TOBACCO OUTLET DENSITY, PROXIMITY, AND TOBACCO USE AMONG AFRICAN AMERICAN YOUNG ADULTS IN BALTIMORE CITY: MECHANISMS OF ACTION

Abstract Objectives: Research exploring the relationship between tobacco use and exposure to tobacco outlets via density and proximity is inconclusive, and no studies focus exclusively on African American young adults – although this population is often the target of tobacco advertisements and exposed to higher levels of tobacco outlet density. To better understand the relationship between tobacco outlet exposure and tobacco use among African American young adults research is needed on the mechanisms driving this relationship. This study explored three specific mechanisms – moderation, mediation, and growth. The specific aims of this investigation were 1. to assess the moderating role of gender in the relationship between tobacco outlet exposure (i.e., density and proximity to outlets) and past month tobacco use among African American young adults living in Baltimore City, Maryland. 2. to assess the mediating role of perceived harmfulness and disapproval of cigarette use in the relationship between tobacco outlet exposure and past month tobacco use among African American young adults living in Baltimore City, Maryland, and 3. to assess the correlation between the growth of tobacco outlet density and past month tobacco use among African American young adults living in Baltimore City, Maryland. Methods: Each aim used data from the Johns Hopkins Second Generation Baltimore Prevention Program (BPP) cohort. The BPP is a field trial of two universal first grade interventions, respondents are predominately African American, and were followed through adulthood. Assessments of tobacco and other drug use began in the sixth grade. Geospatial methods were used to determine the density of tobacco outlets surrounding participants’ homes’, as well as how close participants’ lived to the nearest tobacco outlet. Aim 1 was assessed using logistic regression models via generalized estimating equations. Aim 2 was assessed using path analyses. Aim 3 used parallel process growth curve modeling to assess the simultaneous growth of tobacco outlet density and past month tobacco use. Results: In Aim 1, sex modified the relationship between tobacco outlet density and past month tobacco use, and this relationship was only significant among women, such that after adjusting for confounding, the relationship between past month tobacco use and tobacco outlets that sold tobacco but not alcohol was positive and significant (aOR = 1.02; p < 0.05). Additionally, among women, the relationship between past month tobacco use and tobacco outlets that sold both tobacco and alcohol was positive and significant (OR = 1.04; p < 0.05), however, after adjusting for confounding the relationship was no longer statistically significant (aOR = 1.04; p = 0.12). Proximity to the nearest tobacco outlet was not significantly associated with past month tobacco use for men or women. On average, people lived closer to and the density per quarter mile was higher for outlets that sold tobacco, but not alcohol, relative to outlets that sold both tobacco and alcohol. For example, on average, people lived within 552 meters (standard deviation [SD] = 459 meters) of an outlet that sold tobacco, but not alcohol, and within 658 meters (SD = 500 meters) of an outlet that sold both tobacco and alcohol. Furthermore, there were on average 16.4 outlets per quarter mile (SD = 26.4) that sold tobacco only, whereas the average density for outlets that sold both tobacco and alcohol was 7 outlets per quarter mile (SD = 11.3). In Aim 2, disapproval of cigarette use, but not perceived harmfulness of cigarette use was a significant mediator in the relationship between tobacco outlet density and past month tobacco use, and results varied by gender, such that disapproval of cigarette use significantly mediated the relationship between tobacco outlet density and past month tobacco use for men but not women. The relationship between proximity to the nearest tobacco outlet and past month tobacco use was not mediated by disapproval or perceived harmfulness of cigarette use for men or women. In Aim 3, correlations between several growth factors were evaluated, of primary interest was the correlation between the random effects on the slopes of past month tobacco use and tobacco outlet density. This relationship was not significant (r = 0.31; p-value = 0.08). However, the correlation between the random effects on the intercepts of past month tobacco use and tobacco outlet density was statistically significant (r = 0.19; p-value < 0.05). Conclusions: This study has implications for research, practice and policy. For example, public health practitioners aiming to reduce tobacco use among African American young adults living in areas where tobacco outlet density is high should consider gender-specific interventions as this study implies that the relationship between tobacco outlet density and tobacco use, to include mediating factors, differ by sex. Furthermore, policy should focus on zoning restrictions that prevent the establishment of tobacco outlets in residential neighborhoods, recognizing that neighborhoods where tobacco outlet density is initially high may be associated with initial decisions to use tobacco among African American young adults. Future research should continue evaluating mechanism driving the relationship between exposure to tobacco outlets and tobacco use among this population. Such research will potentially reveal other mediators and moderators that are malleable to intervention, and this will lead to comprehensive preventive efforts that impose restrictions on tobacco outlet density and zoning, while simultaneously addressing other correlates of tobacco use

