Marijuana-Related Posts on Instagram

Instagram is a highly visual social networking site whose audience continues to grow, especially among young adults. In the present study, we examine marijuana-related content on Instagram to better understand the varied types of marijuana-related social networking occurring on this popular social media platform. We collected 417,561 Instagram posts with marijuana-related hashtags from November 29 to December 12, 2014. We assessed content of a random sample (n = 5000) of these posts with marijuana-related hashtags. Approximately 2136 (43 %) were explicit about marijuana and further analyzed. Of the 2136 marijuana-related posts, images of marijuana were common (n = 1568). Among these 1568 marijuana images, traditional forms (i.e., buds/leaves) were the most common (63 %), followed by some novel forms of marijuana, including marijuana concentrates (20 %). Among the 568 posts that displayed marijuana being ingested, 20 % showed someone dabbing marijuana concentrates. Marijuana-related advertisements were also observed among the 2136 marijuana-related posts (9 %). Our findings signal the promotion of marijuana use in its traditional plant-based form; trendy and novel modes of marijuana ingestion were also endorsed. This content along with the explicit marketing of marijuana that we observed on Instagram have potential to influence social norms surrounding marijuana use.

"I feel like I've hit the bottom and have no idea what to do": Supportive social networking on Reddit for individuals with a desire to quit cannabis use

BACKGROUND

Online communities can provide social support to those in need and can foster personal empowerment for individuals experiencing distress. This study examines the content of a Reddit community dedicated to the support of people trying to quit using cannabis, in order to develop an understanding of the type of social networking occurring on this subreddit (e.g., community).

METHODS

A total of 100 Reddit posts and their replies (i.e., comments) were collected from the subreddit on June 12, 2015. Posts were qualitatively coded for expression of DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) symptoms of cannabis use disorder (CUD) as well as other prominently featured themes. Comments on posts where individuals were seeking support/advice were also coded.

RESULTS

Ninety-one people posted the 100 Reddit posts, and of those 35 (38%) people described enough symptoms to be classified as mild disorder severity, 15 (16%) moderate, and 11 (12%) severe, as outlined in the diagnostic criteria for CUD. Over half of posts (n = 51) were seeking advice and/or support from members of the community. There were 174 comments made by 108 unique people on the advice/support seeking posts. Most were supportive/encouraging in nature (140, 80%) and gave advice to the post author (126, 72%).

CONCLUSIONS

This exploratory research highlights the potential of online communities as tools for individuals coping with addiction recovery, and future research should investigate if involvement in such communities would be a beneficial supplement to more traditional recovery practices.

"It Takes Longer, but When It Hits You It Hits You!": Videos About Marijuana Edibles on YouTube

BACKGROUND

Interest in marijuana edibles has increased as perceptions of harm from marijuana have decreased. Media and peer influences impact youth substance use, and YouTube is the most popular video-sharing website. No studies have examined the content and accessibility of YouTube videos related to marijuana edibles.

OBJECTIVES

To describe the messages conveyed to viewers in YouTube videos about edibles and determine their accessibility to youth.

METHODS

On June 12, 2015, we searched YouTube for videos about marijuana/cannabis/weed edibles. A total of 51 videos were coded for presence of an age restriction, purpose(s) of the videos, consumption of edibles during the video, effects, and safety concerns.

RESULTS

Total views across all 51 videos were >9 million. Only 14% (7/51) were restricted to viewers over the age of 18 years. Over half (27/51, 53%) were informative videos, most (20/27, 74%) teaching how to make edibles, and 37% (19/51) were entertaining videos. Someone consumed an edible in 31% (16/51) of the videos, and the type of high was mentioned in 51% (26/51) of the videos, including delayed (18/26, 69%) or intense high (13/26, 50%). Fifty-five percent (28/51) mentioned delta-9-tetrahydrocannabinol potency or dosage. Only 10 of these (36%) presented this information specifically as a warning to prevent adverse effects. Conclusions/Importance: Edibles-related videos are easily found on YouTube, often instructing how to bake your own edibles and lacking information needed for safe consumption, and most are not age-restricted. Videos showing how to make edibles or presenting edibles use in an entertaining way that could influence youth to initiate use.

