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Crosland BA, Garg B, Bandoli GE, Mandelbaum AD, Hayer S, Ryan KS, Shorey-Kendrick LE, McEvoy CT, Spindel ER, Caughey AB, Lo JO. Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure. JAMA Netw Open 2024; 7:e2410151. [PMID: 38713462 PMCID: PMC11077393 DOI: 10.1001/jamanetworkopen.2024.10151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 05/08/2024] Open
Abstract
Importance The prevalence of cannabis use in pregnancy is rising and is associated with adverse perinatal outcomes. In parallel, combined prenatal use of cannabis and nicotine is also increasing, but little is known about the combined impact of both substances on pregnancy and offspring outcomes compared with each substance alone. Objective To assess the perinatal outcomes associated with combined cannabis and nicotine exposure compared with each substance alone during pregnancy. Design, Setting, and Participants This retrospective population-based cohort study included linked hospital discharge data (obtained from the California Department of Health Care Access and Information) and vital statistics (obtained from the California Department of Public Health) from January 1, 2012, through December 31, 2019. Pregnant individuals with singleton gestations and gestational ages of 23 to 42 weeks were included. Data were analyzed from October 14, 2023, to March 4, 2024. Exposures Cannabis-related diagnosis and prenatal nicotine product use were captured using codes from International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification. Main Outcome and Measures The main outcomes were infant and neonatal death, infants small for gestational age, and preterm delivery. Results were analyzed by multivariable Poisson regression models. Results A total of 3 129 259 pregnant individuals were included (mean [SD] maternal age 29.3 [6.0] years), of whom 23 007 (0.7%) had a cannabis-related diagnosis, 56 811 (1.8%) had a nicotine-use diagnosis, and 10 312 (0.3%) had both in pregnancy. Compared with nonusers, those with cannabis or nicotine use diagnoses alone had increased rates of infant (0.7% for both) and neonatal (0.3% for both) death, small for gestational age (14.3% and 13.7%, respectively), and preterm delivery (<37 weeks) (12.2% and 12.0%, respectively). Moreover, risks in those with both cannabis and nicotine use were higher for infant death (1.2%; adjusted risk ratio [ARR], 2.18 [95% CI, 1.82-2.62]), neonatal death (0.6%; ARR, 1.76 [95% CI, 1.36-2.28]), small for gestational age (18.0%; ARR, 1.94 [95% CI, 1.86-2.02]), and preterm delivery (17.5%; ARR, 1.83 [95% CI, 1.75-1.91]). Conclusions and Relevance These findings suggest that co-occurring maternal use of cannabis and nicotine products in pregnancy is associated with an increased risk of infant and neonatal death and maternal and neonatal morbidity compared with use of either substance alone. Given the increasing prevalence of combined cannabis and nicotine use in pregnancy, these findings can help guide health care practitioners with preconception and prenatal counseling, especially regarding the benefits of cessation.
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Affiliation(s)
- B. Adam Crosland
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | | | - Ava D. Mandelbaum
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Sarena Hayer
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Kimberly S. Ryan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | | | - Cindy T. McEvoy
- Division of Neonatology, Department of Pediatrics, Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland
| | - Eliot R. Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton
| | - Aaron B. Caughey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Jamie O. Lo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
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Mattingly DT, Mezuk B, Elliott MR, Neighbors HW, Leventhal AM, Fleischer NL. Distress about social problems and tobacco and cannabis use outcomes among young adults in Los Angeles County. Prev Med 2024; 179:107850. [PMID: 38199591 PMCID: PMC10843547 DOI: 10.1016/j.ypmed.2024.107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To examine associations of concern, worry, and stress about discrimination, shootings/violence, and police brutality and exclusive and dual tobacco and cannabis use among young adults. METHODS A prospective, racially/ethnically diverse cohort of young adults (n = 1960) living in Los Angeles, California completed a baseline survey in 2020 (age range: 19-23) and a follow-up survey in 2021. Exploratory factor analysis (EFA) was employed on nine variables assessing levels of concern, worry, and stress about societal discrimination, societal shootings/violence, and community police brutality at baseline. Past 30-day tobacco and cannabis use at follow-up was categorized as current exclusive tobacco, exclusive cannabis, and dual tobacco and cannabis (vs never/former) use based on eleven use variables. Multinomial logistic regressions estimated adjusted associations between each factor score (translated to standard deviation units) with exclusive and dual tobacco and cannabis use. RESULTS The EFA produced four factor scores representing concern/worry/stress (i.e., distress) about community police brutality (F1), distress about societal shootings/violence (F2), and distress about societal discrimination (F3), as well as generalized stress about police brutality, shootings/violence, and discrimination (F4). F1, F2, and F3 were associated with subsequent exclusive current cannabis use, with F1 having the strongest association (OR: 1.35, 95% CI: 1.18-1.55), while only F1 (OR: 1.51, 95% CI: 1.27-1.78) was associated with dual tobacco and cannabis use. None of the factors were associated with exclusive tobacco use. CONCLUSIONS Young adult concern, worry, and/or stress about social problems may increase risk of cannabis use with or without concurrent tobacco use 6-12 months later.
