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Contributors JCC, KLR, KLK, NLD, DR, and RMA designed the study and wrote the protocol. JCC, CLH, JAT enrolled participants and performed the data collection. JCC, CLH, JAT, KLR, and JS performed the qualitative data analysis. JS, MJ, NMD, GAR added insights in understanding and contextualizing the thematic findings within the context of the current field of perinatal marijuana research. JCC wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Objective Changes in reward-related behavior are an important component of normal adolescent affective development. Understanding the neural underpinnings of these normative changes creates a foundation for investigating adolescence as a period of vulnerability to affective disorders, substance use disorders, and health problems. Studies of reward-related brain function have revealed conflicting findings regarding developmental change in the reactivity of the striatum and medial prefrontal cortex (mPFC) and have not considered puberty. The current study focused on puberty-specific changes in brain function and their association with mood. Method A sample of 77 healthy adolescents (26 pre/early pubertal, 51 mid/late pubertal) recruited in a narrow age range (M=11.94 years, SD=.75) were assessed for sexual maturation and circulating testosterone, completed an fMRI guessing task with monetary reward, and underwent experience sampling of mood in natural environments. For comparison, 19 healthy adults completed the fMRI assessment. Results Adolescents with more advanced pubertal maturation exhibited less striatal and more mPFC reactivity during reward outcome than similarly aged adolescents with less advanced maturation. Testosterone was positively correlated with striatal reactivity in boys during reward anticipation and negatively correlated with striatal reactivity in girls and boys during reward outcome. Striatal reactivity was positively correlated with real-world subjective positive affect and negatively correlated with depressive symptoms. mPFC reactivity was positively correlated with depressive symptoms. Conclusions Reward-related brain function changes with puberty and is associated with adolescents' positive affect and depressive symptoms. Increased reward-seeking behavior at this developmental point could serve to compensate for these changes.

Background-Marijuana is the most commonly used illicit substance in pregnancy. Little is known about how pregnant women who use marijuana obtain and understand information about perinatal marijuana use. We conducted a qualitative study among pregnant women who had used marijuana to understand their information-seeking patterns and perceptions of usefulness of available information about perinatal marijuana use.

Purpose The onset of adolescence is a time of dramatic changes, including changes in sleep, and a time of new health concerns related to increases in risk-taking, sensation-seeking, depression, substance use, and accidents. As part of a larger study examining puberty-specific changes in adolescents' reward-related brain function, the current paper focuses on the relationship between functional neuroimaging measures of reward and measures of sleep. Methods 58 healthy participants age 11-13 completed a functional magnetic resonance imaging scan using a guessing task with monetary rewards and four-days of at home actigraphy and self-reported sleep ratings. Sleep variables included actigraph measures of mean weekend minutes asleep, sleep onset time, and sleep offset time, as well as self-reported sleep quality. Results During reward anticipation, less activation in the caudate (part of the ventral striatum) was associated with fewer minutes asleep, later sleep onset time, and lower sleep quality. During reward outcome, less caudate activation was associated with later sleep onset time, earlier sleep offset time, and lower sleep quality. Conclusions It has been hypothesized that adolescents' low reactivity in reward-related brain areas could lead to compensatory increases in reward-driven behavior. This study's findings suggest that sleep could contribute to such behavior. Because decreased sleep has been associated with risky behavior and negative mood, these findings raise concerns about a negative spiral whereby the effects of puberty and sleep deprivation may have synergistic effects on reward processing, contributing to adolescent behavioral and emotional health problems.

Objective To describe obstetric health care providers’ responses and counseling approaches to patients’ disclosures of marijuana use during first prenatal visits. Methods We performed a content analysis of audio-recorded patient–health care provider first prenatal visits for obstetrics health care providers’ responses to patients’ disclosure of marijuana use. The study was conducted at five urban outpatient clinics located in Pittsburgh, PA. Results Among 468 audio-recorded first obstetric encounters, 90 patients (19%) disclosed marijuana use to 47 health care providers; mean number of recoded encounters containing marijuana disclosures for participating health providers was 1.8+1.4.. In 48% of these 90 visits, obstetric health care providers did not respond to marijuana use disclosures or offer counseling. When counseling was offered, it consisted of general statements without specific information on the risks or outcomes related to marijuana use in pregnancy, discussions regarding the need for urine toxicology testing, and warnings that use detected at the time of delivery would initiate child protective services involvement. Conclusions Obstetric health care provider responses to disclosure of marijuana use occurred in approximately half of patient encounters when marijuana use was disclosed and focused on legal and procedural consequences with less focus on health or medical implications. Our results suggest a need for health care provider training on potential consequences of perinatal marijuana use and communication skills for counseling patients about perinatal marijuana.

Objective To describe obstetric provider attitudes, beliefs, approaches, concerns, and needs about addressing perinatal marijuana use with their pregnant patients. Methods We conducted individual semi-structured interviews with obstetric providers and asked them to describe their thoughts and experiences about addressing perinatal marijuana use. Interviews were transcribed verbatim, coded and reviewed to identify themes. Results Fifty-one providers participated in semi-structured interviews. Providers admitted they were not familiar with identified risks of marijuana use during pregnancy, they perceived marijuana was not as dangerous as other illicit drugs, and they believed patients did not view marijuana as a drug. Most provider counseling strategies focused on marijuana’s status as an illegal drug and the risk of child protective services being contacted if patients tested positive at time of delivery. Conclusions When counseling about perinatal marijuana use, obstetric providers focus more on legal issues than on health risks. They describe needing more information regarding medical consequences of marijuana use during pregnancy. Practice Implications Provider training should include information about potential consequences of perinatal marijuana use and address ways to improve obstetric providers’ counseling. Future studies should assess changes in providers’ attitudes as more states consider the legalization of marijuana.

Objective To describe the observed characteristics of first prenatal visit breastfeeding discussions between obstetric providers and their pregnant patients. Methods This analysis was part of a larger study involving 69 providers and 377 patients attending their initial prenatal visits at a single clinic. Audio recordings and transcripts from the first 172 visits (including 36 obstetric-gynecology residents, six nurse midwives and five nurse practitioners) were reviewed for breastfeeding discussion occurrence, timing, and initiator of discussions, and adherence to American College of Obstetricians and Gynecologists (the College) prenatal breastfeeding guidelines. Descriptive statistics were used to characterize the sample and frequency of breastfeeding discussions. Logistic regression and chi-square tests were used to examine patterns in women's breastfeeding discussion preferences and discussion occurrence. Conversations were qualitatively analyzed for breastfeeding content. Results Breastfeeding discussions were infrequent (29% of visits), brief (m=39 seconds), and most often initiated by clinicians in an ambivalent manner. Sixty-nine percent of breastfeeding discussions incorporated any College breastfeeding recommendations. Breastfeeding was significantly more likely to be discussed by certified nurse midwives (CNMs) than residents (OR 24.54, 95% CI: 3.78-159.06; p<0.01), and CNMs tended to engage patients in more open discussions. Women indicating a preference for breastfeeding discussions at the first visit (n=19) were more likely to actually have the discussion (p<0.001). Conclusion Observed breastfeeding education at the first prenatal visit was suboptimal. The causes and effect of this deficiency on breastfeeding outcomes remains an important point of investigation.