Percent Thrombus Predicts Popliteal Artery Aneurysm Related Limb Threatening Events.

OBJECTIVE: The objective of this study was to identify clinical and anatomic characteristics of Popliteal artery aneurysms (PAAs) associated with acutely limb threatening events. SUMMARY BACKGROUND DATA: Popliteal artery aneurysms (PAAs) are associated with high morbidity and mortality. Current guidelines recommend operative repair for PAAs with a diameter greater than 20 mm based on very limited evidence. METHODS: This retrospective cross-sectional cohort was derived from a multi-institutional database queried for all patients with a PAA from 2008 to 2022. Duplex ultrasound (DUS) characteristics of PAAs were abstracted by registered physicians in vascular interpretation. Symptom status at the time of DUS was divided into three categories: asymptomatic PAA, symptomatic PAA with claudication or chronic limb ischemia, and acutely limb threatening PAAs with a thromboembolic event, acute limb ischemia, or rupture. RESULTS: There were 470 PAAs identified in 331 patients. The mean age was 74 years at diagnosis, 94% of patients were white, and 97% of patients were male. In a univariate analysis, patient comorbidities and medications were not associated with symptom status. In a multivariate analysis including age, higher percent thrombus was significantly associated with symptomatic PAAs (RRR 15.2; CI 2.69-72.3; P<0.01) and PAAs with an acutely limb threatening event (RRR 17.9; CI 3.76-85.0; P<0.01). All other anatomic characteristics were not associated with symptom status. CONCLUSION: Percent thrombus was significantly associated with symptomatic PAAs and acutely limb threatening events, whereas diameter was not significantly associated with any symptom group. This analysis supports the use of percent thrombus in identifying high risk PAAs that warrant repair.

Changes in six categories of alcohol-attributable mortality from before to during the early phases of the COVID-19 pandemic.

OBJECTIVE: The shelter-in-place mandates enacted early in the COVID-19 pandemic resulted in changes in alcohol use and consequent outcomes. We assessed changes in six categories of season-specific alcohol-attributable mortality from before to during the early phases of the COVID-19 pandemic in the U.S. METHODS: We used logistic regression models to assess alcohol-attributable mortality in the U.S. from 2017 through 2020 (n=11,632,725 decedents ages 18 and older). Outcomes included chronic fully alcohol-attributable deaths, poisonings, motor vehicle accidents, suicides, homicides, and falls. Exposure variables included year, season, the interaction between the year 2020 and season, rurality, the interaction between the year 2020 and rurality, decedent age, sex, race, ethnicity, marital status, and education. RESULTS: Compared to 2019, season-specific mortality age-adjusted rates of chronic fully alcohol-attributable deaths, homicides, poisonings, and falls increased during the COVID-19 pandemic. Suicide rates decreased in most 2020 seasons relative to the same seasons in 2019. Motor vehicle deaths decreased in the spring of 2020 vs. 2019. Relative to dying by any other cause, the odds of death by chronic fully alcohol-attributable causes and poisonings were higher across seasons in 2020 vs. 2019. The odds of death by suicide were higher among residents of rural counties in the spring of 2020 vs. 2019. CONCLUSIONS: There were distinct temporal changes in six types of alcohol-attributable deaths during the early phases of the COVID-19 pandemic.

Popliteal artery aneurysm ultrasound criteria for reporting characteristics.