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Affiliation(s)
- Delvon T Mattingly
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40536, USA; Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Michael R Elliott
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Harold W Neighbors
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA 90089, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA; Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
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Adzrago D, Sulley S, Williams F. Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms. Drug Alcohol Depend 2024; 255:111083. [PMID: 38215510 PMCID: PMC10866552 DOI: 10.1016/j.drugalcdep.2024.111083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION E-cigarette and cannabis use has been linked to various health risks, including respiratory and cardiovascular conditions. Yet, extant knowledge about the risk factors for exclusive and dual use of e-cigarettes and cannabis is limited, especially among immigrants. We examined exclusive e-cigarette and cannabis use and their dual use associated with mental health disorders among immigrants and U.S.-born. METHODS We analyzed national cross-sectional data collected between May 13, 2021, and January 9, 2022, among adults aged >18 years (n= 4766) living in U.S. Multinomial logistic regression analyses were conducted to model the associations of exclusivity and dual-use (reference group= non-use) with anxiety/depression. RESULTS The dual-use prevalence was higher than exclusive e-cigarette and cannabis use, especially among U.S.-born (dual use= 14.79% vs. cannabis use= 13.53% vs. e-cigarette use= 7.11%) compared to immigrants (dual use= 8.23% vs. cannabis use= 5.03% vs. e-cigarette use= 6.31%). Immigrants had lower risks of exclusive cannabis and dual use compared to U.S.-born. Anxiety/depression was associated with higher risks of exclusive cannabis use and dual use across immigration status, but was associated with exclusive e-cigarette use among only immigrants. While effect sizes of dual-use associated with anxiety/depression were higher among U.S.-born, the effect sizes of exclusive e-cigarette and cannabis use associated with anxiety/depression were higher among immigrants. CONCLUSIONS The findings revealed significant mental health risks for e-cigarette, cannabis, and their dual use among immigrants and U.S.-born, especially among U.S.-born. These findings highlight the need for public health research and interventions to consider immigration status-related disparities in substance use.
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Affiliation(s)
- David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
| | - Saanie Sulley
- National Healthy Start Association, Washington, DC, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Pebley K, Krukowski RA, Little MA. E-Cigarette Use Among Pregnant Women: A Need for Better Measurement. J Womens Health (Larchmt) 2024; 33:3-4. [PMID: 38019580 PMCID: PMC10794837 DOI: 10.1089/jwh.2023.0889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kinsey Pebley
- Department of Public Health, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca A. Krukowski
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, Virginia, USA
| | - Melissa A. Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, Virginia, USA
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Mattingly DT, Neighbors HW, Mezuk B, Elliott MR, Fleischer NL. Racial/ethnic discrimination and tobacco and cannabis use outcomes among US adults. J Subst Use Addict Treat 2023; 148:208958. [PMID: 37102192 DOI: 10.1016/j.josat.2023.208958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/11/2022] [Accepted: 01/09/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Racial/ethnic discrimination (hereafter, discrimination) is associated with use of individual tobacco and cannabis products. However, we know little about how discrimination affects dual/polytobacco and cannabis use and associated use disorders. METHODS We used cross-sectional data on adults (18+) from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 35,744). We defined past-year discrimination as a summary scale (range: 0-24) based on six scenarios. We created a mutually exclusive six-category use variable: noncurrent, individual tobacco and noncannabis, individual tobacco and cannabis, individual cannabis and nontobacco, dual/polytobacco and noncannabis, and dual/polytobacco and cannabis based on past 30-day tobacco use of four products (i.e., cigarettes, electronic nicotine delivery systems, other combustibles (cigars, pipe), smokeless tobacco) and cannabis use. We also examined past-year tobacco use disorder (TUD) and cannabis use disorder (CUD) as a four-level variable: no disorders, TUD only, CUD only, and TUD and CUD. We estimated associations between discrimination and each outcome using adjusted multinomial logistic regression and assessed effect modification by stratifying adjusted models by race/ethnicity (i.e., Hispanic, non-Hispanic (NH) White, NH Black, and another race/ethnicity). RESULTS Experiencing more discrimination was associated with each outcome but was most strongly associated with dual/polytobacco and cannabis use (OR: 1.13, 95 % CI: 1.07-1.19) and joint TUD and CUD (OR: 1.16, 95 % CI: 1.12-1.20). Models stratified by race/ethnicity showed that discrimination was associated with dual/polytobacco and cannabis only among NH White adults, and with joint TUD and CUD only among NH Black and NH White adults. CONCLUSIONS Discrimination was associated with tobacco and cannabis use outcomes among multiple adult racial/ethnic populations, but associations were more profound for NH White and NH Black adults than adults from other racial/ethnic populations.
