The Effects of Cannabidiol on the Driving Performance of Healthy Adults: A Pilot RCT.

Introduction: A common side effect of cannabidiol is drowsiness, which could impact safe driving. This study's purpose was to determine the feasibility and whether cannabidiol impacts simulated driving performance. Methods: This was a randomized, parallel-group, sex-stratified, double-blind, pilot trial that consisted of a volunteer sample of healthy, currently driving college students. Participants were randomized and allocated to receive a placebo (n=19) or 300 mg cannabidiol (n=21) by oral syringe. Participants completed a ~40-minute driving simulation. A post-test survey assessed acceptability. The primary outcomes were mean SD of lateral position, total percent time the individual drove outside travel lanes, total collisions, time to initial collision, and mean brake reaction time. Outcomes were compared between groups using Student's t-tests and Cox proportional hazards models. Results: None of the relationships were statistically significant, but the study was underpowered. Those receiving cannabidiol experienced slightly more collisions (0.90 vs 0.68, p=0.57) and had slightly higher mean SD of lateral position and slower brake reaction times (0.60 vs 0.58 seconds, p=0.61) than those who received placebo. Participants were satisfied with their experiences. Conclusions: The design was feasible. Larger trials may be warranted because it is unclear whether the small differences in performance seen in the cannabidiol group were clinically relevant.

Substance use in rural trauma patients admitted for motor vehicle injuries before and during the COVID-19 pandemic.

BACKGROUND: Urban trauma centers reported increased substance use among individuals injured in motor vehicle collisions (MVC) after the start of the COVID-19 pandemic. Little is known about individuals admitted to rural trauma centers during this time. This study's purpose was to describe substance use trends before and during the pandemic among individuals injured in MVC and treated at a rural Level-1 trauma center in West Virginia. METHODS: A cross-sectional analysis was performed using patients' medical records. The study population included individuals ≥ 18 years of age who received treatment for a motor vehicle-related injury between September 1, 2018, and September 30, 2021, and were tested for drugs and alcohol upon admittance. The pre-COVID-19 period was defined as September 1, 2018-March 15, 2020. The COVID-19 period was March 16, 2020-September 30, 2021. The primary dependent variable was the patients' drug test results. The primary independent variable was the time period. The data were analyzed using Chi-square tests, logistic regression, and proportional odds models. RESULTS: During this time, 1465 patients received treatment. On average, patients were 45 years ± 20 of age and male (57%). During COVID-19, 17% of patients tested positive for alcohol and 58% tested positive for non-alcohol drugs. After adjusting for patients' sex and age, the number of drugs that patients tested positive for was 31% higher during COVID-19 (aOR 1.31; 95% CI 1.08, 1.58). The proportion of patients testing positive for cannabinoids (p = 0.05), opioids (p = 0.001), and stimulants (p = 0.010) increased from pre-COVID-19 to COVID-19 periods. CONCLUSIONS: Drug and alcohol use increased among trauma patients admitted to a rural trauma center during COVID-19. Significant increases were seen in the number of drugs and for cannabinoids, opioids, and stimulants.

The effects of cannabidiol on subjective states, cognition, and psychomotor function in healthy adults: A randomized clinical trial.

Despite being added to numerous products, little is known about cannabidiol. Drowsiness is a self-reported side effect, which could impact cognitive functioning. To determine whether cannabidiol impacts cognition and psychomotor function, a volunteer sample of healthy, college students were recruited for this randomized, parallel-group, double-blind, feasibility trial from April-November 2021. Participants completed a baseline survey, the Stanford Sleepiness Scale, Visual Analog Mood Scale, Digit Symbol Substitution Test, Trail Making Test, Psychomotor Vigilance Test, and Simple Reaction Time Tests. Participants were then randomized and allocated to receive 300 mg cannabidiol oil (N = 21) or placebo (N = 19). After 120 min, participants retook the tests. Performance between groups was compared using Analysis of Covariance and multi-level Negative Binomial regression. Participants averaged 21 ± 3 years of age, and 52% were female. Self-reported anxiety did not change posttreatment. Performances on the Stanford Sleepiness Scale, Visual Analog Mood Scale, and Psychomotor Vigilance Test increased for both groups. After accounting for baseline scores, attention lapse duration significantly increased for those receiving cannabidiol compared to placebo in the Psychomotor Vigilance Test (76 vs. 66 ms; p = 0.02). Auditory reaction time improved in the cannabidiol group versus placebo for one sound emitted during the Simple Reaction Time Test (241 vs. 245 ms; p = 0.02), but the number of early responses increased from 0.3 to 0.8 for those receiving cannabidiol. While performance on most tests was similar between those receiving cannabidiol and placebo, cannabidiol might affect certain aspects of vigilance. More research and larger trials are needed.

