Washington State and Colorado were the first states to legalize recreational marijuana. According to the Washington Traffic Safety Commission, the number of drivers who tested positive for marijuana in traffic fatalities increased 48% from 2013 to 2014, and marijuana legalization may have influenced this increase. Since marijuana legalization is new to the United States, the effects of this change in policy are untested in the literature. The purpose of this quantitative study using a regression point displacement design was to examine the relationship between traffic fatalities involving cannabinoids in Washington State before and after marijuana legalization. Rational choice theory and perceptual deterrence theory provided the framework for the study. Existing state level data of traffic fatalities from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System were analyzed using regression point displacement. Pre and post legalization Washington state fatalities were compared against 43 control groups where marijuana has not been legalized for recreational use. Results from ANCOVA analysis indicated no statistical difference between Washington State and other nonlegalized states in traffic fatalities involving cannabinoids. This is one of the first studies exploring the effects of marijuana legalization on public safety. These results suggest marijuana legalization may not contribute to the increase in traffic fatalities. Findings may provide legislators and traffic safety stakeholders with information in creating legislation legalizing marijuana as well as strategy and a research agenda to address traffic fatalities.

No description available.

No description available.

The purpose of this study was to analyze gender, race, substance abuse programs such as Drug Abuse Resistance Education (D.A.R.E.), parents, and peers and their ability to influence or predict adolescents and their decisions to use marijuana. All of the variables used for this study came from secondhand data collected by Esbensen and Osgood (1999), Gang Resistance Education and Training (G.R.E.A.T.). The analysis revealed that males are more likely to have ever used marijuana, that mixed race adolescents have a higher rate than other races to have ever used marijuana, that when adolescents complete the substance abuse program, D.A.R.E. have a lower rate than those who did not complete the program, adolescents are less likely to have ever used marijuana when their parents know where they are, and adolescents are more likely to have ever used marijuana when they have friends who use marijuana.

The purpose of this study was to explore the relationship between alcohol, tobacco, and marijuana use among teenagers. This study examined three research questions: (1) Is there a relationship between demographic characteristics (i.e., sex and race), the attitudinal variable (attachment to family), and the admitted use of marijuana, alcohol, and tobacco among teenagers? (2) Is there a relationship between the use of marijuana by teenagers and the use of tobacco by teenagers? (3) Is there a relationship between the use of marijuana by teenagers and the use of alcohol by teenagers? The data used for this paper were from the Evaluation of the Gang Resistance Education and Training Program research project (Esbensen, 2003). The analysis found that the frequency of teenage alcohol use had the strongest correlation with the use of marijuana. The frequency of teenage tobacco use was also found to have a significant correlation to marijuana use.

No description available.

