Recent Publications



Drinking, alcohol use disorder, and treatment access and utilization among U.S. racial/ethnic groups
   Alcoholism, Clinical and Experimental Research (2017)
    Vaeth, Patrice A. C. ; Wang-Schweig, Meme ; Caetano, Raul
Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.


The temporal-spatial distribution of seriously maltreated children
   Spatial and Spatio-temporal Epidemiology (2017)
   Thurston, Holly; Freisthler, Bridget ; Bell, Janice; Tancredi, Daniel; Romano, Patrick S.; Miyamoto, Sheridan; Joseph, Jill G.
While the geographic dispersion of cases relative to controls did not differ, clustering of cases relative to the general population of young children was found in four distinct areas. The clustering accounted for 47 cases spanning 5 years, so the majority of cases were outside these cluster areas. The “hot spots” shifted over time and space.


Environmental and individual attributes associated with child maltreatment resulting in hospitalization or death
   Child Abuse & Neglect (2017)
   Thurston, Holly; Freisthler, Bridget ; Bell, Janice; Tancredi, Daniel; Romano, Patrick S.; Miyamoto, Sheridan; Joseph, Jill G.
Maltreatment continues to be a leading cause of death for young children. Researchers are beginning to uncover which neighborhood attributes may be associated with maltreatment outcomes. However, few studies have been able to explore these influences while controlling for individual family attributes, and none have been able to parse out the most severe outcomes-injuries resulting in hospitalization or death. This study utilizes a retrospective, case-control design on a dataset containing both individual and environmental level attributes of children who have been hospitalized or died due to maltreatment to explore the relative influence of attributes inside and outside the household walls. Binary conditional logistic regression was used to model the outcome as a function of the individual and environmental level predictors. Separate analyses also separated the outcome by manner of maltreatment: abuse or neglect. Finally, a sub-analysis included protective predictors representing access to supportive resources. Findings indicate that neighborhood attributes were similar for both cases and controls, except in the neglect only model, wherein impoverishment was associated with higher odds of serious maltreatment. Dense housing increased risk in all models except the neglect only model. In a sub-analysis, distance to Family Resource Centers was inversely related to serious maltreatment. In all models, variables representing more extreme intervention and/or removal of the victim and/or perpetrator from the home (foster care or criminal court involvement) were negatively associated with the risk of becoming a case. Medi-Cal insurance eligibility of a child was also negatively associated with becoming a case. Government interventions may be playing a critical role in child protection. More research is needed to ascertain how these interventions assert their influence.


Evaluating the change in medical marijuana dispensary locations in Los Angeles following the passage of local legislation
   The Journal Of Primary Prevention (2017)
   Thomas, Crystal; Freisthler, Bridget
In May 2013, Los Angeles voters approved Proposition D, a regulatory measure that set zoning restrictions and capped the number of dispensaries at those that opened before 2007. Specifically, Proposition D stated that only 135 dispensaries were allowed to be in operation and set zoning restrictions prohibiting dispensaries from operating in certain areas. We first assessed whether the legislation changed the physical availability of medical marijuana via dispensaries in Los Angeles. We then used two data points 1 year prior to and 1 year following the implementation of Proposition D to determine if the locations of where the dispensaries are located changed after the enactment of Proposition D. Using a cross-sectional, ecological design, we investigated the change in dispensaries from 2012 to 2014 for Census tracts within the city of Los Angeles (N = 1000). We analyzed data using spatial error regression models that included controls for spatial autocorrelation due to the spatial structure of the data. We found that while the total number of dispensaries in Los Angeles remained largely unchanged, the spatial distribution of dispensaries did change in meaningful ways. Census tracts with more dispensaries in 2014 were significantly and positively associated with the proportion of African American residents and negatively associated with the percent of area that was commercially zoned. In other words, dispensaries opened in areas with a higher proportion of Black residents and closed in Census tract areas that had a higher percentage of commercially zoned land. Findings from this study highlight the importance of continuously regulating dispensary locations. Results suggest that likely as a result of changing regulations, dispensaries may be attempting to conceal their presence and locate in areas that will not advocate against their presence.


