Changes in Prevalence of Marijuana Consumption Modes Among Colorado High School Students From 2015 to 2017

"What Do You Consider Use?" Perspectives of Black Youth on Cannabis Use

PURPOSE

Adolescent health surveillance systems are critical for understanding patterns of cannabis use; however, their limitations underscore the need for studies that generate new insights, particularly from individuals who are most impacted by negative outcomes. Our objectives were to learn about youths' cannabis use and their perceptions of their peers' cannabis use; their perspectives about trajectories of cannabis use over time and factors that influence trajectories; and perceived risks and benefits associated with cannabis use.

METHODS

A group model building approach was used to gather data about cannabis use from a sample of urban, Black youth. Information about participants' cannabis use was assessed on eligibility screener, enrollment survey, and through structured activities over the course of four group model building workshops.

RESULTS

Participants [(n = 20) mean age 18; 35% male and 95% Black] exclusively used the terms weed and blunts for cannabis. Youth who consume peers' blunts would not characterize themselves as cannabis users. Collectively, youth estimated the majority of Baltimore youth used cannabis by age 16 and that most used daily. Youth described cannabis as more beneficial than harmful. There were no gender differences in prevalence of use, but there were gender dynamics to shared use.

DISCUSSION

Participatory research with urban, Black youth suggests youths' perceptions are misaligned with the ways that researchers conceptualize cannabis use. To better understand the scope of youth cannabis use and its harms, it is critical to leverage input from youth with lived experience to ensure survey tools adequately capture the way youth see themselves using cannabis.

Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists

Cannabis use is prevalent among adolescents and young adults in the US. Virtually all modes of cannabis consumption involve the oral cavity, and previous studies have linked cannabis use with poorer oral health. We sought to identify associations between cannabis use and various oral health outcomes and behaviors among individuals 12-25 years of age, and to discuss implications for orthodontists who largely interact with this age group over an extended period of treatment time. We examined data from patient electronic health records (N = 14,657) obtained between 2015 and 2021. Associations between lifetime and current self-reported cannabis use and several oral health outcomes or related behaviors that reflect periodontal health, caries status, oral lesions, and physical integrity of tooth structure and restorations were examined in a bivariable and multivariable manner, controlling for patient age, sex, and self-reported tobacco and alcohol use. Reporting lifetime cannabis use was associated with higher risk for having oral lesions (aPR = 1.41, 95% CI: 1.07-1.85), bruxism (aPR = 1.31, 95% CI: 1.09-1.58), and frequent consumption of sugary beverages and snacks (aPR = 1.27, 95% CI: 1.12-1.41). Reporting current cannabis use was associated with higher risk for oral lesions (aPR = 1.45, 95% CI: 1.03-2.06) and frequent consumption of sugary beverages and snacks (aPR = 1.26, 95% CI: 1.07-1.48). Cannabis users aged 12-25 are at increased risk for bruxism, oral lesions, and frequent consumption of sugary beverages and snacks. Orthodontists and other dental professionals should probe for drug use and be cognizant of increased risk for oral health problems in patients that report actively using cannabis.

Longitudinal associations between e-cigarette use and onset of multiple modes of cannabis use among US adolescents

OBJECTIVE

To examine the prospective associations between e-cigarette use and subsequent onset of various modes of cannabis use during a 12-month follow-up period among US adolescents.

METHODS

Data were from the Wave 4 (2017, baseline) and Wave 4.5 (12-month follow-up) surveys of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study. Study population was cannabis-naïve US adolescents (12-16 years) at baseline who reported cannabis use status at follow-up (N = 9,692). Outcomes were modality-specific past-12-month cannabis use (vaping, blunting, smoking with hookah) and any cannabis use (past-12-month and past-30-day) at follow-up. Multivariate logistic regressions were used to estimate the weighted association between baseline past-30-day e-cigarette use and each outcome.

RESULTS

Baseline e-cigarette use was significantly associated with onset of cannabis vaping (aOR = 4.00, 95% CI = 2.25-7.10), blunting (aOR = 5.30, 95% CI = 2.82-9.94), any cannabis use (aOR = 3.94, 95% CI = 2.35-6.62), and past-30-day cannabis use (aOR = 4.47, 95%CI = 2.64-7.58) at follow-up. Non-Hispanic blacks were more likely to report past-12-month blunting (aOR = 1.55, 95% CI = 1.07-2.24) and smoking cannabis with hookah (aOR = 3.13, 95% CI = 1.14-8.63) compared with non-Hispanic whites. Other tobacco use, alcohol use, perceiving e-cigarette use as having little or some harm, older age, high severity of externalizing mental health problems, and living in states legalized adult recreational cannabis use were significantly associated with future onset of cannabis vaping, blunting, and any cannabis use.