The Effectiveness and Safety of Cannabidiol in Non-seizure-related Indications: A Systematic Review of Published Randomized Clinical Trials.

BACKGROUND: Legislative changes have fueled the global availability of cannabis and cannabis-derived compounds, such as cannabidiol. Little is known about the effectiveness and safety of cannabidiol for treating health conditions other than seizure disorders. OBJECTIVE: A systematic review of the literature was performed to investigate other health conditions, characteristics of the studied populations, and the effectiveness of cannabidiol in randomized clinical trials. METHODS: Seven publication databases were searched from February to March 2021. The inclusion criteria for studies were: (1) utilized a randomized clinical trial design; (2) published in a peer-reviewed journal or thesis/dissertation; (3) published in English; (4) investigated either prescription (i.e., Epidiolex) or non-prescription CBD that was derived from the Cannabis sativa plant with < 3% ∆9-tetrahydrocannabinol; and (5) reported at least one outcome. This review excluded seizure-related disorders as several previous reviews have been done on this topic; it also excluded published protocols, other systematic reviews, or meta-analyses of randomized clinical trials that investigated cannabidiol. Independent reviewing, risk of bias assessment, and data abstraction were performed by two authors. RESULTS: Fifty-eight studies from eight countries were included in this review. Twenty-seven studies (47%) were conducted in healthy populations, 14% were restricted to male individuals (n = 8), and 72% had sample sizes of fewer than 40 participants. Doses of cannabidiol used in these studies ranged from 400 µg to 6000 mg. The effect of cannabidiol on mental health was the most studied topic (53%), which focused mainly on anxiety, psychosis, schizophrenia, and substance use disorders. The remaining studies investigated neurological conditions (19%) and a myriad of other health conditions or outcomes. While cannabidiol appears to be anxiolytic, its effectiveness for other conditions was highly variable. CONCLUSIONS: This review highlights the inconsistencies of cannabidiol as a treatment for non-seizure-related health conditions or outcomes. Studies incorporating larger sample sizes in more diverse populations are encouraged. While cannabidiol was generally safe and well tolerated even in high doses among the included studies, clearer dosing guidelines and increased regulation of cannabidiol products are also needed.

International students challenges during the COVID-19 pandemic in a university in the United States: A focus group study.

Research suggests that the COVID-19 pandemic has deeply impacted college students. However, very few studies have attended to the specific plight of  international students . The purpose of this study was to document challenges international students may have encountered while studying in the United States during the pandemic. Focus groups (N = 4; 13 students total) were conducted with students who were ≥ 18 years of age, enrolled at least part-time, on an F1 visa, and non-resident alien, who did not have parents/guardians living in the United States and were able to read and write in English. Focus groups lasted 1.5-2 h in duration and followed a standardized script. These sessions were audio-recorded and professionally transcribed. Two researchers performed qualitative content analysis. Six themes emerged from the analysis and included residency challenges, lifestyle changes, coping, negative affect, social support, and university structure. It appears that the challenges associated with residency and lifestyle directly impacted students' negative affect. However, the remaining themes moderated this relationship. These findings highlight the role universities can play in providing relief to international students during these challenging times and suggest areas for improving their experiences. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02776-x.

Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016-17.

