General Public Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30812
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Browsing General Public Health by Author "Livingston, Melvin D."
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Item Are Retail Sales of Delta-8 THC and Four Loko Associated? Findings from Fort Worth, Texas(2022) Agwuncha, Theresa; McDonald, Kayla; Walker, Drew; Shah, Mauli Vidyutbhai; Boezinger, Matt; Trangenstein, Pamela; Livingston, Melvin D.; Yockey, Robert; Thombs, Dennis; Rossheim, MatthewObjectives: Four Loko is an inexpensive and high-alcohol content product. Across the U.S., Four Loko retailers concentrate in impoverished areas; however, it is unclear whether this geographic patterning exists at a micro level, such as within a city. Delta-8 THC, an isomer of the more common form of the Cannabis plant Delta-9, is an unregulated psychoactive substance that was legalized by the Farm Bill in 2018. It is unknown if retailers that sell risky products like Delta-8 THC may be more likely to sell Four Loko, creating niche stores that sell unregulated or intoxicating substances. Methods: The study sample included 168 retailers in Fort Worth, Texas that had licenses to sell beer off-premise. Stores were contacted in September and October 2021 and asked whether they sold Delta-8 THC. Data regarding Four Loko's availability at each retail site was obtained from the manufacturer's website. Area deprivation index (ADI) scores, a marker of socioeconomic disadvantage (a continuous variable with range 1-10, with higher scores indicating more disadvantage), were linked to each store's zip code. A multivariable logistic regression model was used to examine associations between retail of Delta-8 THC, having a retail tobacco license, ADI scores, and retail of Four Loko. Results: In the overall sample, 55% of stores sold Four Loko and 17% sold Delta-8 THC. Specifically, 41% of stores only sold Four Loko (mean ADI = 6.46, SE = 0.36), 4% only sold Delta-8 THC (mean ADI = 1.67, SE = 0.33), 14% sold both Four Loko and Delta-8 THC (mean ADI = 5.8, SE = 0.71), and 42% did not sell either (mean ADI = 5.18, SE = 0.42). Logistic regression results indicate higher ADI scores (OR = 1.15, 95% CI = 1.03, 1.28) and selling Delta-8 THC products (OR = 8.50, 95% CI = 2.32, 31.17) were associated with increased odds of selling Four Loko. Having a tobacco license was also associated with increased odds of selling Four Loko products, although not statistically significant (OR = 3.41, 95% CI = 0.99, 11.76, p = 0.052). Discussion: Stores that sold Delta-8 THC were 8 times as likely to sell Four Loko. These results suggest that some retail locations may specialize in the sale of high-risk products, including unregulated products. This is important, especially in the context of retail locations, given the rapid development of novel psychoactive substances which future research should focus on. Given associations between type of product sold at each location and ADI scores, residents of socioeconomically deprived neighborhoods may have higher exposures to these dangerous products. Future research should assess the geographic distribution and density of Four Loko and Delta-8 THC sales to determine specific geographic areas that may be at high risk. Additionally, future research should investigate the etiology of health disparities and crimes near these establishments. Implications may suggest supporting the development and implementation of public nuisance laws and/or policies that restrict the sale of unregulated/high-risk substances.Item Drink prices, drink specials, and tobacco policies in a national sample of on-premise drinking establishments(2022) LoParco, Cassidy; Walker, Drew; Livingston, Melvin D.; Trangenstein, Pamela; Khoshhal, Bita; Gonzalez-Pons, Kwynn; Thombs, Dennis; Rossheim, MatthewBackground: Bar and nightclub practices, such as offering inexpensive drinks, having pricing promotions (e.g., 2-for-1, happy hour), and permitting e-cigarette use indoors can increase the amount of alcohol that individuals consume and the number of negative consequences they experience. College students in particular may have a greater risk of increased consumption and related harms to themselves and others. Despite the implications, few studies have assessed the presence of low-cost alcohol and e-cigarette-friendly environments around colleges. The current study surveilled drink prices and specials and examined associated characteristics of on-premise drinking establishments near large universities. Methods: In 2018, telephone calls about prices, practices, and policies were made to 404 randomly selected bars and nightclubs within 2 miles of the largest residential universities in each U.S. state. The Alcohol Policy Information System provided data on state-level alcohol policies. Multivariable linear and logistic regression models examined associations between drinking establishment characteristics, drink prices, and drink specials. Results: The average price for a beer and a shot of vodka were $3.62 and $4.77, respectively. Most establishments (65%) had happy hour specials and 6% had 2-for-1 drink specials. Nearly all (91%) sold food, while 9% sold cigarettes on-premise and 8% allowed smoking inside. Almost 1 in 5 establishments (18%) allowed e-cigarette use inside. Allowing e-cigarette use indoors (b = -0.54) and selling cigarettes on-premise (b = -0.79) were associated with significantly lower vodka prices, whereas allowing cigarette smoking inside (b = -0.46) was associated with significantly lower beer prices. Several factors were significantly associated with higher odds of having a happy hour special, including lower beer prices (OR = 1.38), selling food (OR = 2.97), no state law banning happy hour specials with full day price reductions permitted (OR = 12.74), and no complete bans on happy hour specials (OR = 4.24). Allowing e-cigarette use indoors was significantly associated with higher odds of having a 2-for-1 drink special (OR = 6.38). Conclusions: The current study is one of the first to identify associations between business practices/policies of on-premise drinking establishments and drink prices. This study used a national sample of on-premise drinking locations near large universities to provide insight into how alcohol prices may be discounted to promote sales of other products. For example, locations selling cigarettes on-premise were associated with lower vodka prices. Importantly, previous research indicates positive associations between alcohol consumption and smoking. Coupled with the lowered drink prices, settings that are permissive of smoking and vaping may be associated with increased risk of both heavy drinking and tobacco use, as well as their related harms. Given the frequently offered drink specials and strong association between price and consumption, more research is needed regarding alcohol prices/specials at on-premise drinking sites.