Browsing by Author "Yockey, Robert"
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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 Characteristics of Delta-8 THC retailers in a large metropolitan city(2022) LoParco, Cassidy; Walker, Drew; McDonald, Kayla; Pathak, Sunidhi Santosh; Eggleston, Jensen; Olsson, Sofia; Yockey, Robert; Luningham, Justin M.; Kong, Amanda; Henry, Doug; Rossheim, MatthewBackground: Retail sales of Delta-8 THC, an isomer of the more common form of cannabis (Delta-9 THC), have increased in the U.S. market since the passing of the 2018 Farm Bill. Specifically, the Farm Bill allowed for the sale of hemp products, which are classified as products having less than 0.3% Delta-9 THC by dry weight. Importantly, sales of Delta-8 THC are unregulated and may introduce possible risk arising from either psychoactive effects or unregulated solvents left behind from the synthesis of Delta-8 THC from CBD. The current study describes the Delta-8 THC retail sales environment in a large metropolitan city. Methods: Potential Delta-8 THC retailers were identified by identifying lists of current retail locations with alcohol, CBD, and tobacco licenses in Fort Worth, Texas (n = 1,961). Research assistants called retailers between September 8 and October 14, 2021, to query about sales of products containing Delta-8 THC; 69% (n = 1,223) of retailers answered and provided data on Delta-8 THC. Outlets' 9-digit ZIP codes were merged with area socioeconomic deprivation index scores. Chi-squared tests compared socioeconomic deprivation index scores between outlets that sold Delta-8 THC versus those that did not sell Delta-8 THC. Among a subsample of those who did sell Delta-8 THC, t-tests examined associations between prices and the type of Delta-8 THC products. Results: Approximately one in ten retail outlets (11%, n = 133) reported selling products containing Delta-8 THC. Most (96%) sold Delta-8 THC in the form of flower/vapes, and three-fourths (76%) sold edibles. Among the least expensive Delta-8 THC products available at these retail outlets were edibles (mean price = $15.39), which cost $8.58 less than flowers/vapes (mean price: $23.97; p < 0.001) on average. Retail outlets that sold Delta-8 THC, compared to those that did not, were in zip codes with greater deprivation (p = 0.02). Most outlets reported having a minimum age for sales of Delta-8 THC as 21 years; however, 4% reported 18 years or no minimum age for sale of Delta-8 THC products. Discussion: Delta-8 THC retail outlets were disproportionately located in ZIP codes with higher levels of socioeconomic deprivation. Legal intervention, such as zoning laws, may be warranted to prevent potential health disparities from overexposing a subset of communities to these products. Policies, such as increasing Delta-8 THC product prices and restricting the types of products sold may help reduce access and appeal to people under 21 years old.Item Consumer Needs for Long-Term Services and Supports and the Road to Improving the Texas No Wrong Door System(2024-03-21) Anaab, Esme; Murphy, Sara; Yockey, Robert; Severance, JenniferPurpose: Long-term services and supports (LTSS) encompass a broad range of medical and personal care assistance needed by individuals who are unable to perform self-care tasks due to aging, chronic illness, or disability. The No Wrong Door (NWD) System is a statewide network that coordinates the system of access to long-term services and supports. As an offshoot of the person-centered planning movement, the NWD System is premised on ensuring that no matter where individuals first interact with the system, they are guaranteed comprehensive information, assessment, and services. The primary goal of this work is to identify strategies to optimize coordination between and awareness of the entry points of this system. The evaluation will help the Texas Health and Human Services Commission create a consumer-driven, cost-effective, and efficient system. Methods: Qualitative input was captured through listening sessions in five Texas cities (i.e. Amarillo, El Paso, Fort Worth, Pharr, and San Antonio) which were supplemented with a statewide survey launched in September 2023 to derive understanding from experiences with the NWD System. Target audiences included people with disabilities, veterans, adults aged 50 and over, family caregivers, and LTSS providers. Several tools (e.g., telephone, mail, and Internet) were utilized for increased survey accuracy and response rate. The survey was distributed in both English and Spanish, and a