Marijuana Use Research Articles

Effects of Marijuana Use in Patients Undergoing Abdominal Free Flap Breast Reconstruction.

Marijuana use has been associated with vascular inflammation and clotting, resulting in endothelial damage and arteritis. As marijuana use rises in the United States, few studies have evaluated its impact on surgical outcomes and wound healing in free flap breast reconstruction. A retrospective cohort study of patients undergoing abdominal free flap breast reconstruction between 2016 and 2022 at a large metropolitan healthcare system was performed. Patient demographics, comorbidities, procedural details, and complications were analyzed. Minor complications were defined as skin or fat necrosis not requiring intervention, nipple loss, any wound requiring management in the clinic, hematoma, and seroma. Major complications were defined as reoperation, flap loss, cardiac or thromboembolic events, and hospital readmission. Active marijuana users were those with marijuana use within 12 weeks of surgery. In total, 168 patients underwent 276 deep inferior epigastric artery-based flaps for breast reconstruction. There were 21 active marijuana users. There were no significant differences in patient demographics, cancer treatment, or minor and major complications. However, there were higher rates of active nicotine use (P = 0.001) and anxiety/depression amongst active marijuana users (P = 0.002). Active users had higher rates of bilateral breast reconstruction (P = 0.029), but no significant differences in other operative details. Active marijuana use of unknown frequency may be safe in patients undergoing breast free flap reconstruction. Advising marijuana abstinence preoperatively may not alter patient outcomes. Further studies of greater sample size are needed to evaluate marijuana's impact on outcomes associated with breast reconstruction using free flap.

Universal School-Based Substance Use Prevention Using Technology-Supported Cooperative Learning.

Substance use in adolescence is a significant public health issue, particularly in early-to-mid adolescence, which represents a window of risk in the etiology of substance abuse and dependence. Substance use during this development period often results from affiliation with deviant peers, who model, facilitate, and reinforce use. Existing school-based substance use prevention programs have historically aimed to build adolescent knowledge regarding the dangers of substance use and/or enhance peer refusal skills. Research finds that these programs have had some success in reducing substance use, but meta-analyses report that average effect sizes are small. In a small one-year cluster randomized trial (12 middle and high schools; N = 813 students; ClinicalTrials.gov: NCT04478240), cooperative learning (CL) was implemented with the support of specialized technology and evaluated for its ability to reduce deviant peer affiliation and, in turn, reduce substance use. CL is a structured approach to small-group learning that provides at-risk youth with the opportunity to build friendships with more prosocial youth, interrupting the process of deviant peer clustering. Multi-level modeling revealed intervention effects for deviant peer affiliation and alcohol use across the sample, while tobacco use was significantly reduced among non-White students; intervention effects for marijuana use were only marginally significant. Effects for dosage were found for all outcomes, suggesting that every lesson taught had a significant impact. We conclude that CL, delivered with the aid of specialized technology, represents a viable option for universal substance use prevention. Future research should attempt to combine this approach with evidence-based prevention curricula.

Changes in substance use among adolescents before and during the COVID-19 pandemic in Guatemala.

Due to the COVID-19 pandemic, on March 16th, schools had to be closed in Guatemala and went to online teaching. We sought to analyze the change in substance use among high school students in Guatemala associated with the lockdown. Data from two surveys (2019, n=2096, and 2020, n=1606) of a student cohort in private high schools in Guatemala City was used. Logistic models for past 30-day cigarette, e-cigarette, marijuana, and alcohol (including binge drinking) were used, regressing these on survey wave, while adjusting for sex, scholastic performance, high school year of student, parental education, substance use, and household member tobacco use. Prevalence declined for smoking (10% to 3%, p<0.001), e-cigarette (31% to 14%, p<0.001), marijuana (4.3% to 1.9%, p<0.001), and alcohol use (47% to 38.5%, p<0.001), and binge drinking (24% to 13%, p<0.001). Adjusted models showed wave 2 associated with lower odds of using cigarettes (AOR=0.44, 95%CI=0.32-0.62), e-cigarettes (AOR=0.41, 95% CI=0.35-0.49, p<0.001), and binge drinking (AOR=0.73, 95%CI=0.59-0.89; p=0.002). Among Guatemalan adolescents, COVID-19 restrictions were associated with a significant decrease in smoking, e-cigarette use, and binge drinking.

