Trends in Cannabis Polysubstance Use During Early Pregnancy Among Patients in a Large Health Care System in Northern California

Young-Wolff, Kelly C.; Sarovar, Varada; Tucker, Lue-Yen; Ansley, Deborah; Goler, Nancy; Conway, Amy; Ettenger, Allison; Foti, Tara R.; Brown, Qiana L.; Kurtzman, Ellen T.; Adams, Sara R.; Alexeeff, Stacey

doi:10.1001/jamanetworkopen.2022.15418

Cited by 20 publications

(13 citation statements)

References 49 publications

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“…As a result, this study may underreport cannabis use, as individuals regularly underreport their substance use . Future studies may consider a combination of self-report and drug screens . Second, this is a cross-sectional study; therefore, we are limited in our ability to assess the direction of causality of reported associations.…”

Section: Discussionmentioning

confidence: 98%

“… 43 Future studies may consider a combination of self-report and drug screens. 44 Second, this is a cross-sectional study; therefore, we are limited in our ability to assess the direction of causality of reported associations. Particularly, there remains the possibility that adolescent cannabis use and adverse events have similar causes (eg, stress-related cannabis use 45 ).…”

Section: Discussionmentioning

confidence: 98%

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Nondisordered Cannabis Use Among US Adolescents

et al. 2023

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ImportanceCannabis use is increasingly viewed by adolescents as not harmful. Youths with cannabis use disorder (CUD) are recognized by clinicians as being at risk for adverse outcomes, yet little is known about the associations between subclinical cannabis use (ie, nondisordered cannabis use [NDCU]) and adverse psychosocial events.ObjectiveTo describe the prevalence and demographics of NDCU and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, NDCU, and CUD.Design, Setting, and ParticipantsThis cross-sectional study used a nationally representative sample derived from the 2015 to 2019 National Survey on Drug Use and Health. Participants were adolescents aged 12 to 17 years, separated into 3 distinct groups: nonuse (no recent cannabis use), NDCU (recent cannabis use below diagnostic threshold), and CUD. Analysis was conducted from January to May 2022.ExposuresCUD, NDCU, or cannabis nonuse. NDCU was defined as endorsing recent cannabis use but not meeting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) CUD criteria. CUD was defined using DSM-5 criteria.Main Outcomes and MeasuresThe main outcomes were prevalence of adolescents meeting criteria for NDCU and associations between adverse psychosocial events and NDCU, adjusted for sociodemographic characteristics.ResultsThe 68 263 respondents (mean [SD] age, 14.5 [1.7] years; 34 773 [50.9%] males) included in the analysis represented an estimated yearly mean of 25 million US adolescents during 2015 to 2019. Among respondents, 1675 adolescents (2.5%) had CUD, 6971 adolescents (10.2%) had NDCU, and 59 617 adolescents (87.3%) reported nonuse. Compared with nonusers, individuals with NDCU had approximately 2 to 4 times greater odds of all adverse psychosocial events examined, including major depression (adjusted odds ratio [aOR], 1.86; 95% CI, 1.67-2.08), suicidal ideation (aOR, 2.08; 95% CI, 1.88-2.29), slower thoughts (aOR, 1.76; 95% CI, 1.58-1.96), difficulty concentrating (aOR, 1.81; 95% CI, 1.65-2.00), truancy (aOR, 1.90; 95% CI, 1.67-2.16), low grade point average (aOR, 1.80; 95% CI, 1.62-2.00), arrest (aOR, 4.15; 95% CI, 3.17-5.43), fighting (aOR, 2.04; 95% CI, 1.80-2.31), and aggression (aOR, 2.16; 95% CI, 1.79-2.62). Prevalence of adverse psychosocial events was greatest for adolescents with CUD (range, 12.6% to 41.9%), followed by NDCU (range, 5.2% to 30.4%), then nonuse (range, 0.8% to 17.3%).Conclusions and RelevanceIn this cross-sectional study of US adolescents, past-year NDCU was approximately 4 times as prevalent as past-year CUD. A stepwise gradient association was observed for odds of adverse psychosocial events between adolescent NDCU and CUD. In the context of US normalization of cannabis use, prospective research into NDCU is necessary.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Nondisordered Cannabis Use Among US Adolescents

et al. 2023

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“…The study was approved by the Kaiser Permanente Northern California IRB; additional details on the study design have been published elsewhere. 13,21 This study followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines to ensure that data collection and analysis were systematic and verifiable. 22 Using electronic health record data, we identified a potentially eligible sample of pregnant non-Hispanic White and non-Hispanic Black English-speaking adults who self-reported any prenatal cannabis use since pregnancy on the universal screening questionnaire at entrance to prenatal care (at about 8 weeks of gestation).…”

