1
|
Harrison ME, Kanbur N, Canton K, Desai TS, Lim-Reinders S, Groulx C, Norris ML. Adolescents' Cannabis Knowledge and Risk Perception: A Systematic Review. J Adolesc Health 2024; 74:402-440. [PMID: 37966406 DOI: 10.1016/j.jadohealth.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/31/2023] [Accepted: 09/08/2023] [Indexed: 11/16/2023]
Abstract
To systematically review evidence evaluating cannabis-related knowledge and perception of risk in children and adolescents. We systematically searched Medline, PsycINFO, and EMBASE using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. 133 studies from around the world (including ages 10-18 yrs) met inclusion criteria, with 70% meeting grade 2C quality. Increased knowledge and perception of risk of cannabis frequently correlated with lower levels of current use and intent to use. Studies examining correlations over time generally demonstrated increased adolescent cannabis use and decreased perception of risk. Included prevention-based interventions often enhanced knowledge and/or perception of risk in adolescents exposed to the intervention. Studies exploring outcomes relating to legislative changes for recreational marijuana use demonstrated considerable heterogeneity regarding knowledge and perception of risk whereas studies that focused on medicinal marijuana legislative changes overwhelmingly demonstrated a decrease in perception of risk post legalization. Increased knowledge and perception of risk of cannabis in adolescents often correlate with lower levels of current use and intention to use in the future. Further study and implementation of public health and clinically-oriented strategies that seek to increase knowledge among youth about the potential health harms of cannabis use should continue and be prioritized.
Collapse
Affiliation(s)
- Megan E Harrison
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Adolescent Health, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada.
| | - Nuray Kanbur
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Adolescent Health, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada
| | - Kyle Canton
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Tejas S Desai
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Chase Groulx
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Mark L Norris
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Adolescent Health, CHEO, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
al'Absi M, DeAngelis BN, Nakajima M, Hodges JS, Budney A, Hatsukami D, Allen S. Biobehavioral and affective stress responses during nicotine withdrawal: Influence of regular cannabis co-use. Psychopharmacology (Berl) 2024; 241:253-262. [PMID: 37897498 DOI: 10.1007/s00213-023-06481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Co-use of cannabis is increasing in nicotine users and presents additional challenges in addressing nicotine dependence. This study examined the links between regular co-use of cannabis and nicotine with biobehavioral and affective changes in response to stress during nicotine withdrawal and ad libitum use. METHODS Participants (N = 79) who regularly used nicotine-only, cannabis-only, both substances, or neither substance were invited to attend two laboratory stress assessment sessions. For nicotine users, one session occurred during ad libitum nicotine use and one occurred after abstinence from nicotine. During the stress sessions, participants provided saliva samples for cortisol assay and completed measures of subjective states. Cardiovascular measures were collected during resting baseline, exposure to acute stressors, and a recovery rest period. RESULTS Nicotine-only users had higher average cortisol levels in the second lab session (nicotine withdrawal) relative to the first lab session (ad libitum nicotine use). Compared to nicotine non-users, nicotine users reported less positive affect and exhibited attenuated cortisol and systolic blood pressure (BP) stress responses. Cannabis users exhibited exaggerated diastolic BP responses to stress compared to cannabis non-users, and co-users of nicotine and cannabis had higher levels of cannabis craving than cannabis-only users (p < .01). CONCLUSIONS This study partially replicated earlier findings on the effects of chronic nicotine use and provided novel results regarding the influence of cannabis co-use on physiological and affective responses to stress in nicotine users during nicotine withdrawal.
Collapse
Affiliation(s)
- Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN, 55812, USA.
| | - Briana N DeAngelis
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN, 55812, USA
| | - Motohiro Nakajima
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN, 55812, USA
- Eikei University of Hiroshima, Hiroshima, Japan
| | - James S Hodges
- School of Public Health, University of Minnesota, Twin Cities. Minneapolis, MN, USA
| | | | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Twin Cities. Minneapolis, MN, USA
| | - Sharon Allen
- Department of Family Medicine and Community Health, University of Minnesota, Twin Cities. Minneapolis, MN, USA
| |
Collapse
|
3
|
Khoj L, Zagà V, Amram DL, Hosein K, Pistone G, Bisconti M, Serafini A, Cammarata LM, Cattaruzza MS, Mura M. Effects of cannabis smoking on the respiratory system: A state-of-the-art review. Respir Med 2024; 221:107494. [PMID: 38056532 DOI: 10.1016/j.rmed.2023.107494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
The diminished perception of the health risks associated with the consumption of cannabis (marijuana) lead to a progressive increase in its inhalational use in many countries. Cannabis can be smoked through the use of joints, spliffs and blunts, and it can be vaporised with the use of hookah or e-cigarettes. Delta-9 tetrahydrocannabinol (THC) is the main psychoactive component of cannabis smoke but contains numerous other substances. While the recreational use of cannabis smoking has been legalised in several countries, its health consequences have been underestimated and undervalued. The purpose of this review is to critically review the impact of cannabis smoke on the respiratory system. Cannabis smoke irritates the bronchial tree and is strongly associated with symptoms of chronic bronchitis, with histological signs of airway inflammation and remodelling. Altered fungicidal and antibacterial activity of alveolar macrophages, with greater susceptibility to respiratory infections, is also reported. The association with invasive pulmonary aspergillosis in immunocompromised subjects is particularly concerning. Although cannabis has been shown to produce a rapid bronchodilator effect, its chronic use is associated with poor control of asthma by numerous studies. Cannabis smoking also represents a risk factor for the development of bullous lung disease, spontaneous pneumothorax and hypersensitivity pneumonitis. On the other hand, no association with the development of chronic obstructive pulmonary disease was found. Finally, a growing number of studies report an independent association of cannabis smoking with the development of lung cancer. In conclusion, unequivocal evidence established that cannabis smoking is harmful to the respiratory system. Cannabis smoking has a wide range of negative effects on respiratory symptoms in both healthy subjects and patients with chronic lung disease. Given that the most common and cheapest way of assumption of cannabis is by smoking, healthcare providers should be prepared to provide counselling on cannabis smoking cessation and inform the public and decision-makers.
Collapse
Affiliation(s)
- Lugain Khoj
- Division of Respirology, Western University, London, ON, Canada; Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | | | - Daniel L Amram
- Ambulatorio per la Cessazione del Fumo di Tabacco, ASL Toscana Nord Ovest, Pontedera, Italy
| | - Karishma Hosein
- Division of Respirology, Western University, London, ON, Canada
| | - Giovanni Pistone
- Centro per il Trattamento del Tabagismo, Local Health Unit, Novara, Italy
| | - Mario Bisconti
- U.O.C. Pneumologia - Ospedale "Vito Fazzi", Lecce, Italy
| | | | | | - Maria Sofia Cattaruzza
- Italian Society of Tobaccology, Bologna, Italy; Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Rome, Italy
| | - Marco Mura
- Division of Respirology, Western University, London, ON, Canada
| |
Collapse
|
4
|
Kreslake JM, Mills S, Liu M, Diaz MC, Kostygina G, Emery S, Hair EC. Youth and Young Adult Blunt Use Predicts Progression to Other Nicotine Product Use in the United States. Subst Use Misuse 2023; 59:263-268. [PMID: 37881835 PMCID: PMC10766086 DOI: 10.1080/10826084.2023.2269561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Little cigars or cigarillos (LCCs) are frequently modified to smoke cannabis ("blunts") by youth and young adults. This study investigated whether young blunt users who are otherwise nicotine-naïve are more likely to initiate other tobacco products compared to never blunt users. METHODS AND MATERIALS Data were from four waves of the Truth Longitudinal Cohort (TLC), a national probability-based sample of youth and young adults (aged 15-24 years) in the United States (Wave 1: January-April 2017; Wave 2: February-May 2018; Wave 3: February-May 2019; Wave 4: September-December 2019). The sample was restricted to nicotine naïve respondents at Wave 1 with possible ever use of blunts (N = 5,284). Logistic regression analyses tested whether ever blunt use at Wave 1 predicted initiation of nicotine products by Wave 4, controlling for established risk factors. RESULTS Compared to never-blunt users, ever users of blunts at Wave 1 had significantly higher odds of ever using cigars (OR: 4.74; 95% CI: 1.80-12.47; p = 0.002), e-cigarettes (OR: 4.66; 95% CI: 2.42-8.95; p < 0.001), cigarettes (OR: 3.02; 95% CI: 1.17-7.84, p = 0.023), or hookah (OR: 3.47; 95% CI: 1.07-11.29, p = 0.039) by Wave 4. Cannabis (never blunt) use by Wave 1 predicted ever use of e-cigarettes (OR: 3.45, 95% CI: 2.38-5.02, p < 0.001), cigarettes (OR: 3.81; 95% CI: 2.26-6.43, p < 0.001), or hookah (OR: 2.13; 95% CI: 1.12-4.05, p = 0.021) by Wave 4. DISCUSSION Blunts are a point of nicotine initiation that places users at increased risk of progression to cigars, while the same relationship was not found for cannabis alone.
Collapse
Affiliation(s)
| | - Sarah Mills
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Michael Liu
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Sherry Emery
- NORC at the University of Chicago, Chicago, Illinois, USA
| | | |
Collapse
|
5
|
Mousavi SE, Tondro Anamag F, Sanaie S. Association between cannabis use and risk of diabetes mellitus type 2: A systematic review and meta-analysis. Phytother Res 2023; 37:5092-5108. [PMID: 37526051 DOI: 10.1002/ptr.7973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/19/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Cannabis consumption exerts multiple effects on metabolism via various pathways, including glucose regulation and insulin secretion. Studies concerning the association between cannabis use and diabetes mellitus type 2 are discrepant. OBJECTIVE This study was conducted to evaluate the association between cannabis use and type 2 diabetes mellitus (T2DM). SEARCH METHODS We searched PubMed, Scopus, Embase, Proquest, Web of Science, and Cochrane Library with no time, language or study types restriction until July 1, 2022, using various forms of "cannabis" and "diabetes mellitus" search terms. SELECTION CRITERIA Randomized control trials, cohort, and case-control studies investigating the relationship between cannabis consumption and diabetes mellitus type 2 were included. DATA COLLECTION AND ANALYSIS The Newcastle-Ottawa scale was used to assess the quality of studies. We pooled odds ratio (OR) with 95% confidence interval (CI) using the random-effects model, generic inverse variance method, DerSimonian and Laird approach. MAIN RESULTS A meta-analysis of seven studies, containing 11 surveys and 4 cohorts, revealed that the odds of developing T2DM in individuals exposed to cannabis was 0.48 times (95% CI: 0.39 to 0.59) lower than in those without cannabis exposure. CONCLUSIONS A protective effect of cannabis consumption on the odds of diabetes mellitus type 2 development has been suggested. Yet given the considerable interstudy heterogeneity, the upward trend of cannabis consumption and cannabis legalization is recommended to conduct studies with higher levels of evidence.
