Marijuana Users Research Articles

Perceptions and prevalence of marijuana use among cancer patients managed at an outpatient department in Zimbabwe: A brief report.

Globally, marijuana is becoming an acceptable complementary medicine for symptom management in cancer. At the time that the study was conducted, Zimbabwean laws only allowed for the cultivation of marijuana for medical and scientific use. As of 18 July 2022, the national medicines regulator released a circular allowing the licensing, distribution, and use of cannabidiol-based products. Anecdotes indicate there is medical marijuana use among Zimbabwean patients with cancer. We sought to determine the prevalence, patterns of use and perceptions of medical marijuana among patients with cancer. A cross-sectional survey was used to determine patterns and perceptions of marijuana use among outpatient patients with cancer. The study included adults attending the outpatient oncology clinic at Parirenyatwa Hospital Radiotherapy Treatment Center. Fifty participants with a median age of 50.5 years (IQR: 41-58) completed the questionnaire, and 28.0% of them were male. The prevalence of marijuana use in the sample was 24.0% (95% CI 13.9-38.2). Most marijuana users were male (83.3%, p < 0.001). The rate of medical marijuana use among users was 66.7%. Participants were generally neutral concerning the benefits of marijuana and how it should be regulated. Just under 50% indicated that they would be open to using it if it were legal. The prevalence of marijuana use in the sample was comparable to other jurisdictions. Perceptions toward medical marijuana were generally neutral. Consequently, for medical marijuana and/or cannabidiol-based products to become acceptable in the Zimbabwean context, there is need for the dissemination of evidence-based information on their benefits.

EP-68 A Case of Spontaneous Pneumomediastinum due to Marijuana usage- A rare cause

Abstract Pneumomediastinum without trauma or clear secondary cause is called Spontaneous pneumomediastinum with an incidence between 0.001%-0.014% and most commonly seen in young males. Marijuana smoking has rarely been identified as a possible cause of spontaneous pneumomediastinum, which is likely caused by barotrauma during breathing manoeuvres. Fewer than 10 case reports have been reported in the literature on Marijuana causing Spontaneous pneumomediastinum. We present a 24year male who presented with dysphagia, swelling and crackling under the skin of his neck for the past 12hours, half an hour after blowing his nose. There was no chest pain or dyspnoea, and he was hemodynamically stable with normal blood investigations. He smokes cannabis regularly and occasionally does cocaine. On examination, surgical emphysema was felt on both sides of the neck; the systemic examination was unremarkable. CT thorax demonstrated extensive pneumomediastinum and surgical emphysema from the angle of the jaw throughout the neck and down to the right subcapsular region. No pneumothorax was seen, and lung parenchyma was unremarkable. However, to rule out the clinical suspicion of oesophageal rupture, he had a CT oesophagus with oral contrast, which showed no extravasation of contrast from the oesophagus. The patient was admitted for observation, and the Chest X-ray after 12hours dint show pneumothorax. He was clinically well, tolerating oral feeds, so he was discharged with oral antibiotics as a prophylactic cover as per UGI surgeons. The knowledge about this rare cause would help the physicians diagnose and educate the patients on the risk involved in using Marijuana.

The Effect of Self-Reported Marijuana Use on Post-Operative Opiate Needs in The Spinal Fusion Surgery Patient