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Affiliation(s)
- Delvon T Mattingly
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Harold W Neighbors
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Michael R Elliott
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
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Lee H, Weerakoon SM, Harrell MB, Messiah SE, Rao DR. Neighborhood Characteristics and the Burden of E-Cigarette, or Vaping, Product Use-Associated Lung Injury: An Ecological Comparison Study. Pediatr Allergy Immunol Pulmonol 2023; 36:16-22. [PMID: 36930825 DOI: 10.1089/ped.2022.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Purpose: E-cigarette, or vaping, product use-associated lung injury (EVALI) is a severe consequence of vaping first described in 2019. Investigating associations between neighborhood-level characteristics and EVALI cases is an important step in identifying at-risk communities to implement future targeted prevention programs. Methods: We retrospectively identified 41 adolescents <19 years hospitalized for treatment for EVALI at Children's Medical Center Dallas from December 2018 to June 2021. Patient ZIP codes were extracted from the electronic medical record and were compared with Dallas area ZIP codes containing no EVALI cases. Socioeconomic status (SES) characteristics were obtained from the 2019 American Community Survey, and they were mapped for ZIP codes using ESRI ArcMap geospatial processing software. A parallel analysis was conducted utilizing data of adolescents hospitalized with appendicitis. Results: Ninety-five percent of our cohort used tetrahydrocannabinol-containing products, and 66% obtained their vaping products from informal sources. EVALI cases were less likely to reside in higher SES ZIP codes as measured by the proportion of the population with at least a high school education (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.99), access to broadband access (OR: 0.95, 95% CI: 0.91-0.99), and private health insurance (OR: 0.97, 95% CI: 0.95-0.99). Alternatively, they were more likely to reside in lower SES ZIP codes as measured by proportion of the population without any health insurance (OR: 1.07, 95% CI: 1.01-1.12). No neighborhood level low SES characteristics were associated with appendicitis hospitalizations. Conclusions: Although small in magnitude, EVALI cases were associated with lower SES ZIP codes but not with vape shop density.
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Affiliation(s)
- Harin Lee
- University of Texas Southwestern Medical Center, Medical School, Dallas, Texas, USA
| | - Sitara M Weerakoon
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston, Dallas, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Melissa B Harrell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Sarah E Messiah
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston, Dallas, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, Texas, USA
- Department of Pediatrics, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Devika R Rao
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, University of Southwestern Medical Center, Dallas, Texas, USA
- Children's Health System of Texas, Dallas, Texas, USA
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Lim CCW, Chan GCK, Wadsworth E, Stjepanović D, Chiu V, Chung JYC, Sun T, Connor J, Leung J, Gartner C, Hall W, Hammond D. Trends and Socio-Demographic Differences of Cannabis Vaping in the USA and Canada. Int J Environ Res Public Health 2022; 19:14394. [PMID: 36361272 PMCID: PMC9659122 DOI: 10.3390/ijerph192114394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
Given the rise in cannabis vaping, it is important to highlight the heterogeneity in vaping different cannabis product because of the potential differences in their health risks. This study aims to estimate the trends and socio-demographic correlates of the use of various cannabis vaping products across jurisdiction with different legal status. Data from the 2018 (n = 27,169) and 2019 (n = 47,747) waves of the International Cannabis Policy Study (ICPS) were used. Respondents aged 16-65 completed web-based surveys. In 2019, proportions of past year vaping of cannabis oil, dried flower and concentrates in the overall sample were highest in U.S. jurisdictions where cannabis was legalized for non-medical use (17.4%, 6.0%, 4.9%), followed by U.S. jurisdiction where non-medical cannabis use is illegal (13.7%, 5.8%, 2.9%), and lowest in Canada (8.1%, 4.4%, 2.1%). Vaping dried flower decreased from 2019 to 2018 in U.S. legal jurisdictions and Canada, while vaping cannabis oil and concentrates increased in all jurisdictions (p < 0.001). The odds of vaping all forms of products were higher among younger respondents (16-55 years), males, respondents with some college education, and persons with low-risk perceptions on daily cannabis vaping. In both ICPS surveys (2018 and 2019), cannabis oil was the most frequently vaped products, followed by dried flower, and concentrates. Detailed measures of product forms for cannabis vaping should be considered in future surveys.
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Affiliation(s)
- Carmen C. W. Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Gary C. K. Chan
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Elle Wadsworth
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Suite 500, Ottawa, ON K1P 5E7, Canada
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Jack Y. C. Chung
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
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Boakye E, El Shahawy O, Obisesan O, Dzaye O, Osei AD, Erhabor J, Uddin SMI, Blaha MJ. The inverse association of state cannabis vaping prevalence with the e-cigarette or vaping product-use associated lung injury. PLoS One 2022; 17:e0276187. [PMID: 36251673 PMCID: PMC9576092 DOI: 10.1371/journal.pone.0276187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
The e-cigarette or vaping product-use-associated lung injury (EVALI) epidemic was primarily associated with the use of e-cigarettes containing tetrahydrocannabinol (THC)- the principal psychoactive substance in cannabis, and vitamin-E-acetate- an additive sometimes used in informally sourced THC-containing e-liquids. EVALI case burden varied across states, but it is unclear whether this was associated with state-level cannabis vaping prevalence. We, therefore, used linear regression models to assess the cross-sectional association between state-level cannabis vaping prevalence (obtained from the 2019 behavioral Risk Factor Surveillance System) and EVALI case burden (obtained from the Centers for Disease Control and Prevention) adjusted for state cannabis policies. Cannabis vaping prevalence ranged from 1.14%(95%CI, 0.61%-2.12%) in Wyoming to 3.11%(95%CI, 2.16%-4.44%) in New Hampshire. EVALI cases per million population ranged from 1.90(0.38-3.42) in Oklahoma to 59.10(19.70-96.53) in North Dakota. There was no significant positive association but an inverse association between state cannabis vaping prevalence and EVALI case burden (Coefficient, -18.6; 95%CI, -37.5-0.4; p-value, 0.05). Thus, state-level cannabis vaping prevalence was not positively associated with EVALI prevalence, suggesting that there may not be a simple direct link between state cannabis vaping prevalence and EVALI cases, but rather the relationship is likely more nuanced and possibly reflective of access to informal sources of THC-containing e-cigarettes.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
