Association of Cannabis Retailer Proximity and Density With Cannabis Use Among Pregnant Women in Northern California After Legalization of Cannabis for Recreational Use

Young-Wolff, Kelly C.; Adams, Sara R.; Padon, Alisa A.; Silver, Lynn; Alexeeff, Stacey; Eeden, Stephen K. Van Den; Avalos, Lyndsay A.

doi:10.1001/jamanetworkopen.2021.0694

Cited by 24 publications

(19 citation statements)

References 5 publications

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“…Cannabis-attributable ED visits increased starting in May 2020, coinciding with large increases in per-capita stores and cannabis sales. This finding is consistent with evidence suggesting that commercialization of recreational cannabis, including greater retail availability of cannabis stores, is associated with higher rates of cannabis use and harms in a variety of populations in the United States [17,[23][24][25]. The reported changes in cannabis-attributable ED visits align with survey data from Ontario, which show that the percentage of Ontarians reporting daily or almost daily cannabis use did not change significantly between pre-legalization (4.9%, 95% CI = 3.3, 6.6 in Q1, 2018) and the first year postlegalization (6.0%, 95% CI = 5.1, 7.1 in Q1-4, 2019) before almost doubling to 9.3% (95% CI = 7.9, 12.1) during the period of market commercialization and COVID-19 (Q4, 2020) [7].…”

Section: Table 1 Describes Observed Changes In Cannabis-attributable Edsupporting

confidence: 88%

The association between recreational cannabis legalization, commercialization and cannabis‐attributable emergency department visits in Ontario, Canada: an interrupted time–series analysis

et al. 2022

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Background and aims Recreational cannabis was legalized in Canada in October 2018. Initially, the Government of Ontario (Canada’s largest province) placed strict limits on the number of cannabis retail stores before later removing these limits. This study measured changes in cannabis‐attributable emergency department (ED) visits over time, corresponding to different regulatory periods. Design Interrupted time–series design using population‐level data. Two policy periods were considered; recreational cannabis legalization with strict store restrictions (RCL, 17 months) and legalization with no store restrictions [recreational cannabis commercialization (RCC), 15 months] which coincided with the COVID‐19 pandemic. Segmented Poisson regression models were used to examine immediate and gradual effects in each policy period. Setting Ontario, Canada. Participants All individuals aged 15–105 years (n = 13.8 million) between January 2016 and May 2021. Measurements Monthly counts of cannabis‐attributable ED visits per capita and per all‐cause ED visits in individuals aged 15+ (adults) and 15–24 (young adults) years. Findings We observed a significant trend of increasing cannabis‐attributable ED visits pre‐legalization. RCL was associated with a significant immediate increase of 12% [incident rate ratio (IRR) = 1.12, 95% confidence interval (CI) = 1.02–1.23] in rates of cannabis‐attributable ED visits followed by significant attenuation of the pre‐legalization slope (monthly slope change IRR = 0.98, 95% CI = 0.97–0.99). RCC and COVID‐19 were associated with immediate significant increases of 22% (IRR = 1.22, 95% CI = 1.09–1.37) and 17% (IRR = 1.17, 95% CI = 1.00–1.37) in rates of cannabis‐attributable visits and the proportion of all‐cause ED visits attributable to cannabis, respectively, with insignificant increases in monthly slopes. Similar patterns were observed in young adults. Conclusions In Ontario, Canada, cannabis‐attributable emergency department visits stopped increasing over time following recreational cannabis legalization with strict retail controls but then increased during a period coinciding with cannabis commercialization and the COVID‐19 pandemic.

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Section: Table 1 Describes Observed Changes In Cannabis-attributable Edsupporting

confidence: 88%

The association between recreational cannabis legalization, commercialization and cannabis‐attributable emergency department visits in Ontario, Canada: an interrupted time–series analysis

et al. 2022

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“…Data from a nationally representative sample of pregnant women in the United States indicated that the prevalence of self‐reported past‐month cannabis use increased from 3.4% in 2002–2003 to 7.0% in 2016–2017 (Volkow, Han, Compton, & McCance‐Katz, 2019). Importantly, as US states continue to legalize cannabis for recreational use (Geiger, 2016; State Medical Marijuana Laws, 2017), cannabis use among pregnant women may increase even more markedly (Gnofam, Allshouse, Stickrath, & Metz, 2020; Skelton, Hecht, & Benjamin‐Neelon, 2020, 2021; Young‐Wolff et al, 2021). Animal models have indicated that in‐utero exposure to cannabis is associated with cognitive abnormalities and impairments in outcomes that simulate neuropsychiatric impairments in humans (Nashed, Hardy, & Laviolette, 2021).…”