<h3>Introduction</h3> Legalization of recreational and medical marijuana is on the rise across the United States. As the popularity of cannabis is growing, more patients with a history of use are being seen in the hospital setting. <h3>Identification of the problem</h3> As nurses in the PACU and inpatient Orthopedic setting, we felt there was a correlation between patients' history of marijuana use and increased narcotic requirements. When we started to search for information on this topic, we found research was limited due to the federal illegality of marijuana. <h3>Purpose of the Study</h3> The purpose of this study was to determine if marijuana usage prior to spinal surgery affected post-operative opiate needs. We measured the usage of opiates by self-reported marijuana users postoperatively. <h3>Methodology</h3> The study design is correlational, investigating the relationship between the pre-operative marijuana use and post-operative narcotic need. We attended our Orthopedic Academy-Spinal Class to introduce our study. If the patients were willing to participate, they were asked to sign an informed consent and complete a survey regarding pain scores and at home pain management, which included marijuana use. Post operatively the EMR was reviewed, and all narcotic usage was documented and converted into milliequivalents of morphine. <h3>Results</h3> Once the conversions were complete, we studied the correlation between those who reported marijuana use (comparison group) with those who denied use (control group). Except for post op day 2, the comparison group received more narcotic than the control group. <h3>Discussion and Implications</h3> Nowknowing that a patient's history of marijuana use does play a role in narcotic requirements post operatively, it can help nurses better plan their care. When a patient reports marijuana use during the preoperative assessment, the nurse can advocate for multi-modal pain control to start preoperatively. Postoperatively, this knowledge can reinforce the importance of finding an appropriate pain management regimen. Personalized and detailed education on pain management after discharge may decrease risk of readmission for pain control. <h3>Conclusion</h3> With our finding we can better educate staff and patients to help optimize their post-operative pain management. More research is needed on this topic to help better understand the correlation and the implication marijuana use has on nursing care.

Michigan Marijuana Legalization: Correlations Among Cannabis Use, Mental Health, and Other Factors.

Introduction: There are health implications with the statewide legalization of recreational marijuana that are still not fully understood and require further examination. This study evaluates the prevalence of marijuana use in patients being treated for a variety of conditions and whether correlations exist between marijuana use, mental health conditions, and concomitant use of psychotropic medications.Methods: Data were collected from an electronic medical record (EMR) as part of a retrospective chart audit. A total of 500 charts were reviewed during a six-month timeframe from December 1, 2018 to May 31, 2019 with the start date approximating the timing of when marijuana became recreationally legalized in the State of Michigan.Results: This study demonstrated a point prevalence of 15.8% since 79 of the 500 charts reviewed had marijuana use documented. Additionally, marijuana users were more likely to have a history of cocaine use, schizophrenia, antipsychotic use, and tobacco use.Conclusion: Trends identified in this study provide a comparison point for the local prevalence of marijuana use immediately post state-wide legalization, with a projected increasing trend due to the removal of legal barriers.

Self-reported marijuana use and its effects on overall approval in potential living kidney donors.

Past and present substance use is an important part of the psychosocial evaluation of potential living kidney donors (LKDs). Increasing state legalizations and social acceptance of marijuana (MJ) use can create challenges for transplant centers. We investigated the frequency of reporting MJ use, and its effect on the LKD evaluation. A retrospective chart review was performed on all living donor candidates from December 2016 to December 2019 for reports of MJ use, both on an electronic intake form and during clinical evaluation with a licensed social worker (SW). Active MJ use was defined as current use or use within 1 year of evaluation. Baseline characteristics between MJ users and non-users were compared at each step of donor evaluation. We explored variables associated with MJ use including additional consults and testing during the donor evaluation. Overall approval and donation rates for living donors with active MJ use were compared to non-users. Additionally, 1-year donor follow-up was compared between the two groups. Results of 1818 living donor candidates who completed the intake form, 132 admitted to active MJ use. Compared to non-users, MJ users were more likely to be younger, male, single, renting a home, and with a lower level of education. Thirty three out of 338 candidates who completed a social work evaluation reported MJ use. Compared to non-users, MJ users were more frequently classified as moderate or high risk on SW evaluation, and often required a toxicology screen or psychiatry visit for clearance to donate. Altogether 24.2% of MJ users versus 9.5% of non-users discontinued their evaluation (p<.01). Altogether 42.4% of MJ users versus 56.1% of non-users donated their kidney (p=.13). For those who donated, MJ users were less likely than non-users to follow up at 1 year (57.1%vs. 83.0, p-value .02). MJ users were often asked to complete additional steps in their evaluation before an approval decision was made, which may have led to the higher rate of donor drop out observed in this group. Further research is needed to assess the effects of MJ use on living donor candidacy, as well as any effects of MJ use on long-term donor outcomes.

