues they face.

Alcohol use disorder among Whites and Hispanics on and off the U.S./Mexico border in California.

This paper examines whether U.S./Mexico border residence in California is related to the prevalence of DSM-5 alcohol use disorder (AUD) among Whites and Hispanics. Household survey data were obtained from 1,209 adults (59.7% female) 18 to 39 years of age resident in four counties in California: Imperial on the U.S./Mexico border; and Kern, Tulare, and Madera in California's Central Valley. Households were selected using a list assisted sample, with data collected on the phone or online. Results show that AUD rates were not different between border and non-border location and between Whites and Hispanics. AUD was negatively associated with higher income ($20,000 to $60,000: AOR=.38; 95%CI=.17-.86; p<.01-more than $60,000: AOR=.27; 95%CI: .09-.81; p<.01) and poor risk perception (AOR=.86; 95%CI=.78-.94; p<.01). AUD was positively associated with continued volume of drinking (AOR = 1.05; 95%CI = 1.01-1.09; p<.01), drinking in Mexico (AOR = 4.28; 95%CI = 1.61-11.36; p<.01), marijuana use (AOR = 4.11; 95%CI = 1.73-9.77; p<.01), and impulsivity (AOR = 1.55; 95%CI = 1.23-1.94). Efforts to prevent AUD in the population in California, and especially among those who live close to the border with Mexico, should take into consideration factors such as impulsivity, marijuana use, border crossing to drink in Mexico, all of which increased risk of AUD.

Trends and correlates of spatially aggregated alcohol-involved crashes among Whites and Hispanics in California.

AIMS: This paper examines trends and correlates of alcohol-involved motor vehicle crashes (AMVCs) in California between 2005 and 2016 among Hispanic and non-Hispanic Whites (Whites hereafter). Together these two groups comprise 76% of the state population. The paper also examines whether alcohol outlet density, percentage of Hispanics in census tract populations, and distance to the U.S./Mexico border are related to greater risks for AMVCs. The border is of interest given the greater availability of alcohol in the area. METHODS: Crash data come from Statewide Integrated Traffic Records System maintained by the California Highway Patrol. Sociodemographic and community characteristics data from the U.S. Census and alcohol outlet density were aggregated to census tracts. Total motor vehicle crashes and AMVCs were related to these characteristics using hierarchical Bayesian Poisson space-time models. RESULTS: There were over two million injury and fatality crashes during the period of analysis, of which 11% were AMVCs. About 1.7% of these crashes had fatalities. The rate of AMVCs increased among both Whites and Hispanics until 2008. After 2008, the rate among Whites declined through 2016 while the rate among Hispanics declined for 2 years (2009 and 2010) and increased thereafter. Crash distance from the border (RR = 1.016, 95% CI = 1.010 to 1.022) and percent Hispanic population (RR = 1.006; 95% CI = 1.003 to 1.009) were well-supported results with 95% credible intervals that did not include 1. The percentages of the following: bars/pubs, males, individuals aged 18 to 29 and 40 to 49 years, U.S. born population, individuals below the 150% poverty level, unemployed, housing vacant, and housing owner-occupied were all positively associated with AMVCs and well supported. CONCLUSIONS: Between 2005 and 2016 the rate of AMVCs in California declined among Whites but not among Hispanics. Population-level indicators of percent Hispanic population, distance to the U.S. Mexico border, gender, age distribution, and socioeconomic stability were positively associated with crash rates, indicating that important contextual characteristics help determine the level of AMVC rates in communities.

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample.

INTRODUCTION: Urban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use. METHODS: Cross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants' past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender. RESULTS: Rates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men's at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization. DISCUSSION: Brief screening of patients' at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.

Population-Based Correlates of Spatially Aggregated Drug-Related Arrests On and Off the U.S.-Mexico Border in California.

OBJECTIVE: The purpose of this study was to examine drug-related arrest rates in California from 2005 to 2017 with a focus on the measurement of presumptive excess arrests across areas proximate to the U.S.-Mexico border. METHOD: Arrest data come from the Monthly Arrest and Citation Register (MACR) by the California Department of Justice. U.S. Census demographic population information, and alcohol outlet data from the California Department of Alcoholic Beverage Control, were aggregated at the level of 499 Law Enforcement Reporting Areas (LERA) that contributed to the MACR report. Multivariable analyses were conducted using hierarchical Bayesian Poisson spacetime models. RESULTS: Multivariable results showed that felony and misdemeanor arrests increased with distance from the U.S.-Mexico border (felony relative rate [RR] = 1.007, 95% CI [1.003, 1.010]; misdemeanor RR = 1.013, 95% CI [1.010, 1.016]) and were greater in areas with greater outlet concentrations (felony RR = 1.008, 95% CI [1.008, 1.008]; misdemeanor RR = 1.007, 95% CI [1.007, 1.007]) and a greater percentage of bars and pubs (felony RR = 1.031, 95% CI [1.030, 1.032]; misdemeanor RR = 1.052, 95% CI [1.051, 1.053]). Areas with greater Black populations had greater felony and fewer misdemeanor arrests (felony RR = 1.078, 95% CI [1.076, 1.079]; misdemeanor RR = 0.865, 95% CI [0.864, 0.867]). Areas with greater Hispanic populations had greater misdemeanor arrests (RR = 1.008, 95% CI [1.006, 1.009]). The percentage of off-premise outlets was inversely associated with misdemeanor arrest rates (RR = 0.995, 95% CI [0.994, 0.995]). CONCLUSIONS: Although arrest rates were substantively related to the racial composition of areas across California, there was no evidence of excess drug-related arrests along border areas.

