Anne Boustead

Interests

Teaching

public policy; policy analysis; drug policy; technology policy; research methods

Research

public policy; policy analysis; drugs; surveillance; privacy; policing; research methods

Courses

Scholarly Contributions

Books

• Balkovich, E., Prosnitz, D., Isley, S. C., Boustead, A. E., & Triezenberg, B. L. (2017). Helping Law Enforcement Use Data from Mobile Applications: A Guide to the Prototype Mobile Information and Knowledge Ecosystem (MIKE) Tool. RAND Corporation. doi:10.7249/RR1482
• Boustead, A. E. (2016). Police, Process, and Privacy: Three Essays on the Third Party Doctrine. doi:10.7249/rgsd384
  More info

  Policymakers — state and federal, legislative and judicial — have expressed their interest in updating the laws regarding electronic surveillance. This interest is motivated by several recent trends. First, law enforcement surveillance has traditionally been limited as much by practical considerations, including the costs and technical difficulty of obtaining evidence, as legal ones. However, technological innovations have undermined these traditional practical protections, raising questions about the adequacy of the legal protections that remain. Second, law enforcement agencies are no longer the only entities collecting information about individuals. A wide variety of commercial entities now collect information about their customers, which law enforcement can access with only minimal legal protections. However, attempts to update electronic surveillance laws are made more difficult by the fact that very little is currently known about how law enforcement officers use electronic surveillance and commercial information requests. This dissertation presents the results of three studies that investigate how law enforcement uses electronic surveillance.
• Balkovich, E., Boustead, A. E., Isley, S. C., & Prosnitz, D. (2015). Electronic Surveillance of Mobile Devices: Understanding the Mobile Ecosystem and Applicable Surveillance Law. doi:10.7249/rr800
  More info

  Law enforcement agencies face major challenges surrounding law enforcement use of the user data collected through mobile phones and describes a prototype tool — the Mobile Information and Knowledge Ecosystem (MIKE) — that could help a wide range of stakeholders understand how information is shared within the mobile ecosystem and the legal protections that govern access to that information.
• Wynn, B. O., & Boustead, A. E. (2015). Home Health Care for California's Injured Workers. RAND Corporation.

Chapters

• Boustead, A. E., & Shackelford, S. (2022). Overcoming Barriers to Empirical Cyber Research. In Cyber Peace: Charting a Path Toward a Sustainable, Stable, and Secure Cyberspace. doi:10.1017/9781108954341.011
  More info

  Empirical studies have the potential to both inform and transform cyber peace research. Empirical research can shed light on opaque phenomena, summarize and synthesize diverse stakeholder perspectives, and allow causal inferences about the impact of policymaking efforts. However, researchers embarking on empirical projects in the area of cyber peace generally, and cybersecurity specifically, face significant challenges – particularly related to data collection. In this chapter, we identify some of the key impediments to empirical cyber research and suggest how researchers and other interested stakeholders can overcome these barriers.

Journals/Publications

• Pessar, S., Smart, R., Naimi, T., Lira, M., Blanchette, J., Boustead, A., & Pacula, R. (2025). The association between state cannabis policies and cannabis use among adults and youth, United States, 2002–2019. Addiction, 120(1). doi:10.1111/add.16663
  More info

  Aims: To measure the association between state cannabis policies and use among adults and youth in the United States from 2002 to 2019, given rapid policy liberalization and complex state cannabis policy environments. Design: Repeated cross-sectional time series analysis. Three sets of models assessed the linear association between the Cannabis Policy Scale (CPS), an aggregate measure of 17 state cannabis policy areas that weights each policy by its efficacy and implementation rating, and prevalence of cannabis use. The first included year and state fixed effects; the second added state-level controls; the third replaced state fixed effects with state random effects. Standard errors were clustered at the state level in all models. Setting and participants: United States. Measurements: Past-month prevalence of cannabis use is from the National Survey on Drug Use and Health Small Area Estimates, a nationally and state-representative cross-sectional survey of household population ages 12 and older for years 2002–2003 to 2018–2019. Exposure data include the CPS. Findings: A 10 percentage-point increase in the CPS (i.e. greater cannabis policy restrictiveness) was associated with lower past-month use prevalence by 0.81 (95% confidence interval [CI] = -1.05 to −0.56) to 0.97 (95% CI = -1.19 to −0.75) percentage-points for the population ages 12 years and older. When models were stratified by age, a 10 percentage-point increase in the CPS was associated with a 0.87 (95% CI = -1.13 to −0.61) to 1.04 percentage-point (95% CI = -1.03 to −0.84) reduction in past-month use prevalence for adults ages 18 years and older, and a 0.17 (95% CI = -0.24 to −0.09) to 0.21 percentage-point (95% CI = -0.35 to −0.07) reduction for youth ages 12–17 years. Conclusions: More restrictive US cannabis policies appear to be associated with reduced cannabis use for both adults and youth.
• Bass, B., Padwa, H., Khurana, D., Urada, D., & Boustead, A. (2024). Adult use cannabis legalization and cannabis use disorder treatment in California, 2010–2021. Journal of Substance Use and Addiction Treatment, 162. doi:10.1016/j.josat.2024.209345
  More info