Risk estimation in relation to anxiety and depression for low probability negative events

Foundational cognitive models propose that people with anxiety and depression show risk estimation bias, but most literature does not compute true risk estimation bias by comparing people's subjective risk estimates to their individualized reality (i.e., person-level objective risk). In a diverse community sample (N = 319), we calculated risk estimation bias by comparing people's subjective risk estimates for contracting COVID-19 to their individualized objective risk. Person-level objective risk was consistently low and did not differ across symptom levels, suggesting that for low probability negative events, people with greater symptoms show risk estimation bias that is driven by subjective risk estimates. Greater levels of anxiety, depression, and COVID-specific perseverative cognition separately predicted higher subjective risk estimates. In a model including COVID-specific perseverative cognition alongside anxiety and depression scores, the only significant predictor of subjective risk estimates was COVID-specific perseverative cognition, indicating that symptoms more closely tied to feared outcomes may more strongly influence risk estimation. Finally, subjective risk estimates predicted information-seeking behavior and eating when anxious, but did not significantly predict alcohol or marijuana use, drinking to cope, or information avoidance. Implications for clinical practitioners and future research are discussed.

Associations between simultaneous use of alcohol and cannabis and cannabis-related problems in 2014–2016: evidence from the Washington panel survey

BackgroundTo address the research question of how simultaneous users of alcohol and cannabis differ from concurrent users in risk of cannabis use problems after the recreational marijuana legalization in Washington State.MethodsWe used generalized estimating equations with a Poisson distribution to analyze the association between simultaneous use of alcohol and marijuana (SAM) and cannabis-related problems compared to concurrent use. The data is a longitudinal sample of drinkers and cannabis users (n = 257, 47% female) aged 18 years and older from Washington State in 2014–2016. We adjusted for survey weights to account for differential probability of selection and response rates. The primary outcome is the past-six-month CUDIT problem subscale (ranging from 0 to 28), which is the total score for seven CUDIT problem items, after excluding the three items that covered marijuana use frequency. Covariates include marijuana use frequency (daily/near daily use, regular use, or infrequent use), marijuana daily quantity, alcohol daily volume, panel survey cycle, medical marijuana recommendation, driving time to nearest marijuana outlet, age of marijuana use onset, and other demographics.ResultsAfter adjusting for covariates, we found that compared to concurrent use, SAM was significantly positively associated with CUDIT problem subscale (IRR = 1.68, 95% CI: 1.25–2.27, p < 0.001); daily/near daily use of marijuana was strongly significantly associated with CUDIT problem subscale compared with infrequent use (IRR = 5.1, 2.71–9.57, p < 0.001) or regular use (IRR = 3.05, 1.91–4.85, p < 0.001). Secondary analyses using CUDIT total score as the outcome also showed a significant positive association with SAM compared to concurrent use (IRR = 1.17, 1.02–1.34, p < 0.05).ConclusionsThis study highlighted the importance of SAM, in addition to cannabis use frequency for predicting cannabis-related problems.

Impact of deceased organ donor marijuana use on donor culture positivity and solid organ transplant recipient outcomes

With the increasing prevalence of marijuana use in the US, many deceased organ donors have a history of marijuana use, raising concerns about infectious risks to transplant recipients. We performed a multicenter retrospective cohort study in which exposed donors were those with recent marijuana use (in the prior 12 months) and unexposed donors were those with no recent marijuana use. Primary outcomes included the following: (1) positive donor cultures for bacteria or fungi, (2) recipient infection due to bacteria or fungi within 3 months posttransplant, and (3) recipient graft failure or death within 12 months posttransplant. Multivariable regression was used to evaluate the relationship between donor marijuana use and each outcome. A total of 658 recipients who received organs from 394 donors were included. Recent marijuana use was not associated with donor culture positivity (aOR: 0.84, 95% CI: 0.39-1.81, P = .65), recipient infection (aHR: 1.02, 95% CI: 0.76-1.38, P = .90), or recipient graft failure or death (aHR: 1.65, 95% CI: 0.90-3.02, P = .11). Our data suggest that organs from donors with a history of recent marijuana use do not pose significant infectious risks in the early posttransplant period.

Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana

ObjectiveMarijuana use is increasingly common among patients with chronic non-cancer pain (CNCP) and long-term opioid therapy (LTOT). We determined if lifetime recreational and medical marijuana use were associated with more frequent and higher dose prescription opioid use.DesignCross-sectionalSubjectsEligible patients (n=1,037), who had a new period of prescription opioid use lasting 30-90 days, were recruited from two midwestern health care systems to a study of long-term prescription opioid use and mental health outcomes. The present cross-sectional analyses uses baseline data from this on-going cohort study.MethodsPrimary exposures were participant reported lifetime recreational and medical marijuana use versus no lifetime marijuana use. Prescription opioid characteristics included daily versus non-daily opioid use and ≥50 morphine milligram equivalent (MME) dose per day vs. <50 MME. Multivariate, logistic regression models estimated the association between lifetime recreational and medical marijuana use vs. no use and odds of daily and higher dose prescription opioid use, before and after adjusting for confounding.ResultsThe sample was an average of 54.9 (SD±11.3) years of age, 57.3% identified as female gender, 75.2% identified as White, and 22.5% identified as Black race. Among all participants, 44.4% were never marijuana users, 21.3% were recreational only, 7.7% medical only and 26.6% were both recreational and medical marijuana users. After controlling for all confounders, lifetime recreational marijuana use, as compared to no use, was significantly associated with increased odds of daily prescription opioid use (OR=1.61; 95%CI:1.02-2.54). There was no association between lifetime recreational or medical marijuana use and daily opioid dose.ConclusionLifetime medical marijuana use is not linked to current opioid dose, but lifetime recreational use is associated with more than a 60% odds of being a daily prescription opioid user. Screening for lifetime recreational marijuana use may identify patients with chronic pain who are vulnerable to daily opioid use which increases risk for adverse opioid outcomes. Prospective data is needed to determine how marijuana use influences the course of LTOT and vice versa.

Reduced Diffusivity along Perivascular Spaces on MR Imaging Associated with Younger Age of First Use and Cognitive Impairment in Recreational Marijuana Users.

The impairment of the glymphatic system, a perivascular network crucial for brain waste clearance, has been linked to cognitive impairment, potentially attributed to the accumulation of brain waste. Although marijuana use has been associated with poorer cognitive performance, particularly in adolescents, its influence on the glymphatic system remains unexplored. This study evaluated the influence of the age of first marijuana use and the total number of lifetime uses on the glymphatic system, measured using the index of DTI along the perivascular space (DTI-ALPS). Furthermore, we explored the correlation between glymphatic clearance and cognitive performance among marijuana users. In this study, 125 individuals who reported using marijuana at least once in their lifetime (43 men; mean age, 28.60 [SD, 3.84] years) and 125 individuals with zero lifetime cannabis use (nonusers; 44 men; mean age, 28.82 [SD, 3.56] years) were assessed. ALPS indices of all study participants were calculated using 3T diffusion MR imaging data (b = 1000 s/mm2). After we adjusted for age, sex, education years, Pittsburgh Sleep Quality Index, alcohol use, tobacco use, and intracranial volume, our analysis using a univariate General Linear Model revealed no significant difference in the ALPS index among nonusers and marijuana users with different ages of first use or various frequencies of lifetime usage. However, in marijuana users, multiple linear regression analyses showed associations between a lower ALPS index and earlier age of first marijuana use (standardized β, -0.20; P = .041), lower accuracy in the working memory 0-back task (standardized β, 0.20; P = .042), and fewer correct responses in the Fluid Intelligence Test (standardized β, 0.19; P = .045). This study shows the potential use of DTI-ALPS as a noninvasive indirect indicator of the glymphatic clearance in young adults. Our findings show novel adverse effects of younger age at first use of marijuana on the glymphatic system function, which is associated with impaired working memory and fluid intelligence. Gaining insight into the alterations in glymphatic function following marijuana use could initiate novel strategies to reduce the risk of cognitive impairment.