INTRODUCTION: Duplex ultrasound (DUS) is the modality of choice for surveillance of popliteal artery aneurysms (PAAs). However, noninvasive vascular laboratories have no standard guidelines for reporting results. This study assessed reports of PAA DUS for inclusion of information pertinent to operative decision-making and timing of surveillance. METHODS: This study was a retrospective review of a multi-institutional repository that was queried for all patients with a PAA from 2008 to 2022 and confirmed via manual chart review. DUS reports were abstracted and images were individually annotated for features of interest including dimensions, flow abnormalities, and percent thrombus burden. RESULTS: A total of 166 PAAs in 130 patients had at least one DUS available for viewing. Postoperative surveillance of PAAs was performed at several intervals: the first at 30 months (IQR 3.7-113, n = 44), the second at 64 months (IQR 20-172, n = 31), and the third at 152 months (IQR 46-217, n = 16) after the operation. The largest diameter of operative PAAs (median 27.5 mm, IQR 21.8-38.0) was significantly greater than nonoperative PAAs (median 20.9 mm, IQR 16.7-27.3); p < 0.01. Fewer than 33 (21%) reports commented on patency of distal runoff. We calculated an average percent thrombus of 60% (IQR 19-81) in nonoperative PAAs, which is significantly smaller than 75% (IQR 58-89) in operative PAAs; p < 0.01. CONCLUSION: In this multi-institutional retrospective study, PAAs are often not followed at intervals recommended by the Society for Vascular Surgery guidelines and do not include all measurements necessary for clinical decision-making in the multi-institutional repository studied. There should be standardization of PAA DUS protocols performed by all noninvasive vascular laboratories to ensure completeness of PAA DUS images and inclusion of characteristics pertinent to clinical decision-making in radiology reports.

Micro-temporal analyses of crime related to alcohol outlets: A comparison of outcomes over weekday, weekend, daytime and nighttime hours.

INTRODUCTION: Causal relationships between alcohol outlets and crime are inferred from their statistical associations across neighbourhoods. However, many unobserved covariates may confound these effects. Recognising that outlet sales vary by time of day and day of week, we assess whether areas with more bars/pubs, restaurants or off-premise outlets have more crime during days and times when alcohol sales are greatest. METHODS: Annual administrative crime counts, sociodemographic data and other area characteristics of 336 Census block groups in Oakland, California, USA, were related to outlet densities from 2000 to 2015. Bayesian space-time Poisson models were used to measure associations between outlet densities and crime during: (i) weekday daytime; (ii) weekday nighttime; (iii) weekend daytime; and (iv) weekend nighttime periods (four seemingly unrelated equations). Comparisons of parameter estimates across equations provided an assessment of outlet effects on crime across days and times within the same analysis units using the same constellation of confounding covariates. RESULTS: Assault and driving under the influence crime incidents during weekend evening hours were more frequent in Census block group areas with greater numbers of bar/pubs. Burglaries were consistently greater in areas with greater densities of restaurants. DISCUSSION AND CONCLUSIONS: The spatiotemporal signature relating densities of bars/pubs over weekend evening hours to assault and driving under the influence incidents suggests that these outlets are a critical source of these crimes across neighbourhoods. Prevention programs and policies that focus upon specific drinking establishments, days and times may be most effective in reducing assault and impaired driving incidents in neighbourhoods.

Mental Health and Alcohol Use during and before the Early Phases of the COVID-19 Pandemic.

The early phases of the coronavirus 19 disease (COVID-19) pandemic were associated with changes in psychological well-being and alcohol use. However, it is unclear whether these changes are artifacts of psychological well-being and alcohol use prior to the pandemic across different sociodemographic groups. We received surveys from 247 adult residents of Allegheny County, Pennsylvania (United States), with an oversampling of sexual- and gender-minority individuals. Responses included measures of psychological well-being, substance use, and sociodemographic characteristics. Unadjusted mean depression scores, anxiety scores, and number of drinking days increased for all age and income groups during COVID-19, while average number of drinks per drinking day and days intoxicated differentially increased or decreased by age and income groups. Using Bayesian seemingly unrelated regression, we assessed depression and anxiety symptoms and alcohol use during the early stages of the pandemic and one month before COVID-19 was first identified in Allegheny County concurrently. Those in the youngest (18-24) group drank on more days during (but not before) the pandemic than those in the 25-44 age group. Compared to cisgender women, gender-minority adults had higher depression scores during the early stages of the pandemic. Employed adults had lower anxiety scores during (but not before) the pandemic than adults who were unemployed. Those with past-year annual incomes above $80,000 had fewer drinks on average drinking occasions than those in the $40,000 or below group before (but not during) the pandemic. Patterns of psychological distress and alcohol use associated with the COVID-19 pandemic differ by subgroup compared to patterns prior to the pandemic. Interventions addressing worsening mental health outcomes and shifting alcohol use patterns must be sensitive to the needs of vulnerable groups, such as younger adults and those experiencing poverty or unemployment.

Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data.

Background Peripheral artery disease is endemic in our globally aging population, with >200 million affected worldwide. Graft/stent thrombosis after revascularization is common and frequently results in amputation, major adverse cardiovascular events, and cardiovascular mortality. Optimizing medications to decrease thrombosis is of paramount importance; however, limited guidance exists on how to use and monitor antithrombotic therapy in this heterogeneous population. Thromboelastography with platelet mapping (TEG-PM) provides comprehensive coagulation metrics and may be integral to the next stage of patient-centered thrombophrophylaxis. This prospective study aimed to determine if TEG-PM could predict subacute graft/stent thrombosis following lower extremity revascularization, and if objective cut point values could be established to identify those high-risk patients. Methods and Results We conducted a single-center prospective observational study of patients undergoing lower extremity revascularization. Patients were followed up for the composite end point postoperative graft/stent thrombosis at 1 year. TEG-PM analysis of the time point before thrombosis in the event group was compared with the last postoperative visit in the nonevent group. Cox proportional hazards analysis examined the association of TEG-PM metrics to thrombosis. Cut point analysis explored the predictive capacity of TEG-PM metrics for those at high risk. A total of 162 patients were analyzed, of whom 30 (18.5%) experienced graft/stent thrombosis. Patients with thrombosis had significantly greater platelet aggregation (79.7±15.7 versus 58.5±26.4) and lower platelet inhibition (20.7±15.6% versus 41.1±26.6%) (all P<0.01). Cox proportional hazards analysis revealed that for every 1% increase in platelet aggregation, the hazard of experiencing an event during the study period increased by 5% (hazard ratio, 1.05 [95% CI, 1.02-1.07]; P<0.01). An optimal cut point of >70.8% platelet aggregation and/or <29.2% platelet inhibition identifies those at high risk of thrombosis with 87% sensitivity and 70% to 71% specificity. Conclusions Among patients undergoing lower extremity revascularization, increased platelet reactivity was predictive of subacute postoperative graft/stent thrombosis. On the basis of the cut points of >70.8% platelet aggregation and <29.2% platelet inhibition, consideration of an alternative or augmented antithrombotic regimen for high-risk patients may decrease the risk of postoperative thrombotic events.

Feasibility of Encord Artificial Intelligence Annotation of Arterial Duplex Ultrasound Images.

DUS measurements for popliteal artery aneurysms (PAAs) specifically can be time-consuming, error-prone, and operator-dependent. To eliminate this subjectivity and provide efficient segmentation, we applied artificial intelligence (AI) to accurately delineate inner and outer lumen on DUS. DUS images were selected from a cohort of patients with PAAs from a multi-institutional platform. Encord is an easy-to-use, readily available online AI platform that was used to segment both the inner lumen and outer lumen of the PAA on DUS images. A model trained on 20 images and tested on 80 images had a mean Average Precision of 0.85 for the outer polygon and 0.23 for the inner polygon. The outer polygon had a higher recall score than precision score at 0.90 and 0.85, respectively. The inner polygon had a score of 0.25 for both precision and recall. The outer polygon false-negative rate was the lowest in images with the least amount of blur. This study demonstrates the feasibility of using the widely available Encord AI platform to identify standard features of PAAs that are critical for operative decision making.

Do Changes to the Alcohol Retail Environment Reduce Interpersonal Violence?