OBJECTIVE: This study examined the association between preconception substance use and unintended pregnancy in a large, nationally representative sample of women. METHODS: In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) comprising, 74,543women who had birth during 2016-17. Logistic regression was used to assess the independent association of unintended pregnancy overall and by subtypes to preconception substance use (smoking and other nicotine/tobacco use, alcohol consumption, and use of cannabis, illicit/recreational drugs) and specific medication including prescription opioids, antidepressants and over the counter pain relief. RESULTS: Overall, 41% of pregnancies were unintended. Nearly 57% of participants reported alcohol consumption during the preconception period, with 32% indicating binge drinking, 17% reported preconception smoking, and 10% cannabis use. Unintended pregnancy was significantly associated with substance use, including smoking (adjusted odds ratio [AOR]:1.5, 95% confidence interval [CI]: 1.4-1.6); as well as the use of other nicotine/tobacco (AOR:1.4, 95% CI: 1.3-1.5); cannabis (AOR: 1.9, 95% CI: 1.5-2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2-2.4), prescription opioids (AOR:1.4, 95% CI: 1.02-1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1-3.0). The likelihood of unintended pregnancy was significantly elevated with heavy smoking, heavy alcohol consumption, and binge drinking. Analyses by unintended pregnancy subtype yielded similar results. CONCLUSIONS: Preconception substance use was significantly and positively associated with unintended pregnancy. Evidence-based interventions are needed addressing substance use behavior and effective contraceptive use to prevent unintended pregnancy and related adverse effects on maternal and child health.

Challenges of enforcing cellphone use while driving laws among police in the USA: a cross-sectional analysis.

OBJECTIVES: Research suggests that cellphone use while driving laws may be difficult for police to enforce in the USA, but this is unknown. A national survey of police officers was conducted to determine whether barriers to enforcing these laws exist, what aspects of laws make them easier to enforce and ways to discourage the behaviour among drivers. DESIGN: Cross-sectional survey. SETTING: USA. PARTICIPANTS: Individuals >18 years of age employed as a law enforcement officer from all 50 states were recruited via convenience sampling through multiple modalities from November 2019 to April 2020. Officers (N=353) from 31 states participated. PRIMARY AND SECONDARY OUTCOME MEASURES: Descriptive statistics and multi-level logistic regression analyses were run to assess the responses. RESULTS: The most common barriers to enforcing texting bans (ie, the most prevalent law) were drivers concealing their phone use (78%) and the officer not being able to determine what the driver was doing on their phone (65%). If a universal hand-held cellphone ban was in effect in their state, officers were 77% less likely (adjusted OR=0.23; 95% CI 0.08 to 0.70) to report that a texting ban was difficult to adjudicate. The majority of officers (86%) agreed that having one general law that prohibits any type of hand-held cellphone use would aid with enforcement, and that laws must be a primary offence (87%), and be applicable to all licensed drivers (91%). Most officers felt that driver education is needed. CONCLUSIONS: While numerous barriers to enforcement were identified, opportunities exist to improve current legislation to aid enforcement efforts and to prevent the behaviour among drivers.

Risk Factors Associated with Passenger Vehicle Fatal Rollover Crashes in West Virginia, 2001-2018.

Background: Rollover crashes cause more injuries and fatalities than other types of motor vehicle crashes. West Virginia (WV) has high rates of drug overdose deaths and motor vehicle crash fatality. However, no studies have investigated risk factors associated with fatal rollover crashes in WV. Purpose: The objective of this study is to evaluate whether drug use and other risk factors are associated with fatal rollover crash fatalities in WV. Methods: This cross-sectional study utilized the Fatality Analysis Reporting System dataset from passenger vehicle crashes involving WV drivers ≥ 16 years of age with known drug test results who died within 2 hours after collision from 2001 to 2018. Risk factors associated with fatal rollover crashes were compared to non-rollover crashes using multivariable logistic regression. Results: During the study period, 880 WV drivers died in rollover crashes. Driving ≥ 60 mph [adjusted odds ratio (aOR): 4.1; 95% confidence interval (CI): 2.4-6.8], alcohol use (aOR: 1.6; 95% CI: 1.1-2.1), rural areas (aOR: 1.4; 95% CI: 1.0-1.9), and the lack of airbag deployment (aOR: 2.7; 95% CI: 2.1-3.5) were associated with fatal rollover crashes in WV. However, drug use was not associated with fatal rollover crashes in the final multivariable logistic regression model (aOR:1.13; 95% CI: 0.9-1.5). Implications: Findings of risk factors associated with rollover crash fatalities in WV can inform several public health interventions. Rapid and sensitive assessment tools and standardized toxicology testing are helpful to provide more comprehensive drug-impaired driving datasets for future analysis.

