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Ruleman AM, Clendennen SL, Chen B, Harrell MB. Reasons for multiple tobacco product and cannabis co-use among Texas young adults. Addict Behav 2024; 156:108063. [PMID: 38824720 DOI: 10.1016/j.addbeh.2024.108063] [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: 01/13/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users. METHODS Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use. RESULTS 26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users. CONCLUSIONS Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.
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Affiliation(s)
- Ashlynn M Ruleman
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA.
| | - Stephanie L Clendennen
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
| | - Baojiang Chen
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
| | - Melissa B Harrell
- University of Texas Health Science Center, School of Public Health, 1836 San Jacinto Blvd, Austin, TX 78701, USA
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Temourian AA, Halliday DM, Yan Y, Chan-Golston AM, Song AV. Marijuana and E-cigarette Initiation Among Adolescents: A Survival Analysis. J Adolesc Health 2024; 74:747-754. [PMID: 38085208 DOI: 10.1016/j.jadohealth.2023.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE Prior literature suggests marijuana and e-cigarette initiation among adolescents is surpassing combustible cigarette uptake. Marijuana and nicotine co-use is also a concern as these products grow in popularity. Initiation trajectories for marijuana and e-cigarette products are not well understood, let alone how the use of one product may impact initiation susceptibility for the other. METHODS We used national longitudinal data from the Population Assessment of Tobacco and Health study from 2013 to 2018. Eighth graders in Wave 1 made up the analytic sample (N = 2,270). We employed discrete time survival analyses to determine the likelihood of initiating marijuana and e-cigarettes between Waves 2 and 5. We used survival analyses to estimate the relationships between prior cigarette and marijuana use and subsequent e-cigarette initiation, as well as prior cigarette and e-cigarette use and subsequent marijuana initiation. RESULTS Previous marijuana initiation was associated with later e-cigarette initiation (odds ratio = 6.88, 95% confidence interval [4.89, 9.67]). Previous e-cigarette initiation was associated with later marijuana initiation (odds ratio = 9.28, 95% confidence interval [6.86, 12.56]). By wave 5, adolescents were more than 42% likely to initiate marijuana and e-cigarettes. DISCUSSION Susceptibility to marijuana and e-cigarette products starts as early as eighth grade and increases over time. The use of one product is significantly related to later initiation for the other. Rather than addressing marijuana and nicotine as separate concerns, interventions may benefit by recognizing the closely related nature of these products.
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Affiliation(s)
- Allison A Temourian
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, California; Nicotine and Cannabis Policy Center, Health Sciences Research Institute, University of California, Merced, California
| | - Deanna M Halliday
- Center for Tobacco Control Research and Education, University of California, San Francisco, California
| | - Yueqi Yan
- Biostatistics and Data Support Center, Health Sciences Research Institute, University of California, Merced, California
| | - Alec M Chan-Golston
- Department of Public Health, School of Social Sciences, Humanities, & Arts, University of California, Merced, California; Biostatistics and Data Support Center, Health Sciences Research Institute, University of California, Merced, California
| | - Anna V Song
- Department of Psychological Sciences, School of Social Sciences, Humanities, & Arts, University of California, Merced, California; Nicotine and Cannabis Policy Center, Health Sciences Research Institute, University of California, Merced, California.
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Sumodhee D, Walsh H, Brose L, McNeill A, McEwen A, Duaso MJ. Support Provided by Stop-Smoking Practitioners to Co-users of Tobacco and Cannabis: A Qualitative Study. Nicotine Tob Res 2024; 26:23-30. [PMID: 37429576 PMCID: PMC10734383 DOI: 10.1093/ntr/ntad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/17/2023] [Accepted: 07/10/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Co-use of tobacco and cannabis is highly prevalent among cannabis users and is associated with poorer tobacco cessation outcomes. This study explored the barriers and enablers influencing stop-smoking practitioners' ability to provide optimal support to co-users. AIMS AND METHODS Online semi-structured interviews were audio recorded. Interviewees (n = 20) were UK-based certified stop-smoking practitioners. An interview schedule informed by the "capability", "opportunity", "motivation" (COM-B) model was designed to explore participants' perceived barriers and enablers in better supporting co-users to achieve abstinence of both substances or tobacco harm reduction. The transcripts were analyzed using framework analysis. RESULTS Capability: Practitioners' lack of knowledge and skills undermines their delivery of smoking cessation interventions to co-users. Interestingly, when cannabis is used for medicinal reasons, practitioners feel unable to provide adequate support. Opportunity: Service recording systems play an important role in screening for co-use and supporting co-users. When responding to clients' specific needs and practitioners' uncertainties, a positive therapeutic relationship and a support network of peers and other healthcare professionals are needed. Motivation: supporting co-users is generally perceived as part of practitioners' roles but there are concerns that co-users are less likely to successfully stop smoking. CONCLUSIONS Practitioners are willing to support co-users, but their lack of knowledge and access to an appropriate recording system are barriers to doing so. Having a supportive team and a positive therapeutic relationship is perceived as important. Identified barriers can be mostly addressed with further training to improve tobacco cessation outcomes for co-users.
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Affiliation(s)
- Dayyanah Sumodhee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (FNMPC), King’s College London, London, UK
| | - Hannah Walsh
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (FNMPC), King’s College London, London, UK
| | - Leonie Brose
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, UK
| | - Maria J Duaso
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (FNMPC), King’s College London, London, UK
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Sevigny EL, Greathouse J, Medhin DN. Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1362. [PMID: 37915420 PMCID: PMC10616541 DOI: 10.1002/cl2.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. Objectives This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. Search Methods We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. Selection Criteria The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws. Data Collection and Analysis Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. Main Results The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. Authors’ Conclusions More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.
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Affiliation(s)
- Eric L. Sevigny
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jared Greathouse
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Danye N. Medhin
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
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Mattingly DT, Mezuk B, Elliott MR, Neighbors HW, Fleischer NL. Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01822-z. [PMID: 37828404 DOI: 10.1007/s40615-023-01822-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear. METHODS We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification. RESULTS We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults. CONCLUSION We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.
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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
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
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Sokolovsky AW, Rubenstein D, Gunn RL, White HR, Jackson KM. Associations of daily alcohol, cannabis, combustible tobacco, and e-cigarette use with same-day co-use and poly-use of the other substances. Drug Alcohol Depend 2023; 251:110922. [PMID: 37625332 PMCID: PMC10538395 DOI: 10.1016/j.drugalcdep.2023.110922] [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: 04/04/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Young adults frequently use alcohol, cannabis, and tobacco together. Given the increased prevalence of e-cigarette use and recreational cannabis use, we investigated daily patterns of alcohol, cannabis, and tobacco use and distinguished combustible tobacco from e-cigarettes. METHODS Young adult college students (N=341) reporting past-month alcohol and cannabis use "at the same time so that their effects overlapped" completed two 28-day bursts of repeated daily surveys. Exposures were day- and person-level use of each substance. Outcomes were (1) same-day co-use of each remaining substance or (2) poly-use of the other substances. RESULTS Daily use of alcohol, cannabis, combustible cigarettes, and e-cigarettes increased the odds of same-day co-use of the other substances (except combustible tobacco with e-cigarettes) and each poly-use outcome. The influence of person-level substance use on daily substance use was less consistent. Only e-cigarette use increased the odds of daily alcohol use. Use of either tobacco product but not alcohol increased the odds of daily cannabis use. Person-level alcohol and cannabis use increased the odds of daily use of either tobacco product but use of one tobacco product was not associated with daily use of the other product. CONCLUSIONS These findings increase our understanding of emerging daily patterns of alcohol, cannabis, and tobacco co-use, and the impact of different tobacco products. Future work is needed to extend this research into non-college samples and people who use tobacco but do not use alcohol and cannabis simultaneously, and examine daily chronologies of multiple substances that could serve as dynamic markers of risk.
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Affiliation(s)
- Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States.
| | - Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2400 Pratt Street, Durham, NC 27705, United States
| | - Rachel L Gunn
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
| | - Helene R White
- Rutgers Center of Alcohol and Substance Studies, Rutgers University, 607 Allison Road, Piscataway, NJ 08854-8001, United States
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, United States
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Croker JA, Werts M, Couch ET, Chaffee BW. Cannabis use among adolescents and emerging adults who use e-cigarettes: Findings from an online, national U.S. Sample. Addict Behav 2023; 140:107620. [PMID: 36724700 PMCID: PMC9984189 DOI: 10.1016/j.addbeh.2023.107620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023]
Abstract
Concurrent use of e-cigarettes and cannabis among adolescents and emerging adults is a growing public health concern. More research is needed describing cannabis use among adolescents and emerging adults who vape. The objective of this study was to characterize cannabis use among adolescents and emerging adults (age 14-20) who reported e-cigarette ever-use, particularly their use of blunts and liquid cannabis vape (LCV) products. Using cross-sectional data from a national online survey, we describe their patterns of cannabis use, detail their use of flavored cannabis and tobacco products, and estimate associations of demographic factors and other current substance use behaviors with levels of blunt and LCV use. Of the 2253 respondents in the sample, 1379 (61 %) reported some form of cannabis use in the past 30 days, among whom 80 % used flavored cannabis (including edibles). Significant associations with current cannabis use were observed on several demographic measures, with current cannabis blunt use more frequent among participants not in school, non-Hispanic Blacks, multiracial respondents, and those whose incomes do not meet their expenses. Other than income, demographic characteristics were generally not associated with LCV use frequency. Use of other substances was associated with more frequent use of both blunts and LCV in the past 30 days, and enrollment in college or the military seems somewhat protective for emerging adults. These findings suggest a need for tailored prevention efforts among high-risk adolescents and emerging adults, potential regulation of added flavors in commercialized cannabis products, and stronger enforcement of retail restrictions for individuals under age 21 more broadly.
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Affiliation(s)
- James A Croker
- Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA.
| | - Miranda Werts
- Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.
| | - Elizabeth T Couch
- Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.
| | - Benjamin W Chaffee
- Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA; Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.
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Glasser AM, Nemeth JM, Quisenberry AJ, Shoben AB, Trapl ES, Klein EG. The Role of Cigarillo Flavor in the Co-Use of Cigarillos and Cannabis among Young Adults. Subst Use Misuse 2023; 58:717-727. [PMID: 36861952 PMCID: PMC10081100 DOI: 10.1080/10826084.2023.2184206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background: Research suggests flavor facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis ("co-use"), which is common among young adult smokers. This study's aim was to determine the role of the cigarillo flavor in co-use among young adults. Methods: Data were collected (2020-2021) in a cross-sectional online survey administered to young adults who smoked ≥2 cigarillos/week (N = 361), recruited from 15 urban areas in the United States. A structural equation model was used to assess the relationship between flavored cigarillo use and past 30-day cannabis use (flavored cigarillo perceived appeal and harm as parallel mediators), including several social-contextual covariates (e.g., flavor and cannabis policies). Results: Most participants reported usually using flavored cigarillos (81.8%) and cannabis use in the past 30 days ("co-use") (64.1%). Flavored cigarillo use was not directly associated with co-use (p = 0.90). Perceived cigarillo harm (β = 0.18, 95% CI = 0.06, 0.29), number of tobacco users in the household (β = 0.22, 95% CI = 0.10, 0.33), and past 30-day use of other tobacco products (β = 0.23, 95% CI = 0.15, 0.32) were significantly positively associated with co-use. Living in an area with a ban on flavored cigarillos was significantly negatively associated with co-use (β = -0.12, 95% CI = -0.21, -0.02). Conclusions: Use of flavored cigarillos was not associated with co-use; however, exposure to a flavored cigarillo ban was negatively associated with co-use. Cigar product flavor bans may reduce co-use among young adults or have a neutral impact. Further research is needed to explore the interaction between tobacco and cannabis policy and use of these products.
