Odds Of Marijuana Use Research Articles

Shared Households in the U.S.: A New Perspective on Family Structure and Adolescent Substance Use

Research on the family structure–adolescent substance use association has largely neglected shared households—those in which non-parent adult figures live in the home—even though the number of these households has increased substantially in the U.S. Using data from the state of Florida, we assessed the association between several shared household structures and adolescent substance use, along with whether their associations were mediated by parent-child relationship quality or parental monitoring/discipline. Adolescents in shared family households, especially when a parent did not reside in the home, manifested a higher odds of marijuana use and vaping than those in two-parent households. Monitoring/discipline partly mediated the household structure effects, suggesting that engaging in high levels of monitoring can lower the risk of substance use even in families without two parents.

Associations between childbirth, gang exposure and substance use among young women in Cape Town, South Africa

The prevalence and influence of gangs on adolescents and young adults remain a concern in Western Cape, South Africa—particularly as they have one of the largest gang presence. While less attention has been focused on young women, there is a need to elucidate the relationship between gang exposure and health behaviors, such substance use, in addition to understanding whether becoming a caregiver impacts this relationship. This study uses baseline data from 496 participants enrolled in a NIDA-funded R01 trial that recruited young women aged 16 to 19 who were out of school and reported recent alcohol or other drug use and sexual risk behavior. At enrollment, a risk behavior survey was administered, and urine drug screening was conducted. Multivariable logistic regression analyses were conducted to examine baseline associations between childbirth, a gang exposure index based on eight items, and positive drug screens of the most prevalent drugs in the Western Cape (marijuana, methaqualone, and methamphetamine). At enrollment, approximately 39% of the sample had a positive urine screen for marijuana, 17% for methaqualone, and 11% for methamphetamine. Additionally, 28% had ever given birth. While only 6% reported ever being a member of a gang, most reported exposure to gangs through their physical and social environments. For all three drugs, gang exposure was associated with statistically significantly higher odds of a positive screen. Every one-point increase in the gang exposure index was associated with a 31% increase in the odds of a positive marijuana screen (p < .001), a 26% increase for methaqualone (p = 0.005) and a 37% increase in the odds of a positive methamphetamine screen (p < .001). Ever given birth was associated with lower odds of marijuana use (adjusted odds ratio [AOR]: 0.63; 95% CI: 0.42–0.96), but it was not associated with methaqualone or methamphetamine use. The findings suggest that exposure to gangs through young women’s social and physical environment is positively associated with drug use. Childbirth was also protective for marijuana use, indicating there may be something unique about this type of drug, such as one’s ability to more easily stop use. Although very few young women reported gang membership, a majority reported some exposure, indicating the need to address how pervasive this exposure is and the potential risk.

Trends in marijuana and heavy alcohol use by cigarette smoking status among US adults: An analysis of the 2002-2019 NSDUH

BackgroundPolysubstance use is associated with adverse health outcomes, yet little research has measured changes in polysubstance use. We aimed to 1) estimate trends in marijuana and heavy alcohol use by cigarette smoking and demographic subgroups, and 2) examine patient factors associated with concurrent use among adults who were smoking. MethodsWe conducted a repeated cross-sectional analysis of 687,225 non-institutionalized US adults ≥18 years from the 2002–2019 National Survey on Drug Use and Health. Participants were stratified into current, former, and never smoking groups. Main outcomes were prevalence of heavy alcohol use, marijuana use, and concurrent use of both substances. ResultsFrom 2002–2019, heavy alcohol use declined from 7.8 % to 6.4 %, marijuana use rose from 6.0 % to 11.8 %, and concurrent use of alcohol and marijuana remained stable. Among adults who were smoking from 2005 to 2019, higher education was associated with higher odds of heavy alcohol use, while older ages, female gender, non-White race/ethnicity, and government-provided health insurance were associated with lower odds. The odds of marijuana use decreased in females, older ages, and higher incomes while increasing in people with poorer health status, higher education, government-provided or no health insurance, and serious mental illness. Compared to White adults who were smoking, Black counterparts had higher odds of marijuana use (OR=1.23; 95 %CI: 1.15–1.29), while Hispanic (OR=0.68; 95 %CI: 0.63–0.72) and other racial/ethnic identities (OR=0.83; 95 %CI: 0.77–0.90) had lower odds. ConclusionsOur study suggests marijuana use might not be sensitive to changes in the use of tobacco and alcohol.