Changes in the clustering of health-related behaviors during the COVID-19 pandemic: examining predictors using latent transition analysis

The COVID-19 pandemic has had a significant impact on daily life, affecting both physical and mental health. Changes arising from the pandemic may longitudinally impact health-related behaviors (HRB). As different HRBs co-occur, in this study, we explore how six HRBs - alcohol (past-week and binge-drinking), tobacco, marijuana, benzodiazepine use, and unhealthy food consumption - were grouped and changed over time during the COVID-19 pandemic. A sample of 1038 university students and staff (18 to 73 years old) of two universities completed an online psychometrically adequate survey regarding their recalled HRB (T0, pre-COVID-19 pandemic) and the impact of COVID-19 on their behaviors during July (T1) and November (T2). Latent Transition Analysis (LTA) was used to identify HRB cluster membership and how clusters changed across T0, T1, and T2. Four clusters emerged, but remained mainly stable over time: ‘Lower risk’ (65.2–80%), ‘Smokers and drinkers’ (1.5–0.01%), ‘Binge-drinkers and marijuana users’ (27.6–13.9%), and ‘Smokers and binge-drinkers’ (5.6–5.8%). Participants who moved from one cluster to another lowered their HRB across time, migrating from the ‘Binge-drinkers and marijuana users’ cluster to ‘Lower risk’. Participants in this cluster were characterized as less affected economically by the COVID-19 pandemic, with lower reported stress levels, anxiety, depression, and loneliness than the other clusters. Our results provide evidence of how HRBs clustered together and transitioned longitudinally during the COVID-19 pandemic. HRB clustering across time offers a valuable piece of information for the tailoring of interventions to improve HRB.

E-cigarette or Vaping product use Associated Lung Injury (EVALI) in a 15 year old female patient – case report

BackgroundE-cigarettes are devices which allow to aerosolize liquids containing nicotine or other substances. Ever since they were released on the market in 2006, the number of users have been constantly increasing, especially among adolescents, ranging from 7,6% to 9,3% in the age group 18–24 years old from 2014 to 2019. Hand in hand with the spread of E-cigarettes many have been the efforts to understand their impact on health. EVALI (E-cigarette or Vaping product use Associated Lung Injury) is an emerging condition with a heterogeneous presentation with several reported cases worldwide. We mean to report a case of EVALI in a 15-year-old female Caucasian patient, who's currently attending her clinic follow-up at Bambino Gesù Pediatric Hospital in Rome.Case presentationThe patient was admitted to the Emergency Room due to acute respiratory failure in November 2020. At admittance, she was severely dyspneic (HR 120 bpm, SatO2 75%). As she was hospitalized amid the COVID-19 pandemics, she underwent a nasopharyngeal swab for SARS-CoV2, which turned out negative, and a chest CT scan. Chest CT scan showed a central ground grass pattern with peripheral sparing. At the anamnestic recall, it was disclosed she was an e-cigarette smoker and occasional marijuana user. The microbiological work-up proved only positive for Rhinovirus. Her clinical and radiological case was discussed with our radiologist who suspected EVALI. She was assisted through HFNC, antibiotical therapy and corticosteroids with a dramatic recovery within the first 48 h.ConclusionsEVALI started being recognized a specifically nosological entity in summer 2019, with increasing cases being reported. No diagnostic criteria have been agreed upon yet, but its usual presentation includes respiratory, gastrointestinal and systemic symptoms of different degree and the diagnosis can be hypothesised in case the patient has an evocative clinical and radiological presentation and has been an E-cigarette smoker in previous 90 days. Due to the novelty of the condition and its heterogeneous presentation it is of interest to report the cases in which EVALI is identified to raise awareness about this emerging new-age disease.