Marijuana advertising exposure among current marijuana users in the U.S

BACKGROUND

Little is known about marijuana advertising exposure among users in the U.S. We examined the prevalence of advertising exposure among young adult marijuana users through traditional and new media, and identified characteristics associated with seeking advertisements.

METHODS

We conducted a cross-sectional survey of 18-34 year-old past-month marijuana users in the U.S. using a pre-existing online panel (N=742). The survey queried about passively viewing and actively seeking marijuana advertisements in the past month, sources of advertisements, and marijuana use characteristics.

RESULTS

Over half of participants were exposed to marijuana advertising in the past month (28% passively observed advertisements, 26% actively sought advertisements). Common sources for observing advertisements were digital media (i.e., social media, online, text/emails; 77%). Similarly, those actively seeking advertisements often used Internet search engines (65%) and social media (53%). Seeking advertisements was more common among those who used medically (41% medical only, 36% medical and recreational) than recreational users (18%), who used concentrates or edibles (44% and 43%) compared to those who did not (20% and 19%), and who used multiple times per day (33%) compared to those who did not (19%) (all p<0.01).

CONCLUSIONS

Exposure to marijuana advertising among users is common, especially via digital media, and is associated with medical use, heavier use, and use of novel products with higher THC concentrations (i.e., concentrates) or longer intoxication duration (i.e., edibles). As the U.S. marijuana policy landscape changes, it will be important to examine potential causal associations between advertising exposure and continuation or frequency/quantity of use.

"No High Like a Brownie High": A Content Analysis of Edible Marijuana Tweets

PURPOSE

To investigate tweets about marijuana edibles for surveillance into the content of edibles-related tweets among individuals socially networking about this topic on Twitter.

DESIGN

Cross-sectional analysis of tweets containing edible marijuana-related key words during 1 month.

SETTING

Twitter.

PARTICIPANTS

Tweets sent during January 1 to 31, 2015.

METHODS

A random sample of 5000 tweets containing edibles-related key words was coded for sentiment (positive, negative, and neutral) by crowdsourced workers. Tweets normalizing or promoting edibles use were further analyzed, and demographic characteristics of the Twitter handles sending these tweets were inferred.

RESULTS

Of the 5000 tweets, 4166 (83%) were about marijuana edibles, and of those 75% (3134 of 4166) normalized or encouraged edibles use. Nearly half (48%, 1509 of 3134) of the tweets normalizing edibles mentioned wanting or planning to consume, currently consuming, or recently consuming edibles, and 12% (378 of 3134) described the intense or long-lasting effects following use. Individuals whose tweets promoted/encouraged edibles use were more likely to be young (between 17 and 24 years old) and of a racial/ethnic minority (52% black; 12% Hispanic) when compared to the Twitter average.

CONCLUSION

Tweets that normalize edibles use have the potential to increase their popularity. The prevalence of tweets about edibles' intense high could have implications for tailoring prevention messages that could be important for youth and young adult minorities who were inferred to be disproportionately socially networking about edibles on Twitter.

"Get drunk. Smoke weed. Have fun.": A Content Analysis of Tweets About Marijuana and Alcohol

PURPOSE

To explore the sentiment and themes of Twitter chatter that mentions both alcohol and marijuana.

DESIGN

Cross-sectional analysis of tweets mentioning both alcohol and marijuana during 1 month was performed.

SETTING

The study setting was Twitter.

PARTICIPANTS

Tweets sent from February 4 to March 5, 2014, were studied.

METHOD

A random sample (n = 5000) of tweets that mentioned alcohol and marijuana were qualitatively coded as normalizing both substances, preferring one substance over the other, or discouraging both substances. Other common themes were identified.

RESULTS

More than half (54%) of the tweets normalized marijuana and alcohol (without preferring one substance over the other), and 24% preferred marijuana over alcohol. Only 2% expressed a preference for alcohol over marijuana, 7% discouraged the use of both substances, and the sentiment was unknown for 13% of the tweets. Common themes among tweets that normalized both substances included using the substances with friends (17%) and mentioning substance use in the context of sex or romance (14%). Common themes among tweets that preferred marijuana over alcohol were the beliefs that marijuana is safer than alcohol (46%) and preferences for effects of marijuana over alcohol (40%).

