1
|
Mantey DS, Montgomery L, Chen B, Omega-Njemnobi O, Harrell MB. Blunt smoking during emerging adulthood: Characterizing transitions in cannabis and cigar co-use among a diverse cohort in Texas. Addict Behav 2024; 156:108062. [PMID: 38805771 DOI: 10.1016/j.addbeh.2024.108062] [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: 11/02/2023] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To characterize and compare transitions in blunt smoking behaviors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021. METHODS We analyzed n = 14,152 observations (i.e., completed surveys) provided by n = 2,610 youth and young adults over six (6) waves from Spring 2019 to Fall 2021 via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were recruited in age-cohorts, reflecting 16.5 years (0.5), 18.5 years (0.6), and 20.1 years (0.8) of age at baseline. We applied a three-state Markov model to estimate blunt initiation (never → ever), onset (never → current), continuation (ever → current), and discontinuation (current → ever). First, we compared transitions in blunt smoking by race/ethnicity, with non-Hispanic (NH) Whites as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of blunt transitions, including sex, age, alcohol use, depression, anxiety, and tobacco cigar smoking. RESULTS At baseline, 73% of participants had never smoked blunts, 15.3% had ever smoked blunts s, and 11.7% currently smoked blunts. NHB (HR: 2.15; 95% CI: 1.21-3.84) and Hispanic (HR: 1.72; 95% CI: 1.08-2.72) participants had significantly greater risk of blunt smoking initiation, relative to NHWs. Similarly, NHBs had great risk for continuation (HR: 1.65; 95% CI: 1.16-2.34) and lower risk of discontinuation (HR: 0.57; 95% CI: 0.42-0.77), relative to NHWs. Alcohol use predicted greater risk for onset among NHW (HR: 5.22; 95% CI: 1.40-19.45), NHB (HR: 3.14; 95% CI: 1.32-7.46), and Hispanic (HR: 2.99; 95% CI: 1.80-4.97) participants. CONCLUSIONS Blunt smoking initiation was most common among NHB and Hispanic youth and young adults while risk for sustained blunt smoking was higher in NHB youth and young adults. Research and interventions should investigate the link between alcohol use and elevated blunt smoking among young people.
Collapse
Affiliation(s)
- Dale S Mantey
- UTHealth, University of Texas School of Public Health, Department of Health Promotion and Behavioral Science, USA; UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA; Michael and Susan Dell Center for Healthy Living, USA.
| | - LaTrice Montgomery
- University of Cincinnati College of Medicine, Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, USA
| | - Baojiang Chen
- Michael and Susan Dell Center for Healthy Living, USA; UTHealth, University of Texas School of Public Health, Department of Biostatics and Data Science, USA
| | - Onyinye Omega-Njemnobi
- UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA
| | - Melissa B Harrell
- UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA; Michael and Susan Dell Center for Healthy Living, USA
| |
Collapse
|
2
|
Zhu SH, Tedeschi GJ, Li S, Wang J, Aughinbaugh E, Pratt AS, Zhuang YL. Tobacco Quitline Callers Who Use Cannabis and Their Likelihood of Quitting Cigarette Smoking. Am J Prev Med 2024; 67:241-248. [PMID: 38484902 DOI: 10.1016/j.amepre.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION Cigarette smoking continues to decline in the U.S., but cannabis use is increasing. Many people who smoke cigarettes also use cannabis. This study examines the characteristics of persons who co-use and those who do not co-use and the likelihood of quitting cigarettes for callers to Kick It California, a large state tobacco quitline. METHODS Data were examined from Kick It California callers from January 2020 through December 2023 (N=45,151), including those from a subgroup randomly sampled and reached for evaluation at 7 months after quitline enrollment (n=3,545). The rate of cigarette smoking cessation at 7 months after enrollment for people who co-use cannabis was compared with that for people who do not. Analyses started in 2023 and concluded in January 2024. RESULTS More than a quarter (27.2%) of Kick It California callers co-used cannabis. They were more likely to be male, to be younger, and to have a mental health condition than those who did not. Those who co-use cannabis and those who do not have similar rates of receiving quitline counseling or using Food and Drug Administration-approved cessation aids. Controlled for effects of personal characteristics and use of smoking-cessation services, people who co-use cannabis were less likely to quit cigarette smoking 7 months after enrollment (23.2% vs 28.9%; p<0.001). Among those who co-use, 42.9% intended to quit using cannabis in the next 30 days. CONCLUSIONS A substantial percentage of tobacco quitline callers use cannabis. Those who do co-use quit cigarette smoking at a lower rate than those who do not. Over 40% of people who co-use reported intention to quit cannabis, making tobacco quitlines a rich environment to learn about people who co-use and develop strategies for intervention.
Collapse
Affiliation(s)
- Shu-Hong Zhu
- Moores Cancer Center, University of California, San Diego, San Diego, California; Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California.
| | - Gary J Tedeschi
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Shuwen Li
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Jijiang Wang
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Emily Aughinbaugh
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Andrea S Pratt
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Yue-Lin Zhuang
- Moores Cancer Center, University of California, San Diego, San Diego, California
| |
Collapse
|
3
|
Arora S, Marti CN, North C, Thomas JE, Harrell MB, Pasch KE, Wilkinson AV, Loukas A. Depressive symptoms predict cannabis vaping initiation among young adults. Drug Alcohol Depend 2024; 262:111397. [PMID: 39018887 DOI: 10.1016/j.drugalcdep.2024.111397] [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: 12/22/2023] [Revised: 05/22/2024] [Accepted: 06/25/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Young adults in the United States, including college students, have the highest prevalence of cannabis use compared with other age groups. Although cannabis vaping is increasingly prevalent during young adulthood, little is known about factors contributing to the onset of cannabis vaping during this developmental period. METHODS Participants were 3085 cannabis vaping naïve young adults aged 18-25 years (M = 20.60; SD = 1.80), initially recruited from 24 Texas colleges and participating in a multi-wave, longitudinal study. A survival analysis was conducted to determine if participants reporting elevated depressive symptoms had an increased risk of onset of cannabis vaping over six follow-up waves from fall 2015 to spring 2019 compared to their peers with lower levels of depressive symptoms. Socio-demographic characteristics, time-varying past 30 day substance use, and time-varying peer nicotine vaping were included as covariates in the model. RESULTS Twenty-five percent of participants initiated cannabis vaping during the four-year study period, with stable initiation rates from 2015 to 2017 but doubling from 2017 to 2019. Analyses, both unadjusted and adjusted for study covariates, indicated that elevated depressive symptoms were significantly associated with an increased risk of cannabis vaping initiation. CONCLUSION Findings indicate that initiation of cannabis vaping during young adulthood is common, and particularly more likely among those with greater depressive symptoms, thus underscoring the importance of prevention programs that include mental health support services tailored to young adults.
Collapse
Affiliation(s)
- Srishty Arora
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - C Nathan Marti
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Caroline North
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Jacob E Thomas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Melissa B Harrell
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Keryn E Pasch
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Anna V Wilkinson
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Alexandra Loukas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA.
| |
Collapse
|
4
|
Olderbak S, Möckl J, Rauschert C, Schäfer E, Helmer S, Seitz NN, Hoch E. Predictors of changes in marijuana consumption in Germany during the covid-19 pandemic. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01861-5. [PMID: 38969751 DOI: 10.1007/s00406-024-01861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/23/2024] [Indexed: 07/07/2024]
Abstract
During the Covid-19 pandemic Germany experienced its first increase in the proportion of heavy cannabis users since 1995. With the expected nationwide decriminalization of cannabis before 2025, we investigate the potential causes for that increase. Data were from the 2021 European Web Survey on Drugs (EWSD) including 762 12-month marijuana users from Germany (72.9% male, mean age = 29.5 years). Both heavy and regular cannabis consumers reported an increase in marijuana consumption during the pandemic, with infrequent users reporting a decrease. Using multinomial logistic regression, we found younger individuals (OR = 0.95 [95% CI = 0.92, 0.98]) and those not pursuing or completing higher education (OR = 1.86 [1.23, 2.81]) had increased use. Additionally, using cannabis to self-medicate (OR = 2.79 [1.56, 4.99]) and purchasing marijuana (OR = 2.26 [1.35, 3.77]) was associated with increased use. We found, relative to infrequent users, both regular (OR = 4.00 [2.39, 6.72]) and notably heavy users (OR = 31.17 [12.10, 80.32]) were more likely to use cannabis to self-medicate. Both regular (OR = 4.09 [2.47, 6.77]) and especially heavy users (OR = 13.53 [6.74, 27.16]) were also more likely to purchase marijuana. Heavy users were also more likely to be past 30-day tobacco users (OR = 5.92 [2.81, 12.45]). We identified the self-reported motivation of using cannabis to self-medicate as well as act of purchasing marijuana as having the strongest relation to being a heavy user and increasing marijuana use during the Covid-19 pandemic.
Collapse
Affiliation(s)
- Sally Olderbak
- IFT Center for Mental Health & Addiction Research, Munich, Germany.
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians- University, Munich, Germany.
| | - Justin Möckl
- IFT Center for Mental Health & Addiction Research, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians- University, Munich, Germany
| | | | - Evita Schäfer
- IFT Center for Mental Health & Addiction Research, Munich, Germany
- Julius-Maximilians-Universität, Würzburg, Germany
| | - Stefanie Helmer
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Institute of Health and Nursing Science, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Eva Hoch
- IFT Center for Mental Health & Addiction Research, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians- University, Munich, Germany
| |
Collapse
|
5
|
Poliakova N, Shrier LA, Harris SK, Bélanger RE. Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products. Tob Use Insights 2024; 17:1179173X241259603. [PMID: 38846268 PMCID: PMC11155328 DOI: 10.1177/1179173x241259603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.
Collapse
Affiliation(s)
- Natalia Poliakova
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Lydia A. Shrier
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sion Kim Harris
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard E. Bélanger
- Research Centre of CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| |
Collapse
|
6
|
Zhang C, Slawek DE, Ross J, Zolotov Y, Castillo F, Levin FR, Sohler NL, Minami H, Cunningham CO, Starrels JL, Arnsten JH. Factors Associated with Medical Cannabis Use After Certification: A Three-Month Longitudinal Study. Cannabis Cannabinoid Res 2024; 9:e859-e869. [PMID: 36961410 DOI: 10.1089/can.2022.0248] [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: 03/25/2023] Open
Abstract
Background: Over the past decade, there has been increased utilization of medical cannabis (MC) in the United States. Few studies have described sociodemographic and clinical factors associated with MC use after certification and more specifically, factors associated with use of MC products with different cannabinoid profiles. Methods: We conducted a longitudinal cohort study of adults (N=225) with chronic or severe pain on opioids who were newly certified for MC in New York State and enrolled in the study between November 2018 and January 2022. We collected data over participants' first 3 months in the study, from web-based assessment of MC use every 2 weeks (unit of analysis). We used generalized estimating equation models to examine associations of sociodemographic and clinical factors with (1) MC use (vs. no MC use) and (2) use of MC products with different cannabinoid profiles. Results: On average, 29% of the participants used predominantly high delta-9-tetrahydrocannabinol (THC) MC products within the first 3 months of follow-up, 30% used other MC products, and 41% did not use MC products. Non-Hispanic White race, pain at multiple sites, and past 30-day sedative use were associated with a higher likelihood of MC use (vs. no MC use). Current tobacco use, unregulated cannabis use, and enrollment in the study during the COVID-19 pandemic were associated with a lower likelihood of MC use (vs. no MC use). Among participants reporting MC use, female gender and older age were associated with a lower likelihood of using predominantly high-THC MC products (vs. other MC products). Conclusion: White individuals were more likely to use MC after certification, which may be owing to access and cost issues. The findings that sedative use was associated with greater MC use, but tobacco and unregulated cannabis were associated with less MC use, may imply synergism and substitution that warrant further research. From the policy perspective, additional measures are needed to ensure equitable availability of and access to MC. Health practitioners should check patients' history and current use of sedative, tobacco, and unregulated cannabis before providing an MC recommendation and counsel patients on safe cannabis use. clinicaltrials.gov (NCT03268551).
