Research Findings
Cigarillo sales in legalized marijuana markets in the U.S.
Drug and Alcohol Dependence, April 2018Daniel P. Giovenco, Torra E. Spillane, Christine M. Mauro, Silvia S. Martins
Background:
Nearly half of marijuana users in the United States also smoke cigarillos, with many using the products as marijuana “blunts.” The relationship between marijuana legalization and tobacco retail has not yet been examined. This study uses tobacco sales data to compare the cigarillo marketplace in states with legalized recreational marijuana to the overall U.S. marketplace in 2016.
Methods:
Cigarillo sales data from 2016 were obtained from the Nielsen Research Company in the following market regions: Denver, CO; Seattle, WA; Portland, OR; and the overall U.S. Descriptive statistics highlighted differences in the market share of various product features (e.g., flavors, brand, pack size) across regions.
Results:
Characteristics such as fruit flavors, single sticks, and 2–3 packs were more popular in legal marijuana regions compared to the overall U.S. Black & Mild, a brand not traditionally used for blunts, was the top brand nationally (32.8% market share), but Swisher was the top brand in legal marijuana regions. In Seattle and Portland, for example, over half of cigarillo sales were for Swisher products (59.1% and 52.1%, respectively). Cigarillo wraps (i.e., no tobacco filler) were particularly popular in Denver, constituting 11.4% all cigarillo sales versus 2.8% nationally.
Conclusions:
Cigarillo product characteristics traditionally associated with blunt use may shape the tobacco market in legal marijuana regions. As more states continue to legalize recreational marijuana, state and local governments should anticipate the potential impact on the tobacco marketplace and implement tobacco control policies (e.g., flavor bans, minimum pack sizes) that discourage product use.
State-level immigration and immigrant-focused policies as drivers of Latino health disparities in the United States
Social Science and Medicine, February 2018Morgan M. Philbin, Morgan Flake, Mark L. Hatzenbuehler, Jennifer S. Hirsch
There has been a great deal of state-level legislative activity focused on immigration and immigrants over the past decade in the United States. Some policies aim to improve access to education, transportation, benefits, and additional services while others constrain such access. From a social determinants of health perspective, social and economic policies are intrinsically health policies, but research on the relationship between state-level immigration-related policies and Latino health remains scarce. This paper summarizes the existing evidence about the range of state-level immigration policies that affect Latino health, indicates conceptually plausible but under-explored relationships between policy domains and Latino health, traces the mechanisms through which immigration policies might shape Latino health, and points to key areas for future research. We examined peer-reviewed publications from 1986 to 2016 and assessed 838 based on inclusion criteria; 40 were included for final review. These 40 articles identified four pathways through which state-level immigration policies may influence Latino health: through stress related to structural racism; by affecting access to beneficial social institutions, particularly education; by affecting access to healthcare and related services; and through constraining access to material conditions such as food, wages, working conditions, and housing. Our review demonstrates that the field of immigration policy and health is currently dominated by a "one-policy, one-level, one-outcome" approach. We argue that pursuing multi-sectoral, multi-level, and multi-outcome research will strengthen and advance the existing evidence base on immigration policy and Latino health.
When “the cure” is the risk: Understanding how substance use impacts HIV and HCV in a layered risk environment in San Juan, Puerto Rico
Health Education & Behavior, September 2017Diana Hernández, Pedro C. Castellón, Yohansa Fernández, Francisco A. Torres-Cardona, Carrigan Parish, Danielle Gorshein, Jose Vargas Vidot, Sandra Miranda de Leon, Allan Rodriguez, Jorge Santana Bagur, Daniel J. Feaster, Bruce R. Schackman, and Lisa R. Metsch
Background:
Substance use, particularly injection drug use, continues to fuel the HIV/HCV (hepatitis C virus) epidemics in San Juan, Puerto Rico (PR).
Aim:
This article examines individual and sociostructural factors that affect HIV/HCV risk among people who use drugs (PWUD) living with or at risk for HIV/HCV in San Juan, PR. Findings were used to inform a community-level intervention to enhance HIV care access and retention for this population.
Method:
A rapid ethnographic assessment in collaboration with a community-based organization was conducted. Data collection took place between June and December 2013 and included field observations, 49 unstructured interviews with PWUD, and 19 key informant interviews with community stakeholders. Fieldnotes, photographs, and interview transcripts were analyzed for recurrent themes and to address the intervention-planning needs. Study results are presented as fieldnote excerpts, direct quotes from interviews, and photographs.
Results:
Findings suggest that PWUD in PR face myriad challenges that affect HIV/HCV risk and hinder linkage to and retention in care. Results describe a layered risk environment where PWUD encounter many barriers to prevention, care, and treatment such as transience, social isolation, stigma, limited housing options, and inadequate medical and substance use disorder treatment services.
Discussion:
These observed circumstances provide an empirical basis for the development and evaluation of comprehensive interventions that may serve to reduce barriers to care and link individuals to other supportive services.
Conclusion:
New approaches and comprehensive interventions are needed to break the structures that perpetuate risk and lack of engagement and retention in HIV care and substance use disorder treatment in San Juan.