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Objective: Alcohol delivery and to-go sales may contribute to changes in drinking patterns, including where and what people drink. This study tested whether home delivery and to-go alcohol purchases were associated with context- and beverage-specific consumption volumes during the first year of the COVID-19 pandemic after adjusting for pre-pandemic consumption volumes. Method: Data from a pre-pandemic panel were compared to a during-pandemic panel of the National Alcohol Survey (n = 1,150 adult drinkers, 52.7% female). Outcomes were past-year alcohol consumption volumes in standard drinks (overall, by beverage type, and by location). Independent variables included past-year alcohol delivery and to-go purchases (separately). Covariates comprised baseline beverage- or context-specific volume, demographics, COVID-19 impacts, and drinking motivations. Negative binomial regression tested associations between alcohol purchases and change in overall, beverage-, and context-specific consumption. Results: On average, respondents who had alcohol delivered (vs. not) reported consuming larger volumes overall (incidence rate ratio [IRR] = 1.58, 95% CI [1.07, 2.32], p = .02), of wine (IRR = 2.90, 95% CI [1.50, 5.63], p < .04), of spirits (IRR = 1.59, 95% CI [1.03, 2.44], p = .04), and at home (IRR = 1.59, 95% CI [1.10, 2.31], p = .01). People who bought alcohol to go (vs. not) reported larger volumes of wine (IRR = 1.41, 95% CI [1.02, 1.96], p = .04), at home (IRR = 1.60, 95% CI [1.10, 2.32], p = .01), and in bars (IRR = 4.55, 95% CI [2.55, 8.11], p < .001). Finally, people who had alcohol delivered reported drinking smaller volumes in bars (IRR = 0.49, 95% CI [0.24, 0.98], p = .04). Conclusions: During the first year of the pandemic, adults who had alcohol delivered or bought it to go reported larger volumes for several locations and beverage types. [ABSTRACT FROM AUTHOR]

Objective: Alcohol is the most commonly used illegal drug among U.S. high school students. This study aimed to estimate the proportion of drinks and sales revenue accruing to alcoholic beverage companies that were attributable to underage consumption in 2011 and 2016.Method: We used national survey data to estimate the number of adult and underage past-30-day drinkers, median volume of alcohol consumed, beverage preferences, and alcohol price by beverage type. We used Impact Databank to determine the total number of alcoholic drinks sold. After adjusting for underreporting, we applied the percentage of alcohol reported to be consumed by underage youth on surveys to the alcohol sales data by beverage type and assigned a beverage-specific cost.Results: Underage youth drank 11.73% of the alcoholic drinks sold in the U.S. market in 2011 and 8.6% in 2016. Total sales revenue attributable to underage consumption was $20.9 billion (10.0%) out of a total of $208.0 billion in 2011 and $17.5 billion (7.4%) out of $237.1 billion in 2016. Three alcoholic beverage companies represented nearly half (43.5%) of the market share of beverages consumed by underage youth.Conclusions: Despite the alcoholic beverage industry's stated commitment to reducing underage drinking, significant revenues appear to accrue from this activity. This presents an opportunity to enact and enforce policies--such as alcohol taxes or required company funding of independently managed youth drinking prevention initiatives--that recover these revenues from the industry and use them to help achieve the goal of preventing youth alcohol consumption. [ABSTRACT FROM AUTHOR]

Objective: Health consequences of commercializing nonmedical cannabis remain unclear, but data suggest that youth may encounter unintended risks. This study examined whether cannabis marketing exposure and engagement are associated with problematic cannabis use among adolescents. Method: The analytic sample included 172 lifetime cannabis users (15-19 years old) who lived in one of six states with legalized nonmedical cannabis in 2018. Predictors included having exposure to or engagement with cannabis marketing on Facebook or Instagram, seeing cannabis billboards, owning/likely to own cannabisbranded merchandise, and reporting a favorite cannabis brand. Logistic regression assessed whether these predictors were associated with weekly cannabis use, high-intensity cannabis use, and cannabis use disorder (CUD). Results: Adolescents who saw billboards rarely/sometimes had 5 times the odds of CUD, whereas youth who saw them most/all of the time had 7 times the odds of weekly use and 6 times the odds of CUD. Adolescents who owned/were likely to own branded merchandise had nearly 23 times the odds of weekly use, and those with a favorite brand had 3 times the odds of weekly use and CUD. Adolescents who reported seeing promotions on Instagram rarely/sometimes had 85% lower odds of weekly use, and those who saw them most/all of the time had 93% lower odds. Conclusions: The ways cannabis businesses market their products, especially branding, may affect patterns of underage cannabis use. Future research should test whether these associations persist in longitudinal designs. In the interim, states should consider an approach that offers youth additional means to protect them from cannabis marketing. [ABSTRACT FROM AUTHOR]