CONCLUSION

Tweets normalizing polysubstance use or encouraging marijuana use over alcohol use are common. Both online and offline prevention efforts are needed to increase awareness of the risks associated with polysubstance use and marijuana use.

A Content Analysis of Vaping Advertisements on Twitter, November 2014

Introduction

Vaping has increased in popularity, and the potential harms and benefits are largely unknown. Vaping-related advertising is expected to grow as the vaping industry grows; people are exposed primarily to vaping advertisements on the Internet, and Twitter is an especially popular social medium among young people. The primary objective of our study was to describe the characteristics of vaping-related advertisements on Twitter.

Methods

We collected data on 403,079 English-language tweets that appeared during November 2014 and contained vaping-related keywords. Using crowdsourcing services, we identified vaping-related advertisements in a random sample of 5,000 tweets. The advertisement tweets were qualitatively coded for popular marketing tactics by our research team. We also inferred the demographic characteristics of followers of 4 Twitter handles that advertised various novel vape products.

Results

The random sample of 5,000 vaping-related tweets included 1,156 (23%) advertisement tweets that were further analyzed. Vape pens were advertised in nearly half of the advertisement tweets (47%), followed by e-juice (21%), which commonly mentioned flavors (42%). Coupons or price discounts were frequently observed (32%); only 3% of tweets mentioned vaping as a way to quit smoking or as an alternative to smoking. One handle had a disproportionately high percentage of racial/ethnic minority followers.

Conclusion

Vaping poses a threat to smoking prevention progress, and it is important for those in tobacco control to understand and counter the tactics used by vaping companies to entice their consumers, especially on social media where young people can easily view the content.

Hypoglycemia during moderate intensity exercise reduces counterregulatory responses to subsequent hypoglycemia

Hypoglycemia, which occurs commonly during and following exercise in people with diabetes, is thought to be due to attenuated counterregulation in the setting of therapeutic insulin excess. To better understand the pathophysiology of counterregulation, we aimed to determine if dextrose administration to maintain euglycemia during moderate intensity exercise alters the attenuation of counterregulatory responses to subsequent hypoglycemia in healthy adults. Counterregulatory responses to hypoglycemia were assessed in 18 healthy adults after bed rest and following exercise with (n = 9) and without (n = 9) dextrose infusion. Responses were measured during a stepped euglycemic‐hypoglycemic clamp 24 h after either bed rest or two 90‐min bouts of exercise at 70% peak oxygen uptake. Hypoglycemia occurred during the second bout of exercise without dextrose infusion. Plasma glucagon and epinephrine responses to stepped hypoglycemia after antecedent exercise without dextrose infusion were significantly lower at the 45 mg/dL glycemic level compared to after bed rest. However, no attenuation of the counterregulatory responses to hypoglycemia was evident after antecedent exercise when dextrose was infused. This study suggests that the attenuation of the counterregulatory responses during hypoglycemia after exercise is likely due to the hypoglycemia that occurs during moderate prolonged exercise and not solely due to exercise or its intensity.

A content analysis of tweets about high-potency marijuana

INTRODUCTION

"Dabbing" involves heating extremely concentrated forms of marijuana to high temperatures and inhaling the resulting vapor. We studied themes describing the consequences of using highly concentrated marijuana by examining the dabbing-related content on Twitter.

METHODS

Tweets containing dabbing-related keywords were collected from 1/1-1/31/2015 (n=206,854). A random sample of 5000 tweets was coded for content according to pre-determined categories about dabbing-related behaviors and effects experienced using a crowdsourcing service. An examination of tweets from the full sample about respiratory effects and passing out was then conducted by selecting tweets with relevant keywords.

