Current Marijuana Research Articles

The Impact of Depression and Anxiety Comorbidities on Acute Postoperative Pain After DIEP Flap Breast Reconstruction.

Depression and anxiety have a complex association with opioid dependence, though their impact on acute postoperative pain is unclear. The present study investigated the impact of depression and anxiety on acute postoperative pain and opioid requirements following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Patients receiving DIEP flap breast reconstruction were retrospectively identified from 2019 to 2023. Patients were classified into the psychiatric comorbidity (PC) group based on a history of depression or anxiety diagnoses, or the control group. Pain (0-10 Numerical Rating Scale [NRS]) scores and cumulative inpatient opioid requirements (in morphine milli-equivalents [MMEs]) were compared between groups. Linear regression analysis assessed the association of psychiatric comorbidities with pain outcomes. In total, 557 patients were included, of which 11.4% reported a psychiatric history. The PC group was younger (50.0 vs. 52.7 years, p = 0.032) and more frequently reported current marijuana use (15.6% vs. 4.3%, p = 0.001) and former smoking (51.6% vs. 24.5%, p < 0.001). The PC group had higher mean (2.5 vs. 2.0, p < 0.001) and maximum pain scores (8.6 vs. 7.8, p = 0.003) than the control group, which corresponded to higher opioid requirements (256 vs. 223 MMEs, p = 0.041). Psychiatric comorbidities were associated with higher average and maximum pain scores (p < 0.01) while current marijuana use was associated with higher opioid requirements (p = 0.033). Patients with depression or anxiety comorbidities tended to have greater acute postoperative pain and opioid consumption. Marijuana use was also more prevalent, potentially exacerbating pain outcomes, and risk of opioid dependence. These findings will inform patient discussions and targeted interventions to mitigate opioid misuse.

Trends in Marijuana Use among Adolescents in the United States.

Marijuana is a widely used substance in the United States (US) and worldwide. We explored trends in self-reported marijuana use among US adolescents overall as well as by gender, race/ethnicity, and school grade. Biennial data from the Youth Risk Behavior Survey from 2011 to 2021 included 88,183 adolescents in grades 9th through 12th. We used percentage change as a measure of effect and the chi-square test for significance. All analyses were conducted at the national level. The percentage of adolescents who reported current marijuana use dropped significantly from 23.1% in 2011 to 15.8% in 2021 (p < 0.05). The self-report of trying marijuana for the first time before age 13 also decreased significantly from 8.1% in 2011 to 4.9% in 2021 (p < 0.05). For current use, there were similar significant decreases by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. In 2021, the percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5%) compared to White (14.8%), Hispanic (16.7%), and Asian (5.1%) adolescents. Although current marijuana use declined significantly for both girls and boys over time, in 2021 girls were more likely (17.8%) to currently use marijuana than boys (13.6%). In 2011, the opposite was true, with boys (25.9%) being more likely to use marijuana than girls (20.1%). In US adolescents in 2021, there were decreases in self-reports of marijuana use compared to 2011. Behavioral interventions within school and family environments may be critical in mitigating the risk of marijuana use.

Adult Caretaker Engagement and School Connectedness and Association with Substance Use, Indicators of Emotional Well-Being and Suicide Risk, and Experiences with Violence Among American Indian or Alaska Native High School Students - Youth Risk Behavior Survey, United States, 2023.