Collapse
Affiliation(s)
- Seyed Ehsan Mousavi
- Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Tondro Anamag
- Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
6
|
Colonna R, Knott M, Kim S, Bagajati R. Qualitative Research on Cannabis Use Among Youth: A Methodological Review. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221139420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recreational cannabis legalization has encouraged research regarding cannabis use among youth, especially the use of qualitative approaches. In fact, alcohol and drug use journals have recently encouraged qualitative submissions and provided criteria to ensure “high-quality” research. This study provides an objective account of the qualitative approaches used by researchers in this field and discusses implications for future research. A methodological review was conducted for studies published between January 2010 and November 2019. Targeted keyword searches in four research databases returned 1956 unique records. Pairs of reviewers independently screened records against eligibility criteria and charted data for study philosophical positioning, methodology, study aims, sampling, sample, data collection, and data analysis. 23 studies met the inclusion criteria. Several gaps in study quality criteria are observed: less than half of the studies specified the overarching methodology and just two stated philosophical positioning, with some methods unjustified. Implications for future research are discussed.
Collapse
Affiliation(s)
- Robert Colonna
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Melissa Knott
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Sean Kim
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Reem Bagajati
- School of Occupational Therapy, Western University, London, ON, Canada
| |
Collapse
|
7
|
Weinberger AH, Wyka K, Goodwin RD. Impact of cannabis legalization in the United States on trends in cannabis use and daily cannabis use among individuals who smoke cigarettes. Drug Alcohol Depend 2022; 238:109563. [PMID: 35870333 DOI: 10.1016/j.drugalcdep.2022.109563] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cannabis legalization and increases in cannabis use are occurring rapidly in the United States (US). Cannabis and tobacco are often used together, but it is unclear whether cannabis legalization will differentially affect cannabis use among those using cigarettes. This study estimated changes from 2004 to 2017 in the prevalence of cannabis use and daily cannabis use by cigarette use status and examined whether state-level cannabis policy modified these trends. METHODS Public and restricted-use data from the 2004-2017 National Survey on Drug Use and Health were analyzed. Weighted logistic regressions were used to examine time trends in past-30-day cannabis use and daily caunabis use by cigarette use and cannabis law status from 2004 to 2017. RESULTS Cannabis use and daily use increased significantly among those with and without cigarette smoking. Cannabis use and daily cannabis use were consistently 2-10x more common throughout this time among those with, versus without, cigarette smoking. In 2017, cannabis use and daily cannabis use were substantially more common among individuals who use cigarettes, and even greater among those who live in states where cannabis was legal for medical or recreational (i.e., non-medical) use. CONCLUSIONS Cannabis use and daily cannabis use are increasing among US individuals who both smoke and do not smoke cigarettes. Cannabis and daily cannabis use are more common among those who smoke cigarettes and elevated even further among those residing in states that have legalized cannabis for recreational (i.e., non-medical) use. Tobacco control efforts should be adjusted to address increases in cannabis use among Americans who smoke cigarettes.
Collapse
Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology & Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| |
Collapse
|
8
|
Factors that Impact the Pharmacokinetic and Pharmacodynamic Effects of Cannabis: a Review of Human Laboratory Studies. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00429-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Dugas EN, Wellman RJ, Sylvestre MP, Bélanger RE, O'Loughlin J. Who mixes tobacco with cannabis and does mixing relate to nicotine dependence? Addict Behav 2022; 128:107254. [PMID: 35085951 DOI: 10.1016/j.addbeh.2022.107254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/21/2021] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cannabis users who mix tobacco with cannabis are exposed to nicotine in the tobacco. We identified characteristics of young adult cannabis users who mix and investigated whether mixing frequency is associated with nicotine dependence (ND). METHODS Data were collected in self-report questionnaires in 2017-20 from 788 young adults (44% male; mean (SD) age 30.6 (1.0) years) participating in a longitudinal investigation of the natural course of ND. Using multivariable logistic regression, we assessed whether any of 16 sociodemographic, lifestyle, psychosocial or other characteristics were associated with mixing among 313 past-year cannabis users. We also assessed whether mixing frequency was associated with ND among 289 past-year cannabis users who had ever smoked cigarettes controlling for age, sex, and other sources of nicotine (i.e., number of cigarettes smoked, other tobacco products, second-hand smoke exposure). RESULTS Of 788 participants, 40 % (n = 313) reported past-year cannabis use. Of these, 150 (48 %) reported mixing. Younger age, lower education and income, past-year cigarette use, use of other tobacco products and illicit drugs, poor coping skills and gambling were associated with mixing. Number of ICD-10 ND criteria endorsed was associated with mixing < weekly (b(95 % CI) = 0.3(0.02,0.7)) and weekly/daily (0.5(0.1,0.9)) after controlling for other sources of nicotine. CONCLUSION Mixing is associated with ND and therefore may threaten tobacco control efforts by rendering quitting cigarette smoking more difficult among smokers who mix tobacco with cannabis. Mixing tobacco with cannabis should be considered as an additional source of nicotine exposure in studies of ND in young people.
Collapse
Affiliation(s)
- Erika N Dugas
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Robert J Wellman
- Department of Population & Quantitative Health Sciences, Division of Preventive & Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Marie-Pierre Sylvestre
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada
| | - Richard E Bélanger
- Department of Pediatrics, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Jennifer O'Loughlin
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada.
| |
Collapse
|
10
|
al’Absi M, DeAngelis B, Fiecas M, Budney A, Allen S. Effects of regular cannabis and nicotine use on acute stress responses: chronic nicotine, but not cannabis use, is associated with blunted adrenocortical and cardiovascular responses to stress. Psychopharmacology (Berl) 2022; 239:1551-1561. [PMID: 35275227 PMCID: PMC9248975 DOI: 10.1007/s00213-022-06087-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE Cannabis is one of the most prevalent substances used by tobacco smokers and, in light of the growing list of states and territories legalizing cannabis, it is expected that co-use of cannabis and nicotine will escalate significantly and will lead to continuing challenges with tobacco use. OBJECTIVES This study was conducted to examine the interactive effects of chronic cannabis and nicotine use on adrenocortical, cardiovascular, and psychological responses to stress and to explore sex differences in these effects. METHODS Participants (N = 231) included cannabis-only users, nicotine-only users, co-users of both substances, and a non/light-user comparison group. After attending a medical screening session, participants completed a laboratory stress session during which they completed measures of subjective states, cardiovascular responses, and salivary cortisol during baseline (rest) and after exposure to acute stress challenges. RESULTS Nicotine use, but not cannabis use, was associated with blunted cortisol and cardiovascular responses to stress across both men and women. Men exhibited larger cortisol responses to stress than women. Co-users had significantly larger stress-related increases in cannabis craving than cannabis-only users. Cannabis users reported smaller increases in anxiety during stress than cannabis non/light-users, and both male nicotine-only users and male cannabis-only users experienced significantly smaller increases in stress than their non/light-user control counterparts. CONCLUSIONS This study replicates and extends earlier research on the impacts of sex and nicotine use on stress responses, and it provides novel findings suggesting that when co-used with nicotine, cannabis use may not confer additional alterations to physiological nor subjective responses to stress. Co-use, however, was associated with enhanced stress-related craving for cannabis.
Collapse
Affiliation(s)
- Mustafa al’Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA
| | - Briana DeAngelis
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA
| | - Mark Fiecas
- School of Public Health, Division of Biostatistics, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | | | - Sharon Allen
- Department of Family Medicine and Community Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| |
Collapse
|
11
|
Kelleghan AR, Sofis MJ, Budney A, Ceasar R, Leventhal AM. Associations of cannabis product source and subsequent cannabis use among adolescents. Drug Alcohol Depend 2022; 233:109374. [PMID: 35272186 PMCID: PMC8999876 DOI: 10.1016/j.drugalcdep.2022.109374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cannabis is obtained from a variety retail and illicit sources, with unknown implications for youth cannabis use. This study assessed whether source of obtaining cannabis was associated with future cannabis use among adolescents. METHODS High-schoolers (N = 835) completed 3 semiannual surveys, reporting use of 7 cannabis sources (i.e., free, bought from someone, from an online dispensary, with a [valid/invalid] medical card, self-grown, or other; separate dichotomous exposure variables) at wave 1 (n = 621; M[SD] age=17.14[.40]) or wave 2 (n = 622; M[SD] age=17.51[.39]). Past-6-month (yes/no) and number of past-30-day (0-30) non-medical use of any cannabis product, combustible, edible, and vaporized cannabis, blunts, and concentrates (i.e., dabs) were reported at waves 2-3. Random-effect time-lagged repeated-measures regression was used to test longitudinal associations of youth's cannabis source (waves 1-2; time-varying exposure) with cannabis use outcomes 6 months later (waves 2-3). RESULTS Most youth (72.1%) received cannabis for free; 50.9% bought cannabis from someone, 15.9% used a valid medical card at a brick-and-mortar dispensary, and 3.9% grew cannabis. Buying cannabis from someone (OR=1.46, 95% CI: 1.07-1.99, p = .02) or using a valid medical card (OR=1.99, 95% CI: 1.20-3.31, p = .008) conferred greater odds of any cannabis product use 6 months later. Buying from someone predicted subsequent past-30-day use frequency (RR=1.25, 95% CI:1.05-1.48, p = .01). Some associations between particular cannabis sources and products were observed. CONCLUSIONS Adolescents may access cannabis from several sources. Those who purchase cannabis illicitly from someone or from a brick-and-mortar dispensary using a valid medical card may be at increased risk for more persistent and frequent patterns of non-medical cannabis use.
Collapse
Affiliation(s)
- Annemarie R Kelleghan
- Department of Psychology, University of Southern California, 3620S. McClintock Ave. SGM 501, Los Angeles, CA 90089, USA; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA
| | - Michael J Sofis
- Department of Psychiatry, Geisel School of Medicine, Dartmouth, 46 Centerra Pkwy, Suite 315, HB 7255, Lebanon, NH 03766, USA
| | - Alan Budney
- Department of Psychiatry, Geisel School of Medicine, Dartmouth, 46 Centerra Pkwy, Suite 315, HB 7255, Lebanon, NH 03766, USA
| | - Rachel Ceasar
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA; Institute for Addiction Science, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA.
| |
Collapse
|
12
|
Hindocha C, Brose LS, Walsh H, Cheeseman H. Cannabis use and co-use in tobacco smokers and non-smokers: prevalence and associations with mental health in a cross-sectional, nationally representative sample of adults in Great Britain, 2020. Addiction 2021; 116:2209-2219. [PMID: 33345423 DOI: 10.1111/add.15381] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co-use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non-smokers and (2) investigate mental health problems among non-users, tobacco-only, cannabis-only and co-users of both substances. DESIGN Cross-sectional national on-line survey (Action on Smoking and Health) fielded in February-March 2020. SETTING Great Britain. PARTICIPANTS Adults in Great Britain aged ≥ 18 years (n = 12 809) MEASUREMENTS: Tobacco use status [smoker (daily or non-daily) or non-smoker (never or ex-smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self-reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. FINDINGS In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non-smokers [past-year: 4.7%; adjusted odds ratio (aOR) = 10.07, 95% confidence interval (CI) = 8.4-12.0; daily: 0.7%; aOR = 24.6, 95% CI = 18.0-33.6)]. Co-administration with tobacco was common (46.2% of non-smokers, 80.8% of tobacco smokers). Co-users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis-only (45.8%), tobacco-only (33.2%) and non-users (22.7%; all P ≤ 0.05). CONCLUSION Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non-smokers. Co-administration of cannabis and tobacco, via smoking, appears to be common, including among self-identified non-smokers. Mental health problems appear to be particularly common among dual users.