CONCLUSIONS

The association of e-cigarette use with cannabis vaping was not stronger than its association with other modes of cannabis use. Future studies are needed to explain the mechanisms linking e-cigarettes and cannabis use.

Prevalence and use of cannabis products and routes of administration among youth and young adults in Canada and the United States: A systematic review

BACKGROUND

The current systematic review aimed to summarize the literature on the prevalence of routes of administration and cannabis products used among youth and young adults in Canada and the United States (US).

METHODS

Five academic databases were searched in April 2020 and February 2021. Peer-reviewed articles were included if they were a population-based quantitative observational study describing the prevalence of a cannabis product or route of administration among youth and young adults in Canada or the US. Risk of bias was assessed using Hoy and colleagues' risk of bias assessment tool. A narrative review was conducted.

RESULTS

Twenty-six studies were identified for the following routes of administration: smoking (n = 16), vaping (n = 21), dabbing (n = 3), oral (n = 13), topical (n = 1); and products: dried flower (n = 2), and concentrates (n = 8). Smoking had the highest prevalence rates among youth and young adults; however, rates of use appeared to reduce over time. Conversely, prevalence of vaping appeared to increase over time. Fewer studies focused on oral or dabbed cannabis but those that did reported prevalence estimates of approximately a third among recent cannabis consumers.

DISCUSSION

The heterogeneity of cannabis routes of administration restricted our ability to collate average prevalence estimates. In jurisdictions where non-medical cannabis is legal, policymakers should provide guidance and education to youth on each type of product and routes of administration.

OTHER

Funding for this study was provided by a Canadian Institutes of Health Research (PJT-153342). The current review was registered with PROSPERO (CRD42020169275).

Edible marijuana products and potential risks for pediatric populations

PURPOSE OF REVIEW

In recent years, an increasing number of states have legalized marijuana, also known as cannabis, for recreational use. As marijuana becomes more accessible, adolescent use and accidental pediatric exposures are likely to become broad public health concerns. Edible marijuana products, which are consumable foods or beverages that contain cannabis extract, are particularly enticing to youth, as they come in appealing forms such as candies, cookies, and drinks. The purpose of this review is to provide pediatricians with an overview of the different types and potential dangers associated with edible marijuana products.

RECENT FINDINGS

Edible marijuana products are often indistinguishable in appearance from normal food items and lack the smell and visible smoke associated with inhaled marijuana. Because they are inconspicuous, palatable, and easily accessible, they are increasingly popular among adolescents. Additionally, the packaging of edible baked goods, candies, and drinks is often purposefully very similar to that of mainstream foods, increasing the risk of accidental ingestion by children. An edible marijuana product must be digested before Δ9-tetrahydrocannabinol can enter the bloodstream, so there is a delayed onset of effects when consuming edibles compared with inhaling marijuana. This also predisposes users to accidental overconsumption.

SUMMARY

Greater knowledge of edible marijuana product consumption by pediatric populations will allow pediatricians to more effectively help patients and advise caregivers in cases of overconsumption, dependence, or accidental ingestion. It is important for parents, guardians, and educators to be able to successfully identify edible marijuana products and recognize signs of cannabis use.

Retail cannabis environment and adolescent use: The role of advertising and retailers near home and school

Youth cannabis use is influenced by overlapping environmental contexts. We examined the associations between proximity to cannabis retailers and seeing cannabis advertisements and cannabis use behaviors in Oregon, a state with adult cannabis legalization. We used 2017 anonymous survey data from 24,154 Oregon 8th and 11th grade students. After adjustments for student and school district characteristics, advertising for 8th graders and presence of a retailer within a mile from school for 11th graders were associated with cannabis use and perceived harm. Additional policy efforts may further reduce youth exposure to cannabis.

Effects of Risk Perception and Accessibility on Cannabis Use among Young Population in Spain: Findings from the 2016 National Survey (ESTUDES)