  Introduction: Many nations and jurisdictions have legalized non-medical adult use of cannabis, or are considering doing so. This paper contributes to knowledge of adult use legalization's associations with cannabis use disorder (CUD) treatment utilization. Methods: This study collected data from a dataset of all publicly funded substance use disorder treatment delivered in California from 2010 to 2021 (1,460,066 episodes). A logistic regression model estimates adult use legalization's impacts on CUD treatment utilization using an individual-level pre-post time series model, including individual and county-level characteristics and county and year-fixed effects. Results: Adult use legalization was associated with a significant decrease in the probability of admission to CUD treatment (average marginal effect (AME): −0.005, 95 % CI: −0.009, 0.000). Adult use legalization was also associated with a decrease in the probability of admission to CUD treatment for males (AME: −0.025, 95 % CI: −0.027, −0.023) Medi-Cal beneficiaries (AME: −0.025, 95 % CI: −0.027, −0.023) adults ages 21+ (AME: −0.011, 95 % CI: −0.014, −0.009) and Whites (AME: −0.012, 95 % CI: −0.015, −0.010), and an increase in the probability of admission to CUD treatment for patients referred from the criminal justice system (AME: 0.017, 95 % CI: 0.015, 0.020) and Blacks (AME: 0.004, 95 % CI: 0.000, 0.007) and Hispanics (AME: 0.009, 95 % CI: 0.006, 0.011). Conclusions: Adult use legalization is associated with declining CUD treatment admissions, even though cannabis-related problems are becoming more prevalent. Policies and practices that protect public health, and engage people with CUD in treatment are needed.
• Hammond, C., Hyer, J., Boustead, A., Fristad, M., Steelesmith, D., Brock, G., Hasin, D., & Fontanella, C. (2024). Association Between Marijuana Laws and Suicide Among 12- to 25-Year-Olds in the United States From 2000 to 2019. Journal of the American Academy of Child and Adolescent Psychiatry, 63(3). doi:10.1016/j.jaac.2023.06.014
  More info

  Objective: Cannabis use is associated with suicide-related outcomes in both adolescents and adults, and may be increasing amid shifting cannabis policies. However, little is known about the impact of medical marijuana legalization (MML) and recreational marijuana legalization (RML) policies on youth suicide. Using 20 years of national data, we examined associations between MML, RML, and suicide-related mortality among US individuals aged 12 to 25 years, and assessed whether they varied based on age and sex. Method: Suicide deaths (N = 113,512) from the 2000-2019 National Vital Statistics System Multiple Cause of Death files for age groups 12 to 13, 14 to 16, 17 to 19, 20 to 22, and 23 to 25 years were examined in relation to time-varying cannabis law status using a staggered adoption difference-in-difference (DiD) approach with a negative binomial regression to determine associations between MML, RML, and suicide rates, controlling for individual- and state-level covariates and accounting for the varying effective dates of MML and RML by state. Results: The overall unadjusted annual suicide rate was 10.93/100,000, varying from 9.76 (states without marijuana laws (ML)) to 12.78 (MML states) to 16.68 (RML states). In multivariable analysis, both MML (incidence rate ratio [IRR] = 1.10, 95% CI: 1.05-1.15) and RML (IRR = 1.16, 95% CI: 1.06-1.27) were associated with higher suicide rates among female youth compared to those in states without ML. Youth aged 14 to 16 years had higher rates of suicide in states with RML compared to states with MML (IRR = 1.14, 95% CI: 1.00-1.30) and states without ML (IRR = 1.09, 95% CI: 1.00-1.20). Findings were consistent across sensitivity analyses. Conclusion: MML and RML were associated with increased suicide-related mortality in female youth and 14- to- 16-year-old individuals of both sexes. Mechanisms through which cannabis policies are related to increased youth suicide warrant further study and should inform legislative reform.
• Bass, B., Urada, D., Khurana, D., Boustead, A., & Joshi, V. (2023). The Effect of the Drug Medi-Cal Organized Delivery System 1115 Demonstration Waiver on Substance Use Disorder Treatment Access: Evidence from California. Drug and Alcohol Dependence, 246. doi:10.1016/j.drugalcdep.2023.109847
  More info

  Background: In August 2015, the California Department of Health Care Services created the Drug Medi-Cal Organized Delivery System 1115 demonstration waiver (DMC-ODS waiver) to improve service delivery to Medi-Cal-eligible individuals with a substance use disorder (SUD). We examine if implementing the DMC-ODS waiver across California counties improved patient access to SUD treatment services. Methods: We use administrative data from 2016 to 2020 from a reporting system for all publicly-funded SUD treatment services delivered in California and employ difference-in-differences and event study empirical strategies exploiting the differential timing of DMC-ODS waiver adoption across counties. Results: Event study analyses show that eleven or more months after the introduction of the DMC-ODS waiver, the number of unique patient admissions significantly increase by nearly 20%. Residential treatment admissions significantly increase by roughly 25% in all months post-waiver introduction. Conclusions: This study provides valuable information for policymakers about implementing 1115 waivers, and the important public health implications. California's DMC-ODS waiver has demonstrated that 1115 waivers similar to it can likely increase access to SUD treatment.
• Boustead, A. E., Makridis, C., & Shackelford, S. (2023). Defining "Reasonable" Cybersecurity: Lessons from the States. Yale Journal of Law and Technology. doi:10.2139/ssrn.3919275
• Boustead, A., & Kugler, M. (2023). Juror interpretations of metadata and content information: implications for the going dark debate. Journal of Cybersecurity, 9(1). doi:10.1093/cybsec/tyad002
  More info