The Effect of Preoperative Marijuana Use on Surgical Outcomes, Patient-Reported Outcomes, and Opioid Consumption Following Lumbar Fusion.

Retrospective Cohort Study. To (1) investigate the effect of marijuana use on surgical outcomes following lumbar fusion, (2) determine how marijuana use affects patient-reported outcomes measures (PROMs), and (3) determine if marijuana use impacts the quantity of opioids prescribed. Patients > 18years of age who underwent primary one- or two-level lumbar fusion with preoperative marijuana use at our institution were identified. A 3:1 propensity match incorporating patient demographics and procedure type was conducted to compare preoperative marijuana users to non-marijuana users. Patient demographics, surgical characteristics, surgical outcomes (90-day all-cause and 90-day surgical readmissions, reoperations, and revision surgeries), pre- and postoperative narcotic usage, and PROMs were compared between groups. Multivariate regression models were created to determine the effect of marijuana on surgical reoperations patient-reported outcomes (PROMs) 1-year postoperatively. Of the 259 included patients, 65 used marijuana preoperatively. Multivariate logistic regression analysis demonstrated that marijuana use (OR = 2.28, P = .041) significantly increased the likelihood of having a spine reoperation. No other surgical outcome was found to be significantly different between groups. Multivariate linear regression analysis showed that marijuana use was not significantly associated with changes in 1-year postoperative PROMs (all, P > .05). The quantity of pre- and postoperative opioids prescriptions was not significantly different between groups (all, P > .05). Preoperative marijuana use increased the likelihood of a spine reoperation for any indication following lumbar fusion, but it was not associated with 90-day all cause readmission, surgical readmission, the magnitude of improvement in PROMs, or differences in opioid consumption. III.

Costs and benefits of cooperative learning as a universal school-based approach to adolescent substance use prevention.

Substance use during early adolescence implies a greater likelihood of abuse and dependence in later adolescence or adulthood. In turn, substance abuse and dependence are linked to a variety of maladaptive long-term health-related outcomes that imply significant individual and societal costs. In this paper, we evaluated an approach to substance use prevention that relies on the vital role of peers, who comprise a key risk factor for adolescent substance use. This approach (i.e., cooperative learning, CL) focuses on interrupting the process of deviant peer clustering and providing at-risk youth with the opportunity to build social skills and cultivate friendships with low-risk youth. In addition to testing the efficacy of CL in reducing the number of students who become regular substance users, we also conducted a cost-benefit analysis. Using four waves of data from a cluster-randomized trial (N = 15 middle schools, 1890 students, 47.1% female, 75.2% White, 13.9% of students were receiving special education services), we found that significantly lower percentages of students in the intervention (CL) schools became regular users of tobacco, alcohol, and marijuana. We estimated that the reduction in substance use associated with the implementation of CL resulted in total lifetime benefits of between $1027 and $4621 per student (in 2019 dollars), or between $8.79 and $39.54 for each dollar invested in CL. Benefit/cost ratios would go up to $22.54-$101.39 per dollar invested with the continual implementation of CL, assuming retraining every 5 years. Implications and future research directions are discussed.

Traditional Chinese Medicine Offers Help to Marijuana Users Determined to Withdraw Report of Two Typical Cases

Marijuana (Cannabis) is the most frequently used illegal substance in the world [1,2]. On the other hand there is a rapidly shifting landscape advocating the legalization of Marijuana for medical and recreational purposes. The regular use of marijuana during adolescence is of particular concern since use by this group is associated with an increased likelihood of deleterious consequences [3]. Legalization of the drug in some countries is steaming up global interests. General excitement and high mood together with energizing effects are the outcome of Cannabis. On the reverse, without the drug, the downward mood and loss of physical energy could be unbearable. The direct manifestations of withdrawal syndrome include irritability, anger, aggression, anxiety, insomnia, restlessness, depression and physical symptoms like headache, sweating, chills and bodily pain [3].

