Nancy Jo Kepple

Evaluating Medical Marijuana Dispensary Policies: Spatial Methods for the Study of Environmentally-Based Interventions

In 1996, California was the first state to pass a Compassionate Use Act allowing for the legal use of marijuana for medical purposes. Here we review several current policy and land use environmental interventions designed to limit problems related to the influx of medical marijuana dispensaries across California cities. Then we discuss the special challenges, solutions, and techniques used for studying the effects of these place-based policies. Finally, we present some of the advanced spatial analytic techniques that can be used to evaluate the effectiveness of environmental interventions, such as those related to reducing problems associated with the proliferation of medical marijuana dispensaries. Further, using data from a premise survey of all the dispensaries in Sacramento, this study will examine what characteristics and practices of these dispensaries are related to crime within varying distances from the dispensaries (e.g., 100, 250, 500, and 1,000 feet). We find that some security measures, such as security cameras and having a door man outside, implemented by medical marijuana dispensary owners might be effective at reducing crime within the immediate vicinity of the dispensaries.

Bias in child maltreatment self-reports using interactive voice response (IVR)

Few methods estimate the prevalence of child maltreatment in the general population due to concerns about socially desirable responding and mandated reporting laws. Innovative methods, such as interactive voice response (IVR), may obtain better estimates that address these concerns. This study examined the utility of interactive voice response (IVR) for child maltreatment behaviors by assessing differences between respondents who completed and did not complete a survey using IVR technology. A mixed-mode telephone survey was conducted in English and Spanish in 50 cities in California during 2009. Caregivers (n=3,023) self-reported abusive and neglectful parenting behaviors for a focal child under the age of 13 using computer-assisted telephone interviewing and IVR. We used hierarchical generalized linear models to compare survey completion by caregivers nested within cities for the full sample and age-specific ranges. For demographic characteristics, caregivers born in the United States were more likely to complete the survey when controlling for covariates. Parenting stress, provision of physical needs, and provision of supervisory needs were not associated with survey completion in the full multivariate model. For caregivers of children 0-4 years (n=838), those reporting they could often or always hear their child from another room had a higher likelihood of survey completion. The findings suggest IVR could prove to be useful for future surveys that aim to estimate abusive and/or neglectful parenting behaviors given the limited bias observed for demographic characteristics and problematic parenting behaviors. Further research should expand upon its utility to advance estimation rates.

The Geography of Drug Market Activities and Child Maltreatment

This study examines how drug market activities place children at risk of maltreatment over space and time. Data were collected for 95 Census tracts in Sacramento, California, over 7 years and were analyzed using Bayesian space–time models. Referrals for child maltreatment investigations were less likely to occur in places where current drug market activity was present. However, past-year local and spatially lagged drugs sales were positively related to referrals. After the investigative phase, Census tracts with more drug sales had higher numbers of substantiations, and those with more possessions also had more entries into foster care. The temporal delay between drug sales and child maltreatment referrals may indicate that the surveillance systems designed to protect children may not be responsive to changing neighborhood conditions or be indicative of the time it takes for the detrimental effects of the drug use to appear.

Are community level prescription opioid overdoses associated with child harm? A spatial analysis of California zip codes, 2001-2011

BACKGROUND Non-medical prescription opioid use is increasing globally within high-income countries, particularly the United States. However, little is known about whether it is associated with negative outcomes for children. In this study, we use prescription opioid overdose as a proxy measure for non-medical prescription opioid use and ask the following: Do California communities with greater rates of non-medical prescription opioid use also have higher rates of child maltreatment and unintentional child injury? METHODS We used longitudinal population data to examine ecological associations between hospital discharges involving overdose of prescription opioids and those for child maltreatment or child injury in California zip codes between 2001 and 2011 (n=18,517 zip-code year units) using Bayesian space-time misalignment models. RESULTS The percentage of hospital discharges involving prescription opioid overdose was positively associated with the number of hospital discharges for child maltreatment (relative rate=1.089, 95% credible interval (1.004, 1.165)) and child injury (relative rate=1.055, 95% credible interval (1.012, 1.096)) over the ten-year period, controlling for other substance use and environmental factors. CONCLUSIONS Increases in community level prescription opioid overdoses between 2001 and 2011 are associated with a 2.06% increase in child maltreatment discharges and a 1.27% increase in discharges for child injury. Communities with higher rates of non-medical prescription opioid use may experience greater levels of child harms.