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Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Abigail B. Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Erika S. Trapl
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Elizabeth G. Klein
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
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Chu A, Chaiton M, Kaufman P, Goodwin RD, Lin J, Hindocha C, Goodman S, Hammond D. Co-Use, Simultaneous Use, and Mixing of Cannabis and Tobacco: A Cross-National Comparison of Canada and the US by Cannabis Administration Type. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4206. [PMID: 36901216 PMCID: PMC10002028 DOI: 10.3390/ijerph20054206] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Increasing cannabis legalization raises concerns that the use of tobacco, frequently used with cannabis, will also increase. This study investigated the association between the legal status of cannabis in places of residence and the prevalence of cannabis and tobacco co-use, simultaneous use, and mixing by comparing the prevalence among adults in Canada (prior to cannabis legalization) vs. adults in US states that had legalized recreational cannabis vs. US states that had not as of September 2018. METHODS Data were drawn from the 2018 International Cannabis Policy Study, conducted with respondents aged 16-65 in Canada and the US recruited from nonprobability consumer panels. Differences in the prevalence of co-use, simultaneous use, and mixing between tobacco and different cannabis products were examined using logistic regression models by legal status of place of residence among past-12-month cannabis consumers (N = 6744). RESULTS Co-use and simultaneous use in the past 12 months were most common among respondents in US legal states. Among cannabis consumers, co-use and simultaneous use were less common in US legal states, while mixing was less frequent in US states with both legal and illegal cannabis compared to Canada. Use of edibles was associated with lower odds of all three outcomes, while smoking dried herb or hash was associated with higher odds. CONCLUSIONS The proportion of cannabis consumers who used tobacco was lower in legal jurisdictions despite higher prevalence of cannabis use. Edible use was inversely associated with co-use, suggesting that edible use does not appear to be associated with increased tobacco use.
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Affiliation(s)
- Alanna Chu
- Ontario Tobacco Research Unit, Toronto, ON M5T 3M7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Michael Chaiton
- Ontario Tobacco Research Unit, Toronto, ON M5T 3M7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Pamela Kaufman
- Ontario Tobacco Research Unit, Toronto, ON M5T 3M7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Renee D. Goodwin
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
- Graduate School of Public Health and Public Policy, The City University of New York, New York, NY 10027, USA
| | - Jodie Lin
- Ontario Tobacco Research Unit, Toronto, ON M5T 3M7, Canada
| | - Chandni Hindocha
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK
| | - Samantha Goodman
- School of Public Health, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - David Hammond
- School of Public Health, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Gravely S, Driezen P, McClure EA, Hammond D, Michael Cummings K, Chan G, Hyland A, Borland R, East KA, Fong GT, Schauer GL, Quah ACK, Ouimet J, Smith DM. Differences between adults who smoke cigarettes daily and do and do not co-use cannabis: Findings from the 2020 ITC four country smoking and vaping survey. Addict Behav 2022; 135:107434. [PMID: 35908323 DOI: 10.1016/j.addbeh.2022.107434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about population-level differences between adults who exclusively smoke cigarettes and those who smoke cigarettes and also use cannabis (co-consumers). Thus, this study describes differences on sociodemographic, cigarette-dependence, health and behavioral variables, and risk perceptions associated with smoking cannabis. METHODS This cross-sectional study included 6941 respondents from the 2020 ITC Four Country Smoking and Vaping Survey (US, Canada, Australia, England). Adult daily cigarette smokers were included and categorized as: cigarette-only smokers (never used cannabis/previously used cannabis, but not in the past 12 months, n = 4857); occasional co-consumers (cannabis use in the past 12 months, but < weekly use, n = 739); or regular co-consumers (use cannabis ≥ weekly, n = 1345). All outcomes were self-reported. Regression models were conducted on weighted data. RESULTS Overall, 19.9 % of respondents reported regular cannabis co-use and 10.1 % reported occasional co-use. Regular co-use was highest in Canada (27.2 %), followed by the US (24.4 %), England (12.7 %) and Australia (12.3 %). Compared to cigarette-only smokers, regular co-consumers were more likely to be male and report chest/breathing problems (p < 0.001). All co-consumers were more likely to be younger, have lower income, be experiencing financial stress, reside in Canada, have depressive symptoms, use alcohol more frequently and binge drink, use other tobacco/nicotine products, and perceive smoking cannabis as low health risk and less harmful than smoking cigarettes (all p < 0.001). Cigarette dependence measures were similar between co-consumers and cigarette-only smokers (all p ≥ 0.05). CONCLUSIONS Although there were no differences on cigarette dependence measures between daily cigarette smokers who do and do not use cannabis, there are several other risk factors that may affect tobacco use and abstinence among co-consumers (e.g., greater depression, high-risk alcohol consumption). Thus, tobacco cessation treatment may require multi-pronged strategies to address other health behaviors. Continued surveillance is needed to determine the nature and health implications of co-use considering changing policies, markets, and products.
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Affiliation(s)
| | | | - Erin A McClure
- Medical University of South Carolina (MUSC), Hollings Cancer Center, USA
| | | | - K Michael Cummings
- Medical University of South Carolina (MUSC), Hollings Cancer Center, USA
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Australia
| | | | | | | | - Geoffrey T Fong
- University of Waterloo, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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11
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Cigarette, electronic cigarette, and marijuana use among young adults under policy changes in California. Addict Behav Rep 2022; 16:100459. [PMID: 36176360 PMCID: PMC9513090 DOI: 10.1016/j.abrep.2022.100459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 10/25/2022] Open
Abstract
Introduction Since 2016, California has implemented a series of policies, including prohibiting the sale of tobacco products and electronic cigarettes (e-cigarettes) to persons under 21, cigarette tax increase, and recreational marijuana legalization. The study aims to examine the use of cigarettes, e-cigarettes, and marijuana among young adults (ages 18-25) and their associations with other factors in the context of these policy changes. Methods We used the data from the California Health Interview Survey (CHIS) 2017-2018 to compare the rates of using cigarettes, e-cigarettes, and marijuana separately or any use of the three. Using CHIS 2018 data, weighted logistic regression models were used to examine associations of using cigarettes, e-cigarettes, and marijuana separately or any use of these products/substance with demo-socioeconomic factors, psychological distress, and use of each product/substances. Results Cigarette smoking remained flat while the use of e-cigarettes and marijuana escalated among young adults from 2017 to 2018. Using tobacco products increased the use of marijuana or vice versa among young adults. Severe psychological distress was significantly associated with cigarette use (adjusted odds ratio [AOR] = 4.06; 95% CI = 1.32, 12.55), marijuana use (AOR = 2.32; 95% CI = 1.10, 4.48), and any use (AOR = 4.11; 95% CI = 1.93, 8.77). Moderate psychological distress was also significantly associated with the use of these products/substance. Underage (ages 18-20) young adults had lower odds of using cigarettes than other young adults (ages 21-25). Conclusions Our findings highlight the importance of addressing the use of cigarettes, e-cigarettes, and marijuana simultaneously through policies to curtail tobacco and marijuana use among young adults.
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12
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Saran SK, Salinas KZ, Foulds J, Kaynak Ö, Hoglen B, Houser KR, Krebs NM, Yingst JM, Allen SI, Bordner CR, Hobkirk AL. A Comparison of Vaping Behavior, Perceptions, and Dependence among Individuals Who Vape Nicotine, Cannabis, or Both. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10392. [PMID: 36012024 PMCID: PMC9408799 DOI: 10.3390/ijerph191610392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Background: Electronic delivery systems (e.g., vapes, e-cigarettes) are now popular modes of cannabis and nicotine administration that are often used by the same individuals; however, we still know little about dual nicotine and cannabis vaping. Materials & Methods: An online convenience sample of adult nicotine and/or cannabis vape users residing in the United States completed a 60 min survey on sociodemographic characteristics, cannabis and/or nicotine vape use behaviors and dependence, reasons for vape use, and perceptions of benefits and harms. After data cleaning, we compared dual vs. nicotine-only and cannabis-only vape users with univariate statistics and step-wise hierarchical linear regression analyses. Additionally, we assessed the factor structure, internal consistency, and criterion and convergent validity of the Penn State Cannabis Vaping Dependence Index (PSCVDI). Results: The final sample included 357 dual, 40 cannabis, and 106 nicotine vape users. Compared to nicotine- and cannabis-only vapers, dual vapers started using their nicotine and cannabis vapes at a younger age (p < 0.001), used them for more years (p < 0.001), and were less likely to use their nicotine vape to replace combustible cigarettes (p = 0.047). Dual users vs. single-substance users did not have significantly higher nicotine or cannabis vape dependence scores after controlling for sociodemographic and use behaviors. The PSCVDI showed adequate validity for measuring cannabis vape dependence. Conclusions: This survey is the first to highlight important differences in vape use behaviors and reasons for use between dual vs. cannabis- and nicotine-only vape users.