Self-reported marijuana use and cardiac arrhythmias (from the Multiethnic Study of Atherosclerosis)

Marijuana use among all age groups has been increasing, including among older adults aged ≥65years. There is a lack of epidemiologic data examining arrhythmia risk among users of marijuana. We evaluated cross-sectional associations between current and past marijuana smoking and arrhythmias among 1485 participants from the Multiethnic Study of Atherosclerosis who underwent extended ambulatory electrocardiographic monitoring with the Zio Patch XT. Outcomes included premature atrial contractions, runs of supraventricular tachycardia, premature ventricular contractions, and runs of nonsustained ventricular tachycardia (NSVT). Compared with never users, participants reporting current use of marijuana (n=40, 3%) had more supraventricular tachycardia/day (adjusted geometric mean ratio [GMR] 1.42, 95% confidence interval [CI] 0.87 to 2.32), more premature atrial contractions/hour (GMR 1.22, 95% CI 0.72, 2.13), and more NSVT/day (GMR 1.28, 95% CI 0.95 to 1.73); although, CIs overlapped 1. Additionally, more frequent marijuana use was associated with more runs of NSVT/day (GMR 1.56, 95% CI 1.13, 2.17). In conclusion, our results suggest that current marijuana use may be associated with a greater burden of arrhythmias. There is a need for additional research, mainly using a prospective design, to clarify if marijuana use causes atrial and ventricular arrhythmias or other cardiovascular complications among older adults.

NURS-04. Marijuana, Hemp, and the Child with Cancer: Education for Nurses

Abstract Many pediatric oncology patients report medical marijuana (MMJ) and hemp-based cannabidiol (CBD) use. Nearly 4,000 minors are registered users of marijuana in Colorado, the first state in the United States of America (USA) to legalize recreational marijuana. Medical marijuana is legalized in 37 states and four territories in the USA. Additionally, due to the bipartisan Farm Bill passed in December of 2018, hemp is federally legal. Forty-three countries have also legalized medical marijuana. With increased legality and many countries decriminalizing marijuana, the use of MMJ and hemp-based CBD is also increasing. This upsurge in use raises significant concerns with pharmacological interactions with CBD and the medications routinely administered to children with cancer (including chemotherapy). Cannabis-derived pharmaceuticals can also have pharmacological interactions. Nurses are the frontline for discussions with patients about MMJ and must be aware of the emerging field of MMJ in pediatric cancer. Education including the difference between tetrahydrocannabinol (THC) and CBD and their indications, extraction methods and safety, product types, infection control, and dosing considerations are important for nurses to learn. Nurses with increased knowledge will then help patients and families make educated and safer choices in treating their children for tumor treatment and side effect management with MMJ and hemp-based CBD. Additionally, nurses can influence patient care protocols and processes for alternative therapy administration enabling an open dialogue between providers, parents, and patients regarding treatments, symptoms, adverse effects, and drug interactions.

Evaluating the Frequency of Postpartum Depression in Marijuana Users With and Without a History of Depression [A226

INTRODUCTION: Existing literature suggests an association between marijuana use in pregnancy and postpartum depression (PPD). We looked closer at this association by examining the role of depression history. METHODS: Institutional review board approval was attained. We conducted a retrospective cohort study of patients receiving perinatal care at an academic medical center between January 2017 and December 2019. Inclusion criteria included: delivery of a live-born infant at ≥24 weeks, no history of or current opioid dependence, and available Edinburgh Postnatal Depression Scale (EPDS). Marijuana use was self-reported. Screen positive for PPD was defined as scoring 10 or higher on the EPDS. Modified Poisson regression was used to calculate the relative risk (RR) of screening positive for depression. RESULTS: A total of 250 women were included in this analysis. Most were non-Hispanic Black (52%) or White (28%); 61 (24%) reported marijuana use during pregnancy; 102 (41%) had a history of depression and 148 (59%) did not; 39 (16%) screened positive for PPD. With a history of depression, the risk of PPD for those who reported marijuana use was 2.67 times (95% CI, 1.46–4.88) that of those who did not report use. Without a depression history, there was no statistically significant elevation in risk (RR, 1.81; 95% CI, 0.39–8.48). Multivariable analyses are ongoing to assess whether the finding is robust to adjustment for confounding. CONCLUSION: Those with a depression history who report using marijuana during pregnancy may have an increased risk of PPD compared to those who do not report use.

