Arab Americans are at risk for disproportionately high use of commercial tobacco products, including among women, for whom waterpipe (shisha) smoking is increasingly normative. Culturally- and gender-responsive interventions, however, are scarce. We developed and tested Commit to Quit (CtQ), a novel community-driven tobacco intervention designed for Arab American women in Northern California. The program mobilized Arab American community women to support tobacco cessation and prevention within their community. Immigrant Arab American women participated in biweekly virtual sessions conducted in Arabicto learn about tobacco risks, cultural smoking norms, and prevention and cessation strategies and then support friends and relatives to quit through a peer-to-peer brief intervention. Pre- and post-program assessments measured changes in tobacco use behaviors, self-efficacy, and community engagement. Compared to a comparison group (n = 190), CtQ participants (n = 28) were significantly more likely to engage in cessation efforts, utilize various quitting methods, and promote smoke-free environments. Participants demonstrated increased self-efficacy incommunity activism and leadership. By centering Arab American women in tobacco interventions through culturally and linguistically accessible programming that addressed social smoking norms, CtQ facilitated increased community awareness and mobilized women to act as change agents to improve their own and their community's health. Community-driven interventions that are gender-responsive may reduce tobacco-related health disparities in underserved populations.

INTRODUCTION:This study examined associations between retail alcohol and cannabis availability, use, and simultaneous use of these substances among youth and potential explanatory variables. METHODS:In 2023-24, 1082 15- to 20-year-olds were surveyed in 40 California cities. The survey included questions about past-year alcohol use, binge drinking, cannabis use, and simultaneous alcohol and cannabis (SAC) use, exposure to opportunities for these behaviours in different contexts, normative and health-related beliefs, and demographic characteristics. City-level measures included retail alcohol and cannabis outlet density and demographic characteristics. Analyses examined associations of these substance use behaviours with retail availability of alcohol and cannabis and potential explanatory variables. RESULTS:On-premises alcohol outlet density was significantly associated with past-year alcohol use (b = 0.36, p < 0.05) and binge drinking (b = 0.23, p < 0.05). Licensed cannabis retail outlet density was positively associated with past-year cannabis use (b = 6.4, p < 0.01), while unlicensed cannabis outlet density was negatively associated with cannabis use (b = -21.1, p < 0.01). On-premises alcohol outlet density was positively associated with past-year SAC use (b = 0.18, p < 0.01). These associations were at least partially explained by greater exposure to opportunities for alcohol, cannabis, and SAC use in different contexts/situations and beliefs related to these behaviours. DISCUSSION AND CONCLUSIONS:Retail availability of alcohol and cannabis is associated with alcohol and cannabis use and SAC use among youth. These associations are at least partly explained by greater exposure to opportunities to engage in these behaviours and related beliefs.

OBJECTIVE:The California (U.S.) Responsible Beverage Service (RBS) Training Act mandated training for all alcohol servers by 2023, giving us a rare opportunity to see how a statewide initiative might influence server behavior. METHOD:In 2022, 300 licensed on-premises establishments were sampled in nine counties representing the San Francisco Bay Area. From July 2022 to January 2023, "pseudopatron" and observer teams visited each establishment, and pseudopatrons attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt and characteristics of establishments, servers, pseudopatrons, and the month, day, and time were recorded. In 2024, the same premises were visited as a follow-up. RESULTS:At baseline, 19.6% of the outlets refused service to the pseudopatron. At follow-up, the refusal rate increased significantly to 39.2% in a regression model controlling for establishment, server, and pseudopatron characteristics (odds ratio [OR] = 4.51, p < .01). A typology of outlets (e.g., sports bar, casual restaurant, fine dining) did not show any association with refusal rate except that fine dining (upscale) places refused more often than other types of establishments. Observer rating of how obvious the pseudopatron's apparent intoxication was strongly associated with refusals (OR = 11.64, p < .01). CONCLUSIONS:This study suggests that there was substantial improvement in alcohol overservice refusals 2 years after the mandatory RBS training law went into effect.