Collapse
Affiliation(s)
- Chenshu Zhang
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System, Bronx, New York, USA
- Department of Medicine, Einstein College of Medicine, New York, New York, USA
| | - Deepika E Slawek
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System, Bronx, New York, USA
- Department of Medicine, Einstein College of Medicine, New York, New York, USA
| | - Jonathan Ross
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System, Bronx, New York, USA
- Department of Medicine, Einstein College of Medicine, New York, New York, USA
| | - Yuval Zolotov
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System, Bronx, New York, USA
- Department of Medicine, Einstein College of Medicine, New York, New York, USA
| | - Felipe Castillo
- Division on Substance Use Disorders, NY State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Frances R Levin
- Division on Substance Use Disorders, NY State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Nancy L Sohler
- Department of Community Health and Social Medicine, City University of New York, New York, New York, USA
| | - Haruka Minami
- Department of Psychology, Fordham University, Bronx, New York, USA
| | | | - Joanna L Starrels
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System, Bronx, New York, USA
- Department of Medicine, Einstein College of Medicine, New York, New York, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Department of Medicine, Montefiore Health System, Bronx, New York, USA
- Department of Medicine, Einstein College of Medicine, New York, New York, USA
| |
Collapse
|
7
|
Freichel R, Kroon E, Kuhns L, Filbey F, Veer IM, Wiers R, Cousijn J. Cannabis Use Disorder Symptoms in Weekly Cannabis Users: A Network Comparison Between Daily Cigarette Users and Nondaily Cigarette Users. Cannabis Cannabinoid Res 2024; 9:e847-e858. [PMID: 37074121 DOI: 10.1089/can.2022.0239] [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] [Indexed: 04/20/2023] Open
Abstract
Background: Concurrent use (co-use) of cannabis and tobacco is common and associated with worse clinical outcomes compared with cannabis use only. The mechanisms and interactions of cannabis use disorder (CUD) symptoms underlying co-use remain poorly understood. Methods: We examined differences in the symptom presence and symptom network configurations between weekly cannabis users who use tobacco daily (co-users, n=789) or non- or nondaily (nondaily co-users, n=428). Results: First, we identified a range of symptoms (craving, failed reduce or quit attempts, neglected responsibilities, and negative social effects) that are most central to the highly interconnected CUD symptom network. Risky cannabis use was mostly associated with negative social and health effects, and independent of other CUD symptoms. Craving symptoms act as a bridge between different CUD and withdrawal symptoms. Among co-users, (1) craving is more strongly associated with negative psychosocial effects, (2) feelings of depression and negative health effects are more central to the network, and (3) the negative health effects are more strongly associated with failed attempts to reduce or quit attempts compared with nondaily co-users. Discussion: Our results go beyond existing findings focused on the mere increase in CUD symptom presence, and speak to the potential synergistic effects of co-use on dependence and withdrawal symptoms. We outline clinical implications with respect to targeting specific CUD symptoms in co-users, and point to future research to disentangle tobacco and cannabis craving symptoms.
Collapse
Affiliation(s)
- René Freichel
- ADAPT-Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Emese Kroon
- ADAPT-Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Neuroscience of Addiction (NofA) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lauren Kuhns
- ADAPT-Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Neuroscience of Addiction (NofA) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Francesca Filbey
- School of Behavioral and Brain Sciences, Department of Psychology, University of Texas at Dallas, Dallas, Texas, USA
| | - Ilya M Veer
- ADAPT-Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinout Wiers
- ADAPT-Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Janna Cousijn
- Neuroscience of Addiction (NofA) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Nguyen N, Islam S, Llanes KD, Koester KA, Ling PM. Classification of patterns of tobacco and cannabis co-use based on temporal proximity: A qualitative study among young adults. Addict Behav 2024; 152:107971. [PMID: 38281461 PMCID: PMC10923078 DOI: 10.1016/j.addbeh.2024.107971] [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: 09/01/2023] [Revised: 12/19/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Co-use of tobacco and cannabis is a common and complex behavior. The lack of harmonized measures of co-use yields confusion and inconsistencies in synthesizing evidence about the health effects of co-use. We aimed to classify co-use patterns based on temporal proximity and describe preferred products and motives for each pattern in order to improve co-use surveillance. METHODS We conducted semi-structured interviews in a sample of 34 young adults (Mage = 22.8 years, 32.4 % female) during 2017-2019 in California, USA. We employed a qualitative thematic analysis to identify timing, reasons, and contexts for tobacco and cannabis co-use and classify co-use patterns. RESULTS Four emergent patterns of co-use with increasing temporal proximity between tobacco use and cannabis use were: Same-month different-day co-use (Pattern 1); Same-day different-occasion co-use (Pattern 2); Same-occasion sequential co-use (Pattern 3); and Same-occasion simultaneous co-use (Pattern 4). Participants used various product combinations within each pattern. Similar motives for all patterns were socialization, product availability, and coping with stress/anxiety. Unique motive for temporally distant patterns (Patterns 1 and 2) was seeking substance-specific effects (e.g., stimulant effect from nicotine, relaxation effects from cannabis), while unique motives for temporally close patterns (Patterns 3 and 4) were seeking combined effects from both substances (e.g., more intense psychoactive effects, mitigating cannabis adverse effects) and behavioral trigger (e.g., cannabis use triggers tobacco use). CONCLUSIONS Our classification of co-use patterns can facilitate consistency for measuring co-use and assessing its health impacts. Future research should also measure product types and motives for different patterns to inform intervention efforts.
Collapse
Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - Sabrina Islam
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Karla D Llanes
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, United States; Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
9
|
Zaman T, Bravata DM, Byers A, Krebs E, Leonard S, Austin C, Sandbrink F, Hasin DS, Keyhani S. A national study of clinical discussions about cannabis use among Veteran patients prescribed opioids. J Cannabis Res 2024; 6:12. [PMID: 38493111 PMCID: PMC10943860 DOI: 10.1186/s42238-024-00221-3] [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: 09/12/2023] [Accepted: 02/15/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use. OBJECTIVE To determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use. DESIGN We identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts. SUBJECTS Twelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients. MAIN MEASURES The presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use. KEY RESULTS Among the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64-0.82]. CONCLUSIONS One-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon.
Collapse
Affiliation(s)
- Tauheed Zaman
- Addiction Recovery and Treatments Services, San Francisco VA Health Care System, 4150 Clement Street, #116F, San Francisco VA Medical Center, San Francisco, CA, 94121, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
| | - Dawn M Bravata
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Amy Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, San Francisco VA Health Care System, San Francisco, USA
| | - Erin Krebs
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Samuel Leonard
- Medical Service, San Francisco VA Health Care System, San Francisco, USA
| | - Charles Austin
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Friedhelm Sandbrink
- National Pain Management, Opioid Safety and Prescription Drug Monitoring Program, Veterans Health Administration, Washington, DC, USA
- Department of Neurology, George Washington University, Washington, DC, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Salomeh Keyhani
- Medical Service, San Francisco VA Health Care System, San Francisco, USA
- Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| |
Collapse
|
10
|
Jensen JK, Ganz O, Tomaino M, Glasser AM, Sterling K, Delnevo CD, Manderski MTB. Patterns of blunt and cigar use in the United States, 2015-2019. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.26.24303391. [PMID: 38464228 PMCID: PMC10925349 DOI: 10.1101/2024.02.26.24303391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background The use of cigars for blunts (i.e., cannabis rolled in cigar paper) is well-documented; proportions of cigar and blunt use and associated characteristics are less studied. Methods Pooled data from the 2015-2019 National Survey on Drug Use and Health (NSDUH) were analyzed in 2023. Respondents aged 12+ who reported past 30-day cigar use were categorized into three mutually exclusive use categories: (1) exclusively cigars, (2) exclusively blunts, and (3) both cigars and blunts. We examined associations between cigar-blunt use category and sociodemographic characteristics. Results Among people 12 and older who reported past 30-day cigar use, 48.6% (95% CI=47.6-49.6) reported exclusive cigar use; 44.3% (95% CI=43.3-45.3) reported exclusive blunt use; and 7.2% (95% CI=6.8-7.6) reported cigars and blunts. The prevalence differed by age, with exclusively blunts most prevalent among youth (72.5% [95% CI=70.7-74.3]) and young adults (62.4% [95% CI=61.4-63.5]), and exclusively cigars most prevalent among adults 26+ (61.2% [95% CI=59.8-62.5]). Exclusive blunt users smoked more days in the past month (17.5; 95% CI=16.8-18.2), compared to 13.8 days (95% CI=13.2-14.4) for cigar and blunt users, and 7.7 days (95% CI=7.5-8.0) for exclusive cigar users. There were significant differences in characteristics, with exclusive blunt use more prevalent among female (41.6%; 95% CI=40.3-42.9) and Hispanic (18.2%; 95% CI=17.3-19.2) participants. Conclusions Exclusive blunt use was the most prevalent pattern of past-30-day cigar use among youth and young adults. Those who use cigars as blunts smoke more cigars per month, suggesting this may be an important group for additional education and policy efforts.
Collapse
Affiliation(s)
- Jessica K Jensen
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ollie Ganz
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Marisa Tomaino
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA
| | - Allison M Glasser
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA
| | - Kymberle Sterling
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Michelle T Bover Manderski
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers Health, New Brunswick, NJ, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| |
Collapse
|
11
|
Salinas KZ, Saran S, Saulnier K, Hoglen B, Houser KR, Krebs NM, Kaynak Ö, Bordner CR, Yingst JM, Foulds J, Allen SI, Hobkirk AL. A Comparison of Mental Health Symptoms among Adults Who Vape Nicotine, Cannabis, or Both. Subst Use Misuse 2024; 59:601-607. [PMID: 38115560 DOI: 10.1080/10826084.2023.2294956] [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] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Dual use of combustible cannabis and nicotine is related to worse mental health symptoms (MHS); however, little is known about MHS among those who vape cannabis and nicotine. The current study aimed to determine if dual use of cannabis and nicotine vapes is associated with worse MHS compared to single use and to identify correlates of MHS for dual users. METHODS We used Amazon Mechanical Turk to survey adults (N = 492) who used nicotine or cannabis vapes in the past 30 days on stress, anxiety, depression, vape use behaviors and sociodemographic information. We conducted hierarchical linear regressions to compare MHS between dual vs. single substance vape use and to identify correlates of MHS, including sociodemographic variables and vape use characteristics. RESULTS The final sample was 37.6% female, 87.6% White, and 11% Hispanic/Latinx with a mean age of 34.15 years. After controlling for sociodemographic characteristics and combustible product use, dual users had significantly higher mean MHS severity than single users. For dual users, younger age and being married were associated with higher symptoms of depression and stress. Holding a medical cannabis card was associated with higher anxiety symptoms. CONCLUSION The findings suggest that dual use of cannabis and nicotine vapes is associated with worse MHS severity compared to single substance use.
Collapse
Affiliation(s)
- Kalin Z Salinas
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Savreen Saran
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kevin Saulnier
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Brianna Hoglen
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kenneth R Houser
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Övgϋ Kaynak
- School of Behavioral Sciences & Education, Penn State Harrisburg, Middletown, Pennsylvania, USA
| | - Candace R Bordner
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jessica M Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jonathan Foulds
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sophia I Allen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
12
|
Rhee JU, Huang Y, Soroosh AJ, Alsudais S, Ni S, Kumar A, Paredes J, Li C, Timberlake DS. The Marketing and Perceptions of Non-Tobacco Blunt Wraps on Twitter. Subst Use Misuse 2024; 59:469-477. [PMID: 37982451 DOI: 10.1080/10826084.2023.2280572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Non-tobacco blunt wraps (N-TBWs), which entered the marketplace in 2017, are being promoted as an alternative to traditional TBWs (e.g., cigarillos) for blunt smoking. The lack of studies on these novel products warrants an investigation. This study was the first to explore blunt smokers' perceptions about N-TBWs and the extent of product marketing on Twitter. METHODS A corpus of tweets from Twitter, posted between January 2017 and November 2021, were identified by a Boolean search string (N = 149,343), where 48,695 tweets were classified as relevant by a machine learning algorithm. These relevant tweets were further screened and labeled as promotional or organic based on product URLs, usernames, keywords, or hashtags. Topic modeling using Dirichlet Allocation was then employed for identifying latent patterns of words among relevant tweets. The Social Networking Potential (SNP) score was employed for identifying influential accounts. RESULTS Most relevant tweets (89%) were organic, non-promotional expressions about N-TBWs. Account users who only posted non-promotional tweets had a significantly higher SNP than those who only posted promotional tweets. Yet, neither of the two groups of account users consisted of known celebrities. Topic modeling revealed three broad groups of topics (7 in total) denoting the attributes of hemp N-TBWs, interest in non-hemp N-TBWs, and product marketing. CONCLUSIONS The large proportion of organic tweets is indicative of the nascency of N-TBWs, which will need to be marketed more extensively if they are to replace cigar products used by blunt smokers.
