Cannabis use and patterns among middle and older aged Canadians prior to legalization: a sex-specific analysis of the Canadian Tobacco, Alcohol and Drugs Survey

Nicotine replacement therapy 'gift cards' for hospital inpatients who smoke: a prospective before-and-after controlled pilot evaluation

INTRODUCTION

A common barrier identified by individuals trying to quit smoking is the cost of cessation pharmacotherapies. The purpose of this evaluation was to: (1) Assess the feasibility of offering nicotine replacement therapy (NRT) 'gift cards' to hospitalised smokers for use posthospitalisation; and, (2) Estimate the effect of providing NRT gift cards on 6-month smoking abstinence.

METHODS

A prospective, quasi-experimental, before-and-after controlled cohort design with random sampling was used to compare patients who had received the Ottawa Model for Smoking Cessation (OMSC) intervention ('control') with patients who received the OMSC plus a $C300 Quit Card ('QCI'), which they could use to purchase any brand or form of NRT from any Canadian pharmacy.

RESULTS

750 Quit Cards were distributed to the three participating hospitals of which 707 (94.3%) were distributed to patients. Of the cards received by patients, 532 (75.2%) were used to purchase NRT. A total of 272 participants completed evaluation surveys (148 control; 124 QCI).Point prevalence abstinence rates adjusted for misreporting among survey responders were 15.3% higher in the QCI group, compared with controls (44.4% vs 29.1%; OR 1.95, 1.18-3.21; p=0.009). Satisfaction was high among participants in both groups, and among staff delivering the QCI. QCI participants rated the intervention as high in terms of motivation, ease of use and helpfulness.

CONCLUSIONS

The NRT gift card appears to be a feasible and effective smoking cessation tool that removes a primary barrier to the use of evidence-based smoking cessation pharmacotherapies, while motivating both patients and health providers.

Prevalence of smoking, alcohol consumption, and drug abuse in Iranian adults: Results of Azar Cohort Study

Background

Substance abuse has significant health impacts on families and society as a whole. We aimed to provide detailed prevalence estimates of substance abuse among the Azar Cohort Study respondents in Tabriz, Iran.

Methods

Data on 15006 participants of Azar Cohort Study were analyzed. The variables included tobacco smoking, alcohol use, drug abuse, and socio-demographic characteristics. The prevalence of substance abuse (with a 95% confidence interval) was calculated using the direct standardization method.

Results

Overall, 9.3% and 6.2% of the participants were regular and heavy cigarette smokers, respectively. Also, 1.9% and 2.1% of participants reported a history of using illicit drugs and alcohol, respectively. Substance abuse was more prevalent among males than females. Substance abuse varied significantly with age and socioeconomic variables.

Conclusion

We identified specific demographic and socioeconomic groups with a higher prevalence of all studied behaviors. Such high-risk groups should be targeted when designing substance abuse prevention programs.

The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications

BACKGROUND

Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress.

OBJECTIVES AND PROJECT DESCRIPTION

The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth.

FUTURE IMPACT

With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.

Enhancing axonal myelination in seniors: A review exploring the potential impact cannabis has on myelination in the aged brain

Consumption of cannabis is on the rise as public opinion trends toward acceptance and its consequent legalization. Specifically, the senior population is one of the demographics increasing their use of cannabis the fastest, but research aimed at understanding cannabis' impact on the aged brain is still scarce. Aging is characterized by many brain changes that slowly alter cognitive ability. One process that is greatly impacted during aging is axonal myelination. The slow degradation and loss of myelin (i.e., demyelination) in the brain with age has been shown to associate with cognitive decline and, furthermore, is a common characteristic of numerous neurological diseases experienced in aging. It is currently not known what causes this age-dependent degradation, but it is likely due to numerous confounding factors (i.e., heightened inflammation, reduced blood flow, cellular senescence) that impact the many cells responsible for maintaining overall homeostasis and myelin integrity. Importantly, animal studies using non-human primates and rodents have also revealed demyelination with age, providing a reliable model for researchers to try and understand the cellular mechanisms at play. In rodents, cannabis was recently shown to modulate the myelination process. Furthermore, studies looking at the direct modulatory impact cannabis has on microglia, astrocytes and oligodendrocyte lineage cells hint at potential mechanisms to prevent some of the more damaging activities performed by these cells that contribute to demyelination in aging. However, research focusing on how cannabis impacts myelination in the aged brain is lacking. Therefore, this review will explore the evidence thus far accumulated to show how cannabis impacts myelination and will extrapolate what this knowledge may mean for the aged brain.