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Affiliation(s)
- Savreen K. Saran
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Kalin Z. Salinas
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Jonathan Foulds
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Övgϋ Kaynak
- School of Behavioral Sciences & Education, Penn State Harrisburg, 777 West Harrisburg Pike, Middletown, PA 17057, USA
| | - Brianna Hoglen
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Kenneth R. Houser
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Nicolle M. Krebs
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Jessica M. Yingst
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Sophia I. Allen
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Candace R. Bordner
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Andrea L. Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
- Department of Public Health Sciences & Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
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13
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Weinberger AH, Wyka K, Kim JH, Smart R, Mangold M, Schanzer E, Wu M, Goodwin RD. A difference-in-difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004-17. Addiction 2022; 117:1768-1777. [PMID: 34985165 DOI: 10.1111/add.15795] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. DESIGN A difference-in-difference approach was applied to data from the 2004-17 National Survey on Drug Use and Health (NSDUH). SETTING United States. PARTICIPANTS Nationally representative cross-sectional survey of Americans aged 12 years and older (combined analytical sample for 2004-17, n = 783 663). MEASUREMENTS Data on past-month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co-use, cigarette-only use, cannabis-only use or no cigarette or cannabis use. State of residence was measured by self-report. MCL/RCL status came from state government websites. FINDINGS Difference-in-difference analyses suggest that MCL was associated with an increase in cigarette-cannabis co-use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02-1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39-1.84), married (aOR = 1.19; CI = 1.07-1.31), non-Hispanic (NH) black (aOR = 1.14; CI = 1.02-1.07) and with a college degree or above (aOR = 1.15; CI = 1.06-1.24). MCL was associated with increases in cigarette-only use among those aged 50 years and above (aOR = 1.07; CI = 1.01-1.14) and NH black (aOR = 1.16; CI = 1.06-1.27) and increases in cannabis-only use among those aged 50 years and above (aOR = 1.24; CI = 1.07-1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01-1.37). RCL was associated with an increase in cannabis-only use overall (aOR = 1.21; 95% CI = 1.09-1.34), a decline in cigarette-only use overall (aOR = 0.89; 95% CI = 0.81-0.97) and increases in co-use among those who were married (aOR = 1.24; CI = 1.02-1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03-1.84). CONCLUSIONS Recreational and medical cannabis legalization have had a varying impact on the use, and co-use, of cannabis and cigarettes in the United States.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - June H Kim
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA
| | | | - Michael Mangold
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ellen Schanzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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14
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Philbin MM, Giovenco DP, Mauro PM. Commentary on Weinberger et al.: Tobacco and cannabis policies as drivers of nicotine and cannabis co-use - research and measurement implications to move the field forward. Addiction 2022; 117:1778-1780. [PMID: 35362234 DOI: 10.1111/add.15885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Morgan M Philbin
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Daniel P Giovenco
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Pia M Mauro
- Columbia University Mailman School of Public Health, New York, NY, USA
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15
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French MT, Zukerberg J, Lewandowski TE, Piccolo KB, Mortensen K. Societal Costs and Outcomes of Medical and Recreational Marijuana Policies in the United States: A Systematic Review. Med Care Res Rev 2022; 79:743-771. [PMID: 35068253 DOI: 10.1177/10775587211067315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significant support exists in the United States for legalization of marijuana/cannabis. As of 2021, 36 states and four territories approved the legalization of medical cannabis via medical marijuana laws (MMLs), and 15 states and District of Columbia (DC) have adopted recreational marijuana laws (RMLs). We performed structured and systematic searches of articles published from 2010 through September 2021. We assess the literature pertaining to adolescent marijuana use; opioid use and opioid-related outcomes; alcohol use; tobacco use; illicit and other drug use; marijuana growing and cultivation; employment, earnings, and other workplace outcomes; academic achievement and performance; criminal activity; perceived harmfulness; traffic and road safety; and suicide and sexual activity. Overall, 113 articles satisfied our inclusion criteria. Except for opioids, studies on use of other substances (illicit drugs, tobacco, and alcohol) were inconclusive. MMLs and RMLs do not generate negative outcomes in the labor market, lead to greater criminal activity, or reduce traffic and road safety.
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16
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Bhatia D, Hinckley J, Mikulich S, Sakai J. Cannabis Legalization and Adolescent Use of Electronic Vapor Products, Cannabis, and Cigarettes. J Addict Med 2022; 16:e16-e22. [PMID: 35120066 DOI: 10.1097/adm.0000000000000831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Cannabis legalization may have unintended consequences, such as effects on prevalence of adolescent use of other substances. We hypothesize that in states that have legalized recreational cannabis (RCL states), electronic vapor product use ("vaping"), cannabis, and cigarette use among adolescents is more prevalent than in states that have only legalized medical cannabis (MCL states) and states that have neither legalized recreational nor medical cannabis (NL states). METHODS Data are from the Center for Disease Control's 2017 Youth Risk Behavior Surveillance Survey (n = 107,665), a nationally representative survey of US high school students. We categorized student responses by cannabis legalization status of the state in which they lived at time of survey, then tested associations between cannabis legalization status and adolescent vaping, cannabis, and cigarette use, using logistic regressions. RESULTS Students in RCL states were significantly more likely to report current vaping behaviors compared to NL students [odds ratios (OR's) 2.07-2.21]. Students in cannabis-legal states were significantly more likely to report ever or currently using cannabis compared to NL students (OR's 1.27-1.40). MCL students were significantly less likely to report current cigarette smoking (OR = 0.86) compared to NL students. CONCLUSIONS Adolescents in cannabis-legal states were more likely to report vaping and cannabis use compared to adolescents in NL states. Public health officials, policymakers, and clinicians should consider the associations between cannabis legalization and adolescent vaping, cigarette, and cannabis use patterns.
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Affiliation(s)
- Devika Bhatia
- University of Colorado Anschutz Medical Campus, Aurora, CO (DB, JH, SM, JS)
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17
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Nigatu YT, Elton-Marshall T, Hamilton HA. Exploring the Association of e-Cigarette and/or Cannabis Use with Heavy Episodic Drinking among Ontario Adults. Subst Use Misuse 2022; 57:1953-1960. [PMID: 36126159 DOI: 10.1080/10826084.2022.2125268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: The use of electronic cigarettes and cannabis has significantly increased in recent years, which raises public health concerns. There are also concerns about the association of these substances with drinking behaviors. The main objective of the present study is to examine the association of e-cigarettes and/or cannabis use with heavy episodic drinking (HED) among Ontario adults. Methods: The sample consisted of 5,564 adults from the Monitor Survey in 2018 and 2019. Cannabis and e-cigarette use reflected any use of the substances in the past 12 months. HED was defined as consumption of four/five or more drinks on a single occasion at least monthly in the past 12 months. Odds ratios (OR) were estimated from logistic regression models accounting for complex survey design and sociodemographic factors. Results: Overall, the prevalence of HED was 17.5% in 2018 and 2019. Among participants who reported both e-cigarette and cannabis use, about one-half (50.4%) reported HED at least monthly. Adjusting for covariates, the odds of HED were 5.71 (95%CI, 3.92-8.30) times higher among those who reported both e-cigarette and cannabis use compared to those who used neither substance. Conclusions: The use of e-cigarettes and cannabis are significantly associated with heavy episodic drinking among adults, indicating that those who engage in the dual use of e-cigarette and cannabis may be an important group to target with intervention programs.
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Affiliation(s)
- Yeshambel T Nigatu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Hayley A Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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18
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Kaur N, Bastien G, Gagnon L, Graham J, Mongeau-Pérusse V, Bakouni H, Morissette F, Theriault C, Fischer B, Jutras-Aswad D. Variations of cannabis-related adverse mental health and addiction outcomes across adolescence and adulthood: A scoping review. Front Psychiatry 2022; 13:973988. [PMID: 36299544 PMCID: PMC9590692 DOI: 10.3389/fpsyt.2022.973988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Evidence supporting associations between cannabis use and many health outcomes is growing, however it remains unclear how such associations vary across the lifespan. We therefore aim to answer the following questions: (1) Are the risks of cannabis's adverse effects on mental health and addiction-related outcomes different in adolescents than in adults? (2) What are the relationships between these cannabis's adverse effects and (a) an individual's age at first cannabis use, (b) age at assessment, and (c) duration of cannabis use? METHODS We searched Medline, Embase, CINAHL, and PsychINFO from inception to 18 October 2021. Two reviewers independently screened studies and descriptively synthesized results. RESULTS We included 140 studies. Cannabis effects on mental health and addiction-related outcomes were worse in adolescents, early cannabis initiators and cannabis users who consumed for longest periods. Evidence of worse long-term adverse effects in adolescents was substantial for psychosis, cannabis, and nicotine use disorders; mixed for depression, suicidality, other substance use and disorders; and limited for anxiety. Additionally, acute cannabis exposure had the opposite trend with adults more often reporting adverse effects than adolescents. CONCLUSION The available evidence suggests that cannabis use should be delayed as late as possible in adulthood and shortened in duration across the lifespan to decrease the risk of negative outcomes, while emphasizing the need for adapted harm reduction approaches. This scoping review provides evidence on the role of age and duration of exposure as determinants of cannabis-related adverse effects, which may inform prevention and harm reduction strategies. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/BYG72.
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Affiliation(s)
- Navdeep Kaur
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Gabriel Bastien
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Lea Gagnon
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Johann Graham
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Violaine Mongeau-Pérusse
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Hamzah Bakouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Florence Morissette
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Camille Theriault
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Benedikt Fischer
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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19
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Chandler L, Abdujawad AW, Mitra S, McEligot AJ. Marijuana use and high-risk health behaviors among diverse college students post- legalization of recreational marijuana use. PUBLIC HEALTH IN PRACTICE 2021; 2. [PMID: 34888536 PMCID: PMC8654161 DOI: 10.1016/j.puhip.2021.100195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives This study examined high-risk health behaviors in marijuana-users among a diverse college population in Southern California, post legalization of marijuana for recreational use. Study design A cross-sectional research design was employed utilizing existing data via the 2018 National College Health Assessment (NCHA) from a large Minority-Serving Institution (MSI) population [n = 1345 (Hispanic/Latino/a, n = 456; White, n = 353; Asian Pacific Islander (API), n = 288; Multiracial/Biracial, n = 195; Other, n = 53)]. Methods Chi square and t-tests assessed differences in descriptive characteristics (age, gender, race/ethnicity and GPA) and high-risk behaviors (alcohol, tobacco and sexual behaviors) among marijuana users and non-users. Logistic regression analyses examined the relationship between race/ethnicity and high-risk behaviors with marijuana use (dependent variable). Results Among marijuana-users, significant (p = 0.004) differences were observed between race/ethnicity with Whites reporting using most (32.7%), followed by Hispanics (27.6%) and then APIs (17.8%). Marijuana-users compared with non-users consistently reported high-risk alcohol behaviors (p < 0.0001), were more likely to smoke tobacco (p < 0.0001) and engaged in more high-risk sexual behaviors (p < 0.0001). Logistic regression showed after adjusting for demographic characteristics and high-risk behaviors, race/ethnicity was borderline significantly associated with marijuana use, specifically for Whites (OR = 1.53; 95% CI: (−0.01, 0.86), p = 0.06) and the Other race/ethnicity category (OR = 2.32; 95% CI: (0.12, 1.56), p = 0.02) compared with APIs. Conclusion Our findings clearly demonstrate deleterious high-risk behaviors such as alcohol use, tobacco use, and certain sexual behaviors occur more among marijuana-users compared to non-users, post legalization of marijuana for recreational use. Further, race-ethnic differences were observed. Therefore, continued examination of marijuana use trends and high-risk behaviors is critical in monitoring the implications of marijuana policy changes, specifically in diverse populations.
