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PubMed2005

Marijuana use and car crash injury.

AIMS: To investigate the relationship between marijuana use prior to driving, habitual marijuana use and car crash injury. DESIGN AND SETTING: Population based case-control study in Auckland, New Zealand. PARTICIPANTS: Case vehicles were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and control vehicles were a random sample of cars driving on Auckland roads. The drivers of 571 case and 588 control vehicles completed a structured interview. MEASUREMENTS: Self reported marijuana use in the 3 hours prior to the crash/survey and habitual marijuana use over the previous 12 months were recorded, along with a range of other variables potentially related to crash risk. The main outcome measure was hospitalization or death of a vehicle occupant due to car crash injury. FINDINGS: Acute marijuana use was significantly associated with car crash injury, after controlling for the confounders age, gender, ethnicity, education level, passenger carriage, driving exposure and time of day (OR 3.9, 95% CI 1.2-12.9). However, after adjustment for these confounders plus other risky driving at the time of the crash (blood alcohol concentration, seat-belt use, travelling speed and sleepiness score), the effect of acute marijuana intake was no longer significant (OR 0.8, 95% CI 0.2-3.3). There was a strong significant association between habitual use and car crash injury after adjustment for all the above confounders plus acute use prior to driving (OR 9.5, 95% CI 2.8-32.3). CONCLUSIONS: This population-based case-control study indicates that habitual use of marijuana is strongly associated with car crash injury. The nature of the relationship between marijuana use and risk-taking is unclear and needs further research. The prevalence of marijuana use in this driving population was low, and acute use was associated with habitual marijuana use, suggesting that intervention strategies may be more effective if they are targeted towards high use groups.

Accidents, Traffic↗

PubMed1996

Three-year results of prevention programs on marijuana use: the New Hampshire study.

The effects on marijuana use of 1) a drug prevention curriculum, or 2) this curriculum with added parent and other adult community activities in comparison with 3) a control community were investigated. Baseline information on drug-related behaviors from a sample of fourth, fifth, and sixth graders aged nine to fourteen years in rural New Hampshire (N = 1200) were obtained. The children completed these initial questionnaires in classrooms in 1987. In the comprehensive community intervention regular marijuana use was reduced by over 50 percent. No program had a significant effect on the initiation of marijuana use. The predictors of initiation were being in a higher grade, low school satisfaction, poor academic achievement, feeling unloved by one's family, feeling unpopular, and being part of a drug-using peer group. The baseline predictors of subsequent regular marijuana use were poor academic achievement, feeling unpopular, and being part of a drug-using peer group. In interviews the cultural and social contexts of marijuana use were explored. Strategies to prevent marijuana use need to take into account the profile of the marijuana-using child, the adult community's attitudes and beliefs about drugs, and the access of drug sellers and users to children.

Adolescent↗

PubMed1997

Correlates of college student marijuana use: results of a US National Survey.

This study examines which personal student background and college characteristics are associated with marijuana use. A self-administered survey was mailed to a national representative sample of 17592 students at 140 American colleges. One of four (24.8%) students reported using marijuana within the past year. Rates of use among the colleges ranged from zero per cent at the lowest use schools to 54% at the highest use schools. Multiple regression models, constructed to determine the college and student characteristics predicting marijuana use, suggest that use was higher among students at non-commuter colleges and at colleges with pubs on campus. Student characteristics associated with marijuana use included being single, white, spending more time at parties and socializing with friends, and less time studying. Marijuana use was higher among students who participate in other high risk behaviors such as binge drinking, cigarette smoking and having multiple sexual partners, and among students who perceived parties as important, and religion and community service as not important. The study points to the social nature of drug use in college, and demonstrates that this behavior is of continuing concern for public health.

Adolescent↗

PubMed1987

Adolescent marijuana use: screening and ethics.

Adolescent marijuana use is an issue of concern to the entire community. The emergence of technology that can identify marijuana use poses questions relating to public health issues such as justification and extension of screening. This article discusses the moral issues relating to surveillance of adolescent marijuana use and postulates a justification for clinical screening.

Adolescent↗

PubMed2005

Epidemiologic review of marijuana use and cancer risk.