Collapse
Affiliation(s)
- Joshua U Rhee
- Department of Population Health and Disease Prevention, Program in Public Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - Yicong Huang
- Department of Computer Science, University of California, Irvine, CA, USA
| | | | - Sadeem Alsudais
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Shengquan Ni
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Avinash Kumar
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Jacob Paredes
- Department of Population Health and Disease Prevention, Program in Public Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - Chen Li
- Department of Computer Science, University of California, Irvine, CA, USA
| | - David S Timberlake
- Department of Population Health and Disease Prevention, Program in Public Health, College of Health Sciences, University of California, Irvine, CA, USA
| |
Collapse
|
13
|
al'Absi M, DeAngelis BN, Nakajima M, Hodges JS, Budney A, Hatsukami D, Allen S. Biobehavioral and affective stress responses during nicotine withdrawal: Influence of regular cannabis co-use. Psychopharmacology (Berl) 2024; 241:253-262. [PMID: 37897498 DOI: 10.1007/s00213-023-06481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Co-use of cannabis is increasing in nicotine users and presents additional challenges in addressing nicotine dependence. This study examined the links between regular co-use of cannabis and nicotine with biobehavioral and affective changes in response to stress during nicotine withdrawal and ad libitum use. METHODS Participants (N = 79) who regularly used nicotine-only, cannabis-only, both substances, or neither substance were invited to attend two laboratory stress assessment sessions. For nicotine users, one session occurred during ad libitum nicotine use and one occurred after abstinence from nicotine. During the stress sessions, participants provided saliva samples for cortisol assay and completed measures of subjective states. Cardiovascular measures were collected during resting baseline, exposure to acute stressors, and a recovery rest period. RESULTS Nicotine-only users had higher average cortisol levels in the second lab session (nicotine withdrawal) relative to the first lab session (ad libitum nicotine use). Compared to nicotine non-users, nicotine users reported less positive affect and exhibited attenuated cortisol and systolic blood pressure (BP) stress responses. Cannabis users exhibited exaggerated diastolic BP responses to stress compared to cannabis non-users, and co-users of nicotine and cannabis had higher levels of cannabis craving than cannabis-only users (p < .01). CONCLUSIONS This study partially replicated earlier findings on the effects of chronic nicotine use and provided novel results regarding the influence of cannabis co-use on physiological and affective responses to stress in nicotine users during nicotine withdrawal.
Collapse
Affiliation(s)
- Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN, 55812, USA.
| | - Briana N DeAngelis
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN, 55812, USA
| | - Motohiro Nakajima
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN, 55812, USA
- Eikei University of Hiroshima, Hiroshima, Japan
| | - James S Hodges
- School of Public Health, University of Minnesota, Twin Cities. Minneapolis, MN, USA
| | | | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Twin Cities. Minneapolis, MN, USA
| | - Sharon Allen
- Department of Family Medicine and Community Health, University of Minnesota, Twin Cities. Minneapolis, MN, USA
| |
Collapse
|
14
|
Kotz D, Kastaun S, Manthey J, Hoch E, Klosterhalfen S. Cannabis Use in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:52-57. [PMID: 37967282 PMCID: PMC10979436 DOI: 10.3238/arztebl.m2023.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The federal government of Germany is planning to liberalize the recreational cannabis market for adults. We aimed to collect key baseline data on frequency of use, routes of administration, and co-use of cannabis and inhaled nicotine or tobacco products in the population. METHODS Based on data from a national survey of 9644 people aged >14 years, we analyzed self-reported use of cannabis in the past 12 months and preferred route of administration (single choice: smoked with tobacco; smoked without tobacco; inhaled without tobacco; consumed with food; consumed in another form). RESULTS The prevalence of past-year cannabis use was 4.6% (95% CI [4,2; 5,1%]), with higher rates among 14-24- (11.4%) and 25-39-year-olds (8.2%) as well as among co-users of inhaled nicotine or tobacco products, particularly waterpipe users (27.0%). Smoking cannabis with or without tobacco was the preferred route of administration, reported by 92.4% (95% CI [89,6; 94,6%]). It was most frequently reported by 14-24-year-olds and by co-users of inhaled nicotine or tobacco products. CONCLUSION Smoking remains the predominant form of using cannabis-especially among younger users, who are at greatest risk of cannabis-related consequences. The true prevalence of cannabis use may have been underestimated in our study, however, as not all participants answered the questions on cannabis. Nevertheless, preventive and harm reduction efforts are needed to reduce the harm from using cannabis. Continuous monitoring is required to evaluate the effects of the forthcoming law changes in Germany.
Collapse
Affiliation(s)
- Daniel Kotz
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sabrina Kastaun
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
- Institute of General Practice (ifam), Patient-Physician Communication Research Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf (UKE)
- Department of Psychiatry, Medical Faculty, University of Leipzig
| | - Eva Hoch
- IFT Institut für Therapieforschung, Center for Mental Health and Addiction Research, Munich
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, Ludwig-Maximilans-Universität München, Munich
- Department of Psychiatry and Psychotherapy, Cannabinoid Research Group, University Hospital, LMU Munich, Munich
| | - Stephanie Klosterhalfen
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
| |
Collapse
|
15
|
Zvolensky MJ, Bakhshaie J, Redmond BY, Garey L, de Dios M, Cano MÁ, Schmidt NB. Anxiety sensitivity reduction-smoking cessation intervention among individuals who engage in dual cigarette and cannabis use: A secondary analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209211. [PMID: 37931686 PMCID: PMC11200176 DOI: 10.1016/j.josat.2023.209211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/27/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Cannabis use among individuals who smoke is prevalent in the general population and related to adverse health effects, including higher levels of interoceptive perturbation (i.e., a disturbance in internal experiences). An important aspect of smoking cessation among individuals who co-use cannabis is to address behavioral associations between physiological sensations and habitual behaviors via integrated treatments focused on reducing reactivity to internal perturbations such as anxiety sensitivity (i.e., the belief that such symptoms produce personal harm). METHODS The current study involved a secondary analysis of a randomized clinical trial (RCT) of an integrated anxiety sensitivity-smoking cessation intervention compared to standard smoking cessation. The current study sought to extend findings from the initial trial to examine if the integrated intervention produced better smoking cessation outcomes than standard care among individuals who engage in dual cigarette and cannabis use. Participants were 149 adults who engage in dual cigarette and cannabis use (41.6 % female; Mage = 30.89, SD = 13.1). RESULTS Results indicated that the anxiety sensitivity intervention produced statistically significant differences in distal (long-term) smoking abstinence at 3-, 6-, and 12-month follow-up assessments but not proximal (short-term; quit-week to 2-weeks) smoking abstinence. CONCLUSIONS Overall, the potential of an integrated anxiety sensitivity smoking cessation intervention to yield better long-term smoking abstinence rates than standard cessation treatment among individuals who engage in dual cigarette and cannabis use is clinically significant.
Collapse
Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Brooke Y Redmond
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Marcel de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
16
|
Clendennen SL, Rangwala S, Sumbe A, Case KR, Wilkinson AV, Loukas A, Harrell MB. Understanding college students' experiences using e-cigarettes and marijuana through qualitative interviews. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2848-2858. [PMID: 34871132 PMCID: PMC9178769 DOI: 10.1080/07448481.2021.1998073] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/28/2021] [Accepted: 10/17/2021] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the contexts in which college students use e-cigarettes and marijuana, perceptions about the benefits and harms, and health effects of use. PARTICIPANTS College student e-cigarette and marijuana ever users (n = 20; 18-21 years old) from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS). METHODS Participants completed a one-hour long online interview about their experiences using e-cigarettes and marijuana. Thematic content analysis in NVivo identified prominent themes. RESULTS Vaping nicotine and marijuana were preferred and perceived as normal, trendy and useful in circumventing smoke-free campus policies. Preference for nicotine versus marijuana fluctuates during the academic school year in response to campus restrictions and work and school-related activities. College students commonly experienced health effects (shortness of breath, wheezing) attributed to vaping, did not perceive their use as very harmful, and perceived their use as a college-related phase. CONCLUSIONS Findings have implications for college-based health education, resources, and smoke-free policies.
Collapse
Affiliation(s)
- Stephanie L. Clendennen
- Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, Texas, USA
| | - Shazia Rangwala
- Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, Texas, USA
| | - Aslesha Sumbe
- Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, Texas, USA
| | - Kathleen R. Case
- Center for Research to Advance Community Health (ReACH), UTHealth San Antonio, San Antonio, Texas, USA
| | - Anna V. Wilkinson
- Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, Texas, USA
| | - Alexandra Loukas
- Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Melissa B. Harrell
- Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, Texas, USA
| |
Collapse
|
17
|
Yoon Y, Lee N, Lee AD, Gehring MB, Constantine R, Mathes DW, Yu JW, Khechoyan D, Iorio ML, Kaoutzanis C. Analysis of postoperative complications related to cannabis and tobacco usage in patients undergoing mandible facial fracture surgeries. J Plast Reconstr Aesthet Surg 2023; 85:127-133. [PMID: 37482026 DOI: 10.1016/j.bjps.2023.06.067] [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: 05/01/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Cannabis is the third most used controlled substance in the world. Despite its widespread use, minimal research investigates cannabis usage in patients undergoing facial fracture surgeries. This study aimed to evaluate patterns of postoperative complications related to cannabis and tobacco usage after mandible fracture surgeries. MATERIALS AND METHODS PearlDiver™, a commercially available healthcare database, was used to identify patients endorsing the use of cannabis, tobacco, or both who underwent mandible fracture surgeries for cross-sectional analysis. The study population was categorized into groups using the Classification of Diseases, 9th revision (ICD-9), ICD-10, and Current Procedural Terminology (CPT) codes. A chi-square analysis was performed to assess the influence of cannabis and tobacco use on postoperative complications. RESULTS A total of 8288 patients met the inclusion criteria, with 72 patients with cannabis-only usage, 914 patients with cannabis and tobacco usage, 3236 patients with tobacco-only usage, and 4066 in the control group. For patients using only cannabis, there was not an increased risk of developing postoperative complications compared with the control population. Patients with concurrent cannabis and tobacco usage and those with tobacco-only usage had an increased risk of surgical site infection, facial nonunion, facial abscess, debridement, and malocclusion after surgical repair of mandibular facial fracture. CONCLUSION Patients with tobacco-only as well as cannabis and tobacco usage had an increased risk of all postoperative complications, except malocclusion, compared with cannabis-only. Based on the results of this study, it is recommended that healthcare providers consider a patient's history of tobacco use when planning and performing surgical treatment for traumatic mandible fractures.
Collapse
Affiliation(s)
- YooJin Yoon
- University of Colorado School of Medicine, United States
| | - Nayun Lee
- University of Colorado School of Medicine, United States
| | - Anna D Lee
- University of Colorado School of Medicine, United States
| | - Michael B Gehring
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Ryan Constantine
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - David W Mathes
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Jason W Yu
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - David Khechoyan
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Matthew L Iorio
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Christodoulos Kaoutzanis
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States.
| |
Collapse
|
18
|
Abraham AD, Wiley JL, Marusich JA. Experimenter administered Δ 9-THC decreases nicotine self-administration in a rat model. Pharmacol Biochem Behav 2023; 231:173632. [PMID: 37690617 PMCID: PMC10543614 DOI: 10.1016/j.pbb.2023.173632] [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: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The co-use of nicotine and cannabis has been steadily rising in the United States. Rodent studies suggest that delta-9-tetrahydrocannabinol (THC) could increase addictive qualities of nicotine, but whether repeated THC exposure alters self-administration of nicotine has not been tested. We hypothesized that THC would increase the reinforcing effects of nicotine and alter nicotine intake. METHODS Adult male and female Sprague-Dawley rats were treated with THC (0, 3, 30 mg/kg) daily for 14 days prior to and during training for intravenous self-administration of nicotine. Rats were allowed to self-administer nicotine for several weeks, then tested for sensitivity to nicotine dose through multiple determinations of a nicotine dose-effect curve with or without THC pretreatment. A separate set of rats were trained on fixed ratio responding for sucrose and assessed for THC effects on behavior. RESULTS Post-session THC decreased nicotine self-administration in male and female rats throughout acquisition and maintenance and increased the latency to stable rates of nicotine intake during acquisition. Post-session THC shifted nicotine dose-effect curves downward, and pre-session THC suppressed responding at higher nicotine doses. Unlike nicotine, responding for sucrose was not affected by post-session THC. Pre-session THC decreased responding for sucrose, particularly for THC-naïve rats. CONCLUSIONS Repeated post-session THC decreased nicotine-taking behaviors but did not alter sucrose responding. Thus, post-session THC may alter sensitivity to nicotine. Pre-session THC treatment decreased lever pressing in both sucrose and nicotine studies, indicating this effect was nonspecific. These studies show that THC modulates patterns of nicotine intake in rat models.
