A feasibility study to assess the recruitment and retention of pregnant patients who regularly use cannabis.

OBJECTIVE: To assess first-trimester recruitment and retention of pregnant patients who regularly used cannabis, but not other substances, measured by willingness to participate in a research study, completion of self-administered electronic questionnaires, and willingness to provide urine samples during each trimester of pregnancy. We designed and launched a prospective feasibility study titled, Cannabis Legalization in Michigan (CALM) - Maternal & Infant Health (MIH), in two Michigan clinics after the recreational use of cannabis became legal for adults 21 years and older. RESULTS: Over half (52%) of patients asked to participate in CALM-MIH were consented to the study. Two-thirds (66%) of screened patients initiated prenatal care during their first trimester of pregnancy and 50% used cannabis, of which the majority did not concurrently use other substances. Of those recruited into the prospective study, all participants completed the first-trimester questionnaire and provided urine samples. Study retention was 80% and all participants who completed follow-up assessments were willing to provide urine samples.

Alcohol and cannabis use among women with infertility: associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatment.

Little is known about substance use among women with infertility, yet substance use has implications for fertility and pregnancy. The purpose was to estimate the prevalence of substance use among women with infertility and examine whether substance use was associated with psychiatric symptoms, active attempts to conceive, and engagement in fertility treatments. Eligible patients were from a single healthcare system who received a female infertility diagnosis within the past 2 years. Participants (n = 188) completed an online questionnaire regarding substance use, psychiatric symptoms, attempts to conceive, and fertility treatments. The prevalence of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with psychiatric symptoms (p > .05). Those with any cannabis use were more likely to have higher depression scores than those without (p = .02). Those with hazardous cannabis use were more likely to have higher depression scores (p = .001) and higher anxiety scores (p = .03). Substance use was not associated with actively trying to conceive. Those pursuing fertility treatments had a lower percentage engaging in hazardous alcohol use compared to those not pursuing fertility treatments (19.0% vs. 36.3%, p = .02). Substance use among women with infertility is common. Hazardous cannabis use was associated with greater psychiatric symptoms, suggesting that cannabis may be used to cope with distress. Pursuing fertility treatments may serve as a protective factor for hazardous alcohol use. Clinicians treating patients with infertility may want to screen for substance use.

Nausea and vomiting of pregnancy and prenatal cannabis use in a Michigan sample.

BACKGROUND: Nausea and vomiting of pregnancy, also referred to as morning sickness, affects more than 70% of all pregnancies. Symptoms range from mild to severe and, in some cases, can be debilitating, resulting in a reduced quality of life. Moreover, prenatal cannabis use prevalence has doubled in the United States, and cannabis potency, measured by the concentration of delta-9-tetrahydrocannabiniol, has increased from 10% in 2009 to 14% in 2019. State-level recreational legalization of cannabis may contribute to the liberalization of its use and reduced risk perception. Furthermore, the relatively recent discovery of cannabinoid hyperemesis syndrome may contribute to the mischaracterization of morning sickness in individuals who use cannabis during pregnancy. Although cannabis has well-documented antiemetic properties, there is insufficient research on the topic. Therefore, it is essential to establish a tangible understanding of the association between nausea and vomiting of pregnancy and prenatal cannabis use. OBJECTIVE: This study aimed to estimate the degree to which nausea and vomiting of pregnancy might be associated with prenatal cannabis use in a sample of pregnant people in Michigan, a state where recreational cannabis use became legal in December 2018. STUDY DESIGN: This was a prospective study of participants from the Michigan Archive for Research on Child Health, a population-based pregnancy cohort that was recruited using a probability-based sampling approach. Participants were recruited from 22 prenatal clinics located throughout Michigan's lower peninsula. Cross-sectional analyses were performed for data available between October 2017 and January 2022. RESULTS: Among this sample of Michigan pregnant people, 14% (95% confidence interval, 11%-16%) reported cannabis use. Participants who experienced increasing morning sickness severity had higher odds of using cannabis (adjust odds ratio, 1.2; 95% confidence interval, 1.1-1.2). When the sample was restricted to first-trimester morning sickness and cannabis use, the results remained statistically robust. When the direction of the association was reversed, an increase in morning sickness severity was detected among participants who used cannabis during pregnancy (ßadjusted, 0.2; 95% confidence interval, 0.1-0.2). Lastly, the association between prepregnancy cannabis use and first-trimester morning sickness was investigated. Study findings suggest an increase in morning sickness severity among people who used cannabis in the 3 months before pregnancy compared with those who did not use cannabis (ßadjusted, 0.1; 95% confidence interval, 0.003-0.200). CONCLUSION: Study findings indicated a link between nausea and vomiting of pregnancy and prenatal cannabis use. Moreover, this study revealed that using cannabis in the 3 months before pregnancy is associated with first-trimester morning sickness severity. The strengths of our study contribute to the scant epidemiologic evidence in this area of research. More fine-grained, time-specific data on nausea and vomiting of pregnancy and prenatal cannabis use are necessary to draw inferences about cause-effect relationships. Our study might provide a basis to discourage cannabis use during pregnancy until more evidence is collected.