Marijuana is the most commonly used illegal drug in the United States and is considered by young adults to be the illicit drug with the least risk. On the other hand, marijuana smoke contains several of the same carcinogens and co-carcinogens as the tar from tobacco, raising concerns that smoking of marijuana may be a risk factor for tobacco-related cancers. We reviewed two cohort studies and 14 case-control studies with assessment of the association of marijuana use and cancer risk. In the cohort studies, increased risks of lung or colorectal cancer due to marijuana smoking were not observed, but increased risks of prostate and cervical cancers among non-tobacco smokers, as well as adult-onset glioma among tobacco and non-tobacco smokers, were observed. The 14 case-control studies included four studies on head and neck cancers, two studies on lung cancer, two studies on non-Hodgkin's lymphoma, one study on anal cancer, one study on penile cancer, and four studies on childhood cancers with assessment of parental exposures. Zhang and colleagues reported that marijuana use may increase risk of head and neck cancers in a hospital-based case-control study in the United States, with dose-response relations for both frequency and duration of use. However, Rosenblatt and co-workers reported no association between oral cancer and marijuana use in a population-based case-control study. An eightfold increase in risk among marijuana users was observed in a lung cancer study in Tunisia. However, there was no assessment of the dose response, and marijuana may have been mixed with tobacco. Parental marijuana use during gestation was associated with increased risks of childhood leukemia, astrocytoma, and rhabdomyosarcoma, but dose-response relations were not assessed. In summary, sufficient studies are not available to adequately evaluate marijuana impact on cancer risk. Several limitations of previous studies include possible underreporting where marijuana use is illegal, small sample sizes, and too few heavy marijuana users in the study sample. Recommendations for future studies are to (1) focus on tobacco-related cancer sites; (2) obtain detailed marijuana exposure assessment, including frequency, duration, and amount of personal use as well as mode of use (smoked in a cigarette, pipe, or bong; taken orally); (3) adjust for tobacco smoking and conduct analyses on nonusers of tobacco; and (4) conduct larger studies, meta-analyses, or pooled analyses to maximize statistical precision and investigate sources of differences in results. Despite the challenges, elucidation of the association between marijuana use and cancer risk is important in weighing the benefits and risks of medical marijuana use and to clarify the impact of marijuana use on public health.

Animals↗

PubMed2002

Does marijuana use have residual adverse effects on self-reported health measures, socio-demographics and quality of life? A monozygotic co-twin control study in men.

AIMS: To assess the effects of former heavy marijuana use on selected aspects of health. DESIGN: A monozygotic co-twin control design was used to compare the health of former heavy marijuana using male monozygotic twins to that of their co-twins who never used marijuana significantly. SETTING: In-person survey and questionnaires. PARTICIPANTS: Fifty-six marijuana use discordant monozygotic twin pair members of the Vietnam Era Twin (VET) Registry. MEASUREMENTS: Current socio-demographic characteristics; current nicotine and alcohol use; life-time nicotine and alcohol abuse/dependence; past 5-year physical and mental health services utilization; and health-related quality of life. FINDINGS: The mean number of days on which the marijuana user twin used marijuana in his life-time was 1085, while the non-marijuana user used marijuana a maximum of 5 days. Marijuana was last used a mean of 20 years previously. No significant differences were found between the former marijuana user twins and their siblings for current socio-demographic characteristics; current nicotine or alcohol use; life-time nicotine or alcohol abuse/dependence; past 5-year out-patient or emergency room visits, hospitalizations or medication use for medical problems; past 5-year mental health out-patient use or hospitalizations; or health-related quality of life. CONCLUSIONS: Previous heavy marijuana use a mean of 20 years earlier by a group of men who reported no other significant illicit drug use does not appear to be associated with adverse socio-demographic, physical or mental health adverse effects. The conclusions of the study are limited by possible participation and recall biases, relatively small sample size and the absence of a physical health examination.

Adult↗

PubMed2006

Marijuana use and depression among adults: Testing for causal associations.