Collapse
Affiliation(s)
- Chandni Hindocha
- Clinical Psychopharmacology Unit, Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.,University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre, London, UK
| | - Leonie S Brose
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), Kings' College London, London, UK.,SPECTRUM Consortium, London, UK
| | - Hannah Walsh
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings' College London, London, UK
| | | |
Collapse
|
13
|
Jayakumar N, Chaiton M, Goodwin R, Schwartz R, O'Connor S, Kaufman P. Co-use and Mixing Tobacco With Cannabis Among Ontario Adults. Nicotine Tob Res 2021; 23:171-178. [PMID: 31867605 DOI: 10.1093/ntr/ntz238] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/17/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The legalization of nonmedical cannabis in 2018 may have important implications for tobacco use in Canada. There is a risk of renormalizing tobacco use with co-use of tobacco and cannabis introducing nontobacco users to tobacco. Co-use is the use of both substances by the same individual at the same time or on different occasions, as well as mixed together. This study assessed the prevalence of co-use and mixing of tobacco and cannabis among Ontario adults and the characteristics of the users. AIMS AND METHODS Data from the 1996 to 2017 cycles of the Centre for Addiction and Mental Health Monitor (n = 4481) were used to examine trends in prevalence and the proportion of Ontario adults co-using and mixing tobacco and cannabis. Logistic regression was used to study associations between user characteristics and co-use and mixing. RESULTS Co-use of cigarettes and cannabis among cannabis users declined from 59.8% in 1996 to 41.7% in 2017. Past-year e-cigarette use was the only predictor of co-use. From 2015 to 2017, 31.1% (95% confidence interval 27.0, 35.9) of Ontario adults who used cannabis reported mixing it with tobacco in the past year. Being white, past-year e-cigarette use, having moderate or high nicotine dependence, and having moderate or high risk for cannabis problems were significant predictors of mixing among cannabis users. CONCLUSION Given the well-established negative health effects associated with tobacco use, alongside a growing evidence base for negative health effects of cannabis smoking, co-use and mixing could pose a considerable public health concern in the context of legalization. IMPLICATIONS Considerable effort has been expended to reduce tobacco smoking. However, current efforts to reduce tobacco smoking may be diminished since this study found the prevalence of mixing tobacco and cannabis among cannabis users in Ontario to be higher than expected. Mixing tobacco and cannabis may introduce nontobacco smokers to tobacco, exposing them to health risks associated with both cannabis and tobacco smoke. Therefore, there is a need to monitor changes in tobacco use and understanding implications for tobacco control and cessation programs within the changing environment of cannabis legalization in Canada and other jurisdictions.
Collapse
Affiliation(s)
- Navitha Jayakumar
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Michael Chaiton
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.,Centre for Addiction and Mental Health, Toronto, ON
| | - Renee Goodwin
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
| | - Robert Schwartz
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.,Centre for Addiction and Mental Health, Toronto, ON
| | - Shawn O'Connor
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Pamela Kaufman
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| |
Collapse
|
14
|
Hahlbeck SM, Vito AG. Adolescent Marijuana Dependence: The Role of Social Bonds and Social Learning Theory. J Psychoactive Drugs 2021; 54:43-53. [PMID: 33775242 DOI: 10.1080/02791072.2021.1903122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Using the 2017 National Survey of Drug Use and Health (NSDUH) data, this research examines the extent to which social bonds and social learning theory predict adolescent marijuana dependence. Full information maximum likelihood (FIML) for logistic regression analyses were conducted in four models to test the competing theories. The results revealed partial support for both theories, such that adolescents with stronger parental bonds and negative definitions of substance use were less likely to be dependent on marijuana, while adolescents who associated with substance using peers were more likely to be dependent on marijuana. The multi-theoretical model suggested that only the social learning theory concepts of differential association and negative definitions were significant theoretical predictors of adolescent marijuana dependence. Additional analyses revealed that first using marijuana at 14 or 15 years old was also significantly related to adolescent marijuana dependence. Implications for future research and risk prevention programs are discussed.
Collapse
Affiliation(s)
- Sydney M Hahlbeck
- Department of Psychological Science, Ball State University, Muncie, IN, USA
| | - Anthony G Vito
- Department of Criminal Justice & Criminology, Ball State University, Muncie, IN, USA
| |
Collapse
|
15
|
Pedersen ER, Tucker JS, Davis JP, Dunbar MS, Seelam R, Rodriguez A, D'Amico EJ. Tobacco/nicotine and marijuana co-use motives in young adults: Associations with substance use behaviors one year later. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:133-147. [PMID: 32551726 PMCID: PMC7746603 DOI: 10.1037/adb0000638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Co-administration of tobacco/nicotine and marijuana (e.g., using both products on the same occasion by mixing them in the same delivery device) is a risky, yet common, form of co-use among young adults. Understanding motivations for co-administration co-use, and how these are associated with subsequent use and related problems, is needed to inform policy, prevention, and intervention efforts. We conducted a latent class analysis on 342 young adults with past-year co-administration of tobacco/nicotine and marijuana to determine how emergent classes of 16 co-use motives were associated with use and co-administration co-use of tobacco/nicotine and marijuana one year later. Four classes emerged: (1) a high all class that reported high endorsement of all motives, (2) a high coping class that reported high endorsement of co-use due to coping with stress and bad moods, (3) a high social/physiological reinforcement class that reported low endorsement of coping but high probability of social and relaxation motives and motives to even out effects of each substance, and (4) a low all class that reported low endorsement of all motives. The high all and high coping classes reported greater frequency and quantity of single substance use and co-administration. The high coping class reported more marijuana consequences than the low all class. The high all and high coping classes reported younger age of initiation of each individual substance and co-administration. Considering co-use motives may be useful in identifying those at highest risk for future use and consequences and tailoring interventions to the distinct needs of co-use subgroups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Jordan P Davis
- Department of Children, Youth, and Families, Suzanne Dworak-Peck School of Social Work, University of Southern California
| | | | | | | | | |
Collapse
|
16
|
Hindson J, Hanstock T, Dunlop A, Kay-Lambkin F. Internet-Delivered Tobacco Treatment for People Using Cannabis: A Randomized Trial in Two Australian Cannabis Clinics. JMIR Form Res 2020; 4:e14344. [PMID: 33284121 PMCID: PMC7752536 DOI: 10.2196/14344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/03/2020] [Accepted: 06/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background Tobacco use is disproportionately higher in people who smoke cannabis than in the general population, increasing the severity of dependence for cannabis use, decreasing the likelihood of successful quit attempts for both cannabis and tobacco, and increasing the risk of relapse for both substances. Opportunities to address tobacco use in people using cannabis are being missed. Objective This study aims to investigate the feasibility of engaging tobacco smokers who were accessing treatment for cannabis, with a tobacco-focused internet-based Healthy Lifestyle Program (iHeLP; 4 modules). It was hypothesized that iHeLP completion would be associated with decreases in tobacco use and improved quality of life (QoL) and psychological health. It was also hypothesized that iHeLP completion would be higher in those who additionally received telephone support. Given that iHeLP aimed to improve healthy lifestyle behaviors, it was also hypothesized that there would be reductions in cannabis use. Methods A total of 13 smokers seeking treatment for cannabis use were randomly allocated to iHeLP alone or iHeLP plus telephone support. Participants were engaged in iHeLP over 8 weeks and completed a 12-week follow-up assessment. Results Results from 10 participants who completed the follow-up indicated that the acceptability of iHeLP was high-very high in terms of general satisfaction, appropriateness of services, effectiveness, and met need. Additional telephone support increased modal module completion rates for iHeLP from 0 to 2 but did not provide any other significant advantages over iHeLP alone in terms of cannabis use, tobacco use, QoL, or psychological health. Participants in the iHeLP-alone condition (n=4) reported a mean reduction of 5.5 (SD 9.00) tobacco cigarettes per day between baseline and follow-up, with a concomitant mean reduction in expired carbon monoxide (CO) of 5.5 parts per million (ppm, SD 6.91). The iHeLP plus telephone support group (n=6) reported a mean reduction of 1.13 (SD 4.88) tobacco cigarettes per day and a mean reduction of 9.337 ppm of expired CO (SD 5.65). A urinalysis indicated that abstinence from cannabis was achieved by 2 participants in the iHeLP-alone group and three participants in the iHeLP plus telephone support group. Between baseline and follow-up assessments, iHeLP-alone participants reported a mean reduction in days of use of cannabis in the prior month of 6.17 days (SD 13.30). The average reduction in the number of days of cannabis use for the iHeLP plus telephone support group was also 6.17 days (SD 13.59). Conclusions Despite the small sample size, this study provides preliminary support for the use of internet-delivered, tobacco-focused interventions in tobacco smokers seeking treatment for cannabis use.
Collapse
Affiliation(s)
| | | | - Adrian Dunlop
- Hunter New England Health District, Newcastle, Australia
| | | |
Collapse
|
17
|
Kumar PS. Interventions to prevent periodontal disease in tobacco-, alcohol-, and drug-dependent individuals. Periodontol 2000 2020; 84:84-101. [PMID: 32844411 DOI: 10.1111/prd.12333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Substance abuse affects more than one sixth of the world's population. More importantly, the nature of the abuse and the type of addictive substances available to individuals is increasing exponentially. All substances with abusive potential impact both the human immuno-inflammatory system and oral microbial communities, and therefore play a critical role in the etiopathogenesis of periodontal diseases. Evidence strongly supports the efficacy of professionally delivered cessation counseling. Dentists, dental therapists, and hygienists are ideally placed to deliver this therapy, and to spearhead efforts to provide behavioral and pharmacologic support for cessation. The purpose of this review is to examine the biologic mechanisms underlying their role in disease causation, to understand the pharmacologic and behavioral basis for their habituation, and to investigate the efficacy of population-based and personalized interventions in prevention of periodontal disease.
Collapse
Affiliation(s)
- Purnima S Kumar
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, USA
| |
Collapse
|
18
|
Hindocha C, Brose L, Walsh H, Cheeseman H. Cannabis use and co-use in tobacco smokers and non-smokers: prevalence and associations with mental health in a nationally representative sample of adults in Great Britain, 2020. ACTA ACUST UNITED AC 2020. [DOI: 10.32388/2f4aq1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
19
|
Akre C, Berchtold A, Barrense-Dias Y, Suris JC. Characteristics defining perceived popularity among same-sex and opposite-sex peers. Int J Adolesc Med Health 2020; 33:227-234. [PMID: 32549149 DOI: 10.1515/ijamh-2019-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/02/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to compare the characteristics of adolescents and young adults (AYA) who perceive themselves as popular with AYAs who perceive themselves as unpopular vis-á-vis peers from same-sex, opposite-sex, or both. METHODS Among a representative sample of in-school 15-24 year-olds students (n=5,179) who completed a self-administrated questionnaire, we measured self-perception of popularity, socio-demographic data, ease to make same/opposite-sex friends, emotional well-being, school variables, substance use, sensation seeking, self-perception of pubertal timing, and aggressive/violent behavior. RESULTS Overall, our findings put forth that popularity was associated to easiness of making same/opposite-sex friends, emotional well-being, socio-economical background, sensation seeking behaviors, and alcohol misuse. Differences appeared between males or females. CONCLUSION Findings indicate that popularity remains a very important issue among this age group and should be a red flag in clinical assessment. Future research should explore whether feeling of unpopularity can be used as a marker of adolescent well-being and hence help identify those youths who might need help.