The contribution of community service during the transition to adulthood to health in adulthood.

Prior studies have linked young people's community service to indicators of health, yet little research takes the long view by connecting youth's community service to health in the next decade of life. Using a lifespan developmental lens, this study examined community service over the transition to adulthood and uses change over time in community service to predict indicators of behavioral, physical, and psychological health at ages 35 and 40. Data were taken from Monitoring the Future U.S. national multi-cohort data spanning ages 18-40 in high school cohorts from 1976 to 1995 for age 40 (N = 4300) and 1976 to 2000 for age 35 (N = 5879). Models estimated a growth curve model for community service from ages 18 to 30 and found that the slope for community service was associated with alcohol use, binge drinking, marijuana use, healthy behaviors, and life satisfaction at ages 35 and 40, with cigarette use at age 35 only, and with self-esteem and depressive symptoms at age 40 only. Less decline in community service over the transition to adulthood was associated with lower substance use, more healthy behaviors, and higher psychological well-being in adulthood. This study contributes evidence that community service and health are linked across the lifespan and suggests the value of examining the long-term implications of developmental change across adolescence and the transition to adulthood.

Observational Analysis of the Influence of Medical Marijuana Use on Quality of Life in Patients

Plain Language SummaryThis research looks at the effects of medical marijuana on a patient’s quality of life. The study involved 103 participants from Pennsylvania who were using medical marijuana for various health conditions. They answered four surveys over 90 days, reporting on their experiences with marijuana and their well-being. The results showed that many participants experienced improvements in their physical and social functioning, energy levels, and emotional well-being within the first 30–60 days of using medical marijuana. Interestingly, the study found that how often someone used medical marijuana could affect their overall health. Those who used it once a day tended to have better general health scores compared to those who used it more frequently. Alcohol use seemed to have an impact too. People who used both alcohol and medical marijuana had lower energy levels and emotional well-being, suggesting that the combination might not be ideal. The study also looked at how people consumed medical marijuana, whether by inhaling it or using it as a flower, and found differences in THC consumption and emotional well-being. However, the study had some limitations, like relying on self-reported data and having a small sample size. Still, it provides valuable insights into how medical marijuana can affect people’s lives and highlights the need for personalized approaches to its use.

Understanding marijuana use initiation vs. frequency of use on risk for hallucinogen use: testing for mediating mechanisms underlying the gateway hypothesis

ABSTRACT The gateway hypothesis posits that marijuana use initiation may lead to neurological changes predisposing individuals to escalation to harder drug use later on. However, there is limited research, which has examined marijuana as a gateway drug leading to hallucinogen use and examination of mechanisms linking the two drug use behaviors. This study examined marijuana use as a predictor of hallucinogen use and tested for mediation via social, affective, and cognitive mechanisms. The Pathways to Desistance data were analyzed. This is a longitudinal dataset comprised a sample of 1,354 justice-involved youth. Path analyses were used to test for direct and indirect effects of interest. Findings indicated that elevated marijuana use frequency prior to baseline was a significant predictor of increased log-odds of later hallucinogen use. None of sensation-seeking, impulse control, nor deviant peer association significantly mediated this relationship. Ever having used marijuana prior to baseline was not significantly related to later hallucinogen use risk and no mediation effects were identified for this independent variable. Results indicated that higher frequency marijuana use may result in gateway effects for later hallucinogen use. Both marijuana use variables were also statistically significant predictors of increased sensation-seeking, diminished impulse control, and greater deviant peer association.

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.

The Effects of Previous Experiences of Healthcare Discrimination on HIV Intervention Outcomes.