| | - Omar El Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Olufunmilayo Obisesan
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States of America
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
| | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States of America
| | - John Erhabor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
| | - S. M. Iftekhar Uddin
- Department of Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, United States of America
- * E-mail:
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Roberts ME, Tackett AP, Singer JM, Wagner DD, Lu B, Wagener TL, Brinkman M, Klein EG, Vickerman KA, Wold LE, Gumina RJ, Mohler PJ. Dual Use of E-Cigarettes and Cannabis Among Young People in America: A New Public Health Hurdle? J Stud Alcohol Drugs 2022; 83:768-770. [PMID: 36136448 PMCID: PMC9523757 DOI: 10.15288/jsad.2022.83.768] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Megan E. Roberts
- College of Public Health, The Ohio State University, Columbus, Ohio
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Alayna P. Tackett
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Jill M. Singer
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - Dylan D. Wagner
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Bo Lu
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Marielle Brinkman
- College of Public Health, The Ohio State University, Columbus, Ohio
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Elizabeth G. Klein
- College of Public Health, The Ohio State University, Columbus, Ohio
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | | | - Loren E. Wold
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard J. Gumina
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter J. Mohler
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
- College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
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Lewis NM, Friedrichs M, Wagstaff SS, Nakashima AK, Dunn AC. Characteristics of Adults Who Use Both Marijuana and E-Cigarette, or Vaping, Products: A Cross-Sectional Study, Utah, 2018. Public Health Rep 2022; 137:695-701. [PMID: 34039118 PMCID: PMC9257507 DOI: 10.1177/00333549211018679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Among young people, dual use of marijuana and e-cigarette, or vaping, products (EVPs) is linked with using more inhalant substances and other substances, and poorer mental health. To understand antecedents and potential risks of dual use in adults, we analyzed a representative adult population in Utah. METHODS We used data from the 2018 Utah Behavioral Risk Factor Surveillance System (n = 10 380) and multivariable logistic regression to evaluate differences in sociodemographic characteristics, comorbidities, and risk factors among adults aged ≥18 who reported currently using both EVPs (any substance) and marijuana (any intake mode), compared with a referent group of adults who used either or neither. RESULTS Compared with the referent group, adults using EVPs and marijuana had greater odds of being aged 18-29 (adjusted odds ratio [aOR] = 12.44; 95% CI, 6.15-25.14) or 30-39 (aOR = 3.75; 95% CI, 1.73-8.12) versus ≥40, being male (aOR = 3.29; 95% CI, 1.82-5.96) versus female, reporting ≥14 days of poor mental health in previous 30 days (aOR = 2.30; 95% CI, 1.23-4.32) versus <14 days, and reporting asthma (aOR = 2.09; 95% CI, 1.02-4.31), chronic obstructive pulmonary disorder (aOR = 2.94; 95% CI, 1.19-7.93), currently smoking cigarettes (aOR = 4.56; 95% CI, 2.63-7.93), or past-year use of prescribed chronic pain medications (aOR = 2.13; 95% CI, 1.06-4.30), all versus not. CONCLUSIONS Clinicians and health promotion specialists working with adults using both EVPs and marijuana should assess risk factors and comorbidities that could contribute to dual use or associated outcomes and tailor prevention messaging accordingly.
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Affiliation(s)
- Nathaniel M. Lewis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Utah Department of Health, Salt Lake City, UT, USA
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11
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Ebrahimi Kalan M, Bursac Z, Jebai R, Zare S, Li W, Gautam P, Rahman A, Ward KD, Ben Taleb Z. State-specific Prevalence and Factors Associated With Current Marijuana, ENDS, and Cigarette use Among US Adults With Asthma. Tob Use Insights 2022; 15:1179173X221105783. [PMID: 35664420 PMCID: PMC9160892 DOI: 10.1177/1179173x221105783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background The use of marijuana (MJ), combustible cigarettes (hereafter cigarettes), and electronic nicotine delivery systems (ENDS) is widespread among United States (US) adults and linked to worsening respiratory symptoms, especially among adults with asthma. This study examined state-specific prevalence and factors associated with MJ, ENDS, and cigarette use among US adults with asthma. Methods We analyzed data of 41 974 adults aged ≥18 years having self-reported current asthma from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). We reported weighted prevalence to account for complex survey design and performed multivariable logistic regression models to examine factors associated with current use of MJ, ENDS, and cigarettes. Results Overall prevalence of current MJ, ENDS, and cigarette use among adults with asthma was 14.5%, 6.6%, and 27.2%, respectively. Our results showed the US states and territories with highest and lowest use prevalence for MJ (California: 23.6% vs Guam: 3.2%), ENDS (Indiana: 12.8% vs North Dakota: 4.0%), and cigarettes (West Virginia: 42.1% vs Guam: 12.3%). Both MJ and ENDS users were more likely to be male, younger, and live in an urban area, but MJ users were more likely and ENDS users less likely to be Non-Hispanic (NH) American Indian/Alaskan Native. Cigarette users were more likely to be older, have at least 1 health condition, and were less likely to be NH Black or Hispanic and college-educated. Conclusion Many US adults with asthma use MJ, ENDS, and cigarettes. Our findings provide insights for clinicians about the urgent need for effective interventions to reduce tobacco and MJ use among adults with asthma.