OBJECTIVES:We investigated whether experiences of overall, race, appearance, and sexual minority discriminatory harassment were associated with adolescents' marijuana use and whether retail availability of legal recreational marijuana in Oregon counties moderated these associations. METHODS:Data for 6th, 8th, and 11th graders from the 2018 Student Wellness Survey in 33 Oregon counties were analyzed to assess marijuana use among students (N = 61,703) who did and did not experience discriminatory harassment and who lived in counties with different levels of marijuana retail availability (low, medium, high) measured as legal recreational outlets per roadway mile within each county. RESULTS:Multi-level logistic regression analyses indicated that students who reported experiencing overall, race, appearance, or sexual minority discriminatory harassment were more than twice as likely to report marijuana use. These associations were not moderated by retail availability. Additionally, students who lived in counties with greater retail marijuana availability were more likely to report marijuana use than students living in counties with less retail marijuana availability. Marijuana beliefs partially accounted for the associations between discriminatory harassment and marijuana use, and completely accounted for the association between retail outlet density and marijuana use. CONCLUSIONS:This study provides a better understanding of the impact of discriminatory harassment and retail marijuana availability on marijuana use among adolescents. Prevention efforts should include school programs focused on addressing bullying and marijuana use as well as comprehensive community programs and policies to reduce adolescents' exposures to marijuana retail sales and marketing.

This study examined the psychometric properties of novel multi-item measures of exposure to opportunities for alcohol use, cannabis use, and simultaneous use (SAM) among youth. Surveys were administered to 1,082 15- to 20-year-olds in 40 California cities in 2023-24. The surveys included questions about how often respondents had an opportunity to engage in alcohol use, cannabis use, and SAM in different contexts/situations in the past year (e.g., at home), beliefs related to these substance use behaviors, and demographic characteristics. A second-order confirmatory factor analysis (CFA) and correlation and regression analyses were conducted to assess the psychometric properties of the exposure to substance use opportunities measures. The CFA indicated that survey items loaded on three primary factors (five items per factor) corresponding to opportunities for alcohol use, cannabis use, and SAM. Factor loadings ranged from 0.61 to 0.90, and the model fit was acceptable [NFI = 0.91; CFI = 0.94; RMSEA = 0.043 (95

Purpose of ReviewThis narrative review summarizes research-to-date on strategies to prevent problematic cannabis use.Recent FindingsTen meta-analytic reviews of cannabis use prevention strategies published after 2010 were identified for this review. The meta-analytic reviews were based on studies evaluating the effectiveness of school-based programs, online/digital interventions, mass-media approaches, culturally specific interventions, and brief interventions. Results indicate that school-based programs, online/digital interventions, and culturally specific interventions may help to prevent or reduce cannabis use, though effect sizes were modest. Brief interventions were found to have no effect on cannabis use frequency, but had small beneficial effects on cannabis use disorder, consequences, and abstinence. Mass media approaches were not effective in preventing cannabis use.SummarySchool-based programs, online/digital interventions, culturally specific interventions, and brief interventions can have modest effects on problematic cannabis use. Research is needed to evaluate environmental strategies to prevent problematic cannabis use at the population level.

Objective: Alcohol overservice at on-premises establishments is associated with driving while intoxicated, violence, and other harms. This study examined rates of alcohol overservice and service refusal among licensed on-premises establishments in northern California and characteristics of establishments, servers, and pseudo-patrons (PPs) that may be associated with service refusal. Method: In 2022, 300 licensed on-premises establishments were sampled in nine counties representing the San Francisco Bay Area. From July 2022 to January 2023, PP and observer teams visited each establishment, and PPs attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt; characteristics of establishments, servers, and PPs; and month, day, and time were recorded. Descriptive and regression analyses were conducted to address study objectives. Results: Twentyone percent of the establishments refused alcohol service to PPs. No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis, nor were month, day, or time. However, service refusal was significantly more likely among female PPs (odds ratio = 3.71, 95% CI [1.67, 8.24], p < .01) and PPs displaying obvious or very obvious signs of intoxication (odds ratio = 9.28, 95% CI [1.99, 43.40], p < .01). There was no significant interaction effect of PP × Server Gender on the likelihood of service refusal. Conclusions: This study indicates that alcohol overservice to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol overservice laws are needed to reduce overservice and related harms.