Objective: There are few cost-effectiveness analyses that model alcohol outlet zoning policies. This study determines the potential decreases in homicides, disability-adjusted life years (DALYs), and victim and criminal justice costs associated with four policy options that would reduce the alcohol outlet access in Baltimore.Method: This cost-effectiveness analysis used associations between on-premise (incidence rate ratio [IRR] = 1.41), off-premise (IRR = 1.76), and combined on- and off-premise outlet density (IRR = 1.07) and homicide in Baltimore. We determined the potential change in the level of homicide that could occur with changes in the density of alcohol outlets, assuming that 50% of the association was causal.Results: Reducing alcohol outlet density in Baltimore City by one quintile was associated with decreases of 51 homicides per year, $63.7 million, and 764 DALYs. Removing liquor stores in residential zones was associated with 22 fewer homicides, which would cost $27.5 million and lead to 391 DALYs. Removing bars/taverns operating as liquor stores was associated with a decrease of one homicide, $1.2 million, and 17 DALYs. Removing both the liquor stores in residential zones and the bars/taverns operating as liquor stores was associated with 23 fewer homicides, which translated to $28.7 million and 409 DALYs.Conclusions: For preventing homicides, the strategy of removing liquor stores in residential zones was preferred because it was associated with substantial reductions in homicides without closing unacceptably high numbers of outlets. It is possible that policies that close the bars/taverns operating as liquor stores would be associated with decreases in other types of violent crime. [ABSTRACT FROM AUTHOR]

Objective: The increasing number of states legalizing recreational cannabis use has raised growing concerns about exposure and access to cannabis for youth. The objective of this study was to develop an adolescent stakeholder-driven concept map toward identifying priority areas for preventing youth cannabis marketing influence. Method: This study used concept mapping, a validated research method that leverages both qualitative and quantitative approaches to integrate stakeholder input on complex topics. We recruited adolescents for the five steps of concept mapping: preparation, generation, structuring, representation, and interpretation. Analysis included hierarchical cluster analysis to develop a concept map representing approaches to protect youth from the influence of cannabis marketing, and youth focus groups to interpret the concept map. Results: A total of 208 participants contributed to the study, including 74.0% females, 62.0% Caucasian, and 38.9% with previous cannabis use. There were 119 brainstorming items generated and sorted into a concept map that included 8 clusters. Clusters represented existing approaches, including education and regulation, and novel approaches, such as changing interpersonal communication and media norms around cannabis. Youth prioritized education-based approaches, including "showing both positive and negative effects of marijuana." Conclusions: This study leveraged adolescent input toward a stakeholder-driven concept map focused on prevention of youth cannabis use. Based on this concept map, there are existing and novel approaches to improve current efforts. The concept map brings adolescent voices forward to advance research, educational, and policy efforts. [ABSTRACT FROM AUTHOR]

The 2018 U.S. Federal Agriculture Improvement Act ("Farm Bill") resulted in what some have called a "legal loophole" in cannabis regulation. As different types of cannabis products proliferate, so has the terminology used to attempt to categorize them. This article presents a variety of potential descriptors to encourage dialogue about the language used to classify the multitude of psychoactive cannabinoid products that have grown in popularity since the passage of the 2018 Farm Bill. Our recommended term for these products is derived psychoactive cannabis products. The term derived helps distinguish these products from naturally grown cannabis products. Psychoactive makes clear that these products can produce psychoactive effects. Finally, cannabis products balances accuracy and understandability regarding the substance while discouraging perpetuation of the word marijuana because of its racist inception. The resulting term, derived psychoactive cannabis products, is broad enough to encapsulate all related products while being specific enough to exclude other substances. Adopting accurate and consistent terminology will reduce confusion and help establish a more cohesive scientific literature base. [ABSTRACT FROM AUTHOR]