Collapse
Affiliation(s)
- Christina Akre
- Institut Universitaire de Médecine Sociale et Préventive, Lausanne University Hospital, Biopole 2, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - André Berchtold
- Institute of Social Sciences and LIVES, University of Lausanne, Lausanne, Switzerland
| | - Yara Barrense-Dias
- Institut Universitaire de Médecine Sociale et Préventive, Lausanne University Hospital, Lausanne, Switzerland
| | - Joan-Carles Suris
- Institut Universitaire de Médecine Sociale et Préventive, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
20
|
Murphy T, Le Foll B. Targeting the Endocannabinoid CB1 Receptor to Treat Body Weight Disorders: A Preclinical and Clinical Review of the Therapeutic Potential of Past and Present CB1 Drugs. Biomolecules 2020; 10:biom10060855. [PMID: 32512776 PMCID: PMC7356944 DOI: 10.3390/biom10060855] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Obesity rates are increasing worldwide and there is a need for novel therapeutic treatment options. The endocannabinoid system has been linked to homeostatic processes, including metabolism, food intake, and the regulation of body weight. Rimonabant, an inverse agonist for the cannabinoid CB1 receptor, was effective at producing weight loss in obese subjects. However, due to adverse psychiatric side effects, rimonabant was removed from the market. More recently, we reported an inverse relationship between cannabis use and BMI, which has now been duplicated by several groups. As those results may appear contradictory, we review here preclinical and clinical studies that have studied the impact on body weight of various cannabinoid CB1 drugs. Notably, we will review the impact of CB1 inverse agonists, agonists, partial agonists, and neutral antagonists. Those findings clearly point out the cannabinoid CB1 as a potential effective target for the treatment of obesity. Recent preclinical studies suggest that ligands targeting the CB1 may retain the therapeutic potential of rimonabant without the negative side effect profile. Such approaches should be tested in clinical trials for validation.
Collapse
Affiliation(s)
- Thomas Murphy
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Department of Psychiatry, Division of Brain and Therapeutics, University of Toronto, Toronto, ON M5T 1R8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence: ; Tel.: +1-416-535-8501
| |
Collapse
|
21
|
Kumar N, Puljević C, Ferris J, Winstock A, Barratt MJ. The Intersection between Spliff Usage, Tobacco Smoking, and Having the First Joint after Waking. Sci Rep 2020; 10:7650. [PMID: 32376881 PMCID: PMC7203254 DOI: 10.1038/s41598-020-64110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/25/2020] [Indexed: 11/08/2022] Open
Abstract
Cannabis users who are also tobacco smokers are more likely to exhibit cannabis dependence and psychosocial problems. However, there has been minimal research around various cannabis and tobacco mixing (spliff usage) behaviours and likeliness to smoke the first joint within an hour of waking, known colloquially as wake and bake. The time of first joint and spliff usage may be related as they are associated with the intersection of tobacco and cannabis use. Compared to non-morning cannabis users, morning users reported significantly more cannabis-related problems. Through a survey of US cannabis users, we test the association between various cannabis and spliff use behaviours and likeliness to smoke the first joint within an hour of waking. Compared to those who smoked tobacco and used spliffs, the following spliff use behaviour groups were less likely to have their first joint within 60 minutes after waking: those who smoked tobacco and used spliffs (95%CI: 0.605-0.988); those who never smoked tobacco and did not use spliffs (95%CI: 0.489-0.892); those who never smoked tobacco and used spliffs (95%CI:0.022-0.915). We provided possible explanations for our results and suggested further research to better understand findings, important given expanding US cannabis markets.
Collapse
Affiliation(s)
- Navin Kumar
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA.
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Cheneal Puljević
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Jason Ferris
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Adam Winstock
- University College London, London, UK
- Global Drug Survey Ltd, London, UK
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| |
Collapse
|
22
|
Klupinski TP, Strozier ED, Makselan SD, Buehler SS, Peters EN, Lucas EA, Casbohm JS, Friedenberg DA, Landgraf AJ, Frank AJ, Mikheev VB, Ivanov A. Chemical characterization of marijuana blunt smoke by non-targeted chemical analysis. Inhal Toxicol 2020; 32:177-187. [PMID: 32408835 DOI: 10.1080/08958378.2020.1765052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Background: Marijuana blunts, which are tobacco cigar wrappers filled with marijuana, are commonly smoked in the US as a means of cannabis use. The use of marijuana blunts presents toxicity concerns because the smoke contains both marijuana-related and tobacco-related chemicals. Thus, it is important to understand the chemical composition of mainstream smoke (MSS) from marijuana blunts. This study demonstrates the ability to detect and identify chemical constituents exclusively associated with blunt MSS in contrast to tobacco cigar MSS (designated as 'new exposures') through non-targeted chemical analysis.Methods: Samples collected separately from blunt MSS and tobacco cigar MSS were analyzed using two-dimensional gas chromatography-time-of-flight mass spectrometry (GC × GC-TOFMS).Results and Discussion: Two new exposures, which likely represent only a subset of all new exposures, were identified by evaluating the data from thousands of detected signals and then confirming selected compound identities in analyses using authentic chemical standards. The two confirmed new exposures, mellein and 2-phenyl-2-oxazoline, are not cannabinoids and, to the best of our knowledge, have not been previously reported in association with cannabis, tobacco, or smoke of any kind. In addition, we detected and quantified three phenols (2-, 3-, and 4-ethylphenol) in blunt MSS. Given the toxicity of phenols, quantifying the levels of other phenols could be pursued in future research on blunt MSS.Conclusion: This study shows the power and utility of GC × GC-TOFMS as a methodology for non-targeted chemical analysis to identify new chemical exposures in blunt MSS and to provide data to guide further investigations of blunt MSS.
Collapse
|
23
|
Chen-Sankey JC, Jewett BJ, Orozco L, Duarte DA, Dang K, Seaman EL, Choi K. "Hey, I Got to Smoke Some Weed": Favorable Perceptions of Marijuana Use Among Non-College-Educated Young Adult Cigarette Smokers. Subst Use Misuse 2020; 55:48-55. [PMID: 31448650 PMCID: PMC6917969 DOI: 10.1080/10826084.2019.1654515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: As marijuana legalization progresses in the U.S., this study investigated the perceptions of marijuana use among non-college-educated young adult smokers. Methods: Twelve focus groups were conducted to explore themes related to marijuana and marijuana use among a racially and ethnically diverse sample of 75 young adult smokers (ages 18-29 years) with <4-year college education and <$90,000 annual household income living in the Washington, D.C. metropolitan area. Thematic content analysis was employed to analyze the transcripts. Data collection and analysis took place in 2017 and 2018, respectively. Results: Many participants reported smoking cigarettes to boost and maintain the psychoactive effect ("high") of smoking marijuana; some smoked marijuana to substitute frequent cigarette smoking. Participants generally stated that they believed marijuana smoking was healthier and less addictive than cigarette smoking; many preferred smoking marijuana over cigarettes. Participants also mentioned that cigarette smoking was stigmatized and not socially acceptable but marijuana smoking was "trendy" and "cool." Some reported that they smoked marijuana to cut down on cigarettes, although most were unsuccessful. Racial and ethnic differences in marijuana use were also identified. Discussion: Non-college-educated young adult smokers expressed largely favorable views towards smoking marijuana. Such positive views may lead to prolonged and escalated use of cigarettes and marijuana, resulting in exacerbated adverse health consequence of smoking both products as well as worsened outcomes of cigarette smoking cessation. Evidence-based messages are greatly needed to communicate the harm and risks of marijuana use and marijuana and tobacco co-use among this group.
Collapse
Affiliation(s)
- Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Bambi J Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Leah Orozco
- Department of Biology, College of the Holy Cross, Worcester, Massachusetts, USA
| | - Danielle A Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Kathleen Dang
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| |
Collapse
|
24
|
Dallery J, Raiff BR, Grabinski MJ, Marsch LA. Technology-Based Contingency Management in the Treatment of Substance-Use Disorders. Perspect Behav Sci 2019; 42:445-464. [PMID: 31976444 PMCID: PMC6768925 DOI: 10.1007/s40614-019-00214-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Contingency management is one of the most efficacious interventions to promote drug abstinence. Contingency management has traditionally been delivered in person so that clinicians could confirm drug abstinence and provide access to additional therapeutic services. Now, new technologies not only permit remote confirmation of abstinence, but also remote delivery of incentives. We discuss several technology-based tools to assess substance use, and new ways to deliver contingency management to promote tobacco, alcohol, and cannabis abstinence. These new tools have the potential to dramatically increase access while maintaining high levels of treatment fidelity. Technology-based methods also allow arranging group contingencies that harness online communities, and they permit targeting multiple health-risk behaviors with a combination of sensor-based technologies. Overall, there are unprecedented opportunities to link technology with contingency management to promote drug abstinence.
Collapse
Affiliation(s)
- Jesse Dallery
- Department of Psychology, University of Florida, PO Box 112250, Gainesville, FL 32611 USA
| | | | | | - Lisa A. Marsch
- The Geisel School of Medicine, Dartmouth College, Hanover, NH USA
| |
Collapse
|
25
|
Fairman BJ, Anthony JC. Does Starting to Smoke Cigars Trigger Onset of Cannabis Blunt Smoking? Nicotine Tob Res 2019; 20:355-361. [PMID: 28339595 DOI: 10.1093/ntr/ntx015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Among United States teens during the 1990s, increasing cigar use coincided with increasing use of tobacco cigar shells filled with cannabis, called "blunts." Cigar smokers are more likely to use cannabis, and we hypothesized that starting to smoke cigars might be a probabilistic "trigger" of blunt smoking. We turned to the case-crossover approach to evaluate this hypothesis. Methods Within US National Surveys on Drug Use and Health, 2009-2013, we identified a nationally representative sample of newly incident blunt smokers aged 12- to 21-years-old (n = 4868) and compared month-of-onsets for smoking of cigars and blunts. Using the subjects-as-their-own-controls case-crossover design, we specified the first month prior to blunt use as a "hazard interval" and the second month prior to blunt use as a "control interval." We used Mantel-Haenszel (MH) estimators to estimate the matched-pairs odds ratio (OR). Results The MH OR estimate was 1.7 (95% CI = 1.3, 2.3), with excess odds of cigar onsets during the hazard interval relative to the control interval. Two alternative control interval specifications yielded congruent estimates (OR = 2.7 and 2.9, respectively). Conclusions A short interval right after starting to smoke cigars may be one of increased risk of starting to smoke blunts. We discuss cigar, cigarillo, and "blunt wraps" control approaches that might reduce both tobacco and cannabis-related harms. Implications If this evidence is correct, increased market-targeting to promote youthful cigar and cigarillo smoking might be followed by increased rates of blunt smoking in a vulnerable population. As noted by others, enhanced risk of smoking-attributable harms might be a consequence of mixed tobacco-cannabis formulations.