Tobacco and Marijuana Use and Effect on Gestational Weight Gain [A195

INTRODUCTION: Previous work has addressed the effect of marijuana and tobacco use in pregnancy on infant birth weight; however, there is a paucity of data reporting the potential impact of marijuana and tobacco use on maternal gestational weight gain (GWG). This study sought to determine an association between marijuana and/or tobacco use and meeting GWG recommendations. METHODS: This retrospective study included patients who delivered at a single academic institution between January 2019 and June 2021. Institutional review board approval was obtained. Data collected included prepregnancy weight, BMI, and gestational weight gain (GWG), as well as tobacco and marijuana use. GWG was categorized according to Institute of Medicine and American College of Obstetricians and Gynecologists recommendations as adequate, inadequate, or excessive. RESULTS: A total of 7,653 patients were included in the study. Polysubstance use was excluded. Overall, 52% of patients experienced excessive GWG, 28% adequate GWG, and 19% inadequate GWG. Former tobacco users were more likely to have excessive GWG than non-smokers and current tobacco users (61% versus 51% and 51%; P&lt;.001), while current tobacco users were more likely to have inadequate GWG than non-users and former tobacco users (24% versus 19% and 15%; P&lt;.001). Marijuana users were more likely to have excessive GWG than non-users (57% versus 52%; P=.007). Marijuana use remained a significant predictor of excessive GWG, even when controlling for tobacco use (P&lt;.035). CONCLUSION: It appears that tobacco and marijuana use may play a role in GWG. Further research is needed in order to fully understand and appropriately counsel on the potential effects of marijuana and tobacco use on GWG and pregnancy outcomes.

Understanding Heterogeneity Among Simultaneous Alcohol and Marijuana Users: Latent Classes Derived From Daily Diary Data

Simultaneous use of alcohol and marijuana (SAM) is common among U.S. college students, but little research has examined specific substance use behaviors during SAM use episodes. This study identified latent classes of SAM users based on their SAM, alcohol-only, and marijuana-only use episodes. College student SAM users (N = 284; 50.7% female; M age = 19.8 years) completed up to five surveys each day across two 4-week bursts. Latent class analysis (LCA) was used to characterize SAM users based on seven latent class indicators of use behavior. Sex was examined in relation to latent class membership. Five unique classes emerged: Frequent Marijuana-Focused SAM users (21%); Frequent Alcohol-Initiating SAM users (29%); Heavy-Drinking Infrequent SAM users (12%); Moderate SAM users (29%); and Light Infrequent SAM users (9%). These groups were differentiated primarily by their frequency of SAM use, form of marijuana, whether marijuana was used on non-SAM occasions, and whether consequences were experienced. Groups differed significantly by sex. College student SAM users are heterogeneous with respect not only to their degree of SAM use but also in their pattern of drinking, type of marijuana use, relative focus on alcohol versus marijuana, and risk of experiencing acute negative consequences. Describing this heterogeneity is an important step toward developing interventions for different types of users.

