In spring 2020, many states in the United States enacted stay-at-home orders to limit the spread of COVID-19 and lessen effects on hospitals and health care workers. This required parents to act in ...new roles without much support. Although studies have asked parents about stress before and during the pandemic, none have examined how stress may have fluctuated throughout the day and the characteristics related to those daily changes.
Our study assesses how time-varying (e.g., presence of a focal child) and day-varying (e.g., weekend vs. weekday) factors were related to parents’ level of stress.
We use Ecological Momentary Assessment to examine stress three times a day (10 a.m., 3 p.m., and 9 p.m.) for 14 days. We include two different dates hypothesized to be related to parents’ stress levels: (1) when Ohio announced schools would go virtual for the rest of the academic year and (2) when most retail businesses were allowed to re-open. Our sample of 332 individuals, recruited via Facebook, Craigslist, and word of mouth, completed 13,360 of these brief surveys during April–May 2020. Data were analyzed using generalized ordered logit models.
Parents report lower levels of stress when completing the 9 p.m. survey, but higher levels when they were at work, during weekdays (compared to weekends) or when they were with the focal child. COVID-19 milestone dates were not related to stress levels.
Parents need some form of respite (e.g. child care, child-only activities) to reduce stress, especially during the week when parents are juggling their outside employment and their child(ren)'s schooling. Providing parents with skills and tools to identify and reduce stress, such as apps monitoring heart rate or providing deep breathing techniques, may be one way of helping parents cope with extremely stressful situations.
•We assess time- and day-varying characteristics related to stress during COVID-19.•Parents report higher stress in the evenings during COVID-19.•Working during COVID-19 was related to higher levels of stress.•Weekdays were more stressful than weekends.•Being with a focal child was related to higher stress, at lower levels of the scale.
Highlights • Total physical availability of medical marijuana was related to current use. • Total physical availability of medical marijuana was related to more frequent use. • Alternative use of ...delivery services may provide easy access to marijuana.
ABSTRACT
Aims This paper summarizes several theoretical perspectives that serve to explain observed associations between concentrations of alcohol outlets and alcohol‐related problems. A critique of ...each perspective discusses how each addresses the social etiology of these problems; that is, how, where and why these problems arise in association with alcohol outlets?
Methods This theoretical work is based upon mathematical and computational models of the ecology of alcohol‐related problems developed in the ‘Ecosystems Modeling Project’, an advanced research project of the National Institute on Alcohol Abuse and Alcoholism, United States.
Results Associations between outlets and problems are thought to arise from the concentration of individuals in drinking places (‘flow models’), the attraction of some places for people at risk for problems (‘gravity models’), or because outlets are located in high‐risk neighborhoods and have negative social normative effects (‘social contextual models’). None of these approaches explain how some outlets come to have more problems than others (e.g. violent outlets). An alternative social ecological model is introduced which asserts that the complementary processes of niche marketing and assortative drinking form the social dynamic that explains these relationships. Alcohol sellers ‘niche market’ to select social strata, drinkers return to establishments at which they find people like themselves, and consequent social stratification of the market‐place increases the levels of related problems in some outlets.
Conclusions The proposed mechanism is very general, and suggests that over‐concentrations of outlets will lead to stratification of drinking groups and intensification of problems related to those outlets.
•Situational and social context characteristics increase risks for simultaneous use.•Larger numbers of underage drinkers increase risks for simultaneous use.•Lack of adult supervision increases risks ...for simultaneous use.•Simultaneous use is associated with increased subsequent risks.•Alcohol may be the primary contributor to risks associated with simultaneous use.
We investigated contexts of simultaneous use of alcohol and marijuana and the impact of simultaneous use on problems among adolescents. Ecological momentary assessment data were obtained over two weekends from 150 adolescents in California (47% female, M age=16.36years), using smartphone surveys administered early and late in the evening and again the following morning. We assessed whether, in what context, and with whom adolescents drank alcohol and used other substances over 3 evening hours. We assessed problems they experienced each evening on the following morning. Results showed that greater adult supervision in every context was associated with a 55% lower risk of simultaneous use (RRR=0.45, p≤.05). Contexts with no other underage drinkers were associated with 99% lower risk of simultaneous use (RRR=0.01, p≤.005). Each occasion of simultaneous use was related to 110% increase in the number of problems (IRR=2.10, p≤.005), with 83%, 221% and 311% greater odds of violence (OR=1.83, p≤.05), driving under the influence or riding with a drunk driver (OR=3.21, p≤.05), or being drunk (OR=4.11, p≤.005). Additional analyses showed that these problems may be attributed largely to the alcohol consumed in each context. Results demonstrate that it is essential to consider situational and social characteristics of substance use contexts to better understand adolescent simultaneous use of alcohol and drugs and problems.
