Joint impacts of local alcohol and cannabis policies and outlet densities on violence

项目总结/摘要 K99/R 00提案审查了当地酒精和大麻政策对暴力的联合影响， 2018年娱乐性大麻合法化前后的加州。自我导向和人际暴力 是美国死亡和受伤的主要原因。酒精和大麻使用的变化， 国家大麻合法化政策可能是这些结果的重要但未被承认的贡献者。 酒精在暴力中的作用是众所周知的。关于大麻对暴力的影响的证据有限，而且好坏参半。 大麻合法化可以通过大麻酒精替代品降低与酒精有关的暴力发生率。 关于大麻合法化的现有研究往往集中在州一级的变化。然而，大多数国家都遵循 市、县政府实施大麻合法化政策，包括确定在哪里销售大麻。 被定位。地方控制导致地方政策和出口密度在地方一级的巨大差异。高 酒类销售点的地理密度增加了暴力发生率;最近的研究报告显示， 大麻店在合法化的州，大麻销售点与酒精不成比例地共存 低社会经济地位（SES）社区。然而，没有研究调查当地酒精是否以及如何 和大麻政策一起导致麻醉剂饱和（即，更高密度醇和 在低社会经济地位的社区。此外，没有证据表明大麻和大麻是否共存 酒类销售点相互作用，影响社区居民的健康。 我们将执行准实验性的地理空间分析的公共衍生政策，出路，和行政 健康数据：（1）评估加州241个城市和县的酒精和大麻政策如何影响出口 密度和地理位置;（2）确定酒精和大麻出口的相互影响 急诊就诊率、住院率和自残死亡率的密度， （3）评估以上记录的关系如何导致 酒精和大麻出口的共同位置，密度以及对自我伤害和攻击的影响。 该研究计划是由一个特殊的导师团队和培训计划在大学的补充 加州、弗朗西斯科和NIAAA资助的预防研究中心。该计划建立在申请人的 有暴力预防研究背景，包括酒精和毒品使用方面的新培训 暴力、酒精和毒品控制政策以及地理空间统计方法。联合研究和 培训计划将为申请人成功的独立流行病学研究生涯做好准备，重点是 如何设计最佳的酒精和毒品政策，以防止暴力和减少健康差距。 这项研究符合NIAAA的战略目标，以评估新的 防止与酒精有关的后果，如暴力的政策。这项研究是迫切需要的， 其他地方考虑大麻合法化和管制模式。

PROJECT SUMMARY/ABSTRACT This K99/R00 proposal examines the joint impacts of local alcohol and cannabis policies on violence in California before and after recreational cannabis legalization in 2018. Self-directed and interpersonal violence are leading causes of death and injury in the United States. Changes in alcohol and cannabis use, driven by state cannabis legalization policies, may be important but unrecognized contributors to these outcomes. Alcohol’s role in violence is well established. Evidence on cannabis’ effects on violence is limited and mixed. Cannabis legalization could lower rates of alcohol-related violence through cannabis-alcohol substitution. Existing research on cannabis legalization often focuses on state-level variation. However, most states defer to city and county governments to implement cannabis legalization policies, including determining where outlets are located. Local control results in enormous local-level heterogeneity in local policies and outlet density. High geographic density of alcohol outlets increases rates of violence; recent studies report similar patterns for cannabis outlets. In legalizing states, cannabis outlets are being disproportionately co-located with alcohol outlets in low-socioeconomic status (SES) communities. However, no studies examine if and how local alcohol and cannabis policies together contribute to intoxicant saturation (i.e., high densities of both alcohol and cannabis outlets) in low-SES communities. Further, there is no evidence on whether co-located cannabis and alcohol outlets interact to affect the health of community residents. We will perform quasi-experimental geospatial analyses of publicly-derived policy, outlet, and administrative health data to: (1) assess how alcohol and cannabis policies in 241 California cities and counties impact outlet density and geographic co-location; (2) determine the interactive effects of alcohol and cannabis outlet densities on rates of emergency department visits, inpatient hospitalizations, and deaths due to self-harm and assault throughout California; (3) evaluate how the relationships documented above contribute to disparities in alcohol and cannabis outlet co-location, densities, and effects on self-harm and assault. The research plan is complemented by an exceptional mentorship team and training plan at the University of California, San Francisco and NIAAA-funded Prevention Research Center. The plan builds on the applicant’s background in violence prevention research and includes new training in alcohol and drug use as contributors to violence, alcohol and drug control policies, and geospatial statistical methods. The combined research and training plans will prepare the applicant for a successful independent epidemiology research career focused on how to design optimal alcohol and drug policies to prevent violence and reduce health disparities. This research aligns with NIAAA’s strategic goal to evaluate the effectiveness and implementation of new policies for preventing alcohol-related consequences such as violence. This research is urgently needed as other localities consider cannabis legalization and models for regulation.