RESULTS

Among the 5000 randomly sampled tweets, 3540 (71%) were related to dabbing marijuana concentrates. The most common themes included mentioning current use of concentrates (n=849; 24%), the intense high and/or extreme effects from dabbing (n=763; 22%) and excessive/heavy dabbing (n=517; 15%). Extreme effects included both physiological (n=124/333; 37%) and psychological effects (n=55/333; 17%). The most common physiologic effects, passing out (n=46/333; 14%) and respiratory effects (n=30/333; 9%), were then further studied in the full sample of tweets. Coughing was the most common respiratory effect mentioned (n=807/1179; 68%), and tweeters commonly expressed dabbing with intentions to pass out (416/915; 45%).

CONCLUSIONS

This study adds to the limited understanding of marijuana concentrates and highlights self-reported physical and psychological effects from this type of marijuana use. Future research should further examine these effects and the potential severity of health consequences associated with concentrates.

The Impact of the Minimum Legal Drinking Age on Alcohol-Related Chronic Disease Mortality

BACKGROUND

The minimum legal drinking age (MLDA) of 21 has been associated with a number of benefits compared to lower MLDAs, including long-term effects, such as reduced risk for alcoholism in adulthood. However, no studies have examined whether MLDA during young adulthood is associated with mortality later in life. We examined whether individuals exposed to permissive MLDA (<21) had higher risk of death from alcohol-related chronic disease compared to those exposed to the 21 MLDA. Because prior work suggests that MLDA affects college students differently, we also conducted conditional analyses based on ever having attended college.

METHODS

Data from the 1990 through 2010 U.S. Multiple Cause-of-Death files were combined with data on the living population and analyzed. We included individuals who turned 18 during the years 1967 to 1990, the period during which MLDA varied across states. We examined records on death from several alcohol-related chronic diseases, employing a quasi-experimental approach to control for unobserved state characteristics and stable time trends.

RESULTS

Individuals who reported any college attendance did not exhibit significant associations between MLDA and mortality for the causes of death we examined. However, permissive MLDA for those who never attended college was associated with 6% higher odds for death from alcoholic liver disease, 8% higher odds for other liver disease, and 7% higher odds for lip/oral/pharynx cancers (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.02, 1.10]; OR = 1.08, 95% CI [1.03, 1.13]; OR = 1.07, 95% CI [1.03, 1.12], respectively).

CONCLUSIONS

The 21 MLDA likely protects against risk of death from alcohol-related chronic disease across the lifespan, at least for those who did not attend college. This is consistent with other work that shows that the long-term association between MLDA and alcohol-related outcomes is specific to those who did not attend college.

An Analysis of Depression, Self-Harm, and Suicidal Ideation Content on Tumblr

BACKGROUND

Social networking about depression can be indicative of self-reported depression and/or can normalize risk behaviors such as self-harm and suicidal ideation.

AIM

To gain a better understanding of the depression, self-harm, and suicidal content that is being shared on Tumblr.

METHOD

From April 16 to May 10, 2014, 17 popular depression-related Tumblr accounts were monitored for new posts and engagement with other Tumblr users. A total of 3,360 posts were randomly selected from all historical posts from these accounts and coded based on themes ascertained by the research team.

RESULTS

The 17 Tumblr accounts posted a median number of 185 posts (range = 0-2,954). Content was engaged with (i.e., re-blogged or liked) a median number of 1,677,362 times (range = 0-122,186,504). Of the 3,360 randomly selected posts, 2,739 (82%) were related to depression, suicide, or self-harm. Common themes were self-loathing (412, 15%), loneliness/feeling unloved (405, 15%), self-harm (407, 15%), and suicide (372, 14%).

CONCLUSION

This study takes an important first step at better understanding the displayed depression-related references on Tumblr. The findings signal a need for suicide prevention efforts to intervene on Tumblr and use this platform in a strategic way, given the depression and suicidal content that was readily observed on Tumblr.

Patterns and Predictors of Inpatient Falls and Fall-Related Injuries in a Large Academic Hospital

Objectives:

Most research on hospital falls has focused on predictors of falling, whereas less is known about predictors of serious fall-related injury. Our objectives were to characterize inpatients who fall and to determine predictors of serious fall-related injury.