Purpose of Review: To summarize recent research on the alcohol retail environment (sales, policies, availability) and interpersonal violence (assault, intimate partner violence, sexual assault), including methods utilized, theoretical frameworks employed, and associations by types of alcohol environmental exposure and violence. Recent Findings: Studies continue to demonstrate that reducing alcohol availability directly and indirectly lowers rates of interpersonal violence. Many of the 30 studies used state-of-the-art analytic methods and study designs. Few studies examined heterogeneity by minoritized identities or between alcohol environments and violence by other contextual characteristics. There was a dearth of theoretical frameworks and mechanisms explicated. Summary: To increase impacts of alcohol control policies, specific, practical advice is needed about where, when, and for whom changes will reap the biggest effects. Methodological next steps include analyzing natural experiments, incorporating legal epidemiology, designing studies to examine heterogeneities, developing spatiotemporal simulations, and investigating how embodiment of historic injustices contributes to violence. Supplementary Information: The online version contains supplementary material available at 10.1007/s40471-022-00315-7.

Context-Specific Drinking Risks among Adolescents.

Background: Research has shown that specific contexts are associated with alcohol related problems in adults, but less is known about adolescents. Objectives: We examined how frequencies of drinking in different contexts and the amount of alcohol consumed in these contexts may be related to different alcohol-related problems among adolescent drinkers. Methods: Data were collected through a cross-sectional survey with 377 adolescents (13 to 18 years old) who reported past-6-month alcohol use, sampled from California households. Outcome measures included the breadth of alcohol-related problems participants experienced in the past 6-months overall and in 4 domains (physical, personal, social, and driving under the influence of alcohol or riding with a drunk driver [DUI/RDD]). We also assessed socio-demographics, the number of days adolescents drank alcohol in five contexts (restaurants, own homes, others' homes, outdoors, and fraternities/sororities) and the typical number of drinks they had in each context. Context-specific dose-response models were used to analyze data. Results: In adjusted models, drinking more frequently in outdoor venues was associated with greater number of alcohol-related problems. Drinking frequency in others' homes and in fraternities/sororities was positively associated with a greater number of physical problems. Drinking frequencies in outdoor venues and in others' homes were associated with greater number of personal problems. Finally, drinking more frequently in outdoor venues was associated with greater number of social problems and DUI/RDD. Conclusions/Importance: Results suggest the importance of considering drinking contexts independent of heavier drinking in the context, and they can be used to inform prevention interventions targeting specific risks in relation to alcohol use in specific contexts.KEY POINT SUMMARYThe associations between contexts and drinking problems among adolescents cannot be fully explained by heavier drinking in these contexts.Adolescents' drinking frequencies in specific contexts are uniquely associated with different types of alcohol-related problems.Results inform prevention interventions targeting specific risks in relation to alcohol use in specific contexts among adolescents.

Changes in activity locations during the COVID-19 pandemic and associations with depression, anxiety, loneliness, and alcohol use.

Introduction: Restrictions and guidelines to limit the spread of COVID-19 caused considerable and rapid changes to individuals' daily routines. This study examines how activity locations changed during the COVID-19 pandemic and associated social distancing restrictions, and whether these changes were associated with depression, anxiety, loneliness, and alcohol use. Methods: A web-based survey was conducted early in the COVID-19 pandemic (May-June 2020) in Allegheny County (Pittsburgh), Pennsylvania. Participants (n = 265) reported visits to activity locations in the last 30 days and retrospectively for February 2020 (pre-pandemic). A principal components analysis was conducted to assess change in utilization of activity locations. Component scores of changes to activity locations were compared by sociodemographics. Poisson and zero-inflated negative binomial models were used to examine the relationship between component scores and pandemic depression symptoms, anxiety symptoms, loneliness, and drinking days. Results: Five distinct principal components of activity location changes were identified. The first component, characterizing broad reductions in activity locations during the early phases of the pandemic, was associated with increased depression and loneliness. Conclusions: Results indicate non-uniform shifts in routine activities during the pandemic and highlight the importance of understanding how changes to the social environment affect individuals' psychological wellbeing and alcohol use.

Assessing the impacts of alcohol outlets on crime as a natural experiment: agglomeration, churning and spatial effects.