Objective: Delta-8 tetrahydrocannabinol (THC) is a largely unregulated psychoactive substance rising in popularity in the United States. This study aimed to understand how retailers explained Delta-8 THC to potential customers and if these descriptions were associated with socioeconomic deprivation surrounding the retail location. Method: In Fort Worth, Texas, stores with retail alcohol, cannabidiol (CBD), or tobacco licenses were called. Among the 133 stores that sold Delta-8 THC, 125 retailers (94%) answered the question "What is Delta-8?" Qualitative methods were used to identify related themes; logistic regression models tested associations between themes and area deprivation index (ADI) scores, a measure of socioeconomic deprivation (1-10; 10 = most deprived areas). Results: Retailers often compared Delta-8 THC to other substances (49%). Although most often described as a type of cannabis (34%), several retailers likened Delta-8 to CBD (19%) or hemp (7%), which are nonpsychoactive. Retailers also described potential effects from use (35%). Some retailers reported that they were unsure of what Delta-8 was (21%), told surveyors to look it up themselves (6%), or withheld information (9%). Higher ADI scores were associated with higher odds of retailers communicating limited information (odds ratio = 1.21, 95% CI [1.04, 1.40], p = .011). Conclusions: Study findings may inform the development of marketing regulations, as well as informational campaigns for both retailers and consumers. [ABSTRACT FROM AUTHOR]

Objective: Marketing messages can influence adolescents' attitudes and behaviors toward alcohol and tobacco. In the era of legalized cannabis use, retail cannabis companies often use social media marketing on platforms popular among youth. The purpose of this study was to evaluate adherence to state-based regulations for restricted and required content across social media from recreational cannabis businesses.Method: A retrospective content analysis was used to evaluate one year of publicly displayed posts by retail cannabis companies on Facebook and Instagram from four states in which recreational cannabis use is legal (Alaska, Colorado, Oregon, and Washington State). We evaluated restricted content including the following: (a) business practices, such as avoiding discounts/promotions or promoting branded products; (b) modeling cannabis use or overconsumption; (c) youth-focused messaging; and (d) health benefits. We evaluated required content including three types of warnings: (a) limiting cannabis use to those age 21 and over, (b) avoiding impaired driving, and (c) describing health risks.Results: A total of 2,660 posts were evaluated from 14 businesses. In the area of restricted content, discounts/promotions were present in approximately 35% of all posts. Another common category was overconsumption, found in 12% of posts. Required content regarding warnings was present in less than half of all social media posts.Conclusions: Despite state-based advertising restrictions, recreational cannabis business pages use messages with youth appeal. Required safety message adherence is not typical on social media business pages. [ABSTRACT FROM AUTHOR]

Objective: In June 2012, Baltimore City, MD, enacted legislation (commonly referred to as the Mosby Bill) prohibiting all liquor stores (outlets that primarily sell alcoholic beverages) from selling "any food, goods, wares, supplies, or other merchandise to any person under the age of 18." Three years after enactment, we evaluated the impact of this legislation on non-alcohol product sales among youth. Method: Research assistants (RAs) ages 16-20 were trained in using a standardized observational tool to quantify and record characteristics of the outlets, including products sold. A trained pair comprising one RA age 16 to 20 and one RA exactly age 18 were sent into every liquor store (i.e., packaged goods stores and bar/taverns with packaged goods sales) in Baltimore to conduct the assessment and make a non-alcohol purchase. Since the research was not conducted in concert with the police, the 18-year-old RA made the purchase attempt while the other (age 16 to 20) RA completed the assessment. Results: Purchase attempts were made at 502 liquor stores, and 352 of those attempts were successful (able to make purchase without being asked for identification or age; noncompliance rate = 68.1%). Noncompliance was highest among packaged goods stores compared with bar/taverns, and in neighborhoods with a lower median household income and a higher proportion of African American residents (p < .050). Noncompliant outlets were also located closer to public schools (p < .050). Conclusions: This evaluation demonstrates that, in the absence of enforcement, ordinances are neither likely to be honored nor to achieve the intended public health benefits. [ABSTRACT FROM AUTHOR]