Jack Kerouac's spontaneous prose method was inspired in part by his use of drugs while writing. While there is abundant biographical evidence that Kerouac used drugs frequently, little attention has been paid to their effects on the development of his style. This thesis attempts to demonstrate that the altered states of consciousness produced by Kerouac's drug use should be considered in conjunction with historical, cultural, and biographical forces in tracing the evolution of Kerouac's creative growth. As a member of the Beat Generation, Kerouac used drugs both as a social statement of rebellion and for artistic insight. In fact, he consciously entered into a well-established tradition of writers looking to drugs as modern-day muses. Within this legacy, drugs were commonly viewed as chemical gateways to a transcendental realm of visionary truth that the artists could enter and return with, thus becoming a literary seer. Kerouac, who believed that the ossification of standardized written English into rigid forms of grammar and sentence construction curtailed its potential for complete communication, sought a prose style that would allow for a maximum of authenticity and fidelity to organic thought with a minimum of revision. Kerouac used drugs like amphetamine, marijuana, and alcohol, each of which offered unique modes of perception, to enter into new frameworks of consciousness, and then recreated these altered states in writing. These three substances—amphetamine, marijuana, and alcohol—served as the basis in the development of Kerouac's style. Amphetamine, in the form of the over-the-counter drug Benzedrine, gave Kerouac the energy for his legendary typing marathons, allowing him to write On the Road in three weeks and The Subterraneans in three days. While writing On the Road in particular, Kerouac began formulating the stylistic approach that he subsequently dubbed "spontaneous prose." Its basic tenants, including a de-emphasis on revision, limited punctuation, and long sentences, were encouraged by Benzedrine's stimulant properties, which tended to focus Kerouac's attention on the exterior world of events, temporality, and movement. His amphetamine-induced texts attempt to communicate accurately by confessing the minutia of surface details. Kerouac's spontaneous style, however, soon evolved into the "sketching" technique seen in Visions of Cody and Dr. Sax, partially as a result of his marijuana-induced desire to share subjective perceptions truthfully. Rather than focusing on the exterior world, the marijuana texts look inward for authenticity. Marijuana helped Kerouac facilitate this inner orientation by its pharmacodynamic tendency to induce dream-like, associative states; when reproduced textually, these impressions seemed to resemble the unconscious structures of Kerouac's mind, which he shared hoping for complete communication via the universality of shared experience. Kerouac used both the amphetamine and marijuana modes to varying degrees and interchangeably for most of his career, and with the first section of Desolation Angels, written in sobriety, achieved their greatest synthesis, demonstrating that drugs were not the props to his style, but rather the impetus—even in the absence of drugs, Kerouac's prose retained its own essential, idiosyncratic features. Finally, in the latter part of Kerouac's career, alcohol proved that drugs could also negatively affect his style, as shown in Big Sur and Vanity of Duluoz. Their return to a plainer prose—some would say poorer prose—was no doubt the result of rampant alcohol abuse, and the unfortunate end to Kerouac's life and writing.

Background: Electronic nicotine delivery systems (ENDS) use among adolescents in the United States (U.S.) has surpassed conventional tobacco products (CTPs), including cigarettes. Increasingly, ENDS are used concurrently with CTPs and substances such as cannabis. However, few studies involve Central Appalachia, a region with historically high rates of tobacco and other substance use. Objective: To examine prevalence of concurrent use of ENDS and cannabis among school-going adolescents in Appalachian Tennessee and delineate associations between ENDS use and substance-related risk behavior (cannabis use), social relations (peer use), and school-related risk behavior (academic performance). Methods: Data were obtained from a survey conducted with youth aged 13-17 years in 2018 in a county in Appalachian Tennessee (n = 280). A multivariable logistic regression model was fit to evaluate associations between ENDS and cannabis use, and other factors. Results: Overall, lifetime ENDS and cannabis prevalence estimates were 31.1% and 18.6%, respectively. Lifetime ENDS users had increased odds of also being lifetime cannabis users [OR = 9.22, 95% confidence interval (CI): 3.44-24.75]. Lifetime ENDS users had increased odds of reporting ENDS use among peers [OR = 12.11; 95% CI: 5.40-27.12] and lower academic performance (OR associated with mostly C or D vs. A grades was 4.28, 95% CI: 1.68-10.90). Conclusion: This study found an association between ENDS and cannabis use among adolescents in Appalachian Tennessee exists. Additionally, peer use and academic performance were associated with ENDS use. The findings have implications for public health intervention planning to address not only ENDS but also substance use among Appalachian youth.