The strength of American Indian and Alaska Native (AI/AN) communities comes from generations of Indigenous traditions, language, culture, and knowledge. These strengths have been challenged by a complex set of systemic, structural, and social factors related to historical and intergenerational trauma that affects the health of AI/AN communities. Furthermore, AI/AN population health data often are inaccurate because of analytic coding practices that do not account for multiracial and ethnic AI/AN identification and inadequate because of statistical suppression. The 2023 national Youth Risk Behavior Survey included a supplemental sample of AI/AN high school students. Coding of race and ethnicity was inclusive of all AI/AN students, even if they also identified as another race or as Hispanic or Latino, providing comprehensive data on health behaviors and experiences among AI/AN high school students nationwide. Adult caretaker engagement and school connectedness and their association with 13 health behaviors and experiences were examined, including five types of current substance use, four indicators of emotional well-being and suicide risk, and four types of violence. Pairwise t-tests and adjusted prevalence ratios from logistic regression models identified significant associations between exposure and outcome variables. Among AI/AN students, having an adult who always tried to meet their basic needs, high parental monitoring, and high school connectedness were associated with lower prevalence of certain measures of substance use, poor emotional well-being and suicide risk, and violence. Compared with non-AI/AN students, the prevalence of current electronic vapor product use, current marijuana use, attempted suicide, and experience of sexual violence was higher among AI/AN students.This report presents the most comprehensive, up-to-date data on substance use, indicators of emotional well-being and suicide risk, and experiences with violence among AI/AN high school students nationwide. The findings suggest the importance of engaged household adults and school connectedness in promoting emotional well-being and preventing substance use, suicide-related behavior, and experiences of violence among AI/AN students. Understanding the historical context and incorporating Indigenous knowledge when developing interventions focused on AI/AN youths are critical to ensure such interventions are successful in improving AI/AN health and well-being.

Examining the pathways from adverse childhood experiences to substance use

BackgroundAdverse childhood experiences (ACEs) are traumatic events that occur early in life and can have lasting effects on health and well-being. Previous research has linked ACEs to substance use in adulthood, but there is limited research on the underlying mechanisms or pathways of this relationship. This study explores whether depression mediates the relationship between ACEs and current substance use among U.S. adults. MethodsData were obtained from the 2021 Behavioral Risk Factor Surveillance System (n = 30,978). Generalized Structural Equation Modeling was used to examine the links between ACEs, cigarette, e-cigarette, and marijuana use while adjusting for sociodemographic characteristics. ResultsApproximately 71 % of respondents reported experiencing at least one ACE. The findings show that depressive disorders mediate the relationship between ACEs and current substance use among U.S. adults. There was a significant indirect effect of ACEs on current cigarette use (OR = 1.13, 95 % CI [1.10, 1.16]), e-cigarette use (OR = 1.17, 95 % CI [1.12–1.22]), and marijuana use (OR = 1.22, 95 % CI [1.13, 1.33]) through the mediator of depressive disorders. Additionally, the most pronounced effects were found among those aged 18–24 years for cigarette use (OR = 1.32, 95 % CI [1.11, 1.56]), e-cigarette use (OR = 1.22 [1.09, 1.36]), and especially marijuana use (OR = 1.52 [1.18, 1.96]). ConclusionThese findings suggest that depression may be a key pathway from negative experiences during childhood to certain types of substance use in adulthood, particularly among young adults.

A National Survey of Marijuana Use Among U.S. Adults According to Obesity Status, 2016-2022.

Background and Objective: Research has linked marijuana use with lower body mass index (BMI). The current study explores the correlation between marijuana use on BMI in the general U.S. population. It reports the prevalence of marijuana in adults in relation to BMI, overall and across the levels of important variables. Materials and Methods: This study used a probability sample of U.S. adults 18 years of age and older from the 2016 through 2022 Behavioral Risk Factor Surveillance System, a telephone-administered survey. The survey collects data from a representative sample regarding health-related risk behaviors, chronic health conditions, and use of preventive services. The primary outcome variables are current (at least once in the last 30 days) and daily (at least 20 of the last 30 days) marijuana use. Results: The study sample consists of 735,921 participants in the surveys that completed the optional module on marijuana use. Prevalence of marijuana use in adults doubled during the study period (7.48% to 14.91%). The increase directly corresponds with a shift toward legalization of medical and recreational marijuana. On average, the prevalence of use is 9% higher when medical marijuana is legal and 81% higher when recreational marijuana is legal (vs. not legal). For obese individuals, prevalence of current marijuana use is 35% lower than for nonobese individuals on average. Lower prevalence of marijuana use in obese individuals is consistently observed across the levels of certain demographic variables, employment status, tobacco smoking history, marijuana legalization status, and certain medical conditions (asthma, arthritis, and depression). In 2022, the adjusted odds of current or daily marijuana use are significantly lower and similar among obese (vs. non-obese) (0.68, 0.69, respectively), such that reduced obesity does not require daily use. Similarly, the adjusted odds of current marijuana use decrease in similar fashion to daily marijuana use with higher BMI weight classification. Conclusion: Marijuana use is correlated with lower BMI. As legalization and prevalence of the drug in the U.S. increases, the prevalence of obesity may decline. However, clinicians should view this outcome along with the known health risks associated with marijuana use.