  The rise of consumer encryption has led to a fierce debate over whether the loss of potential evidence due to encryption will be offset by the increase in evidence available from electronic metadata. One major question raised by this debate is how jurors will interpret and value metadata as opposed to content information. Though there are plausible arguments in favor of the persuasive power of each type of evidence, to date no empirical study has examined how ordinary people, potential jurors, view each of these sorts of evidence. We address this issue through a series of survey experiments that present respondents with hypothetical criminal trials, randomly assigning them to descriptions featuring either metadata or content information. These studies show that the relative power of content and metadata information is highly contextual. Content information and metadata can be equally useful when conveying logically equivalent information. However, content information may be more persuasive where the defendant's state of mind is critical, while metadata can more convincingly establish a pattern of behavior. This suggests that the rise of encryption will have a heterogeneous effect on criminal cases, with the direction of the effect depending on the facts that the prosecution must prove.
• Bruzelius, E., Levy, N., Segura, L., Livne, O., Gutkind, S., Boustead, A., Hasin, D., Mauro, P., Silver, D., Macinko, J., Martins, S., & Gonçalves, P. (2023). Recreational cannabis legislation and binge drinking in U.S. adolescents and adults. International Journal of Drug Policy, 118. doi:10.1016/j.drugpo.2023.104085
  More info

  Background: Recreational cannabis laws (RCLs) may have spillover effects on binge drinking. Our aims were to investigate binge drinking time trends and the association between RCLs and changes in binge drinking in the United States (U.S.). Methods: We used restricted National Survey on Drug Use and Health data (2008-2019). We examined trends in the prevalence of past-month binge drinking by age groups (12-20, 21-30, 31-40, 41-50, 51+). Then, we compared model-based prevalences of past-month binge drinking before and after RCL by age group, using multi-level logistic regression with state random intercepts, an RCL by age group interaction term, and controlling for state alcohol policies. Results: Binge drinking declined overall from 2008 to 2019 among people aged 12-20 (17.54% to 11.08%), and those aged 21-30 (43.66% to 40.22%). However, binge drinking increased among people aged 31+ (ages 31-40: 28.11% to 33.34%, ages 41-50: 25.48% to 28.32%, ages 51+: 13.28% to 16.75%). When investigating model-based prevalences after versus before RCL, binge drinking decreased among people aged 12-20 (prevalence difference=-4.8%; adjusted odds ratio (aOR)=0.77, [95% confidence interval (CI) 0.70-0.85]), and increased among participants aged 31-40 (+1.7%; 1.09[1.01-1.26]), 41-50 (+2.5; 1.15[1.05-1.26]) and 51+ (+1.8%; 1.17[1.06-1.30]). No RCL-related changes were noted in respondents ages 21-30. Conclusions: Implementation of RCLs was associated with increased past-month binge drinking in adults aged 31+ and decreased past-month binge drinking in those aged < 21. As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.
• Joseph Hammond, C., E Boustead, A., A Fristad, M., Pawar, A., L Steelesmith, D., & A Fontanella, C. (2023). Impact of Changing Cannabis Laws on Cannabis Use Disorders, Serious Mental Illness, and Mortality Outcomes in US Youth: A Narrative Review. Adolescent Psychiatry, 13(3), 123-142. doi:10.2174/0122106766248146231006061511
  More info

  Abstract: Youth cannabis use is a major public health crisis. Cannabis laws carry significant health implications for American youth. Relaxing of these laws – through decriminalization, medical and recreational legalization – by a majority of states in the United States (US) over the past 25 years has dramatically shifted societal perceptions and adult use. How cannabis policy changes have affected the population-wide health of US youth and downstream public health implications of cannabis laws remain topics of significant debate. Cannabis is the most commonly used federally-illicit drug by US adolescents and the main drug for which US teens obtain substance use treatment. Adolescent cannabis use is associated with negative long-term consequences for mental health, risk-taking behaviors, and academic/job achievement. As of January 2023, 37 states and the District of Columbia (DC) have enacted medical cannabis laws; of these, 21 states and DC have recreational cannabis laws. Multiple studies have assessed the association between cannabis laws and youth cannabis use; results indicate mostly null effects for medical laws and mixed effects for recreational laws. Little is known about the effects of cannabis laws on mental health and mortality outcomes for American youth. Methodological limitations have made the interpretation of this literature difficult. This article presents a narrative review of current scientific literature investigating the impact of changing cannabis policies on cannabis and other drug use, mental health, and mortality outcomes in US youth. Implications are framed within a larger discussion on national trends in youth drug use, effects of adolescent cannabis exposure on health outcomes, and research-based policymaking.
• Kerr, D., Levy, N., Bae, H., Boustead, A., & Martins, S. (2023). Cannabis and Alcohol Use by U.S. Young Adults, 2008–2019: Changes in Prevalence After Recreational Cannabis Legalization. American Journal of Preventive Medicine, 65(6). doi:10.1016/j.amepre.2023.06.009
  More info