Collapse
Affiliation(s)
- Brian J Fairman
- Health Behavior Branch, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - James C Anthony
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
| |
Collapse
|
26
|
Pourtau L, Martin E, Menvielle G, El Khoury-Lesueur F, Melchior M. To smoke or not to smoke? A qualitative study among young adults. Prev Med Rep 2019; 15:100927. [PMID: 31321203 PMCID: PMC6612927 DOI: 10.1016/j.pmedr.2019.100927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/12/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
Smoking is the major preventable cause of disease and premature death in many countries, including France, where approximately 30% of adults are daily smokers. About 60% of them want to quit, however, long-term smoking cessation rates are low, particularly among individuals with low socio-economic position. The aim of this study is to examine whether motivations for smoking cessation among young adults differ across socio-economic groups. 3 focus groups of smokers and former smokers aged 22–40 years were constituted and conducted in November 2014 in Paris. Data from the focus groups were analyzed thematically and in a cross-cutting manner. Our study shows the existence of social “communities” of smokers, in occupational and festive contexts. In addition, new forms of resistance to public health messages are observed (“neutralization”), particularly among smokers with low socioeconomic position. Finally, stress is often cited as a source of unsuccessful smoking cessation or smoking relapse. Tobacco smoking is a social behavior and is associated with symbolic as well as relational benefits, particularly among smokers who have low socioeconomic position. To be effective, interventions aiming to decrease smoking levels in the population should aim to create group dynamics encouraging smokers to quit and address the physical as well as the psychological consequences of smoking withdrawal. Young adults who smoke congregate in social “communities”, at work or at parties. Persons with low socioeconomic status “neutralize” the risks related to smoking. Smoking is a social behavior, associated with symbolic and relational benefits.
Collapse
Affiliation(s)
- Lionel Pourtau
- Université Paris Sud/Paris Saclay, Laboratoire EA 1610, équipe ES3, Kremlin-Bicêtre, France
| | - Elise Martin
- Université Paris Sud/Paris Saclay, Laboratoire EA 1610, équipe ES3, Kremlin-Bicêtre, France
| | - Gwenn Menvielle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012 Paris, France
| | - Fabienne El Khoury-Lesueur
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012 Paris, France
| | - Maria Melchior
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012 Paris, France
| |
Collapse
|
27
|
Roche DJO, Bujarski S, Green R, Hartwell EE, Leventhal AM, Ray LA. Alcohol, tobacco, and marijuana consumption is associated with increased odds of same-day substance co- and tri-use. Drug Alcohol Depend 2019; 200:40-49. [PMID: 31085377 PMCID: PMC6675401 DOI: 10.1016/j.drugalcdep.2019.02.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about event-level patterns of marijuana co- or tri-use with alcohol and tobacco. Thus, the study goal was to examine patterns of same-day alcohol, cigarette, and marijuana co- and tri-use at the individual level in non-treatment-seeking alcohol users. METHODS Participants (N = 551) completed an in-person interview for alcohol, cigarette, and marijuana use over the previous 30 days, and the event-level substance use patterns of n = 179 participants who reported using each of these substances at least once per month were analyzed. RESULTS The use of alcohol, marijuana, or cigarettes independently increased the probability of subsequent, simultaneous co-use of one of the two remaining substances. The co-use of alcohol with cigarettes and marijuana with cigarettes produced generally additive effects on the odds of same day tri-use of marijuana and alcohol, respectively. Conversely, the co-use of alcohol and marijuana produced sub-additive effects on likelihood of cigarette use. Sex moderated several of the observed patterns of co- and tri-use: the relationship between alcohol or cigarette use predicting marijuana co-use was stronger in men, whereas the observed additive relationships between drug co-use leading to tri-use was stronger in women. CONCLUSIONS The presented results may aid in the understanding of how simultaneous co-use of marijuana with alcohol and/or tobacco relates to the etiology, maintenance, and treatment of comorbid and trimorbid substance use disorder. Replication and extension of the results in treatment seeking populations using more fine-grained analysis approaches, e.g. ecological momentary assessment, is needed.
Collapse
Affiliation(s)
- D J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - S Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - R Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - E E Hartwell
- Mental Illness Research, Education and Clinical Center, Corporal Michael J Crescenz VA Medical Center, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - A M Leventhal
- Departments of Preventive Medicine and Psychpology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - L A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| |
Collapse
|
28
|
Papanastasiou N, Hill S, Amos A. Evidence From Qualitative Studies of Youth About the Impacts of Tobacco Control Policy on Young People in Europe: A Systematic Review. Nicotine Tob Res 2019; 21:863-870. [PMID: 29370431 DOI: 10.1093/ntr/nty007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/18/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION A range of tobacco control policies endeavor to prevent smoking uptake in young people, yet relatively little is known about how such interventions impact young people's engagement with smoking. We reviewed existing qualitative evidence on young people and smoking in Europe to assess whether, in what ways and why young people comply with, adapt to, resist, or circumvent tobacco control policies in their respective countries. METHODS We undertook a systematic review of academic literature presenting qualitative research from Europe on smoking and young people (11-18 years), published from 2000 to 2015. Bibliographic searches (PubMed, PsycInfo, SSCI) produced 1357 records, from which 43 relevant articles were assessed for quality and 39 included in the review. RESULTS Most studies were from the United Kingdom (27), with a small number (one or two each) from other European countries (Denmark, Sweden, Switzerland, Belgium, Cyprus, Greece, Hungary, Ireland, and Spain). Only 16 articles (11 from United Kingdom) provided any evidence about the impacts of tobacco control policies on young people's smoking. These focused on smoke-free legislation (four), age of sale laws (four), plain packaging (three), and black market tobacco (one). CONCLUSIONS There is very little qualitative evidence exploring the impacts of tobacco control on youth smoking in Europe. To develop more effective smoking prevention policies that take account of local political, social, and cultural contexts, more qualitative research from a wider range of European countries is needed to understand how tobacco control impacts on young people's social worlds and smoking behaviors. IMPLICATIONS Smoking is the leading cause of premature mortality in Europe. However, there is little qualitative evidence exploring the impact of tobacco control policies on young people in Europe. Most comes from the United Kingdom and focuses on a narrow range of policies. Thus, we have a limited understanding of how and in what ways tobacco control policies reach young people, their engagement with these, and how local context affects their impact. More qualitative research is needed, from a wider range of countries and on a broader range of tobacco control policies, to strengthen the evidence-base for reducing youth smoking.
Collapse
Affiliation(s)
- Natalie Papanastasiou
- UK Centre for Tobacco and Alcohol Studies, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Sarah Hill
- Global Public Health Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- UK Centre for Tobacco and Alcohol Studies, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
29
|
Fix BV, Smith D, O'Connor R, Heckman BW, Willemsen MC, Cummings M, Fong G. Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey. BMJ Open 2019; 9:E024497. [PMID: 30833306 PMCID: PMC6443198 DOI: 10.1136/bmjopen-2018-024497] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Existing evidence shows that co-occurring use of tobacco and cannabis is widespread. Patterns of co-use of tobacco and cannabis may change as more jurisdictions legalise medicinal and/or recreational cannabis sales. This analysis examined predictors of current cannabis use and characterised methods of consumption among smokers and non-smokers in a context where cannabis use is legal. SETTING The 2015 International Tobacco Control Netherlands-Gold Magic Survey conducted between July and August 2015. PARTICIPANTS Participants (n=1599; 1003 current smokers, 283 former smokers and 390 non-smokers) were asked to report their current (past 30-day) use of cigarettes and cannabis. Cigarette smokers reported whether they primarily used factory made of roll-your-own cigarettes. Those who reported any cannabis use in the last 30 days were asked about forms of cannabis used. X2and logistic regression analyses were used to assess relationships among combustible tobacco and cannabis use. RESULTS Past 30-day cannabis use was somewhat higher among current tobacco (or cigarette) smokers (n=57/987=5.8%) than among former or never smokers (n=10/288=3.5% and n=6/316=1.9%, respectively). Joints were the most commonly used form of cannabis use for both current cigarette smokers (96.9%) and non-smokers (76.5%). Among those who smoked cannabis joints, 95% current smokers and 67% of non-smokers reported that they 'always' roll cannabis with tobacco. CONCLUSIONS In this Netherlands-based sample, most cannabis was reported to be consumed via smoking joints, most often mixed with tobacco. This behaviour may present unique health concerns for non-cigarette smoking cannabis users, since tobacco use could lead to nicotine dependence. Moreover, many non-cigarette smoking cannabis users appear to be misclassified as to their actual tobacco/nicotine exposure.
Collapse
Affiliation(s)
- Brian Vincent Fix
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Danielle Smith
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Richard O'Connor
- Department of Health Behaviour, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marc C Willemsen
- STIVORO, The Hague, The Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Geoffrey Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| |
Collapse
|
30
|
Abstract
BACKGROUND Based on the prevalence and health implications of tobacco and cannabis use, aiming to reduce their use, especially among youth, is a sound objective at both the individual and public health level. A proper understanding of the relationships between tobacco and cannabis use may help to achieve this goal. OBJECTIVES To review the relationships between tobacco and cannabis use. METHODS A selective review of the literature. RESULTS We present an overview of the motivations for tobacco and cannabis use, and their perceived harmfulness. The article then reviews the gateway theory, reverse gateway theory, route of administration theory, and common liability theory. We describe the link between co-use and dependence symptoms, and the substitution phenomenon between tobacco and cannabis use. Three forms of simultaneous use-mulling, blunt smoking, and chasing-and their impacts are explained. We summarize the impact of tobacco use on cannabis (and vice versa) treatment outcomes, and, finally, review new treatments that simultaneously target tobacco and cannabis dependence. Most of the literature reviewed here relates to substance use among adolescents and young adults. CONCLUSIONS The use of tobacco and cannabis-two of the most widely used substances around the world-are strongly intertwined in several respects. Both health professionals and researchers should have well-informed views on this issue to better evaluate, understand, inform, and provide care to their patients.
Collapse
Affiliation(s)
- Alexandre Lemyre
- a School of Psychology , Université Laval , Québec , QC , Canada.,b Population Health and Optimal Health Practices Branch , CHU de Québec Research Centre , Québec , QC , Canada
| | - Natalia Poliakova
- b Population Health and Optimal Health Practices Branch , CHU de Québec Research Centre , Québec , QC , Canada
| | - Richard E Bélanger
- b Population Health and Optimal Health Practices Branch , CHU de Québec Research Centre , Québec , QC , Canada.,c Department of Paediatrics , Centre mère-enfant Soleil, CHU de Québec, Université Laval , Québec , QC , Canada
| |
Collapse
|
31
|
Cobb CO, Soule EK, Rudy AK, Sutter ME, Cohn AM. Patterns and Correlates of Tobacco and Cannabis co-use by Tobacco Product Type: Findings from the Virginia Youth Survey. Subst Use Misuse 2018; 53:2310-2319. [PMID: 29963944 PMCID: PMC6193481 DOI: 10.1080/10826084.2018.1473437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cannabis use is more common among tobacco users than nonusers, and co-use (i.e., use of both substances individually) may be increasing. Better understanding of patterns and correlates of co-use is needed. The current study aimed to compare rates and correlates of tobacco and cannabis co-use by tobacco product among youth. METHODS High school students who completed the 2013 Virginia Youth Survey and reported past 30-day tobacco use (cigarette, smokeless tobacco, cigar) were included (n = 1390). Prevalence of past 30-day tobacco-only and cannabis co-use was calculated. Demographic, tobacco, and other substance use characteristics were compared by co-use status. Multivariate logistic regression models examined correlates of co-use overall and by tobacco product. RESULTS Over half of tobacco users were co-users. Poly-tobacco use, particularly combusted tobacco, was more prevalent among co-users. Past 30-day alcohol use and lifetime other illegal drug use/prescription drug misuse were common correlates of co-use. Black Non-Hispanic (NH) race/ethnicity was associated with co-use when restricted to cigarette users. "Other" race/ethnicity was associated with co-use in the overall model and when restricted to cigar users. Past 30-day cigarette smoking was associated with co-use in all models except among cigar smoking co-users. Conclusions/Importance: Rates and correlates of tobacco and cannabis co-use were not uniform and differed by tobacco product type. Tobacco and cannabis co-users may be at greater risk for negative health effects associated with inhaled tobacco and other risky substance use. The efficacy of prevention efforts may be improved if risk factors associated with product-specific co-use are considered.
