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Cain D, Samrock S, Jones SS, Jimenez RH, Dilones R, Tanney M, Outlaw A, Friedman L, Naar S, Starks TJ. Marijuana and illicit drugs: Correlates of condomless anal sex among adolescent and emerging adult sexual minority men. Addict Behav 2021; 122:107018. [PMID: 34171584 DOI: 10.1016/j.addbeh.2021.107018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
The association between "illicit drugs" (e.g., cocaine/crack, methamphetamine, gamma-hydroxybutyrate-GHB, ketamine, and ecstasy) and condomless anal sex (CAS) with casual partners is well established for sexual minority men (SMM). Recent evidence from adult SMM has indicated that marijuana is associated with the occurrence of CAS with casual partners above and beyond illicit drug use. The purpose of the current study was to evaluate associations between CAS and the use of marijuana and illicit drugs in a sample of young SMM (aged 15-24). Participants (n = 578) completed an online survey assessing demographics, current PrEP prescription, age, marijuana use, as well as drug use and sexual behavior in the past 90 days. A hurdle model simultaneously predicted the occurrence of CAS as well as the frequency of CAS among those reporting it. Illicit drug use was associated with both the occurrence (OR = 2.26; p = .01) and frequency of CAS (RR = 1.63; p = .02). In contrast, marijuana use was associated with the occurrence (OR = 1.69; p = .01), but not the frequency of CAS (RR = 1.07; p = .74). Findings mirror recent observations in large samples of adult SMM. While the effect size of marijuana is more modest than illicit drug use, marijuana does have significant and unique associations with the occurrence of CAS. HIV prevention services for young SMM may therefore benefit from assessing and addressing marijuana use in the context of HIV sexual behavior.
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Affiliation(s)
- Demetria Cain
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Steven Samrock
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - S Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Ruben H Jimenez
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Rafael Dilones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA.
| | - Mary Tanney
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Angulique Outlaw
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 60 West Hancock, Detroit, MI 48201 USA.
| | - Lawrence Friedman
- Department of Pediatrics, University of Miami, 1580 Northwest 10th Avenue, Miami, FL 33136, USA.
| | - Sylvie Naar
- Center for Translational Behavioral Science, 12236 Florida State University (FSU) College of Medicine, Tallahassee, FL, USA.
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 142 W. 36th Street, New York, NY 10018, USA; Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, 695 Park Avenue, New York, NY 10065, USA.
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Jones TM, Eisenberg N, Kosterman R, Lee JO, Bailey JA, Haggerty KP. Parents' Perceptions of Adolescent Exposure to Marijuana Following Legalization in Washington State. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2020; 11:21-38. [PMID: 33841719 PMCID: PMC8034260 DOI: 10.1086/707642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Parents in Washington State face new challenges related to the non-medical marijuana legislation that was passed in 2012. We asked parent focus group participants about changes they have observed in their environment, how their children are exposed to marijuana, and how this exposure might affect youth marijuana use. METHOD We conducted 6 focus groups with parents of youth ages 8 to 15 (N = 54). Parents were recruited from the Seattle Social Development Project, a multi-ethnic, longitudinal panel study that originated in Seattle in 1985. Thematic content analysis was used to analyze qualitative data. RESULTS Parents agreed that they did not want their children using marijuana, and were concerned that their children were exposed to marijuana more often and in many different contexts. Parents said they now need to monitor their children's environment more carefully, especially the other adults that spend time around their children. Edible marijuana products were particularly concerning for parents, as they offer a new set of challenges for parents in monitoring their children's exposure to and use of marijuana. Parents were concerned that marijuana exposure would increase risk of marijuana use in adolescents. CONCLUSIONS Parents' experiences in Washington State provide valuable lessons for social work practitioners, policymakers and those developing preventive interventions. Prevention efforts and public health messaging should begin before legalization takes effect to support parents in preparing for changes in their social and physical environments, and should seek to incorporate parenting strategies to monitor and intervene when children are exposed to marijuana.
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Abstract
PURPOSE OF REVIEW To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population. RECENT FINDINGS There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge. SUMMARY An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.