  Introduction: Young adults’ cannabis and alcohol use patterns have changed after state recreational cannabis legalization according to studies based on college samples but not nationally representative samples. Associations between recreational cannabis legalization and changes in cannabis and alcohol use outcomes among young adults were examined, including differences by college enrollment and minor status (ages 18–20 vs 21–23 years). Methods: Repeated cross-sectional data (2008–2019) were collected from college-eligible participants aged 18–23 years in the National Survey on Drug Use and Health. Self-reported past-month cannabis use and frequent use (≥20 days) and a proxy for past-year DSM-5 cannabis use disorder were primary outcomes; past-month frequent alcohol use and binge drinking were secondary outcomes. Multilevel logistic regression models quantified changes in outcome prevalence from the study years before to after recreational cannabis legalization, adjusting for secular trends. Analyses were conducted on March 22, 2022. Results: Prevalence increased from before to after recreational cannabis legalization for past-month cannabis use (from 21% to 25%) and past-year proxy cannabis use disorder (from 11% to 13%); the increases were statistically significant [adjusted odds ratio (95% CI) = 1.20 (1.08–1.32) and 1.14 (1.003–1.30), respectively]. Increases were detected for young adults who were not in college and who were aged 21–23 years. Recreational cannabis legalization impacts were not detected for secondary outcomes. Conclusions: Some young adults appear sensitive to state recreational cannabis legalization, including in terms of cannabis use disorder risk. Additional prevention efforts should be directed to young adults who are not in college and timed to occur before age 21 years.
• Levy, N., Segura, L., Bruzelius, E., Boustead, A., Hasin, D., Mauro, P., Martins, S., & Gonçalves, P. (2023). Cannabis Recreational Legalization and Prevalence of Simultaneous Cannabis and Alcohol Use in the United States. Journal of General Internal Medicine, 38(6). doi:10.1007/s11606-022-07948-w
  More info

  Background: Simultaneous cannabis/alcohol use, using both substances within a short time interval so that their effects overlap, has a greater risk of potential negative consequences than single-substance use and is more common in younger age. Relationships between recreational cannabis laws (RCLs) and changes in simultaneous cannabis/alcohol use prevalence remain untested. Objective: To examine trends in simultaneous cannabis/alcohol use from 2008 to 2019, and investigate associations between implementation of RCLs (i.e., presence of active legal dispensaries or legal home cultivation) and simultaneous cannabis/alcohol use in the United States (U.S.). Design: Repeated cross-sectional samples from the 2008–2019 U.S. National Survey on Drug Use and Health (NSDUH). Participants: Respondents (51% female) aged 12 and older. Interventions: Changes in simultaneous cannabis/alcohol use before and after RCL implementation (controlling for medical cannabis law implementation) were compared in different age groups (12–20, 21–30, 31–40, 41–50, 51+), using adjusted multi-level logistic regression with state random intercepts and an RCL/age group interaction. Measurements: Self-reported simultaneous cannabis/alcohol use. Results: From 2008 to 2019, the overall prevalence of simultaneous cannabis/alcohol use declined among those aged 12–20 but increased in adults aged 21+. Model-based simultaneous cannabis/alcohol use prevalence increased after RCL implementation among respondents aged 21–30 years (+1.2%; aOR= 1.15 [95%CI = 1.04–1.27]), 31–40 years (+1.0; 1.15 [1.04–1.27]), and 41–50 years (+1.75; 1.63 [1.34–1.98]), but not in individuals aged
• Samples, H., Levy, N., Bruzelius, E., Segura, L., Mauro, P., Boustead, A., Mauro, C., & Martins, S. (2023). Association Between Legal Access to Medical Cannabis and Frequency of Non-Medical Prescription Opioid Use Among U.S. Adults. International Journal of Mental Health and Addiction. doi:10.1007/s11469-023-01191-y
  More info

  The impact of state-level medical cannabis laws (MCL) on individual-level opioid outcomes is inconclusive. We analyzed representative samples of U.S. adults ≥ 21 years reporting past-year non-medical prescription opioid (NMPO) use in the 2004–2014 National Surveys on Drug Use and Health. Multi-level mixed effects models estimated associations of state-level MCL with individual-level NMPO use frequency, categorized as occasional (1–12 days), regular (13–52 days), or frequent (53–365 days). Further analyses stratified by past-year cannabis use and disorder (no use, use only, DSM-IV cannabis use disorder). MCL was associated with increases in occasional NMPO use (2.1% points, 95% CI: 0.5, 3.8) alongside reductions in regular (-0.6% points, 95% CI: -1.1, -0.1) and frequent NMPO use (-1.5% points, 95% CI: -2.7, -0.4). In stratified analyses, significant changes were observed only for adults with cannabis use disorder, including increases in occasional NMPO use (5.6% points, 95% CI: 1.5, 9.6) and decreases in frequent NMPO use (-4.9% points, 95% CI: -8.1, -1.8). The association of MCL with lower frequency of NMPO use was driven by individuals with cannabis use disorder, highlighting the importance of identifying tradeoffs of cannabis legalization as an intervention to reduce opioid-related harms.
• Blanchette, J., Pacula, R., Smart, R., Lira, M., Boustead, A., Caulkins, J., Kilmer, B., Kerr, W., Treffers, R., & Naimi, T. (2022). Rating the comparative efficacy of state-level cannabis policies on recreational cannabis markets in the United States. International Journal of Drug Policy, 106. doi:10.1016/j.drugpo.2022.103744
  More info