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Affiliation(s)
- Mohammad Ebrahimi Kalan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Rime Jebai
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Samane Zare
- School of Medicine, Department of Social Medicine, Population, & Public Health, University of California Riverside, Riverside, CA, USA
| | - Wei Li
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Prem Gautam
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Abir Rahman
- Cabell-Huntington Health Department, WV, USA
| | - Kenneth D Ward
- School of Public Health, Memphis University, Tennessee, USA
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
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12
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Cowan EA, Tran H, Watson CH, Blount BC, Valentín-Blasini L. The Quantitation of Squalene and Squalane in Bronchoalveolar Lavage Fluid Using Gas Chromatography Mass Spectrometry. Front Chem 2022; 10:874373. [PMID: 35464226 PMCID: PMC9021504 DOI: 10.3389/fchem.2022.874373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Chemicals of unknown inhalational toxicity are present in electronic cigarette and vaping products. E-cigarettes typically contain nicotine and other relatively hydrophilic chemicals while vaping products typically contain cannabinoids and other hydrophobic chemicals. For example, vaping products can include hydrophobic terpenes such as squalane (SQA) and squalene (SQE). However, little is known about the SQA and SQE transmission from liquid to aerosol. SQA and SQE are used in commercial products that are applied dermally and ingested orally, but limited information is available on their inhalational exposure and toxicity. We developed and validated a quantitative method to measure SQE and SQA in bronchoalveolar lavage fluid to assess if these chemicals accumulate in lung epithelial lining fluid after inhalation. Calibration curves spanned a range of 0.50–30.0 µg analyte per mL bronchoalveolar lavage fluid. Recoveries were found to be 97–105% for SQE and 81–106% for SQA. Limits of detection were 0.50 μg/ml for both SQE and SQA. The method was applied to bronchoalveolar lavage fluid samples of patients from the 2019 outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) and a comparison group. Neither SQA nor SQE was detected above the method LOD for any samples analyzed; conversely, SQA or SQE were reproducibly measured in spiked quality control BAL fluids (relative standards deviations <15% for both analytes). Further applications of this method may help to evaluate the potential toxicity of SQA and SQE chronically inhaled from EVPs.
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13
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Han DH, Seo DC. Identifying risk profiles for marijuana vaping among U.S. young adults by recreational marijuana legalization status: A machine learning approach. Drug Alcohol Depend 2022; 232:109330. [PMID: 35123363 DOI: 10.1016/j.drugalcdep.2022.109330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study attempted to identify risk profiles of marijuana vaping by state-level recreational marijuana legalization (RML) status among U.S. young adults (YA). METHODS Data were drawn from the most recent two waves of restricted use files of the Population Assessment of Tobacco and Health Study with state identifiers. We analyzed 6155 young adult (18-24 years) respondents who were naïve to marijuana vaping at Wave 4 and had matched data at Wave 5. We employed a two-stage machine learning approach to predict marijuana vaping initiation at Wave 5 with predictors measured at Wave 4. RESULTS Among YA who had never vaped marijuana at Wave 4, 19% of those who lived in the states with RML and 15% of those who lived in the states without RML reported marijuana vaping at Wave 5. Substance-use-related predictors were rarely found as leading predictors in the states with RML. In the states without RML, substance use behaviors, including electronic nicotine delivery systems and smokeless tobacco use, and the presence of externalizing symptoms emerged as predictors for marijuana vaping. Results also revealed that nonlinear interactions between the predictors of marijuana vaping. CONCLUSIONS Our results highlight the importance of accounting for the RML status in developing risk profiles of marijuana vaping. Externalizing symptoms may be a behavioral endophenotype of marijuana vaping in the states without RML. Machine learning appears to be a promising analytical approach to identify complex interactions between factors in predicting an emerging risk behavior such as marijuana vaping.
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Affiliation(s)
- Dae-Hee Han
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Dong-Chul Seo
- Indiana University School of Public Health, Bloomington, IN, USA.
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Abstract
PURPOSE Heavy and prolonged use of cannabis is associated with several adverse health, legal and social consequences. Although cannabis use impacts all U.S. racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention and treatment of cannabis use and Cannabis Use Disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers. FINDINGS The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlight unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use and cultural identity. SUMMARY Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.