Collapse
Affiliation(s)
- Antony D Abraham
- Center for Drug Discovery, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709, USA
| | - Jenny L Wiley
- Center for Drug Discovery, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709, USA
| | - Julie A Marusich
- Center for Drug Discovery, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709, USA.
| |
Collapse
|
19
|
Rabinowitz JA, Reboussin BA, Sosnowski DW, Kuo SIC, Strickland JC, García-Marín LM, Rentería ME, Gillespie N, Maher B, Ialongo NS, Thorpe RJ, Uhl G. Associations of polygenic risk scores for smoking heaviness and lifetime cannabis use with tobacco and cannabis co-use trajectories among African Americans. Drug Alcohol Depend 2023; 250:110895. [PMID: 37517263 PMCID: PMC10495192 DOI: 10.1016/j.drugalcdep.2023.110895] [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] [Received: 03/25/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND We aimed to identify distinct trajectories of tobacco, cannabis, and their co-use among African Americans, and to investigate whether these patterns were associated with polygenic risk scores (PRS) for tobacco and cannabis use. METHOD Participants (N=428 participants; 50.9% male) were initially recruited for an elementary school-based prevention in a Mid-Atlantic city when they were in first grade. From ages 14-26, participants reported on their frequency of tobacco and cannabis use in the past year during annual assessments. DNA was collected from participants at age 21. PRS for smoking heaviness (i.e., cigarettes per day) and lifetime cannabis use were created based on genome-wide association study results derived from Liu et al. (2019) and Pasman et al. (2018), respectively. RESULTS We identified five distinct trajectories of tobacco and cannabis co-use, including (1) Low Tobacco and Cannabis Use, (2) Adolescent Limited Tobacco and Cannabis Use, (3) Experimental Cannabis, Young Adult Increasing Tobacco, (4) Experimental Tobacco, Young Adult Increasing Cannabis, and (5) High, Chronic Tobacco and Cannabis Use. Compared to the Low Tobacco and Cannabis Use subgroup, individuals in the High, Chronic Tobacco and Cannabis Use subgroup had greater PRS for smoking heaviness, and individuals in the Experimental Cannabis, Young Adult Increasing Tobacco subgroup had higher PRS for lifetime cannabis use. CONCLUSIONS Polygenic risk for lifetime cannabis use and smoking heaviness is associated with the developmental progression of tobacco and cannabis co-use among African Americans, furthering knowledge on the etiology of co-use in this population.
Collapse
Affiliation(s)
- Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David W Sosnowski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Services, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Luis M García-Marín
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland4006, Australia; School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland4012, Australia
| | - Miguel E Rentería
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland4006, Australia; School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland4012, Australia
| | - Nathan Gillespie
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, USA
| | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Department of Psychiatry and Behavioral Services, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George Uhl
- New Mexico VA Health Care SystemAlbuquerque, NMUSA
| |
Collapse
|
20
|
Buckner JD, Morris PE, Threeton EM, Zvolensky MJ. Cannabis and Nicotine Dual Use among Sexual Minority Individuals: Relations to Cannabis Use and Negative Affect. Subst Use Misuse 2023; 58:1813-1817. [PMID: 37622481 PMCID: PMC10786340 DOI: 10.1080/10826084.2023.2250427] [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] [Indexed: 08/26/2023]
Abstract
Background: Sexual minority individuals report significantly more cannabis use and use-related problems than their heterosexual peers, and emerging data indicate sexual minority individuals who use cannabis are at greater risk for dual use of nicotine products (combustible smoking, e-cigarette use) than heterosexual individuals. Although cannabis-nicotine dual use is related to worse cannabis outcomes and negative affect, little work has identified factors related to dual use among sexual minority individuals or tested if sexual orientation-based discrimination (microaggressions, overt discrimination) is related to dual use. Objectives: The current study tested if cannabis-nicotine dual use is related to more frequent cannabis use, more cannabis-related problems, negative affect, and discrimination among sexual minority undergraduate students who endorsed current (past three-month) cannabis use (N = 328), 43.6% of whom endorsed dual nicotine use. Cannabis-nicotine dual use was related to more frequent cannabis use, more cannabis-related problems, more anxiety (but not depression), and more sexual orientation-based microaggressions and microaggressions-related negative affect (but not overt discrimination or non-sexual orientation-based daily stressors). Conclusions/Importance: Overall, this is the first known study to identify that sexual orientation-based discrimination is related to cannabis-nicotine dual use and that dual use is related to more frequent cannabis use, use-related problems, and negative affect (especially anxiety) among this underrepresented group.
Collapse
Affiliation(s)
- Julia D. Buckner
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Paige E. Morris
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Evan M. Threeton
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| |
Collapse
|
21
|
Herbst ED, Pennington DL, Borsari B, Manuel J, Yalch M, Alcid E, Martinez Rivas M, Delacruz J, Rossi N, Garcia B, Wong N, Batki SL. N-acetylcysteine for smoking cessation among dual users of tobacco and cannabis: Protocol and rationale for a randomized controlled trial. Contemp Clin Trials 2023; 131:107250. [PMID: 37271412 PMCID: PMC10847050 DOI: 10.1016/j.cct.2023.107250] [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: 01/26/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Tobacco and cannabis co-use is a growing public health problem. The synergistic effects of cannabis and nicotine on neurobiological systems that mediate reward and shared environmental cues reinforcing use may make tobacco smoking cessation more difficult. N-acetylcysteine (NAC), an FDA-approved medication and over-the-counter supplement, has shown promise in animal studies and randomized controlled trials (RCTs) in reducing tobacco and cannabis craving and use. NAC's potential efficacy in treating addiction may be attributable to its central nervous system effects in reducing excessive glutamatergic activity, oxidative stress, and inflammation. To date, no RCT has examined NAC for smoking cessation among dual users of tobacco and cannabis. METHOD In a double-blind, placebo-controlled RCT, we will examine NAC for smoking cessation among dual users of tobacco and cannabis. Sixty adult cigarette-cannabis co-users are randomized to receive NAC 3600 mg per day or placebo over 8 weeks. Participants in both groups receive 8 weekly cognitive behavioral therapy sessions addressing smoking cessation and cannabis reduction. Outcomes are assessed at Weeks 0, 4, 8, and 12. Primary aims are to determine NAC's efficacy in decreasing cigarette craving, nicotine dependence, and use; and cannabis craving and use. Exploratory aims include examination of changes in neurocognition with NAC and their potential mediational effects on cigarette and cannabis use outcomes. CONCLUSION Results will inform smoking cessation treatment among dual users of tobacco and cannabis. CLINICALTRIALS gov Identifier: NCT04627922.
Collapse
Affiliation(s)
- Ellen D Herbst
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA.
| | - David L Pennington
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Brian Borsari
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Jennifer Manuel
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Matthew Yalch
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA; Palo Alto University, 1791 Arastradero Rd., Palo Alto, CA 94304, USA
| | - Eric Alcid
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Madeline Martinez Rivas
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Joannalyn Delacruz
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Nathan Rossi
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Brianna Garcia
- California Institute of Technology, 1200 E California Blvd, Pasadena, CA 91125, USA
| | - Natalie Wong
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| | - Steven L Batki
- Mental Health Service (116B), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, USA
| |
Collapse
|
22
|
Wang Q, Wang H. Cannabis and tobacco use among adolescents aged 12-17 years from 16 low- and middle-income countries. J Glob Health 2023; 13:04066. [PMID: 37499128 PMCID: PMC10374269 DOI: 10.7189/jogh.13.04066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Background We aimed to examine the association between cannabis use and tobacco use in 12-17-year-old adolescents residing in low- and middle-income countries (LMICs). Methods We used data from the Global School-based Student Health Survey collected between 2012 and 2022. We selected 16 LMICs based on pre-defined inclusion criteria and compared the prevalence of cannabis use for female and for male adolescents for each country. We estimated age- and sex-standardised distributions of tobacco use, school truancy, suicide attempt, sex with multiple partners, physical fighting, perceived school kindness, and parental monitoring were estimated. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) measuring associations between cannabis use and other variables. We generated pooled estimates through random effects meta-analyses. Results The overall pooled prevalence of cannabis use was 4.3% (95% CI = 3.2-5.9), with significant between-country heterogeneities (I2 = 91.4%; P = 0.000). Cannabis use was more prevalent in males than in females in each country. Tobacco use was strongly associated with cannabis use in all 16 LMICs. Tobacco users had approximately 11 to 14 times greater odds of cannabis use than non-tobacco users. Sex with multiple partners, suicide attempts, and school truancy had a robust association with cannabis use in over half of LMICs. Conclusions There is a need for comprehensive preventive measures targeting multiple risk behaviours associated with cannabis use for adolescents in LMICs.
Collapse
Affiliation(s)
- Qian Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Key Laboratory of Systems Medicine for Cancer, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
23
|
Yeap ZJS, Marsault J, George TP, Mizrahi R, Rabin RA. Does tobacco dependence worsen cannabis withdrawal in people with and without schizophrenia-spectrum disorders? Am J Addict 2023; 32:367-375. [PMID: 36815595 DOI: 10.1111/ajad.13394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of cannabis use disorder (CUD) are higher in people with schizophrenia than in the general population. Irrespective of psychiatric diagnosis, tobacco co-use is prevalent in those with CUD and leads to poor cannabis cessation outcomes. The cannabis withdrawal syndrome is well-established and increases cannabis relapse risk. We investigated whether cannabis withdrawal severity differed as a function of high versus no/low tobacco dependence and psychiatric diagnosis in individuals with CUD. METHOD Men with CUD (N = 55) were parsed into four groups according to schizophrenia diagnosis and tobacco dependence severity using the Fagerstrom Test for Nicotine Dependence (FTND): men with schizophrenia with high tobacco dependence (SCT+, n = 13; FTND ≥ 5) and no/low tobacco dependence (SCT-, n = 22; FTND ≤ 4), and nonpsychiatric controls with high (CCT+, n = 7; FTND ≥ 5) and no/low (CCT-, n = 13; FTND ≤ 4) tobacco dependence. Participants completed the Marijuana Withdrawal Checklist following 12-h of cannabis abstinence. RESULTS There was a significant main effect of tobacco dependence on cannabis withdrawal severity (p < .001). Individuals with high tobacco dependence had significantly greater cannabis withdrawal severity (M = 13.85 [6.8]) compared to individuals with no/low tobacco dependence (M = 6.49, [4.9]). Psychiatric diagnosis and the interaction effects were not significant. Lastly, cannabis withdrawal severity positively correlated with FTND (r = .41, p = .002). CONCLUSION AND SCIENTIFIC SIGNIFICANCE Among individuals with CUD and high tobacco dependence, cannabis withdrawal severity was elevated twofold, irrespective of diagnosis, relative to individuals with CUD and no/low tobacco dependence. Findings from this study emphasize the importance of addressing tobacco co-use when treating CUD.
Collapse
Affiliation(s)
- Zac J S Yeap
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Justine Marsault
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Tony P George
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Complex Interventions and Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Romina Mizrahi
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rachel A Rabin
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
24
|
Gravely S, Driezen P, McClure EA, Smith DM, Fong GT. Prevalence of depressive symptoms and cannabis use among adult cigarette smokers in Canada: cross-sectional findings from the 2020 International Tobacco Control Policy Evaluation Project Canada Smoking and Vaping Survey. CMAJ Open 2023; 11:E516-E526. [PMID: 37311596 DOI: 10.9778/cmajo.20220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Tobacco smoking and cannabis use are independently associated with depression, and evidence suggests that people who use both tobacco and cannabis (co-consumers) are more likely to report mental health problems, greater nicotine dependence and alcohol misuse than those who use either product exclusively. We examined prevalence of cannabis use and depressive symptoms among Canadian adults who smoke cigarettes and tested whether co-consumers of cannabis and tobacco were more likely to report depressive symptoms than cigarette-only smokers; we also tested whether cigarette-only smokers and co-consumers differed on cigarette dependence measures, motivation to quit smoking and risky alcohol use by the presence or absence of depressive symptoms. METHODS We analyzed cross-sectional data from adult (age ≥ 18 yr) current (≥ monthly) cigarette smokers from the Canadian arm of the 2020 International Tobacco Control Policy Evaluation Project Four Country Smoking and Vaping Survey. Canadian respondents were recruited from Leger's online probability panel across all 10 provinces. We estimated weighted percentages for depressive symptoms and cannabis use among all respondents and tested whether co-consumers (≥ monthly use of cannabis and cigarettes) were more likely to report depressive symptoms than cigarette-only smokers. Weighted multivariable regression models were used to identify differences between co-consumers and cigarette-only smokers with and without depressive symptoms. RESULTS A total of 2843 current smokers were included in the study. The prevalence of past-year, past-30-day and daily cannabis use was 44.0%, 33.2% and 16.1%, respectively (30.4% reported using cannabis at least monthly). Among all respondents, 30.0% screened positive for depressive symptoms, with co-consumers being more likely to report depressive symptoms (36.5%) than those who did not report current cannabis use (27.4%, p < 0.001). Depressive symptoms were associated with planning to quit smoking (p = 0.01), having made multiple attempts to quit smoking (p < 0.001), the perception of being very addicted to cigarettes (p < 0.001) and strong urges to smoke (p = 0.001), whereas cannabis use was not (all p ≥ 0.05). Cannabis use was associated with high-risk alcohol consumption (p < 0.001), whereas depressive symptoms were not (p = 0.1). INTERPRETATION Co-consumers were more likely to report depressive symptoms and high-risk alcohol consumption; however, only depression, and not cannabis use, was associated with greater motivation to quit smoking and greater perceived dependence on cigarettes. A deeper understanding of how cannabis, alcohol use and depression interact among people who smoke cigarettes is needed, as well as how these factors affect cessation activity over time.
