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Voci S, Veldhuizen S, Ivanova A, Melamed OC, Selby P, Zawertailo L. Cannabis Use Among Adults in Cigarette Smoking Cessation Treatment in Ontario, Canada: Prevalence and Association With Tobacco Cessation Outcome, 2015-2021. Am J Public Health 2024; 114:98-107. [PMID: 38091559 PMCID: PMC10726933 DOI: 10.2105/ajph.2023.307445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives. To examine cannabis use prevalence and its association with tobacco cessation among adults enrolled in cigarette smoking cessation treatment before and after Canada legalized recreational cannabis in October 2018. Methods. The sample comprised 83 206 adults enrolled in primary care-based cigarette smoking cessation treatment between 2015 and 2021 in Ontario, Canada. Past-30-day cannabis use was self-reported at enrollment and cigarette smoking abstinence at 6-month follow-up. Results. Past-30-day prevalence of cannabis use increased from 20.2% in 2015 to 37.7% in 2021. The prevalence increased linearly both before and after legalization. Cannabis and tobacco co-use was associated with lower odds of self-reported cigarette smoking abstinence at 6-month follow-up than tobacco use only (24.4% vs 29.3%; odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.75, 0.81). This association was attenuated after adjustment for covariates (OR = 0.93; 95% CI = 0.89, 0.97) and weakened slightly over time. Conclusions. Cannabis use prevalence almost doubled from 2015 to 2021 among primary care patients in Ontario seeking treatment to quit cigarettes and was associated with poorer quit outcomes. Further research into the impact of cannabis policy on cannabis and tobacco co-use is warranted to mitigate harm. (Am J Public Health. 2024;114(1):98-107. https://doi.org/10.2105/AJPH.2023.307445).
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Affiliation(s)
- Sabrina Voci
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Scott Veldhuizen
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Anna Ivanova
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Osnat C Melamed
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Peter Selby
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
| | - Laurie Zawertailo
- Sabrina Voci, Scott Veldhuizen, and Anna Ivanova are with the INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Osnat C. Melamed is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, University of Toronto. Peter Selby is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Family and Community Medicine, Department of Psychiatry, and Dalla Lana School of Public Health, University of Toronto. Laurie Zawertailo is with the INTREPID Lab, Centre for Addiction and Mental Health, and the Department of Pharmacology and Toxicology, University of Toronto
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Yockey RA, Barnett TE. Past-Year Blunt Smoking among Youth: Differences by LGBT and Non-LGBT Identity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5304. [PMID: 37047919 PMCID: PMC10094410 DOI: 10.3390/ijerph20075304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
Blunt use (co-use of tobacco and marijuana) is a growing phenomenon among youth and disproportionately affects minority populations. LGBT+ populations are significantly more likely to use marijuana and tobacco, but this relationship has yet to be examined among LGBT+ adolescents. This analysis aimed to investigate past-year blunt use among a national sample of youth and delineate the differences between non-LGBT and LGBT+ youth. We used Wave 2 of the Population and Tobacco Health (PATH) study. We analyzed data from 7518 youth, comparing past-year blunt use between LGBT+ and non-LGBT youth, controlling for biological sex, race, and age using weighted logistic regression models. Greater than 1 in 10 youth (10.6%) reported using blunts in the past year. More than one in five (21.6%) LGBT+ youth reported using blunts in the past year. There were no significant differences between boys and girls. Older youth (17 years old) were more likely to use blunts in the past year (aPR: 3.04, 95% CI 2.48, 3.79) than younger youth. Compared with non-LGBT youth, LGBT+ youth were 2.17 times (95% CI 1.86, 2.54) more likely to report using blunts in the past year. Blunt use and its respective impact on health outcomes among developing youth are of concern to public health. These findings demonstrate that certain subgroups of youth are more at risk for use and emphasize the need for tailored interventions to mitigate initiation and current use, given that one of the goals of the Healthy People 2030 initiative is to "Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals".
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Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med 2023; 48:97-117. [PMID: 36596580 DOI: 10.1136/rapm-2022-104013] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear. METHODS In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement. RESULTS Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes. CONCLUSIONS Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.