BACKGROUND AND AIMS: Retail alcohol outlets appear to open in neighborhoods with low land and structure rents near sources of demand; they may 'agglomerate', open near to one another or 'churn', replace one another, over time. We used the turnover in numbers of outlets over time to measure agglomeration and churning and the impacts of openings and closings of outlets on neighborhood crime. DESIGN: Interrupted quasi-experiments using spatial panel population data from 3768 synthetic block areas over 6 years. SETTING: City of Oakland, CA, USA. PARTICIPANTS: City population. MEASUREMENTS: Census-based socio-demographic estimates and counts of openings and closings of bars/pubs, restaurants and off-premises outlets related to assault, burglary and robbery crime incidents across synthetic Census blocks. Bayesian space-time models were used to assess agglomeration and churning and measure impacts of openings/closings on crime. FINDINGS: Churning was substantial; openings followed closings for all outlets [bars/pubs, relative risk (RR) = 50.9, 95% credible interval (CI) = 3.0-449.9; restaurants, RR = 3.1, CI = 1.5-6.1; off-premises, RR = 23.5, CI = 2.0-129.8]. Bars/pub and restaurant openings agglomerated with other outlets (e.g., RR = 1.02, CI = 1.00-1.03 and RR = 1.01, CI = 1.00-1.01), but off-premises outlets did not. Covarying out effects related to outlet densities, bar/pub openings were related to a 3.5% increase in assaults (RR = 1.04, CI = 1.01-1.06) and 6.9% increase in robberies (RR = 1.07, CI = 1.03-1.11). Restaurant openings were related to a 5.3% increase in burglaries (RR = 1.05, CI = 1.04-1.06). Openings and closings of off-premises outlets were unrelated to all three crime types. CONCLUSIONS: Retail alcohol outlets appear to follow a pattern of opening near to one another and replacing each other over time. Bar, pub and restaurant openings appear to be related to increases in neighborhood crime.

Utilization of Thromboelastography with Platelet Mapping to Predict Infection and Poor Wound Healing in Postoperative Vascular Patients.

BACKGROUND: Postoperative infection and wound dehiscence rates are higher than expected in peripheral artery disease and contribute significantly to limb loss and mortality. Microvascular pathology characterized by microthrombi and increased platelet aggregation have been cited as contributing factors to poor wound healing and infection. The emergence of viscoelastic assays, such as thromboelastography with platelet mapping (TEG-PM), have been utilized to identify prothrombotic states and may provide insight into a patient's microvascular coagulation profile. This prospective, observational study aimed to determine if TEG-PM could predict poor wound healing or infection following lower extremity revascularization. METHODS: All patients undergoing revascularization between December 2020 and January 2022 were prospectively included and followed for wound complications or non-surgical site infections of the index limb. TEG-PM metrics at the first postoperative follow-up in the nonevent group was compared to the TEG-PM sample preceding the diagnosis of infection/dehiscence in the event group. Cox proportional hazards (PH) regression was used to model the predictive value of viscoelastic parameters. Cut-point analysis to determine high-risk groups was determined by performing receiver operating characteristic curve analysis. RESULTS: Of the 102 patients, 18.6% experienced infection/dehiscence. The TEG-PM sample analyzed in the event group was, on average, 19.5 days prior to the diagnosis of an event. The event group had significantly higher maximum clot amplitude (MA) (47.3 mm ± 16.0 vs. 30.6 mm ± 15.3, P < 0.01), higher platelet aggregation (71.3% ± 27.7 vs. 31.2% ± 24.0, P < 0.01), and lower platelet inhibition (28.7% ± 27.7 vs. 68.7% ± 24.1, P < 0.01). Cox PH analysis identified platelet aggregation as an independent and consistent predictor of infection (hazard ratio = 1.04, 95% confidence interval 1.03-1.06, P < 0.01). An optimal cut-point of > 33.2 mm MA, > 46.6% platelet aggregation, or < 55.8% platelet inhibition identifies those with infection/dehiscence with 79.0-89.5% sensitivity. CONCLUSIONS: These are the first data to provide a quantitative link between prothrombotic viscoelastic coagulation profiles with the development of infection/dehiscence. Based on the cut-points of > 33.2 mm MA, > 46.6% platelet aggregation, or < 55.8% platelet inhibition, we recommend consideration of an enhanced antimicrobial or antithrombotic approach for these high risk groups.