T22 - Emerging Sex Differences in Current Tobacco and Marijuana Use Trends Among Members of a Community Engagement Program in Florida

T22 - Emerging Sex Differences in Current Tobacco and Marijuana Use Trends Among Members of a Community Engagement Program in Florida

Marijuana Use and Hemoglobin Concentrations in NHANES 2009-2018: Implications for Subclinical Hypoxemia.

Cannabis use is rapidly growing in the United States, but its health implications are poorly understood, particularly when compared with cigarette smoking. Previous research conducted on animal models or non-representative populations with small sample sizes has yielded mixed results on the impact of marijuana use on hemoglobin levels, which may reflect subclinical hypoxemia and/or carbon monoxide exposure. We evaluated the association between marijuana use and hemoglobin levels in a nationally representative sample of U.S. adults. This cross-sectional study included 16,038 individuals aged 18 to 59 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. We related current and former marijuana use with measured hemoglobin levels, with adjustment for demographics, education, housing, and cigarette smoking status in multivariable analyses that incorporated complex survey weights. As candidate positive and negative control exposures, we used similar methods to relate cigarette smoking and benzodiazepine use, respectively, with hemoglobin concentrations. Current marijuana use was associated with significantly higher hemoglobin concentrations. After multivariable adjustment, compared with never use, current marijuana use was associated with a 0.111, 95% CI [0.021,0.201] g/dL higher hemoglobin concentration, whereas former use was associated with a 0.047, 95% CI [-0.018,0.113] g/dL higher concentration (linear trend p=0.01). As hypothesized, cigarette smoking was also associated with higher hemoglobin concentrations, while benzodiazepine use was not. Among American adults, current marijuana use was associated with higher hemoglobin concentrations, as is cigarette smoking but not benzodiazepine use. These results suggest the possibility that marijuana smoking induces subclinical hypoxemia stimulating hemoglobin production. Further confirmation of this observational finding is needed, in light of the increasing medical and recreational use of smoked marijuana products.

Does Marijuana Smoking Increase the Odds of Surgical Site Infection After Orthopaedic Surgery? A Retrospective Cohort Study

OBJECTIVES: Does marijuana smoking increase the risk of surgical site infection (SSI) after open reduction and internal fixation of fractures? METHODS: Design: Retrospective. Setting: Single academic level 1 trauma center in Southern California. Patient Selection Criteria: Adult patients who underwent open treatment for closed fractures between January 2009 and December 2021, had hardware placed, and had at least 6 months of postoperative follow-up. Outcome Measures and Comparisons: Risk factors associated with the development of SSI were compared between current inhalational marijuana users and nonmarijuana users. RESULTS: Complete data were available on 4802 patients after exclusion of 82 who did not have a complete variable set. At the time of surgery, 24% (1133 patients) were current users of marijuana. At the final follow-up (minimum 6 months), there was a 1.6% infection rate (75 patients). The average age of the infection-free group was 46.1 ± 23.1 years, and the average age of the SSI group was 47.0 ± 20.3 (P = 0.73) years. In total, 2703 patients (57%) in the infection-free group were male compared with 48 (64%) in the SSI group (P = 0.49). On multivariate analysis, longer operative times (OR 1.002 [95% CI, 1.001–1.004]), diabetic status (OR 2.084 [95% CI, 1.225–3.547]), and current tobacco use (OR 2.493 [95% CI, 1.514–4.106]) (P &lt; 0.01 for all) were associated with an increased risk of SSI; however, current marijuana use was not (OR 0.678 [95% CI, 0.228–2.013], P = 0.48). CONCLUSIONS: Tobacco use, diabetes, and longer operative times were associated with the development of SSI after open reduction and internal fixation of fractures; however, marijuana smoking was not shown to be associated with the development of SSI. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prevalence and Determinants of Current Cigarette Smoking Among Adolescents in Thailand: Evidence From 2021 Global School-Based Health Survey.