Facilitators, barriers and lessons learnt from the first state-wide naloxone distribution conducted in West Virginia.

BACKGROUND: Overdose education and naloxone distribution programmes are known to reduce opioid-related deaths. A state-wide naloxone distribution effort of 8250 rescue kits was undertaken by government, community and university partners in West Virginia in 2016-2017. The purpose of this study was to discern the barriers, facilitators and lesson learnt from implementing this endeavour in a rural state with the highest opioid overdose fatality rate in the US. METHODS: Structured interviews (n=26) were conducted among both internal and external stakeholders. Those who participated were >18 years of age and were the lead representative from agencies that either received naloxone (ie, external stakeholders) or helped implement the distribution (ie, internal stakeholders). The interviews followed standardised scripts and lasted approximately 40 min. Sessions were audio-recorded and transcribed. Qualitative content analysis was performed by two researchers to determine themes surrounding facilitators or barriers to programme implementation. RESULTS: The primary facilitators reported by stakeholders included collaborative partnerships, ease of participating in the programme, being established in prevention efforts, demand for naloxone and the need for personal protection from overdose. The primary barriers identified by stakeholders included bureaucracy/policy/procedures of their organisation or agency, stigma, logistical or planning issues, problems with reporting, lack of communication post distribution and sustainability. Numerous lessons were learnt. CONCLUSIONS: Based on the implementation of the programme in 87 organisations, including law enforcement and fire departments, the impact of facilitators outweighed that of barriers. These findings may inform others planning to conduct a similar, large-scale project.

Triple Negative Breast Cancer in an Appalachian Region: Exponential Tumor Grade Increase with Age of Diagnosis.

Introduction: Triple negative breast cancer is an aggressive breast cancer with decreased five-year survival, increased risk for recurrence, and higher risk for metastases. Unlike other breast cancers, it has no targeted treatment and has heterogeneous genetics which make classification and treatment difficult. Purpose: The purpose of our research was to compare triple negative breast cancer to non-triple negative breast cancer to identify key epidemiologic factors that might lead to improved basic science directives for biomarkers, treatments, and classification. Methods: The state cancer registry was used to provide the first West Virginia state-wide population evaluation of triple negative breast cancer. Results: The research reveals novel results that tumor grade increases exponentially with the age at diagnosis. Implications: This creates an epidemiologic foundation for future research to define whether the disease, access to care, biology of aging, or some other factor cause this significant finding. In addition, results reveal decreased use of testing that could be increased to improve biomarker identification, targeted treatments, and classification of triple negative breast cancer.

Risk factors associated with driving under the influence of drugs in the USA.

BACKGROUND: Driving under the influence of drugs (DUID) is a burgeoning public health concern in the USA. Because little is known about individuals who engage in DUID, the purpose of this study was to analyse potential sociodemographic characteristics and behavioural risk factors associated with the behaviour. METHODS: Self-reported data from drivers ≥18 years of age who ever used drugs and participated in the 2018 National Survey on Drug Use and Health were used. Characteristics of those who reported to engage and not engage in DUID were compared via frequencies, percentages and logistic regression analyses, which accounted for the multistage survey design. RESULTS: Among eligible respondents, 10.4% (weighted n=117 275 154) reported DUID. DUID was higher among those aged 18-25 year (34%), males (65%), unmarried individuals (61%), lesbian/gay/bisexuals (13%), those whom abused or were drug dependent (45%), engaged in numerous risky lifestyle behaviours (12%) and those taking medication for a mental health issue (22%). Nearly 20% and 6% of respondents engaged in DUID abused or were dependent on marijuana or methamphetamine, respectively. The adjusted odds of DUID were greatest among those 18-25 years of age (OR 3.7; 95% CI 2.8 to 5.0), those never/not married (OR 1.8; 95% CI 1.5 to 2.2), those who abused or were drug dependent (OR 4.0; 95% CI 3.5 to 4.7), exhibited riskier lifestyle behaviours (OR 8.0; 95% CI 5.9 to 11.0), were employed (OR 1.3; 95% CI 1.1 to 1.6) or lesbian/gay/bisexuals (OR 1.4; 95% CI 1.1 to 1.7). CONCLUSIONS: DUID was common among some population sub-groups who may benefit from intervention.