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Affiliation(s)
- Shalini Shah
- Dept of Anesthesiology & Perioperative Care, UC Irvine Health, Orange, California, USA
| | - Eric S Schwenk
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Hance Clarke
- Anesthesiology and Pain Medicine, Univ Toronto, Toronto, Ontario, Canada
| | - Mark Zakowski
- Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Brent Yeung
- Anesthesiology and Perioperative Care, University of California Irvine, Irvine, California, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA.,Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Mark Wallace
- Anesthesiology, Division of Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
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Matson PA, Flessa SJ, Hoff A, Alinsky R, Alexander K, Lich KH, Johnson RM. "What Do You Consider Use?" Perspectives of Black Youth on Cannabis Use. J Adolesc Health 2023; 72:254-259. [PMID: 36443160 DOI: 10.1016/j.jadohealth.2022.09.024] [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] [Received: 03/22/2022] [Revised: 08/30/2022] [Accepted: 09/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescent health surveillance systems are critical for understanding patterns of cannabis use; however, their limitations underscore the need for studies that generate new insights, particularly from individuals who are most impacted by negative outcomes. Our objectives were to learn about youths' cannabis use and their perceptions of their peers' cannabis use; their perspectives about trajectories of cannabis use over time and factors that influence trajectories; and perceived risks and benefits associated with cannabis use. METHODS A group model building approach was used to gather data about cannabis use from a sample of urban, Black youth. Information about participants' cannabis use was assessed on eligibility screener, enrollment survey, and through structured activities over the course of four group model building workshops. RESULTS Participants [(n = 20) mean age 18; 35% male and 95% Black] exclusively used the terms weed and blunts for cannabis. Youth who consume peers' blunts would not characterize themselves as cannabis users. Collectively, youth estimated the majority of Baltimore youth used cannabis by age 16 and that most used daily. Youth described cannabis as more beneficial than harmful. There were no gender differences in prevalence of use, but there were gender dynamics to shared use. DISCUSSION Participatory research with urban, Black youth suggests youths' perceptions are misaligned with the ways that researchers conceptualize cannabis use. To better understand the scope of youth cannabis use and its harms, it is critical to leverage input from youth with lived experience to ensure survey tools adequately capture the way youth see themselves using cannabis.
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Affiliation(s)
- Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Sarah J Flessa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Annika Hoff
- College of Arts and Sciences, Cornell University, Ithaca, New York
| | - Rachel Alinsky
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Vaping motivations: Association of behavioral inhibition and behavioral activation systems with nicotine and cannabis vaping among adolescents. Addict Behav 2022; 135:107436. [PMID: 35917635 PMCID: PMC10064800 DOI: 10.1016/j.addbeh.2022.107436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite copious information on the hazards of nicotine and cannabis, many adolescents report vaping nicotine and cannabis. To advance knowledge on the precursors of vaping behaviors, this study examined the association of behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivities with nicotine and cannabis vaping among adolescents. METHODS Data were part of a longitudinal survey on substance use and mental health among adolescents and included 2,467 11th grade students from 10 public high schools in California. Participants completed a 20-item scale assessing BIS (one aspect) and BAS (three aspects: drive, fun-seeking, reward responsiveness) sensitivities at baseline and reported their past 30-day nicotine and cannabis vaping at baseline and again at 6-month follow-up. Unadjusted and adjusted (controlled for demographic characteristics and product-specific baseline vaping) regression models estimated vaping risk at follow-up by BIS/BAS scores at baseline. RESULTS Bivariate analyses showed participants who vaped nicotine had significantly higher drive and fun-seeking scores (p < 0.05); and cannabis vapers had lower BIS and reward responsiveness scores (p < 0.05) compared to non-users. Higher fun seeking scores was associated with increased odds (OR = 1.15, 95 %CI = 1.03-1.29) of nicotine vaping and higher reward responsiveness scores reduced odds (OR = 0.89, 95 %CI = 0.79-0.99) of nicotine vaping. Higher scores on BIS was associated with decreased the odds (OR = 0.91, 95 %CI = 0.84-0.99) of cannabis vaping. CONCLUSION Different behavioral motivations should be targeted when developing interventions designed to reduce nicotine and cannabis vaping among diverse adolescents.
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Skelton E, Rich J, Handley T, Bonevski B. Prevalence of cannabis use among tobacco smokers: a systematic review protocol. BMJ Open 2022; 12:e050681. [PMID: 35501085 PMCID: PMC9062809 DOI: 10.1136/bmjopen-2021-050681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/08/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Understanding the prevalence of cannabis use among tobacco smokers has important implications for research in terms of intervention effectiveness and measurement in smoking cessation trials. The co-use of these substances also has important implications for health service planning, specifically ensuring appropriate and adequate clinical treatment. To date, there have been no synthesis of the literature on the prevalence of tobacco and cannabis co-use in adult clinical populations. Improved understanding of the current prevalence, route of administration and specific subpopulations with the highest rates of tobacco and cannabis co-use will support future intervention development. We aim to provide a pooled estimate of the percentage of smokers who report using cannabis and to examine the prevalence of co-use by sociodemographic characteristics. METHODS AND ANALYSIS We will conduct a systematic review using six scientific databases with published articles from 2000 to 2022 inclusive (CENTRAL, CINAHL, EMBASE, Medline, PsycINFO, Psychology and Behavioural Sciences Collection, Scopus). Peer-reviewed journal articles published in English that report on tobacco and cannabis use will be included. Rates of co-use (simultaneous or sequentially) and routes of administration will be assessed. Use in populations groups will be described. Quality assessments will be conducted for all included studies. Data will be synthesised using a narrative approach. This study will be conducted from June 2022 to the end of August 2022. ETHICS AND DISSEMINATION This review is based on previously published data and, therefore, ethical approval or written informed consent will not be required. It is the intention of the research team to disseminate the results of the systematic review as a peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020194051.