Adolescent cigarette smoking remains a concern globally, including in Thailand. This research aimed to elucidate the prevalence and determinants of cigarette smoking among Thai adolescents. Study Design: A cross-sectional study. A cross-sectional analysis of data from the 2021 Thailand Global School-Based Health Survey with 5545 adolescents aged 13-17 with complete information was conducted on their cigarette smoking status. Bivariate analysis and multivariable logistic regression were performed to discern the determinants of tobacco smoking among adolescents. The overall weighted prevalence of cigarette smoking was 11.5% (95% confidence interval [CI]=9.7%, 13.5%), with adolescent males at 18.2% (95% CI=15.3%, 21.4%) and adolescent females at 5.6% (95% CI=4.2%, 7.4%). The multivariable logistic regression also revealed that males were more likely to be smokers (Adjusted Odd Ratio [AOR]=1.58; 95% CI=1.02, 2.45, P=0.040) compared to females. The presence of smokers in their vicinity significantly increased the odds of smoking (AOR=2.21, 95% CI=1.46, 3.36, P<0.001). Current alcohol use (AOR=3.37, 95% CI=2.21-5.14, P<0.001) and current marijuana use (AOR=4.53, 95% CI=2.06, 9.99, P<0.001) were both significant determinants of smoking. Notably, early initiation of cigarette use (before age 14) was associated with a lower likelihood of current smoking (AOR=0.54, 95% CI=0.33, 0.92, P=0.022). With an overall prevalence of smoking among adolescents at 11.5%, our study highlights a significant public health concern. The positive determinants of the identified tobacco smoking include being male, having smokers in their vicinity, and currently using alcohol, and marijuana, while early initiation of cigarette use before age 14 is identified as an inverse determinant.

Marijuana Use May Be Associated with Reduced Prevalence of Prostate Cancer: A National Survey on Drug Use and Health Study from United States of America.

Preclinical evidence indicates the potential anti-tumor capabilities of cannabinoids in prostate cancer (PC). We undertook a cross-sectional study using National Survey on Drug Use and Health data from 2002 to 2020, involving 2503 participants in the USA. The independent variable was marijuana use status (current, former, never), while the dependent variable was self-reported PC (yes, no). Eleven other demographic variables were assessed as covariates. PC prevalence was lower among current marijuana users (46/145, 31.7%) and former users (323/1021, 31.6%) compared to non-users (534/1337, 39.9%, p < 0.001). PC prevalence was lower among users versus non-users in the elderly (≥65) (36.4% vs. 42.4%, p = 0.016) and non-Hispanic white subgroups (28.9% vs. 38.3%, p < 0.001). There were no significant PC prevalence differences between users and non-users in the younger population (50-64) or other race/ethnicity. In the multivariable analyses, former marijuana use was associated with lower PC compared to never using (odd ratio = 0.74, 95% CI 0.62-0.90, p = 0.001). Current use was also suggestive of reduced prevalence but was not statistically significant (odd ratio = 0.77, 95% CI 0.52-1.14, p = 0.198), possibly due to low sample size. Our findings from a large national survey provide additional data to link marijuana use with lower PC prevalence.

Racial Disparities in Patterns and Modes of Current and Daily Marijuana Use among Adults Living with Children.