The development and reliability of a national survey of police officers regarding the enforceability of cell phone use while driving laws.

Even though numerous types of cellphone use while driving (CPWD) laws have been passed in the United States, it does not appear that these laws are heavily enforced by police. Two studies conducted among officers from West Virginia and Washington states found that numerous barriers to CPWD enforcement exist. However, no studies have investigated whether barriers to enforcement exist for officers nationally. The purpose of this study was to design a national survey of police regarding the enforcement of CPWD laws and to assess the survey's reliability. The survey was designed based on the existing literature, cognitive tested, and assessed for face validity among experts. Officers were recruited via convenience sampling to assess the survey for test-retest correlation, test-retest agreement, and internal consistency reliability using standardized Cronbach's α and weighted Kappa statistics. Among participants, the test-retest correlations for most sections of the survey showed acceptable correlation (Cronbach α's > 0.7) (N = 6). For test-retest agreement, the median Kappa equaled 0.77 (N = 6). As for internal consistency reliability, responses thought to be associated showed acceptable correlation with Cronbach α ranging from 0.41 to 0.94 (N = 353). Despite the limited number of officers that participated in test-retest correlation and agreement, the survey appeared quite reliable.

Association between cellphone use while driving legislation and self-reported behaviour among adult drivers in USA: a cross-sectional study.

OBJECTIVES: Cellphone use behaviours can vary demographically in the USA. This study examined whether legislation restricting cellphone use while driving was associated with lower self-reported hand-held cellphone conversations or texting behaviours among adult drivers of different ages (19-24, 25-39, 40-59,≥60 years), sex, race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, Other) or rurality (urban, rural). DESIGN: Cross-sectional study. SETTING: USA. PARTICIPANTS: Individuals ≥19 years of age who indicated they were a current driver and participated in the 2011-2014 Traffic Safety Culture Index Surveys (n=9706). PRIMARY OUTCOME: The exposure was the presence of a hand-held calling or texting ban applicable to all drivers (ie, universal) at time of survey. Modified Poisson regression with robust SE was used to estimate the risk of engaging in these self-reported behaviours. RESULTS: In fully adjusted models, universal texting bans were not associated with lower texting behaviours (adjusted risk ratio [aRR]=0.92; 95% CI 0.84, 1.01). In stratified, fully adjusted models, men and those of other racial/ethnic origin were 13% and 33% less likely, respectively (aRR=0.87; 95% CI 0.77, 0.98; aRR=0.67; 95% CI 0.46, 0.97), to engage in texting behaviours if a universal texting ban was effective in their state. Conversely, universal hand-held calling bans were associated with lower self-reported hand-held cellphone conversations across every sub-group. In fully adjusted models, the presence of a hand-held calling ban was associated with 40% lower (aRR=0.60, 95% CI 0.54, 0.67) self-reported hand-held cellphone conversations while driving. CONCLUSIONS: Universal hand-held calling bans were associated with lower self-reported cellphone conversations for adult drivers. More interventional work targeting adult drivers may be needed to reduce texting while driving.

Differences between occupational and non-occupational-related motor vehicle collisions in West Virginia: A cross-sectional and spatial analysis.