specific QR code and survey link was incorporated to track responses. Results: Of 4,185 survey respondents, 69% self-identified within the target group (excluding LTSS providers), and 61% expressed a need for LTSS in the past year. Of the 52% who applied for LTSS, 44% stated use of LTSS daily, and 14% weekly. The top three problems accessing LTSS include a confusing system, long wait times for services, and not knowing where to get help. 79% of consumers were unaware of the NWD System; 2% unsure. Of the 19% aware, 45% felt very or somewhat uninformed about the system in their community. The reasonability of time spent applying for services, ease of applying for services, and timeliness in handling service concerns were among the lowest-scoring statements regarding the system. Conclusions: Our results form the blueprint for facilitating access to care at the community and agency levels throughout Texas to ensure vulnerable populations obtain a high quality of life. Recommendations for the NWD system include effective community outreach and streamlined application processes for services and supports.Item School-based factors associated with attempted suicide among united states adolescents, 2015-2019(2022) Forschner, Caylee; Yockey, Robert; Griner, StaceyPurpose: Suicide is the second leading cause of death among adolescents in the United States, ages 15 to 19 years old. Previous research has identified an extensive list of risk factors associated with adolescent suicide and indicates sexual minority youth, who identify as lesbian, gay, bisexual, or unsure, are at increased risk for suicidal behaviors, but limited research examines the contextual factors that may be associated with suicide attempts among these youth. Additional research is warranted into school-based factors and their relationship with suicide among sexual minority youth. The purpose of the present study is to investigate school-based factors associated with suicide and explore differences by sexual minority status among a large, nationally representative sample of U.S. youth over multiple years. Methods: Pooled data from the 2015-2019 Youth Risk Behavior Survey (YRBS) were analyzed. The YRBS is a bi-annual survey conducted in the United States to examine health behaviors among youth in middle and high school. Weighted logistic regression models were conducted to determine conditional associations to past-year suicide attempt ("yes or no"). The conditional associations considered were, sexual orientation ("heterosexual, gay/lesbian, bisexual and not sure"), did not go to school because they felt unsafe ("yes and no"), and grades over the last year ("mostly A's/B's, mostly C's/D's/F's and none of these grades/not sure"). Interactions between sexual orientation and not going to school because they felt unsafe, were built and were mean centered to reduce multi-collinearity and interpretability of findings. Missing data were handled with multiple imputation methods and combined in multivariate analyses using Rubin's rules. The level of significance was set at p < .05 and were two-tailed. Analyses were conducted in Stata. Results: The total sample comprised of 44,066 students in 9th-12th grades, with nearly equal percentages of boys and girls (50.0% vs. 49.2%, respectively). An estimated 3.4% (95% confidence interval (CI): 3.15-3.62) of youth reported past year suicide attempt. Compared to heterosexual youth, bisexual youth (aOR: 1.38, 95%CI 1.24-1.53) were more likely to report attempting suicide. Students who reported feeling unsafe at school (aOR: 1.49, 95%CI 1.34-1.64) were more likely to attempt suicide compared to those who reported feeling safe at school. Sexual orientations and feeling safe at school interactions were not significant- the students who did not feel safe were not those that identified as sexual minorities. Students who reported their grades as C's/D's/F's (aOR: 0.75, 95%CI 0.64-0.86) were less likely than students who reported A's/B's to attempt suicide. Conclusions: These findings indicate that students who do not feel safe in school have an increased risk of suicide attempts, underscoring the importance of programs that promote a safe and supportive school environment. Students who reported lower grades have a decreased risk of suicide attempts, necessitating further research to identify the influence of academic pressures. Understanding school-based factors affecting adolescent suicide risk is important to identify students at greatest risk and develop targeted and effective programs to reduce suicide in this age group.