Charris Rafael, Ahern Jennifer, Apollonio Dorie E, Jent Victoria, Jacobs Laurie M, Jung Shelley, Schmidt Laura A, Gruenewald Paul, Matthay Ellicott C
From the Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY.
Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA.
Epidemiology. 2025 Mar 1;36(2):196-206. doi: 10.1097/EDE.0000000000001822. Epub 2024 Dec 16.
Cannabis use and alcohol use are associated with self-harm injuries, but little research has assessed links between recreational cannabis outlet openings on rates of self-harm within communities or the interactions of cannabis outlets with the density of alcohol outlets. We estimated the associations of recreational cannabis outlets, alcohol outlets, and their interaction on rates of fatal and nonfatal self-harm injuries in California, 2017-2019.
Using California statewide data on recreational cannabis outlets, alcohol outlets, and hospital discharges and deaths due to self-harm injuries, we conducted Bayesian spatiotemporal analyses of quarterly ZIP code-level data over 3 years, accounting for confounders and spatial autocorrelation. Using the model posteriors, we estimated parameters corresponding to hypothetical shifts in outlet densities.
If recreational cannabis outlets had never opened, we estimated that nonfatal self-harm injuries would have been -0.35 per 100,000 lower (95% credible interval [CI]: -1.25, 0.51), while fatal self-harm injuries would have been -0.004 per 100,000 lower (95% CI: -0.26, 0.25). These associations did not depend on alcohol outlet density, but a hypothetical 20% reduction in alcohol outlet densities was associated with fewer self-harm injuries (risk difference per 100,000, nonfatal: -1.59; 95% CI: -2.60, -0.59; fatal: -0.10; 95% CI: -0.37, 0.16). Associations for nonfatal incidents were strongest for people aged 15-34 years, and White and Hispanic people.
We did not find evidence that the introduction of recreational cannabis outlets was associated with self-harm injuries or that cannabis and alcohol outlet densities interact, but alcohol outlet density had a strong association with nonfatal self-harm injuries.
使用大麻和饮酒都与自我伤害性损伤有关，但很少有研究评估社区内休闲大麻销售点的开设与自我伤害发生率之间的联系，或者大麻销售点与酒精销售点密度之间的相互作用。我们估计了2017 - 2019年加利福尼亚州休闲大麻销售点、酒精销售点及其相互作用与致命和非致命自我伤害性损伤发生率之间的关联。
利用加利福尼亚州关于休闲大麻销售点、酒精销售点以及因自我伤害性损伤导致的医院出院和死亡情况的全州数据，我们对3年期间季度邮政编码级别的数据进行了贝叶斯时空分析，同时考虑了混杂因素和空间自相关。利用模型后验概率，我们估计了与销售点密度假设性变化相对应的参数。
如果休闲大麻销售点从未开设，我们估计非致命自我伤害性损伤的发生率每10万人会降低0.35例（95%可信区间[CI]：-1.25，0.51），而致命自我伤害性损伤的发生率每10万人会降低0.004例（95% CI：-0.26，0.25）。这些关联并不依赖于酒精销售点的密度，但假设酒精销售点密度降低20%与自我伤害性损伤减少有关（每10万人的风险差异，非致命：-1.59；95% CI：-2.60，-0.59；致命：-0.10；95% CI：-0.37，0.16）。非致命事件的关联在15 - 34岁人群以及白人和西班牙裔人群中最为强烈。
我们没有发现证据表明休闲大麻销售点的引入与自我伤害性损伤有关，或者大麻和酒精销售点密度之间存在相互作用，但酒精销售点密度与非致命自我伤害性损伤有很强的关联。