The Complex Nature of Parental Substance Use: Examining Past Year and Prior Use Behaviors as Correlates of Child Maltreatment Frequency

ABSTRACT Background: Child maltreatment studies predominantly have operationalized parental substance use as dichotomous variables for any use, any harmful/risky use, or any substance use disorder (SUD). This limits our understanding about how a range of use behaviors may contribute to child maltreatment. Objective: Build upon prior studies by incorporating a multi-faceted approach to operationalizing parental substance use. Methods: Cross-sectional, secondary data analyses were conducted using the National Survey of Child and Adolescent Well-being (NSCAW I). The study used weighted negative binomial regression to examine relationships between annual child maltreatment frequency and different ways of operationalizing substance use among 2,100 parents. Results: Several, inter-related behaviors (i.e., heavy drinking, illicit drug use, polysubstance use, SUD, and prior SUD < 4 years) appeared to be relevant for understanding differences in child maltreatment frequencies. A gradient effect was detected across five substance use behavior patterns: (1) lowest estimated counts were observed for nonusers, light-to-moderate drinkers, and parents with a prior (but not past year) SUD (ӯ < 7.0), (2) slightly higher estimated count was observed for heavy drinkers and/or illicit drug users (ӯ = 9.3), and (3) highest estimated count was observed for parents with past year SUD (ӯ = 17.6). Conclusions/Importance: SUD is a critical screening criteria for potential child harm. Parents reporting risky substance use behaviors may benefit from prevention or brief intervention services related to both their substance use and parenting behaviors. Administrative systems also could benefit from detailed tracking of substance use behaviors for future program evaluation and development.

Correlates of Amount Spent on Marijuana Buds During a Discrete Purchase at Medical Marijuana Dispensaries: Results from a Pilot Study

ABSTRACT Marijuana purchasing behaviors vary by the purchaser’s individual characteristics; however, little is known about patients’ purchasing behaviors when buying from medical marijuana dispensaries (MMDs). Our objective was to explore whether patient characteristics were associated with amount spent during one financial transaction at medical marijuana dispensaries. We conducted a pilot study of four purposively sampled MMD locations in Long Beach, California, in 2012. A total of 132 medical marijuana patients (33 patients per dispensary) participated in an exit survey about their demographic characteristics, conditions for their medical marijuana recommendation, amount spent at the dispensary, and cross-streets of where they lived. The sample reported amounts spent on discrete purchases of marijuana buds averaging

Concordance of Parent- and Child-Reported Physical Abuse Following Child Protective Services Investigation

40.82 (ranging from

Drug Use, the Drug Environment, and Child Physical Abuse and Neglect:

10 to

Unpacking the parallel effects of parental alcohol misuse and low income on risk of supervisory neglect

255). Multivariate regression analyses indicated average amount spent differed significantly by patient age and condition. An increase in 10 years of age was associated with a 10% higher amount spent. Receiving a recommendation for anxiety and/or sleeping problems or other nonspecified conditions was related to higher discrete purchase amounts than chronic pain. This pilot suggests that variations in patient purchasing behaviors from MMDs exist. These purchase behaviors can provide insight into variations in how patients use dispensaries, consume products, and allocate personal resources.

Place over traits? Purchasing edibles from medical marijuana dispensaries in Los Angeles, CA

Knowledge about the concordance of parent- and child-reported child physical abuse is scarce, leaving researchers and practitioners with little guidance on the implications of selecting either informant. Drawing from a 2008–2009 sample of 11- to 17-year-olds (N = 636) from Wave 1 of the second National Survey of Child and Adolescent Well-Being, this study first examined parent–child concordance in physical abuse reporting (Parent–Child Conflict Tactic Scale). Second, it applied multivariate regression analysis to relate parent–child agreement in physical abuse to parent-reported (Child Behavior Checklist) and child-reported (Youth Self Report) child behavioral problems. Results indicate low parent–child concordance of physical abuse (κ = .145). Coreporting of physical abuse was related to clinical-level parent-reported externalizing problems ( y ̄ = 64.57), whereas child-only reports of physical abuse were the only agreement category related to child-reported internalizing problems (B = 4.17, p < .001). Attribution bias theory may further understanding of reporting concordance and its implications.