AIM: To determine whether marijuana use predicts later development of depression after accounting for differences between users and non-users of marijuana. DESIGN: An ongoing longitudinal survey of 12 686 men and women beginning in 1979. SETTING: The National Longitudinal Survey of Youth of 1979, a nationally representative sample from the United States. PARTICIPANTS: A total of 8759 adults (age range 29-37 years) interviewed in 1994 had complete data on past-year marijuana use and current depression. MEASUREMENTS: Self-reported past-year marijuana use was tested as an independent predictor of later adult depression using the Center for Epidemiologic Studies-Depression questionnaire. Individual's propensity to use marijuana was calculated using over 50 baseline covariates. FINDINGS: Before adjusting for group differences, the odds of current depression among past-year marijuana users is 1.4 times higher (95% CI: 1.1, 1.9) than the odds of depression among the non-using comparison group. After adjustment, the odds of current depression among past-year marijuana users is only 1.1 times higher than the comparison group (95% CI: 0.8, 1.7). Similarly, adjustment eliminates significant associations between marijuana use and depression in four additional analyses: heavy marijuana use as the risk factor, stratifying by either gender or age, and using a 4-year lag-time between marijuana use and depression. CONCLUSIONS: After adjusting for differences in baseline risk factors of marijuana use and depression, past-year marijuana use does not significantly predict later development of depression. These findings are discussed in terms of their relevance for understanding possible causal effects of marijuana use on depression.

Adult↗

PubMed2006

Association between marijuana use and transitional cell carcinoma.

OBJECTIVES: Marijuana smoking has been implicated as a causative factor in traditionally tobacco-related tumors of the head and neck and of the lung. When associated with marijuana use, such tumors occur in a much younger patient population than do similar tumors in tobacco smokers. Owing to the large number of young men with a history of marijuana presenting with transitional cell carcinoma to VA facilities, this study was designed to compare the marijuana use among young (aged less than 60 years) transitional cell carcinoma patients with that among age-matched controls. METHODS: Fifty-two men aged less than 60 years presenting consecutively with transitional cell carcinoma and 104 age-matched controls (defined by having no history of transitional cell carcinoma, hematuria, or irritative voiding symptoms, as well as unremarkable results on urinalysis and urine cytology) completed questionnaires about exposure to various potential carcinogens, including radiation, Agent Orange, smoked or processed meats, dyes, tobacco, and marijuana. RESULTS: Of the 52 transitional cell carcinoma patients, 46 (88.5%) reported a history of habitual marijuana usage, and 72 (69.2%) of the age-matched controls gave a history of habitual marijuana use. This difference was statistically significant (P = 0.008). In those with transitional cell carcinoma, marijuana use significantly correlated with tumor stage, grade, and number of recurrences. CONCLUSIONS: Marijuana smoking might increase the risk of transitional cell carcinoma.

Carcinoma, Transitional Cell↗

PubMed1986

Depersonalization and agoraphobia associated with marijuana use.

This paper examines the role of uncontrolled depersonalization associated with marijuana use in the development of agoraphobia. Cases of six people are described, all of whom reported first experiencing depersonalization while using marijuana, and subsequently experiencing depersonalization while not using the drug. A fear of this 'uncontrolled' depersonalization resulted in considerable anticipatory anxiety and panic attacks. Patients ultimately presented for treatment of agoraphobia. A temporal relationship between marijuana use, uncontrolled depersonalization, panic attacks and agoraphobia does not imply causality. Comparison of these cases with other agoraphobia clinic patients provides tentative evidence for a difference between the two types of patients. There were no systematic patterns of stressors in the cases prior to the onset of symptoms. Data obtained before and after treatment indicated the cases were slightly more severe than clinic patients. Males and females were represented equally in the cases, whereas there was a higher incidence of females in the clinic patients. The cases' age of onset was younger than that of the clinic patients. Our standard cognitive-behavioural treatment programme required modification to account for the intensity of the fear of depersonalization in the cases.

Adult↗

PubMed1997

How do genes influence marijuana use? The role of subjective effects.

This study investigated determinants of the subjective effects of marijuana and the relationship of subjective effects to marijuana use. Subjects were 8169 twins drawn from the Vietnam Era Twin Registry. Subjects who used marijuana more than five times (n = 2513) reported whether they experienced each of 23 subjective reactions. Factor analysis identified a positive (pleasant) reaction factor and a negative (unpleasant) reaction factor. Both factors were related to duration and frequency of use. Pairs in which both members used marijuana more than five times (MZ = 352 pairs; DZ = 255 pairs) were examined to assess determinants of subjective effects. Approximately one-quarter of the variance in each factor was determined by additive genetic influences; the remaining variance was determined by environmental factors that are not shared by members of a twin pair. The shared or family environment had no detectable influence on either subjective reaction factor.

Adult↗

PubMed1995

The impact of cocaine and marijuana use on low birth weight and preterm birth: a multicenter study.

