Objectives

To determine whether state medical marijuana laws "send the wrong message," that is, have a local influence on the views of young people about the risks of using marijuana.

Methods

We performed multilevel, serial, cross-sectional analyses on 10 annual waves of the US National Survey on Drug Use and Health (2004-2013) nationally and for states with marijuana laws using individual- and state-level controls.

Results

Living in medical marijuana states was associated with more permissive views regarding marijuana across 5 different measures. However, these associations became non-statistically significant after we adjusted for state-level differences. By contrast, there was a consistent and significant national time trend toward more permissive attitudes, which was less pronounced among children of middle school age than it was among their older counterparts.

Conclusions

Passing medical marijuana laws does not seem to directly affect the views of young people in medical marijuana states. However, there is a national trend toward young people taking more permissive views about marijuana independent of any effects within states.

Introduction State legalization of marijuana for medical purposes could increase illicit marijuana use among young people. Medical marijuana laws may boost the availability of marijuana and reduce perceptions of its harmfulness, leading more young people to try it. Prior studies report little evidence that these laws are impacting marijuana consumption by young Americans, and none have systematically compared developmentally distinct age groups. Methods We performed multilevel, serial cross-sectional analyses on ten annual waves of U.S. National Survey on Drug Use and Health, from 2004 to 2013, comparing young people in states with and without medical marijuana laws. Disaggregated analyses compared multiple measures of marijuana use across approximately 450,300 individuals in early adolescence (12-14 years), late adolescence (15-17 years) and young adulthood (18-25 years). Results Dwelling in a state that had legalized medical marijuana was not associated with marijuana consumption in the past month among early adolescents, late adolescents or young adults. However, young adults living in medical marijuana states were significantly more likely to have initiated first use in the past year. Conclusions Medical marijuana laws increase the likelihood that young adults will start using marijuana but do not affect more vulnerable developmental groups in early and late adolescence. Delaying the age of first use into young adulthood can reduce the risk of a drug use disorder later in life. Young adults are in the peak years of engagement with illicit drugs and state medical marijuana laws appear to be leading larger numbers to try the drug.

Consumer engagement is increasingly emphasized in healthcare initiatives and has been a priority in healthcare reforms. Consumer engagement takes multiple forms, including increased involvement of consumers in their own care, in organizational design, and in broader policy decision-making processes. Determining the effectiveness of such involvement requires both effective measurement and empirical study, both of which have yet to be standardized or fully explored. In this review, we examine both existing measurement tools for consumer engagement and current empirical knowledge regarding the outcomes associated with each of three levels of consumer engagement. Although measurement and results at the level of direct care are more established, measurement of consumer engagement, let alone its effects at the organizational design or policy level, is less well developed. Building on our review, we make suggestions for how to fill the current gaps in understanding the measurement and outcomes of consumer engagement.

Background

Employees with fluoridated drinking water access at work can reap oral health benefits. The purpose of this study was to assess the availability, appeal, and promotion of fluoridated tap water in publicly accessible spaces compared with retail beverages at the University of California, San Francisco.

Methods

The authors collected information on beverages available in publicly accessible spaces at University of California, San Francisco hospitals and campuses in San Francisco, California, from December 2019 through February 2020 using a web-based survey tool. Data collected included fluoridated water and retail beverage locations; type of water or retail beverage source; number of water sources per station; cleanliness, flow, and any obstruction of water sources; proximity of water stations to retail beverage locations; signage near the beverage locations about water and beverage consumption; and type of retail beverages available.

Results

Fluoridated water stations were identified in 230 locations and had 377 water sources (for example, traditional drinking fountain and motion-sensor bottle-filling station). One water station was available for every 80 students and employees; however, 25% were obstructed, dirty, or had unsatisfactory flow. Approximately 1 in 5 watercoolers lacked disposable cups. Of 41 retail beverage locations identified, 29% had a water station within sight. Only 11% of beverage locations had signage encouraging healthier beverage choices.

Conclusions

A systematic assessment of work site access to fluoridated water can provide actionable evidence to improve availability, appeal, and promotion.

Practical implications

This study provides a model to assess work site availability of fluoridated drinking water that can be used for future evaluations.

Background: There is limited information on separate use and simultaneous use of tobacco and cannabis products, particularly for new electronic nicotine delivery systems (ENDS). This study presents detailed information about the prevalence and correlates of individual use, separate use, and simultaneous use of tobacco and cannabis in California, the first state to allow medical marijuana in the US. It specifically distinguishes between simultaneous use (both substances used in the same occasion) and separate use (both products used, but not simultaneously). Objectives: Participants in the 2016 California Adult Tobacco Survey (N = 3,058; age range 18-64 years) completed online surveys between February and March 2016 that assessed tobacco and cannabis use in the past 30 days. Results: Participants' use of tobacco (15% cigarettes) was higher than use of ENDS (6%) or cannabis (10%); the overall rate of separate use was 6% and the overall rate of simultaneous use was 3%. Correlates of tobacco use included lower levels of education and income. Correlates of simultaneous tobacco and cannabis use included being unemployed or having a disability. Conclusions/Importance: This survey of California residents suggests how use patterns change in states that legalize medical marijuana prior to recreational cannabis, although it may underestimate prevalence due to reliance on self-reported use. Persons who were unemployed and persons with disabilities were at higher risk for simultaneous use of tobacco and cannabis. These findings suggest that prevention and cessation interventions intended to target simultaneous use should address these populations, as well as adolescents and young adults.