Collapse
Affiliation(s)
- Shannon Gravely
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont.
| | - Pete Driezen
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Erin A McClure
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Danielle M Smith
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| | - Geoffrey T Fong
- Department of Psychology (Gravely, Driezen, Fong), University of Waterloo, Waterloo, Ont.; Hollings Cancer Center (McClure), Medical University of South Carolina, Charleston, SC; Roswell Park Comprehensive Cancer Center (Smith), Buffalo, NY; Ontario Institute for Cancer Research (Fong), Toronto, Ont
| |
Collapse
|
25
|
Stringfield SJ, Sanders BE, Suppo JA, Sved AF, Torregrossa MM. Nicotine Enhances Intravenous Self-administration of Cannabinoids in Adult Rats. Nicotine Tob Res 2023; 25:1022-1029. [PMID: 36426873 PMCID: PMC10077937 DOI: 10.1093/ntr/ntac267] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/24/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Nicotine and cannabis are commonly used together, yet few studies have investigated the effects of concurrent administration. Nicotine exhibits reinforcement enhancing effects by promoting the reinforcing properties of stimuli including other drugs. As many studies of this effect used non-contingent nicotine, we implemented a dual-self-administration model where rats have simultaneous access to two drugs and choose which to self-administer throughout a session. Here, we investigated the effect of self-administered or non-contingently delivered nicotine on cannabinoid self-administration. METHODS Adult male rats were allowed to self-administer the synthetic cannabinoid WIN 55,212-2 (WIN) intravenously, with or without subcutaneous nicotine injections before each session. A separate group of animals were allowed to self-administer WIN, nicotine, or saline using a dual-catheter procedure, where each solution was infused independently and associated with a separate operant response. A third group of male and female rats were allowed to self-administer delta-9-tetrahydrocannabinol (THC) with or without pre-session injections of nicotine. RESULTS Nicotine injections increased self-administration of WIN and THC. During dual self-administration, nicotine availability increased saline and WIN infusions but nicotine intake was not changed by WIN or saline availability. Rats preferred nicotine over saline, but preferred nicotine and WIN equally when both were available. The effect of nicotine on cannabinoid self-administration was acute and reversible when nicotine was no longer present. CONCLUSIONS These results expand our understanding of the ability of nicotine to enhance reinforcement of other drugs and suggest that co-use of nicotine and cannabinoids promotes cannabinoid use beyond what would be taken alone. IMPLICATIONS This study utilizes a dual intravenous self-administration model to investigate the ability of nicotine to enhance cannabinoid intake. Our results demonstrate that the reinforcement enhancing properties of nicotine on drug use extend to include cannabinoids, but that this effect occurs specifically when nicotine is administered alongside the cannabinoid. Interestingly, cannabinoid use did not promote nicotine intake, suggesting this mechanism of reinforcement is specific to nicotine.
Collapse
Affiliation(s)
| | - Bryson E Sanders
- Department of Neuroscience, School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jude A Suppo
- Department of Neuroscience, School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alan F Sved
- Department of Neuroscience, School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary M Torregrossa
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Jones DM, Guy MC, Fairman BJ, Soule E, Eissenberg T, Fagan P. Nicotine Dependence among Current Cigarette Smokers Who Use E-Cigarettes and Cannabis. Subst Use Misuse 2023; 58:618-628. [PMID: 36852436 PMCID: PMC10249428 DOI: 10.1080/10826084.2023.2177961] [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: 03/01/2023]
Abstract
BACKGROUND Co-use of tobacco and cannabis and dual use of cigarettes and e-cigarettes are very common among young adults. However, it is unclear whether co-use of cigarettes, e-cigarettes, and/or cannabis is associated with higher levels of nicotine dependence than cigarette-only use. We investigated the relationship between cigarette/nicotine dependence and co-use of tobacco and cannabis among 4 groups of cigarette smokers aged 18-35: cigarette-only smokers, cigarette-e-cigarette (CIG-ECIG) co-users, cigarette-cannabis (CIG-CAN) co-users, and cigarette-e-cigarette-cannabis (CIG-ECIG-CAN) co-users. METHODS Data were from a 2018 cross-sectional survey based on a national convenience sample of smokers aged 18-35 (n = 315). Cigarette/nicotine dependence was measured by the Fagerstrom Test of Nicotine Dependence (FTND) and e-cigarette dependence was measured by the Penn State E-cigarette Dependence Index. Bivariate analyses examined sociodemographic and tobacco/other substance use characteristics by co-use status and multivariable linear regression assessed the relationship between co-use and nicotine dependence. RESULTS In the sample, 27.6% were cigarette-only smokers, 24.8% were CIG-ECIG, 27.6% were CIG-CAN, and 20.0% were CIG-ECIG-CAN co-users. Significant differences were observed in sociodemographic and tobacco/other substance use characteristics by co-use status. E-cigarette co-users had low e-cigarette dependence, but moderate FTND scores. In adjusted analyses, only CIG-ECIG co-use was associated with higher FTND scores compared to cigarette-only smoking. However, CIG-ECIG and CIG-ECIG-CAN co-use were associated with higher FTND scores compared to CIG-CAN co-use. CONCLUSIONS Co-use of cigarettes and e-cigarettes was associated with greater nicotine dependence among smokers aged 18-35. Additional research is needed to understand the underlying mechanisms of these relationships and inform prevention efforts.
Collapse
Affiliation(s)
- Dina M. Jones
- Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, Slot #820, Little Rock, AR 72205 USA
| | - Mignonne C. Guy
- Center for the Study of Tobacco Products, Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, 100 West Franklin Street, Suite 200, Richmond, VA 23220 USA
- Department of African American Studies, Virginia Commonwealth University, 816 W. Franklin Street, Room 201, Richmond, VA 23284-3509 USA
| | - Brian J. Fairman
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, Slot #820, Little Rock, AR 72205 USA
| | - Eric Soule
- Center for the Study of Tobacco Products, Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, 100 West Franklin Street, Suite 200, Richmond, VA 23220 USA
- Eastern Carolina University, Department of Health Education and Promotion, 300 Curry Ct., Carol Belk Building, Greenville, NC 27858 USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, 100 West Franklin Street, Suite 200, Richmond, VA 23220 USA
| | - Pebbles Fagan
- Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, Slot #820, Little Rock, AR 72205 USA
| |
Collapse
|
28
|
Cooper M, Panchalingam T, Ce S, Shi Y. Behavioral economic relationship between cannabis and cigarettes: Evidence from hypothetical purchase tasks. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103951. [PMID: 36608406 PMCID: PMC11147132 DOI: 10.1016/j.drugpo.2022.103951] [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: 08/25/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the United States (U.S), cannabis policies have been increasingly liberalized whereas tobacco policies have been increasingly stringent. Given the high prevalence of cannabis and tobacco dual use, there are concerns that a policy regulating one substance may unintendedly influence the other. This study examined the responsiveness of the demand for cannabis joints and cigarettes when price varied. METHODS The study included 338 adult participants (21+) who used both cannabis and tobacco and lived in one of the U.S. states with recreational cannabis legalized by the time of interview in 2019. They completed hypothetical purchase tasks to indicate the quantity desired of cannabis joints and cigarette packs 1) when only one substance was available with escalating prices and 2) when both substances were concurrently available with escalating prices of cannabis joints and a fixed price of cigarette packs. We estimated 1) the own-price elasticity of demand for each substance using nonlinear exponential demand model, and 2) the cross-price elasticity of demand at aggregate level using nonlinear exponential demand model and at individual level using log-linear demand model. RESULTS The estimates for the rate of change of own-price elasticity (α) were 0.0011 (SE = 0.000039, p < 0.001) for cannabis joints and 0.00095 (SE = 0.000037, p < 0.001) for cigarette packs. The aggregate-level estimates of cross-price elasticity (I = 13.032, SE = 0.34, p < 0.001; β = 0.0029, SE = 0.0021, p > 0.05) suggest an independent relationship between the two substances. At individual level, 78.70% of the participants treated the two substances as independent, 17.46% as complements, and 3.85% as substitutes. CONCLUSIONS For most adults who used both cannabis and tobacco in the U.S., cannabis joints and cigarettes had an independent relationship. Policies regulating the price of cannabis may not have large unintended consequences on cigarette use.
Collapse
Affiliation(s)
- Michael Cooper
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Thadchaigeni Panchalingam
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Shang Ce
- Department of Internal Medicine, The Ohio State University. 281 W Lane Ave, Columbus, OH 43120, USA
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, USA.
| |
Collapse
|
29
|
Walters KJ, Baker NL, Tomko RL, Gray KM, Carpenter MJ, McClure EA. Determining the impact of cannabis use and severity on tobacco cessation outcomes: study protocol for a prospective tobacco treatment trial. BMC Psychol 2023; 11:25. [PMID: 36698194 PMCID: PMC9875760 DOI: 10.1186/s40359-023-01060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Several evidence-based tobacco cessation treatment strategies exist, though significant barriers to cessation remain which must be addressed to improve abstinence rates for sub-populations of those smoking cigarettes. Cannabis co-use among those who use tobacco is common and appears to be increasing among adults in the United States (US). The literature evaluating the impact of cannabis use on tobacco cessation has been mixed and has several important limitations, which precludes development of treatment recommendations specific to individuals who use tobacco and co-use cannabis. To date, no prospective studies have evaluated the impact of cannabis use and severity on tobacco cessation or quantified cannabis use changes during tobacco treatment to assess for concurrent reductions, abstinence, or compensatory (i.e., increased) cannabis use. This study's aims are to: (1) evaluate tobacco cessation outcomes among participants who co-use cannabis compared to participants only using tobacco, (2) using daily diaries and biochemical verification, assess changes in cannabis use during tobacco treatment, and (3) assess for a dose-dependent impact of cannabis use on tobacco cessation. METHOD A multi-site, prospective, quasi-experimental 12-week tobacco treatment trial enrolling treatment-seeking adults (ages 18-40; N = 208) from three sites across South Carolina (US) who use tobacco daily and oversampling (2:1) those who co-use cannabis. Participants receive tobacco cessation pharmacotherapy (varenicline) paired with behavioral support, while cannabis use is not addressed as part of treatment. The primary outcome is 7-day point prevalence tobacco abstinence at the week 12 end of treatment visit, measured via biochemical verification and self-report. Secondary outcome measures include changes in cannabis use (via biochemical verification and self-report) during tobacco cessation treatment. DISCUSSION Results from this trial have the potential to inform tobacco treatment among those co-using cannabis, which may require a tailored approach to address the role of cannabis in quitting tobacco. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov: NCT04228965. January 14th, 2020.