Cannabis use and gastrointestinal tract illnesses: The National Health and Nutrition Examination Surveys, 2005-2018.

INTRODUCTION: The antiemetic properties of cannabis have motivated its use in the management of chemotherapy-induced nausea and vomiting. Conversely, case reports of intractable vomiting among heavy cannabis users have increasingly appeared in the literature. Studies on cannabis and gastrointestinal tract (GIT) health are scare. Here, we use data for the National Health and Nutrition Examination Surveys (NHANES, 2005-2018) to estimate the association between cannabis use and GIT illness. METHODS: The study sample included non-pregnant adult NHANES participants (20-59 years) without history of cancer or HIV (n = 18,753). Cannabis use was categorised into never, former (0 day in the past 30 days), infrequent (1-2 days), occasional (3-19 days) and frequent (20-30 days) use. Recent GIT illness was defined as experiencing GIT illness with vomiting or diarrhoea that started in the 30 days prior to NHANES. Logistic regression was used to regress GIT illness on cannabis use, adjusting for potential confounders. RESULTS: Compared to never use, frequent cannabis use was associated with higher odds of GIT illness (OR = 1.4; 95% confidence interval 1.04, 1.9). There were no associations between former, infrequent or occasional cannabis use and GIT illness. DISCUSSION AND CONCLUSIONS: Frequent cannabis use is associated with GIT illnesses in a large cross-sectional study of US residents. It is possible that frequent cannabis use adversely affects GIT health, consistent with clinical case reports. Alternatively, patients with GIT illness might self-medicate with cannabis given its antiemetic properties. Prospective studies are needed to understand the effects of cannabis use on GIT health.

The impact of a parent-based prevention intervention on Mexican-descent youths' perceptions of harm associated with drug use: Differential intervention effects for male and female youths.

Parent training (PT) interventions reduce the likelihood of youth problematic behaviors, including drug use. However, the dissemination of culturally adapted PT interventions in low-income Latina/o immigrant communities remains scarce. In this selective prevention study, we examined the extent to which exposure to CAPAS-Youth, a culturally adapted version of the PT intervention known as GenerationPMTO© , resulted in increased adolescent perception of harm associated with use of alcohol and other drugs. In a randomized controlled trial with 71 Latina/o immigrant families (95% of parents self-identified as Mexican origin, n = 98), 37 families were allocated to the CAPAS-Youth intervention condition versus wait-list control (n = 34 families). According to adolescents' reports at intervention completion, significant increased levels of perceived harm associated with drug use were found for female youths, but not for males. Differential results indicate the importance of tailoring PT prevention interventions according to youths' sex differences (i.e., males vs. females).

Building a nest in a storm: The impact of immigration-related stress on Latino mothers' parenting.