  Background: Cannabis policy is developing faster than empirical evidence about policy effects. With a panel of experts in substance use policy development and research, we identified key cannabis policies and their provisions enacted by U.S. states; rated their theoretical efficacy in a restrictive form for reducing problematic use and impaired driving in the context of a recreational cannabis market as judged by experts; and rated the strength of evidence for each policy. Methods: Using a modified Delphi approach, 9 panelists rated the comparative efficacy of 18 state cannabis policies for reducing youth use of cannabis, excessive cannabis use among the general population, and cannabis-impaired driving. Each outcome was rated separately using a Likert scale, and panelists also rated the strength of evidence supporting each efficacy rating. Investigators provided descriptions of each policy so that the nine panelists had similar conceptions of each policy. Results: State monopoly (state owns all production, manufacturing, wholesale, and retail operations) was rated as the most effective policy for all three outcome areas. Restrictions on retail physical availability, taxes, retail price restrictions, and retail operations restrictions were also highly rated for all three outcomes. Policies regulating cannabis businesses and products were judged more effective than policies targeting consumer use and behavior. Panelists reported there was little or no direct evidence from the cannabis policy literature for most of the included policies. Conclusion: These ratings can facilitate research as well as policy-making decisions. A relatively small number of policies were judged to be highly effective across all three domains, indicating that for the most part adult excessive use, youth use, and impaired driving can all be reduced with the same set of policies; these policies tended to target the behaviors of businesses rather than consumers. The low levels of direct evidence available to inform policy ratings, as reported by the policy panelists, makes clear the need for ongoing and sustained cannabis policy research.
• Padwa, H., Huang, D., Mooney, L., Grella, C. E., Grella, C., Urada, D., Bell, D. S., Bell, D., Bass, B., Boustead, A. E., & Boustead, A. (2022). Medical conditions of primary care patients with documented cannabis use and cannabis use disorder in electronic health records: a case control study from an academic health system in a medical marijuana state. Substance Abuse: Treatment, Prevention, and Policy, 17(1). doi:10.1186/s13011-022-00467-1
  More info

  Background: Approximately 3.8% of adults worldwide have used cannabis in the past year. Understanding how cannabis use is associated with other health conditions is crucial for healthcare providers seeking to understand the needs of their patients, and for health policymakers. This paper analyzes the relationship between documented cannabis use disorders (CUD), cannabis use (CU) and other health diagnoses among primary care patients during a time when medical use of marijuana was permitted by state law in California, United States of America. Methods: The study utilized primary care electronic health record (EHR) data from an academic health system, using a case–control design to compare diagnoses among individuals with CUD/CU to those of matched controls, and those of individuals with CUD diagnoses with individuals who had CU otherwise documented. Associations of documented CU and CUD with general medical conditions and health conditions associated with cannabis use (both medical and behavioral) were analyzed using conditional logistic regression. Results: Of 1,047,463 patients with ambulatory encounters from 2013–2017, 729 (0.06%) had CUD diagnoses and 3,731 (0.36%) had CU documented in their EHR. Patients with documented CUD and CU patients had significantly (p < 0.01) higher odds of most medical and behavioral diagnoses analyzed. Compared to matched controls, CUD-documented patients had highest odds of other substance use disorders (OR = 21.44: 95% CI 9.43–48.73), any mental health disorder (OR = 6.99; 95% CI 5.03–9.70) social anxiety disorder (OR = 13.03; 95% CI 2.18–77.94), HIV/AIDS (OR = 7.88: 95% CI 2.58–24.08), post-traumatic stress disorder (OR = 7.74: 95% CI 2.66–22.51); depression (OR = 7.01: 95% CI 4,79–10.27), and bipolar disorder (OR = 6.49: 95% CI 2.90–14.52). Compared to matched controls, CU-documented patients had highest odds of other substance use disorders (OR = 3.64; 95% CI 2.53–5.25) and post-traumatic stress disorder (OR = 3.41; 95% CI 2.53–5.25). CUD-documented patients were significantly more likely than CU-documented patients to have HIV/AIDS (OR = 6.70; 95% CI 2.10–21.39), other substance use disorder (OR = 5.88; 95% CI 2.42–14.22), depression (OR = 2.85; 95% CI 1.90–4.26), and anxiety (OR = 2.19: 95% CI 1.57–3.05) diagnoses. Conclusion: The prevalence of CUD and CU notation in EHR data from an academic health system was low, highlighting the need for improved screening in primary care. CUD and CU documentation were associated with increased risk for many health conditions, with the most elevated risk for behavioral health disorders and HIV/AIDS (among CUD-documented, but not CU-documented patients). Given the strong associations of CUD and CU documentation with health problems, it is important for healthcare providers to be prepared to identify CU and CUD, discuss the pros and cons of cannabis use with patients thoughtfully and empathically, and address cannabis-related comorbidities among these patients.
• Boustead, A. (2021). Privacy protections and law enforcement use of prescription drug monitoring databases. Law and Policy, 43(3). doi:10.1111/lapo.12174
  More info

  Prescription drug monitoring programs (PDMPs) are databases that can be used by healthcare professionals to identify problematic drug-seeking behavior. Law enforcement officers can also obtain PDMP information, raising significant privacy concerns. In this paper, I use regression analysis to explore the association between state PDMP protections and law enforcement information requests. I find that while requiring law enforcement to meet a specified standard of proof prior to accessing PDMP information is associated with fewer requests, other methods of regulating law enforcement access are not. These findings provide important and novel evidence about law enforcement behavior in response to privacy protections.
• Boustead, A. E., Ge, Y., Pacula, R. L., Pessar, S. C., & Smart, R. (2021). Assessment of State and Federal Health Policies for Opioid Use Disorder Treatment During the COVID-19 Pandemic and Beyond. JAMA health forum, 2(11), e213833. doi:10.1001/jamahealthforum.2021.3833
  More info

