娱乐性大麻合法化后怀孕早期的大麻使用情况。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES JAMA Health Forum Pub Date : 2024-11-01 DOI:10.1001/jamahealthforum.2024.3656
Kelly C Young-Wolff, Natalie E Slama, Lyndsay A Avalos, Alisa A Padon, Lynn D Silver, Sara R Adams, Monique B Does, Deborah Ansley, Carley Castellanos, Cynthia I Campbell, Stacey E Alexeeff
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引用次数: 0

摘要

重要性:目前尚不清楚各州娱乐大麻合法化(RCL)是否与产前大麻使用率增加有关,也不清楚与 RCL 有关的变化是否因大麻筛查方法或当地政策环境而异:目的: 检验加利福尼亚州的 RCL 是否与产前大麻使用率的变化有关,自我报告和尿液毒理学检测中的变化是否明显,以及 RCL 后禁止与允许成人使用零售商的地方政策是否会导致产前大麻使用率的变化:这项基于人群的时间序列研究使用了北加州凯泽医疗机构(Kaiser Permanente Northern California)从 2012 年 1 月 1 日至 2019 年 12 月 31 日通过自我报告和毒理学检测对怀孕早期使用大麻的孕妇进行普遍筛查的数据。分析时间为 2022 年 9 月至 2024 年 8 月:加利福尼亚州 RCL 的通过(2016 年 11 月 9 日)和合法销售的实施(2018 年 1 月 1 日)滞后 1 个月进行研究。此外,还对 RCL 之前允许与禁止医疗零售商以及 RCL 之后允许与禁止成人使用零售商的地方政策进行了研究:任何产前大麻使用情况均基于产前护理入门时(通常在妊娠 8-10 周时)的筛查,并定义为(1)尿液毒理学检测结果呈阳性或自我报告,(2)尿液毒理学检测结果呈阳性,或(3)自我报告。采用泊松回归法拟合间断时间序列模型,并对年龄、种族和民族以及邻里贫困指数进行调整:样本中有 300 993 名孕妇(236 327 人),其中亚裔占 25.9%,黑人占 6.4%,西班牙裔占 26.0%,白人占 37.7%,其他、多重或未知种族占 4.1%,平均(标清)年龄为 30.3 (5.4)岁。在实施 RCL 之前,产前大麻使用率从 2012 年 1 月的 4.5% 稳步上升至 2018 年 1 月的 7.1%。在 RCL 通过时,使用率没有变化(水平变化率比 [RR],1.03;95% CI,0.96-1.11),而在 RCL 实施后的第一个月,使用率出现了统计意义上的显著增长,在 2018 年 2 月增至 8.6%(水平变化率比,1.10;95% CI,1.04-1.16)。当通过(1)毒理学测试或(2)自我报告来定义产前大麻使用时,结果相似。在地方政策分析中,只有在允许成人使用大麻零售商的辖区内,才会发现 RCL 实施后使用量的增加(允许 RR,1.21;95% CI,1.10-1.33;禁止 RR,1.01;95% CI,0.93-1.10):在这项时间序列研究中,加利福尼亚州 RCL 的实施与妊娠早期大麻使用率的增加有关,妊娠早期大麻使用率由自我报告和毒理学测试确定,由生活在允许成人使用零售商辖区的个人驱动。
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Cannabis Use During Early Pregnancy Following Recreational Cannabis Legalization.

Importance: It is unknown whether state recreational cannabis legalization (RCL) is related to increased rates of prenatal cannabis use or whether RCL-related changes vary with cannabis screening methods or the local policy environment.

Objective: To test whether RCL in California was associated with changes in prenatal cannabis use rates, whether changes were evident in both self-report and urine toxicology testing, and whether rates varied by local policies banning vs allowing adult-use retailers post-RCL.

Design, setting, and participants: This population-based time-series study used data from pregnancies in Kaiser Permanente Northern California universally screened for cannabis use during early pregnancy by self-report and toxicology testing from January 1, 2012, to December 31, 2019. Analyses were conducted from September 2022 to August 2024.

Exposures: California state RCL passage (November 9, 2016) and implementation of legal sales (January 1, 2018) were examined with a 1-month lag. Local policies allowing vs banning medical retailers pre-RCL and adult-use retailers post-RCL were also examined.

Main outcomes and measures: Any prenatal cannabis use was based on screening at entrance to prenatal care (typically at 8-10 weeks' gestation) and defined as (1) a positive urine toxicology test result or self-report, (2) a positive urine toxicology test result, or (3) self-report. Interrupted time series models were fit using Poisson regression, adjusting for age, race and ethnicity, and neighborhood deprivation index.

Results: The sample of 300 993 pregnancies (236 327 unique individuals) comprised 25.9% Asian individuals, 6.4% Black individuals, 26.0% Hispanic individuals, 37.7% White individuals, and 4.1% individuals of other, multiple, or unknown race, with a mean (SD) age of 30.3 (5.4) years. Before RCL implementation, rates of prenatal cannabis use rose steadily from 4.5% in January 2012 to 7.1% in January 2018. There was no change in use rates at the time of RCL passage (level change rate ratio [RR], 1.03; 95% CI, 0.96-1.11) and a statistically significant increase in rates in the first month after RCL implementation, increasing to 8.6% in February 2018 (level change RR, 1.10; 95% CI, 1.04-1.16). Results were similar when defining prenatal cannabis use by (1) a toxicology test or (2) self-report. In local policy analyses, the post-RCL implementation increase in use was only found among those in jurisdictions allowing adult-use cannabis retailers (allowed RR, 1.21; 95% CI, 1.10-1.33; banned RR, 1.01; 95% CI, 0.93-1.10).

Conclusions and relevance: In this time-series study, RCL implementation in California was associated with an increase in rates of cannabis use during early pregnancy, defined by both self-report and toxicology testing, driven by individuals living in jurisdictions that allowed adult-use retailers.

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来源期刊
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期刊介绍: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health, and health care. The journal publishes original research, evidence-based reports, and opinion about national and global health policy. It covers innovative approaches to health care delivery and health care economics, access, quality, safety, equity, and reform. In addition to publishing articles, JAMA Health Forum also features commentary from health policy leaders on the JAMA Forum. It covers news briefs on major reports released by government agencies, foundations, health policy think tanks, and other policy-focused organizations. JAMA Health Forum is a member of the JAMA Network, which is a consortium of peer-reviewed, general medical and specialty publications. The journal presents curated health policy content from across the JAMA Network, including journals such as JAMA and JAMA Internal Medicine.
期刊最新文献
Cannabis Use During Early Pregnancy Following Recreational Cannabis Legalization. Change of Ownership and Quality of Home Health Agency Care. Errors in Conflict of Interest Disclosures. JAMA Health Forum. Surgeon Workforce in Underserved Communities.
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