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Defoe IN, Khurana A, Betancourt LM, Hurt H, Romer D. Disentangling longitudinal relations between youth cannabis use, peer cannabis use, and conduct problems: developmental cascading links to cannabis use disorder. Addiction 2019; 114:485-493. [PMID: 30457181 PMCID: PMC6519359 DOI: 10.1111/add.14456] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/07/2018] [Accepted: 09/24/2018] [Indexed: 01/31/2023]
Abstract
AIMS To determine whether cannabis use during adolescence can increase risk not only for cannabis use disorder (CUD) but also for conduct problems, potentially mediated by exposure to peers who use cannabis. DESIGN, SETTING, PARTICIPANTS Longitudinal study analyzing four waves of longitudinal data from 364 racially and socio-economically diverse, urban, US community youth (at baseline: Mage = 13.51 (0.95); 49.1% female). MEASUREMENTS Self-reports of cannabis use, conduct problems, proportion of peers using cannabis and CUD criteria at the final wave were analyzed using a method sensitive to changes over development, the random-intercept cross-lagged panel model. FINDINGS Change in cannabis use did not predict changes in conduct problems or peer cannabis use over time, controlling for gender, race-ethnicity and socio-economic status. Instead, increases in conduct problems predicted increases in cannabis use and ultimately CUD, with some of the effect mediated by increases in the prevalence of peer cannabis use [β = 0.12, 95% confidence interval (CI) = 0.07, 0.20]. Additionally, affiliation with peers who used cannabis predicted subsequent CUD via increased personal cannabis use (β = 0.08, 95% CI = 0.04, 0.14). Significant within-person betas for the cross-lagged effects ranged between 0.20 and 0.27. CONCLUSIONS Cannabis use in adolescence does not appear to lead to greater conduct problems or association with cannabis-using peers apart from pre-existing conduct problems. Instead, adolescents who (1) increasingly affiliate with cannabis-using peers or (2) have increasing levels of conduct problems are more likely to use cannabis, and this cascading chain of events appears to predict cannabis use disorder in emerging adulthood.
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Affiliation(s)
- Ivy N. Defoe
- Annenberg Public Policy CenterThe University of PennsylvaniaPhiladelphiaPAUSA
- Psychology of Conflict, Risk and Safety, University of TwenteEnschedethe Netherlands
| | | | - Laura M. Betancourt
- The Children's Hospital of PhiladelphiaDivision of NeonatologyPhiladelphiaPAUSA
| | - Hallam Hurt
- The Children's Hospital of PhiladelphiaDivision of NeonatologyPhiladelphiaPAUSA
| | - Daniel Romer
- Annenberg Public Policy CenterThe University of PennsylvaniaPhiladelphiaPAUSA
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Silliman Cohen R, Barron CE, Goldberg A. Altered Mental Status in a Young Child: A Case of Child Neglect. Clin Pediatr (Phila) 2019; 58:123-125. [PMID: 30296842 DOI: 10.1177/0009922818805225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rachel Silliman Cohen
- 1 Hasbro Children's Hospital, Providence, RI, USA.,2 Brown University, Providence, RI, USA
| | - Christine E Barron
- 1 Hasbro Children's Hospital, Providence, RI, USA.,2 Brown University, Providence, RI, USA
| | - Amy Goldberg
- 1 Hasbro Children's Hospital, Providence, RI, USA.,2 Brown University, Providence, RI, USA
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Ananth P, Reed-Weston A, Wolfe J. Medical marijuana in pediatric oncology: A review of the evidence and implications for practice. Pediatr Blood Cancer 2018; 65. [PMID: 28926679 DOI: 10.1002/pbc.26826] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022]
Abstract
Medical marijuana (MM) has become increasingly legal at the state level and accessible to children with serious illness. Pediatric patients with cancer may be particularly receptive to MM, given purported benefits in managing cancer-related symptoms. In this review, we examine the evidence for MM as a supportive care agent in pediatric oncology. We describe the current legal status of MM, mechanism of action, common formulations, and potential benefits versus risks for pediatric oncology patients. We offer suggestions for how providers might approach MM requests. Throughout, we comment on avenues for future investigation on this growing trend in supportive care.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Anne Reed-Weston
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Joanne Wolfe