•Prescription opioid overdose is concentrated in economically disadvantaged areas.•Economic stress plays a larger role in heroin overdoses in urban than rural areas.•Alternative contextual factors ...may be driving heroin overdoses in rural areas.
Prescription opioid overdose (POD) and heroin overdose (HOD) rates have quadrupled since 1999. Community-level socioeconomic characteristics are associated with opioid overdoses, but whether this varies by urbanicity is unknown.
In this serial cross-sectional study of zip codes in 17 states, 2002–2014 (n = 145,241 space-time units), we used hierarchical Bayesian Poisson space-time models to analyze the association between zip code-level socioeconomic features (poverty, unemployment, educational attainment, and income) and counts of POD or HOD hospital discharges. We tested multiplicative interactions between each socioeconomic feature and zip code urbanicity measured with Rural-Urban Commuting Area codes.
Percent in poverty and of adults with ≤ high school education were associated with higher POD rates (Rate Ratio RR, 5% poverty: 1.07 95% credible interval: 1.06–1.07; 5% low education: 1.02 1.02–1.03), while median household income was associated with lower rates (RR, $10,000: 0.88 0.87–0.89). Urbanicity modified the association between socioeconomic features and HOD. Poverty and unemployment were associated with increased HOD in metropolitan areas (RR, 5% poverty: 1.12 1.11–1.13; 5% unemployment: 1.04 1.02–1.05), and median household income was associated with decreased HOD (RR, $10,000: 0.88 0.87–0.90). In rural areas, low educational attainment alone was associated with HOD (RR, 5%: 1.09 1.02–1.16).
Regardless of urbanicity, elevated rates of POD were found in more economically disadvantaged zip codes. Economic disadvantage played a larger role in HOD in urban than rural areas, suggesting rural HOD rates may have alternative drivers. Identifying social determinants of opioid overdoses is particularly important for creating effective population-level interventions.
Background
Despite well‐known associations between heavy drinking and child physical abuse, little is known about specific risks related to drinking different amounts of alcohol in different drinking ...venues. This study uses a context‐specific dose–response model to examine how drinking in various venues (e.g., at bars or parties) is related to physically abusive parenting practices while controlling for individual and psychosocial characteristics.
Methods
Data were collected via a telephone survey of parents in 50 cities in California, resulting in 2,163 respondents who reported drinking in the past year. Child physical abuse and corporal punishment were measured using the Conflict Tactics Scale, Parent–Child version. Drinking behaviors were measured using continued drinking measures. Data were analyzed using zero‐inflated Poisson models.
Results
Drinking at homes, parties, or bars more frequently was related to greater frequencies of physically abusive parenting practices. The use of greater amounts of alcohol in association with drinking at bars appeared to increase risks of corporal punishment, a dose–response effect. Dose–response relationships were not found for drinking at homes or parties or drinking at bars for physical abuse nor for drinking at home and parties for corporal punishment.
Conclusions
Frequencies of using drinking venues, particularly bars and home or parties, are associated with greater use of abusive parenting practices. These findings suggest that a parent's routine drinking activities place children at different risks of being physically abused. They also suggest that interventions that take into account parents’ alcohol use at drinking venues are an important avenue for secondary prevention efforts.
Background
Distinguishing the impacts of neighborhood income and off‐premise alcohol outlet density on alcohol use has proven difficult, particularly given the conflation of these measures across ...neighborhood areas. We explicitly test for differential effects related to individual and area income and outlet densities on alcohol use and alcohol use disorders (AUDs) by implementing a stratified microecological sample.
Methods
The East Bay Neighborhoods Study included a survey of 984 residents of 72 microenvironments within a geographically contiguous 6‐city area in California and Systematic social observations of each site. The sites included 18 areas in each of 4 strata (high/low median household income and off‐premise outlet density). We assessed 4 outcomes: 28‐day drinking frequency, average quantity of alcohol consumed per drinking occasion, 28‐day drinking volume, and Alcohol Use Disorders Identification Test (AUDIT) score. We used zero‐inflated negative binomial regression with standard errors adjusted for site clusters to relate drinking measures to individual‐level age, race/ethnicity, gender, marital status, education, and income, and neighborhood indicators of site strata, physical disorder, and physical decay. An interaction term was tested representing site‐level by individual‐level income.
Results
Living in a high‐income site, regardless of off‐premise alcohol outlet density, was associated with more frequent drinking and higher alcohol dependence/problems. Both individual‐level income and site‐level income were related to greater frequencies of use, but lower income drinkers in high‐income areas drank more than comparable drinkers in low‐income areas. Study participants living in high‐density off‐premise alcohol outlet sites drank less frequently but did not differ in terms of either AUDIT scores or heavy drinking from participants living in low‐density sites.
Conclusions
Using a stratified microecological sampling design, we were able to directly assess statistical associations of off‐premise outlet density and neighborhood median household income with patterns of drinking and AUDs. Caution should be used interpreting prior study findings linking off‐premise outlet densities to drinking.