Collapse
Affiliation(s)
- Kyle J. Walters
- grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425 USA
| | - Nathaniel L. Baker
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Rachel L. Tomko
- grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425 USA
| | - Kevin M. Gray
- grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425 USA
| | - Matthew J. Carpenter
- grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425 USA ,grid.259828.c0000 0001 2189 3475Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Charleston, SC 29425 USA
| | - Erin A. McClure
- grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425 USA ,grid.259828.c0000 0001 2189 3475Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., Charleston, SC 29425 USA
| |
Collapse
|
30
|
Blair LM, Ickes M, McCubbin A, Ashford K. PATH to understanding cannabis and nicotine initiation and co-use among emerging adults. Public Health Nurs 2022; 39:973-981. [PMID: 35609183 DOI: 10.1111/phn.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/22/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the characteristics and age of initiation of nicotine and cannabis use, with a particular focus on the emerging adult period (ages 18-24 years) and concurrent use of nicotine with cannabis. DESIGN A secondary analysis of Population Assessment of Tobacco and Health (PATH). SAMPLE 32,078 participants from a nationally representative study of tobacco use and health outcomes. MEASUREMENT Variables of interest included ever use, regular use and age of initiation (first-time use) of nicotine (including tobacco) and/or cannabis and selected demographic factors. RESULTS Ever-use of nicotine was associated with a 13-fold increase in the likelihood of having ever used cannabis. Among those who reported cannabis use, 96.4% had also used nicotine. While initiation in adolescence was most common, 27.1% of those who use nicotine and 34.9% of those who use cannabis initiated during emerging adulthood. Among regular users of nicotine, 41.5% began regular use in emerging adulthood. CONCLUSIONS These findings underscore the continued susceptibility of emerging adults to initiation of these substances. Co-use of nicotine and cannabis is an understudied phenomenon in emerging adults with significant potential to cause harm and should be a public health priority.
Collapse
Affiliation(s)
- Lisa M Blair
- University of Kentucky College of Medicine, Lexington, Kentucky, USA.,University of Kentucky College of Nursing Perinatal Research and Wellness Center, Lexington, Kentucky, USA
| | - Melinda Ickes
- University of Kentucky College of Education, Lexington, Kentucky, USA
| | - Andrea McCubbin
- University of Kentucky College of Nursing Perinatal Research and Wellness Center, Lexington, Kentucky, USA
| | - Kristin Ashford
- University of Kentucky College of Nursing Perinatal Research and Wellness Center, Lexington, Kentucky, USA
| |
Collapse
|
31
|
Min JY, Levin J, Weinberger AH. Associations of tobacco cigarette use and dependence with substance use disorder treatment completion by sex/gender and race/ethnicity. J Subst Abuse Treat 2022; 140:108834. [PMID: 35803029 DOI: 10.1016/j.jsat.2022.108834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Individuals with substance use disorders (SUD) are approximately five times more likely to smoke cigarettes than the general population. Individuals who smoke cigarettes have greater odds of SUD relapse compared to individuals who do not smoke cigarettes, but we know little about how cigarette use is related to SUD treatment completion overall by sex/gender or race/ethnicity. METHODS This study examined 2855 adults (71.98 % male; >70 % racial/ethnic minority) in outpatient and residential SUD treatment at a New York-based treatment agency over a six-month period in 2018. RESULTS Overall, approximately three-fourths of SUD treatment-seeking participants smoked cigarettes, with high rates across sex/gender and racial/ethnic groups. Nicotine dependence did not differ by sex/gender, and White Non-Hispanic adults had the highest levels of nicotine dependence across racial/ethnic groups. Those who smoked cigarettes were significantly less likely to complete treatment compared to those who did not smoke cigarettes (OR = 0.69; 95 % CI: 0.58, 0.82). The study found no overall differences in SUD treatment completion and length of stay by sex/gender or race/ethnicity. CONCLUSIONS Given the high prevalence of cigarette smoking and lower odds of completing SUD treatment, the current system of care for SUD treatment may be enhanced by addressing cigarette smoking from onset of treatment.
Collapse
Affiliation(s)
- Jung-Yun Min
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Jacob Levin
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
32
|
Weinberger AH, Wyka K, Goodwin RD. Impact of cannabis legalization in the United States on trends in cannabis use and daily cannabis use among individuals who smoke cigarettes. Drug Alcohol Depend 2022; 238:109563. [PMID: 35870333 DOI: 10.1016/j.drugalcdep.2022.109563] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cannabis legalization and increases in cannabis use are occurring rapidly in the United States (US). Cannabis and tobacco are often used together, but it is unclear whether cannabis legalization will differentially affect cannabis use among those using cigarettes. This study estimated changes from 2004 to 2017 in the prevalence of cannabis use and daily cannabis use by cigarette use status and examined whether state-level cannabis policy modified these trends. METHODS Public and restricted-use data from the 2004-2017 National Survey on Drug Use and Health were analyzed. Weighted logistic regressions were used to examine time trends in past-30-day cannabis use and daily caunabis use by cigarette use and cannabis law status from 2004 to 2017. RESULTS Cannabis use and daily use increased significantly among those with and without cigarette smoking. Cannabis use and daily cannabis use were consistently 2-10x more common throughout this time among those with, versus without, cigarette smoking. In 2017, cannabis use and daily cannabis use were substantially more common among individuals who use cigarettes, and even greater among those who live in states where cannabis was legal for medical or recreational (i.e., non-medical) use. CONCLUSIONS Cannabis use and daily cannabis use are increasing among US individuals who both smoke and do not smoke cigarettes. Cannabis and daily cannabis use are more common among those who smoke cigarettes and elevated even further among those residing in states that have legalized cannabis for recreational (i.e., non-medical) use. Tobacco control efforts should be adjusted to address increases in cannabis use among Americans who smoke cigarettes.
Collapse
Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology & 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
| | - 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.
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
Lanza HI, Orozco M, Motlagh G. Differential Associations between Weight Status (Obesity, Overweight, and Underweight) and Substance Use in Young Adulthood. Subst Use Misuse 2022; 57:1663-1672. [PMID: 35946172 PMCID: PMC9582253 DOI: 10.1080/10826084.2022.2107670] [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] [Indexed: 10/15/2022]
Abstract
BACKGROUND Past evidence suggests obesity co-occurs with tobacco/nicotine, cannabis, and alcohol use in young adulthood, but whether this relationship extends to nicotine or cannabis vaping is unclear. Furthermore, differential relationships between substance use and specific weight status categories (obesity, overweight, and underweight) have not been assessed. This study assessed prevalence of tobacco/nicotine, cannabis, and alcohol use by weight status categories in young adulthood. METHODS Of the 1322 young adults (18-29 years; 20.5 ± 2.3 years; 63% female; 42% Hispanic/Latino/a/x, 30% Asian-American/Asian, 18% Caucasian/White, 7% Multiracial, and 2% African-American/Black) from a public, urban university were surveyed on their health-risk behaviors in the spring and fall of 2021. RESULTS Multinomial logistic regression models assessed six-month follow-up substance use prevalence (never, lifetime but no past 30-d use, and past 30-d use) by baseline weight status (obese, overweight, underweight; reference: healthy weight). Obesity predicted lower odds of past 30-d nicotine vaping (aOR [95% CI] = 0.27 [0.08-0.92]). Overweight predicted higher odds of lifetime combustible cannabis (aOR [95% CI] = 1.58 [1.08-2.30]) and past 30-d binge drinking (aOR [95% CI] = 1.79 [1.12-2.85]). Underweight was associated with lower odds of lifetime cannabis vaping (aOR [95% CI] = 0.35 [0.12-0.99]) and combustible cannabis (aOR [95% CI] = 0.38 [0.16-0.87]). CONCLUSIONS Differential relationships between obesity and overweight on tobacco/nicotine, cannabis, and alcohol use suggest greater specificity is needed when evaluating relationships between higher weight status and substance use. It appears that overweight young adults may be at higher risk of substance use than obese young adults. Greater efforts to consider multiple weight status groups, not just obese, may have significant implications for tobacco/nicotine prevention and intervention efforts targeting vulnerable populations.
Collapse
Affiliation(s)
- H. Isabella Lanza
- Department of Human Development, California State University, Long Beach, CA, United States
| | - Monica Orozco
- Department of Human Development, California State University, Long Beach, CA, United States
| | - Gabriella Motlagh
- Department of Psychology, California State University, Fullerton, CA, United States
| |
Collapse
|
35
|
Pakdaman S, Broun A, Duart DA, Ajith A, Jewett B, Wong N, Mead-Morse EL, Choi K, Chen-Sankey J. Exploring the hypothetical impact of flavored cigar sales restrictions among black young adult cigar smokers: a semi-structured in-depth interview investigation. J Ethn Subst Abuse 2022:1-19. [PMID: 35943488 PMCID: PMC9908770 DOI: 10.1080/15332640.2022.2109089] [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] [Indexed: 10/15/2022]
Abstract
This study assessed the hypothetical impact of flavored cigar sales restrictions on cigar smoking among Black young adult cigar smokers (ages 21-29). Forty in-depth interviews were conducted in 2020. Interviews were independently coded and analyzed using thematic analysis. When asked how they would smoke cigars given a flavor sales restriction, half of participants reported they would smoke in the same way, a third would stop or reduce smoking, and a few were unsure of what they would do. Cigar smoking outcome expectancies, preference for flavors, and perceived addictiveness of cigar products may predict cigar smoking change given flavor sales restrictions.
Collapse
Affiliation(s)
- Sheila Pakdaman
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Aaron Broun
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- George Washington University, Milken Institute School of Public Health, Washington, D.C., USA
| | - Danielle A. Duart
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- National Cancer Institute. Division of Cancer Epidemiology & Genetics, Rockville, MD, USA
| | - Aniruddh Ajith
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- University of Pittsburgh, School of Medicine
| | - Bambi Jewett
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
| | - Nicholas Wong
- Health, Emotion, and Addiction Laboratory, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| |
Collapse
|
36
|
Smith PH, Ward RM, Bartoszek LA, Branscum PW. College students' patterns of electronic nicotine delivery system use and other substance use. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1882-1888. [PMID: 33151843 DOI: 10.1080/07448481.2020.1841210] [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: 02/26/2020] [Revised: 08/07/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
Objective: Electronic nicotine delivery system (ENDS) use on college campuses increased dramatically in recent years. Little is known about how ENDS use among college students relates to other substance use. Participants: Undergraduates (n = 3,917) at a mid-sized Midwestern public university in the United States. Methods: Cross-sectional survey data and latent class analysis of ENDS, cigarettes, alcohol, marijuana, and non-medical use of attention-deficit/hyperactivity disorder (ADHD) medication. Results: Over 95% of ENDS users fit into one of two classes comprising a minority of college students engaged in multiple and often problematic substance use behaviors. Only 4% of ENDS users were grouped into a class comprising 85% of the sample and characterized by either little/no substance use or moderate alcohol consumption. Conclusions: ENDS use in this sample was not indicative of general exploration with substances, nor was it indicative of isolated tobacco use, but rather more heavy and problematic substance use.
Collapse
Affiliation(s)
- Philip H Smith
- Kinesiology and Health, Miami University, Oxford, Ohio, USA
| | | | | | | |
Collapse
|
37
|
Connor JP, Stjepanović D, Budney AJ, Le Foll B, Hall WD. Clinical management of cannabis withdrawal. Addiction 2022; 117:2075-2095. [PMID: 34791767 PMCID: PMC9110555 DOI: 10.1111/add.15743] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ9 -tetrahydrocannabinol (THC). This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research. METHODS Narrative review of literature. RESULTS Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications. CONCLUSIONS The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.