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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Ananth P, Ma C, Al-Sayegh H, Kroon L, Klein V, Wharton C, Hallez E, Braun I, Michelson K, Rosenberg AR, London W, Wolfe J. Provider Perspectives on Use of Medical Marijuana in Children With Cancer. Pediatrics 2018; 141:peds.2017-0559. [PMID: 29233937 PMCID: PMC5744275 DOI: 10.1542/peds.2017-0559] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although medical marijuana (MM) may have utility in the supportive care of children with serious illness, it remains controversial. We investigated interdisciplinary provider perspectives on legal MM use in children with cancer. METHODS We sent a 32-item, cross-sectional survey to 654 pediatric oncology providers in Illinois, Massachusetts, and Washington characterizing MM practices, knowledge, attitudes, and barriers. Forty-eight percent responded; 44% (n = 288) were included in analyses. Providers were stratified by status as legally eligible to certify (ETC) for MM. We used Fisher's exact and Wilcoxon rank tests and univariate and multivariate logistic regression models for group comparisons. RESULTS The provider median age was 35 years (range 22-70 years); 33% were ETC (83 physicians; 13 Washington state advance practice providers). Thirty percent of providers received ≥1 request for MM in the previous month. Notably, only 5% of all providers knew state-specific regulations. ETC providers were more likely to know that MM is against federal laws (P < .0001). Whereas most providers (92%) reported willingness to help children with cancer access MM, in adjusted models, ETC providers were less likely to indicate approval of patient MM use by smoking, oral formulations, as cancer-directed therapy, or to manage symptoms (P < .005 for all). Forty-six percent of all providers cited the absence of standards around formulations, potency, or dosing to be the greatest barrier to recommending MM. CONCLUSIONS Most pediatric oncology providers are willing to consider MM use in children with cancer and receive frequent inquiries. However, ETC providers endorse less favorable attitudes overall. The absence of standards is an important barrier to recommending MM.
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Affiliation(s)
- Prasanna Ananth
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut;
| | - Clement Ma
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - Hasan Al-Sayegh
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Leah Kroon
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington;,Treuman Katz Center for Pediatric Bioethics, Seattle, Washington
| | - Victoria Klein
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington
| | - Claire Wharton
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington
| | - Elise Hallez
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ilana Braun
- Harvard Medical School, Boston, Massachusetts;,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kelly Michelson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois;,Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Abby R. Rosenberg
- Seattle Children's Cancer and Blood Disorders Center, Seattle, Washington;,Treuman Katz Center for Pediatric Bioethics, Seattle, Washington;,University of Washington School of Medicine, Seattle, Washington
| | - Wendy London
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts;,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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8
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Burdzovic Andreas J, Bretteville-Jensen AL. Ready, willing, and able: the role of cannabis use opportunities in understanding adolescent cannabis use. Addiction 2017; 112:1973-1982. [PMID: 28600881 DOI: 10.1111/add.13901] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/19/2016] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
Abstract
AIMS To examine adolescent cannabis use-both at national and individual levels-by deconstructing it into its necessary conditions of realistic use opportunities and willingness to use the drug given such opportunities. DESIGN Nationally representative, repeated cross-sectional survey. SETTING Norway. PARTICIPANTS A total of 8818 16-year-olds who participated in the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2007, 2011, and 2015. MEASUREMENTS Adolescent reports concerning their life-time 'cannabis use' and 'possibilities to use cannabis' were used to assess: (a) overall cannabis use, (b) exposure to realistic cannabis use opportunities, and (c) cannabis use among those exposed to use opportunities. Logistic regression models were used to estimate national trends since 2007 in these indicators, and to identify individual-level factors associated with cannabis use versus non-use among youth exposed to concrete use opportunities. FINDINGS Prevalence of life-time cannabis use remained stably low, averaging 6.4% across the three surveys. Life-time exposure to cannabis use opportunities decreased [odds ratio (OR)ESPAD assessment = 0.90, 95% confidence interval (CI) = 0.84-0.97, P = 0.006], yet cannabis use among adolescents with such opportunities increased significantly (ORESPAD assessment = 1.17, 95% CI = 1.03-1.34, P = 0.02) since 2007. After controlling for a range of other risk factors, abstinence from alcohol intoxication and cigarette use, as well as the perceptions of even minimal cannabis use as risky remained the factors most robustly associated with lower likelihood of cannabis use among youth with realistic use opportunities. CONCLUSIONS Approaches accounting for realistic use opportunities proved critical in our understanding of underage cannabis use, both at the national and individual level, and may be informative for development of prevention strategies in the era of cannabis liberalization. In addition, delineation of realistic opportunities from behaviours conditioned upon such opportunities is generalizable to a range of public health issues.