This study sought to examine racial disparities in marijuana use among U.S. adults living with children. Data are drawn from the 2022 Behavioral Risk Factor Surveillance System to examine the prevalence of current (past month) and frequent (≥20 days in the last 30 days) marijuana use along with the mode of marijuana use by 7 racial and ethnic groups (non-Hispanic [NH] White, NH-Black, Hispanic, NH American Indian or Alaskan Native [AI/AN], NH-Asian, NH Native Hawaiian or other Pacific Islander only [NH/PI], and other/multiple races, n=22,659). Compared to NH White adults with children, NH Black adults had a higher prevalence of current marijuana use (23.1% vs. 16.9%, p=0.003) and NH AI/AN adults had two times higher prevalence of frequent use (17.3% vs. 8.4%, p=0.0003). Adults living in recreational marijuana legal states (vs. no) were also more likely to report marijuana use, and there were significant age × race/ethnicity and education × race/ethnicity interactions (p<0.05) on marijuana use. Regarding the mode of use, racial minority users except Asians also reported a higher prevalence of smoking marijuana than their White counterparts. Substantial racial disparities in marijuana use patterns among adults who live with children highlight a potential risk for adolescents' health. Addressing these differences is essential for promoting equitable health outcomes in diverse communities.

Exploring perceptions of self-stigma of substance use and current alcohol and marijuana use patterns among college students.

While research has examined the effect of stigma from others towards individuals with substance use disorders, few studies have examined the relationship between perceived self-stigma and engagement in substance use more broadly, especially among non-clinical samples. The present study examined the relationships between perceptions of self-stigma if one were to develop a substance use disorder, consisting of negative self-esteem and negative self-efficacy, and alcohol or marijuana use behaviors and outcomes. Participants (n = 2,243; 71.5% female) were college students within the U.S. recruited to participate in an online survey on substance use with a special focus on alcohol and marijuana. Results indicated no significant differences in stigma scores across individuals with different lifetime alcohol and marijuana use. Stigma ratings did differ between individuals with different profiles of last 30-day alcohol and marijuana use where, generally, individuals with lifetime use but no use in the last 30-day reported higher levels of self-stigma. Correlation analyses indicated that perceived impact of substance use disorder on sense of self-efficacy and self-esteem related negatively to nearly all observed factors of alcohol and marijuana use. Though self-stigma, and stigma more broadly, has been shown to have negative implications for people with substance use disorders, the present study suggests that for non-clinical populations there may be some protective association between perceived self-stigma and alcohol or marijuana use engagement. This is not to say that self-stigma is a positive clinical intervention. Rather, we interpret these findings to indicate that negative perceptions of substance use disorder on the sense of self may be associated with distinct alcohol and marijuana use behaviors among young adults.

Pathways from prenatal cocaine exposure to adult substance use and behavior

This is a report from the most recent adult follow-up of the longest running cohort study of prenatal cocaine exposure (PCE), in which women were enrolled prenatally and offspring were assessed in infancy, childhood, adolescence, and young adulthood. In previous studies, PCE was linked to offspring behavior problems such as early substance use and externalizing behavior problems. The current analyses examine pathways from PCE to behavioral outcomes in offspring at the 25-year assessment. Prenatal cocaine exposure was moderate in this cohort; most women decreased or discontinued use after the first trimester. During the first and third trimesters, 38% and 11% used cocaine, respectively. This represents the most common pattern of PCE in non-treatment samples. At this phase, the adult offspring were, on average, 27.3 years old (range = 25–30), had 13.4 years of education, 83% were employed, 55% were Black, and 55% were female. Offspring who were exposed to cocaine during the first trimester were significantly more likely to use marijuana in the past year, report more arrests, and have poorer scores on a decision-making task, controlling for other prenatal substance exposure, demographic, and socioeconomic factors. In mediation analyses, there were indirect pathways from PCE to current marijuana use through early initiation of marijuana use and 21-year marijuana use, and through 15-year status offenses and 21-year marijuana use. There was also an indirect pathway from PCE to lifetime arrests through early initiation of marijuana use and 21-year Conduct Disorder, although the direct pathway from PCE to arrests also remained significant. These findings are consistent with those from previous phases and are an indication that there are detrimental associations with PCE that persist across developmental stages and into adulthood.

Factors Associated with Drug Abuse among Adolescents; A Cross-Sectional Study in Army Day Secondary School Birnin Kebbi, Nigeria.