Alcohol Use Frequencies and Associated Problems Across Drinking Contexts.

OBJECTIVE: To better quantify the impact of specific on- and off-premise drinking contexts on population-level alcohol-related problems, we evaluated context-specific risks relative to frequency of use of each context. METHOD: We surveyed 860 adult (21-100 years) past-year drinkers in the California East Bay, sampled in areas of high versus low median household income and off-premise alcohol outlet densities. We examined associations of context-specific drinking frequencies in seven on- and off-premise drinking locations with individual and area characteristics using negative binomial regression. Next, we used heteroscedastic ordered logistic regression to relate context-specific drinking frequencies and continued volumes to five drinking-related problems (Alcohol Use Disorders Identification Test scores, physiological problems, risky sex, social problems, and driving after drinking too much). To estimate population-level effects, we assessed drinking frequencies relative to mean past-year use of each drinking context. RESULTS: Higher individual annual income (>$60,000) was associated with more frequent drinking in all on-premise drinking contexts (bars/clubs, restaurants, and stadiums). Heavier overall drinking was associated with drinking more frequently at bars. Drinking more frequently in respondents' own homes and heavier drinking at friends'/relatives' homes were associated with most drinking-related problems. The population-level effects of physiological problems and driving after drinking too much were highest for parties and friends'/relatives' homes, whereas that of risky sex outcomes was highest for bars. CONCLUSIONS: Assessing context-specific risks related to heavy and/or frequent drinking, in combination with scaling these risks to determine population-level impacts, can help tailor interventions to reduce alcohol-related problems across different on- and off-premise contexts.

Relationships Between Opioid-Related Hospitalizations and Intimate Partner Violence and Child Maltreatment Hospitalizations in Pennsylvania Across Space and Time.

Intimate partner violence (IPV) and child maltreatment outcomes are markedly associated with substance abuse disorders. However, few studies have explored these serious family violence outcomes in connection to the opioid epidemic or population-level geographic connections between these variables. This study assesses associations of ZIP code-level IPV and child maltreatment hospitalization outcomes with opioid- and alcohol-related diagnoses as well as economic and demographic neighborhood characteristics. We used 11 years (2004-2014) of ZIP code-level Pennsylvania hospital discharge data and U.S. Census neighborhood characteristics data. As nearby ZIP codes are more likely to be similar than those that are distant, we incorporated spatial autocorrelation using conditionally autoregressive Bayesian hierarchical space-time models. There was a positive relationship between ZIP code-level opioid-related diagnoses and both IPV (relative risk 1.061; 95% credible interval [1.015, 1.106]) and child maltreatment (relative risk 1.055; 95% credible interval [1.035, 1.070]) hospitalizations. There was a positive relationship between alcohol-related diagnoses and IPV but not child maltreatment. Higher median household incomes were associated with lower counts of both IPV and child maltreatment hospitalizations. To illustrate geographic heterogeneity of model estimates, posterior distributions were used to compare variability of effects across ZIP codes. Our findings emphasize the secondary implications of the opioid epidemic in the form of family violence within communities.

Dual Use of Off-Premise Outlets for Alcohol and Grocery Purchases: Results From the East Bay Neighborhoods Study.

OBJECTIVE: Alcohol privatization efforts have enabled consumers in many states in the United States to purchase alcohol in a variety of off-premise outlets, including grocery stores. This study examines the dual use of outlets to purchase both alcohol and groceries and the extent to which dual use is related to individual income, neighborhood income, and local physical availability of alcohol. METHOD: The East Bay Neighborhoods Study surveyed residents from 72 microecological neighborhoods across six cities in Alameda County, California. Eligible respondents who purchased alcohol in the last year (n = 707) were asked about the off-premise outlet in which they most often purchase alcohol. Purchasing behaviors within this outlet, including purchasing groceries and frequency of visits to the outlet, were assessed. Multilevel logistic regression and negative binomial models assessed outcomes. RESULTS: Seventy-three percent of participants reported dual use of their most used outlet for groceries and alcohol. In adjusted models, dual use of the outlet was not associated with individual income, alcohol use, or neighborhood outlet density but was positively associated with neighborhood income and the number of outlet visits. After adjustment, dual use of the most used outlet was associated with 0.77 more visits per 28 days. CONCLUSIONS: Results suggest that convenience and reduced time costs for purchasing alcohol encourage the dual use of outlets, particularly in high-income neighborhoods. Differences in the dual use of outlets and frequency in outlet use by neighborhood environments highlight the importance of understanding the role of alcohol availability in distinct neighborhood income and outlet-level contexts.