646: BURDEN OF SUBSTANCE USE AMONG U.S. POPULATION WITH CHILDHOOD AND ADULT-ONSET ASTHMA

Introduction: Asthma is the most common chronic childhood disease. Substance use is associated with increasing severity of asthma symptoms and a major risk factor for status asthmaticus or asthma-related death. In the last decade, there is no nationwide literature showing prevalence of various substance use among asthmatics. Aim of this study is to identify the burden of substance use in US population with childhood onset asthma (COA) and adult-onset asthma (AOA) Methods: We conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. AOA and COA assessed using questionnaire MCQ010 and MCQ025. Drug use variables were summarized and univariate analysis was performed using Mann Whitney test and Chi-square test to determine association between asthma and drug use. Mix-effect multivariate survey logistic regression analysis was performed to identify predictors of AOA and COA. Results: Out of a total of 402,167 participants, prevalence of COA was 10.51% (42,275) and AOA was 4.79% (19,245). Prevalence of methamphetamine use (42.03% vs 41.99% vs 39.34%, p<.0001), was higher in AOA, than COA and no asthma. Smoking (21.41% vs 18.12% vs 16.09%, p<.0001), high alcohol intake (50.98% vs 44.02% vs 47.33%, p<.0001), cocaine use (97.14% vs 93.53% vs 95.30%, p<.0001), marijuana use (62.22% vs 55.42% vs 51.67%, p<.0001) and heroin use (18.89% vs 18.74% vs 14.50%, p<.0001) were more prevalent in COA than AOA and no asthma. In regression analysis, AOA was associated with higher prevalence odds of marijuana use (aOR 2.53, 95%CI 2.53-2.54, p<.0001) and heroin use (1.82, 1.82-1.83, p<.0001) whereas COA was associated with higher prevalence odds of smoking (1.19, 1.19-1.19, p<.0001), alcohol abuse (1.06, 1.06-1.06, p<.0001), cocaine use (67.99, 67.67-68.31, p<.0001) and methamphetamine use (1.67, 1.67-1.67, p<.0001). Conclusions: Substance use is common in childhood and adult asthmatics. Given the high risk of association between asthma and substance use, policy makers and community programs should be built in a way to help improve the compliance in asthma care and decrease rates of substance use disorders in this population. Our study was limited with recall bias, absence of causality, absence of severity and follow up of asthma, and quantification of substance use.

Concurrent Hookah (Waterpipe) and Substance Use among Sexual Minority Adults in the United States: Findings from the Population Assessment of Tobacco and Health Study

Despite higher rates of hookah (i.e., waterpipe) tobacco smoking among sexual minority (SM) adults, little is known on concurrent substance use, including alcohol or other drugs, among SM hookah smokers as compared to their heterosexual counterparts. Utilizing data from the Population Assessment of Tobacco and Health Study (2013–2015), weighted analyses compared concurrent substance use among current SM adult hookah smokers versus heterosexuals. Findings revealed that SM hookah smokers had a higher prevalence of concurrent alcohol, marijuana and other drug use, including stimulants and sedatives, than heterosexuals (p &lt; 0.05). As compared to heterosexuals, SM women and young adult (18–24 years old) smokers had higher odds of marijuana use (Women: Wave 1 odds ratio (OR), 2.16, [95% CI = 1.30–3.60]; Wave 2 OR, 2.67 [95% CI = 1.36–5.25]); young adults: Wave 1 OR, 1.55, [95% CI = 0.99–2.43]; Wave 2 OR, 2.19, [95% CI = 1.22–3.94]). In this population-based, representative sample of U.S. adults, concurrent hookah smoking and substance use differed between SM and heterosexuals. Sexual minority women and young adult hookah tobacco smokers were at increased risk for concurrent marijuana use, increasing the risk for health-related consequences in this group vulnerable to tobacco and substance use.