Methods:

We performed a retrospective observational study of 1,082 patients who fell (1,235 falls) during January 2001 to June 2002 at an urban academic hospital. Multivariate analysis of potential risk factors for serious fall-related injury (vs no or minor injury) included in the hospital's adverse event reporting database was conducted with logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CI95).

Results:

The median age of patients who fell was 62 years (interquartile range, 49-77 years), 50% were women, and 20% were confused. The hospital fall rate was 3.1 falls per 1,000 patient-days, which varied by service from 0.86 (women and infants) to 6.36 (oncology). Some (6.1%) of the falls resulted in serious injury, ranging by service from 3.1% (women and infants) to 10.9% (psychiatry). The most common serious fall-related injuries were bleeding or laceration (53.6%), fracture or dislocation (15.9%), and hematoma or contusion (13%). Patients 75 years or older (aOR, 3.2; CI95, 1.3-8.1) and those on the geriatric psychiatry floor (aOR, 2.8; CI95,1.3-6.0) were more likely to sustain serious fall-related injuries.

Conclusions:

There is considerable variation in fall rates and fall-related injury percentages by service. More detailed studies should be conducted by floor or service to identify predictors of serious fall-related injury so that targeted interventions can be developed to reduce them.

Declining Prevalence of Marijuana Use Disorders Among Adolescents in the United States, 2002 to 2013

OBJECTIVE

Little is known about recent trends in marijuana use disorders among adolescents in the United States. We analyzed trends in the past-year prevalence of DSM-IV marijuana use disorders among adolescents, both overall and conditioned on past-year marijuana use. Potential explanatory factors for trends in prevalence were explored.

METHOD

We assembled data from the adolescent samples of the 2002 to 2013 administrations of the National Survey on Drug Use and Health (N = 216,852; aged 12-17 years). The main outcome measures were odds ratios describing the average annual change in prevalence and conditional prevalence of marijuana use disorders, estimated from models of marijuana use disorder as a function of year. Post hoc analyses incorporated measures of potentially explanatory risk and protective factors into the trend analyses.

RESULTS

A decline in the past-year prevalence of marijuana use disorders was observed (odds ratio = 0.976 per year; 95% CI = 0.968, 0.984; p < .001). This was due to both a net decline in past-year prevalence of use and a decline in the conditional prevalence of marijuana use disorders. The trend in marijuana use disorders was accounted for by a decrease in the rate of conduct problems among adolescents (e.g., fighting, stealing).

CONCLUSION

Past-year prevalence of marijuana use disorders among US adolescents declined by an estimated 24% over the 2002 to 2013 period. The decline may be related to trends toward lower rates of conduct problems. Identification of factors responsible for the reduction in conduct problems could inform interventions targeting both conduct problems and marijuana use disorders.

Maternal age and risk of labor and delivery complications

We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11-18 years of age, compared to 25-29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were ≥35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women (≥40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications.

Selected State Policies and Associations With Alcohol Use Behaviors and Risky Driving Behaviors Among Youth: Findings from Monitoring the Future Study

BACKGROUND

Effective policies that can reduce alcohol use behaviors and impaired driving among young people at a population level are needed. Graduated driver licensing (GDL) laws increase the driving privileges of young novice drivers as they age and gain more driving experience. In this study, we seek to determine the effects of GDLs on risky driving behaviors of youth and to assess if GDLs have an unintended effect on underage drinking behaviors.

METHODS

We utilized 2000 to 2013 data on 12th grade students from the Monitoring the Future (MTF) study, an ongoing, annual national survey (since 1975) that studies the substance use behaviors of adolescents, as well as data on GDL laws obtained via the Insurance Institute for Highway Safety (IIHS). We conducted a series of regular logistic regression models that included fixed effects for year and state, and adjusted for demographic characteristics, school characteristics, and other state alcohol policies.

RESULTS

Total weighted sample size was 129,289 12th graders. Past month alcohol use and binge drinking (i.e., ≥5 drinks on one occasion) in the past 2 weeks were 45 and 26%, respectively. Seventeen percent of respondents reported riding with a driver who drank alcohol. Nearly 12% reported driving in the past 2 weeks after drinking alcohol, and 7% reported driving after binge drinking. Over half of the students lived in a state with a "good" GDL law. The logistic regression models suggest a link between restrictive GDL policies and a reduction of alcohol use behaviors and risky driving behaviors among youth.