OBJECTIVE: Our aim was to evaluate prospectively the effects of cocaine and marijuana use on pregnancy outcomes. STUDY DESIGN: A prospective multicenter cohort study was conducted at seven university-based prenatal clinics in the United States from 1984 to 1989. The cohort described herein consisted of a multiethnic population of 7470 pregnant women. Information on the use of drugs was obtained from personal interviews at entry to the study and assays of serum obtained during pregnancy. Pregnancy outcome data (low birth weight [< 2500 gm], preterm birth [< 37 weeks' gestation], and abruptio placentae) were obtained with a standardized study protocol. RESULTS: A total of 2.3% of the women used cocaine and 11.0% used marijuana during pregnancy. Cocaine use was not associated with having a low-birth-weight infant (adjusted odds ratio 0.7, 95% confidence interval 0.4 to 1.3) or a preterm birth (1.3, 0.9 to 2.0). There was no association between short-term exposure to cocaine and preterm delivery (1.1, 0.3 to 4.0). However, cocaine use was strongly associated with abruptio placentae (adjusted odds ratio 4.2, 1.9 to 9.5). Marijuana use was not associated with low birth weight (1.1, 0.9 to 1.5), preterm delivery (1.1, 0.8 to 1.3) or abruptio placentae (1.3, 0.6 to 2.8). By comparison, 35% of the women smoked cigarettes during pregnancy, and cigarette smoking was positively associated with low birth weight (1.5, 1.2 to 1.8). CONCLUSIONS: In this population of women receiving prenatal care, cocaine use was uncommon and was not related to most adverse birth outcomes. Marijuana use was relatively common and was not related to adverse pregnancy outcomes. Tobacco is still the most commonly abused drug during pregnancy, 15% of all cases of low birth weight in this study could have been prevented if women did not smoke cigarettes during pregnancy.

Abruptio Placentae↗

PubMed2003

Marijuana use and prior injury among injured problem drinkers.

OBJECTIVES: The purpose of this paper is to better understand marijuana use among injured problem drinkers in the emergency department (ED). The specific objectives are: 1) to assess the prevalence of marijuana use; 2) to identify factors associated with marijuana use; 3) to determine whether prior injury is associated with marijuana use; and 4) to determine whether marijuana-using problem drinkers want to change behaviors. METHODS: The authors conducted a post-hoc analysis on data obtained prospectively. Subjects had injury and problem drinking: either measurable alcohol level (blood alcohol concentration, BAC), report of drinking, or an Alcohol Use Disorders Identification Test (AUDIT) score of > or =8. The study was conducted on weekend nights; 3,776 injured ED patients were screened, 383 refused, 578 were enrolled, and 433 had complete data. RESULTS: Of the 433 subjects, 48.3% reported using marijuana in the three months prior. Marijuana-using problem drinkers had more hazardous drinking, higher AUDIT scores (14.0 vs. 11.4, p < 0.001), and higher risk-taking scores (12.4 vs. 10.1, p < 0.001). More used other drugs (69.7% vs. 30.3%, p < 0.001). In regression analyses, marijuana use remained an independent predictor of prior injury (OR = 2.16, 95% CI = 1.25 to 3.75), particularly prior alcohol-related (OR = 2.26, 95% CI = 1.45 to 3.53) and motor-vehicle-related (OR = 1.69, 95% CI = 1.03 to 2.79) injury. Readiness-to-change scores were similar (4.14 vs. 4.22, p = 0.21) between users and nonusers. CONCLUSIONS: Marijuana use among injured problem drinkers is prevalent. Their risk of prior injury is increased. Counseling for alcohol and injury should address marijuana use.

Adult↗

PubMed2006

Misperceptions of college student marijuana use: implications for prevention.

OBJECTIVE: This study investigates the relationship between marijuana use, perceived norms of use by friends and students in general, and negative experiences or problems from alcohol and drug use. It was hypothesized that students would overestimate the marijuana use of students in general and that perceptions about the prevalence of marijuana use would be related to drug-related consequences. METHOD: In this study, 5,990 participants provided information on the perceptions and consequences of drug use via an online survey or via a paper-based survey. RESULTS: Although two thirds of participants reported no marijuana use, 98% of respondents incorrectly predicted that students in general use marijuana at least once per year. Perceptions of use by friends and students in general accounted for variance in drug use and related problems or experiences. CONCLUSIONS: Given the relationship between norm misperception and behavior with marijuana use, future research could explore the impact of targeting misperceived norms through prevention and intervention efforts.