Cannabis Consumption Onset and Addiction: Data from the Second Brazilian Drugs and Alcohol Survey (BNADS).

The objective of this study was to provide rates of cannabis use and dependence and risk factors, proposing a conditional path model for cannabis addiction. A subsample of adult participants from a Brazilian household survey was analyzed to estimate cannabis dependence. Estimation of prevalence rates and association between dependence and age of cannabis use initiation were performed. The conditional model was applied to investigate the mediation of depressive symptoms and alcohol consumption in the association of early cannabis use and dependence. Lifetime and last year cannabis use were 6.47% and 2.81%, respectively. Moderate and severe cannabis dependence were 0.74% and 0.18% in the population, and 26.47% and 6.38% among last year's cannabis users. A Parallel Multiple Mediator Model revealed strong association between cannabis use initiation age and dependence, when depressive symptoms or alcohol consumption mediate this association. The proportion of cannabis users displaying dependence symptoms is elevated and it is associated with the age of cannabis use initiation. The results show the importance of primary prevention interventions, prioritizing the delay of cannabis and alcohol experimentation. Our findings can enrich the debate on drugs policies and legislation, reinforcing the need for stronger restrictions of adolescent drug access and ensuring its enforcement.

Interrelationships of Economic Stressors, Mental Health Problems, Substance Use, and Intimate Partner Violence among Hispanic Emergency Department Patients: The Role of Language-Based Acculturation.

We analyzed the interrelationships of economic stressors, mental health problems, substance use, and intimate partner violence (IPV) among a sample of Hispanic emergency department patients and probed if Spanish language preference, which may represent low acculturation and/or immigrant status, had a protective effect, in accordance with the Hispanic health paradox. Study participants (n = 520; 50% female; 71% Spanish speakers) provided cross-sectional survey data. Gender-stratified logistic regression models were estimated for mental health problems (PTSD, anxiety, depression), substance use (risky drinking, cannabis, illicit drug use), and IPV. Results showed that economic stressors were linked with mental health problems among men and women. Among men, PTSD was associated with greater odds of cannabis and illicit drug use. Men who used cannabis and illicit drugs were more likely to report IPV. Male Spanish speakers had lower odds of anxiety and cannabis use than English speakers. Female Spanish speakers had lower odds of substance use and IPV than English speakers. The protective effect of Spanish language preference on some mental health, substance use, and IPV outcomes was more pronounced among women. Future research should identify the mechanisms that underlie the protective effect of Spanish language preference and explore factors that contribute to the observed gender differences.

Proximity to the U.S./Mexico border, alcohol outlet density and population-based sociodemographic correlates of spatially aggregated violent crimes in California.

This paper examines trends and population-level correlates of violent crime rates from 2005 to 2017 in California, including proximity to the U.S./Mexico border and alcohol outlet density. Crime data come from the Crimes and Clearances report compiled by the California Department of Justice. These and U.S. Census data were aggregated at the level of 499 Law Enforcement Reporting Areas (LERA) that contributed to the report. Reported crime rates were related to area characteristics using hierarchical Bayesian Poisson space-time models. Violent crime rates declined 16% from 2005 to 2017. Crime rates were positively related to distance to the border, total alcohol outlet density, percent outlets that are bars and pubs, percent population Black, percent population Hispanic, percent population 30-49 years of age, percent population U.S. born, percent 150% below federal poverty level, percent high school graduate, and percent houses vacant. Violent crimes were negatively related to percent total outlets that are off-premise, percent population male, percent with higher than 2017 adjusted median income, percent owner occupied houses, and lower population density. In conclusion, several population level characteristics including ethnic composition, community socioeconomic stability, and alcohol availability are associated with violent crime rates. Contrary to public perceptions, violent crime rates increase as distance to the Mexico border increases.

Drinking Context-Specific Dose-Response Models of Intimate Partner Violence Among an Urban Emergency Department Sample.

OBJECTIVE: This cross-sectional study evaluates the association between physical intimate partner violence (IPV) and frequencies of drinking and volume consumed in six different contexts among a sample of urban emergency department (ED) patients. METHOD: We obtained survey data from 1,037 married, cohabiting, or partnered patients (53% female; 50% Hispanic; 29% African American) at a Northern California safety-net hospital. Past-year physical IPV was measured with the Revised Conflict Tactics Scale. We asked patients about frequency of drinking and usual number of drinks consumed at bars, restaurants, homes of friends or relatives, own home, public places such as street corners or parking lots, and community centers or large events. Gender-stratified dose-response models were estimated for frequencies of IPV perpetration and victimization, with adjustment for sociodemographic and psychosocial factors, marijuana use, and spouse/partner problem drinking. RESULTS: None of the women's context-based frequency and volume measures were associated with frequency of IPV victimization. Women's volume of alcohol consumed at home was associated positively with frequency of their IPV perpetration (ß = .008, SE = .003, p < .01), and volume consumed in public places was associated negatively with this outcome (ß = -.023, SE = .010, p < .05). Among men, none of the context-based frequency and volume measures were associated with frequency of either IPV outcome. Spouse/partner's problem drinking was associated with each gender's IPV victimization, and with IPV perpetration by men. CONCLUSIONS: Frequency of drinking and volume consumed in specific contexts do not substantively contribute to frequency of IPV perpetration or victimization in this sample of urban ED patients.

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment. OBJECTIVES: To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males. METHODS: Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome. RESULTS: One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females' cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males' separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes. CONCLUSION: ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.