Sugar-sweetened beverages (SSBs) increase chronic disease risk. We estimated the impact on employee health and health care spending of banning SSB sales in California-based health care organizations. We used survey data from a large, multisite health care organization in California, sampling 2,276 employees three months before and twelve months after a workplace SSB sales ban was imposed. We incorporated the survey data into a simulation model to estimate chronic disease incidence and costs. We estimated that an SSB ban as effective as the one observed would save about $300,000 per 10,000 people over ten years among similar employers, as a result of averted health care and productivity spending-after both SSB sales losses and non-SSB beverage sales gains were accounted for. Sales bans would typically need to reduce SSB consumption by 2.2 ounces per person per day for lost revenue to be fully offset if there were no increase in non-SSB beverage sales.

Objective

Workplace sugar-sweetened beverage (SSB) sales bans can reduce SSB consumption. Because stress and anxiety can promote sugar consumption, we examined whether anxiety among hospital employees during the COVID-19 pandemic was associated with changes in SSB consumption and explored whether this relationship varied by exposure to a workplace SSB sales ban.

Design

In a prospective, controlled trial of workplace SSB sales bans, we examined self-reported anxiety (generalised anxiety disorder-7) and self-reported SSB consumption (fluid ounces/d) before (July 2019) and during (May 2020) the COVID-19 pandemic.

Setting

Hospital sites in two conditions (four with SSB sales bans and three without sales bans) in Northern California.

Participants

We sampled 580 participants (hospital employees) from a larger trial of sales bans; all were regular consumers of SSB (minimum 3/week at main trial enrollment). This subsample was chosen based on having appropriately timed data for our study questions.

Results

Across conditions, participants reduced SSB consumption over the study period. However, participants with higher pandemic-era anxiety scores experienced smaller reductions in SSB consumption after 9 months compared with those with lower anxiety scores (β = 0·65, P < 0·05). When the sample was disaggregated by sales ban condition, this relationship held for participants in the control group (access to SSB at work, β = 0·82, P < 0·05), but not for those exposed to an SSB sales ban (β = 0·42, P = 0·25).

Conclusions

SSB sales bans likely reduce SSB consumption through multiple pathways; buffering stress-related consumption may be one mechanism.

Background

Shorter leukocyte telomere length (LTL) is associated with increased risk of a number of metabolic diseases including insulin resistance and the development of type 2 diabetes mellitus. Shorter LTL is also associated with stress reactivity suggestive of a possible role for LTL to predict response to behavioral interventions. However, few studies have evaluated how interventions, such as weight loss or dietary changes, are associated with LTL changes or whether LTL can predict behavioral responses to interventions.

Objectives

We evaluated metabolic changes in relation to LTL changes and LTL at baseline in a cohort of at-risk adults in response to a 10-mo workplace-based sugar-sweetened beverage (SSB) intervention.

Methods

At baseline, metabolic health and LTL measurements were assessed through standard blood draws on 212 participants. Multivariable linear regression models were used to assess changes in anthropometrics, SSB consumption, and 13 blood-based metabolic risk factors, in relation to LTL at baseline and changes in LTL.

Results

Longer LTL at baseline was associated with decreases in SSB consumption over the 6-mo follow-up period (B = -29.67; P = 0.04). Slower LTL attrition rates were associated with decreases in waist circumference (B = -0.27; P  = 0.03), HDL cholesterol (B = -0.20; P  = 0.05), and apoA1 (B = -0.09; P = 0.01).

Conclusions

Longer LTL at baseline predicted a favorable overall response to a behavioral intervention: decreases in SSB consumption. Abdominal adiposity losses paralleled slower declines in LTL suggestive of overall health benefits, but we found differences in the relations between metabolic changes and LTL at baseline compared with LTL attrition rates. Longer LTL may be a proxy marker of a positive behavioral response.This trial was registered at clinicaltrials.gov as NCT02585336.

Objective

To examine the effectiveness of a workplace sugar-sweetened beverage (SSB) sales ban on reducing SSB consumption in employees, including those with cardiometabolic disease risk factors.

Design

A controlled trial of ethnically diverse, full-time employees who consumed SSB heavily (sales ban n 315; control n 342). Outcomes included standardised measures of change in SSB consumption in the workplace (primary) and at home between baseline and 6 months post-sales ban.

Setting

Sutter Health, a large non-profit healthcare delivery system in Northern California.

Participants

Full-time employees at Sutter Health screened for heavy SSB consumption.

Results

Participants were 66·1 % non-White. On average, participants consumed 34·7 ounces (about 1 litre) of SSB per d, and the majority had an elevated baseline BMI (mean = 29·5). In adjusted regression analyses, those exposed to a workplace SSB sales ban for 6 months consumed 2·7 (95 % CI -4·9, -0·5) fewer ounces of SSB per d while at work, and 4·3 (95 % CI -8·4, -0·2) fewer total ounces per d, compared to controls. Sales ban participants with an elevated BMI or waist circumference had greater post-intervention reductions in workplace SSB consumption.

Conclusions

Workplace sales bans can reduce SSB consumption in ethnically diverse employee populations, including those at higher risk for cardiometabolic disease.