CONCLUSIONS

Our findings indicate that the effects of GDLs extend beyond driving-related risks and into other drinking-related behaviors that pose immediate or delayed health risks for young people. We speculate that GDLs may dictate social norms and expectations for youth risk behaviors, and should be maximized throughout the United States.

A content analysis of depression-related Tweets

This study examines depression-related chatter on Twitter to glean insight into social networking about mental health. We assessed themes of a random sample (n=2,000) of depression-related tweets (sent 4-11 to 5-4-14). Tweets were coded for expression of DSM-5 symptoms for Major Depressive Disorder (MDD). Supportive or helpful tweets about depression was the most common theme (n=787, 40%), closely followed by disclosing feelings of depression (n=625; 32%). Two-thirds of tweets revealed one or more symptoms for the diagnosis of MDD and/or communicated thoughts or ideas that were consistent with struggles with depression after accounting for tweets that mentioned depression trivially. Health professionals can use our findings to tailor and target prevention and awareness messages to those Twitter users in need.

"Hey Everyone, I'm Drunk." An Evaluation of Drinking-Related Twitter Chatter

OBJECTIVE

The promotion of drinking behaviors correlates with increased drinking behaviors and intent to drink, especially when peers are the promotion source. Similarly, online displays of peer drinking behaviors have been described as a potential type of peer pressure that might lead to alcohol misuse when the peers to whom individuals feel attached value such behaviors. Social media messages about drinking behaviors on Twitter (a popular social media platform among young people) are common but understudied. In response, and given that drinking alcohol is a widespread activity among young people, we examined Twitter chatter about drinking.

METHOD

Tweets containing alcohol- or drinking-related keywords were collected from March 13 to April 11, 2014. We assessed a random sample (n = 5,000) of the most influential Tweets for sentiment, theme, and source.

RESULTS

Most alcohol-related Tweets reflected a positive sentiment toward alcohol use, with pro-alcohol Tweets outnumbering anti-alcohol Tweets by a factor of more than 10. The most common themes of pro-drinking Tweets included references to frequent or heavy drinking behaviors and wanting/needing/planning to drink alcohol. The most common sources of pro-alcohol Tweets were organic (i.e., noncommercial).

CONCLUSIONS

Our findings highlight the need for online prevention messages about drinking to counter the strong pro-alcohol presence on Twitter. However, to enhance the impact of anti-drinking messages on Twitter, it may be prudent for such Tweets to be sent by individuals who are widely followed on Twitter and during times when heavy drinking is more likely to occur (i.e., weekends, holidays).

Risk Factors Associated With Hookah Use

BACKGROUND

Potential harms associated with hookah smoking are largely unrecognized and it is emerging as a trendy behavior. To help inform policy and preventive interventions, we used responses from a population survey of US adults to examine risk factors associated with hookah involvement.

METHOD

An online survey of 17 522 US adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel plus off-panel recruitment. Multinomial logistic regression was used to examine the relationships between tobacco use patterns across multiple products (cigarettes, cigars, and dissolvables), perceived harms towards regular pipe/hookah use, and demographic characteristics with hookah involvement (never used, ever used with/without reusing intent).

RESULT

Nearly one in five (16%) of the respondents had smoked hookah at least once in their life ("ever users"). Ever users of hookah were at higher risk of having used cigarettes, cigars, and dissolvable tobacco products (all P < .01). Odds for hookah use were greater for those who perceived regular pipe/hookah use as less dangerous (P < .05). Odds for hookah involvement were higher among young adults (P < .001), individuals with higher educational attainment (P < .01), and Hispanics/Latinos (P < .05).

CONCLUSIONS

Information about the public health harms associated with hookah smoking should be delivered to individuals at-risk for hookah smoking. It is likely that misconceptions about the safety of hookah smoking could be driving, at least in-part, its increase in popularity.