The lifetime prevalence of alcohol in the United States is 8% and lifetime prevalence of illicit drug use is about 2-3%. Substance use is common among adolescents and polysubstance use is becoming a public health threat. The prevalence of adolescent physical dating violence was 8.2%, the prevalence of adolescent sexual violence was also 8.2% while the prevalence of dual adolescent physical and sexual violence was 2.6%. Compared to those who used only single substances, adolescents who did not use any substance were 60% less likely (OR = 0.42, 95% CI = 0.24 – 0.74) to experience physical dating violence, 50% less likely (OR = 0.45, 95% CI = 0.31 – 0.66) to experience sexual dating violence and 70% less likely (OR = 0.34, 95% CI = 0.16– 0.69) to have experienced both physical and sexual dating violence. The prevalence of adolescent criminal arrests was 17.2%. Adolescents who combined select illicit drugs with alcohol were 1.7 times more likely to be arrested (OR = 1.66 ,95% CI = 1.49 – 1.85). Adolescents who used both select illicit drugs and marijuana were 1.5 times (OR = 1.55, 95% CI = 1.46 – 1.65) more likely to be arrested than those who used only select illicit drugs. Also, adolescents who used all three substances (select illicit drugs, alcohol and marijuana) were 1.6 times (OR = 1.62, 95% CI = 1.50 – 1.75) more likely to be arrested than those who used only select illicit drugs. The prevalence of weapon-related injuries was 7.4%. Adolescents who did not use substances were 50% less likely (OR = 0.47, 95% CI = 0.29 – 0.75, p The odds of dating violence, criminal arrests and weapon-related were higher with polysubstance use than with either mono-substance or no substance use. Therefore, prevention of substance use may be beneficial in reducing these public health concerns.

My doctoral thesis examines the broad question of the effect of some recent health policies on health and also tries to measure socioeconomic inequalities. The first essay investigates the effect of public health insurance on people with vulnerable health. The second chapter analyses the effect of the legalization of marijuana on health, while the third chapter measures socioeconomic inequalities in health. In chapter 1, I study the evolution of access to health care for individuals in vulnerable health before and after the Affordable Care Act. I define leakage of health care as the aggregation of accessibility hurdles for individuals in vulnerable health. However, "being in vulnerable health" is a linguistic concept that does not have a sharp mathematical definition. I draw on the fuzzy sets theory and assume a non-dichotomous membership function to capture the linguistic imprecision. However, the task of choosing the "right" membership function remains an issue. To circumscribe this additional issue, I use a stochastic dominance approach to test for changes in leakage. In order to establish causality, I exploit two quasi-experimental settings offered by the dependent coverage and the states in which medicaid expansion took place. In order to use these quasi-experiments in a stochastic dominance framework, I extend Athey and Imbens (2006) changes in changes approach to a bivariate setting. Using data from the National Health Interview Survey, the results from a before and after analysis show that leakages are much lower in 2015 compared to 2009 in the US. These before and after results hold irrespective of a person's sex or socio-economic status. The causal analysis shows that leakages in not having insurance and access are reduced in medicaid expansion states after the ACA. Chapter 2 analyzes the implications of these recreational marijuana legalization (RML) on Body Mass Index (BMI) and some healthy behaviours. I exploit the quasi experimental nature of marijuana legalization policy in states using changes in changes and difference in difference approaches to identify the effect of these recreational marijuana policies. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), the results show that recreational marijuana legalization reduces BMI for the entire population. The effect is mainly in the mid and top part of the BMI distribution. Subgroup analysis shows that the reduced BMI resulting from RML is significant among women but not among men. For females, the effect is found both at the lower tail (being underweight) and at the upper tail (morbid obesity). While we found evidence of a reduction in being overweight for both whites and non-whites due to RML, the reduction in obesity and morbid obesity was only found for non-whites. In addition, RML reduces obesity for those below 45 years. I also found evidence that RML increases alcohol consumption, has no effect on smoking of tobacco and binge drinking but reduces the probability of doing any physical activity. The final chapter explores the measurement of socioeconomic inequality using ordinal variables. Most measures of socioeconomic inequality are developed for ratio scale variables. These measures use the mean as a reference point which is non-robust in the presence of categorical variables. This chapter extends Allison and Foster (2004) median based approach to measuring inequalities to a bivariate case and provides conditions to robustly rank any two distributions of socioeconomic inequalities in well-being or mental health. Using the Canadian Community Health Survey (CCHS), I provide robust ordering for socioeconomic inequalities in well-being and mental health for different sub-populations in 2015. The results show that there is less socioeconomic inequality in life satisfaction, happiness, mental health, and general health status among employed males and females compared to their respective unemployed groups in 2015.