Trends in Marijuana Use Among Pregnant and Nonpregnant Reproductive-Aged Women, 2002-2014

Between 2001 and 2013, marijuana use among US adults more than doubled, many states legalized marijuana use, and attitudes toward marijuana became more permissive. In aggregated 2007-2012 data, 3.9% of pregnant women and 7.6% of nonpregnant reproductive-aged women reported past-month marijuana use. Although the evidence is mixed, human and animal studies suggest that prenatal marijuana exposure may be associated with poor offspring outcomes (eg, low birth weight, impaired neurodevelopment). The American College of Obstetricians and Gynecologists recommends that pregnant women and women contemplating pregnancy be screened for and discouraged from using marijuana and other substances. Whether marijuana use has changed over time among pregnant and nonpregnant reproductive-aged women is unknown

Trajectories of Sensation Seeking Among Puerto Rican Children and Youth

Objective: To document the natural course of sensation seeking from childhood to adolescence, characterize distinct sensation seeking trajectories, and examine how these trajectories vary according to selected predictors. Method: Data were obtained from the Boricua Youth Study, a longitudinal study of 2,491 children and adolescents of Puerto Rican background (3 assessments from 2000 to 2004). First, age-specific sensation seeking levels were characterized, and then age-adjusted residuals were analyzed using growth mixture models. Results: On average, sensation seeking was stable in childhood (ages 5–10 years) and increased during adolescence (ages 11–17 years). Mean scores of sensation seeking were higher in the South Bronx versus Puerto Rico and among males versus females. Four classes of sensation seeking trajectories were observed: most study participants had age-expected sensation seeking trajectories following the average for their age (“normative,” 43.8%); others (37.2%) remained consistently lower than the expected average for their age (“low” sensation seeking); some (12.0%) had an “accelerated” sensation seeking trajectory, increasing at a faster rate than expected; and a minority (7.0%) had a decreasing sensation seeking trajectory that started high but decreased, reaching scores slightly higher than the age-average sensation seeking scores (“stabilizers”). Site (South Bronx versus Puerto Rico) and gender were predictors of membership in a specific class of sensation seeking trajectory. Conclusion: It is important to take a developmental approach when examining sensation seeking and to consider gender and the social environment when trying to understand how sensation seeking evolves during childhood and adolescence

Prevalence of co-occurring conditions among youths receiving treatment with primary anxiety, ADHD, or depressive disorder diagnoses

Introduction: Anxiety disorders, depressive disorders, and attention-deficit/hyperactivity disorder (ADHD) are some of the most common conditions that youths (≤ 18 years old) receive mental health treatment for. These conditions are associated with high-risk substance use or substance use disorders (SUDs). This study sought to identify the proportion of youths (≤ 18 years old) with anxiety disorders, depressive disorders, or ADHD as a primary diagnosis in community mental health centers (CMHCs) having co-occurring high-risk substance use or a SUD. Methods: Analysis included binary logistic regression models using the Mental Health Client-Level Data 2017 to 2019 datasets which contains annual cross-sectional administrative data from mental health treatment facilities. The final sample included n = 458,888 youths with an anxiety disorder as a primary diagnosis, n = 570,388 youths with a depressive disorder as a primary diagnosis, and n = 945,277 youths with ADHD as a primary diagnosis. Results: In the subsample with anxiety as a primary diagnosis, approximately 5% of youth had high-risk substance use or a SUD. Approximately 10% of youth with depression as a primary diagnosis had high-risk substance use or a SUD. Among youth with ADHD as a primary diagnosis, 5% had high-risk substance use or a SUD. Odds of having a co-occurring high-risk substance use or SUD differed based on the youth's age, region, race and ethnicity, gender, and their number ofother mental health diagnoses. Conclusions: Effective care for this high-need youth population at CMHCs will require mental health clinicians to possess knowledge and skills related to substance use treatment

An epidemiological, developmental and clinical overview of cannabis use during pregnancy

The objective of the current narrative literature review is to provide an epidemiological, developmental and clinical overview on cannabis use during pregnancy. Cannabis use in pregnancy poses major health concerns for pregnant mothers and their developing children. Although studies on the short- and long-term consequences of prenatal cannabis exposure are increasing, findings have been inconsistent or difficult to interpret due to methodological issues. Thus, consolidating these findings into clinical recommendations based on the mixed studies in the literature remains a challenge. Synthesizing the available observational studies is also difficult, because some of the published studies have substantial methodological weaknesses. Improving observational studies will be an important step toward understanding the extent to which prenatal exposure to cannabis influences neurodevelopment in the offspring. Therefore, further research on prenatal cannabis exposure and the long-term consequences to offspring health in representative samples are needed to guide and improve clinical care for pregnant women and their children. Future research should also investigate the role of policies on prenatal cannabis use

Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age

Background: Understanding the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women can provide important insight into the role of access to care in preventing tobacco and alcohol use among pregnant women and women planning to become pregnant. Methods: We examined the association between health insurance coverage and both past month alcohol use and past month tobacco use in a nationally representative sample of women age 12–44 years old, by pregnancy status. The women (n = 97,788) were participants in the National Survey of Drug Use and Health (NSDUH) in 2010–2013. Logistic regression models assessed the association between health insurance (insured versus uninsured), past month tobacco and alcohol use, and whether this was modified by pregnancy status. Results: Pregnancy status significantly moderated the relationship between health insurance and tobacco use (p-value ≤ 0.01) and alcohol use (p-value ≤ 0.01). Among pregnant women, being insured was associated with lower odds of alcohol use (adjusted odds ratio [AOR] = 0.47; 95% confidence interval [CI] = 0.27–0.82), but not associated with tobacco use (AOR = 1.14; 95% CI = 0.73–1.76). Among non-pregnant women, being insured was associated with lower odds of tobacco use (AOR = 0.67; 95% CI = 0.63–0.72), but higher odds of alcohol use (AOR = 1.23; 95% CI = 1.15–1.32). Conclusion: Access to health care, via health insurance coverage is a promising method to help reduce alcohol use during pregnancy. However, despite health insurance coverage, tobacco use persists during pregnancy, suggesting missed opportunities for prevention during prenatal visits

An epidemiological, developmental and clinical overview of cannabis use during pregnancy

The objective of the current narrative literature review is to provide an epidemiological, developmental and clinical overview on cannabis use during pregnancy. Cannabis use in pregnancy poses major health concerns for pregnant mothers and their developing children. Although studies on the short- and long-term consequences of prenatal cannabis exposure are increasing, findings have been inconsistent or difficult to interpret due to methodological issues. Thus, consolidating these findings into clinical recommendations based on the mixed studies in the literature remains a challenge. Synthesizing the available observational studies is also difficult, because some of the published studies have substantial methodological weaknesses. Improving observational studies will be an important step toward understanding the extent to which prenatal exposure to cannabis influences neurodevelopment in the offspring. Therefore, further research on prenatal cannabis exposure and the long-term consequences to offspring health in representative samples are needed to guide and improve clinical care for pregnant women and their children. Future research should also investigate the role of policies on prenatal cannabis use

Modes of cannabis administration in the year prior to conception among patients in Northern California.

Cannabis use among individuals before and during pregnancy is increasing alongside the proliferation of new products with various modes of administration. Preconception cannabis use is a strong predictor of prenatal cannabis use. Yet little is known about how individuals administer cannabis during the preconception period, particularly in socioeconomically vulnerable populations. This study examined the prevalence and correlates of modes of cannabis administration (smoke, vape, blunts, edible/oral, dabs/wax, lotion/topical) during the year before conception, among patients who self-reported preconception cannabis use during universal screening in prenatal care. Descriptive statistics included sociodemographic characteristics, preconception cannabis use frequency, and modes of administration. Chi-square tests examined whether mode was associated with sociodemographic characteristics and use frequency. The sample (N&nbsp;=&nbsp;11,936, screened from February 2020-May 2021) was 59.8% non-White and 26.1% were&nbsp;&lt;&nbsp;26&nbsp;years old; 50.7% reported monthly or less, 21.8% weekly, and 27.4% daily preconception cannabis use; 69.7% smoked (any method), 34.5% smoked blunts, 53.4% used edibles/oral, 28.2% vaped, 9.9% used lotion/topical; 54.2% reported 1 mode, 30.4% reported 2 modes, 15.4% reported 3+&nbsp;modes. Smoking was more common among daily users, younger patients, those with greater neighborhood deprivation, and Black and Hispanic patients, while edibles/oral were more common among&nbsp;≤&nbsp;monthly users, older patients, those with less neighborhood deprivation, and Asian patients. Use of other modes also varied by sociodemographic characteristics and use frequency. Research is needed to understand preconception cannabis use in vulnerable subpopulations, continuation of use during pregnancy, and whether health risks associated with preconception and prenatal cannabis use differ by administration mode