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Affiliation(s)
- Laura Chandler
- Department of Public Health. California State University, Fullerton, 800 N. State College Blvd., Room KHS-121, Fullerton, CA, 92834, USA
- Corresponding author.
| | - Aimn W. Abdujawad
- Department of Public Health. California State University, Fullerton, 800 N. State College Blvd., Room KHS-121, Fullerton, CA, 92834, USA
| | - Sinjini Mitra
- ISDS Department of Information Systems and Decision Sciences, California State University, Fullerton, USA
| | - Archana J. McEligot
- Department of Public Health. California State University, Fullerton, 800 N. State College Blvd., Room KHS-121, Fullerton, CA, 92834, USA
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20
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Weinberger AH, Dierker L, Zhu J, Levin J, Goodwin RD. Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002-2019. Tob Control 2021:tobaccocontrol-2021-056723. [PMID: 34815363 DOI: 10.1136/tobaccocontrol-2021-056723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/27/2021] [Indexed: 01/16/2023]
Abstract
SIGNIFICANCE Cannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The current study estimated the prevalence of cigarette dependence among US individuals who smoke cigarettes by cannabis use status, and investigated trends in cigarette dependence from 2002 to 2019 among cigarette smokers by cannabis use status and cigarette consumption (ie, cigarettes per day, CPD). METHODS Data were drawn from the 2002-2019 annual National Survey on Drug Use and Health and included US individuals aged 12+ years who used cigarettes at least once in the past month (n=231 572). Logistic regression was used to estimate the prevalence of cigarette dependence, measured as time to first cigarette <30 min, by past-month cannabis use (no use, non-daily use, daily use), and to estimate trends in cigarette dependence from 2002 to 2019 overall and stratified by cannabis use and smoking level (light, 1-5 CPD; moderate, 6-15 CPD; heavy, 16+ CPD). RESULTS Across all levels of cigarette use, cigarette dependence was significantly more common among individuals with daily cannabis use compared with those with non-daily or no cannabis use. From 2002 to 2019, cigarette dependence increased among cigarette smokers with non-daily cannabis use, and among light and moderate cigarette smokers with no cannabis use. CONCLUSIONS US individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who use cigarettes and do not use cannabis at virtually all levels of cigarette consumption. Further, cigarette dependence is increasing in the USA both among those who use and do not use cannabis. Given the increase in cannabis use among those using cigarettes, efforts to elucidate the nature of the association between cannabis and cigarette dependence are needed.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lisa Dierker
- Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Jiaqi Zhu
- Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA
| | - Jacob Levin
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Renee D Goodwin
- Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA .,Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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21
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Hindocha C, McClure EA. Unknown population-level harms of cannabis and tobacco co-use: if you don't measure it, you can't manage it. Addiction 2021; 116:1622-1630. [PMID: 33047862 PMCID: PMC8041912 DOI: 10.1111/add.15290] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nationally representative data of cannabis-tobacco co-use have shown that these substances are closely entwined and have significant adverse health consequences, although population-level harms of co-use are largely unknown. Current epidemiological research does not assess co-use in a manner that has yielded the necessary data to draw conclusions regarding health effects. This has given rise to a hidden population of co-users who go under-served. Therefore, this paper has two aims: (1) to review new challenges in the collection of co-use data due to rapidly changing regulations of cannabis and nicotine products and (2) to provide recommendations for the terminology and assessment of co-use. ARGUMENT We argue that: (1) the prevalence of co-use is not being assessed accurately at a population level and (2) changes in legalization have created novel challenges, but without proper monitoring the impact on co-use will go undetected. We propose a three-level tiered set of recommendations for co-use assessments, which includes assessments of cannabis, tobacco and co-use metrics ranging from least burdensome (self-report of co-administered products) to most burdensome (assays, event-level data). CONCLUSIONS We propose that clinical studies begin to incorporate cannabis-tobacco co-use assessments to justify better their inclusion in clinical trials and national surveillance surveys. Integration of co-use assessments will aid in understanding the true impact on co-use of the changing cannabis and tobacco/nicotine regulatory environments. Co-use is prevalent and problematic, and the ability to make conclusions about its health outcomes is hindered by lack of nuance in data collection. If you do not measure it, you cannot manage it.
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Affiliation(s)
- Chandni Hindocha
- Clinical Psychopharmacology Unit, Department of Clinical, Educational & Health Psychology, University College London, Faculty of Brain Sciences, University College London
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, MSC 861, 67 President Street, Charleston, SC 29425-8610, USA
- Hollings Cancer Center, Medical University of South Carolina
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22
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Smith CL, Cooper BR, Miguel A, Hill L, Roll J, McPherson S. Predictors of cannabis and tobacco co-use in youth: exploring the mediating role of age at first use in the population assessment of tobacco health (PATH) study. J Cannabis Res 2021; 3:16. [PMID: 34074338 PMCID: PMC8170934 DOI: 10.1186/s42238-021-00072-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/12/2021] [Indexed: 11/11/2022] Open
Abstract
Background Adolescents often use substances such as tobacco and cannabis. Co-use of these substances can lead to physical, mental, and psychosocial difficulties beyond that which would be anticipated by simple additivity of their individual effects. Methods We aimed to examine the mediating role of age at first use of cannabis or tobacco (AU) between youth factors of internalizing, externalizing, and sensation seeking and two co-use outcomes (lifetime; last 30 days). Path analytic modeling using data from youth age 12–17 who had tried cannabis or tobacco at least once in their lives and participated in the Population Assessment of Tobacco Health (PATH) waves one and two (collected 2013–2015; n=3,847; approximately 46% female) study allowed us to examine these relationships. Results The lifetime use model indicated significant direct (internalizing (B = 0.18), externalizing (B = 0.30), sensation seeking (B = 0.15)) and indirect relationships (internalizing (B = 0.18), externalizing (B = 0.33), sensation seeking (B = 0.10)) between each of the three youth factors, the mediator (AU) and the lifetime co-use outcome (p < 0.05 for all). A direct relationship between AU and lifetime co-use was also observed (B = − 1.54). In the past 30-day use model, significant direct paths from AU (B = − 0.49) and sensation seeking (B = 0.06) to past 30-day use were present (p < 0.05 for all). Discussion Examination of mediation by AU in the relationships between youth factors and youth co-use of cannabis and tobacco is an important step in understanding these complex relationships. This study is strengthened by the use of a large, nationally representative sample, yet is limited by several factors, such as the use of a secondary dataset and the use of youth self-report. Conclusions Based on the findings, programs or interventions targeting youth factors of internalizing, externalizing, and sensation seeking as well as interventions aiming to stave off AU should promote decreased tobacco and cannabis co-use. Sensation seeking and AU appear to be the most influential factors and should be considered when developing and promoting prevention policies/programs for higher risk youth populations.
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Affiliation(s)
- Crystal Lederhos Smith
- Elson S. Floyd College of Medicine, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA.
| | | | - Andre Miguel
- Elson S. Floyd College of Medicine, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA
| | - Laura Hill
- Human Development, Washington State University, Spokane, WA, USA
| | - John Roll
- Elson S. Floyd College of Medicine, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA
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23
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D'Amico EJ, Rodriguez A, Tucker JS, Dunbar MS, Pedersen ER, Shih RA, Davis JP, Seelam R. Early and Late Adolescent Factors that Predict Co-use of Cannabis with Alcohol and Tobacco in Young Adulthood. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:530-544. [PMID: 31960260 DOI: 10.1007/s11121-020-01086-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The changing legal landscape of cannabis in the USA has coincided with changes in how cannabis is used, including its co-use with other substances. This study analyzed 10 years of data from a diverse cohort of youth (N = 2429; 54% Hispanic, 16% Asian, 16% white, 3% black, 10% multiracial) to examine predictors in early and late adolescence of co-use of alcohol with cannabis (AC) and tobacco with cannabis (TC) at age 21. Two forms of co-use were examined: concurrent (use of both substances in past month) and sequential (use of one substance right after the other). Analyses focused on four predictor domains: individual (e.g., resistance self-efficacy), peer (e.g., time spent around peers who use), family (e.g., sibling use), and neighborhood (i.e., perceived alcohol and drug problems in neighborhood). For each co-use combination (AC or TC), we estimated parallel process piecewise latent growth models in a structural equation modeling framework using Mplus v8. The final AC and TC co-use models included all predictor variables from the four domains. Increases in positive expectancies and time spent around peers who use AC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of AC co-use in young adulthood. Increases in sibling TC use and time spent around peers who use TC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of TC co-use in young adulthood. Overall, findings highlight the importance of addressing peer influence in prevention programming during both early and late adolescence.
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Affiliation(s)
| | | | - Joan S Tucker
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Michael S Dunbar
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | - Eric R Pedersen
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Regina A Shih
- RAND Corporation, 1200 S Hayes St, Arlington, VA, 22202, USA
| | - Jordan P Davis
- University of Southern California, Los Angeles, CA, 90089, USA
| | - Rachana Seelam
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
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24
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Mantey DS, Onyinye ON, Montgomery L. Prevalence and correlates of daily blunt use among U.S. African American, Hispanic, and White adults from 2014 to 2018. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:514-522. [PMID: 33914562 DOI: 10.1037/adb0000702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Blunt smoking presents unique public health concerns relative to other methods of marijuana use, including greater exposure to toxins and carcinogens as well as increased risk for cannabis use disorder. This study examines correlates of self-reported daily blunt use among a nationally representative sample of adult blunt users in the United States. METHOD We pooled and analyzed 5 years of cross-sectional data from n = 10,826 adult blunt smokers in the United States using the National Survey on Drug Use and Health (2014-2018). Multiple logistic regression analysis examined correlates of daily blunt use among non-Hispanic White, non-Hispanic African American, and Hispanic/Latino adult blunt users in the United States. Next, multiple logistic regression analyses stratified by race/ethnicity were conducted. This study examined: (a) socio-demographic (age, sex, and income); (b) behavioral (alcohol, tobacco, and illicit drug use); (c) intrapersonal (depression); and (d) regulatory (marijuana laws) factors. RESULTS African Americans had the greatest prevalence of daily blunt use (24.2%), relative to Whites (9.1%) and Hispanic/Latinos (13.9%) (p < .001). African Americans aged 26-34 years old (adjusted odds ratio [Adj OR]: 1.37) and living in medical marijuana states (Adj OR: 1.28) were more likely to be daily blunt users; these factors were not associated with daily blunt use in the full sample or in stratified models of Whites or Hispanic/Latinos. Alcohol use was negatively associated with daily blunt use among Whites and Hispanic/Latinos but not African Americans. CONCLUSIONS Socio-demographic, behavioral, and regulatory factors appear differently associated with daily blunt use across racial/ethnic groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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25
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Das A, Johnson JK, Hard GA, Jones AA. State Medical Marijuana Laws and Initiation of Cigarettes among Adolescents in the U.S., 1991-2015. CANNABIS (RESEARCH SOCIETY ON MARIJUANA) 2021; 4:60-68. [PMID: 36405952 PMCID: PMC9674114 DOI: 10.26828/cannabis/2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective Although cigarette use has declined among adolescents, marijuana use has increased in subgroups of this population. The association between medical marijuana laws (MMLs) and cigarette initiation among adolescents, however, needs further examination. We investigated the association between MMLs and age of cigarette initiation and stratified findings by gender, race/ethnicity, and state dispensary status. Method Data were from N=939,725 adolescents in 9th-12th grade living in 46 states who participated in the Youth Risk Behavior Surveillance System between 1991-2015. Participants were asked the age they first smoked a cigarette and other sociodemographic characteristics. States were categorized as MML states if they had legalized marijuana for medicinal purposes by 2015. We used a difference-in-difference methodology and logistic regressions to assess the relationship between MMLs and cigarette initiation. Results Our results indicate lower odds of initiating cigarettes, in every age group (8 years old or younger, 9-10, 11-12, 13-14, 15-16, 17 years old or older) in states with MMLs when compared to non-MML states. After stratification, we find lower odds of cigarette initiation in certain age groups by gender, race/ethnicity, and state dispensary status. We report no difference in state MML implementation and age of cigarette initiation among Hispanic adolescents in every age group, and Black adolescents 8 years or younger and 17 years or older. Conclusions Cigarette initiation has decreased among adolescents in MML states compared with those in non-MML states. Further research should evaluate how MMLs and recreational marijuana policies are associated with e-cigarette initiation and use.