Although several healthcare interventions have been developed to address HIV among young Black/African American men who have sex with men (YBMSM), the HIV epidemic in the United States continues to disproportionately burden this population. The current study examines previous healthcare discrimination and how it affects HIV intervention delivery. One hundred seventy-two YBMSM participated in the Peer Promotion of Wellness and Enhanced Linkage to Resources (PPOWER) project, which used a short, multi-faceted, community-level intervention based on Community Peers Reaching Out and Modeling Intervention Strategies (Community PROMISE). Data were collected at baseline, a 45-day follow up, and a 90-day follow up. Generalized Estimating Equations (GEE) were used to examine the effects of previous healthcare discrimination on outcomes related to HIV testing, alcohol and drug use, and sexual behaviors. Previous healthcare discrimination was found to moderate the relationship between time and intentions to test for HIV, perceptions of sexual risk, problem marijuana use, and problem other drug use, such that those who had experienced more healthcare discrimination showed greater improvements over time compared to those who had experienced less healthcare discrimination. The results of the current study suggest that a community-level peer intervention, in combination with a component to promote cultural competency and address prior experiences of discrimination in healthcare settings, may be highly effective for people who have experienced a barrier in their continuum of care as a result of racial discrimination.

Association between nucleus accumbens volume and future tobacco and Marijuana use in early adolescence

IntroductionNucleus accumbens (NAc), a crucial component of the brain's reward network, plays a role in reward-related behaviors like substance use. However, limited knowledge exists about sex differences in the predictive power of NAc volume for the initiation of tobacco and marijuana use among children transitioning into early and middle adolescence. Our aim was to compare the predictive utility of NAc volume for adolescents' initiation of tobacco and marijuana use over a three-year period. MethodsData from the Adolescent Brain Cognitive Development study (ABCD), a longitudinal study of pre-adolescents aged 9–10 years, were utilized. The study included 9–10 pre-adolescents (n = 11,795) who were followed for 36 months. Cox regression was employed to examine whether NAc volume predicts subsequent initiation of tobacco and marijuana during the follow-up period. Covariates included age, race/ethnicity, puberty, parental composition, parental education, and area-level median income. Sex was the moderator. ResultsWhile NAc volume predicted future substance use, this association varied based on substance type (tobacco vs. marijuana), sex (male vs. female), and laterality (brain hemisphere). A larger right NAc volume (mm^3) inversely associated with subsequent tobacco use initiation for female youth (HR = 0.998; 95% CI: 0.996–1.000), while it showed no association for male youth (p = 0.385). Larger left NAc volume (mm^3) did not associate with subsequent tobacco use initiation for female youth (p = 0.108) but showed a positive association for male youth (HR = 1.002; 95% CI: 1.001–1.003). NAc volume did not show an association with subsequent marijuana use initiation for either sex. ConclusionsThe predictive impact of right and left NAc volumes on future tobacco or marijuana use may differ for male and female adolescents, suggesting that the salience of NAcc in regulating the reward system is influenced by sex, substance type, and brain hemisphere.

Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use.

Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic. Data was sourced from a nationally representative sample of U.S. 9th-12th students (n = 3241) who completed the CDC's 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson's chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents. This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05). Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.

An ecological examination of early adolescent e-cigarette use: A machine learning approach to understanding a health epidemic.