The East Bay Neighborhoods Study surveyed a stratified sample of individuals living in 72 microenvironments (4 strata of high/low median household income and off‐premise alcohol outlet density) in California. This study design enabled us to directly assess statistical associations of off‐premise outlet density and area and individual income with patterns of drinking and AUDs. Living in a high‐income site was associated with more frequent drinking and higher alcohol dependence/problems, while those in high‐density off‐premise alcohol outlet sites drank less frequently.
Aims
To determine whether the density of marijuana dispensaries in California, USA, in 2012–13 was related to violent and property crimes, both locally and in adjacent areas, during a time in which ...local law enforcement conducted operations to reduce the number of storefront medical marijuana dispensaries.
Design
Data on locations of crimes and medical marijuana dispensaries as well as other covariates were collected for a sample of 333 Census block groups.
Setting
Long Beach, California, USA from January 2012 to December 2013.
Observations
A total of 7992 space–time observations (from 333 Census block groups over 24 time‐points).
Measurements
Outcome measures focused on block‐group counts of violent and property crimes. Predictors were numbers of local and adjacent‐area medical marijuana dispensaries. Covariates included markers of alcohol availability as well as area demographic and economic characteristics.
Findings
After adjustment for covariates, density of medical marijuana dispensaries was unrelated to property and violent crimes in local areas but related positively to crime in spatially adjacent areas incident rate ratio (IRR) = 1.0248, CI (1.0097, 1.0402) for violent crime, IRR = 1.0169, CI (1.0071, 1.0268) for property crime.
Conclusions
Using law enforcement to reduce medical marijuana dispensaries in California appears to have reduced crime in residential areas near to, but not in, these locations.
Background Public policy can limit alcohol consumption and its associated harm, but no direct comparison of the relative efficacy of alcohol control policies exists for the U.S. Purpose To identify ...alcohol control policies and develop quantitative ratings of their efficacy and strength of evidence. Methods In 2010, a Delphi panel of ten U.S. alcohol policy experts identified and rated the efficacy of alcohol control policies for reducing binge drinking and alcohol-impaired driving among both the general population and youth, and the strength of evidence informing the efficacy of each policy. The policies were nominated on the basis of scientific evidence and potential for public health impact. Analysis was conducted in 2010–2012. Results Panelists identified and rated 47 policies. Policies limiting price received the highest ratings, with alcohol taxes receiving the highest ratings for all four outcomes. Highly rated policies for reducing binge drinking and alcohol-impaired driving in the general population also were rated highly among youth, although several policies were rated more highly for youth compared with the general population. Policy efficacy ratings for the general population and youth were positively correlated for reducing both binge drinking ( r =0.50) and alcohol-impaired driving ( r =0.45). The correlation between efficacy ratings for reducing binge drinking and alcohol-impaired driving was strong for the general population ( r =0.88) and for youth ( r =0.85). Efficacy ratings were positively correlated with strength-of-evidence ratings. Conclusions Comparative policy ratings can help characterize the alcohol policy environment, inform policy discussions, and identify future research needs.
Background: Previous assessments of empirical relationships between alcohol outlets and rates of interpersonal violence have been conducted using cross‐sectional spatial data, data collected across ...small geographic units such as Census Tracts and zip codes. These assessments demonstrate that the availability of alcohol, measured by the number and types of alcohol outlets, is related to violence. These analyses have examined many potential confounds of the outlets–violence connection (i.e., population and place characteristics) and statistically corrected for biases that arise in analyses of spatial data. The current study contributes the first observation of longitudinal relationships between alcohol outlets and violence.
Method: The study examined longitudinal data from 581 consistently defined zip code areas represented in the California Index Locations Database, a geographic information system that coordinates population and ecological data with spatial attributes for areas across the state. Six years of data were collected on features of local populations (e.g., household size) and places (e.g., retail markets) thought to be related to 1 measure of violence (i.e., hospital discharges related to violent assaults). Assault rates were related to changes in population and place characteristics using random effects models with controls for spatial autocorrelation (n×t= 3,486 observations). Changes in population and place characteristics of bordering (spatial lagged) areas were also considered.
Results: Lower median household income and greater percentages of minorities (African American, Hispanic, and Asian) were related to increased rates of violence. Ten percent increases in numbers of off‐premise outlets and bars were related to 1.67 and 2.06% increases in violence rates across local and lagged spatial areas. Every 6 outlets accounted for 1 additional violent assault that resulted in at least 1 overnight stay at hospital. These effects increased with larger male populations, doubling with every 3% increase in percent males.
Conclusion: Assault rates were most strongly related to median household incomes and minority populations within zip code areas. Controlling for changes in assault rates related to these measures, greater numbers of licensed alcohol retail establishments, especially bars and off‐premise outlets, were related to rates of assault. Failures to regulate the growth in numbers of bars will increase rates of violence, especially in urban areas.
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