Background: Drug abuse and use are substantial public health concerns, particularly among adolescents, who are frequently put at risk due to their curiosity, resulting in negative behavioral, physical, social, and economic repercussions. However, there is a lack of comprehensive research on the prevalence and associated determinants of drug abuse and use (tobacco, alcohol, and marijuana) among school-age adolescents in a statewide sample from northern Nigeria. This study looked into the factors that contribute to drug abuse and use, as well as their impact on school-aged adolescents at Army Day Secondary School in Birnin-Kebbi, Nigeria. Methods: Data for the study were acquired from a self-administered questionnaire administered to senior students in both the boys’ and girls’ arms of the institution. A Youth Risk Behavior Surveillance System (YRBSS), a conventional survey designed to assess cigarette smoking, alcohol consumption, and marijuana usage was used in generating data on drug abuse among the respondents. Results: Three variables were significantly associated with drug abuse/use class level (AOR = 2.272, 95% CI: 1.249, 4.133, p = 0.007; AOR = 2.252, 95% CI: 1.229, 4.127, p = 0.009), gender (AOR = 1.840, 95% CI: 1.164, 2.907, p = 0.009), and family types (AOR = 0.581, 95% CI: 0.361, 0.933, p = 0.025) for current cigarette smoking, alcohol, and marijuana. The majority of respondents (47–60%) were aware of drug abuse or use, with females having a 52.4% positive attitude as opposed to males (47%). Other variables, such as age, religion, parent education, and who the respondents reside with, have been found to have no significant relationship with adolescent drug use or usage. Conclusion: There is a need for comprehensive public health strategies that go beyond school-based psycho-behavioral interventions to address the considerable risk factors for substance use among our secondary school students.

Abstract A001: Racial differences in cigarettes and marijuana use among acute pancreatitis patients

Abstract Background/Objectives: Smoking increases the risk of pancreatitis and pancreatic cancer, while the effects of marijuana on pancreatic disorders are unknown. Black and White patients with chronic pancreatitis differ in the prevalence of behavioral risk factors, contributing to subsequent racial differences in pancreatic cancer risk, but the behavior pattern has been unexplored in patients with acute pancreatitis (AP). Our objectives were to: 1) estimate the prevalence of current and lifetime cigarettes and marijuana use among AP patients who identify as Black, White, and other races, and examine racial differences in their usage patterns, and 2) describe the type and frequency of marijuana or other cannabis products used among the different racial groups. Methods: We utilized data from an on-going case-crossover study of patients diagnosed with alcohol-associated AP who are recruited from five medical sites in the United States. Hospitalized patients who meet the Revised Atlanta Classification of AP and have an AUDIT-C score of 3 or higher are enrolled in the study. Chi-squared tests were used to assess for racial differences in co-substance use and the type of substance used; while Fisher’s exact test was used to examine racial differences in the frequency of marijuana and other cannabis products used. To account for multiple testing, post-hoc pairwise comparisons were conducted using Holm procedure. Other races included American Indian/Alaska Native, Asian, Brazilian, Mexican, Indian, and people who did not know or could not provide their race. Results: In this analysis, a total of 143 participants were included, among whom 71 identified as White, 46 as Black, and 20 as belonging to other racial backgrounds. Males comprised 69% of patients and the median age was 39 years. Current cigarette smoking and use of marijuana was reported by 51% and 48% patients, respectively. Concurrent cigarette smoking and marijuana use at enrollment was reported in 19%, while 51.8% reported ever use of both substances. Joints/cigars/blunts (JCB) was the most common form of cannabis product used followed by edibles. Majority of the marijuana users used it regularly: daily (36.2%) or 1-6 days a week (38%). While current co-use was not statistically different between races (24% in White, 17% in Black, and 10% in Other), we found that White (62%) and Black (54%) patients were more likely to report ever use of both cigarette and marijuana than other races (20%) (p= 0.013). The differences were also noted for the use of JCB: 38% in White, 52% in Black, and 10% in other races (p=0.006). Conclusions: We identified racial differences in the usage of cigarettes and marijuana, the use of JCB, and the number of marijuana or other cannabis products. Our findings underscore the importance of considering race when addressing multiple substance use in AP patients. Citation Format: Esther A. Adeniran, Dhiraj Yadav, Sungjin Kim, Georgios I. Papachristou, James L. Buxbaum, Joseph R. Pisegna, Stephen J. Pandol, Christie Y. Jeon. Racial differences in cigarettes and marijuana use among acute pancreatitis patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A001.