E-cigarette use among adolescents is a national health epidemic spreading faster than researchers can amass evidence for risk and protective factors and long-term consequences associated with use. New technologies, such as machine learning, may assist prevention programs in identifying at risk youth and potential targets for intervention before adolescents enter developmental periods where e-cigarette use escalates. The present study utilized machine learning algorithms to explore a wide array of individual and socioecological variables in relation to patterns of lifetime e-cigarette use during early adolescence (i.e., exclusive, or with tobacco cigarettes). Extant data was used from 14,346 middle school students (Mage = 12.5, SD = 1.1; 6th and 8th grades) who participated in the Utah Prevention Needs Assessment. Students self-reported their substance use behaviors and related risk and protective factors. Machine learning algorithms examined 112 individual and socioecological factors as potential classifiers of lifetime e-cigarette use outcomes. The elastic net algorithm achieved outstanding classification for lifetime exclusive (AUC = .926) and dual use (AUC = .944) on a validation test set. Six high value classifiers were identified that varied in importance by outcome: Lifetime alcohol or marijuana use, perception of e-cigarette availability and risk, school suspension(s), and perceived risk of smoking marijuana regularly. Specific classifiers were important for lifetime exclusive (parent's attitudes regarding student vaping, best friend[s] tried alcohol or marijuana) and dual use (best friend[s] smoked cigarettes, lifetime inhalant use). Our findings provide specific targets for the adaptation of existing substance use prevention programs to address early adolescent e-cigarette use.

A277 SYNOPTIC REPORTING IN INFLAMMATORY BOWEL DISEASE

Abstract Background Inflammatory bowel disease is a chronic medical condition requiring regular clinical assessment and evaluation. Specialist involvement often occurs regularly to determine disease activity, progression, and consider therapeutic changes for disease control. The rapid advancement of scientific evidence and addition of novel medications have combined to make IBD care increasingly complex. Moreover, evolving standards of care have led to an increased burden of documentation. Synoptic reporting is a novel documentation method that standardizes the input of clinical data and generates comprehensive reports based on that data. It has yet to be widely accepted throughout medicine, but is commonly used in surgery and diagnostics. Advancements within IBD have amplified the need for meticulous reporting of patients' previous therapies and preventative health care: areas synoptic reporting excels in. Aims We analyzed for the presence of disease-related, treatment-based, and preventative health elements in consultation reports across standard of care and synoptic reporting methods. Methods We identified consecutive IBD consultations from Jan 1 2023 onwards for participating gastroenterologists, up to 10 reports for most clinicians, if available. Each report was labeled synoptic or standard reporting. Manual review was used to determine whether each element was present and coded in binary fashion, except for female reproductive health, which was absent, present, or N/A. For analysis, data was partitioned based on whether synoptic reporting was used, with the percentage of reports including each element being calculated based on this data. Comparisons for inclusion were then completed between the groups. Results We identified a total of 62 consultations with 19 utilizing synoptic reporting. Reporting methods fared similarly for age, sex, year of diagnosis, and summary of course. Synoptic reporting performed significantly better in reporting vaccinations, marijuana use, as well as B12, vitamin D, and ferritin levels. Differences exceeding 20% were found in the reporting of EIMs, CRC screening, and female reproductive health, though these were not at a level of statistical significance in this preliminary study. Conclusions We found through our analysis that synoptic reporting is a simple tool that creates reports with a greater inclusion of elements important for disease management and health maintenance. Relaying this information back to patients' practitioners can theoretically improve outcomes through better preventative care, active monitoring, and awareness of patients’ disease history by future consultants. Future research will focus on expanding the study population as well as gaining further insight into the utility of synoptic reporting in improving clinical communication and disease management. Funding Agencies None