Abstract #1185149: Hypoglycemia from sulfonylurea, methamphetamine and Tetrahydrocannabinol usage

Hypoglycemia among non-diabetics is rare. The etiologies range from drugs, critical illnesses, hormone deficiencies, autoimmune or insulinomas. Diagnosis of symptomatic hypoglycemia includes the evaluation for Whipples Triad: symptoms of hypoglycemia, plasma glucose concentration less than 55 mg/dl, and resolution of symptoms after plasma glucose is increased. This case report details symptomatic hypoglycemia secondary to concurrent illicit drugs use. A 32 year-old Caucasian female with a history of homelessness and polysubstance abuse was admitted for dizziness and lethargy for several days. There was no known history of diabetes. Initial labs were significant for hemoglobin A1C was 5.3% with glucose level of 31 mg/dL. Glucose improved to 73 mg/dL after 2 intravenous boluses of 50% dextrose. Subsequently, her glucose levels continued to drop to as low as 10 mg/dL prompting additional rounds of D50W boluses and glucagon. ACTH and morning cortisol levels were normal; insulin antibody level, serum and urine ketone, and alcohol level were negative. Urine drug screen was positive for MDMA, marijuana, and cocaine. Her pro-insulin, C-peptide levels and insulin levels were elevated at 19.36 ng/mL and 164.2 mcInt Units/mL, respectively. MRI abdomen was unremarkable for insulinoma or mass. However, a sulfonylurea level came back positive for glimepiride. Given this positive sulfonylurea finding along with her history of illicit drug usage, she was diagnosed with symptomatic hypoglycemia secondary to sulfonylurea and amphetamine usage confounded by marijuana usage. She was safely discharged to a homeless shelter with recommended follow up to the endocrine clinic in two weeks. Glimepiride stimulates pancreatic insulin secretion leading to elevated pro-insulin and C-peptide levels. She denied taking any medication. Given that she experienced hypoglycemic episodes after the ingestion of her illicit drugs, we speculated glimepiride must have been added by her drug supplier. Glimepiride has a half-life of 6-10 hours meaning her hypoglycemic symptoms should have abated within a day. Since her hypoglycemia persisted for several days, this raised suspicions of another contributing factor. A case report by Carrera et al demonstrated amphetamines and THC associated with hyperinsulinemia-induced hypoglycemia. Given the similarity to Carrera et al, the diagnosis of hyperinsulinemia-induced hypoglycemia secondary to sulfonylurea concurrent with amphetamine and THC usage. The pathophysiology of amphetamines and THC-induced insulin secretion is unclear. This case report emphasizes the importance of maintaining a wide differential for hypoglycemia including polysubstance abuse.

Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness \u2013 considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors

BackgroundCigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention.MethodsThis study included 96 youth (ages 14–24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana.ResultsMost youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85.4%) in the past month. One-third (n = 34) used electronic vapor products (EVPs), 19.8% (n = 19) smoked hookah, and 11.5% (n = 11) used smokeless tobacco (ST). Most marijuana users co-administered with tobacco (n = 67, 69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one’s housing situation. Newport (n = 66, 72.5%) and Black & Mild (n = 48, 51.1%) were the most popular brands of cigarettes and cigars among ever users. Most non-combustible tobacco ever users reported not having a usual brand (EVPs: n = 51, 73.9%; ST: n = 16, 57.1%). Cigar smokers reported the most varied selection of flavors.ConclusionsYoung combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support smoking cessation in this population.

Effects of Cannabis-Delivered THC on mood and negative attentional bias in the context of positive vs. neutral Alternatives-a pilot study.