Collapse
Affiliation(s)
- Jason P. Connor
- National Centre for Youth Substance Use ResearchThe University of QueenslandSt LuciaQLDAustralia,Discipline of Psychiatry, Faculty of MedicineThe University of QueenslandHerstonQLDAustralia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use ResearchThe University of QueenslandSt LuciaQLDAustralia
| | - Alan J. Budney
- Center for Technology and Behavioral HealthGeisel School of Medicine at DartmouthLebanonNHUSA
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthUniversity of TorontoONCanada,Departments of Family and Community Medicine, Psychiatry, Pharmacology and ToxicologyUniversity of TorontoONCanada
| | - Wayne D. Hall
- National Centre for Youth Substance Use ResearchThe University of QueenslandSt LuciaQLDAustralia,Queensland Alliance for Environmental Health SciencesThe University of QueenslandWoolloongabbaQLDAustralia
| |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Young-Wolff KC, Sarovar V, Tucker LY, Ansley D, Goler N, Conway A, Ettenger A, Foti TR, Brown QL, Kurtzman ET, Adams SR, Alexeeff SE. Trends in Cannabis Polysubstance Use During Early Pregnancy Among Patients in a Large Health Care System in Northern California. JAMA Netw Open 2022; 5:e2215418. [PMID: 35666502 PMCID: PMC9171564 DOI: 10.1001/jamanetworkopen.2022.15418] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Rates of prenatal cannabis use are increasing alongside perceptions that cannabis is a harmless therapeutic for pregnancy-related ailments, while rates of prenatal use of alcohol and tobacco are decreasing. It is important to examine whether cannabis use during pregnancy is increasing similarly among patients with and patients without co-occurring substance use. OBJECTIVES To examine trends in cannabis polysubstance use during pregnancy and to test differences in cannabis use over time among pregnant individuals who use only cannabis vs those who use cannabis and other substances. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional time-series study used data from 367 138 pregnancies among 281 590 unique pregnant patients universally screened for prenatal substance use as part of standard care in Kaiser Permanente Northern California from January 1, 2009, to December 31, 2018. Statistical analysis was performed from October 5, 2021, to April 18, 2022. EXPOSURES Time (calendar year). MAIN OUTCOMES AND MEASURES Use of substances during early pregnancy was assessed via universal screening with a self-administered questionnaire (for cannabis, alcohol, stimulants, and nicotine) and/or positive results of a urine toxicology test (for cannabis, alcohol, stimulants, and pharmaceutical opioids), and data were extracted from the electronic health record. RESULTS The study sample of 367 138 pregnancies from 281 590 unique pregnant patients (median gestation at time of screening, 8.6 weeks [IQR, 7.3-10.6 weeks]) was 25.9% Asian or Pacific Islander, 6.6% Black, 25.8% Hispanic, 38.0% non-Hispanic White, and 3.6% other race or ethnicity; 1.1% were aged 11 to 17 years, 14.9% were aged 18 to 24 years, 61.9% were aged 25 to 34 years, and 22.1% were aged 35 years or older; and the median neighborhood household income was $70 455 (IQR, $51 563-$92 625). From 2009 to 2018, adjusted rates of use of only cannabis during pregnancy (no other substances) increased substantially from 2.39% (95% CI, 2.20%-2.58%) in 2009 to 6.30% (95% CI, 6.00%-6.60%) in 2018, increasing at an annual relative rate of 1.11 (95% CI, 1.10-1.12). The rate of use of cannabis and 1 other substance also increased (annual relative rate, 1.04 [95% CI, 1.03-1.05]), but not as rapidly (P < .001 for difference), while the rate of use of cannabis and 2 or more other substances decreased slightly (annual relative rate, 0.97 [95% CI, 0.96-0.99]). Adjusted rates of prenatal use of cannabis and alcohol (1.04 [95% CI, 1.03-1.06]) and cannabis and stimulants (1.03 [95% CI, 1.01-1.06]) increased over time, while rates of prenatal use of cannabis and nicotine (0.97 [95% CI, 0.96-0.98]) decreased. CONCLUSIONS AND RELEVANCE In this cross-sectional time-series study, rates of prenatal cannabis use during early pregnancy increased significantly more rapidly among patients without co-occurring substance use, which could reflect increased acceptability of cannabis and decreased perceptions of cannabis-related harms. Furthermore, increased rates of use of cannabis with alcohol and stimulants warrant continued monitoring.
Collapse
Affiliation(s)
- Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Amy Conway
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Allison Ettenger
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Tara R. Foti
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Qiana L. Brown
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick
| | | | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | |
Collapse
|
40
|
Young-Wolff KC, Adams SR, Brown QL, Weisner C, Ansley D, Goler N, Skelton KR, Satre DD, Foti TR, Conway A. Modes of cannabis administration in the year prior to conception among patients in Northern California. Addict Behav Rep 2022; 15:100416. [PMID: 35252535 PMCID: PMC8894140 DOI: 10.1016/j.abrep.2022.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 11/26/2022] Open
Abstract
Cannabis use among individuals before and during pregnancy is increasing alongside the proliferation of new products with various modes of administration. Preconception cannabis use is a strong predictor of prenatal cannabis use. Yet little is known about how individuals administer cannabis during the preconception period, particularly in socioeconomically vulnerable populations. This study examined the prevalence and correlates of modes of cannabis administration (smoke, vape, blunts, edible/oral, dabs/wax, lotion/topical) during the year before conception, among patients who self-reported preconception cannabis use during universal screening in prenatal care. Descriptive statistics included sociodemographic characteristics, preconception cannabis use frequency, and modes of administration. Chi-square tests examined whether mode was associated with sociodemographic characteristics and use frequency. The sample (N = 11,936, screened from February 2020-May 2021) was 59.8% non-White and 26.1% were < 26 years old; 50.7% reported monthly or less, 21.8% weekly, and 27.4% daily preconception cannabis use; 69.7% smoked (any method), 34.5% smoked blunts, 53.4% used edibles/oral, 28.2% vaped, 9.9% used lotion/topical; 54.2% reported 1 mode, 30.4% reported 2 modes, 15.4% reported 3+ modes. Smoking was more common among daily users, younger patients, those with greater neighborhood deprivation, and Black and Hispanic patients, while edibles/oral were more common among ≤ monthly users, older patients, those with less neighborhood deprivation, and Asian patients. Use of other modes also varied by sociodemographic characteristics and use frequency. Research is needed to understand preconception cannabis use in vulnerable subpopulations, continuation of use during pregnancy, and whether health risks associated with preconception and prenatal cannabis use differ by administration mode.
Collapse
Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Qiana L Brown
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kara R Skelton
- Department of Health Sciences, College of Health Professions, Towson University, Towson, MD, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Tara R Foti
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amy Conway
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
| |
Collapse
|
41
|
Ng JY, Chang N. A bibliometric analysis of the cannabis and cannabinoid research literature. J Cannabis Res 2022; 4:25. [PMID: 35610633 PMCID: PMC9131698 DOI: 10.1186/s42238-022-00133-0] [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] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background Cannabis refers to a plant in the family Cannabaceae, which has been used medically, recreationally, and industrially. The last two decades, in particular, have seen a large increase in the volume of literature on this topic. The present bibliometric analysis aims to capture the characteristics of scholarly journal publications on the topic of cannabis and cannabinoid research. Methods Searches were run on the Scopus database on April 02, 2021, as follows “(TITLE (cannabi* OR hashish OR marijuana OR marihuana)) AND ( LIMIT-TO ( DOCTYPE,"ar" ) OR LIMIT-TO ( DOCTYPE,"re" ) )”. Results were exported on the same day to prevent discrepancies between daily database updates. Only “article” and “review” publication types were included; no further search limits were applied. The “article” publication type includes publications featuring original research, whereas “review” includes reviews and conference papers. The following data were collected: number of publications (in total and per year), authors, and journals; open access status; publications per journal; journals publishing the highest volume of literature and their impact factors, language of publication; document type; publication country; author affiliations; funding sponsors; most highly cited publications; and most highly published authors. Trends in this subset of publications were identified and presented. Bibliometric networks were constructed using the software tool VOSviewer. Results A total of 29 802 publications (10 214 open access), published by 65 109 authors, were published in 5474 journals from 1829 to 2021. The greatest number of publications was published over the last 20 years. The journal that published the largest number of publications was Drug and Alcohol Dependence (n = 705). The most productive countries included the USA (n = 12 420), the UK (n = 2236), and Canada (n = 2062); many of the most common institutional affiliations and funding sponsors originated from these countries. Conclusions The number of publications published on the topic of cannabis follows an upward trend. Over the past 20 years, the volume of cannabis research has grown steeply, which can be attributed to a large amount of funding dedicated to researching this topic. Future research should continue to investigate changes in the publication characteristics of emerging research, as the volume of publications on this topic is expected to rapidly grow. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-022-00133-0.
Collapse
Affiliation(s)
- Jeremy Y Ng
- Michael G. DeGroote Centre for Learning and Discovery, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Room 2112, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Nathan Chang
- Michael G. DeGroote Centre for Learning and Discovery, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Room 2112, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Dugas EN, Wellman RJ, Sylvestre MP, Bélanger RE, O'Loughlin J. Who mixes tobacco with cannabis and does mixing relate to nicotine dependence? Addict Behav 2022; 128:107254. [PMID: 35085951 DOI: 10.1016/j.addbeh.2022.107254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/21/2021] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cannabis users who mix tobacco with cannabis are exposed to nicotine in the tobacco. We identified characteristics of young adult cannabis users who mix and investigated whether mixing frequency is associated with nicotine dependence (ND). METHODS Data were collected in self-report questionnaires in 2017-20 from 788 young adults (44% male; mean (SD) age 30.6 (1.0) years) participating in a longitudinal investigation of the natural course of ND. Using multivariable logistic regression, we assessed whether any of 16 sociodemographic, lifestyle, psychosocial or other characteristics were associated with mixing among 313 past-year cannabis users. We also assessed whether mixing frequency was associated with ND among 289 past-year cannabis users who had ever smoked cigarettes controlling for age, sex, and other sources of nicotine (i.e., number of cigarettes smoked, other tobacco products, second-hand smoke exposure). RESULTS Of 788 participants, 40 % (n = 313) reported past-year cannabis use. Of these, 150 (48 %) reported mixing. Younger age, lower education and income, past-year cigarette use, use of other tobacco products and illicit drugs, poor coping skills and gambling were associated with mixing. Number of ICD-10 ND criteria endorsed was associated with mixing < weekly (b(95 % CI) = 0.3(0.02,0.7)) and weekly/daily (0.5(0.1,0.9)) after controlling for other sources of nicotine. CONCLUSION Mixing is associated with ND and therefore may threaten tobacco control efforts by rendering quitting cigarette smoking more difficult among smokers who mix tobacco with cannabis. Mixing tobacco with cannabis should be considered as an additional source of nicotine exposure in studies of ND in young people.
Collapse
Affiliation(s)
- Erika N Dugas
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Robert J Wellman
- Department of Population & Quantitative Health Sciences, Division of Preventive & Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Marie-Pierre Sylvestre
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada
| | - Richard E Bélanger
- Department of Pediatrics, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Jennifer O'Loughlin
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada.
| |
Collapse
|
44
|
al’Absi M, DeAngelis B, Fiecas M, Budney A, Allen S. Effects of regular cannabis and nicotine use on acute stress responses: chronic nicotine, but not cannabis use, is associated with blunted adrenocortical and cardiovascular responses to stress. Psychopharmacology (Berl) 2022; 239:1551-1561. [PMID: 35275227 PMCID: PMC9248975 DOI: 10.1007/s00213-022-06087-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE Cannabis is one of the most prevalent substances used by tobacco smokers and, in light of the growing list of states and territories legalizing cannabis, it is expected that co-use of cannabis and nicotine will escalate significantly and will lead to continuing challenges with tobacco use. OBJECTIVES This study was conducted to examine the interactive effects of chronic cannabis and nicotine use on adrenocortical, cardiovascular, and psychological responses to stress and to explore sex differences in these effects. METHODS Participants (N = 231) included cannabis-only users, nicotine-only users, co-users of both substances, and a non/light-user comparison group. After attending a medical screening session, participants completed a laboratory stress session during which they completed measures of subjective states, cardiovascular responses, and salivary cortisol during baseline (rest) and after exposure to acute stress challenges. RESULTS Nicotine use, but not cannabis use, was associated with blunted cortisol and cardiovascular responses to stress across both men and women. Men exhibited larger cortisol responses to stress than women. Co-users had significantly larger stress-related increases in cannabis craving than cannabis-only users. Cannabis users reported smaller increases in anxiety during stress than cannabis non/light-users, and both male nicotine-only users and male cannabis-only users experienced significantly smaller increases in stress than their non/light-user control counterparts. CONCLUSIONS This study replicates and extends earlier research on the impacts of sex and nicotine use on stress responses, and it provides novel findings suggesting that when co-used with nicotine, cannabis use may not confer additional alterations to physiological nor subjective responses to stress. Co-use, however, was associated with enhanced stress-related craving for cannabis.
Collapse
Affiliation(s)
- Mustafa al’Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA
| | - Briana DeAngelis
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA
| | - Mark Fiecas
- School of Public Health, Division of Biostatistics, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | | | - Sharon Allen
- Department of Family Medicine and Community Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| |
Collapse
|
45
|
Alghamdi AA, Gartner C, Najman J, Smirnov A. Co-administering cannabis with tobacco and persistent tobacco smoking after 4½ years in young adults who use stimulants: A prospective population-based study. J Psychoactive Drugs 2022; 54:119-128. [PMID: 34254884 DOI: 10.1080/02791072.2021.1947546] [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: 12/08/2020] [Revised: 04/22/2021] [Accepted: 05/13/2021] [Indexed: 10/20/2022]
Abstract
Tobacco smoking remains highly prevalent in high-risk groups, including young adults who use cannabis and a variety of other drugs. We examine whether co-administering cannabis with tobacco is associated with heavier and more persistent tobacco smoking compared to separate use of these substances among young adults who use drugs recreationally. Data are from a prospective population-based study of young adults residing in Queensland, Australia, who recurrently used ecstasy or methamphetamine. The mean age was 20.8 years at baseline, and 47% were female. An ordinal regression model was developed (n = 277) with levels of tobacco smoking at 4½ years as the outcome. At baseline, just under half the sample (44.6%) had not co-administered cannabis with tobacco in the last month, 9.5% rarely co-administered, 7.7% sometimes co-administered, and 38.2% always co-administered. Always co-administering cannabis with tobacco was associated with more frequent and persistent tobacco smoking at 4½ years (Odds Ratio (OR): 1.98, 95% Confidence Interval (CI): 1.02, 3.83), independently of factors including baseline frequency of cannabis and tobacco use. Young adults who use cannabis should be advised not to co-administrate cannabis with tobacco, and comprise an important target group for tobacco smoking cessation interventions.