A290 ILLICIT SUBSTANCE USE AND ITS IMPACT ON ALCOHOL-ASSOCIATED HEPATITIS IN LATIN AMERICA

Abstract Background Concomitant substance use is frequent among patients with alcohol use disorder (AUD), but its impact on alcohol-associated hepatitis (AH) is unknown. Aims To assess the prevalence and impact of substance use in patients hospitalized for AH in a multinational cohort in Latin America. Methods Multicenter prospective cohort study including patients with AH between 2015-2022. We recorded sociodemographic and clinical information, including data on alcohol and drug use. We assessed the impact of substance consumption using competing-risk models. Results We included 405 patients from 24 centers in 8 countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru). The mean age was 49.6±12.2 years, 345 (85.4%) were men, 210 (57.5%) had a previous diagnosis of cirrhosis, and the median MELD at diagnosis was 25 [20–31] points. Around 74% of patients fulfilled ACLF criteria (ACLF-1: 11.1%, ACLF-2: 11.6%, ACLF-3: 49.6%). A total of 82 (20.3%) reported active substance use, while 22 (5.4%) were former substance users. The most common drugs used at admission were marijuana (11.1%), cocaine (10.4%), methamphetamine (4.4%), and heroin (0.5%). Out of the total, 35.7% died, and only 2.5% underwent liver transplantation during follow-up. Active substance use was higher in younger patients (users 44.4±16.1 years vs. non-users 51.0±10.6 years; pampersand:003C0.001) and in men compared to women (22.0% vs 10.2%, p=0.036). In a competing-risk model adjusted by age, sex, history of cirrhosis, MELD, and ACLF grade, active substance use was independently associated with mortality (subdistribution Hazard Ratio [sHR] 1.53, 95%CI:1.01–2.32; p=0.043). Also, active cocaine (sHR 1.69, 95%CI:1.07–2.70; p=0.025) and marijuana use (sHR 1.83, 95%CI:1.11–3.04; p=0.018) were independently associated with mortality in adjusted competing-risk analyses. Conclusions Active drug use is common in AH patients. Marijuana and cocaine were the most frequent substances and were independently associated with increased mortality. Substance use should be screened in patients with AUD, and integrated management with addiction specialists and psychiatrists could impact survival in AH. Funding Agencies None

Disentangling the Contexts of Adolescent Substance Use: An Examination of Gender Differences

Previous studies of adolescent substance use have noted how adolescent substance use is influenced by both protective and risk factors. Additionally, researchers have also noted the gradual convergence of female and male substance use, resulting in similar substance use patterns across the two. Using data from a nationally representative sample of high school seniors, this study examines the distinct effects of contextual factors upon the substance use by adolescent females and males. While both girls and boys do report similar patterns of substance use, the analyses demonstrate that peer, family, school, and work contexts affect females’ and males’ substance use in different manners. While peers readily affect drinking behaviors of each sex, peer influence yields significant associations with females’ vaping, but not males’. Among males, family contextual factors are associated with both vaping and marijuana use, while females’ vaping and marijuana use are more substantially affected by school and work contexts. The findings of this study, along with the implications thereof, are framed within the ecodevelopmental perspective.

What is Common Becomes Normal; Black-White Variation in the Effects of Adversities on Subsequent Initiation of Tobacco and Marijuana During Transitioning into Adolescence.

While adversities across domains of finance, race, family, and life may operate as risk factors for initiation of substance use in adolescents, the influence of these factors may vary across racial groups of youth. Unfortunately, the existing knowledge is minimal about racial differences in the types of adversities that may increase the risk of subsequent substance use initiation during the transition into adolescence. To compare racial groups for the effects of adversities across domains of finance, race, family, and life on subsequent substance use initiation among pre-adolescents transitioning into adolescence. In this longitudinal study, we analyzed data from 6003 non-Latino White and 1562 non-Latino African American 9-10-year-old children transitioning into adolescence. Data came from the Adolescent Brain Cognitive Development (ABCD) study. Participants were followed for up to thirty-six months as they transitioned to adolescence. The independent variables were adversities related to the domains of finance, race, family, and life. The primary outcomes were time to first tobacco or marijuana use. Age, puberty, and gender were confounders. Cox regression models were used for data analysis. For White youth, tobacco use was under influence of having two parents in the household (HR = .611; 95% CI = .419-.891), parental education (HR = .900; 95% CI = .833-.972), household income (HR = .899; 95% CI = .817-.990), racial stress (HR = 1.569; 95% CI = 1.206-2.039), and life stress (HR =1.098 ; 95% CI = 1.024-1.178) and marijuana use was under influence of neighborhood income (HR = .576; 95% CI = .332-.999) and financial stress (HR =4.273; 95% CI = 1.280-17.422). No adverse condition predicted tobacco or marijuana use of African American youth. The effects of adversities on substance use depend on race. While various types of adversities tend to increase subsequent initiation of tobacco and marijuana, such factors may be less influential for African American adolescents, who experience more of such adversities. What is common may become normal.