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Affiliation(s)
- LaTrice Montgomery
- University of Cincinnati College of Medicine, Center for Addiction Research/Addiction Sciences Division, Cincinnati, Ohio
- Corresponding Author: LaTrice Montgomery, Ph.D., University of Cincinnati College of Medicine, Center for Addiction Research/Addiction Sciences Division, 3131 Harvey Avenue, Suite 204, Cincinnati, Ohio 45229; ; Phone: 513-585-8286
| | - Shapree Dixon
- University of Cincinnati College of Medicine, Center for Addiction Research/Addiction Sciences Division, Cincinnati, Ohio
| | - Dale S. Mantey
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center, Houston, Texas
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Unger JB, Falcon A. E-cigarette use among Hispanics: Reducing risk or recruiting new tobacco users? Addict Behav 2022; 125:107149. [PMID: 34678711 DOI: 10.1016/j.addbeh.2021.107149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/25/2021] [Accepted: 10/09/2021] [Indexed: 12/15/2022]
Abstract
The prevalence of cigarette smoking in the United States has been declining for over 50 years among all racial/ethnic groups. However, this progress could be stalled or even reversed by the increasing popularity of electronic cigarettes (e-cigarettes). Hispanics have experienced tobacco-related health disparities resulting from early age of cigarette smoking initiation and less success in quitting smoking. The effects of e-cigarettes on tobacco-related health disparities among Hispanics have not been well described. The uptake of e-cigarettes among Hispanic youth could lead to a "tipping point" phenomenon, in which Hispanics disproportionately become nicotine-dependent in adolescence and suffer increased tobacco-related disease in adulthood. Hypothetically, if Hispanic adult cigarette smokers switch to e-cigarettes, they could reduce (but not completely eliminate) their health risks. This article summarizes the research on the use of e-cigarettes among Hispanics. We describe the prevalence and patterns of e-cigarette use among Hispanic adolescents and adults compared with non-Hispanic whites. Findings indicate that e-cigarette use is rare among Hispanic adults, but Hispanic adolescents are at risk of experimenting with e-cigarettes at early ages, potentially leading to early nicotine addiction and exacerbating tobacco-related disparities in the future. Health education and policy interventions are needed to prevent e-cigarette use among Hispanic adolescents, while acknowledging that some Hispanic adult cigarette smokers may benefit from switching to e-cigarettes.
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Affiliation(s)
- Jennifer B Unger
- University of Southern California Keck School of Medicine, United States.
| | - Adolph Falcon
- National Alliance for Hispanic Health, United States
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16
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Case KR, Clendennen SL, Shah J, Tsevat J, Harrell MB. Changes in marijuana and nicotine vaping perceptions and use behaviors among young adults since the COVID-19 pandemic: A qualitative study. Addict Behav Rep 2022; 15:100408. [PMID: 35075434 PMCID: PMC8769660 DOI: 10.1016/j.abrep.2022.100408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/17/2021] [Accepted: 01/16/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Research is lacking on the impact of the COVID-19 pandemic on marijuana vaping behaviors; a notable limitation as marijuana vaping has been previously associated with respiratory issues among young people. This qualitative study explored how the COVID-19 pandemic influenced vaping perceptions and behaviors among young adults (18 to 25-year-olds). METHODS Qualitative interviews were conducted with 50 regular marijuana vapers. Individuals were eligible if they vaped marijuana at least 3 days per week (exclusively or dual use with nicotine). Interview transcripts were analyzed using deductive coding processes to identify themes. Differences in themes by gender and user status (regular marijuana versus regular dual vapers) were explored. RESULTS While many participants indicated that the pandemic negatively impacted their attitudes about vaping, participants also noted that their negative attitudes did not translate into reductions in use. Overall, 54% of participants reported increasing vaping during COVID-19. For both regular dual vapers and marijuana vapers, boredom was a prominent theme for increases in vaping. Lack of accessibility of marijuana was cited as a reason for decreasing marijuana among regular marijuana vapers but not for regular dual vapers. Males reported more unchanged attitudes about vaping and more males than females reported still sharing their devices. CONCLUSIONS More than half of participants reported increasing their vaping behaviors since the COVID-19 pandemic despite concerns about the potential for vaping to adversely impact lung and immune health. As the U.S. adapts to the COVID-19 pandemic, interventions should address factors that may contribute to increases in use behaviors.
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Affiliation(s)
- Kathleen R. Case
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229, United States,Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States,Corresponding author at: 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229, United States.
| | - Stephanie L. Clendennen
- UTHealth, UTHealth Science Center at Houston, School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, United States
| | - Jay Shah
- UTHealth, UTHealth Science Center at Houston, School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, United States
| | - Joel Tsevat
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229, United States,Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Melissa B. Harrell
- UTHealth, UTHealth Science Center at Houston, School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, United States
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17
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Harrell MB, Clendennen SL, Sumbe A, Case KR, Mantey DS, Swan S. Cannabis Vaping Among Youth and Young Adults: a Scoping Review. Curr Addict Rep 2022; 9:217-34. [PMID: 35573056 DOI: 10.1007/s40429-022-00413-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/16/2022]
Abstract
Purpose of Review The purpose of this review was to describe the state-of-the-literature on research specific to cannabis vaping among youth and young adults. Recent Findings Out of 1801 records identified, a total of 202 articles met eligibility criteria for inclusion in this review. Most of this literature (46.0% of studies) was specific to the health effects of cannabis vaping, particularly EVALI (e-cigarette and vaping associated lung injury). Other research areas identified in the review included the etiology (24.3%) and epidemiology (24.8%) of cannabis vaping, in addition to articles on regulation (8.4%) and marketing (5.5%) of the same. Summary Cannabis vaping is increasingly common among youth and young adults and more prevalent is settings where recreational use for adults has been legalized. The literature documents a number of negative health effects of cannabis vaping for young people, along with risk factors and reasons for the same. Supplementary Information The online version contains supplementary material available at 10.1007/s40429-022-00413-y.