Assessing the prevalence and risk factors of marijuana use in adults with disabilities

BackgroundPublic support for the legalization of marijuana (cannabis) for medical or recreational use by adults has grown rapidly over the past two decades. Given the growing prevalence and concerns about potential harms, a better understanding is needed of disparities in marijuana use among adults by disability status. MethodsUsing 2015–2019 data from the National Survey on Drug Use and Health (NSDUH), we obtained a national sample of 195,130 working-age (18–64 year) adults. Descriptive and multivariable analyses were conducted to assess the prevalence and risk factors associated with marijuana use among adults by disability status and type. ResultsWe found the prevalence of marijuana use was higher among adults with disabilities (16.6% vs 10.9%) compared to those without disabilities, and this disparity widened from 2015 to 2019. Furthermore, the odds of marijuana use varied by disability type. Specifically, adults with vision disability only (OR 1.28; 95% CI 1.14–1.44), cognitive disability only (OR 1.24; 95% CI 1.13–1.35), and those with multiple disabilities (OR 1.22; 95% CI 1.11–1.34) had higher odds of marijuana use compared to adults without any disability. ConclusionsAdults with disabilities have a higher prevalence of marijuana use compared to those without disabilities. Living in a state with legalized medical marijuana also increased the odds of marijuana use. These findings can help to inform policy and public health surveillance of marijuana use in the U.S. Further studies are needed to monitor the rising prevalence of marijuana use and examine how intensity of marijuana use affects health outcomes in adults with and without disabilities.

Abstract 11890: Association Between State Marijuana Legalization Policies and Marijuana Use Reasoning Among Adults With Cardiovascular Disease, 2017-2020

Introduction: The rapid adoption of marijuana legalization policies in states has forced clinicians to evaluate the health effects of marijuana due to increased availability; however, little is known about changes in marijuana use among adults with CVD after legalization (medical, recreational, dual) in the US. Methods: Using a sample of 298,651 adults from 2017-2020 survey data from the Behavioral Risk Factor and Surveillance System (BRFSS), we estimated the prevalence of recent (past-month) marijuana use in eleven states among adults with and without CVD by marijuana legalization (ML) status of a state. Multivariate logistic regression models were conducted to examine factors associated with marijuana use by self-reported CVD status. Results: Recent marijuana use was higher among adults with CVD in ML states compared to non-ML states (10.7% vs. 6.4%). The mean days of marijuana use in the CVD cohort in ML-states were 17.2±15.5, and 16.1±13.7 days in non-ML-states. Medical use among CVD adults decreased from 57.4% in 2017 to 47% in 2020. In contrast, dual-use increased from 14.4% in 2017 to 30.9% in 2020. However, trends were different in ML vs non-ML states(Figure). Adults with CVD in ML-states had higher (OR=1.75, p&lt;.001), while in non-ML states had lower (OR=0.81, p&lt;0.05), odds of marijuana use compared to those without CVD in non-ML states (reference group). Among CVD adults who used marijuana, odds of medical use were 85% higher in ML-states (OR=1.85, p&lt;0.05), while more than two-fold for recreational (OR=2.10, p&lt;0.05) and 2.5-fold for dual-use (OR=2.53, p&lt;0.05), than non-ML states. Conclusions: We found a higher prevalence and likelihood of marijuana use in adults with CVD living in legalized vs. non-legalized states, which was not unexpected. However, marginal decline in use for medical reasons in ML states with the increasing prevalence of recreational and dual-use in the CVD population requires greater attention to the risk/benefits of individual preferences.

Residential greenness and substance use among youth and young adults: Associations with alcohol, tobacco, and marijuana use

IntroductionResearch has identified positive associations between green space and physical and mental health outcomes. Substance use outcomes, however, have received considerably less attention. This study investigates the association between residential greenness and substance use through an analysis of alcohol, tobacco, and marijuana use among youth and young adults. MethodsThis study utilized three waves (2016–2018) of the Canadian Community Health Survey (CCHS), as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multinomial logistic regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 youth and young adults (15–25 years). ResultsResidential greenness was not associated with alcohol use in general but was associated with lower odds of frequent binge drinking. Residential greenness was also associated with lower odds of tobacco use and greater odds of marijuana use. ConclusionThis study provides evidence that residential greenness is associated with patterns of substance use. The strength and direction of association, however, is highly contingent upon the substance under investigation. Living in greener neighborhoods may confer certain benefits to substance use and abuse among youth and young adults.