Collapse
Affiliation(s)
- Caroline O Cobb
- a Virginia Commonwealth University, Department of Psychology , Center for the Study of Tobacco Products , Richmond , Virginia , USA
| | - Eric K Soule
- a Virginia Commonwealth University, Department of Psychology , Center for the Study of Tobacco Products , Richmond , Virginia , USA
| | - Alyssa K Rudy
- a Virginia Commonwealth University, Department of Psychology , Center for the Study of Tobacco Products , Richmond , Virginia , USA
| | - Megan E Sutter
- b Moffitt Cancer Center , Department of Health Outcomes and Behavior , Tampa , Florida , USA
| | - Amy M Cohn
- c Georgetown University Medical Center , Washington , DC , USA
| |
Collapse
|
32
|
Beckham JC, Adkisson KA, Hertzberg J, Kimbrel NA, Budney AJ, Stephens RS, Moore SD, Calhoun PS. Mobile contingency management as an adjunctive treatment for co-morbid cannabis use disorder and cigarette smoking. Addict Behav 2018; 79:86-92. [PMID: 29268146 DOI: 10.1016/j.addbeh.2017.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cannabis is the most widely used illicit drug in the U.S. with 19.8 million current users. Population-based data indicate that almost all cannabis users (90%) have a lifetime history of tobacco smoking and the majority (74%) currently smoke tobacco. Among cannabis users, smoking tobacco is associated with increased frequency of cannabis use, increased morbidity, and poorer cannabis cessation outcomes. There is a lack of research, however, focused on addressing cessation of both substances simultaneously. The purpose of the current pilot study was to evaluate the feasibility and acceptability of a multi-component tobacco/cannabis abstinence treatment. METHODS Five participants completed Abstinence Reinforcement Therapy, an intervention that included five sessions of cognitive-behavioral telephone counseling for tobacco/cannabis, pharmacotherapy for smoking cessation, and five weeks of mobile contingency management to remain abstinent from tobacco and cannabis. RESULTS Feasibility of recruitment, retention and treatment completion was high. Satisfaction with the treatment was also high. CONCLUSION Results support the feasibility and acceptability of this approach with dual cannabis and tobacco users and suggest that further research examining the efficacy of this approach is warranted.
Collapse
Affiliation(s)
- Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA.
| | - Kelsie A Adkisson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA
| | - Jeffrey Hertzberg
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth, Center for Technology and Behavioral Health, Lebanon, NH 03766, USA
| | - Robert S Stephens
- Virginia Polytechnic Institute and State University, Department of Psychology, Blacksburg, VA 24061, USA
| | - Scott D Moore
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Patrick S Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA
| |
Collapse
|
33
|
Akre C, Suris JC. Adolescents and young adults' perceptions of electronic cigarettes as a gateway to smoking: a qualitative study in Switzerland. HEALTH EDUCATION RESEARCH 2017; 32:448-454. [PMID: 28931165 DOI: 10.1093/her/cyx054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
Electronic cigarettes (ECs) acting as a gateway to smoking traditional cigarettes (TCs) is a growing public health concern of EC use among youths. To gather the opinions and perceptions of adolescents and young adults (AYAs) on whether and how EC can act as a gateway to smoking TC among youths. A qualitative method included 42 AYAs. Participants identified a significant risk of EC acting as a gateway to TC use, several factors contributing to this phenomenon such as a facilitated transition to smoking or its perception as a harmless toy. Participants considered an even greater gateway threat regarding very young adolescents. A minority did not identify the gateway risk and some believed that it was nicotine-dependent. This potential gateway effect brought forth several recommendations: health professionals should screen adolescents (even very young ones) for EC use and inform consumers of the potential gateway effect; this possible effect should be acknowledged to end the harmless perception many might have; there is an urge for better preventive and regulatory policies directed at protecting adolescents and children who never smoked and support those who have quit.
Collapse
Affiliation(s)
- Christina Akre
- Institut Universitaire de Médecine Sociale et Préventive, Lausanne University Hospital, Biopole 2, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Joan-Carles Suris
- Institut Universitaire de Médecine Sociale et Préventive, Lausanne University Hospital, Biopole 2, Route de la Corniche 10, 1010 Lausanne, Switzerland
| |
Collapse
|
34
|
García-Moya I, Ortiz Barón MJ, Moreno C. Emotional and Psychosocial Factors Associated With Drunkenness and the Use of Tobacco and Cannabis in Adolescence: Independent or Interactive Effects? Subst Use Misuse 2017; 52:1039-1050. [PMID: 28323506 DOI: 10.1080/10826084.2016.1271431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although previous research has examined emotional and psychosocial factors associated with substance use, there is a paucity of studies examining both at the same time, and insufficient attention has been paid to how these factors may interact. OBJECTIVES The aim of this study was to simultaneously examine the contributions from emotional (emotional control and depression) and psychosocial (peers' conventional behavior, peers' substance use and parent-child relationships) factors to drunkenness and the use of tobacco and cannabis in adolescence. METHODS Sample consisted of 1,752 adolescents aged 15 to 16 years who had participated in the 2014 edition of the WHO Health Behaviour in School-aged Children survey in Spain. Data were collected by means of anonymous online questionnaires, and hierarchical multiple regression models (with sex and age as controls and including interactions among the examined predictors) were used for statistical analysis. RESULTS Emotional and psychosocial factors showed significant interactive effects on substance use. Emotional control, which tended to buffer the effects of potential risk factors, and peers' substance use were consistent predictors of substance use. In contrast, the role of other factors depended on the substance under study, with depression and peers' conventional behavior being part of interactive terms for tobacco use and cannabis use only, and the quality of parent-child relationships being absent from the final model on cannabis use. Conclusions/Importance: Exploring interactions and potential substance-specific effects is fundamental to reach a better understanding of how emotional and psychosocial factors work in concert relative to substance use in adolescence.
Collapse
Affiliation(s)
- Irene García-Moya
- a Department of Developmental and Educational Psychology , University of Seville , Seville , Spain
| | - María José Ortiz Barón
- b Department of Basic Psychological Processes and Their Development , University of Basque Country , San Sebastián , Spain
| | - Carmen Moreno
- a Department of Developmental and Educational Psychology , University of Seville , Seville , Spain
| |
Collapse
|
35
|
Schauer GL, Rosenberry ZR, Peters EN. Marijuana and tobacco co-administration in blunts, spliffs, and mulled cigarettes: A systematic literature review. Addict Behav 2017; 64:200-211. [PMID: 27654966 DOI: 10.1016/j.addbeh.2016.09.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Blunts and spliffs/mulled cigarettes combine marijuana and tobacco for co-administration (use at the same time, in the same product). Co-administration of marijuana and tobacco presents significant potential for nicotine exposure, and may lead to exclusive tobacco use patterns, nicotine addiction, and compounded health effects. No review articles have summarized the number and nature of studies published on these co-administered products. METHODS Keywords "(blunt* OR spliff OR mull* OR joint) AND (tobacco OR smok* OR cigarette) AND (cannabis OR marijuana OR hashish)" were searched in the published literature. A total of 220 articles were considered for inclusion, 49 were reviewed by two independent qualitative coders, and 45 were included in this review. RESULTS Of the 45 articles, most (n=27) of studies were observational or descriptive; ten were qualitative, five employed causal designs, and three were mixed methods. A majority of the studies assessed blunts; only 11 studies assessed spliffs/mulled cigarettes. Many studies focused on sub-populations of youth, males, and African Americans. Use of co-administered marijuana and tobacco products was associated with several indicators of problematic use patterns, including perceptions of less risk, dependence on nicotine and marijuana, and greater subjective effects related to marijuana. CONCLUSIONS Literature on marijuana and tobacco co-administration comes largely from qualitative and observational/descriptive studies. In addition to continued surveillance, experimental research that directly assesses the smoking patterns of co-administered marijuana and tobacco products as compared with to those of marijuana and tobacco only products is needed to determine the potential long-term health consequences of using blunts, spliffs, or other co-administered products.
Collapse
|
36
|
Twyman L, Bonevski B, Paul C, Kay-Lambkin FJ, Bryant J, Oldmeadow C, Palazzi K, Guillaumier A. The association between cannabis use and motivation and intentions to quit tobacco within a sample of Australian socioeconomically disadvantaged smokers. HEALTH EDUCATION RESEARCH 2016; 31:771-781. [PMID: 27923866 DOI: 10.1093/her/cyw049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to (i) describe concurrent and simultaneous tobacco and cannabis use and (ii) investigate the association between cannabis use and motivation and intentions to quit tobacco in a sample of socioeconomically disadvantaged smokers. A cross-sectional survey was conducted in 2013 and 2014 with current tobacco smokers receiving aid from two community service organizations in New South Wales, Australia. At least weekly cannabis use for the month prior to survey, motivation to quit tobacco and intentions to quit tobacco were measured in 369 participants (77% consent rate). Regressions were carried out to investigate associations between weekly cannabis use and motivation and intentions to quit tobacco.Concurrent tobacco and cannabis use was reported by 19% (n = 71) of the sample and of these users, 100% reported simultaneous use. Although regular cannabis use was significantly associated with lower motivation to quit tobacco, it was not significantly associated with intentions to quit tobacco in the next 30 days. Concurrent cannabis use is common in disadvantaged smokers and may play a role in decreased motivation to quit tobacco; however, it does not appear to be associated with intentions to quit in a sample of disadvantaged smokers.
Collapse
Affiliation(s)
- Laura Twyman
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Christine Paul
- Priority Research Centre for Health Behaviour and Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Frances J Kay-Lambkin
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2000, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour and Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - C Oldmeadow
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Clinical Research Design, IT and Statistical Support, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
| | - K Palazzi
- Clinical Research Design, IT and Statistical Support, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
| | - A Guillaumier
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia
| |
Collapse
|
37
|
Mokaya AG, Mutiso V, Musau A, Tele A, Kombe Y, Ng’ang’a Z, Frank E, Ndetei DM, Clair V. Substance Use among a Sample of Healthcare Workers in Kenya: A Cross-Sectional Study. J Psychoactive Drugs 2016; 48:310-9. [PMID: 27485987 PMCID: PMC5020342 DOI: 10.1080/02791072.2016.1211352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/20/2016] [Accepted: 06/09/2016] [Indexed: 01/08/2023]
Abstract
This study describes reported substance use among Kenyan healthcare workers (HCWs), as it has implications for HCWs' health, productivity, and their ability and likelihood to intervene on substance use. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) was administered to a convenience sample of HCWs (n = 206) in 15 health facilities. Reported lifetime use was 35.8% for alcohol, 23.5% for tobacco, 9.3% for cannabis, 9.3% for sedatives, 8.8% for cocaine, 6.4% for amphetamine-like stimulants, 5.4% for hallucinogens, 3.4% for inhalants, and 3.9% for opioids. Tobacco and alcohol were also the two most commonly used substances in the previous three months. Male gender and other substance use were key predictors of both lifetime and previous three months' use rates. HCWs' substance use rates appear generally higher than those seen in the general population in Kenya, though lower than those reported among many HCWs globally. This pattern of use has implications for both HCWs and their clients.