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Boakye E, Obisesan OH, Uddin SMI, El-Shahawy O, Dzaye O, Osei AD, Benjamin EJ, Stokes AC, Robertson RM, Bhatnagar A, Blaha MJ. Cannabis vaping among adults in the United States: Prevalence, trends, and association with high-risk behaviors and adverse respiratory conditions. Prev Med 2021; 153:106800. [PMID: 34520787 PMCID: PMC9830549 DOI: 10.1016/j.ypmed.2021.106800] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/04/2021] [Accepted: 09/06/2021] [Indexed: 01/14/2023]
Abstract
The e-cigarette or vaping product-use-associated lung injury outbreak in the United States has raised concerns about the potential health effects of cannabis vaping, a method of cannabis use that is becoming increasingly popular. We used 2017-2019 Behavioral Risk Factor Surveillance System data to estimate yearly prevalence and trends of past-30-day cannabis use and vaping among US adults. We used multivariable logistic regression to evaluate the associations of cannabis vaping with high-risk behaviors, asthma, and other respiratory symptoms. Our sample size was 160,209 (53,945-2017; 55,475-2018; and 50,789-2019). Past-30-day cannabis use prevalence increased from 10.0% (95% CI, 9.4%-10.7%) in 2017 to 13.4% (12.8%-12.0%) in 2019. Similarly, past-30-day cannabis vaping prevalence increased from 1.0% (0.8%-1.2%) to 2.0% (1.7%-2.2%) over the same period, with the greatest increase, 1.2% to 3.9%, observed among young adults (18-24 years). Individuals who vaped cannabis were more likely to concurrently vape nicotine. Cannabis vaping was associated with increased odds of heavy alcohol use (aOR, 1.95; 95% CI, 1.45-2.63), binge drinking (aOR, 2.82; 95% CI, 2.25-3.54), and other high-risk behaviors (aOR, 2.47; 95% CI, 1.89-3.24). In analyses adjusting for sociodemographic characteristics and body mass index, cannabis vaping was not associated with asthma (aOR, 1.03; 95% CI, 0.64-1.64) or other respiratory symptoms (aOR, 1.08; 95% CI, 0.44-2.63). Adjusting for nicotine vaping did not substantively alter these associations. The prevalence of past-30-day cannabis vaping has increased, particularly among young adults, and was associated with high-risk behaviors. Although there was no association between cannabis vaping and asthma or other respiratory symptoms, the increasing trends of cannabis vaping, particularly among young adults, raise concern and underscore the need for continued surveillance.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
| | - Olufunmilayo H Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
| | - S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
| | - Omar El-Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
| | - Albert D Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Emelia J Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Andrew C Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Rose Marie Robertson
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; University of Louisville School of Medicine, Louisville, KY, USA.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
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Buckner JD, Morris PE, Zvolensky MJ. Cannabis use and electronic cigarette use: The role of dual use on use frequency and related problems. Psychiatry Res 2021; 304:114126. [PMID: 34303947 DOI: 10.1016/j.psychres.2021.114126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 01/17/2023]
Abstract
Despite high rates of use of both cannabis and electronic nicotine delivery systems (ENDS), little is known about the role of cannabis use among ENDS users and of ENDS use among cannabis users. This study tested whether dual use was related to more frequent use, use-related problems, and negative affect. Among cannabis users (n=315), ENDS was associated with more frequent cannabis use, cannabis-related problems, anxiety, and depression. Among ENDS users (n=156), cannabis was associated with more frequent ENDS use, ENDS-related problems, and anxiety. Overall, ENDS use is common among cannabis users and cannabis use is common among ENDS users. Further, use of both of these substances is related to more use, use-related problems, and negative affect, especially anxiety.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States.
| | - Paige E Morris
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; HEALTH Institute, University of Houston, Houston, TX, United States
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Abstract
This study reports the prevalence of ever use of marijuana in e-cigarettes among US youth in 2020 and changes in prevalence from 2017 to 2020 by racial and ethnic groups.
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Affiliation(s)
- Christina V. Watson
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samantha Puvanesarajah
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katrina F. Trivers
- Office on Smoking and Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Garrett PI, Honeycutt SC, Marston C, Allen N, Barraza AG, Dewey M, Turner B, Peterson AM, Hillhouse TM. Nicotine-free vapor inhalation produces behavioral disruptions and anxiety-like behaviors in mice: Effects of puff duration, session length, sex, and flavor. Pharmacol Biochem Behav 2021; 206:173207. [PMID: 34019915 DOI: 10.1016/j.pbb.2021.173207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Electronic-cigarette's (ECIGs) popularity has grown over the last decade and changed the way individuals administer nicotine. Preclinical research is imperative for understanding the addictive properties and health-risks associated with ECIG use; however, there is not a standard dosing regimen used across research laboratories. The main objective was to determine how vapor puff durations, administration session length, and flavored e-liquid alter general and mood-disorder related behaviors while providing a foundation of vapor administration parameters. Adult male and female C57BL/6 mice were exposed to several nicotine-free unflavored vapor puff durations (1, 3, 6, or 10 s) and vapor administration session lengths (10 and 30 min) then measured on the following assays: locomotor activity (LMA), tail suspension test (TST), and light-dark test. The effects of mecamylamine and the time-course of vapor-induced depression of LMA also were assessed. Additionally, mice were exposed to flavored (strawberry and adventurers tobacco blend) vapor inhalation and measured on locomotor activity, tail suspension test, and light-dark test. Following both 10 and 30 min vapor administration session, there was a puff duration-dependent decrease in distance traveled, time in center, and rearing. The vapor-induced depression of LMA was not mediated by nicotine or nicotinic acetylcholine receptor (nAChR) activation and lasted 60-90 min. The 10 s puff duration produced an anxiogenic-like effect in the light-dark test by decreasing the time spent in the light side. Vapor inhalation did not significantly alter TST behavior. No significant effects of sex or flavor were found. The anxiogenic-like effects of nicotine-free vapor inhalation are concerning as many adolescents vape nicotine-free flavored e-liquid, and there is an association between ECIGs and mood disorders. Additionally, these studies demonstrate that vapor puff duration, but not vapor administration session length, is an important variable to consider during research design as it can become a confounding variable and alter baseline behaviors.