Availability of medical cannabis dispensaries and cannabis abuse/dependence-related hospitalizations in California.

AIMS: To estimate associations between both current- and prior-year medical cannabis dispensary densities and hospitalizations for cannabis use disorder in California, USA between 2013 and 2016. DESIGN: Spatial analysis of ZIP code-level hospitalization discharge data using Bayesian Poisson hierarchical space-time models over 4 years. SETTING AND CASES: California, USA from 2013 to 2016 (6832 space-time ZIP code units). MEASUREMENTS: We assessed associations of annual hospitalizations for cannabis use disorder [assignment of a primary or secondary code for cannabis abuse and/or dependence using ICD-9-CM or ICD-10-CM (outcome)] with the total number of medical cannabis dispensaries per square mile in a ZIP code as well as dispensary temporal and spatial lags (primary exposures). Other exposure covariates included alcohol outlet densities, manual labor and retail sales densities and ZIP code-level economic and demographic conditions. FINDINGS: One additional dispensary per square mile was associated with a median risk ratio of 1.021 (95% credible interval 1.001, 1.041). Prior-year dispensary density did not appear to be associated with hospitalizations (median risk ratio = 1.006, 95% CrI = 0.986, 1.026). Higher median household income, higher unemployment, greater off-premises alcohol outlet density and lower on-premises alcohol outlet density and poverty were all associated with decreased ZIP code-level risk of cannabis abuse/dependence hospitalizations. CONCLUSIONS: In California, USA, the increasing density of medical cannabis dispensaries appears to be positively associated with same-year but not next-year hospitalizations for cannabis use disorder.

Predicting the Future Course of Opioid Overdose Mortality: An Example From Two US States.

BACKGROUND: The rapid growth of opioid abuse and the related mortality across the United States has spurred the development of predictive models for the allocation of public health resources. These models should characterize heterogeneous growth across states using a drug epidemic framework that enables assessments of epidemic onset, rates of growth, and limited capacities for epidemic growth. METHODS: We used opioid overdose mortality data for 146 North and South Carolina counties from 2001 through 2014 to compare the retrodictive and predictive performance of a logistic growth model that parameterizes onsets, growth, and carrying capacity within a traditional Bayesian Poisson space-time model. RESULTS: In fitting the models to past data, the performance of the logistic growth model was superior to the standard Bayesian Poisson space-time model (deviance information criterion: 8,088 vs. 8,256), with reduced spatial and independent errors. Predictively, the logistic model more accurately estimated fatality rates 1, 2, and 3 years in the future (root mean squared error medians were lower for 95.7% of counties from 2012 to 2014). Capacity limits were higher in counties with greater population size, percent population age 45-64, and percent white population. Epidemic onset was associated with greater same-year and past-year incidence of overdose hospitalizations. CONCLUSION: Growth in annual rates of opioid fatalities was capacity limited, heterogeneous across counties, and spatially correlated, requiring spatial epidemic models for the accurate and reliable prediction of future outcomes related to opioid abuse. Indicators of risk are identifiable and can be used to predict future mortality outcomes.

Multiresolution Analyses of Neighborhood Correlates of Crime: Smaller Is Not Better.