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Schinke S, Schwinn T, Hopkins J, Gorroochurn P, Wahlstrom L. Is the Legalization of Marijuana Associated With Its Use by Adolescents? Subst Use Misuse 2017; 52:256-258. [PMID: 27754733 PMCID: PMC5159284 DOI: 10.1080/10826084.2016.1223139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Growing moves in the U.S. toward relaxed laws surrounding adult use of marijuana raise concerns about concurrent increases in adolescent use of marijuana. OBJECTIVES This study collected and analyzed primary data on the relationship between marijuana legalization status in U.S. states and adolescents' marijuana use. METHODS Recruited through social networking sites and youth-services community agencies, a sample of 1,310 adolescents from 48 U.S. states and the District of Columbia reported their use of marijuana. Youths' use rates were compared with the marijuana legalization status of youths' states of residence. RESULTS Study findings failed to show a relationship between adolescents' use of marijuana and state laws regarding marijuana use. Relationships were found for increased marijuana use by older youths, females, and non-Hispanic youths. Youths whose parents completed 2 or more years of college were less likely to report marijuana use than those whose parents completed fewer than 2 years of college. CONCLUSIONS Albeit study findings do not support predictions of growing marijuana use by adolescents in states with liberalized adult use laws, further monitoring of adolescents' use with larger and more representative samples is needed.
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Affiliation(s)
- Steven Schinke
- a School of Social Work, Columbia University , New York , New York , USA
| | - Traci Schwinn
- a School of Social Work, Columbia University , New York , New York , USA
| | - Jessica Hopkins
- a School of Social Work, Columbia University , New York , New York , USA
| | - Prakash Gorroochurn
- b Mailman School of Public Health, Columbia University , New York , New York , USA
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10
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Zhang X, Wu LT. Marijuana use and sex with multiple partners among lesbian, gay and bisexual youth: results from a national sample. BMC Public Health 2017; 17:19. [PMID: 28056883 PMCID: PMC5217629 DOI: 10.1186/s12889-016-3905-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Sex with multiple partners (SMP) is one of the important contributing factors for contracting sexually transmitted infections (STIs) among adolescents and young adults, especially among Lesbian, Gay, and Bisexual (LGB) youth. Past studies mainly focus on examining associations of alcohol or club drugs use with unprotected sexual behaviors among adult homo/bisexual men, while little is known about the temporal association between marijuana use (MU) and SMP among LGB youth. Methods This study examined the relationship between MU and SMP among LGB adolescents and young adults. Generalized estimating equations (GEE) logistic regression analyses were utilized to analyze four waves’ public-use Add Health data (N = 694, youth who reported a homo/bisexual status at any wave; Wave 1: aged 11–21; Wave 4: aged 24–32). Results After adjusting for other substance use, current depression, mother-child relationship quality at Wave 1, and socioeconomic variables, past-year MU was both concurrently and prospectively associated with past-year SMP. The moderating effect of age was not found. Conclusion MU is concurrently and prospectively associated with increased odds of SMP in the adolescent sample and in the young adult sample. Findings imply that prevention/intervention on HIV risk behaviors may benefit from MU reduction not only in LGB adolescents but also in young adults.
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Affiliation(s)
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, BOX 3903, Durham, NC, 27710, USA. .,Department of Medicines, School of Medicine, Duke University, Durham, NC, USA. .,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Chapman SA, Spetz J, Lin J, Chan K, Schmidt LA. Capturing Heterogeneity in Medical Marijuana Policies: A Taxonomy of Regulatory Regimes Across the United States. Subst Use Misuse 2016; 51:1174-84. [PMID: 27191472 PMCID: PMC4979574 DOI: 10.3109/10826084.2016.1160932] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is considerable movement in the U.S. to legalize use of cannabis for medicinal purposes. Twenty-three U.S. states and the District of Columbia have laws that decriminalize use of marijuana for medicinal purposes. Most prior studies of state medical marijuana laws and their association with overall marijuana use, adolescent use, crime rates, and alcohol traffic fatalities have used a binary coding of whether the state had a medical marijuana law or not. Mixed results from these studies raise the question of whether this method for measuring policy characteristics is adequate. OBJECTIVES Our objective was to develop a validated taxonomy of medical marijuana laws that will allow researchers to measure variation in aspects of medical marijuana statutes as well as their overall restrictiveness. METHODS/RESULTS We used a modified Delphi technique using detailed and validated data about each state's medical marijuana law. Three senior researchers coded elements of the state laws in initiation of use, quantity allowed, regulations around distribution, and overall restrictiveness. We used 2013 data from the U.S. National Survey on Drug Use and Health to assess validity of the taxonomy. Results indicate substantial state-level variation in medical marijuana policies. Validation analysis supported the taxonomy's validity for all four dimensions with the largest effect sizes for the quantity allowed in the state's medical marijuana policy. CONCLUSIONS/IMPORTANCE This analysis demonstrates the potential importance of nondichotomous measurement of medical marijuana laws in studies of their impact. These findings may also be useful to states that are considering medical marijuana laws, to understand the potential impact of characteristics of those laws.