To assess: (1) the acute effects of smoked marijuana (MJ) on negative attentional bias (NAB), (2) moderation of these effects by positive versus neutral alternatives, and (3) the associations of tetrahydrocannabinol (THC)-induced changes in NAB with changes in affect. Fourteen MJ users (1-4 uses/wk) smoked a THC cigarette on 1day and a placebo cigarette on the other counterbalanced day. After smoking, participants freely gazed back and forth at a series of two side-by-side pictures pairs presented for 3000ms (one negative, while the other was either positive or neutral) while eye gaze was tracked. The effects of THC relative to placebo varied across time such that THC increased NAB during the early temporal component of threatening picture viewing, 333-858ms after dual-picture onset, regardless of alternative picture valance. However, contrary to the attentional bias-causes affect hypothesis, during the early viewing phase THC-enhanced positive affect (PA)correlated positively with THC-induced NAB. In contrast, during the late phase (891-3000ms) THC-enhanced PA did not correlate significantly with NAB, though THC-induced negative affect (NA) change did correlate positively with THC-induced change in NAB in the positive alternative condition. We replicated findings of others showing that THC can enhance NAB during the early stages of threatening picture viewing. We extended previous results by demonstrating the THC-induced NAB is associated with increased PA during initial threat viewing, but with increased NA during later processing if positive alternatives are present.

Perceptions of Game cigarillo packaging among young adult tobacco users: The effect of package color and the “natural leaf” descriptor

IntroductionTobacco packaging elements have been shown to influence product perceptions and use intentions. Garcia y Vega’s Game cigarillos are distinct from other brands in their use of “natural leaf” on packaging. The term “natural” has been linked to misperceptions about lower risk in the context of cigarettes. This study examines the impact of the “natural leaf” descriptor and pack color on young adults’ cigarillo perceptions and intentions. MethodsIn April-June 2020, we conducted an online experiment with 1,063 young adults (ages 18–34) that were past year users of cigars, vaping products, or marijuana. Subjects were randomly assigned to view one of eight images of Game cigarillo packs that varied in color and presence of the “natural leaf” descriptor. ResultsPurple packaging increased perceptions that the product tasted good, smelled nice, was flavored, and that a typical user was young. “Natural leaf” increased beliefs that the product contained high quality tobacco and that a typical user was trendy. When on grey packs, it increased favorable perceptions compared to when on brightly colored packs, including perceptions that the product tasted good, was fresh, that a typical user was trendy, and that the product was flavored. ConclusionsThis study is the first to present quantitative evidence on the impact of the “natural leaf” descriptor on cigarillo perceptions and intentions, extending work that has been done in the context of cigarettes. Utilizing highly realistic stimuli, findings demonstrate that both the term “natural leaf” and packaging color can increase favorable perceptions of cigarillos.

The importance of cigarillo product characteristics among young adult cigarillo users: Differences by demographics, cigarillo use and other tobacco/substance use behaviors.

IntroductionCigar products, including cigarillos, have increased in popularity in the U.S. and are disproportionately used by young adults. Cigarillo product characteristics can influence consumer perceptions and the appeal of these characteristics can vary by subgroup. The goal of this study was to examine a) product characteristics important to young adult cigarillo users and b) differences based on demographics and cigarillo and other tobacco/substance use behaviors.MethodsIn 2016, a convenience sample of 628 past-year cigarillo users rated the importance of the following cigarillo product characteristics when choosing a cigarillo to smoke tobacco: brand, tobacco filler quality, tobacco wrap quality, flavors, price, package graphic design, and number of cigars in the pack. Differences in mean importance by demographic, cigarillo use and other tobacco/substance use characteristics were analyzed using t-tests and ANOVA tests.ResultsThe most important cigarillo product characteristics were price, quality of tobacco wrap, and flavors. The least important was graphic design of packaging. There were differences in importance by demographics and/or cigar and other tobacco/substance use behaviors for all product characteristics. In particular, pack size was rated as more important among current cigarillo users, users of foil pouches (2–3 cigarillos) or cardboard/paper boxes or other packaging styles, and current users of cigarettes, blunts and marijuana. Price was rated as more important among Hispanic/Latino and lower income smokers, and current cigarette and blunt smokers.ConclusionsFindings suggest cigarillo users prioritize different product characteristics depending on their demographics or smoking behavior. Further research is needed to examine whether various cigar-related policies, such as those that ban flavors or set minimum pack sizes, could impact sub-populations of cigarillo users differently.