Latina/o immigrant mothers in the United States (U.S.) often experience discrimination, which results in deleterious impacts on their parenting practices. Because of the cumulative impact of immigration-related stress, there is a need for research aimed at identifying specific contextual stressors that have the greatest impact on Latina/o immigrant parenting. Further, given significant barriers to access mental health services, there is an urgency to comprehend how pre-existing family strengths might counteract these parenting shortcomings in Latina/o families. Accordingly, we examined in these investigation-specific pathways through which immigration-related stress affects maternal parenting practices, and how emotional and relational processes within families might act as predecessors to positive parenting practices within a context of adversity. This study is embedded within a larger program of research aimed at culturally adapting evidence-based parenting programs for low-income Latina/o immigrants. Our sample consisted of 71 Mexican-origin Latina/o mothers, residents of an urban setting in the Midwest. According to Bayesian estimated path analysis, immigration-related stress was associated with parenting stress and emotional support, while emotional support, parenting stress, and the co-parenting alliance were associated with positive parenting practices. Indirect effects demonstrate that immigration-related stress is negatively associated with positive parenting practices when mediated by parenting stress and emotional support. Current findings highlight the need to carefully examine the impact of immigration-related stress on the parenting practices of Latina/o immigrant families and the need to inform parent training interventions accordingly.

Trends and Characteristics of Prenatal Cannabis Use in the U.S., 2002-2019.

INTRODUCTION: The prevalence of prenatal cannabis use has nearly doubled in the U.S. from 2002 to 2017. As cannabis legalization continues to expand, this study aimed to estimate the recent trends in the prevalence of cannabis use, cannabis dependence, and cannabis risk perceptions among U.S. pregnant people. METHODS: The National Survey on Drug Use and Health (2002-2019) was designed to be representative of the U.S. civilian non-institutionalized population. The study sample included pregnant participants (aged 12-44 years; n=15,109). Cannabis consumption was defined as using cannabis at least once in the 30 days before assessment. Past 12‒month cannabis dependence was defined on the basis of the DSM-IV. Joinpoint regression was used to test for significant changes in the trends while controlling for age, race/ethnicity, and family income. Analyses were conducted between August 2021 and April 2022. RESULTS: No evidence of change in the prevalence of prenatal cannabis use was detected between 2016-2017 (5.8%) and 2018-2019 (4.7%) (prevalence difference= -1.1; 95% CI= -2.9, 0.7). The prevalence of cannabis dependence did not change significantly among pregnant people from 2002 to 2019. The percentage of pregnant people perceiving regular cannabis use (1-2 times/week) as a great risk remained stable from 2002 to 2007 (∼53%) and declined sharply after (27%). CONCLUSIONS: Three of 4 pregnant people in the U.S. do not characterize regular cannabis use as a great risk. As cannabis legalization increases, public health efforts are needed to raise awareness of the possible harms associated with cannabis use.

A Culturally Adapted Parenting Intervention for Mexican-Origin Immigrant Families with Adolescents: Integrating Science, Culture, and a Focus on Immigration-Related Adversity.

Low-income Latina/o immigrants are very likely to experience intense contextual challenges in the USA, such as limited exposure to culturally relevant parent training (PT) prevention interventions. This prevention study consisted of an exploratory randomized controlled trial, aimed at empirically testing the implementation feasibility and initial efficacy of a culturally adapted version of the evidence-based PT intervention known as GenerationPMTO©. The parenting intervention was adapted to overtly address immigration-related stressors, discrimination, and challenges associated with biculturalism. Seventy-one Mexican-origin immigrant mothers participated in this study and were allocated to one of two conditions: (a) culturally adapted GenerationPMTO (i.e., CAPAS-Youth) or (b) wait-list control. Measurements were completed at baseline (T1) and intervention completion (T2). When compared to mothers in the control condition at T2, CAPAS-Youth participants reported significant improvements on four of the core parenting practices delivered in the CAPAS-Youth intervention. As hypothesized, no significant differences in limit-setting skills were identified at T2. With regards to adolescents' outcomes, mothers exposed to CAPAS-Youth reported significant improvements in youth internalizing and externalizing behaviors at T2 when compared to a wait-list control condition. Mothers in both conditions also reported significant reductions in levels of immigration-related stress. Current findings indicate the feasibility of implementing CAPAS-Youth within a context of considerable adversity, as well as the beneficial impacts of the parent-based intervention on salient parenting and youth outcomes.