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Affiliation(s)
- Patrick I Garrett
- Neuroscience Graduate Program, University of Wyoming, Laramie, WY, USA; Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Sarah C Honeycutt
- Department of Psychology, University at Buffalo, Buffalo, NY, USA; Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Clarissa Marston
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Nicole Allen
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Allyson G Barraza
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Megan Dewey
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Breeann Turner
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Ashley M Peterson
- Department of Psychological Science, Weber State University, Ogden, UT, USA
| | - Todd M Hillhouse
- Department of Psychological Science, Weber State University, Ogden, UT, USA; Department of Psychology, University of Wisconsin Green Bay, Green Bay, WI, USA.
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22
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Abstract
Sexual minorities (i.e. individuals who identify as lesbian, gay, and bisexual) are at increased risk for marijuana use. However, little is known about initiation during adulthood. This study examines: (1) sexual minority status as a risk factor for marijuana initiation, and (2) the modifying effect of sex (labeled at birth) on this relationship. Methods: We analyzed Wave 1 (2013-2014) and Wave 2 (2014-2015) of the Population Assessment of Tobacco and Health, a nationally representative survey. Participants were n = 10,756 adult never marijuana users. A multivariable logistic regression examined the relationship between sexual minority status and initiation of marijuana use at Wave 2. Multivariable logistic regressions, stratified by sex, were used to assess for effect modification. Covariates were sex, age, race/ethnicity, income, currently attending college, and mental health well-being. Results: Approximately 1.1% of adults initiated marijuana use from Wave 1 to Wave 2. Sexual minority status was associated with 1.57 (95% CI: 1.00-2.46) greater odds of marijuana initiation. In stratified analyses, sexual minority status was associated with greater odds of marijuana initiation for females (Adj OR: 1.97; 95% CI: 1.19-3.26) but not males (Adj OR: 0.84: 95% CI: 0.33-2.16). Conclusions: Sexual minority status is a risk factor for marijuana initiation during adulthood. This relationship was only consistent for females, suggesting that sex may be an effect modifier. However, research designed and powered to directly detect this effect is needed. Findings highlight a need for public health interventions that reduce disparities in marijuana use among sexual minorities.
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Affiliation(s)
- Dale S Mantey
- School of Public Health, University of Texas, Austin, Texas, USA
| | - R Andrew Yockey
- Department of Health Promotion and Education, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joseph G L Lee
- Department of Maternal & Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Yonek JC, Meacham MC, Ramo D, Delucchi K, Tolou-Shams M, Satre DD. The Relationship of E-Cigarette Use to Tobacco Use Outcomes Among Young Adults Who Smoke and Use Alcohol. J Addict Med 2021; 15:421-4. [PMID: 33229934 DOI: 10.1097/ADM.0000000000000773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES E-cigarette use is increasing among young adults in the U.S. However, longitudinal research studies examining associations between e-cigarette use and combustible cigarette use among young adults are limited. This study assessed the relationship of e-cigarette use to smoking reduction and cessation among young adults. METHODS This is a secondary analysis of a randomized controlled social media-based smoking cessation trial comprising adults ages 18 to 25 who smoked cigarettes and engaged in heavy episodic drinking (N = 179). Over 12 months, participants reported past month e-cigarette use with nicotine or tetrahydrocannabinol, cigarette quantity in the past week, quit attempts, and cessation strategies including nicotine e-cigarettes. Longitudinal regression models estimated associations between e-cigarette use, smoking reduction, and 7-day abstinence. RESULTS Past-month nicotine e-cigarette use prevalence ranged from 53.1% at baseline to 50.3% at 12 months. Over 70% of participants who reported past month nicotine e-cigarette use also smoked cigarettes (ie, dual use). Neither past month nicotine nor tetrahydrocannabinol e-cigarette use was associated with smoking reduction or cessation. However, use of nicotine e-cigarettes as a cessation strategy among participants attempting to quit (N = 137) was positively associated with abstinence (adjusted odds ratio = 2.47, 95% CI = 1.20-5.09) and ≥50% reduction in cigarettes per week from baseline (aOR = 2.36,95% CI = 1.08-5.18), relative to other strategies. CONCLUSIONS Nicotine e-cigarettes were significantly associated with improved tobacco use outcomes when used as a cessation strategy, but not when used apart from trying to quit smoking. Dual use may not be an effective path to achieve smoking cessation.
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