1 Perceived Cognitive Impairment in High School Students in the United States During the COVID-19 Pandemic

Objective:The Youth Risk Behavior Survey (YRBS), conducted by the United States Centers for Disease Control and Prevention (CDC) in 2019, revealed that a large percentage of boys (30%) and girls (45%) reported serious difficulty concentrating, remembering, or making decisions as a result of a physical, mental, or emotional problem. In 2021, the CDC conducted the Adolescent Behaviors and Experiences Survey (ABES). The ABES included similar methodology and content as the YRBS. This study analyzed ABES data to examine correlates of perceived cognitive impairment among high school students in the United States during the COVID-19 pandemic.Participants and Methods:The ABES was a one-time, online survey that was conducted to assess and evaluate the challenges that high-school aged youth experienced during the COVID-19 pandemic. Students’ perceived cognitive impairment was assessed using the same question used in the 2019 YRBS: 'Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?' Response options were binary: 'Yes’ or 'No.' The students’ responses were evaluated in relation to nine adversity, mental health, and lifestyle variables.Results:Participants were 6,992 students, age 14 to 18, with 3,294 boys (47%) and 3,698 girls (53%). A large proportion endorsed experiencing serious difficulties concentrating, remembering, and making decisions (45%). Girls (56%) were significantly more likely to endorse perceived cognitive impairment compared to boys (33%) [X2(1)=392.55, p&lt;.001; OR=2.66, 95% CI=2.41-2.93]. Youth who reported that their mental health was poor most of the time or always were very likely to report perceived cognitive impairment (boys: 67%; girls: 81%). Binary logistic regressions were used to examine the associations between perceived cognitive impairment, adversity, and lifestyle variables while controlling for mental health. These analyses were conducted separately for boys [X2(9)=596.70, p&lt;.001; Nagelkerke R2=.24] and girls [x2(9)=883.35, p&lt;.001; Nagelkerke R2=.30]. After controlling for current mental health, significant independent predicters of cognitive problems in boys and girls included: a lifetime history of discrimination based on race or ethnicity, lifetime history of being sexually assaulted or abused, lifetime history of using illicit drugs, being bullied in the past year, current marijuana use, and getting insufficient sleep (5 of fewer hours per night). Participation in sports and exercising regularly were both independently associated with lower rates of cognitive impairment.Conclusions:Perceived cognitive impairment was endorsed by a strikingly high percentage of high school students in 2021 during the COVID-19 pandemic. More than half of high school aged girls and one third of boys reported having serious difficulty concentrating, remembering, and making decisions. These rates are considerably higher than in 2019. Current mental health, unfair treatment because of race or ethnicity, being sexually assaulted, being bullied, drug use, and insufficient sleep were associated with perceived cognitive impairment. Indicators of a physically active lifestyle (participation in sports and exercising regularly) were associated with lower rates of cognitive problems.

Suicide ideation and behavior and ATOD use among bisexual high school students

ABSTRACT Background Research has indicated that sexual minorities have higher prevalence rates for ATOD use and suicide ideation and behavior compared to heterosexual youth. Yet, most studies to date have combined gay, lesbian, and bisexuals into one category. This study sought to assess the uniqueness of bisexuality to assess the risk of ATOD use and suicide ideation and behavior among bisexual high school students. Methods Data for this study were derived from the 2019 Centers for Disease Control’s Youth Risk Behavior Survey (YRBS). Chi-square analysis was conducted to determine the prevalence of ATOD use and suicide ideation and behavior. Logistic regression was then used to estimate the association between ATOD use and suicide ideation and behavior among bisexual adolescents. Results This study found that ever use an electronic vape product, non-medical use of prescription drugs, and current alcohol and marijuana use were significant predictors for suicide ideation and behavior. Conclusions Based on our results, we believe that it is important to address the relationship of substance use as a risk factor for suicide and ideation and behavior of bisexual adolescents, as bisexual adolescents may need more emotional support as they come to understand their sexual identity.

Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era

ABSTRACT Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.

Nationwide Study of Postlegalization Marijuana Use Among Patients With Epilepsy in Canada.

Patients with epilepsy have long sought alternatives to conventional antiseizure medications (ASMs) for the treatment of their epilepsy and to improve the significant side effect burden of ASMs and comorbidities. It was established before the legalization of marijuana in Canada in 2018 that many patients with epilepsy use marijuana to treat their seizures or for recreational purposes. However, there exists no current data on the prevalence and habits of marijuana use in the Canadian epilepsy population since legalization. We conducted a nationwide cross-sectional survey of patients recruited through health care providers or epilepsy organizations to investigate marijuana usage habits and perceptions. From 395 responses obtained through the survey, 221 responses stated that they used marijuana within the past year. A history of seizures for more than 10 years was noted in 50.7% (n = 148) patients with generalized seizures being the most common type (n = 169; 57.1%). Most of them (n = 154; 52.0%) had tried 3 or more ASMs, and 37.2% (n = 110) used various other treatments (ketogenic diet, vagus nerve stimulation, or resective surgery) indicating a proportion with drug-resistant epilepsy. This subgroup was more likely to have started using marijuana for drug-resistant epilepsy (p < 0.001). Current marijuana use for epilepsy management was endorsed by 47.5% (n = 116). Marijuana was "somewhat" to "very" effective at reducing seizure frequency for 60.1% (n = 123). The main side effects of marijuana were impaired thinking (n = 40; 17.17%), anxiety (n = 37; 15.74%), and altered hunger (n = 36; 15.32%). Marijuana was used at least once daily by 70.3% (n = 168) with the median amount per week being 5.0 g (IQR = 1-10), and the preferred method of consumption was smoking (n = 83; 34.7%). The participants expressed concerns regarding financial strain (n = 108; 36.5%), lack of recommendation from a doctor (n = 89; 30.1%), and lack of information (n = 56; 18.9%) surrounding marijuana use. This study reveals a high prevalence of marijuana use among patients with epilepsy living in Canada particularly when seizures are drug resistant. A significant proportion of patients reported improvement of seizures with marijuana use, consistent with previous studies. With the increased accessibility of marijuana, it is imperative that physicians are aware of marijuana usage habits among patients with epilepsy.

Marijuana use is inversely associated with liver steatosis detected by transient elastography in the general United States population in NHANES 2017-2018: A cross-sectional study.

The impact of marijuana on the general population is largely unknown. The present study aimed to assess the association between marijuana use and liver steatosis and fibrosis in the general United States population utilizing data from the National Health and Nutrition Examination Survey (NHANES). This cross-sectional study was performed with data from the 2017-2018 cycle of NHANES. The target population comprised adults in the NHANES database with reliable vibration controlled transient elastography (VCTE) results. The median values of the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were used to evaluate liver steatosis and fibrosis, respectively. After adjusting for relevant confounders, a logistic regression analysis was used to assess the association between marijuana use and liver steatosis and fibrosis. A total of 2622 participants were included in this study. The proportions of never marijuana users, past users, and current users were 45.9%, 35.0%, and 19.1%, respectively. Compared to never marijuana users, past and current users had a lower prevalence of liver steatosis (P = 0.184 and P = 0.048, respectively). In the alcohol intake-adjusted model, current marijuana use was an independent predictor of a low prevalence of liver steatosis in people with non-heavy alcohol intake. The association between marijuana use and liver fibrosis was not significant in univariate and multivariate regression. In this nationally representative sample, current marijuana use is inversely associated with steatosis. The pathophysiology is unclear and needs further study. No significant association was established between marijuana use and liver fibrosis, irrespective of past or current use.