Prevalence of marijuana use in pregnant women with concurrent opioid use disorder or alcohol use in pregnancy

BackgroundA quarter of pregnant women use alcohol, 6.5/1000 deliveries are affected by opioid use disorder (OUD), and the prevalence of cannabis use in pregnant women is increasing. However, marijuana co-exposure in polysubstance-using women is not well described.MethodsThe well-characterized ENRICH-1 cohort (n = 251), which focused on the effects of two primary exposures of interest—opioids and alcohol, was used to (1) estimate the prevalence/frequency of marijuana use in those with OUD and/or alcohol use, and (2) examined correlates of marijuana use. Participants were classified into an OUD group (n = 125), Alcohol group (n = 69), and concurrent OUD and Alcohol (OUD + Alcohol) group (n = 57). Self-report and biomarkers ascertained substance use. Multivariable logistic regression identified correlates of marijuana use.ResultsThe prevalence of any marijuana use in pregnancy was 43.2%, 52.6%, and 46.4% in the OUD, OUD + Alcohol, and Alcohol groups, respectively. Correspondingly, weekly or daily use was reported by 19.4%, 21.0%, and 24.6% of participants. In the OUD and OUD + Alcohol groups, the proportion of women using marijuana was significantly higher in those taking buprenorphine (45.8% and 58.3%, respectively) compared to women using methadone (37.5% and 42.9%, respectively). Mean maternal age was lower in women who used marijuana in all three groups compared to non-marijuana users. Independent correlates of marijuana use (controlling for group, race/ethnicity, education, and smoking) were maternal age (adjusted Odds Ratio (aOR) per 5-year increment 0.61; (95% CI 0.47, 0.79)), and polysubstance use (aOR 2.02; 95% CI 1.11, 3.67). There was a significant interaction between partnership status and group: among women who were not in a partnership, those in the OUD and OUD + Alcohol groups had lower odds of marijuana use relative to the Alcohol group. For women in the Alcohol group, partnered women had lower odds of marijuana use than un-partnered women (aOR 0.12; 95% CI: 0.02, 0.68).ConclusionsResults indicate a relatively high prevalence and frequency of marijuana use in pregnant women being treated for OUD and/or women consuming alcohol while pregnant. These results highlight the need for ongoing risk reduction strategies addressing marijuana use for pregnant women receiving OUD treatment and those with alcohol exposure.

Caregivers' Cannabis Use: Does Burden Lead to Blunts?

Research on risky health behaviors among caregivers is limited. In this paper, we examine the association between informal caregiving and marijuana use and whether this association varies by age. Using data from Behavioral Risk Factor Surveillance System (2016-2019), a multivariable logistic regression model compared marijuana use in “caregivers” and “expectant caregivers.” We stratified the analyses by age and also assessed the association between caregiving intensity and marijuana use. Among younger individuals (18-49 years), informal caregiving was associated with higher odds of marijuana use. In this group, higher prevalence of marijuana use was positively associated with care intensity. There was no detectable association between caregiving and marijuana use among older individuals (50 years or older). Health behaviors among caregivers differ by age. Combined exposure to informal caregiving and marijuana in young adulthood may lead to adverse long-term health consequences. Immediate effects of marijuana use may negatively influence care recipient outcomes.

Is Adversity in Childhood Linked to Marijuana Use in Adulthood?: Findings from the Behavioral Risk Factor Surveillance System

Background: Adverse childhood experiences (ACEs) are potentially traumatic events, which can have long-term, negative consequences. Few studies have examined ACEs’ relationship to marijuana use. Objectives: We examined the association between ACEs and past-month marijuana use among adults and the pathways between childhood adversity and marijuana use. Methods: Adults from five states (n = 22,991) who responded to the 2019 Behavioral Risk Factors Surveillance System were included. We examined the prevalence of ACEs and marijuana use. We employed generalized structural equation modeling to assess the relationship between ACEs and marijuana use and the role of depression and poor mental and physical health as possible mediators. Results: Overall, 65.0% of the population reported 1+ ACE. Heavy marijuana use and past-month marijuana use prevalence rates were 10.3% and 5.0%, respectively. We found mediation effects for depression and poor mental health but not poor physical health. The number of ACEs was associated with a statistically significant increase in any past-month marijuana use—indirect effects ranged from 1.0 (95% CI, 1.0–1.0) to 1.4 (95% CI, 1.2–1.7), direct effects ranged from 1.1 (95% CI, 07–1.7) to 5.3 (95% CI 3.2–8.8), and total effects ranged from 1.1 (95% CI, 0.7–1.7) to 5.9 (95% CI, 3.6–9.8). Women, married persons, and middle aged and older adults had a lower odds of marijuana use. Reporting at least one HIV risk behavior was associated with an increased odds of marijuana use. Conclusion: ACE exposure was positively associated with marijuana use. Depression and poor mental health separately mediated this relationship.

Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

BackgroundFasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020.MethodsData from four academic survey years (2016–2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates.ResultsAny fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy).ConclusionsThe results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.

Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a feasibility randomized controlled trial

Alcohol and other drug (AOD) use among American Indians and Alaska Natives (AI/ANs) is a significant health issue in the United States. However, few evidence-based substance use interventions that utilize AI/AN traditional practices, such as drumming, exist. The current study is a feasibility randomized controlled trial (RCT) analyzing the potential benefits of DARTNA (Drum-Assisted Recovery Therapy for Native Americans) among 63 AI/AN adults seeking substance use treatment within an urban area in southern California. We compared DARTNA participants to usual care plus, which involved an integrated multimedia health educational program and usual care from providers for AOD use. At end of treatment, DARTNA participants reported significantly lower cognitive impairment and lower counts of physical ailments. Given that this was a feasibility trial, we also used Cohen's d = 0.20 or odds ratio = 2 or 0.5 to determine clinical significance. At end of treatment, we found promising benefits for DARTNA participants related to better physical health, fewer drinks per day, and lower odds of marijuana use in the past 30 days compared to the control group. Using these criteria, at 3-month follow-up, DARTNA participants reported less adoption of 12-step principles, less cognitive impairment, and lower anxiety with relationships. However, DARTNA participants reported more drinks per day and more cigarettes compared to the control group. Overall, this study demonstrates feasibility of conducting an RCT with AI/AN people in urban settings and highlights how a substance use treatment intervention utilizing drumming may help to meet the diverse needs of AI/AN people seeking substance use treatment.

Investigating differential protective effects of marriage on substance use by sexual identity status.

Research suggests that marriage is protective against substance use. However, few studies have examined whether this protective effect differs for sexual minorities, a population at increased risk for substance use. Using data from four waves of the cross-sectional U.S. National Alcohol Survey (NAS; 2000, 2005, 2010, and 2015), we investigated whether the protective effects of marriage varied by sexual identity. Sex-stratified logistic regression models were used to examine independent and interactive effects of current marital status (being married vs. not) and sexual minority status (lesbian/gay/bisexual vs. heterosexual) on high-intensity drinking, alcohol use disorder, and marijuana use in the past year. Among both women and men, sexual minority status was generally associated with higher odds of these outcomes and marriage was consistently associated with lower odds. Differential effects of marriage by sexual identity with respect to marijuana use were found only among men; marriage was significantly associated with decreased odds of marijuana use among heterosexual men but increased odds among sexual minority men. Marriage may be less consistently protective against hazardous drinking and marijuana use among sexual minorities than heterosexuals. Findings underscore the importance of both quantitative and qualitative studies designed to better understand disparities in substance use across both sexual identity and relationship statuses.

Food Insecurity, Sexual Risk, and Substance Use in Young Adults

PurposeThe aim of the study was to determine the association between food insecurity, sexual risk behaviors, sexually transmitted infections (STIs), and substance use in a nationally representative sample of U.S. young adults. MethodsCross-sectional nationally representative data of U.S. young adults aged 24–32 years from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed. Multiple logistic and linear regression analyses were conducted with food insecurity as the independent variable and self-reported STIs, sexual risk behaviors, and substance use as the dependent variables, adjusting for covariates and stratifying by sex. ResultsOf the 14,786 young adults in the sample, 14% of young women and 9% of young men were food insecure. Food-insecure young women had greater odds of any STI, HIV, chlamydia, exchanging sex for money, and multiple concurrent sex partners in the past 12 months compared to young women reporting food security, adjusting for covariates. Food insecurity was associated with higher odds of any STI, chlamydia, and exchanging sex for money among young men who identify as gay or bisexual, but not in the general population of young men. Food insecurity was associated with greater odds of marijuana use, methamphetamine use, and nonmedical use of prescription opioids, sedatives, and stimulants in both young men and women. ConclusionsFood insecurity is associated with risk behaviors and self-reported STIs, including HIV, in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate.