Collapse
Affiliation(s)
- Aggrey G. Mokaya
- Master Student, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
- Master Student, Kenya Medical Research Institute, Centre for Public Health Research, Nairobi, Kenya
| | - Victoria Mutiso
- Director, Research Administration and Finance, Africa Mental Health Foundation, Nairobi, Kenya
| | - Abednego Musau
- Research Officer, Africa Mental Health Foundation, Nairobi, Kenya
| | - Albert Tele
- Statistician, Africa Mental Health Foundation, Nairobi, Kenya
| | - Yeri Kombe
- Chief Research Officer, Kenya Medical Research Institute, Centre for Public Health Research, Nairobi, Kenya
| | - Zipporah Ng’ang’a
- Deputy Vice Chancellor (Academic, Research and Student Affairs), South Eastern Kenya University, Kitui, Kenya
| | - Erica Frank
- Professor and Canada Research Chair, University of British Columbia, Vancouver, BC, Canada
- Founder and President, NextGenU.org, Clear Lake, WA, USA
| | - David M. Ndetei
- Founding Director, Africa Mental Health Foundation, Nairobi, Kenya
- Professor of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Veronic Clair
- Co-PI eDATA K NextGenU.org, Vancouver, BC, Canada and Senior Scientist, Africa Mental Health Foundation, Nairobi, Kenya
- Clinical Faculty, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
38
|
Subramaniam P, McGlade E, Yurgelun-Todd D. Comorbid Cannabis and Tobacco Use in Adolescents and Adults. CURRENT ADDICTION REPORTS 2016; 3:182-188. [PMID: 27175326 DOI: 10.1007/s40429-016-0101-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prevalence of comorbid cannabis and tobacco use has been increasing among adolescents and adults and has been shown to be associated with a range of changes or deficits in physical, psychological and behavioral outcomes. Moreover, comorbid use has been shown to have a differential effect on the structure and function of the brain, especially as it relates to the reward circuitry and learning and memory. This interaction might be mediated by the involvement of the endocannabinoid system and alterations in dopamine signaling in regions associated with reward and cognitive functioning. While current findings demonstrate a differential effect of comorbid use on neurobiological and behavioral correlates compared with single substance use, additional studies are needed controlling for potential psychiatric comorbidities, age of onset of use and use of other substances. Understanding the neurobiological mechanisms associated with comorbid cannabis and tobacco use will be important in developing successful treatment outcomes in the future.
Collapse
Affiliation(s)
- Punitha Subramaniam
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT USA
| | - Erin McGlade
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT USA; Department of Psychiatry, University of Utah, Salt Lake City, UT; George E. Whalen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Deborah Yurgelun-Todd
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT USA; Department of Psychiatry, University of Utah, Salt Lake City, UT; George E. Whalen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| |
Collapse
|
39
|
Hublet A, Bendtsen P, de Looze ME, Fotiou A, Donnelly P, Vilhjalmsson R, Baska T, Aasvee K, Franelic IP, Nic Gabhainn S, ter Bogt TFM. Trends in the co-occurrence of tobacco and cannabis use in 15-year-olds from 2002 to 2010 in 28 countries of Europe and North America. Eur J Public Health 2015; 25 Suppl 2:73-5. [PMID: 25805793 DOI: 10.1093/eurpub/ckv032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cannabis and tobacco use frequently co-occur. Adolescents who consume both substances experience more respiratory distress and psychosocial problems and are less likely to stop compared with those who use either tobacco or cannabis alone. This study examined time trends in tobacco and cannabis use among 15-year-olds in Europe and North America between 2002 and 2010. METHODS Twenty-eight countries were included and merged into six regions based on their welfare systems. Adolescents (n = 142 796) were divided in four 'user groups': 'no-users', 'tobacco and cannabis users', 'tobacco-only users' and 'cannabis-only users'. Prevalence rates are reported by study-wave and region. Logistic regressions with study wave as independent variable were used to study trends in the user groups and regions. Interaction effects between time and gender were considered. RESULTS Overall, tobacco use, and concurrent tobacco and cannabis use decreased by 3 and 3.7%, respectively, but prevalence rates varied by region. Only in North America, an interaction effect between time and gender was found in tobacco and cannabis users. CONCLUSIONS Although this study demonstrates a decrease in tobacco and cannabis use in most regions, it also shows that the use of both substances is related. Therefore, studying the co-occurring use of tobacco and cannabis is necessary.
Collapse
Affiliation(s)
- Anne Hublet
- 1 Department of Public Health, Ghent University, Ghent, Belgium
| | - Pernille Bendtsen
- 2 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Margreet E de Looze
- 3 Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anastasios Fotiou
- 4 Epidemiology Unit, University Mental Health Research Institute, Athens, Greece
| | - Peter Donnelly
- 5 School of Medicine, University of St Andrews, St Andrews, Scotland
| | | | - Tibor Baska
- 7 Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
| | - Katrin Aasvee
- 8 Chronic Disease Department, The National Institute for Health Development, Tallinn, Estonia
| | - Iva P Franelic
- 9 Croatian National Institute of Public Health, Zagreb, Croatia
| | - Saoirse Nic Gabhainn
- 10 Health Promotion Research Centre, National University of Ireland, Galway, Ireland
| | - Tom F M ter Bogt
- 3 Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
40
|
Assessing the overlap between tobacco and marijuana: Trends in patterns of co-use of tobacco and marijuana in adults from 2003-2012. Addict Behav 2015; 49:26-32. [PMID: 26036666 DOI: 10.1016/j.addbeh.2015.05.012] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/05/2015] [Accepted: 05/16/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND As marijuana legalization and acceptability increase in the U.S., it is important to understand the potential impact on tobacco use. Accordingly, we assessed prevalence, correlates, and ten-year trends in co-use of marijuana and tobacco among U.S. adults. METHODS Data came from 378,459 adults participating in the 2003-2012 National Survey on Drug Use and Health, an annual, cross-sectional, household survey. Data from 2011-2012 were used to compute the most recent prevalence of past 30-day marijuana and tobacco use (co-use). Data from 2003-2012 were used to compute demographic correlates of co-use, overall trends in co-use, and trends by age, race, and sex. We also assessed trends in tobacco use among marijuana users and marijuana use among tobacco users. RESULTS From 2011 to 2012, 5.2% of participants were past month co-marijuana and tobacco users, 24.0% were tobacco-only users, and 2.3% were marijuana-only users. From 2003 to 2012, prevalence of co-use increased overall (p<.0001), and among males and females (p<.001, p<.05), those ages 26-34 (p<.001) and 50+years (p<.0001), and Whites (p<.01), Blacks (p<.05), and Hispanics (p<.01); there were no changes among adults 18-25 years. Tobacco use among marijuana users decreased between 2003 and 2012 (from 74.3% to 69.6%, p<.0001), while marijuana use increased among tobacco users (from 14.2% to 17.8, p<.0001). CONCLUSIONS Co-use of tobacco and marijuana increased from 2003-2012, with marijuana use increasing among past-month tobacco users and tobacco use declining among past-month marijuana users. Improved surveillance of co-use is needed as marijuana legalization policies expand and become more integrated in communities.
Collapse
|
41
|
Reasons to use e-cigarettes and associations with other substances among adolescents in Switzerland. Drug Alcohol Depend 2015; 153:140-4. [PMID: 26077606 DOI: 10.1016/j.drugalcdep.2015.05.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objectives of this research were to describe the main reason(s) why adolescents use electronic cigarettes, to assess how e-cigarette experimenters and users differ based on personal characteristics, and to determine whether its use is associated with the use of other substances among a representative sample of youths in Switzerland. METHODS A representative sample of 621 youths (308 females) was divided into never users (n=353), experimenters (Only once, n=120) and users (Several times, n=148) of e-cigarettes. Groups were compared on socio-demographic data and current smoking, alcohol misuse and cannabis use. Reasons for e-cigarette use were compared between experimenters and users. A multinomial regression was performed using never users as the reference category. RESULTS Forty-three percent had ever tried e-cigarettes, and the main reason was curiosity. Compared to never users, experimenters were more likely to be out of school (Relative Risk Ratio [RRR]: 2.68) and to misuse alcohol (RRR: 2.08), while users were more likely to be male (RRR: 2.75), to be vocational students (RRR: 2.30) or out of school (RRR: 3.48) and to use any of the studied substances (tobacco, RRR: 5.26; alcohol misuse, RRR: 2.71; cannabis use, RRR: 30.2). CONCLUSIONS Although often still part of adolescent experimentation, e-cigarettes are becoming increasingly popular among adolescents and they should become part of health providers' standard substance use screening. As health providers (and especially paediatricians) do not seem to have high levels of knowledge and, consequently, little comfort in discussing e-cigarettes, training in this domain should be available to them.
Collapse
|
42
|
Akre C, Bélanger RE, Suris JC. Cannabis Users Identifying Themselves as Non-Cigarette Smokers: Who Are They? JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2015. [DOI: 10.1080/1067828x.2013.839406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
43
|
Fairman BJ. Cannabis problem experiences among users of the tobacco-cannabis combination known as blunts. Drug Alcohol Depend 2015; 150:77-84. [PMID: 25746234 PMCID: PMC4387065 DOI: 10.1016/j.drugalcdep.2015.02.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In most of the world, cannabis smokers mix loose tobacco inside a joint, pipe, spliff, or cone. More recently, a 'blunt' formulation combines these two drugs by inserting cannabis into a hollowed-out cigar. Epidemiological research linking simultaneous use of these two drugs and the development of cannabis use disorders (CUD) remains unclear. This study estimates associations linking blunt smoking with levels and subtypes of cannabis problems. METHODS Cross-sectional data on 27,767 past-year cannabis users were analyzed from the US National Survey on Drug Use and Health (NSDUH) conducted from 2009 to 2012. Ten self-reported items of DSM-IV CUD features elicited a single latent trait of cannabis problem (CP) severity, which was then regressed on past-year blunt smoking and past-month blunt frequency measures within the context of a conceptual model. Differential item functioning (DIF) analysis evaluated potential bias in CP feature response by blunt smoking history. RESULTS Past-year blunt smoking was associated with higher CP severity compared to cannabis users who did not smoke blunts. Days of blunt smoking in the past month also predicted higher CP severity than less frequent blunt use. Those smoking blunts experienced more subjectively felt tolerance and having spent more time obtaining or using cannabis, but were less likely to experience other problems, even at the same level of CP severity. CONCLUSIONS These findings suggest smoking blunts might promote the development of problematic cannabis use. Responses to cannabis problems differed by history of blunt smoking, possibly implicating an influence of tobacco on measurement of cannabis use disorders.