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Affiliation(s)
- Susan A Chapman
- a Department of Social and Behavioral Sciences , University of California , San Francisco , California , USA
| | - Joanne Spetz
- b Philip R. Lee Institute for Health Policy Studies , University of California , San Francisco , California , USA
| | - Jessica Lin
- c School of Public Health , University of Michigan , Ann Arbor , Michigan , USA
| | - Krista Chan
- b Philip R. Lee Institute for Health Policy Studies , University of California , San Francisco , California , USA
| | - Laura A Schmidt
- b Philip R. Lee Institute for Health Policy Studies , University of California , San Francisco , California , USA
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Abstract
Drug testing, when carefully collected and thoughtfully interpreted, offers a critical adjunct to clinical care and substance use treatment. However, because test results can be misleading if not interpreted in the correct clinical context, clinicians should always conduct a careful interview with adolescent patients to understand what testing is likely to show and then use testing to validate or refute their expectations. Because of the ease with which samples can be tampered, providers should also carefully reflect on their own collection protocols and sample validation procedures to ensure optimal accuracy."
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Affiliation(s)
- Scott E. Hadland
- Boston Children’s Hospital, Division of Adolescent / Young Adult Medicine, Boston Children’s Hospital, Division of Developmental Medicine, Department of Medicine, 300 Longwood Avenue, Boston, MA, USA, 02115,Harvard Medical School, Department of Pediatrics, 25 Shattuck St., Boston, MA, USA, 02115
| | - Sharon Levy
- Department of Medicine, 300 Longwood Avenue, Boston, MA, USA, 02115,Harvard Medical School, Department of Pediatrics, 25 Shattuck St., Boston, MA, USA, 02115
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13
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Wu LT, Swartz MS, Brady KT, Hoyle RH. Perceived cannabis use norms and cannabis use among adolescents in the United States. J Psychiatr Res 2015; 64:79-87. [PMID: 25795093 PMCID: PMC4404217 DOI: 10.1016/j.jpsychires.2015.02.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/10/2015] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
Abstract
Due to changes in cannabis policies, concerns about cannabis use (CU) in adolescents have increased. The population of nonwhite groups is growing quickly in the United States. We examined perceived CU norms and their association with CU and CU disorder (CUD) for White, Black, Hispanic, Native-American, Asian-American, Native Hawaiian/Pacific Islander (NH/PI), and mixed-race adolescents. Data were from adolescents (12-17 years) in the 2004-2012 National Surveys on Drug Use and Health (N = 163,837). Substance use and CUD were assessed by computer-assisted, self-interviewing methods. Blacks, Hispanics, Native-Americans, and mixed-race adolescents had greater odds of past-year CU and CUD than Whites. Among past-year cannabis users (CUs), Hispanics and Native-Americans had greater odds of having a CUD than Whites. Asian-Americans had the highest prevalence of perceived parental or close friends' CU disapproval. Native-Americans and mixed-race adolescents had lower odds than Whites of perceiving CU disapproval from parents or close friends. In adjusted analyses, adolescent's disapproval of CU, as well as perceived disapproval by parents or close friends, were associated with a decreased odds of CU in each racial/ethnic group, except for NHs/PIs. Adolescent's disapproval of CU was associated with a decreased odds of CUD among CUs for Whites (personal, parental, and close friends' disapproval), Hispanics (personal, parental, and close friends' disapproval), and mixed-race adolescents (personal, close friends' disapproval). Racial/ethnic differences in adolescent CU prevalence were somewhat consistent with adolescents' reports of CU norm patterns. Longitudinal research on CU health effects should oversample nonwhite adolescents to assure an adequate sample for analysis and reporting.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kathleen T. Brady
- South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Rick H. Hoyle
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
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Abstract
Marijuana policy is rapidly evolving in the United States and elsewhere, with cannabis sales fully legalized and regulated in some jurisdictions and use of the drug for medicinal purposes permitted in many others. Amidst this political change, patients and families are increasingly asking whether cannabis and its derivatives may have therapeutic utility for a number of conditions, including developmental and behavioral disorders in children and adolescents. This review examines the epidemiology of cannabis use among children and adolescents, including those with developmental and behavioral diagnoses. It then outlines the increasingly well-recognized neurocognitive changes shown to occur in adolescents who use cannabis regularly, highlighting the unique susceptibility of the developing adolescent brain and describing the role of the endocannabinoid system in normal neurodevelopment. The review then discusses some of the proposed uses of cannabis in developmental and behavioral conditions, including attention-deficit hyperactivity disorder and autism spectrum disorder. Throughout, the review outlines gaps in current knowledge and highlights directions for future research, especially in light of a dearth of studies specifically examining neurocognitive and psychiatric outcomes among children and adolescents with developmental and behavioral concerns exposed to cannabis.