Adolescent↗

PubMed1991

Marijuana use, introspectiveness, and mental health.

Conflicting evidence suggests that marijuana use may be associated with either positive or negative mental health. This study explores the possibility that the association of marijuana use with mental health differs among various subgroups of users. Specifically, we investigate the hypothesis that marijuana use and the personality disposition of introspectiveness interact in their effects on psychological well-being. Results support this hypothesis and show that marijuana use is associated significantly with psychological distress for highly introspective individuals. In contrast, marijuana use has no such association for those low on introspectiveness. Additional evidence shows that marijuana use involves primarily self-oriented cognitive and emotional experiences for highly introspective individuals, whereas for those low on introspectiveness it is characterized more often by perceptual distortions and sensorimotor sensations.

Adult↗

PubMed1980

The social network in marijuana-using groups.

Three ongoing marijuana-using groups were studied in their natural environments. Group characteristics and the relationship of each member to individuals within the group were assessed, in addition to the members' primary social roles outside the group. The relationship of sociometric data to user characteristics was determined. The social and drug histories of the three groups were highly similar. Despite high levels of drug use, the most frequent reason for group participation was friendship, and diverse social activities occurred in the group. Social resources outside the group were minimal, whereas enduring, positive relationships characterized each group. Popularity was related to frequency of group participation, but not to extent of drug use. The function of marijuana-using groups in fulfilling interpersonal needs is discussed.

Adult↗

PubMed1998

Marijuana use and medically attended injury events.

STUDY OBJECTIVE: This study evaluated the relation between self-reported marijuana use and 3-year incidence of injury. METHODS: We conducted a retrospective cohort study of adult Kaiser Permanente Medical Care Program members who underwent multiphasic health examinations between 1979 and 1986 (n=4,462). Injury-related outpatient visits, hospitalizations, and fatalities within 3 years of examination were determined. RESULTS: Outpatient injury events totaled 2,524; 1,611 participants (36%) had at least 1 injury-related outpatient visit. Injury-related hospitalizations (n=22) and fatalities (n=3) were rare. Among men, there was no consistent relation between marijuana use and injury incidence for either former users (rate ratio, 1.15; 95% confidence interval [CI], .97 to 1.36) or current users (rate ratio, 0.97; 95% CI, .81 to 1.17), compared with those who had never used marijuana. Among women, former and current users showed little difference in their rate of later injury compared with never users; the rate ratios were 1.05 (95% CI, .87 to 1.26) and 1.20 (95% CI, 1.00 to 1.44), respectively. No statistically significant associations were noted between marijuana use and cause-specific injury incidence in men or women. CONCLUSION: Among members of a health maintenance organization, self-reported marijuana use in adult men or women was not associated with outpatient injury within 3 years of marijuana use ascertainment.

Adolescent↗

PubMed2000

Marijuana use among adults. A longitudinal study of current and former users.

This study examines the pattern of marijuana use among respondents who have passed the age of risk of onset, as well as some of the correlates related to the initiation and current use of marijuana. The data for this study included 8885 respondents drawn from the National Longitudinal Survey of Labor Market Experience of Youth (NLSY). Based on cross-tabulations of lifetime marijuana use in 1984 and 1994, the following outcomes were examined: incidence of lifetime marijuana use, inconsistent reports of lifetime marijuana use, and current compared with former use. Controlling for the effects of all variables studied, significant and independent effects were noted for sociodemographic factors, former patterns of use, and the use of other substances.

Adult↗

PubMed2002

Marijuana use among adolescents.

More than half of US adolescents will experiment with marijuana. Of those who try marijuana more than once, approximately one third will subsequently use marijuana regularly, although most will have stopped by their late 20s. Although genetic predisposition plays the most important role in determining who will develop dependence, environmental factors influence who will initiate marijuana use. One of the challenges for prevention and treatment programs is that the immediate adverse effects of marijuana use are not extreme, and many adolescents have difficulty in making decisions based on future risks. Therefore, the consequences of leaving school early, having unprotected sex, and driving while intoxicated are often insufficient to deter adolescents from using marijuana. Thus, it is not surprising that current prevention and treatment programs have had limited success in decreasing the rates of initiation and regular use of marijuana among adolescents. However, the accumulation of data about marijuana use in adolescents has the potential to enable the development of more effective prevention and treatment programs.

Adolescent↗