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Clark SL, McGinnis EW, Zhao M, Xie L, Marks GT, Aberg KA, van den Oord EJCG, Copeland WE. The Impact of Childhood Mental Health and Substance Use on Methylation Aging Into Adulthood. J Am Acad Child Adolesc Psychiatry 2024; 63:825-834. [PMID: 38157979 DOI: 10.1016/j.jaac.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/11/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To test whether childhood mental health symptoms, substance use, and early adversity accelerate the rate of DNA methylation (DNAm) aging from adolescence to adulthood. METHOD DNAm was assayed from blood samples in 381 participants in both adolescence (mean [SD] age = 13.9 [1.6] years) and adulthood (mean [SD] age = 25.9 [2.7] years). Structured diagnostic interviews were completed with participants and their parents at multiple childhood observations (1,950 total) to assess symptoms of common mental health disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, anxiety, and depression) and common types of substance use (alcohol, cannabis, nicotine) and early adversities. RESULTS Neither childhood mental health symptoms nor substance use variables were associated with DNAm aging cross-sectionally. In contrast, the following mental health symptoms and substance variables were associated with accelerated DNAm aging from adolescence to adulthood: depressive symptoms (b = 0.314, SE = 0.127, p = .014), internalizing symptoms (b = 0.108, SE = 0.049, p = .029), weekly cannabis use (b =1.665, SE = 0.591, p = .005), and years of weekly cannabis use (b = 0.718, SE = 0.283, p = .012). In models testing all individual variables simultaneously, the combined effect of the variables was equivalent to a potential difference of 3.17 to 3.76 years in DNAm aging. A final model tested a variable assessing cumulative exposure to mental health symptoms, substance use, and early adversities. This cumulative variable was strongly associated with accelerated aging (b = 0.126, SE = 0.044, p = .005). CONCLUSION Mental health symptoms and substance use accelerated DNAm aging into adulthood in a manner consistent with a shared risk mechanism. PLAIN LANGUAGE SUMMARY Using data from 381 participants in the Great Smoky Mountains Study, the authors examined whether childhood mental health symptoms, substance use, and early adversity accelerate biological aging, as measured by DNA methylation age, from adolescence to adulthood. Depressive symptoms and cannabis use were found to significantly accelerate biological aging. Models that tested the combined effect of mental health symptoms, substance use, and early adversity demonstrated that there was a shared effect across these types of childhood problems on accelerated aging.
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Affiliation(s)
| | | | - Min Zhao
- Virginia Commonwealth University, Richmond, Virginia
| | - Linying Xie
- Virginia Commonwealth University, Richmond, Virginia
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Cohen N, Mathew M, Brent J, Wax P, Davis AL, Obilom C, Burns MM, Canning J, Baumgartner K, Koons AL, Wiegand TJ, Judge B, Hoyte C, Chenoweth JA, Froberg B, Farrar H, Carey JL, Hendrickson RG, Hodgman M, Caravati EM, Christian MR, Wolk BJ, Seifert SA, Bentur Y, Levine M, Farrugia LA, Vearrier D, Minns AB, Kennedy JM, Kirschner RI, Aldy K, Schuh S, Campleman S, Li S, Myran DT, Feng L, Freedman SB, Finkelstein Y. Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry. Clin Toxicol (Phila) 2023; 61:591-598. [PMID: 37603042 DOI: 10.1080/15563650.2023.2238121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication. METHODS In this prospective cohort study, we collected data on all pediatric patients (<18 years) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics. RESULTS One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7-16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6-58.3; P < 0.001)) and cannabis edibles ingestion (adjusted odds ratio = 5.5; 95% confidence interval: 1.9-15.9; P = 0.001) were strong independent predictors of severe outcome. In an age-stratified regression analysis, in children older than >10 years, only polysubstance abuse remained an independent predictor for the severe outcome (adjusted odds ratio 37.1; 95% confidence interval: 6.2-221.2; P < 0.001). As all children 10 years and younger ingested edibles, a dedicated multivariable analysis could not be performed (unadjusted odds ratio 3.3; 95% confidence interval: 1.6-6.7). CONCLUSIONS Severe outcomes occurred for different reasons and were largely associated with the patient's age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role.
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Affiliation(s)
- Neta Cohen
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Mathew Mathew
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jeffrey Brent
- Departments of Medicine and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Toxicology Associates, Littleton, USA
| | - Paul Wax
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Adrienne L Davis
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Cherie Obilom
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Joshua Canning
- Department of Medical Toxicology, Banner - University Medical Center, Phoenix, AZ, USA
| | - Kevin Baumgartner
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew L Koons
- Department of Emergency Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA
| | - Timothy J Wiegand
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Bryan Judge
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA
| | - James A Chenoweth
- Department of Emergency Medicine, University of California at Davis, Sacramento, CA, USA
| | - Blake Froberg
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Henry Farrar
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Michael Hodgman
- Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA
| | - E Martin Caravati
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Brian J Wolk
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Steven A Seifert
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Yedidia Bentur
- Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Levine
- Department of Emergency Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lynn A Farrugia
- UF Health Shands Hospital, University of Florida College of Medicine, Gainesville, FL, USA
| | - David Vearrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alicia B Minns
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA
| | - Joseph M Kennedy
- Department of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | | | - Kim Aldy
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Suzanne Schuh
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | | | - Shao Li
- American College of Medical Toxicology, Phoenix, AZ, USA
| | | | - Lisa Feng
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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Roberts SCM, Raifman S, Biggs MA. Relationship between mandatory warning signs for cannabis use during pregnancy policies and birth outcomes in the Western United States. Prev Med 2022; 164:107297. [PMID: 36228875 PMCID: PMC9762150 DOI: 10.1016/j.ypmed.2022.107297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/01/2022] [Accepted: 10/04/2022] [Indexed: 10/31/2022]
Abstract
As U.S. states legalize recreational cannabis, some enact policies requiring Mandatory Warning Signs for cannabis during pregnancy (MWS-cannabis). While previous research has found MWS for alcohol during pregnancy (MWS-alcohol) associated with increases in adverse birth outcomes, research has not examined effects of MWS-cannabis. This study uses Vital Statistics birth certificate data from June 2015 - June 2017 in seven western states and policy data from NIAAA's Alcohol Policy Information System and takes advantage of the quasi-experiment created by Washington State's enactment of MWS-cannabis in June 2016, while nearby states did not. Outcomes are birthweight, low birthweight, gestation, and preterm birth. Analyses use a Difference-in-Difference approach and compare changes in outcomes in Washington to nearby states in the process of legalizing recreational cannabis (Alaska, California, Nevada) and, as a secondary analysis, nearby states continuing to criminalize recreational cannabis (Idaho, Montana, Wyoming). Birthweight was -7.03 g lower (95% CI -10.06, -4.00) and low birthweight 0.3% higher (95% CI 0.0, 0.6) when pregnant people were exposed to MWS-cannabis than when pregnant people were not exposed to MWS-cannabis, both statistically significant (p = 0.005 and p = 0.041). Patterns for gestation, -0.014 weeks earlier (95% CI -0.038, 0.010) and preterm birth 0.2% higher (95% CI -0.2, 0.7), were similar, although not statistically significant (p = 0.168 and 0.202). The direction of findings was similar in secondary analyses, although statistical significance varied. Similar to MWS-alcohol, enacting MWS-cannabis is associated with an increase in adverse birth outcomes. The idea that MWS-cannabis provide a public health benefit is not evidence-based.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States of America.
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States of America
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States of America
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