Collapse
Affiliation(s)
- Brian J. Fairman
- Department of Mental Health, John Hopkins Bloomberg School of Public Health, 624 North Broadway, 8th Floor, Baltimore, MD 21205 , Phone: (410) 347-3211, Fax: (410) 614-7569
| |
Collapse
|
44
|
Rabin RA, George TP. A review of co‐morbid tobacco and cannabis use disorders: Possible mechanisms to explain high rates of co‐use. Am J Addict 2015; 24:105-116. [DOI: 10.1111/ajad.12186] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 10/16/2014] [Accepted: 11/16/2014] [Indexed: 01/29/2023] Open
Affiliation(s)
- Rachel Allison Rabin
- Institute of Medical Science (IMS)Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Schizophrenia DivisionCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
| | - Tony Peter George
- Institute of Medical Science (IMS)Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Schizophrenia DivisionCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
- Division of Brain and TherapeuticsDepartment of PsychiatryUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
45
|
Becker J, Haug S, Sullivan R, Schaub MP. Effectiveness of different Web-based interventions to prepare co-smokers of cigarettes and cannabis for double cessation: a three-arm randomized controlled trial. J Med Internet Res 2014; 16:e273. [PMID: 25486674 PMCID: PMC4275498 DOI: 10.2196/jmir.3246] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 09/30/2014] [Accepted: 10/25/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The relationship between tobacco and cannabis use is strong. When co-smokers try to quit only one substance, this relationship often leads to a substitution effect, that is, the increased use of the remaining substance. Stopping the use of both substances simultaneously is therefore a reasonable strategy, but co-smokers rarely report feeling ready for simultaneous cessation. Thus, the question of how co-smokers can be motivated to attempt a simultaneous cessation has arisen. To reach as many co-smokers as possible, we developed brief Web-based interventions aimed at enhancing the readiness to simultaneously quit tobacco and cannabis use. OBJECTIVE Our aim was to analyze the efficacy of three different Web-based interventions designed to enhance co-smokers' readiness to stop tobacco and cannabis use simultaneously. METHODS Within a randomized trial, three brief Web-based and fully automated interventions were compared. The first intervention combined the assessment of cigarette dependence and problematic cannabis use with personalized, normative feedback. The second intervention was based on principles of motivational interviewing. As an active psychoeducational control group, the third intervention merely provided information on tobacco, cannabis, and the co-use of the two substances. The readiness to quit tobacco and cannabis simultaneously was measured before and after the intervention (both online) and 8 weeks later (online or over the phone). Secondary outcomes included the frequency of cigarette and cannabis use, as measured at baseline and after 8 weeks. RESULTS A total of 2467 website users were assessed for eligibility based on their self-reported tobacco and cannabis co-use, and 325 participants were ultimately randomized and analyzed. For the post-intervention assessment, generalized estimating equations revealed a significant increase in the readiness to quit tobacco and cannabis in the total sample (B=.33, 95% CI 0.10-0.56, P=.006). However, this effect was not significant for the comparison between baseline and the 8-week follow-up assessment (P=.69). Furthermore, no differential effects between the interventions were found, nor were any significant intervention or time effects found on the frequency of tobacco or cannabis use. CONCLUSIONS In the new field of dual interventions for co-smokers of tobacco and cannabis, Web-based interventions can increase the short-term readiness to quit tobacco and cannabis simultaneously. The studied personalized techniques were no more effective than was psychoeducation. The analyzed brief interventions did not change the secondary outcomes, that is the frequency of tobacco and cannabis use. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 56326375; http://www.isrctn.com/ISRCTN56326375 (Archived by WebCite at http://www.webcitation.org/6UUWBh8u0).
Collapse
Affiliation(s)
- Julia Becker
- Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Zurich, Switzerland.
| | | | | | | |
Collapse
|
46
|
Rubinstein ML, Rait MA, Prochaska JJ. Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers. Drug Alcohol Depend 2014; 141:159-62. [PMID: 24928480 PMCID: PMC4097075 DOI: 10.1016/j.drugalcdep.2014.05.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/01/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Marijuana and tobacco are the substances used most commonly by adolescents and co-occurring use is common. Use of one substance may potentiate the addictive properties of the other. The current study examined the severity of nicotine addiction among teen smokers as a function of co-occurring marijuana use. METHODS Participants were 165 adolescents (13-17 years old) who reported smoking at least 1 cigarette per day (CPD) in the past 30 days. General linear models examined the association of marijuana use with multiple measures of nicotine addiction including the Modified Fagerström Tolerance Questionnaire (mFTQ), Hooked on Nicotine Checklist (HONC), ICD-10, and the Nicotine Dependence Syndrome Scale (NDSS). RESULTS The adolescent sample (mean age=16.1 years, SD=0.95) averaged 3.0 CPD (SD=3.0) for 1.98 years (SD=1.5). Most (79.5%) also smoked marijuana in the past 30 days. In models controlling for age, daily smoking status, and years of tobacco smoking, frequency of marijuana use accounted for 25-44% of the variance for all four measures of adolescent nicotine dependence. CONCLUSIONS Marijuana use was associated with greater reported nicotine addiction among adolescent smokers. The findings suggest a role of marijuana in potentiating nicotine addiction and underscore the need for treatments that address both smoked substances.
Collapse
Affiliation(s)
- Mark L Rubinstein
- Division of Adolescent Medicine at the University of California, San Francisco, San Francisco, CA, USA.
| | - Michelle A Rait
- Division of Adolescent Medicine at the University of California, San Francisco, San Francisco, CA, USA.
| | - Judith J Prochaska
- Stanford Prevention Research Center at Stanford University, Stanford, CA, USA.
| |
Collapse
|
47
|
Haines-Saah RJ, Moffat B, Jenkins EK, Johnson JL. The Influences of Health Beliefs and Identity on Adolescent Marijuana and Tobacco Co-Use. QUALITATIVE HEALTH RESEARCH 2014; 24:946-956. [PMID: 24970249 DOI: 10.1177/1049732314539854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Among youth, the co-use of marijuana and tobacco is highly prevalent, yet a considerable gap remains in the drug-prevention literature pertaining to such co-use. In particular, the prevention field lacks research exploring how adolescents understand the health implications of smoking these two substances in combination. In this article, we draw on qualitative interviews with adolescents from three communities in British Columbia, Canada, and describe the health beliefs and social identities that they associated with smoking marijuana and tobacco. We argue that smoking prevention and cessation initiatives targeting adolescents must address both marijuana and tobacco. Such initiatives must also be designed to identify and address how adolescents frame the potential health harms associated with smoking these substances.
Collapse
Affiliation(s)
| | - Barbara Moffat
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily K Jenkins
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joy L Johnson
- University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
48
|
Webster L, Chaiton M, Kirst M. The co-use of tobacco and cannabis among adolescents over a 30-year period. THE JOURNAL OF SCHOOL HEALTH 2014; 84:151-159. [PMID: 24443776 DOI: 10.1111/josh.12137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 11/29/2012] [Accepted: 12/03/2012] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study explores the patterns of use and co-use of tobacco and cannabis among Ontario adolescents over 3 decades and if characteristics of co-users and single substance users have changed. METHODS Co-use trends for 1981-2011 were analyzed using the Centre for Addiction and Mental Health Ontario Student Drug Use and Health Survey, which includes 38,331 students in grades 7, 9, and 11. A co-user was defined as someone reporting daily tobacco and/or cannabis use in the past month. Trends over time (by gender and academic performance) were analyzed with logistic regression. RESULTS The prevalence of tobacco-only use, cannabis-only use, and co-use fluctuated considerably. During 1981-1993, there were more tobacco-only users than co-users and cannabis-only users; since 1993 the prevalence of tobacco use has decreased dramatically. Co-use prevalence peaked at 12% (95% confidence interval: 9, 15) in 1999, when prevalence of overall use of both substances was highest. In 2011, 92% of tobacco users also used cannabis, up from 16% in 1991. CONCLUSIONS In 2011 nearly all students who smoke tobacco daily also use cannabis. Non-regular use of either substance is highest now compared with the past 3 decades. Contemporary tobacco and cannabis co-users are significantly different than past users. Youth prevention programs should understand the changing context of cannabis and tobacco among youth.
Collapse
Affiliation(s)
- Lauren Webster
- Student, , Dalla Lana School of Public Health, c/o Ontario Tobacco Research Unit, T523, 33 Russell St, Toronto, ON M5S 2S1, Canada
| | | | | |
Collapse
|
49
|
Banbury A, Zask A, Carter SM, van Beurden E, Tokley R, Passey M, Copeland J. Smoking mull: a grounded theory model on the dynamics of combined tobacco and cannabis use among adult men. Health Promot J Austr 2014; 24:143-50. [PMID: 24168742 DOI: 10.1071/he13037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/23/2013] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED Australians' use of cannabis has been increasing. Over a third of Australians (35.4%) have used cannabis at some time in their lives and 10.3% are recent users. Almost two-thirds of cannabis users combine cannabis with tobacco. The aim of this study was to understand the process of mulling - smoking tobacco and cannabis together - using a grounded theory approach. METHODS Twenty-one in-depth semistructured interviews were conducted with men aged 25-34 and living on the North Coast of New South Wales. Interviews explored participants' smoking practices, histories and cessation attempts. RESULTS A model describing mulling behaviour and the dynamics of smoking cannabis and tobacco was developed. It provides an explanatory framework that demonstrates the flexibility in smoking practices, including substance substitution - participants changed the type of cannabis they smoked, the amount of tobacco they mixed with it and the devices they used to smoke according to the situations they were in and the effects sought. CONCLUSION Understanding these dynamic smoking practices and the importance of situations and effects, as well as the specific role of tobacco in mulling, may allow health workers to design more relevant and appropriate interventions. SO WHAT? Combining tobacco with cannabis is the most common way of smoking cannabis in Australia. However, tobacco cessation programmes rarely address cannabis use. Further research to develop evidence-based approaches for mull use would improve cessation outcomes.
Collapse
Affiliation(s)
- A Banbury
- Southern Cross University, Lismore, NSW 2480, Australia
| | | | | | | | | | | | | |
Collapse
|
50
|
Psychiatric, psychosocial, and physical health correlates of co-occurring cannabis use disorders and nicotine dependence. Drug Alcohol Depend 2014; 134:228-234. [PMID: 24183498 PMCID: PMC3865597 DOI: 10.1016/j.drugalcdep.2013.10.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several gaps in the literature on individuals with co-occurring cannabis and tobacco use exist, including the extent of psychiatric, psychosocial, and physical health problems. We examine these gaps in an epidemiological study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), of a large, nationally representative sample. METHODS The sample was drawn from Wave 2 NESARC respondents (N=34,653). Adults with current cannabis use disorders and nicotine dependence (CUD+ND) (n=74), CUD only (n=100), and ND only (n=3424) were compared on psychiatric disorders, psychosocial correlates (e.g., binge drinking; partner violence), and physical health correlates (e.g., medical conditions). RESULTS Relative to those with CUD only, respondents with CUD+ND were significantly more likely to meet criteria for bipolar disorder, Clusters A and B personality disorders, and narcissistic personality disorder, and reported engaging in a significantly higher number of antisocial behaviors. Relative to those with ND only, respondents with CUD+ND were significantly more likely to meet criteria for bipolar disorder, anxiety disorders, and paranoid, schizotypal, narcissistic, and borderline personality disorders; were significantly more likely to report driving under the influence of alcohol and being involved in partner violence; and reported engaging in a significantly higher number of antisocial behaviors. CUD+ND was not associated with physical health correlates. CONCLUSIONS Poor treatment outcomes for adults with co-occurring cannabis use disorders and nicotine dependence may be explained in part by differences in psychiatric and psychosocial problems.
Collapse
|