Objective: This follow-up study examines whether a multi-component, high-visibility alcohol enforcement intervention implemented in 12 California cities had long-term effects on alcohol-related motor vehicle crashes beyond the period of the original study. Previous results indicated a significant reduction in single-vehicle night-time (SVN) crashes among 15- to 30-year-olds in intervention cities relative to controls. Method: A randomized trial was conducted with 24 randomly chosen California cities from 2012 to 2017 to evaluate a multi-component intervention to reduce excessive drinking and driving while impaired among adolescents and young adults. Twelve of the cities were randomly assigned to the intervention condition and implemented high-visibility alcohol enforcement operations and other components from April 2013 to March 2016. Multi-level negative binomial regression analyses were conducted with motor vehicle crash data from 2010 to 2021 to examine whether SVN crashes among 15- to 30-year-olds decreased in intervention cities relative to controls after the multi-component intervention was implemented. Analyses controlled for community sociodemographic characteristics, the overall time trend, the COVID pandemic, and pre-intervention levels of SVN crashes and adjusted for correlation of repeated observations within cities over time. Results: Regression analyses indicated a significantly lower level of monthly SVN crashes among 15- to 30-year-olds in intervention cities during post-intervention months through 2021 relative to control cities (incidence rate ratio [95% CI] = 0.88 [0.79, 0.98], p < .05) when controlling for community sociodemographic characteristics, the overall time trend, COVID, and pre-intervention levels of SVN crashes. Conclusions: Study findings suggest that a multi-component, high-visibility alcohol enforcement intervention can have long-term effects on alcohol-related motor vehicle crashes and related injuries and fatalities among adolescent and young adult drivers.

INTRODUCTION:We investigated whether greater concentrations of on- and off-sale alcohol outlets were associated with crime and whether this association was moderated by COVID-19 shelter-in-place orders (SIP) that restricted on-premises consumption of alcohol. METHODS:Crimes (2019-2020) and addresses of licenced alcohol outlets in a medium-sized California city were geocoded within census block groups (N = 61). On- and off-sale alcohol outlet density was calculated as licenced outlets/2.59 km2 (1 square mile). Multilevel negative binomial regression analyses were conducted to examine associations between alcohol outlet density and crime, and possible moderating effects of SIP, controlling for block group demographic characteristics and density of other retail businesses. RESULTS:On-sale outlet density was positively associated with total crimes and Part 2 crimes, while off-sale outlet density was inversely associated with total crime and Part 2 crimes. Overall, SIP was not significantly associated with crime, but moderated the associations of on-sale density with total crime and Part 1 crimes such that reductions in crime during SIP were observed in higher density areas. The association of off-sale outlets with crime was not moderated by SIP policies. DISCUSSION AND CONCLUSION:On-sale outlet density, but not off-sale density, appears to be associated with increased crime. The results further indicate that restrictions in hours and service imposed by SIP policies reduced crime in high on-sale outlet density areas. These findings reinforce the importance of regulating alcohol outlet density and hours of service, especially for on-sale outlets, as a crime reduction strategy.

Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to “normalize” what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve “normalization.”

Introduction: This study evaluated how Shelter-in-Place (SIP), modified reopening orders, and self-reported compliance with these orders have affected adolescent alcohol frequency and quantity of use across contexts during the COVID-19 pandemic. Materials and Methods: Differences-in-differences (DID) models and multi-level modeling analyses were con-ducted on longitudinal data collected as part of a larger study on alcohol use among adolescents in California. 1,350 adolescents at baseline contributed 7,467 observations for a baseline and 5 six-month follow-up surveys. Analytic samples ranged from 3,577-6,245 participant observations based on models. Alcohol use outcomes included participant frequency (days) and quantity (number of whole drinks) of alcohol use in past 1-month and past 6-month periods. Context-specific alcohol use outcomes included past 6-month frequency and quantity of use at: restaurants, bars/nightclubs, outside, one's own home, another's home, and fraternities/sororities. Participant self-reported compliance with orders in essential business/retail spaces and at outdoor/social settings were also assessed. Results: Our DID results indicated that being under a modified reopening order was associated with decreases in past 6-month quantity of alcohol use (IRR = 0.72, CI = 0.56-0.93, p < 0.05). Higher self-reported compliance with SIP orders related to social outdoor/social settings was associated with decreases in overall drinking fre-quency and quantity as well as decreases in frequency and quantity of alcohol use in all contexts in the past six months. Compliance with SIP orders impacting essential businesses and retail spaces was associated with decreased frequency and quantity of use at other's home and outdoors. Conclusions: Results suggest that SIP and modified reopening policies may not directly affect adolescent alcohol use or drinking contexts, and that individual compliance with such orders may be a protective factor for alcohol use.