BACKGROUND: Motor vehicle collisions comprise the majority of occupational-related fatalities in the United States and West Virginia has one of the highest occupational-related fatality rates in the nation. The purpose of this study was to compare work and non-work-related collisions, crash locations, and the characteristics of in-state and out-of-state drivers ≥18 years of age who were fatally injured in work-related collisions in West Virginia. METHODOLOGY: Data were from the 2000-2017 Fatality Analysis Reporting System. Work and non-work-related crashes and characteristics in-state vs. out-of-state drivers were compared using binary and multivariable logistic regression analyses. Crash locations were compared via spatial analyses using kernel density estimations. RESULTS: Among the 5,835 individuals fatally injured in crashes, 209 were designated 'at work'. The odds of being a work-related crash were 85% lower [Odds Ratio (OR) = 0.15; 95% confidence interval (CI): 0.04, 0.49] among those testing positive for alcohol, but 2.5 times greater (OR = 2.56; 95% CI: 1.16, 5.65) among those holding a commercial driver's license. The odds of being an in-state driver were 75% lower (OR = 0.25; 95% CI: 0.12, 0.53) among those wearing a safety belt, but 2.7 times greater among workers testing drug positive (OR = 2.67; 95% CI: 1.10, 6.52). In-state drivers were also less likely to be driving a large truck or be involved in single vehicle collisions and less likely to experience crashes on weekends, nights, or on highways. Spatial patterns of crash locations varied slightly between workers and non-workers. CONCLUSIONS: Work-related crashes differed greatly from non-work-related crashes in West Virginia. Stark differences existed between in-state and out-of-state workers and their crashes. Various avenues for workplace safety interventions exist, including seatbelt initiatives and drug testing policies for non-commercial drivers, which could help mitigate West Virginia's elevated, occupational-related, traffic fatality rate.

Challenges of enforcing cell phone use while driving laws among police: a qualitative study.

BACKGROUND: Cell phone use while driving laws do not appear to be heavily enforced in the USA. This study seeks to gain law enforcements' perspective and learn potential barriers to cell phone law enforcement. METHODS: Qualitative interviews (ie, focus groups) were conducted with officers (N=19) from five West Virginia law enforcement agencies. The officers who participated were >18 years of age, sworn into their departments and employed in law enforcement for >1 year. Focus group sessions lasted 45-60 min and followed a standardised, pilot-tested script. These sessions were audio recorded and transcribed. Qualitative content analysis was employed among three researchers to determine themes surrounding enforcement. RESULTS: Four themes emerged including current culture, the legal system, the nature of police work and issues with prevention. Specific barriers to enforcement included cultural norms, lack of perceived support from courts/judges, different laws between states, the need for a general distracted driving law, unclear legislation, officers' habits and perceived risk, wanting to maintain a positive relationship with the public, not being able to see the driver (impediments of vehicle design, time of day), phones having multiple functions and not knowing what drivers are actually doing, risk of crashing during traffic stops and lack of resources. Prevention activities were debated, and most felt that technological advancements implemented by cell phone manufacturers may deter use. CONCLUSIONS: Numerous barriers to cell phone law enforcement exist. Legislation could be amended to facilitate enforcement. Prevention opportunities exist to deter cell phone use while driving.

Traffic Fatalities in West Virginia and the Remaining United States, 2008-2012.

Purpose: Research has shown that Appalachia has a higher traffic fatality rate than the non-Appalachian United States. This study compared traffic fatality rates in West Virginia to the rest of the United States. Methods: Fatality Analysis Reporting System and Census data from 2008-2012 were used to calculate traffic fatality rates. Poisson regression was used to model rate ratios stratified by age, sex, rurality, and transportation type, as well as rate ratios per licensed driver, vehicles registered and miles travelled. Results: The West Virginia traffic fatality rate was 71% higher that the United States. Fatality rates per-capita were elevated for vehicle passengers and drivers of passenger vehicles, and large trucks. In contrast, rates for pedestrians and bicyclists were lower that the rest of the country. Conclusion: Public health intervention and further research are likely needed to discern reasons as to why this disparity exists in West Virginia.