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Affiliation(s)
- Abhery Das
- Program in Public Health, University of California, Irvine, 653 East Peltason Drive, Irvine, CA 92617
| | - Julie K. Johnson
- Cannabis Policy Research Center of Excellence, Research Department, Cannabis Control Commission, Commonwealth of Massachusetts, 2 Washington Square, 2nd Floor, Worcester, MA 01604
| | - Gregory A. Hard
- MGH Institute of Health Professions, 36 First Avenue, Boston MA 02129
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, 105 Health and Human Development Building, University Park, PA 16802, USA
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26
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Smith J, Woolley T, Brown A, Vangaveti V, Chilkuri M. Smoking cessation in head and neck cancer patients: Factors influencing successes and failures. J Med Imaging Radiat Oncol 2021; 65:233-241. [PMID: 33620161 DOI: 10.1111/1754-9485.13158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This study investigated the smoking behaviours and cessation rates of head and neck cancer (HNC) patients, and their barriers and facilitators to cessation. METHOD The study used a mixed methods, sequential explanatory design. The quantitative data were collected at baseline (around time of cancer diagnosis) via a survey prior to commencement of treatment. Participants identified as current smokers at baseline were then followed up to determine their smoking status after treatment and asked to participate in one-on-one, semi-structured interviews. RESULTS Sixty-four participants with HNC were recruited, with 29 classified as current smokers. The 7-day point prevalence cessation rate for current smokers was 72% at 1-month follow-up, and 67% at 3 months, while continuous smoking cessation was 54% at 1 month, and 42% at 3 months. Participants who continued smoking were found to consume more alcohol (P = 0.032), be in a lower stage of change (pre-contemplation or contemplation stages of the transtheoretical model) at baseline (P = 0.012) and be less confident in being able to cease smoking (P = 0.004). Qualitative analysis revealed 5 key themes associated with smoking cessation: the teachable moment of a cancer diagnosis and treatment, willpower and cessation aids, psychosocial environment, relationship with alcohol and marijuana, and health knowledge and beliefs surrounding smoking and cancer. CONCLUSIONS This study demonstrates that the majority of HNC patients achieve smoking cessation, but relapses are common. Cessation programmes should be developed that are comprehensive, sustained and address factors such as alcohol, marijuana and depression.
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Affiliation(s)
- Justin Smith
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Radiation Oncology, Townsville University Hospital, Townsville, Queensland, Australia
| | - Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Amy Brown
- Department of Radiation Oncology, Townsville University Hospital, Townsville, Queensland, Australia
| | - Venkat Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Madhavi Chilkuri
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Radiation Oncology, Townsville University Hospital, Townsville, Queensland, Australia
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27
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McClure JB, Lapham G. Tobacco quitline engagement and outcomes among primary care patients reporting use of tobacco or dual tobacco and cannabis: An observational study. Subst Abus 2020; 42:417-422. [PMID: 33270541 PMCID: PMC8386948 DOI: 10.1080/08897077.2020.1846665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Dual use of tobacco and cannabis is increasingly common, but it is unclear how it impacts individuals' interest in or ability to stop smoking. If dual users fail to engage in treatment or have worse treatment outcomes, it would suggest that tobacco treatment programs may need to be tailored to the specific needs of those using cannabis and tobacco. Methods: We conducted an observational study using electronic treatment records from adults (18 years and older) who (a) were enrolled in a regional healthcare system in Washington state, (b) sought tobacco cessation treatment through an insurance-covered quitline from July 2016 to December 2018 and (c) had cannabis use frequency during the period of their quitline enrollment documented in their electronic health record (EHR) (n = 1,390). Treatment engagement was defined by the total number of quitline counseling calls and web-logins completed. Point prevalent self-reported tobacco abstinence was assessed 6 months post-quitline enrollment. Results: Thirty-two percent of participants (n = 441) reported dual use of tobacco and any cannabis during the observation period; 9.4% (n = 130) reported daily cannabis use. Among dual users reporting daily cannabis use, 13.9% had a diagnosed cannabis user disorder in the EHR. Neither engagement with quitline counseling nor long-term tobacco abstinence rates differed between those using tobacco-only and either dual-use group (i.e., persons using any cannabis or daily cannabis). Conclusions: Dual use of tobacco and cannabis is common among smokers seen in primary care and those enrolling in quitline care, but it may not undermine tobacco quitline engagement or smoking cessation. Opportunities exist in the US to leverage quitlines to identify and intervene with dual users of tobacco and cannabis.HIGHLIGHTSTobacco quitline care was equally engaging and effective among tobacco users and dual users of tobacco and cannabisMany daily cannabis users calling tobacco quitlines likely have a cannabis use disorderTobacco quitlines can be leveraged to identify and intervene with dual users of tobacco and cannabis.
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Affiliation(s)
- Jennifer B. McClure
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA USA 98101
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA USA 98101
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28
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McClure EA, Rabin RA, Lee DC, Hindocha C. Treatment Implications Associated with Cannabis and Tobacco Co-Use. CURRENT ADDICTION REPORTS 2020; 7:533-544. [PMID: 33777645 PMCID: PMC7992053 DOI: 10.1007/s40429-020-00334-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE OF THE REVIEW The goal of this article is to summarize the treatment-focused literature on cannabis and tobacco co-use and the treatment implications of co-use. This review will focus on: 1) the impact of co-use on cessation outcomes, 2) compensatory use/substitution of the non-treated substance among co-users, and 3) treatment interventions to address co-use. This article will highlight the limitations to co-use captured in the literature and offer considerations and directives for co-use research and treatment moving forward. RECENT FINDINGS The degree to which co-use affects cessation for a single, targeted substance remains in question, as the literature is largely mixed. Cannabis treatment trials are better equipped to answer these questions given that they do not typically exclude tobacco users. While the relationship between tobacco use and poorer cannabis outcomes appears to have some evidence, the reverse relationship (cannabis use affecting tobacco outcomes) is not consistently supported. SUMMARY The co-use of cannabis and tobacco and its impact on single substance cessation and/or compensatory substance use during cessation is generally overlooked in treatment trials, while interventions to address both substances are rare. Capturing co-use adds burden for researchers, clinicians, and participants, but is warranted given the prevalence of co-use and a rapidly changing cannabis and tobacco regulatory environment, which may further complicate co-occurring substance use. Co-users are a heterogeneous population; trials focused on co-users, in addition to better data capture and consistent terminology, will aid in an understanding of nuanced patterns of co-use critical to inform treatment interventions.
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Affiliation(s)
- Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel A. Rabin
- Department of Psychiatry, McGill University and The Douglas Mental Health Institute, Montreal, Canada
| | - Dustin C. Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Department of Clinical, Educational & Health Psychology, University College London, Faculty of Brain Sciences, University College London
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London
- University College Hospital National Institute of Health Research (NIHR) Biomedical Research Centre
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29
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Cassidy RN, Long V, Tidey JW, Colby SM. Validation of an E-cigarette Purchase Task in Advanced Generation Device Users. Nicotine Tob Res 2020; 22:1851-1859. [PMID: 32267947 PMCID: PMC7542643 DOI: 10.1093/ntr/ntaa060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/07/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Behavioral economic purchase tasks are used to estimate the reinforcing value of drugs by asking participants how much they would purchase across a range of increasing prices. We sought to validate such a task for e-cigarettes in experienced users of advanced generation, tank-style devices. METHODS Dual users of cigarettes and e-cigarettes (N = 54) and exclusive e-cigarette users (N = 59) attended one session during which they completed assessments including two versions of the E-cigarette Purchase Task: one that asked how many puffs of their e-cigarette they would purchase in 24 hours at varying prices and one that asked how many mLs of e-liquid they would purchase. We correlated purchase task outcomes with other measures of e-cigarette use. We also compared the tasks across dual and exclusive users. RESULTS Indices derived from the mLs-based task were more likely to be correlated with self-reported use rates, e-cigarette dependence, and cotinine levels than the puffs-based task. Exclusive users showed greater demand on than dual users only on the mLs version when using an F-test comparison method, while multivariate analysis of variance (MANOVA) results showed that dual users showed greater demand only on the puffs task. CONCLUSIONS Results indicate that the mLs version had greater validity than the puffs version in terms of clinical indices. Dual users may still be on a trajectory to fully switching to e-cigarettes; thus, puffs as a measure may be more intuitive, as this measure is shared by cigarettes and e-cigarettes. For exclusive users, the unit they purchase their e-liquid in may be the most relevant unit and better capture their demand for that product. IMPLICATIONS Behavioral economic purchase tasks have been widely used to understand nicotine use. We have developed two versions of a purchase task for e-cigarette use and compared the two versions in users of advanced generation e-cigarette devices. We found that the mLs version of the task better-reflected use patterns relative to a puffs version, which suggests that participants struggle to place monetary value on a unit of consumption (ie, puffs). Validated measures of e-cigarette reinforcement will be important as researchers and regulators determine which features of these products contribute to reinforcing efficacy.
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Affiliation(s)
- Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Victoria Long
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
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30
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Woloshchuk CJ, Carlos Portillo, Lerma M, Villegas D, Fregoso R, Posada E, Torres J, Frietze GA, Cooper TV. Characteristics associated with marijuana use in Latinx college students. J Ethn Subst Abuse 2020; 21:923-938. [PMID: 32857681 DOI: 10.1080/15332640.2020.1808872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While marijuana use rates are significantly high within college students, less is known about use patterns and correlates in Latinx groups. This study assessed the relationships between ever use and frequency of use of marijuana, polysubstance use, expectancies, motives, and mental illness symptoms among Latinx college students (n = 345). Results indicated more frequent marijuana use was positively associated with: enjoyment, celebration, social anxiety, low risk, sleep and availability and was negatively associated with: experimentation, boredom, altered perception, and anxiety. Other dual use with tobacco expectancies were also observed. These constructs should be explored prospectively and inform prevention and intervention efforts.