  Federal and state governments implemented temporary strategies for providing access to opioid use disorder (OUD) treatment during the COVID-19 pandemic. Advocates hope many of these policies become permanent because of their potential to expand access to care.To consider the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy so researchers can do a better job evaluating the effectiveness of specific policy approaches, which will depend on the interaction with other state policies.We summarize state-level policy data reported by government and nonprofit agencies that track health care regulations, specifically the Kaiser Family Foundation, Federation of State Medical Boards, American Association of Nurse Practitioners, American Academy of Physician Assistants, and the National Safety Council. Data were collected by these sources from September 2020 through January 2021. We examine heterogeneity in policy elements adopted across states during the COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication for opioid use disorder. The analysis was conducted from March 2020 through January 2021.This cross-sectional study found that federal and state governments have taken important steps to ensure OUD treatment availability during the COVID-19 pandemic, but few states are comprehensive in their approach. Although all states and Washington, DC have adopted at least 1 telehealth policy, only 17 states have adopted telehealth policies that improve access to OUD treatment for new patients. Furthermore, only 9 states relaxed privacy laws, which influence the ability to use particular technology for telehealth visits. Similarly, all states have adopted at least 1 policy related to health care professional licensing permissions, but only 35 expanded the scope of practice laws for both physician assistants and nurse practitioners. Forty-four states expanded access to initiation and delivery of medication for OUD treatment. Together, no state has implemented all of these policies to comprehensively expand access to OUD treatment during the COVID-19 pandemic.With considerable policy changes potentially affecting access to treatment and treatment retention for patients with OUD during the pandemic, evaluations must account for the variation in state approaches in related policy areas because the interactions between policies may limit the potential effectiveness of any single policy approach.
• Boustead, A. (2019). The Tools at Hand: Surveillance Innovations and the Shifting Role of Federal Law Enforcement in Drug Control. Ohio State Journal of Criminal Law.
  More info

  Although enforcement is a key component of any drug prohibition scheme, changes in enforcement capabilities frequently occur independently of efforts by policymakers to manage the sometimes-conflicting public health and law enforcement aspects of drug policy. Since its passage in 1970, the Controlled Substances Act (CSA) has been amended several times to enhance enforcement of drug laws. Simultaneously, the surveillance tools available to law enforcement officers investigating narcotics crimes have become exponentially more powerful. By functioning as a force multiplier, these surveillance tools can fundamentally shift the ability of federal law enforcement to enforce drug laws, and consequently further augment the role of federal law enforcement in drug control efforts. However, the role of surveillance innovations in molding federal enforcement of drug laws has not yet been systematically analyzed in the context of the post-CSA policy environment. In this paper, I explore the relationship between efforts to enforce the regulatory scheme established by the CSA and the development of surveillance infrastructure in the United States over the last 50 years. I pay particular attention to how the role of the federal law enforcement in drug control has been shaped by advancements in law enforcement surveillance capabilities, and argue that efforts to understand the policy changes brought about by the CSA are likely to be incomplete unless they also consider intervening changes in surveillance capabilities. I conclude by discussing the implications of this analysis for future efforts to reform the CSA.
• Boustead, A. E. (2020). The Tools at Hand: Surveillance Innovations and the Shifting Role of Federal Law Enforcement in Drug Control. Ohio State Journal of Criminal Law.
• Boustead, A., & Herr, T. (2020). Analyzing the Ethical Implications of Research Using Leaked Data. PS - Political Science and Politics, 53(3). doi:10.1017/S1049096520000323
  More info

  Although information made public after a data breach can provide insight into difficult research questions, use of these data raises ethical questions not directly addressed by current ethical guidelines. This article develops a framework for identifying and managing risks to human subjects when conducting research involving leaked data. We contend that researchers who seek to use leaked data should identify and address ethical challenges by considering the process through which the data were originally released into the public domain.
• Boustead, A., & Shackleford, S. (2020). State of Hoosier Cybersecurity 2020. Indiana Business Research Center.
  More info