Displays of dabbing marijuana extracts on YouTube

BACKGROUND

Dabbing involves heating marijuana extracts to a high temperature and inhaling the vapor. Little is known about this new method of using marijuana. YouTube, the most popular platform for sharing online videos, may be a go-to resource for individuals interested in learning about dabbing. Our objective was to explore the content of dabbing-related videos on YouTube.

METHODS

We searched for dabbing-related videos on YouTube using the search terms "dabbing" and "dabs" on January 22, 2015. For each term, videos were sorted by relevance and view count. A sample of 116 dabbing videos were viewed and coded for content.

RESULTS

The 116 videos (published by 75 unique channels) had a total of 9,545,482 views. Most (76%) of the channels had a specific focus on marijuana and 23% were located in California. Eighty-nine percent of the videos showed at least one person dabbing, and 61% of these showed someone dabbing repeatedly. Most dabbers were male (67%) and many appeared to be >25 years old (42%). Approximately 34% of the videos contained a product review, 28% provided instructions on dabbing or other educational information, and 21% contained at least a brief cautionary message. Over half (54%) of the videos referenced medical marijuana, and only 20% of the videos had an age-restriction.

CONCLUSIONS

Dabbing-related videos are easily found and can be readily viewed on YouTube. As marijuana use becomes more accepted by the general population, the popularity of dabbing-related videos could increase, potentially normalizing this potent form of marijuana use.

Hookah-Related Twitter Chatter: A Content Analysis

Introduction

Hookah smoking is becoming increasingly popular among young adults and is often perceived as less harmful than cigarette use. Prior studies show that it is common for youth and young adults to network about substance use behaviors on social media. Social media messages about hookah could influence its use among young people. We explored normalization or discouragement of hookah smoking, and other common messages about hookah on Twitter.

Methods

From the full stream of tweets posted on Twitter from April 12, 2014, to May 10, 2014 (approximately 14.5 billion tweets), all tweets containing the terms hookah, hooka, shisha, or sheesha were collected (n = 358,523). The hookah tweets from Twitter users (tweeters) with high influence and followers were identified (n = 39,824) and a random sample of 5,000 tweets was taken (13% of tweets with high influence and followers). The sample of tweets was qualitatively coded for normalization (ie, makes hookah smoking seem common and normal or portrays positive experiences with smoking hookah) or discouragement of hookah smoking, and other common themes using crowdsourcing.

Results

Approximately 87% of the sample of tweets normalized hookah use, and 7% were against hookah or discouraged its use. Nearly half (46%) of tweets that normalized hookah indicated that the tweeter was smoking hookah or wanted to smoke hookah, and 19% were advertisements/promotions for hookah bars or products.

Conclusion

Educational campaigns about health harms from hookah use and policy changes regarding smoke-free air laws and tobacco advertising on the Internet may be useful to help offset the influence of pro-hookah messages seen on social media.

A reexamination of medical marijuana policies in relation to suicide risk

OBJECTIVES

Previous research has suggested that medical marijuana policies lead to reductions in suicide rates. In this study, we further investigate the association between these policies and within-state changes in suicide risk.

METHODS

Data on suicide deaths (n=662,993) from the National Vital Statistics System Multiple Cause of Death files were combined with living population data. Fixed-effects regression methods were employed to control for state differences in suicide rates and national and state secular trends. Analyses extended prior research that suggested a protective effect of medical marijuana policies by incorporating newer data and additional covariates.

RESULTS

After adjustment for race/ethnicity, tobacco control policies, and other covariates, we found no association between medical marijuana policy and suicide risk in the population ages 15 and older (OR=1.000; 95% CI: 0.956, 1.045; p=0.98), among men overall (OR=0.996; 95% CI: 0.951, 1.043; p=0.87) or for any other age-by-sex groups.

CONCLUSION

We find no statistically significant association between medical marijuana policy and suicide risk. These results contradict prior analyses which did not control for race/ethnicity and certain state characteristics such as tobacco control policies. Failure to control for these factors in future analyses would likely bias estimates of the associations between medical marijuana policy and health outcomes.