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Affiliation(s)
- Claudia J Woloshchuk
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Carlos Portillo
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Marcos Lerma
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Diana Villegas
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Roman Fregoso
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Emilio Posada
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Joshua Torres
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
| | - Gabriel A Frietze
- School of Pharmacy, The University of Texas at El Paso, El Paso, TX, USA
| | - Theodore V Cooper
- Prevention and Treatment of Clinical Health Laboratory Department of Psychology, The University of Texas at El Paso, El Paso, TX, USA
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31
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Dunbar MS, Davis JP, Tucker JS, Seelam R, Shih RA, D'Amico EJ. Developmental Trajectories of Tobacco/Nicotine and Cannabis Use and Patterns of Product Co-use in Young Adulthood. Tob Use Insights 2020; 13:1179173X20949271. [PMID: 32922109 PMCID: PMC7446261 DOI: 10.1177/1179173x20949271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Concurrent co-use of tobacco/nicotine and cannabis (T/C) products is common among young people and may increase risks for negative health and psychosocial outcomes, but little is known about developmental patterns of T/C co-use. This study aimed to identify distinct trajectory classes of concurrent T/C co-use from ages 16 to 21 and compare groups on T/C co-use behaviors in young adulthood. Methods Participants (n = 2497) reported T/C use on annual online surveys from 2015 to 2019 (ages 16-22). We used parallel process growth mixture models to model simultaneous trajectories of past-month cigarette, e-cigarette, smokeless tobacco, and cannabis use and identify latent classes of T/C trajectories. Classes were then compared on types and number of T/C products used and types of T/C co-use in young adulthood. Results Models revealed 4 T/C classes: Low/No T/C Use, Early Concurrent T/C Co-use, Late Concurrent T/C Co-use, and Tobacco Quitters/Cannabis Maintainers. Compared to other classes, the Early Concurrent T/C Co-use group-individuals with rapid progression to concurrent T/C co-use during adolescence-were more likely to report poly-tobacco use, poly-cannabis use, same-occasion sequential T/C co-use and T/C co-administration (ie, mixing T/C) of both combustible and vaping products in young adulthood. Conclusion Early progression to concurrent T/C co-use in adolescence is prospectively linked to poly-product use and co-use of T/C products in young adulthood. Prevention efforts targeting co-use of T/C products in adolescence may help to reduce riskier patterns of T/C use and co-use in young adulthood.
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32
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Affiliation(s)
- Lisa R. LaRowe
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
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Carrara L, Giroud C, Concha-Lozano N. Development of a Vaping Machine for the Sampling of THC and CBD Aerosols Generated by Two Portable Dry Herb Cannabis Vaporisers. Med Cannabis Cannabinoids 2020; 3:84-93. [PMID: 34676343 PMCID: PMC8489338 DOI: 10.1159/000505027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022] Open
Abstract
Cannabis sativa is known for its recreational use, but also for its therapeutic potential. There has been wide discussion over the use of cannabis for medical purposes in recent years, especially because a consensus has not been reached regarding its risk/benefit balance. Among the more common modes of administration, vaping with a vaporiser is most frequently used for self-medication. Vaping seems to be a better alternative to preventing adverse health effects due to toxic compounds produced during combustion when cannabis is smoked. However, the delivery kinetics and efficiency of most portable vaporisers are not fully characterised with an appropriate vaping regime. This determination requires a specific vaping machine operating under realistic puffing conditions. In this study, a vaping machine was conceived to fit with the common uses of portable vaporisers that requires conditions different from those used for electronic cigarettes. The experimental setup in this study was optimised to sample aerosolised cannabinoids. The delivery kinetics, efficiency, and decarboxylation yields of two commercially available vaporisers (DaVinci® and Mighty Medic®) were evaluated for delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Among all tested sampling supports, the glass fibre filter is the most efficient medium to collect mixed THC and CBD aerosols. From the delivery kinetics of cannabinoids, a single-parameter model was used to calculate the extraction coefficient of each vaporiser. The results show that the Mighty Medic® vaporiser had a higher extraction coefficient (0.39) and a more immediate release of cannabinoids than the DaVinci® vaporiser (0.16), which had a gradual and slower rate of vaporisation. This parameter could be a quantitative input in pharmacokinetic models of administration of volatile compounds using vaporisers and a useful tool for the comparison of vaporisers.
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Affiliation(s)
| | | | - Nicolas Concha-Lozano
- Forensic Toxicology and Chemistry Unit, University Centre of Legal Medicine Lausanne, Lausanne, Switzerland
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Tamargo CL, Quinn GP. Don't Ask, Don't Tell: Cannabis Use in Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2020; 10:26-28. [PMID: 32614266 DOI: 10.1089/jayao.2020.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
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35
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Nguyen N, Nguyen C, Thrul J. Digital health for assessment and intervention targeting tobacco and cannabis co-use. CURRENT ADDICTION REPORTS 2020; 7:268-279. [PMID: 33643768 DOI: 10.1007/s40429-020-00317-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose of review This article aims to summarize current research on digital health for assessment and intervention targeting tobacco and cannabis co-use and to answer the following questions: Which digital tools have been used? Which populations have been targeted? And what are implications for future research? Recent findings Ecological Momentary Assessment (EMA) via text messages or interactive voice response calls has been used to capture co-use patterns within a time window or co-administration of both substances via blunts among young adults. Feasibility of multicomponent interventions targeting dual cessation of both substances among adult co-users with cannabis use disorder, delivered via smartphone apps, online, and computer modules has been demonstrated. Summary Digital tools, particularly those using EMAs and mobile sensors, should be expanded to assess co-use of emerging tobacco and cannabis products. Digital cessation interventions should be tailored to different groups of co-users and address specific mechanisms underlying different co-use patterns.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Charlie Nguyen
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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36
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Fischer B, Russell C, Rehm J, Leece P. Assessing the public health impact of cannabis legalization in Canada: core outcome indicators towards an 'index' for monitoring and evaluation. J Public Health (Oxf) 2020; 41:412-421. [PMID: 29860521 DOI: 10.1093/pubmed/fdy090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/13/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
The legalization of non-medical cannabis use and supply is impending in Canada. This constitutes a major policy change with the declared objective of improving public health outcomes, which requires rigorous monitoring and evaluation. While numerous different aspects associated with legalization will be examined, a focused perspective is required for effective policy evaluation purposes. To these ends, we have identified a set of 10 core indicators associated with cannabis-related risk/harm outcomes-based on current best evidence-that are expected to measure the primary impacts of legalization on public health outcomes. We briefly review these indicators, and their respective data availability in Canada. As ideally an integrated outcome assessment of cannabis legalization's impact on public health will be available, we further propose options to merge the individual indicators into an integrated, weighted 'index', considering their expected relative impact for public health. One possible approach to undertake this is 'multi-criteria decision analysis' as a method to weight the relative indicator impact on public health; alternative approaches are proposed. The integrated 'public health index' for cannabis legalization will allow for scientifically comprehensive, while focused, monitoring and evaluation of the effects of legalization in Canada for the benefits of science and evidence-based policy alike.
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Affiliation(s)
- Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Canada.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), 785 05403-903 São Paulo, Brazil
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
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37
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Perry CL, Creamer MR, Chaffee BW, Unger JB, Sutfin EL, Kong G, Shang C, Clendennen SL, Krishnan-Sarin S, Pentz MA. Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science. Nicotine Tob Res 2020; 22:1063-1076. [PMID: 31127298 PMCID: PMC7457341 DOI: 10.1093/ntr/ntz059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/16/2019] [Indexed: 12/21/2022]
Abstract
The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA's priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10-18 years) and/or young adults (ages 18-34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior. IMPLICATIONS The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science.
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Affiliation(s)
- Cheryl L Perry
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | - MeLisa R Creamer
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Jennifer B Unger
- Keck School of Medicine,University of Southern California, Los Angeles, CA
| | | | | | - Ce Shang
- Oklahoma Tobacco Research Center, Stephenson Cancer Center
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephanie L Clendennen
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Mary Ann Pentz
- Keck School of Medicine,University of Southern California, Los Angeles, CA
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38
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Gravely S, Driezen P, Smith DM, Borland R, Lindblom EN, Hammond D, McNeill A, Hyland A, Cummings KM, Chan G, Thompson ME, Boudreau C, Martin N, Ouimet J, Loewen R, Quah ACK, Goniewicz ML, Thrasher JF, Fong GT. International differences in patterns of cannabis use among adult cigarette smokers: Findings from the 2018 ITC Four Country Smoking and Vaping Survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102754. [PMID: 32305827 PMCID: PMC7967289 DOI: 10.1016/j.drugpo.2020.102754] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/26/2020] [Accepted: 04/02/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization. METHODS Data are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England. RESULTS Among this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent ( CONCLUSION Patterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia. Further attention as to how varying cannabis regulations may impact co-use patterns is warranted.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada.
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Danielle M Smith
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Cancer Council Victoria, Melbourne, VIC, Australia
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC United States
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Ann McNeill
- King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; UK Centre for Tobacco & Alcohol Studies, Nottingham, United Kingdom
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Gary Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Ruth Loewen
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States; Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada; Ontario Institute for Cancer Research, Toronto, Canada
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Abstract
OBJECTIVES Cannabis and tobacco dual use is a growing concern in the United States, especially among African Americans (AAs). Dual use increases nicotine dependence and poses negative health effects. Despite decreasing numbers of people who smoke daily, nondaily smokers (NDS) are increasing. Polytobacco use, including blunt use, is higher in AA NDS than AAs who smoke daily. This study examined factors associated with cannabis use among AA NDS. METHODS Adult AA NDS participated in a randomized controlled trial (n = 278) for smoking cessation. A subset of this sample (n = 262; mean age 48.2 years; 50% male) was analyzed to identify correlates of cannabis use. Logistic regression assessed the associations of demographic, smoking-related, and psychosocial variables with cannabis use. RESULTS Participants smoked cigarettes on an average of 18 days of the last 30 and used 4.5 cigarettes on smoking days. Of the participants analyzed, 38% used cannabis, including blunts (ie, cigars hollowed out filled with cannabis) at baseline. Cannabis use was associated with polytobacco product use not including blunts (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.18-3.77, P = 0.012), depressive symptoms (OR 1.22, 95% CI 1.05-1.42, P = 0.011), and younger age (OR 0.97, 95% CI 0.94-0.99, P = 0.004). CONCLUSIONS Rates of cannabis and tobacco dual use in our sample exceed national rates. Dual use poses harmful health effects that exceed the risk of either substance alone. Findings will inform future work in tailoring treatments to vulnerable groups of people who use both tobacco and cannabis.