Population analyses of the correlates of neighborhood crime implicitly assume that a single spatial unit can be used to assess neighborhood effects. However, no single spatial unit may be suitable for analyses of the many social determinants of crime. Instead, effects may appear at multiple spatial resolutions, with some determinants acting broadly, others locally, and still others as some function of both global and local conditions. We provide a multiresolution spatial analysis that simultaneously examines US Census block, block group, and tract effects of alcohol outlets and drug markets on violent crimes in Oakland, California, incorporating spatial lag effects at the 2 smaller spatial resolutions. Using call data from the Oakland Police Department from 2010-2015, we examine associations of assaults, burglaries, and robberies with multiple resolutions of alcohol outlet types and compare the performance of single (block-level) models with that of multiresolution models. Multiresolution models performed better than the block models, reflected in improved deviance and Watanabe-Akaike information criteria and well-supported multiresolution associations. By considering multiple spatial scales and spatial lags in a Bayesian framework, researchers can explore multiresolution processes, providing more detailed tests of expectations from theoretical models and leading the way to more effective intervention efforts.

Opioid Misuse and the Availability of Medical Marijuana Through Dispensaries.

OBJECTIVE: In this study we assess whether changes in ZIP code-level density of medical marijuana facilities are related to changes in rates of opioid poisonings and opioid use disorder hospitalizations in California. METHOD: A panel study using California hospital discharge data was conducted to assess the relationship between density of medical marijuana dispensaries and opioid poisonings and use disorder. There were 8,536 space-time units at the ZIP code level. Outcome measures included ZIP code counts of opioid poisonings and opioid use disorder; independent variables were local- and adjacent-area medical marijuana dispensaries and demographic and economic characteristics. RESULTS: Independent of effects for covariates, densities of medical marijuana dispensaries were positively related to opioid use disorder (RR = 1.05, CI [1.03, 1.06]) and opioid poisonings (RR = 1.04, CI [1.02, 1.05]) in local areas, but negatively related to opioid misuse in spatially adjacent areas (RR = 0.91, CI [0.88, 0.94] for opioid use disorder, RR = 0.89, CI [0.86, 0.93] for opioid poisonings). CONCLUSIONS: Although state-level studies suggest that more liberal marijuana policies may result in fewer opioid overdose deaths, our results within one state suggest that local availability of medical marijuana may not reduce those deaths. The relationship appears to be more complex, possibly based on socioeconomic conditions within and adjacent to areas with higher densities of medical marijuana dispensaries.

Microecological Relationships Between Area Income, Off-Premise Alcohol Outlet Density, Drinking Patterns, and Alcohol Use Disorders: The East Bay Neighborhoods Study.

BACKGROUND: Distinguishing the impacts of neighborhood income and off-premise alcohol outlet density on alcohol use has proven difficult, particularly given the conflation of these measures across neighborhood areas. We explicitly test for differential effects related to individual and area income and outlet densities on alcohol use and alcohol use disorders (AUDs) by implementing a stratified microecological sample. METHODS: The East Bay Neighborhoods Study included a survey of 984 residents of 72 microenvironments within a geographically contiguous 6-city area in California and Systematic social observations of each site. The sites included 18 areas in each of 4 strata (high/low median household income and off-premise outlet density). We assessed 4 outcomes: 28-day drinking frequency, average quantity of alcohol consumed per drinking occasion, 28-day drinking volume, and Alcohol Use Disorders Identification Test (AUDIT) score. We used zero-inflated negative binomial regression with standard errors adjusted for site clusters to relate drinking measures to individual-level age, race/ethnicity, gender, marital status, education, and income, and neighborhood indicators of site strata, physical disorder, and physical decay. An interaction term was tested representing site-level by individual-level income. RESULTS: Living in a high-income site, regardless of off-premise alcohol outlet density, was associated with more frequent drinking and higher alcohol dependence/problems. Both individual-level income and site-level income were related to greater frequencies of use, but lower income drinkers in high-income areas drank more than comparable drinkers in low-income areas. Study participants living in high-density off-premise alcohol outlet sites drank less frequently but did not differ in terms of either AUDIT scores or heavy drinking from participants living in low-density sites. CONCLUSIONS: Using a stratified microecological sampling design, we were able to directly assess statistical associations of off-premise outlet density and neighborhood median household income with patterns of drinking and AUDs. Caution should be used interpreting prior study findings linking off-premise outlet densities to drinking.