Section: Methodsmentioning

confidence: 99%

“…[8][9][10][11] Prenatal cannabis use differs by race and ethnicity, with higher prevalence among White and Black individuals relative to those of other races and ethnicities. 7,12,13 Many clinical settings provide training and resources to ensure that obstetricians are prepared to discuss cannabis use with patients. However, some obstetricians report a lack confidence and knowledge to have these conversations.…”

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Patient Perceptions of Prenatal Cannabis Use and Implications for Clinicians

Foti,

Green,

Altschuler

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To understand pregnant patients' reasons for prenatal cannabis use and perceptions of safety, desired and undesirable health care experiences, and desired information about prenatal cannabis use and secondarily to understand racial differences in these perceptions and preferences. METHODS: We conducted a qualitative study including 18 semi-structured, race-concordant virtual focus groups with pregnant individuals who self-reported cannabis use at prenatal care entry in a large integrated health care system in Northern California from November 2021 to December 2021. The focus groups included semi-structured questions that were recorded, transcribed, and coded by the research team. Thematic analysis was used to analyze the data. RESULTS: Overall, 53 participants were included; 30 self-identified, as White and 23 self-identified as Black. Participants averaged 30.3 years of age (SD 5.2 years) and were on average at 20.9 weeks of gestation at study enrollment; 69.8% reported daily cannabis use, 24.5% reported weekly cannabis use, and 5.7% reported monthly or less cannabis use at entrance to prenatal care. Although some participants quit cannabis use in early pregnancy because of concerns about potential health risks, many perceived a lack of scientific evidence or believed that prenatal cannabis use was safe. Many preferred cannabis to over-the-counter or prescription medications for treating mood, morning sickness, pain, and sleep. Participants valued open interactions with obstetricians that acknowledged their motivations for use, and they desired information about potential risks through conversations and educational materials. White and Black participants' perspectives were generally similar, but a few Black participants uniquely described concerns about racial bias related to their prenatal cannabis use. CONCLUSION: Pregnant patients used cannabis to manage mood and medical symptoms, and many believed that prenatal cannabis use was safer than the use of prescription medications. Obstetrician-initiated, patient-centered conversations around prenatal cannabis use, advice to discontinue cannabis use during pregnancy, and exploration of willingness to switch to medically recommended interventions for pregnancy-related symptoms may benefit patients.

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Perceptions About Cannabis Following Legalization Among Pregnant Individuals With Prenatal Cannabis Use in California

et al. 2022

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ImportanceAs rates of prenatal cannabis use increase and cannabis legalization spreads across the US, studies are needed to understand the potential impacts of legalization from the perspectives of pregnant individuals who use cannabis.ObjectiveTo characterize pregnant individuals’ perspectives on legalization of cannabis for adult use in California (effective in 2018) in relation to prenatal cannabis use behaviors and beliefs.Design, Setting, and ParticipantsThis qualitative study was conducted in Kaiser Permanente Northern California, a large health care system with universal screening for self-reported cannabis use at entrance to prenatal care. Eighteen semistructured focus groups were conducted from November 17 to December 17, 2021, using a secure video conferencing platform with Black and White pregnant participants who self-reported cannabis use during early pregnancy. Data were analyzed from March to June 2022.Main Outcomes and MeasuresVideo-recorded interviews were transcribed and analyzed using thematic analysis to identify major themes and subthemes.ResultsAmong 53 participants (mean [SD] age, 30.3 [5.2] years), 23 (43%) identified as non-Hispanic Black and 30 (57%) identified as non-Hispanic White; 16 participants (30%) reported continued cannabis use at the time of recruitment. Major themes regarding the perceived impact of legalization included easier access (via retailers and delivery), greater acceptance (including reduced stigma and more discussions about prenatal cannabis use with health care practitioners), and trust in cannabis retailers (including safety and effectiveness of diverse products sold and perceptions of cannabis retailer employees as knowledgeable, nonjudgmental, and caring). Responses were mixed about whether retailer marketing and advertising were associated with prenatal cannabis use and whether legalization resulted in reduced concerns about Child Protective Services involvement.Conclusion and RelevanceThe findings of this qualitative study suggest pregnant individuals perceive cannabis legalization as having reduced barriers to prenatal cannabis use and that legalization has created challenges and opportunities for supporting the health of pregnant individuals. The results of this qualitative study highlight key areas that can be further explored in future educational materials, public health campaigns, and policy adaptations to address increasing rates of prenatal cannabis use.

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Trends in Cannabis Polysubstance Use During Early Pregnancy Among Patients in a Large Health Care System in Northern California

Cited by 20 publications

References 49 publications

Nondisordered Cannabis Use Among US Adolescents

Nondisordered Cannabis Use Among US Adolescents

Patient Perceptions of Prenatal Cannabis Use and Implications for Clinicians

Perceptions About Cannabis Following Legalization Among Pregnant Individuals With Prenatal Cannabis Use in California

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