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40
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Lake S, Kerr T, Werb D, Haines-Saah R, Fischer B, Thomas G, Walsh Z, Ware MA, Wood E, Milloy MJ. Guidelines for public health and safety metrics to evaluate the potential harms and benefits of cannabis regulation in Canada. Drug Alcohol Rev 2020; 38:606-621. [PMID: 31577059 DOI: 10.1111/dar.12971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023]
Abstract
ISSUES Canada recently introduced a public health-based regulatory framework for non-medical cannabis. This review sought to identify a comprehensive set of indicators to evaluate the public health and safety impact of cannabis regulation in Canada, and to explore the ways in which these indicators may be expected to change in the era of legal non-medical cannabis. APPROACH Five scientific databases were searched to compile a list of cannabis-related issues of interest to public health and safety. A set of indicators was developed based on topics and themes that emerged. Preliminary evidence from other jurisdictions in the USA and Canada that have legalised medical and/or non-medical cannabis (e.g. Colorado, Washington) was summarised for each indicator, wherever possible. KEY FINDINGS In total, 28 indicators were identified under five broad themes: public safety; cannabis use trends; other substance use trends; cardiovascular and respiratory health; and mental health and cognition. Preliminary trends from other legalised jurisdictions reveal little consensus regarding the effect of cannabis legalisation on public health and safety harms and an emerging body of evidence to support potential benefits (e.g. reductions in opioid use and overdose). IMPLICATIONS In addition to indicators of commonly discussed challenges (e.g. cannabis-related hospitalisations, cannabis-impaired driving), this review led to the recommendation of several indicators to monitor for possible public health and safety improvements. CONCLUSION In preparing a comprehensive public health and safety monitoring and evaluation system for cannabis regulation, this review underscores the importance of not only measuring the possible risks but also the potential benefits.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Dan Werb
- Department of Medicine, University of California San Diego, La Jolla, USA.,International Centre for Science in Drug Policy, St. Michael's Hospital, Toronto, Canada
| | - Rebecca Haines-Saah
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Benedikt Fischer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Canada.,Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Gerald Thomas
- Alcohol, Tobacco, Cannabis and Gambling Policy and Prevention, British Columbia Ministry of Health, Victoria, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | - Mark A Ware
- Departments of Family Medicine and Anesthesia, McGill University, Montréal, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
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41
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Azagba S, Latham K, Shan L. Marijuana use and subsequent cigarette use among U.S. adolescents: A longitudinal study. Addict Behav 2020; 102:106194. [PMID: 31862682 DOI: 10.1016/j.addbeh.2019.106194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The extant literature on the relationship between marijuana and tobacco among youth is mixed. The present study examined the temporal association of marijuana use with subsequent cigarette use in a nationally representative sample of U.S. adolescents. METHODS We used data from Waves 1, 2 and 3 of the Population Assessment of Tobacco and Health. A propensity score method was used to address imbalance between marijuana ever and non-ever users. Logistic regressions were used to examine the temporal associations of marijuana ever use at Wave 1 on cigarette use at Waves 2 and 3 among youth that were classified as never cigarette users at Wave 1. RESULTS Among the 422 youth marijuana ever users at Wave 1, 15.5% reported subsequent past 12-month (P12M) cigarette use and 8.2% reported subsequent past 30-day (P30D) cigarette use at Wave 2. Of the 7924 youth never marijuana users at Wave 1, 3.5% reported P12M cigarette use and 1.4% reported P30D cigarette use. Youth marijuana ever users at Wave 1 were more likely to report P12M cigarette use (aOR = 5.11; 95% CI 2.91-8.95) and P30D cigarette use (aOR = 6.14; 95% CI 2.89-13.04) at Wave 2. CONCLUSIONS Our findings suggest that youth marijuana ever users were more likely to report subsequent P12M cigarette use and P30D cigarette use. Given the known health effects related to both products, findings suggest there is a need for continued monitoring of both marijuana and cigarette use among adolescents, especially in a rapidly changing regulatory environment.
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Patterns of cigarette, e-cigarette, and cannabis use among adult smokers in primary care 2014-2015. Addict Behav 2020; 100:106109. [PMID: 31522133 DOI: 10.1016/j.addbeh.2019.106109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Poly-use of tobacco, cannabis, and electronic cigarettes (e-cigarettes) is an emerging problem in the general population. The current study investigated poly-use of these products and receipt of smoking cessation counseling in a primary care setting. METHODS We conducted a cross-sectional secondary data analysis from a trial of a tablet intervention to increase provider delivery of the 5As (Ask, Advise, Assess, Assist, Arrange follow-up), a brief counseling intervention for smoking cessation, in 3 diverse primary care clinics in San Francisco, CA from 2014 to 2015. Participants were currently smoking cigarettes (N = 601; mean age = 50.8; 38.1% female) and reported information on past 30-day cigarette and e-cigarette use and past 3-month cannabis use. We classified participants into 4 groups: (1) cigarette-only, (2) dual-use of cigarettes and e-cigarettes, (3) dual-use of cigarettes and cannabis, (4) poly-use of cigarettes, e-cigarettes, and cannabis, and examined correlates of use. RESULTS Only cigarette smoking was reported by 48.6% of participants, 30.4% reported use of cigarettes and cannabis, 10.5% reported use of cigarettes and e-cigarettes, and 10.5% reported use of cigarettes, e-cigarettes, and cannabis. Cigarette-only smokers did not differ from other groups by cigarette smoking behavior and motivation to quit. Patients reporting dual-use of cigarettes and e-cigarettes had a higher likelihood of receiving the Arrange step and all 5As compared to cigarette-only smokers. CONCLUSIONS Providers should screen for co-use of cigarettes and other nicotine/cannabis products and consider co-use when delivering smoking cessation treatment and evaluating treatment outcomes. Development of guidelines to help facilitate provider training is needed.
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43
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Chen-Sankey JC, Jewett BJ, Orozco L, Duarte DA, Dang K, Seaman EL, Choi K. "Hey, I Got to Smoke Some Weed": Favorable Perceptions of Marijuana Use Among Non-College-Educated Young Adult Cigarette Smokers. Subst Use Misuse 2020; 55:48-55. [PMID: 31448650 PMCID: PMC6917969 DOI: 10.1080/10826084.2019.1654515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: As marijuana legalization progresses in the U.S., this study investigated the perceptions of marijuana use among non-college-educated young adult smokers. Methods: Twelve focus groups were conducted to explore themes related to marijuana and marijuana use among a racially and ethnically diverse sample of 75 young adult smokers (ages 18-29 years) with <4-year college education and <$90,000 annual household income living in the Washington, D.C. metropolitan area. Thematic content analysis was employed to analyze the transcripts. Data collection and analysis took place in 2017 and 2018, respectively. Results: Many participants reported smoking cigarettes to boost and maintain the psychoactive effect ("high") of smoking marijuana; some smoked marijuana to substitute frequent cigarette smoking. Participants generally stated that they believed marijuana smoking was healthier and less addictive than cigarette smoking; many preferred smoking marijuana over cigarettes. Participants also mentioned that cigarette smoking was stigmatized and not socially acceptable but marijuana smoking was "trendy" and "cool." Some reported that they smoked marijuana to cut down on cigarettes, although most were unsuccessful. Racial and ethnic differences in marijuana use were also identified. Discussion: Non-college-educated young adult smokers expressed largely favorable views towards smoking marijuana. Such positive views may lead to prolonged and escalated use of cigarettes and marijuana, resulting in exacerbated adverse health consequence of smoking both products as well as worsened outcomes of cigarette smoking cessation. Evidence-based messages are greatly needed to communicate the harm and risks of marijuana use and marijuana and tobacco co-use among this group.
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Affiliation(s)
- Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Bambi J Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Leah Orozco
- Department of Biology, College of the Holy Cross, Worcester, Massachusetts, USA
| | - Danielle A Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Kathleen Dang
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
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44
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Steinberg J, Unger JB, Hallett C, Williams E, Baezconde-Garbanati L, Cousineau MR. A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications. Am J Public Health 2019; 110:203-208. [PMID: 31855488 DOI: 10.2105/ajph.2019.305423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states-Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington-allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking.We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state's smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues.States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health.
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Affiliation(s)
- Jane Steinberg
- Jane Steinberg, Jennifer B. Unger, Lourdes Baezconde-Garbanati, and Michael R. Cousineau are with the Department of Preventive Medicine, University of Southern California, Los Angeles. Cynthia Hallett and Elizabeth Williams are with the American Nonsmokers' Rights Foundation, Berkeley, CA
| | - Jennifer B Unger
- Jane Steinberg, Jennifer B. Unger, Lourdes Baezconde-Garbanati, and Michael R. Cousineau are with the Department of Preventive Medicine, University of Southern California, Los Angeles. Cynthia Hallett and Elizabeth Williams are with the American Nonsmokers' Rights Foundation, Berkeley, CA
| | - Cynthia Hallett
- Jane Steinberg, Jennifer B. Unger, Lourdes Baezconde-Garbanati, and Michael R. Cousineau are with the Department of Preventive Medicine, University of Southern California, Los Angeles. Cynthia Hallett and Elizabeth Williams are with the American Nonsmokers' Rights Foundation, Berkeley, CA
| | - Elizabeth Williams
- Jane Steinberg, Jennifer B. Unger, Lourdes Baezconde-Garbanati, and Michael R. Cousineau are with the Department of Preventive Medicine, University of Southern California, Los Angeles. Cynthia Hallett and Elizabeth Williams are with the American Nonsmokers' Rights Foundation, Berkeley, CA
| | - Lourdes Baezconde-Garbanati
- Jane Steinberg, Jennifer B. Unger, Lourdes Baezconde-Garbanati, and Michael R. Cousineau are with the Department of Preventive Medicine, University of Southern California, Los Angeles. Cynthia Hallett and Elizabeth Williams are with the American Nonsmokers' Rights Foundation, Berkeley, CA
| | - Michael R Cousineau
- Jane Steinberg, Jennifer B. Unger, Lourdes Baezconde-Garbanati, and Michael R. Cousineau are with the Department of Preventive Medicine, University of Southern California, Los Angeles. Cynthia Hallett and Elizabeth Williams are with the American Nonsmokers' Rights Foundation, Berkeley, CA
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Nguyen N, Barrington-Trimis JL, Urman R, Cho J, McConnell R, Leventhal AM, Halpern-Felsher B. Past 30-day co-use of tobacco and marijuana products among adolescents and young adults in California. Addict Behav 2019; 98:106053. [PMID: 31357072 PMCID: PMC6708734 DOI: 10.1016/j.addbeh.2019.106053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/03/2019] [Accepted: 07/14/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Limited research among adolescents and young adults (AYA) has assessed tobacco and marijuana co-use in light of specific products. We examined the patterns of past 30-day co-use of tobacco and marijuana products, and the product-specific associations among past 30-day use of these substances. METHODS Data from three school-based convenience samples of California AYA (aged 15-22) (Sample 1 = 3008; Sample 2 = 1419; Sample 3 = 466) were collected during 2016-2017. Proportions of past 30-day co-use of tobacco (e-cigarettes, cigarettes, hookah, cigars) and marijuana (combustible, vaporized, edible, blunt) were estimated. Multivariable logistic regression analyses examined associations between use of each tobacco and marijuana product for individual samples, then the pooled analysis calculated combined ORs. RESULTS In the three samples, 7.3-11.3% of participants reported past 30-day co-use. Combinations of e-cigarettes or cigarettes and combustible marijuana were the most common co-use patterns. Past 30-day use of e-cigarettes or cigarettes (vs. non-use) increased the odds of past 30-day use of all marijuana products [e-cigarettes: ORs (95%CI) ranging from 2.5 (1.7, 3.2) for edible marijuana to 4.0 (2.8, 5.2) for combustible marijuana; cigarettes: from 3.2 (2.1, 4.2) for vaporized marijuana to 5.5 (3.8, 7.3) for combustible marijuana]. Past 30-day use of hookah or cigars was positively associated with past 30-day use of three of four marijuana products, except for hookah and vaporized marijuana, and for cigars and combustible marijuana. CONCLUSIONS Given various co-use patterns and significant associations among tobacco and marijuana products, interventions targeting AYA should address co-use across the full spectrum of specific products for both substances.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, CA, USA.
| | | | - Robert Urman
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Junhan Cho
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Rob McConnell
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Adam M Leventhal
- University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA.