BackgroundCannabis use in the young population has undergone a significant increase in Europe. Empirical assessments of individual and contextual mediating variables in relation to cannabis use are informative for prevention actions and have yet to be conducted in Spain. Objectives: This study used the 2016 National Survey on Drug Use in Secondary Education in Spain (ESTUDES) to inform on potentially relevant cannabis prevention targets. We examined individual variables (sex, age, and cannabis risk perception), past 30-day legal and illicit substance use, substance-free activities, and contextual factors (perceived accessibility to cannabis) associated to past 30-day cannabis use. Methods: Data were drawn from 35,369 adolescents (% females: 50.1). Structural equation modeling (SEM) was implemented to identify predictors of cannabis use, and indirect paths were tested via bootstrapping to examine the mediating effects of cannabis risk perception and accessibility. Results: Demographics (male sex, higher age), and past 30-day tobacco, alcohol, and illicit substance use were associated with past 30-day cannabis use. Frequency of past-year engagement in hobbies and reading did also predict past 30-day cannabis use. The mediators worked on most of the relationships examined, except for hobbies and illegal substance use in the case of accessibility and reading and hobbies in the case of risk perception. Conclusions/importance: Cannabis use is more likely to emerge in the event of low risk perception and high accessibility. Lower frequency of past year reading and higher engagement in some hobbies that are often carried out alone represent risk factors, which could potentially influence prevention programs.

Heterogeneities in administration methods among cannabis users by use purpose and state legalization status: findings from a nationally representative survey in the United States, 2020

BACKGROUND AND AIMS

Different cannabis administration methods have differential impacts on health. This study aimed to describe administration methods among cannabis users in the United States categorized by (1) use purpose and (2) state legalization status.

DESIGN

Cross-sectional, probability-based online survey in 2020.

SETTING

All 50 states and Washington DC in the United States.

PARTICIPANTS

A total of 21 903 adults (18+) were recruited from a probability-based online panel to provide nationally representative estimates.

METHODS

Eleven administration methods were grouped into combustion, vaporization, ingestion and topicals. Weighted prevalence was reported among (1) medical-only, recreational-only and dual-purpose users based on self-reported purposes and (2) users in states that legalized both recreational and medical cannabis (RCL states), legalized medical cannabis only and did not legalize cannabis.

FINDINGS

Among past-year users, the proportions of medical-only, recreational-only and dual-purpose users were 25.55, 43.81 and 30.64%, respectively. The most common primary methods were combustion (42.08%) and topicals (28.65%) for medical purposes and combustion (72.07%) and ingestion (15.05%) for recreational purposes. Dual-purpose users were more likely to report combustion and vaporization but less likely to report ingestion and topicals as primary methods for medical use than medical-only users (P < 0.001) and more likely to report combustion and topicals but less likely to report ingestion as primary methods for recreational use than recreational-only users (P < 0.041). A higher proportion of dual-purpose users (82.82%) used more than one method than medical-only (40.52%) and recreational-only users (63.91%) (P < 0.001). For both medical and recreational purposes, RCL states had the lowest rate of combustion and the highest rates of ingestion and topicals reported as primary methods (P < 0.033). The rate of using more than one administration method did not differ across states (P > 0.05).

CONCLUSION

Cannabis users whose purposes are medical, recreational or both tend to differ in their selected administration methods.

The association between recreational cannabis commercialization and cannabis exposures reported to the US National Poison Data System

BACKGROUND AND AIMS

Recreational cannabis has been legalized in 11 states and District of Columbia (DC) in the United States. Among these, 10 states further permitted retail sale to provide a legal supply to adults. This study examined the associations of cannabis exposures with recreational cannabis legalization and commercialization.

DESIGN

Secondary data analysis of state-quarter level cannabis exposures during 2010-17 in the United States. Linear regressions with a difference-in-differences design were used to compare pre- and post-legalization trends in states that legalized recreational cannabis to contemporaneous trends in states that did not legalize recreational cannabis.

SETTING

United States, including all 50 states and DC.

CASES

Cannabis exposures reported to the US National Poison Data System.

MEASUREMENTS

The primary outcome was state age-adjusted cannabis exposures reported to the US National Poison Data System per 1 000 000 population per quarter. The two policy variables of interest included (1) the enactment of recreational cannabis legalization (i.e. removing penalties for adults' possession of cannabis in a small amount for recreational use) and (2) the initiation of recreational cannabis commercialization (i.e. providing a legal supply of cannabis to adults through licensed dispensaries).

FINDINGS

The association between a state's enactment of recreational cannabis legalization and its changes in cannabis exposures was statistically non-significant overall. After controlling for recreational cannabis legalization, however, the initiation of recreational cannabis commercialization was associated with 5.06-5.80 more exposures per 1 000 000 population per quarter (67-77% increase relative to the pre-legalization average), depending on the composition of comparison states. The increase associated with commercialization was higher among minors than adults (7.97-9.53 versus 3.83-4.21 more exposures), higher among males than females (6.16-7.56 versus 3.76-3.91 more exposures) and higher among exposures with medical consequences than those without medical consequences (4.09-4.79 versus 0.97-1.01 more exposures).

CONCLUSION

An increase in cannabis exposures reported to the US National Poison Data System was observed following recreational cannabis commercialization in the United States.