Browsing 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 Differences by Depression Severity Category in Cigarette Smoking Among Low-Income Housing Residents(2018-03-14) Mallampati, Rajesh; Barnett, Tracey; Livingston, Melvin D.; Rendon, AlexisPurpose: Smoking is especially prevalent in low-income groups with additional characteristics. Smoking prevalence is estimated to be 70% among homeless individuals and 77% among low-income substance users in treatment. Among the low-income and mentally ill, the smoking prevalence is 31.7%. The most common mental illness, depression, has been frequently studied as a comorbidity of smoking. Approximately 60% of individuals with depression are current or former smokers. This association has often been studied with a binary measure of depression, which may overlook the effects of depression severity on smoking behavior. Methods: This study used data collected from participants in subsidized housing enrolled in a health coaching intervention called “Mobile Community Health Assistance for Tenants” or “m.chat.” The sample included 420 residents with a mental health condition. A zero-inflated Poisson regression was used to determine the association between smoking cigarettes and four levels of depression: minimal or none (PHQ9 ≤4), mild (PHQ9 5 - 9), moderate (PHQ9 10 - 14), and severe (PHQ9 ≥15). Results: The majority (73.3%) of individuals smoked an average of 7.5 cigarettes per day. In our population with a high prevalence of smoking and depression, when we controlled for depression severity, we found that those without depressive symptoms were more likely to smoke. Depression risk was significantly associated with both the likelihood of smoking (chi-sq=11.03, p=0.0116) and the number of cigarettes smoked among smokers (chi-sq=14.89, p=0.0019). Moderate depression severity resulted in increased odds of being a smoker (OR=2.16, 95%CI:[1.01,4.64]), but a decrease in the number of cigarettes smoked (RR=0.87, 95%CI:[0.77,0.99]). Conclusion: Further study is warranted to examine the relationship between depression severity and cigarette smoking.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.Item Illicit Substance Use Among a Sample of Subsidized Housing Residents: Concordance, Longitudinal Trends, and Quality of Life(2019-05) Rendon, Alexis; Walters, Scott T.; Spence-Almaguer, Emily; Mun, Eun-Young; Livingston, Melvin D.; Suzuki, SumihiroThis three-paper model dissertation investigates issues related to self-reported substance use. Self-report is a less invasive and expensive method of collecting substance use behavior when compared to a toxicological test, but the self-report method has been shown to be unreliable in some populations. We found that self-report missed some use captured by a saliva toxicological test administered to a subsidized housing population enrolled in a technology-assisted health coaching program. Concordance was highest among marijuana users and increased over time. Higher rates of concordance were found when the recall window was expanded from a restricted biological recall window to match the toxicological test to the full 90 day window of the Timeline Follow-Back. Participants who reported using substances more frequently reported having more problems related to their substance use. We also found that both substance use problems and the frequency of consumption of a combined Other category of substances, including cocaine, amphetamine, methamphetamine, opiates, prescription pills, or phencyclidine were predictive of lower quality of life. This dissertation validates previous literature indicating that self-report is a fair to moderately good measure of actual substance use behavior in vulnerable populations that may intentionally or unintentionally misreport their substance use. Programs limited to self-reported measures may consider widening their recall windows to increase accuracy of self-report.Item Serious mental illness and negative substance use consequences among adults on probation(BioMed Central Ltd., 2018-03-22) Rossheim, Matthew E.; Livingston, Melvin D.; Lerch, Jennifer A.; Taxman, Faye S.; Walters, Scott T.BACKGROUND: Adults on probation are at greater risk of both using substances and having a mental disorder compared to the general population. Several theories explain the relationship between substance use and poor mental health. However, the interaction between substance use, mental health, and substance-related consequences is not well understood. A better understanding of this relationship may help treatment programs become more responsive to people with serious mental illness (SMI). METHOD: The current study used interview data from 313 adults on probation who reported recent substance use. We examined associations between SMI risk, substance use, and substance use consequences. RESULTS: A substantial proportion of the sample (37.5%) screened at risk of having a SMI. Adjusting for type and amount of substance use, those who screened at risk of having a SMI reported more negative substance use consequences. Significant interaction effects were observed between use of alcohol or opiates and SMI risk. Alcohol use was associated with more negative substance use consequences among those at risk of SMI, while opiate use was associated with more consequences among those not at risk. CONCLUSIONS: Programs are sorely needed to identify and treat adults with comorbid substance use and mental health symptoms, particularly for adults in the justice system. Clinicians should carefully consider how mental health may interact with substance use to exacerbate consequences.Item What’s the Agreement between Self-Reported and Biochemical Verification of Drug Use? A Look at Permanent Supportive Housing Residents in Ft. Worth(2016-03-23) Walters, Scott; Livingston, Melvin D.; Suzuki, Sumihiro; Rendon, AlexisPeople who are chronically homeless are nearly seven times as likely to use illicit drugs, compared to the general population. We evaluated the validity of self-reported drug use in a sample of previously homeless people housed in permanent supportive housing programs in Ft. Worth. We used data from 345 clients who completed a baseline assessment prior to participating in a health coaching intervention. Self-reported drug use and saliva drug tests were compared to determine the positive predictive value for amphetamines/methamphetamines (47.1% agreement), cocaine (43.8% agreement), and marijuana (69.7% agreement) drug tests. Exclusively relying on self-reported drug use may not be a valid measure of drug use in this population. However, we also found instances where people self-reported recent drug use that was not captured by the saliva drug test. In general, amphetamine/methamphetamine and cocaine use was adequately captured by the biological test, while marijuana use was best captured by a combination of self-report and biological data. Assessments of drug use among permanent supportive housing residents should not rely exclusively on self-reported measurements of drug use.