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
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Manwell LA, Miladinovic T, Raaphorst E, Rana S, Malecki S, Mallet PE. Chronic nicotine exposure attenuates the effects of Δ 9 -tetrahydrocannabinol on anxiety-related behavior and social interaction in adult male and female rats. Brain Behav 2019; 9:e01375. [PMID: 31583843 PMCID: PMC6851810 DOI: 10.1002/brb3.1375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Anxiogenic and anxiolytic effects of cannabinoids are mediated by different mechanisms, including neural signaling via cannabinoid receptors (CBRs) and nicotinic cholinergic receptors (nAChRs). This study examined the effects of prior nicotine (the psychoactive component in tobacco) exposure on behavioral sensitivity to delta-9-tetrahydrocannabinol (THC; the psychoactive component of cannabis) challenge in animals. METHODS Male and female adult Sprague-Dawley rats (N = 96) were injected daily with nicotine (1 mg/kg, i.p.) or vehicle for 14 days, followed by a 14-day drug-free period. On test day, rats were injected with THC (0.5, 2.0, or 5.0 mg/kg, i.p.) or vehicle and anxiety-related behavior was assessed in the emergence (EM), elevated plus maze (EPM), and social interaction (SI) tests. RESULTS Chronic nicotine pretreatment attenuated some of the anxiogenic effects induced by THC challenge which can be summarized as follows: (a) THC dose-dependently affected locomotor activity, exploratory behavior, and social interaction in the EM, EPM, and SI tests of unconditioned anxiety; (b) these effects of acute THC challenge were greater in females compared with males except for grooming a conspecific; (c) prior nicotine exposure attenuated the effects of acute THC challenge for locomotor activity in the EPM test; and (d) prior nicotine exposure attenuated the effects of THC challenge for direct but not indirect physical interaction in the SI tests. CONCLUSIONS The ability of nicotine prior exposure to produce long-lasting changes that alter the effects of acute THC administration suggests that chronic nicotine may induce neuroplastic changes that influence the subsequent response to novel THC exposure.
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Affiliation(s)
- Laurie A Manwell
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Tanya Miladinovic
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Elana Raaphorst
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Shadna Rana
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sarah Malecki
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Paul E Mallet
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
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Roche DJO, Bujarski S, Green R, Hartwell EE, Leventhal AM, Ray LA. Alcohol, tobacco, and marijuana consumption is associated with increased odds of same-day substance co- and tri-use. Drug Alcohol Depend 2019; 200:40-49. [PMID: 31085377 PMCID: PMC6675401 DOI: 10.1016/j.drugalcdep.2019.02.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about event-level patterns of marijuana co- or tri-use with alcohol and tobacco. Thus, the study goal was to examine patterns of same-day alcohol, cigarette, and marijuana co- and tri-use at the individual level in non-treatment-seeking alcohol users. METHODS Participants (N = 551) completed an in-person interview for alcohol, cigarette, and marijuana use over the previous 30 days, and the event-level substance use patterns of n = 179 participants who reported using each of these substances at least once per month were analyzed. RESULTS The use of alcohol, marijuana, or cigarettes independently increased the probability of subsequent, simultaneous co-use of one of the two remaining substances. The co-use of alcohol with cigarettes and marijuana with cigarettes produced generally additive effects on the odds of same day tri-use of marijuana and alcohol, respectively. Conversely, the co-use of alcohol and marijuana produced sub-additive effects on likelihood of cigarette use. Sex moderated several of the observed patterns of co- and tri-use: the relationship between alcohol or cigarette use predicting marijuana co-use was stronger in men, whereas the observed additive relationships between drug co-use leading to tri-use was stronger in women. CONCLUSIONS The presented results may aid in the understanding of how simultaneous co-use of marijuana with alcohol and/or tobacco relates to the etiology, maintenance, and treatment of comorbid and trimorbid substance use disorder. Replication and extension of the results in treatment seeking populations using more fine-grained analysis approaches, e.g. ecological momentary assessment, is needed.
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Affiliation(s)
- D J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - S Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - R Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - E E Hartwell
- Mental Illness Research, Education and Clinical Center, Corporal Michael J Crescenz VA Medical Center, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - A M Leventhal
- Departments of Preventive Medicine and Psychpology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - L A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
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Weinberger AH, Platt J, Copeland J, Goodwin RD. Is Cannabis Use Associated With Increased Risk of Cigarette Smoking Initiation, Persistence, and Relapse? Longitudinal Data From a Representative Sample of US Adults. J Clin Psychiatry 2019; 79:17m11522. [PMID: 29570966 PMCID: PMC6355334 DOI: 10.4088/jcp.17m11522] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/14/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The current study prospectively investigated the relationship between cannabis use and cigarette smoking initiation, persistence, and relapse during a 3-year period among adults in the United States. METHODS Analyses included respondents who completed Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions and responded to questions about cannabis use and smoking status (n = 34,639). Multivariable logistic regression models were used to calculate the odds of cigarette use at Wave 2 among Wave 1 daily smokers, nondaily smokers, former smokers, and nonsmokers by Wave 1 cannabis use. RESULTS In unadjusted analyses, Wave 1 cannabis use was associated with increased odds of Wave 2 daily and nondaily smoking for Wave 1 nonsmokers (daily OR = 2.90; 95% CI, 2.10-4.00; nondaily OR = 4.45; 95% CI, 3.97-5.00) and Wave 2 relapse to daily and nondaily smoking for Wave 1 former smokers (daily OR = 4.18, 95% CI, 3.01-5.81; nondaily OR = 5.24; 95% CI, 3.74-7.34). Wave 1 cannabis use was associated with decreased odds of Wave 2 smoking cessation for Wave 1 daily cigarette smokers (OR = 0.57; 95% CI, 0.51-0.64). The associations remained significant for daily smoking initiation (OR = 1.43; 95% CI, 1.06-1.93), daily smoking relapse (OR = 1.47; 95% CI, 1.00-2.16), and smoking cessation (OR = 0.77; 95% CI, 0.69-0.87) after adjusting for demographics and psychiatric disorders. Associations remained significant for nondaily smoking initiation (OR = 1.85; 95% CI, 1.59-2.16) and nondaily smoking relapse (OR = 1.63; 95% CI, 1.05-2.54) after adjusting for these covariates as well as for alcohol and substance use disorders. CONCLUSIONS Cannabis use was associated with increased initiation of, persistence of, and relapse to cigarette smoking. Additional attention to cannabis use in tobacco control efforts and in clinical settings aimed at reducing cigarette smoking and smoking-related negative consequences may be warranted.
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Affiliation(s)
- Andrea H Weinberger
- Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jonathan Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jan Copeland
- National Drug and Alcohol Research Centre, University of New South Wales Medicine, Sydney, Australia
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, 55 West 125th Street, Rm 611, New York, NY 10027.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA
- Institute for Implementation Science in Population Health, The City University of New York, New York, New York, USA
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49
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McClure EA, Tomko RL, Salazar CA, Akbar SA, Squeglia LM, Herrmann E, Carpenter MJ, Peters EN. Tobacco and cannabis co-use: Drug substitution, quit interest, and cessation preferences. Exp Clin Psychopharmacol 2019; 27:265-275. [PMID: 30556733 PMCID: PMC6538467 DOI: 10.1037/pha0000244] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The co-use of tobacco and cannabis is a common practice worldwide and carries with it substantial public health burden. Few interventions exist that target both substances and little is known about quit interest, treatment preferences, and drug substitution during past cessation attempts, which is critical to guide the development of treatment strategies. The goal of this study was to provide descriptive information regarding quit interest, treatment preferences, and perceived drug substitution among adult (age 18 +) cannabis-tobacco co-users. Participants (N = 282) from two independent survey samples (recruited from Amazon Mechanical Turk) from across the United States were combined. Among all participants, 57% were female, 79% were White, and average age was 33.31 (SD = 9.54) years old. Approximately 80% had tried to quit smoking cigarettes at least once, while 40% had tried to quit using cannabis at least once. Of those who tried to quit, 50% self-reported a perceived increase in their cannabis use during tobacco cessation and 62% self-reported a perceived increase in their tobacco use during cannabis cessation. Average quit interest (10-point scale) for cannabis was 2.39 (SD = 2.35) and for tobacco was 7.07 (SD = 2.90). Results of this study suggest that tobacco use should be addressed among cannabis-tobacco co-users, but interventions should consider lack of interest in cannabis cessation. Reduction-based strategies for cannabis use appear to be more acceptable to this nontreatment-seeking, co-using population. Drug substitution during quit attempts for one substance should be further explored as an important treatment consideration. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Erin A. McClure
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Rachel L. Tomko
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Claudia A. Salazar
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Saima A. Akbar
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | - Lindsay M. Squeglia
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
| | | | - Matthew J. Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
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50
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Weinberger AH, Pacek LR, Wall MM, Gbedemah M, Lee J, Goodwin RD. Cigarette smoking quit ratios among adults in the USA with cannabis use and cannabis use disorders, 2002-2016. Tob Control 2019; 29:74-80. [PMID: 30952691 DOI: 10.1136/tobaccocontrol-2018-054590] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/02/2018] [Accepted: 11/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking is nearly three times higher among persons who use cannabis and have cannabis use disorders (CUDs), relative to those who do not. The current study examined cigarette quit ratios from 2002 to 2016 among US adults with and without cannabis use and CUDs. METHODS The current study analysed US adults aged 18 years and older from the National Survey on Drug Use and Health, an annual cross-sectional study. Quit ratios (ie, proportion of former smokers among ever-smokers) were calculated annually from 2002 to 2016. Time trends in quit ratios by cannabis use/CUDs were tested using logistic regression. RESULTS In 2016, the quit ratios for people with any cannabis use (23%) and CUDs (15%) were less than half the quit ratios of those without cannabis use and CUDs (51% and 48%, respectively). After controlling for demographics and substance use disorders, the quit ratio did not change from 2002 to 2016 among persons with CUD, though it non-linearly increased among persons with cannabis use, without cannabis use and without CUDs. Quit ratios increased more rapidly among those who reported past-month cannabis use compared with those without past-month cannabis use. CONCLUSIONS Cigarette smoking quit ratios remain dramatically lower among people who use cannabis and have CUDs and quit ratios did not change significantly from 2002 to 2016 among those with CUDs. Public health and clinical attention are needed to increase quit ratios and reduce harmful cigarette smoking consequences for persons with cannabis use and CUDs.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, USA.,Institute for Implementation Science in Population Health, The City University of New York, New York, USA
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Department of Genetics, Albert Einstein College of Medicine, Bronx, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, USA.,Institute for Implementation Science in Population Health, The City University of New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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