0359 The Moderating Role of Race in the Association of Adolescent Sleep Duration and Marijuana Use

Abstract Introduction Insufficient sleep and marijuana use during adolescence vary by race and are associated with poor outcomes in various domains. Sleep difficulties predict drug-related problems, but not all adolescents with insufficient sleep go on to use substances. We examined whether race/ethnicity moderates the association of sleep duration and marijuana use among Black/African-American and White adolescents using a countywide probability-based survey of adolescents. Methods Using cross-sectional data (n=1447), logistic regression examined whether race moderated the association of adolescent sleep duration and recent marijuana use alone and after controlling for covariates in both weighted and unweighted models. Results Hours of sleep was significantly negatively associated with recent marijuana use. Black/African-American youth in our sample had up to a 60% increased odds of marijuana use in the past 30 days compared to White youth, and they reported significantly shorter sleep duration than their White peers. In weighted models, Black/African-American youth had an increased probability of marijuana use with fewer hours of sleep as compared to White youth, even after accounting for covariates. Conclusion In our countywide survey of adolescents, we found racial differences in the association of sleep duration and marijuana use. Future work should replicate our analyses with a longitudinal sample of adolescents to better evaluate the direction of these effects. Future efforts should also focus on identifying contextual factors that may explain racial differences in the sleep duration—substance use relationship, as well as developing strategies to reduce disparities in this relationship. Support The Heinz Foundation, the Hillman Foundation, the Grable Foundation, and the FISA Foundation. Dr. Levenson’s effort was supported by NICHD.

Construction trade and extraction workers: A population at high risk for drug use in the United States, 2005–2014

ObjectiveTo estimate prevalence of past-month marijuana, cocaine, and nonmedical prescription opioid (NPO) use and determine employment-related correlates of drug use among construction trade/extraction workers (CTEW). MethodsWe analyzed ten years of data (2005–2014) from 293,492 adults (age≥18) in the National Survey on Drug Use and Health, comparing CTEW and non-CTEW. ResultsCTEW were 5.6% (n = 16,610) of the sample. Compared to non-CTEW, CTEW were significantly more likely to report past-month marijuana (12.3% vs. 7.5%), cocaine (1.8% vs. 0.8%), and/or NPO use (3.4% vs. 2.0%; Ps<.001). Among CTEW, past-week unemployment and working for >3 employers was associated with increased odds of marijuana and NPO use. Missing 1–2 days in the past month because the participant did not want to go into work was associated with increased odds for use of marijuana, cocaine, and NPO use. Missing 3–5 days of work in the past month because sick or injured was associated with double the odds (aOR = 2.00 [95% CI: 1.33–3.02]) of using NPO. Having written drug policies was associated with reduced odds for cocaine use, and workplace tests for drug use during hiring and random drug testing were also associated with lower odds of marijuana use. ConclusionsCTEW are a high-risk population for drug use. Precarious employment is associated with higher prevalence of drug use while some workplace drug policies were associated with lower prevalence. Coupled with reports of high overdose mortality among CTEW, these findings suggest that prevention and harm reduction programming is needed to prevent drug-related morbidity and mortality among CTEW.

College attendance type and subsequent alcohol and marijuana use in the U.S

BackgroundCollege attendance is a risk factor for frequent and heavy drinking and marijuana initiation but less is known about the extent to which risk varies by type of college attendance and across age. MethodsUsing panel data of young adults who were high school seniors in 1990–1998 from the Monitoring the Future study (n = 13,123), we examined the associations between college attendance at age 19/20 (4-year college full-time, other college, and non-attendance) and subsequent alcohol and marijuana use at age 21/22, 25/26, 29/30 and 35. Inverse propensity score weighting was used to balance the three college groups on pre-existing differences when examining associations with substance use outcomes. ResultsCompared to non-attendance, attending a 4-year college full-time was associated with significantly greater odds of binge drinking at age 21/22 (aOR = 1.20) and 25/26 (aOR = 1.12) and lower odds of alcohol abstinence at age 35 (aOR = 0.51). Similarly, other college attendance was associated with greater odds of binge drinking at age 21/22 (aOR = 1.08) and 25/26 (aOR = 1.04) and lower odds of abstinence at age 35 (aOR = 0.70). Four-year college full-time attendance was associated with greater odds of marijuana use at age 21/22 (aOR = 1.07) and 25/26 (aOR = 1.02) but lower odds at age 29/30 (aOR = 0.99). Other college attendance was associated with lower odds of marijuana use at age 25/26 (aOR = 0.98) and 29/30 (aOR = 0.97). Marijuana use at age 35 did not differ by college attendance. ConclusionsCollege attendance may confer elevated risk of substance use post-college. The magnitude and duration of risk vary by type of college attendance and substance.