  As is the case in many jurisdictions, public and private organizations in Indiana are unfortunately no stranger to cyber attacks. Counties across the state such as Lake, Lawrence, and LaPorte have been targeted by criminals in recent ransomware campaigns, leading to hundreds of thousands in losses. Healthcare providers such as Hancock Memorial Hospital have been similarly breached, as have universities, small business, utilities, and school corporations. Yet it has proven difficult to understand the full scope of these cyber threats, and how Hoosier organizations are attempting to prevent and respond to them.To get a more complete picture of Hoosier cyber risk planning, the Legal and Insurance working group of the Indiana Executive Cybersecurity Council, in collaboration with researchers at Indiana University and the University of Arizona, conducted this study to help explore how Indiana organizations perceive and manage cyber risks. We pay particular attention to the role of insurance as part of an overarching cyber risk mitigation strategy. The report is broken down into the following sections. Section 1 offers background on the technical, organizational, and legal dimensions of the cyber threat, along with a policy review highlighting recent primarily state-level efforts in Indiana and beyond to better manage cyber risk. Section 2 reviews the methods used in this study. Section 3 summarizes our results, paying particular attention to such topics as risk perceptions, management, and the evolving role of cyber risk insurance. Section 4 concludes the study with a look at policy opportunities to address the vulnerabilities and governance gaps revealed by the survey.This goal of this report is to provide business leaders, policymakers, law enforcement professionals, and all Hoosiers with important information about cyber readiness, help organizations of all sizes better understand current cyber threats facing Indiana, and describe current efforts to address them. In the end, cybersecurity is a team sport,and we’re all in this together.
• BOUSTEAD, A. E. (2018). Small Towns, Big Companies: How Surveillance Intermediaries Affect Small and Midsize Law Enforcement Agencies. Hoover Institution, Aegis Series Paper.
• Sarvet, A. L., Wall, M. M., Fink, D. S., Greene, E., Le, A., Boustead, A. E., Pacula, R. L., Keyes, K. M., Cerd'a, M., Galea, S., & others, . (2018). Medical marijuana laws and adolescent marijuana use in the United States: A systematic review and meta-analysis. Addiction.
• Sarvet, A. L., Wall, M. M., Fink, D. S., Le, A., Boustead, A. E., Keyes, K. M., Cerda, M., Galea, S., Hasin, D. S., Greene, E. A., & Pacula, R. L. (2018). Medical Marijuana Laws and Adolescent Marijuana Use in the United States. Addiction.
• Balkovich, E., Prosnitz, D., Isley, S. C., Boustead, A. E., & Triezenberg, B. (2017). Helping Law Enforcement Use Data from Mobile Applications. RAND Reports.
• Boustead, A. (2017). A Legislator's Guide to Reauthorizing Section 702. Belfer Center Paper.
• Boustead, A. E., Buchanan, B., Deckard, A. N., Herr, T., Schneier, B., Shackelford, S., Smith, J. M., & Sulmeyer, M. (2017). Making Democracy Harder to Hack. University of Michigan Journal of Law Reform, 50(3), 629-668.
• Shackelford, S. J., Schneier, B., Sulmeyer, M., Boustead, A., Buchanan, B., Deckard, A., Herr, T., & Smith, J. M. (2016). Making Democracy Harder to Hack. U. Mich. JL Reform, 50, 629.
• Yerukhimovich, A., Balebako, R., Boustead, A., Cunningham, R. K., Welser, W., Housley, R., Shay, R., Spensky, C., Stanley, K. D., Stewart, J., Trachtenberg, A., & Winkelman, Z. (2016). Can Smartphones and Privacy Coexist? Assessing Technologies and Regulations Protecting Personal Data on Android and iOS Devies. RAND Reports.
• Balkovich, E., Prosnitz, D., Boustead, A., & Isley, S. C. (2015). Electronic Surveillance of Mobile Devices: Understanding the Mobile Ecosystem and Applicable Surveillance Law. RAND Reports.
• Boustead, A. E., & Stanley, K. D. (2015). The Legal and Policy Road Ahead: An Analysis of Public Comments in NHTSA's Vehicle-to-Vehicle Advance Notice of Proposed Rulemaking. Minn. JL Sci. & Tech., 16, 693.
• Wynn, B. O., & Boustead, A. (2015). Home Health Care for California's Injured Workers: Options for Implementing a Fee Schedule. Rand Health Quarterly, 5(1).
• Boustead, A. E., Hunt, P., & Pacula, R. L. (2014). Words Can Be Deceiving. Journal of Drug Policy Analysis.
• Pacula, R. L., Boustead, A. E., & Hunt, P. (2014). Words Can Be Deceiving: A Review of Variation Among Legally Effective Medical Marijuana Laws in the United States. Journal of Drug Policy Analysis, 7(1), 1--19.

Presentations

• Baldwin-Rowe, J., Joshi, N., McCann, L., Boustead, A., Baldwin, E., Lien, A., & Evans, T. (2021). Rural vs. urban differences in COVID-19 legal response. American Public Health Association Annual Meeting.
• Evans, T., Lien, A., Boustead, A., Baldwin, E., Zimmer, A., McCann, L., Joshi, N., & Rowitt, J. (2021, October). Rural vs. urban differences in COVID-19 non-pharmaceutical interventions. American Public Health Association Annual Meeting. Online: American Public Health Association.
• Evans, T., McCann, L., Joshi, N., Baldwin, E., Boustead, A., & Lien, A. (2021, November). Design of a national database of state and local COVID-19 policies using the institutional grammar. Institutional Grammar Research Institute Seminar. Online: Syracuse University.
• Boustead, A. (2020, February 2020). The Tools at Hand: Surveillance Innovations and the Shifting Role of Federal Law Enforcement in Drug Control. Controlled Substances Act at 50 Years Symposium.
  More info

  Although enforcement is a key component of any drug prohibition scheme, changes in enforcement capabilities frequently occur independently of efforts by policymakers to manage the sometimes-conflicting public health and law enforcement aspects of drug policy. Since its passage in 1970, the Controlled Substances Act (CSA) has been amended several times to enhance enforcement of drug laws. Simultaneously, the surveillance tools available to law enforcement officers investigating narcotics crimes have become exponentially more powerful. By functioning as a force multiplier, these surveillance tools can fundamentally shift the ability of federal law enforcement to enforce drug laws, and consequently further augment the role of federal law enforcement in drug control efforts. However, the role of surveillance innovations in molding federal enforcement of drug laws has not yet been systematically analyzed in the context of the post-CSA policy environment. In this paper, I explore the relationship between efforts to enforce the regulatory scheme established by the CSA and the development of surveillance infrastructure in the United States over the last 50 years. I pay particular attention to how the role of the federal law enforcement in drug control has been shaped by advancements in law enforcement surveillance capabilities, and argue that efforts to understand the policy changes brought about by the CSA are likely to be incomplete unless they also consider intervening changes in surveillance capabilities. I conclude by discussing the implications of this analysis for future efforts to reform the CSA.
• Boustead, A. (2019, Fall 2019). The Impact of Marijuana Outlet Density on DUI Arrests and Substance-Related Fatal Accidents. APPAM Fall Research Conference 2019.
  More info