Erratum to: Evaluating the change in medical marijuana dispensary locations in Los Angeles following the passage of local legislation
   Journal of Primary Prevention (2017)
   Thomas, Crystal; Freisthler, Bridget
A correction to the article "Evaluating the Change in Medical Marijuana Dispensary Locations in Los Angeles Following the Passage of Local Legislation" that was published in the May 19, 2017 issue is presented.


Child and adolescent health from 1990 to 2015: Findings from the global burden of diseases, injuries, and risk factors 2015 study
   JAMA Pediatrics (2017)
   The Global Burden of Disease, Child Adolescent Hea
Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. Objective:  To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. Findings:  Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (e.g., neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries. Conclusions and Relevance:  Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.


Down in the valley: Trajectories of injection initiation among young injectors in California's Central Valley
   International Journal of Drug Policy (2017)
   Syvertsen, J. L.; Paquette, C. E. ; Pollini, R. A.
Injection drug use initiation represents a critical point of public health intervention, as injection increases risk for blood borne infections including Hepatitis C and HIV. In this paper, we explore pathways to injection initiation among youth (=30) in the rural context of California's Central Valley, where rates of injection drug use are among the highest in the nation. We draw on semi-structured qualitative interviews with 20 young injectors to examine drug use histories, including the factors that participants associated with their transition to injection drug use. The average age was 24.7 years (range: 20-30), 45% were female (n=9), and 30% were Latino (n=6). Participants described a variety of pathways to injection, culminating in a first injection that involved either opioids (n=12) or methamphetamine (n=8). Among the opioid group, the majority used prescription opioids before transitioning to injection, while a smaller number transitioned to opioid injection from non-opioid recreational drug use. Injectors who first used prescription opioids often described growing up in affluent suburban areas and transitioned to injection with peers, owing to a combination of factors related to individual tolerance, cost, and shifting drug markets. In contrast, methamphetamine initiates grew up in less affluent families with histories of substance use that exposed them to drugs at an early age. Methamphetamine users transitioned from smoking and snorting to injection, often with family members or intimate partners, within broader contexts of social disadvantage and stress. While much of the focus on young injectors has centered on the current opioid epidemic, our data suggest a need to consider multiple pathways towards injection initiation of different drugs. Targeted interventions addressing the unique injection transition contexts of both opioids and methamphetamine are urgently needed in the Central Valley of California.


Long-term recall of social relationships related to addiction and HIV risk behaviors
   Drug and Alcohol Dependence (2017)
    Stout, R. L. ; Janssen, T.; Braciszewski, J. M. ; Vose-O'Neal, A.
Social relationships have been demonstrated as a key predictor of relapse among addicted persons and are likely to be important determinants of HIV risk behaviors also. However, the degree to which this population can reliably and consistently identify important people (IPs) in retrospect has been understudied. Using the modified Important People and Activities questionnaire, we investigated to what degree IPs were dropped, added, or retained, and whether data about individual IPs were reported accurately on 6- and 12-month follow up periods using a sample of 50 drug or alcohol abusing participants. We found that IPs were largely retained, and that those retained versus dropped/added differed by their reaction to participant alcohol/drug use, as well as frequency of contact. We further found that there were differences in reliability of data describing specific IPs. While both 6- and 12-month follow up periods led to reliabilities ranging from excellent to fair, we found poorer reliability on responses to recall of "frequency of contact" and "reactions to drinking", as well as "reactions to drug use". Future investigations of reliability of social relationships recalled retrospectively should attempt to examine possible systematic biases in addition to the reliability of specific IP data. More sophisticated studies are needed on factors associated with systematic variation in reporting of aspects of social relationships that are associated with addictions or HIV risk outcomes.