Section: Introductionmentioning

confidence: 99%

In‐utero cannabis exposure and long‐term psychiatric and neurodevelopmental outcomes: The limitations of existing literature and recommendations for future research

Sujan

Young-Wolff

Avalos

2022

Birth Defects Research

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Given increases in cannabis use in pregnancy and animal model researchshowing effects of in-utero cannabis exposure, high-quality information on long-term consequences of in-utero cannabis exposure in humans is needed. While reviews have summarized findings from observational studies with humans, reviews have not focused on limitations of these studies and recommendations for future research. Therefore, we critically reviewed observational research on in-utero cannabis exposure and psychiatric and neurodevelopmental outcomes measured at or after age 3 and provided recommendations for future research. We used Web of Science, Google Scholar, and work cited from relevant identified publications to identify 46 papers to include in our review. Our review includes two main sections. The first section highlights the extensive limitations of the existing research, which include small and nongeneralizable samples, reliance on self-reported data, lack of detail on timing and amount of exposure, inclusion of older exposure data only, not accounting for important confounders, inclusion of potential mediators as covariates, not including outcome severity measures, and not assessing for offspring sex differences. The second section provides recommendations for future research regarding exposure and outcome measures, sample selection, confounder adjustment, and other methodological considerations. For example, with regard to exposure definition, we recommend that studies quantify the amount of cannabis exposure, evaluate the influence of timing of exposure, and incorporate biological measures (e.g., urine toxicology measures). Given that highquality information on long-term consequences of in-utero cannabis exposure in humans does not yet exit, it is crucial for future research to address the limitations we have identified.

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“…However, another study found Dutch individuals who lived closer to a coffee shop were more likely to start cannabis at an earlier age (Palali & vanOurs, 2015). In California, longer drive time to the nearest outlet was associated with lower odds of cannabis use among pregnant women in California, OR = 0.96; 95% CI = 0.95–0.98 (Young‐Wolff et al., 2021). Having more retailers within a 15‐min drive was also associated with an increased likelihood of cannabis consumption (Young‐Wolff et al., 2021).…”

Section: Introductionmentioning

confidence: 99%

“…In California, longer drive time to the nearest outlet was associated with lower odds of cannabis use among pregnant women in California, OR = 0.96; 95% CI = 0.95–0.98 (Young‐Wolff et al., 2021). Having more retailers within a 15‐min drive was also associated with an increased likelihood of cannabis consumption (Young‐Wolff et al., 2021). Washington State residents who lived close to a cannabis retailer were more likely to report current use or frequent use (Everson et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Municipal regulation of cannabis and public health in Canada: A comparison of Alberta, Ontario, and Québec

Gagnon

Huỳnh²,

Kilborn

et al. 2022

Behavioral Sci & The Law

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Canada legalized nonmedical cannabis in October 2018, but significant variations in municipal regulations exist. This study explored the variations that exist and pondered their potential public health consequences. A comparative analysis was completed on the regulations and guidelines that addressed retailers' location and public consumption in the municipalities of Alberta, Ontario, and Québec. Municipal regulations that addressed the location of retailers were more numerous and extensive in Alberta and Ontario (in the context of provincial private retail models) than in Québec (government-based model). Municipalities in Alberta added more restrictions to public consumption laws as compared to municipalities in Ontario and in Québec. These additions were made to Alberta's and Ontario's provincial-level smoking and vaping bans which used tobacco-inspired frameworks, and to Québec's ban on smoking and vaping in all public spaces. The comparative analysis showed the importance of considering municipal cannabis regulations when studying the impact of legalization, given the significant variations that exist. Policy makers should be made aware of these variations in the regulation of cannabis in order to limit health harms and further social inequalities.

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Association of Cannabis Retailer Proximity and Density With Cannabis Use Among Pregnant Women in Northern California After Legalization of Cannabis for Recreational Use

Abstract: Open Access. This is an open access article distributed under the terms of the CC-BY License.

Cited by 24 publications

References 5 publications

The association between recreational cannabis legalization, commercialization and cannabis‐attributable emergency department visits in Ontario, Canada: an interrupted time–series analysis

The association between recreational cannabis legalization, commercialization and cannabis‐attributable emergency department visits in Ontario, Canada: an interrupted time–series analysis

In‐utero cannabis exposure and long‐term psychiatric and neurodevelopmental outcomes: The limitations of existing literature and recommendations for future research

Municipal regulation of cannabis and public health in Canada: A comparison of Alberta, Ontario, and Québec

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