Impact of Marijuana Legalization on Prevalence of Maternal Marijuana Use and Perinatal Outcomes.

We aimed to assess whether marijuana legalization was associated with a difference in prevalence of prenatal use or an increase in incidence of adverse perinatal outcomes. The present study is a retrospective cohort of September and October deliveries in the years 2012 through 2015 at a tertiary center in Colorado. Primary outcome of the study was use of marijuana, defined by self-report or biodetection. Secondary outcomes of the study included growth restriction, spontaneous preterm birth, stillbirth, preeclampsia, and neonatal or maternal death. Marijuana use prevalence was compared by year, and secondary outcomes between two periods, before and after the opening of the first recreational dispensary. A total of 2,392 pregnant women were included (1,165 before legalization and 1,227 after). More women used marijuana over the period of legalization (trend p = 0.01). Odds of marijuana use were higher after legalization versus before (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI]: 1.2-2.6). Incidence of growth restriction was higher after legalization (2.9 vs. 5.1%, p = 0.0084). This difference persisted after adjustment for ethnicity and other drugs in multivariable modeling (aOR = 1.9, 95%CI: 1.2-3.0). The prevalence of prenatal marijuana use increased over the time of legalization. Further investigation into the population impact of legalization on obstetrical outcomes is warranted given the observed increase in growth restriction.

Association Between Electronic Cigarette Use and Marijuana Use Among Adolescents and Young Adults

Use of electronic cigarettes (often called e-cigarettes) has increased considerably among young people in the past 5 years. Use of e-cigarettes has been associated with higher rates of marijuana use, which is associated with several adverse health outcomes in youth. To characterize and quantify the association between e-cigarette and marijuana use among youth using a meta-analysis. PubMed, Embase, and Web of Science & ProQuest Dissertations and Theses were searched from inception to October 2018. A gray-literature search was also conducted on conference abstracts, government reports, and other sources. Included studies compared rates of marijuana use among youth aged 10 to 24 years who had used e-cigarettes vs those who had not used e-cigarettes. Two reviewers independently assessed studies for inclusion; disagreements were discussed with a third reviewer and resolved by consensus. Data were extracted by 2 independent reviewers following Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines and pooled using a random-effects analysis. The Newcastle-Ottawa Scale was used to assess data quality and validity of individual studies. Adjusted odds ratios (AORs) of self-reported past or current marijuana use by youth with vs without past or current e-cigarette use. Twenty-one of 835 initially identified studies (2.5%) met selection criteria. The meta-analysis included 3 longitudinal and 18 cross-sectional studies that included 128 227 participants. Odds of marijuana use were higher in youth who had an e-cigarette use history vs those who did not (AOR, 3.47 [95% CI, 2.63-4.59]; I2, 94%). Odds of marijuana use were significantly increased in youth who used e-cigarettes in both longitudinal studies (3 studies; AOR, 2.43 [95% CI, 1.51-3.90]; I2, 74%) and cross-sectional studies (18 studies; AOR, 3.70 [95% CI, 2.76-4.96]; I2, 94%). Odds of using marijuana in youth with e-cigarette use were higher in adolescents aged 12 to 17 years (AOR, 4.29 [95% CI, 3.14-5.87]; I2, 94%) than young adults aged 18 to 24 years (AOR, 2.30 [95% CI, 1.40-3.79]; I2, 91%). This meta-analysis found a significant increase in the odds of past or current and subsequent marijuana use in adolescents and young adults who used e-cigarettes. These findings highlight the importance of addressing the rapid increases in e-cigarette use among youths as a means to help limit marijuana use in this population.