Development of scales to measure Lebanese university students’ perceived knowledge about and attitudes about cannabis use: initial psychometric properties

Background

For a long period, cannabis in Lebanon was categorized as an illegal psychoactive substance criminalized by law, despite being the 3rd largest producer of cannabis resin after Morocco and Afghanistan. The current available literature on the topic in Lebanon is scarce, as perceived knowledge towards cannabis use in the general population is not well established, and public health policies are absent. In the context of future legalization of cannabis for both medical and recreational purposes, what is the public’s perception of cannabis perceived knowledge about and attitude against cannabis use? The objectives of this study were to create two scales to assess perceived knowledge towards cannabis use and attitude against cannabis use and check their psychometric properties in a sample of Lebanese university students.

Methods

The study was designed as a cross-sectional study involving 415 Lebanese university students aged between 18 and 30 years. Students were only recruited from one university and were sent an email with a brief description of the study and a link to the questionnaire. The questionnaire items covered perceived knowledge and attitude about cannabis use, recovered and adapted from available literature.

Results

Perceived knowledge items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 64% of the variance (factor 1 = perceived knowledge about cannabis quality of life improvement; factor 2 = perceived knowledge about cannabis psychiatric use; factor 3 = perceived knowledge about cannabis risks; factor 4 = perceived knowledge about cannabis neurological use). Attitude items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 58.2% of the variance (factor 1 = negative attitude about cannabis use; factor 2 = positive attitude about cannabis use). Good Cronbach’s alpha values were found for the perceived knowledge and attitude scales (α = 0.78 and α = 0.73 respectively). Greater perceived knowledge was found in male participants and in those who have tried cannabis for recreational purposes. Greater perceived knowledge was also associated with stronger attitude about cannabis use and older age. Furthermore, greater mean attitude about cannabis use scores were significantly found in male participants and in those who have tried cannabis for recreational or medicinal purposes.

Conclusion

Primary results showed acceptable psychometric properties for the perceived knowledge towards and attitudes about cannabis use scale. Further studies are needed in order to validate them among the general population and assess more psychometric properties of these scales.

Who mixes tobacco with cannabis and does mixing relate to nicotine dependence?

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.

The relationship between cannabis use and IVF outcome-a cohort study

Background

The effects of cannabis use on male and female reproduction have been the focus of scientific research for decades. Although initial studies raised concerns, more recent studies were reassuring. Considering the recent legalization of recreational use of cannabis in Canada, we sought to analyze IVF outcomes among users and non-users in a single IVF center.

Methods

This is a retrospective cohort study from a single IVF center assessing IVF outcomes among male-female, non-donor IVF patients that are either cannabis users or non-users. We analyzed the ongoing pregnancy rate as well as oocyte yield, fertilization rate, peak serum estradiol, sperm, and embryo quality. We used the Mann-Whitney test, chi-square test, and Kruskal-Wallis tests where appropriate.

Results

Overall, the study included 722 patients of which 68 (9.4%) were cannabis users, most defined as light users. The results of the study show similar implantation rate (40.74% vs. 41.13%) and ongoing pregnancy rate (35.2% vs. 29.1%) between the users and non-users, respectively. No significant difference between users and non-users in any of the other analyzed outcomes could be detected.

Conclusions

The results may provide some reassurance for the lack of any demonstrable detrimental effects of cannabis consumption on IVF outcomes. This study was limited by its retrospective nature, self-reporting of cannabis use, and a small user sample size. A larger prospective study is needed to validate its findings.