Cultural correlates of DUI risk perceptions among documented and undocumented recent Latino immigrants in South Florida
   Hispanic Journal of Behavioral Sciences (2017)
   Sanchez, M.; Romano, E. ; Dawson, C.; M., Martinez; Li, T.; Cyrus, W.; De La Rosa, M.
Latinos do not drink and drive more often than non-Latino Whites, yet are disproportionately involved in alcohol-related arrests and fatal crashes. These disparities have been linked to a failure in recognizing the impairing effects of alcohol on driving psychomotor abilities and low risk perceptions of being caught or prosecuted by law enforcement for DUI (driving under the influence). However, little is known about the role that cultural factors play in shaping drinking and driving risk perceptions among Latino immigrants. This study examines associations between cultural factors and DUI risk perceptions in a sample of 467 documented and undocumented recent Latino immigrants. Results revealed cultural risk factors were associated with higher alcohol use and decreased DUI risk perceptions. Cultural protective factors were linked with less drinking behaviors. Undocumented immigrants reported higher rates of alcohol use, lower levels of cultural protective factors, and higher levels of cultural risk factors. Findings contribute to the limited knowledge of drinking and driving among Latino immigrants early in the immigration process and suggest a need for greater attention to cultural factors in developing DUI prevention programs tailored toward Latino immigrants.


Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015
   Journal of the American College of Cardiology (2017)
   Roth, Gregory A.; Johnson, Catherine; Abajobir, Amanuel; Abd-Allah, Foad; Abera, Semaw Ferede; Abyu, Gebre; Ahmed, Muktar; Aksut, Baran; Alam, Tahiya; Alam, Khurshid; Alla, François; Alvis-Guzman, Nelson; Amrock, Stephen; Ansari, Hossein; Ärnlöv, Johan; Asayesh, Hamid; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Banerjee, Amitava; Barac, Aleksandra; Bärnighausen, Till; Barregard, Lars; Bedi, Neeraj; Belay Ketema, Ezra; Bennett, Derrick; Berhe, Gebremedhin; Bhutta, Zulfiqar; Bitew, Shimelash; Carapetis, Jonathan; Carrero, Juan Jesus; Malta, Deborah Carvalho; Castañeda-Orjuela, Carlos Andres; Castillo-Rivas, Jacqueline; Catalá-López, Ferrán; Choi, Jee-Young; Christensen, Hanne; Cirillo, Massimo; Cooper Jr, Leslie; Criqui, Michael; Cundiff, David; Damasceno, Albertino; Dandona, Lalit; Dandona, Rakhi; Davletov, Kairat; Dharmaratne, Samath; Dorairaj, Prabhakaran; Dubey, Manisha; Ehrenkranz, Rebecca; El Sayed Zaki, Maysaa; Faraon, Emerito Jose A.; Esteghamati, Alireza; Farid, Talha; Farvid, Maryam; Feigin, Valery; Ding, Eric L.; Fowkes, Gerry; Gebrehiwot, Tsegaye; Gillum, Richard; Gold, Audra; Gona, Philimon; Gupta, Rajeev; Habtewold, Tesfa Dejenie; Hafezi-Nejad, Nima; Hailu, Tesfaye; Hailu, Gessessew Bugssa; Hankey, Graeme; Hassen, Hamid Yimam; Abate, Kalkidan Hassen; Havmoeller, Rasmus; Hay, Simon I.; Horino, Masako; Hotez, Peter J.; Jacobsen, Kathryn; James, Spencer; Javanbakht, Mehdi; Jeemon, Panniyammakal; John, Denny; Jonas, Jost; Kalkonde, Yogeshwar; Karimkhani, Chante; Kasaeian, Amir; Khader, Yousef; Khan, Abdur; Khang, Young-Ho; Khera, Sahil; Khoja, Abdullah T.; Khubchandani, Jagdish; Kim, Daniel