OBJECTIVE:This study examined whether recreational marijuana legalization (RML) and local retail availability were associated with marijuana and alcohol use and co-use among adolescents.METHOD:We investigated associations between RML and past-30-day marijuana and alcohol use and co-use, and moderating effects of retail availability of marijuana and alcohol, using data from the 2010-2011 to 2018-2019 California Healthy Kids Surveys (CHKS) of 9th and 11th grade students in 38 California cities. Multilevel mixed-effects logistic regression analyses were conducted, controlling for secular trends and student and city demographics. Additional analyses examined associations of RML and retail availability with co-use among subgroups of drinkers and marijuana users.RESULTS:For the full sample, RML was inversely associated with alcohol use but was not significantly associated with marijuana use or co-use with alcohol. However, significant interactions between RML and marijuana outlet density showed that there were increases in marijuana and alcohol co-use and alcohol following legalization in cities with higher densities of marijuana outlets. RML was positively associated with co-use among non-heavy and heavy drinkers, but inversely related to co-use among occasional and frequent marijuana users. A significant positive interaction between RML and marijuana outlet density indicated that RML was associated with increases in co-use for occasional marijuana users in cities with higher densities of marijuana outlets.CONCLUSIONS:RML was associated with increases in marijuana and alcohol co-use and alcohol use among California high school students, particularly those in cities with higher densities of retail cannabis stores, although this varied across alcohol and marijuana use subgroups.

Background: American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska.Methods: The study used baseline data from "Got Neqpiaq?" a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3-5 years, enrolled in Head Start in 12 communities in southwest Alaska (n = 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured.Results: Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels.Conclusions: The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov #NCT03601299.

Introduction: Little is known about the possible impacts of recreational marijuana legalization on alcohol and marijuana co-use among underage youth. This study examines the association between recreational marijuana legalization in California in 2016 and alcohol and marijuana co-use among adolescents. Additional analyses investigate the associations between recreational marijuana legalization and co-use among past 30-day drinkers and marijuana users and the frequency of alcohol and marijuana use among co-users. Methods: This study used annual cross-sectional data from 7th, 9th, and 11th graders (N=3,319,329) who participated in the California Healthy Kids Survey from 2010-2011 to 2018-2019. Measures included past 30-day alcohol and marijuana use and student demographic characteristics, survey year, pre-post recreational marijuana legalization, and urbanicity. Multilevel regression analyses were conducted in 2021. Results: Recreational marijuana legalization was associated with greater odds of past 30-day alcohol and marijuana co-use in the total sample (OR=1.06, 95% CI=1.05, 1.07). Recreational marijuana legalization was more strongly associated with co-use among adolescents who reported past 30-day alcohol use (OR=1.58, 95% CI=1.52, 1.62) and heavy drinking (OR=1.25, 95% CI=1.21, 1.29) but was inversely related to co-use among past 30-day marijuana users (OR=0.76, 95% CI=0.74, 0.78). Among past 30-day co-users, there was a positive association with the frequency of marijuana use (beta=0.36, SE=0.07). Conclusions: Recreational marijuana legalization may increase the risk of alcohol and marijuana co-use among adolescents. Greater restrictions on the numbers of alcohol and marijuana retail outlets and hours of operation and advertising and higher taxes on alcohol and marijuana products may help reduce the availability of these substances to adolescents. (C) 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Background This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI. Methods Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics. Results Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil. Conclusion Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI.

ObjectiveA California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents’ use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups.MethodsSecondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010–11 to 2017–2018.ResultsMultilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups.ConclusionsOur findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.

Issues Policy enforcement is crucial to achieve impacts on alcohol-related harm. It is not clear what level of enforcement intensity or 'dosage' is necessary for addressing drink driving and related harms. Given competing enforcement demands and agencies' resource constraints, understanding how much enforcement is sufficient to deter drink driving is critical. Approach This systematic literature review followed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines to examine research about dosage effects of enforcement and related visibility on drink-driving outcomes, including motor vehicle crashes and fatalities. Risk of bias was assessed using the Cochrane Collaboration Effective Practice and Organization of Care tool and the JBI checklist. Key Findings The 21 studies that met the inclusion criteria for this review differed in measures of enforcement dosage and outcomes, making it difficult to synthesise results across studies and draw conclusions about a threshold or optimal level of enforcement. Although most included studies found that sustained enforcement was associated with reductions in drink driving or related harms, only two studies tested an optimal dosage. Due to study design limitations, a substantial percentage of these studies must be considered with caution. Implications Additional research with rigorous study designs with appropriate controls is needed to determine an optimal high visibility enforcement dosage level to help law enforcement agencies make realistic decisions about allocating enforcement resources to address drink driving. Conclusion Consistent evidence about a drink-driving enforcement dosage threshold is lacking, partly due to an insufficient number of well-designed studies. Addressing challenges of conducting rigorous studies in community settings is crucial.