  Intoxicated operation of motor vehicles is a pervasive and significant threat to public health and safety in the United States: in 2016, more than 1 million people were arrested for driving under the influence and more than 10,000 people were killed in alcohol-related car accidents (CDC 2019). As increased marijuana availability may change consumption of alcohol and opioids (Subbaraman 2016, Powell et al. 2018), policymakers and advocates have argued that marijuana legalization may decrease driving under the influence and related harms. Prior research has demonstrated a relationship between the passage of medical marijuana laws and a reduction in alcohol-related (Anderson, Hansen, and Rees 2013) and opioid-related traffic fatalities (Kim et al. 2016). These prior studies are based on state-level measures of marijuana legalization; however, in practice the availability of marijuana varies substantially both within and across states that have legalized medical or recreational marijuana. Accounting for local variation in marijuana availability will lead to better estimates of the effects of marijuana legalization on driving under the influence, and improved policymaking related to intoxicating substances.In this paper, I use novel measures of marijuana outlet density to evaluate the effects of state-recognized sources of marijuana on DUI arrests and alcohol-related fatal accidents. Drawing from a dataset comprised of the address, opening date, and closing date of all state-licensed medical and recreational marijuana in 18 states, marijuana outlet density is measured on the county level by the percent of the population within 5, 25, and 50 miles of any state-licensed marijuana outlet. Data on DUI arrests are obtained through Uniform Crime Reports county-level dataset; data on alcohol and opioid related marijuana traffic fatalities are obtained through the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System Data. Difference-in-difference analysis is used to analyze the effect of marijuana outlet density on DUI arrests and fatal accidents. When complete, this analysis will provide policymakers with vital information on the public health and safety effects of legally recognized sources of marijuana.
• Boustead, A. (2019, June 2019). Intergovernmental Cooperation in Electronic Surveillance. Privacy Law Scholars Conference 2019.
  More info

  There is much still unknown about how law enforcement surveillance behavior is shaped by legal and contextual constraints. One area of particular pragmatic interest is the relationship between electronic surveillance use by federal law enforcement and electronic surveillance use by state/local law enforcement. On one hand, intergovernmental cooperation is vital for protecting public safety and national security. If intergovernmental cooperation in electronic surveillance does not appear to be widespread, then federal and state policymakers may wish to take steps to further encourage this behavior. On the other hand, states governments can – and have – crafted stronger protections for their citizens than those provided by the federal government. If cooperation between federal and state law enforcement hinders these state protections, then state policymakers may seek to ensure that their policy preferences remain effective. However, despite the importance of this issue, few studies to date have investigated intergovernmental cooperation in electronic surveillance. In this paper, I explore the relationship between federal and state/local law enforcement cooperation and use of electronic surveillance in the context of wiretap use. I begin by discussing existing (and unexplained) variation in surveillance use across jurisdictions, analyze potential two mechanisms through which interagency cooperation could change how law enforcement conducts electronic surveillance, and describe the federal and state rules governing law enforcement use of wiretaps. Next, I empirically explore the effect of intergovernmental cooperation on electronic surveillance use using data extracted from the Wiretap Reports. Specifically, I seek to answer two questions: does the development of state-level wiretap capabilities change the use of wiretaps on the federal level and, based on evidence from California, is there an association between the presence of a federal law enforcement office in a locality and the locality’s uptake of wiretap use? Using a difference-in-difference analysis, I find that state level wiretap capabilities have no effect on wiretap requests in federal court; using survival analysis, I find that the presence of a federal law enforcement agency office in a locality is associated with a decrease in the time it takes for state-level wiretap authorizations requests to be made in that locality. I conclude with a discussion how these results might inform our understanding of law enforcement surveillance behaviors, and the policy implications for privacy and public safety.
• Boustead, A. (2018, December). Privacy Protections and Law Enforcement Use of Prescription Drug Monitoring Databases. Workshop on Economics & Privacy, George Mason University Antonin Scalia Law School and the University of Arizona James E. Rogers College of Law.
• Boustead, A. (2018, July). Privacy Protections and Law Enforcement Use of Prescription Drug Monitoring Databases. Small Group Session on Technology, Surveillance & Health at the Data & Society Research Institute.
• Boustead, A. (2018, May). Privacy Protections and Law Enforcement Use of Prescription Drug Monitoring Databases. Privacy Law Scholars Conference.
• Boustead, A. (2018, November). The Impact of State-Licensed Marijuana Outlets on Opioid-Related Outcomes. 2018 APPAM Fall Research Conference.
• Boustead, A. (2018, November). The Impact of State-Licensed Marijuana Outlets on Opioid-Related Outcomes. Southern Economic Association Annual Meeting.

Others

• Boustead, A. E. (2016, September). Police, Process, and Privacy Three Essays on the Third Party Doctrine. https://www.rand.org/pubs/rgs_dissertations/RGSD384.html