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Affiliation(s)
- Eliza Skelton
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jane Rich
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tonelle Handley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- College of Health and Medicine, Flinders University, Bedford Park, South Australia, Australia
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Kendzor DE, Ehlke SJ, Kharazi Boozary L, Smith MA, Cohn AM. Characteristics of adults with a medical cannabis license, reasons for use, and perceptions of benefit following medical cannabis legalization in Oklahoma. Prev Med Rep 2022; 27:101777. [PMID: 35392181 PMCID: PMC8980491 DOI: 10.1016/j.pmedr.2022.101777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 01/13/2023] Open
Abstract
Little is known about the risks and benefits associated with medical cannabis legalization. The current study was an online panel survey of adult Oklahomans recruited between September and October 2020 (N = 1898). Respondents with and without a medical cannabis license were compared on sociodemographic, substance use and health characteristics, and sub-analyses focused on the characteristics of licensed and unlicensed past 30-day cannabis users. Among all participants, 19.34% (n = 367) reported that they had a medical cannabis license, and 35.73% (n = 676) reported past 30-day cannabis use. Licensees were more likely to be younger (i.e., 18-35 years of age; p = 0.001), identify as a sexual minority (p < 0.001), and report past 30-day cannabis, cigarette, alcohol, and prescription opiate use (all p's ≤ 0.003). Licensed participants most commonly reported medically-recommended cannabis use for anxiety (42.51%), depression (33.24%), sleep problems (26.98%), chronic pain (24.25%), and arthritis (12.81%). The likelihood of medically-recommended cannabis use for anxiety, depression, and chronic pain differed by age group (all p's ≤ 0.028). Licensees were most likely to perceive that cannabis delivered "very much/extreme" relief from anxiety (78.57%), sleep problems (76.30%), nausea/vomiting (70.00%), and depression (67.05%). Compared to licensed past 30-day cannabis users (n = 308), unlicensed users (n = 368) were more likely to be non-White, to have ≤ high school education, to report an annual household income <$30,000, and to report current smoking (all p's ≤ 0.027). Findings provide initial information about the personal characteristics associated with having a medical cannabis license in Oklahoma, the reasons for medical cannabis use, and the perceived medical benefits.
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Affiliation(s)
- Darla E. Kendzor
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 900 N.E. 10th Street, Oklahoma City, OK 73104, USA,TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Corresponding author at: TSET Health Promotion Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA.
| | - Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
| | - Laili Kharazi Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, 455 W. Lindsey Street, Dale Hall Tower, Room 705, Norman, OK 73019, USA
| | - Michael A. Smith
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Hudson College of Public Health, The University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA
| | - Amy M. Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA,Department of Pediatrics, The University of Oklahoma Health Sciences Center, 800 Stanton L. Young Boulevard, Oklahoma City, OK 73117, USA
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Boyd CJ, McCabe SE, Evans-Polce RJ, Veliz PT. Cannabis, Vaping, and Respiratory Symptoms in a Probability Sample of U.S. Youth. J Adolesc Health 2021; 69:149-152. [PMID: 33676824 PMCID: PMC8238794 DOI: 10.1016/j.jadohealth.2021.01.019] [Citation(s) in RCA: 27] [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: 05/01/2020] [Revised: 11/09/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to explore the association between respiratory symptoms among U.S. adolescents who were current (past 30-day) users of cigarettes, e-cigarettes, and/or cannabis, as well as lifetime users of cannabis with electronic nicotine delivery systems (ENDS). METHODS Wave 4 from a national probability sample (N = 14,798) of adolescents (12-17 years) using Population Assessment of Tobacco and Health Study data was used for this study. Retention rate was 88.4%. RESULTS The odds of indicating "wheezing or whistling" in the chest were roughly two times higher among those who had used cannabis in ENDS (adjusted odds ratio 1.81, 95% confidence interval 1.47-2.22); neither e-cigarettes nor cigarettes had a significant association with all five respiratory symptoms in the fully adjusted models. CONCLUSIONS This study provides preliminary evidence that adolescents' cannabis use with ENDS may have negative health consequences. Lifetime cannabis use with ENDS was substantially associated with higher odds of respiratory symptoms.
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Affiliation(s)
- Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan.
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan
| | - Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan
| | - Philip T Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan
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