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Abstract
PURPOSE OF REVIEW Despite widespread marijuana use among adolescents, accurate information on known health effects is poorly disseminated to clinicians and their patients. Amidst rapidly evolving drug policy in the United States and elsewhere, it is imperative that providers understand the short-term and long-term consequences of marijuana use. RECENT FINDINGS Research on regular marijuana use highlights a unique susceptibility of the developing adolescent brain to adverse neurocognitive and psychiatric outcomes. Although studies have not firmly established causality, onset of regular marijuana use in adolescence is associated with later decline in cognitive function, as well as with adult onset of psychosis and anxiety. Educational and employment outcomes may be poorer among regular marijuana-using adolescents. A number of other adverse respiratory, cardiovascular, endocrine and gastrointestinal associations with regular marijuana use have also been established. Good screening tools and promising brief intervention and behavioral treatment programs are available to clinicians, who are in a position to identify problematic marijuana use among adolescents. SUMMARY A common misperception among youth is that marijuana use is without harm. However, adolescent marijuana use may have measurable, durable, and potentially irreversible effects on later cognitive function and mental health.
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Wu LT, Brady KT, Mannelli P, Killeen TK. Cannabis use disorders are comparatively prevalent among nonwhite racial/ethnic groups and adolescents: a national study. J Psychiatr Res 2014; 50:26-35. [PMID: 24342767 PMCID: PMC3941308 DOI: 10.1016/j.jpsychires.2013.11.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/23/2013] [Accepted: 11/20/2013] [Indexed: 11/20/2022]
Abstract
The racial/ethnic composition of the US population is shifting, with the nonwhite population growing faster than whites. We examined cannabis use disorder (CUD) prevalences and correlates in seven racial/ethnic groups. We included cannabis use (CU) prevalence as a comparison. Data were from the 2005-2011 National Surveys on Drug Use and Health (N = 394,400). Substance use among respondents aged ≥12 years was assessed by computer-assisted, self-interviewing methods. The following were included as control variables: age, sex, family income, government assistance, county type, residential stability, major depressive episode history, arrest history, nicotine dependence, alcohol disorder, and survey year. Past-year CU prevalence increased significantly from 10.45% in 2005 to 11.41-11.54% during 2009-2011. Compared with whites, mixed-race individuals had higher odds of CU; Asian Americans and Hispanics had lower odds of CU. There were no significant yearly changes in CUD prevalence in the sample during 2005-2011 (1.58-1.73%). Compared with whites, individuals who were mixed-race, black, and Native American had higher odds of CUD; Asian Americans had lower odds. In aggregate, 15.35% of past-year cannabis users met criteria for a CUD in the 12-month period. Past-year cannabis users who were black, Native American, Hispanic, or Asian American had higher odds of CUD than white users. In each racial/ethnic group, adolescent cannabis users generally showed greater odds of CUD than adult users. Behavioral health indicators (major depressive episode, arrest history, nicotine dependence, alcohol disorder) were associated with CU and CUD. In conclusion, CUD disproportionally affects nonwhite groups and youth.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Kathleen T Brady
- South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, Charleston, SC, USA
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