Visit-to-visit variability in blood pressure among cannabis users participating in the Third National Health and Nutrition Examination Survey.

OBJECTIVE: Blood pressure variability (BPV) has emerged as an important predictor of cardiovascular morbidity and mortality. Plausible biological mechanisms link cannabis use and blood pressure (BP) regulation. Here, we assess the relationship between cannabis use and BPV, measured by the SD and coefficient of variation across three separate study visits. METHODS: Data for individuals (17-59 years, n = 758) participating in the United States Third National Health and Nutrition Examination Survey substudy were used. Associations between cannabis use and mean BP, SBP and DBP variability were estimated. Participants were classified according to recency or lifetime frequency of cannabis use. Generalized linear regressions were used to model BPV as the outcome and cannabis use status as the exposure, adjusting for potential confounding variables. RESULTS: Compared with nonuse, active cannabis use was associated with higher SD (mmHg) of mean BP [ß = 0.97; 95% confidence interval (CI) = 0.22, 1.73], SBP (ß = 0.95; 95% CI = 0.04, 1.85) and DBP (ß = 1.18; 95% CI = 0.28, 2.08). Similar conclusions were obtained when the coefficient of variation was modelled as the outcome. A robust association was not observed for lifetime use frequency. The association between active cannabis use and SBP variability was stronger in the tobacco smoking subgroup, whereas the association between active cannabis use and DBP variability was stronger in the tobacco nonsmoking subgroup. CONCLUSION: Active cannabis use is associated with BPV. Future research is needed to understand the effects of cannabis use on BP regulation.

Trends in heroin use among women of reproductive age in the United States, 2004-2017.

Opioid use during pregnancy has been linked to several adverse outcomes including stillbirth, preterm birth and neonatal abstinence syndrome. Recent data suggest that heroin use has increased in the United States (US) whereas prescription opioid use has decreased. Prevalence estimates for reproductive age women combine heroin and non-medical prescription opioid use, which might mask the increasing heroin trend. The aim of the current study is to estimate the prevalence of heroin use among US women of reproductive age, stratified by pregnancy status. For each year, a representative sample of the US civilian non-institutionalized population is recruited for the National Survey on Drug Use and Health (NSDUH). Pregnancy status and heroin use were assessed in women 15-44 years of age (n = 277,333) using audio computerized-assisted self-interviews. From 2004 to 2017, the prevalence of past 30-day heroin use was 12 per 10,000 reproductive age women (95% confidence interval [CI] = 11, 14). Heroin use has increased from 6 per 10,000 women in 2004-05 to 18 per 10,000 women in 2016-17 (Average percent change = 20.8; 95% 11.2, 31.2). The increase was evident among non-pregnant women, but not among pregnant women. Heroin use remains uncommon among women of reproductive age, yet its prevalence has increased over time. Screening for heroin use might be needed at multiple time points including prior to pregnancy to mitigate adverse outcomes associated with use during pregnancy.

The negative growth of a brief depressive spell among U.S. adolescents.

OBJECTIVE: Studying adolescent-onset brief depressive spells, we saw a chance to adapt a cross-cohort approach for successive cross-sectionally gathered epidemiological estimates on birth cohorts. METHODS: The United States (US) study population estimates are for noninstitutionalized community-dwelling 17- to 18-year-olds, sampled, recruited, and assessed using audio computer assisted self-interviews for the National Surveys on Drug Use and Health each year, 2008-2016. Estimated age and year-specific lifetime history cumulative incidence proportions are presented, with 95% confidence intervals, as well as age-specific meta-analysis summary estimates. RESULTS: Occurrence of a brief depressive spell (BDS) among the 2008 U.S. 17-year-olds showed a surprising difference with the 2009 statistically independent sample of that same "birth cohort" assessed at age 18 years. "Negative growth" was seen instead of an expected increase in those affected. Independent replication estimates of this BDS negative growth difference were seen in multiple successive birth cohorts. CONCLUSIONS: This well-replicated difference in BDS estimates offers a fascinating puzzle to be solved with focused inquiry. The puzzle's solution is important because National Surveys on Drug Use and Health does not assess Major Depression unless a BDS lifetime history is ascertained.