Collapse
Affiliation(s)
- Abdullah Ahmed Alghamdi
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jake Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andrew Smirnov
- Senior Lecturer and Director of Research Training, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
46
|
Karoly HC, Milburn MA, Brooks-Russell A, Brown M, Streufert J, Bryan AD, Lovrich NP, DeJong W, Cinnamon Bidwell L. Effects of High-Potency Cannabis on Psychomotor Performance in Frequent Cannabis Users. Cannabis Cannabinoid Res 2022; 7:107-115. [PMID: 33998859 PMCID: PMC8864436 DOI: 10.1089/can.2020.0048] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Recently increased access to cannabis products in the United States has been associated with increased rates of driving after cannabis use. Although numerous studies indicate that cannabis impairs psychomotor and neurocognitive functions that can affect driving ability, the determination of cannabis-impaired driving risk is complicated by the extent to which frequent cannabis users develop tolerance to THC's subjective, cognitive, and psychomotor effects, and by the fact that there is no validated behavioral or biological marker of recent cannabis use or cannabis-related impairment. This study examined the psychomotor impairment-related effects experienced by frequent cannabis users in Colorado after naturalistic consumption of smoked cannabis, both immediately and 1 h postuse. Results were then validated in a smaller replication sample from Washington state. Methods: In the primary Colorado study, participants (n=70) used the DRUID® mobile app, a brief measure of psychomotor and cognitive domains that are sensitive to the effects of cannabis. First, participants used DRUID to establish a sober baseline impairment score. During a second appointment, they used DRUID at three time points: preuse, immediately after acutely using cannabis, and 1 h postuse. In the Washington replication sample, participants (n=39) used DRUID before acute cannabis consumption and then every half hour for 2.5 h. Results: In both studies, peak DRUID impairment effects were seen immediately after cannabis use, with recovery of performance at 1 h postuse. Specifically, significant quadratic effects of time emerged for both studies (Colorado study: (β=-0.935, SE=0.204, p<0.001); Washington study: β=3.0299, SE=1.3085, p<0.01). Domain-specific effects were tested in the larger Colorado study and were observed for reaction time within a complex divided attention task and a postural-stability balance task. Conclusions: These findings demonstrate that psychomotor impairment emerges immediately after acute cannabis use even in regular users, but decreases significantly 1 h postuse. These results underscore the potential utility of the DRUID app for assessing acute cannabis-related psychomotor impairment. Further research is needed to explore whether the DRUID app and/or the specific psychomotor functions it assesses might serve as a tool for measuring cannabis-related driving impairment. Clinical trials registration number for the Colorado Study: NCT03522103.
Collapse
Affiliation(s)
- Hollis C. Karoly
- Institute for Cognitive Science, University of Colorado, Boulder, Colorado, USA.,*Address correspondence to: Hollis C. Karoly, PhD, Institute of Cognitive Science, University of Colorado, 1777 Exposition Drive, Boulder, CO 80309, USA,
| | | | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Brown
- Advanced Integrative Medical Science Institute, Seattle, Washington, USA.,SMJ Consulting, Seattle, Washington, USA
| | | | - Angela D. Bryan
- Institute for Cognitive Science, University of Colorado, Boulder, Colorado, USA.,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| | - Nicholas P. Lovrich
- Department of Criminal Justice and Criminology, Washington State University, Pullman, Washington, USA
| | - William DeJong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - L. Cinnamon Bidwell
- Institute for Cognitive Science, University of Colorado, Boulder, Colorado, USA.,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| |
Collapse
|
47
|
Smith DM, Hyland A, Kozlowski L, O'Connor RJ, Collins RL. Use of Inhaled Nicotine and Cannabis Products among Adults Who Vape Both Substances. Subst Use Misuse 2022; 57:432-441. [PMID: 34986066 DOI: 10.1080/10826084.2021.2019773] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Co-occurring use (co-use) of nicotine and cannabis is common, and represents a broad range of use behaviors, including concurrent use, sequential use, and co-administration. Co-use has primarily been examined through the lens of smoked tobacco and cannabis. Little is known about those who co-use vaped nicotine and cannabis, and the degree to which specific co-use behaviors are associated, based on mode of use and/or substance. METHODS We conducted an online pilot survey on use behaviors related to inhaled modes of nicotine and cannabis. The survey was administered to 112 concurrent vapers of these substances. Descriptive analyses examined sample characteristics and co-administered vaping and smoking behaviors. Logistic regressions examined associations in use behaviors by mode and substance. RESULTS Participants who vaped nicotine and cannabis monthly also reported monthly smoking of cannabis (100%), and cigarettes (58%). Most exhibited moderate-to-high degrees of mental health and substance use problems requiring clinical intervention. Monthly concurrent use exhibited more differences by mode, and more similarities by substance. Specific sequential use practices showed mode-specific associations; with greater frequency of cigarette smoking and nicotine vaping. Co-administration was associated with more frequent tobacco and cannabis smoking. CONCLUSIONS Those who regularly vape nicotine and cannabis tend to engage in some form of smoking. Different subsets of nicotine and cannabis co-use behaviors showed different associations with patterns of use and modes of drug delivery. Findings underscore the diversity of nicotine and cannabis use behaviors among co-users, and the importance of considering associations by both substance and mode of use.
Collapse
Affiliation(s)
- Danielle M Smith
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Andrew Hyland
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Lynn Kozlowski
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - R Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| |
Collapse
|
48
|
Smith CL, Rhoades Cooper B, Miguel A, Roll J, Hill L, Cleveland M, McPherson S. Youth risk profiles and their prediction of distal cannabis and tobacco co-use in the Population Assessment of Tobacco Health (PATH). Subst Abus 2022; 43:733-741. [PMID: 35100083 DOI: 10.1080/08897077.2021.2007516] [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] [Indexed: 10/19/2022]
Abstract
Background: Co-use of cannabis and tobacco is common and increases negative behavioral, physical and mental health consequences. This study aimed to describe latent profiles of youth internalizing and externalizing problems, sensation seeking, and family environment in the US and their relationships with substance co-use. Methods: Data come from the Population Assessment of Tobacco Health (PATH). Using latent profile analysis with a distal outcome, we conducted a secondary data analysis examining relationships between latent profiles and the distal outcome of cannabis/tobacco use and co-use one year later. Participants were a nationally representative sample of youth ages 12-17 (N = 13,651). Results: We identified five youth subgroups: (1;11%) Family Risk, (2;32%) Family Protection with Very Low Internalizing, (3;21%) Family Protection with High Youth Risk, (4;24%) Family Protection with Moderate Youth Risk, (5;12%) Family Risk with High Youth Risk. Relationships between group membership and tobacco/cannabis outcomes, one year later, indicated that the least likely tobacco/cannabis users were the Family Protection with Very Low Internalizing class (no lifetime use probability (PR)=0.86, standard error (SE)=0.007; no 30-day use PR = 0.96, SE = 0.004). In contrast, the Family Risk with High Youth Risk class had the highest probability of both co-use (lifetime co-use PR = 0.33; SE = 0.014; 30-day co-use PR = 0.10; SE = 0.010) and single substance use (probability of lifetime single substance use PR = 0.30; SE = 0.013; 30-day single substance use PR = 0.24; SE = 0.014). Conclusions: A "protective but reactive" risk buffering pattern effect of family factors on youth factors was observed in that the lowest rates of co-use were observed in the three classes with family protection. These findings highlight the need for interventions addressing multiple domains and focusing on youth and family risk factors.
Collapse
Affiliation(s)
- Crystal Lederhos Smith
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, Washington, USA
| | | | - Andre Miguel
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, Washington, USA
| | - John Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, Washington, USA
| | - Laura Hill
- Human Development, Washington State University, Spokane, Washington, USA
| | - Michael Cleveland
- Human Development, Washington State University, Spokane, Washington, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, Washington, USA
| |
Collapse
|
49
|
Le A, Han BH, Palamar JJ. Underreporting of past-year cannabis use on a national survey by people who smoke blunts. Subst Abus 2022; 43:349-355. [PMID: 34214396 PMCID: PMC8720324 DOI: 10.1080/08897077.2021.1941520] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Accurate prevalence estimates are critical to epidemiological research but discordant responses on self-report surveys can lead to over- or underestimation of drug use. We sought to examine the extent and nature of underreported cannabis use (among those later reporting blunt use) from a national drug survey in the US. Methods: We used data from the 2015-2019 National Survey on Drug Use and Health (N = 281,650), a nationally representative probability sample of non-institutionalized populations in the US. We compared self-reported prevalence of past-year cannabis use and blunt use and delineated correlates of underreporting cannabis use, defined as reporting blunt use but not overall cannabis use. Results: An estimated 4.8% (95% CI: 4.4-5.2) of people reported blunt use but not cannabis use. Although corrected prevalence, cannabis use recoded as use only increased from 15.2% (95% CI: 15.0-15.4) to 15.5% (95% CI: 15.3-15.7), individuals who are aged ≥50 (aOR = 1.81, 95% CI: 1.06-3.08), female (aOR = 1.35, 95% CI: 1.12-1.62), Non-Hispanic Black (aOR = 1.43, 95% CI: 1.16-1.76), or report lower English proficiency (aOR = 3.32, 95% CI: 1.40-7.83) are at increased odds for providing such a discordant response. Individuals with a college degree (aOR = 0.57, 95% CI: 0.39-0.84) and those reporting past-year use of tobacco (aOR = 0.75, 95% CI: 0.62-0.91), alcohol (aOR = 0.42, 95% CI: 0.33-0.54), cocaine (aOR = 0.50, 95% CI: 0.34-0.73), or LSD (aOR = 0.52, 95% CI: 0.31-0.87) were at lower odds of providing a discordant response. Conclusion: Although changes in prevalence are small when correcting for discordant responses, results provide insight into subgroups that may be more likely to underreport use on surveys.
Collapse
Affiliation(s)
- Austin Le
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA;,New York University College of Dentistry, New York, New York, USA
| | - Benjamin H. Han
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA;,Department of Medicine, Division of Geriatrics and Gerontology, University of California San Diego, San Diego, California, USA
| | - Joseph J. Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
50
|
Clawson AH, Ruppe NM, Nwankwo CN, Blair AL. Profiles of Nicotine and Cannabis Exposure among Young Adults with Asthma. Behav Med 2022; 48:18-30. [PMID: 32703091 DOI: 10.1080/08964289.2020.1763904] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
Abstract
There is a paucity of data on nicotine and cannabis use among young adults (YAs) with asthma. This study aimed to do the following among YAs with asthma: (1) describe YAs' active and passive exposure to nicotine and cannabis; (2) identify latent classes of active use of nicotine and cannabis; and (3) explore predictors of class membership (i.e., demographics, parental and friend use of nicotine and cannabis, and hours of environmental exposure to tobacco smoke, e-cigarette vapor, and marijuana smoke). YAs with asthma (N = 178) self-reported on nicotine and cannabis exposure and the included covariates. Latent class analysis was used to identify latent classes of lifetime nicotine and cannabis use. High rates of nicotine and cannabis use among YAs with asthma were found: 37% reporting a lifetime history of using both nicotine and cannabis. Regarding past year use, 25% had smoked cigarettes, 40% had used e-cigarettes, and 35% had used cannabis. Five classes of lifetime use were identified. The largest class was a non-user class (53%); the other four classes indicate concerning patterns of nicotine and cannabis use. The most consistent predictor of being in a class characterized by more nicotine and cannabis exposure (versus being in the non-user class) was past week exposure to cannabis smoke. This is the first study to identify classes of lifetime nicotine and cannabis use, and examine predictors of class membership, among YAs with asthma. There is a critical need to address environmental and active tobacco and marijuana exposure among YAs with asthma.
Collapse
Affiliation(s)
- Ashley H Clawson
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Nicole M Ruppe
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Cara N Nwankwo
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Alexandra L Blair
- Center for Pediatric Psychology, Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| |
Collapse
|