This survey study using data from 169 036 participants in the 2016 and 2017 Behavioral Risk Factor Surveillance System surveys found that, compared with adults without medical conditions, adults with medical conditions had a significantly higher prevalence of current and daily marijuana use, were more likely to report using marijuana for medical reasons, and were less likely to report using marijuana for recreational purposes. Among respondents with medical conditions, 11.2% of young adults reported using marijuana on a daily basis, and the prevalence of marijuana use decreased with increasing age.
Richard Garfein, Ph.D., M.P.H., of UC San Diego Department of Medicine, presents "HIV, HCV, and TB Infection among Injection Drug Users in San Diego" at AIDS Clinical Rounds
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the ...Δρ. Γιώργος K. Κασάπης
There was a more than twofold increase in the rate of suspected self-poisoning suicide cases between 2011 and 2018, according to a new study that looked at more than 1.6 million such cases.
Here’s what else you need to know:
•Overall trends: Cases of suicide attempts by self-poisoning doubled in those aged 10-18 between 2011 and 2018, rising from around 39,000 to more than 78,000.
•Gender: More girls than boys attempted suicide by self-poisoning. The rate of intentional attempts among girls 10-18 also steadily increased from 2011-2018.
•Outcomes: The number of serious outcomes — including death and hospitalizations — as a result of the poisoning increased 235% between 2000 and 2018, and more than 1,400 children died.
Richard Garfein, Ph.D., M.P.H., of UC San Diego Department of Medicine, presents "HIV, HCV, and TB Infection among Injection Drug Users in San Diego" at AIDS Clinical Rounds
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the ...Δρ. Γιώργος K. Κασάπης
There was a more than twofold increase in the rate of suspected self-poisoning suicide cases between 2011 and 2018, according to a new study that looked at more than 1.6 million such cases.
Here’s what else you need to know:
•Overall trends: Cases of suicide attempts by self-poisoning doubled in those aged 10-18 between 2011 and 2018, rising from around 39,000 to more than 78,000.
•Gender: More girls than boys attempted suicide by self-poisoning. The rate of intentional attempts among girls 10-18 also steadily increased from 2011-2018.
•Outcomes: The number of serious outcomes — including death and hospitalizations — as a result of the poisoning increased 235% between 2000 and 2018, and more than 1,400 children died.
College Student Perceptions of Marijuana 2015SarahMartin33
This marketing research project was created to better understand college students perceptions on marijuana. In this paper we cover background research concerning legalization of marijuana and behavior. After identifying questions that were not answered during our research, we administered a survey via Qualtrics and received over 700 responses from college students in different colleges in the nation. We took their responses and analyzed our data over SPSS. We discovered that most of our hypotheses held true.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Decision makers in the healthcare field like doctors, patients and policy makers need access to clinical evidence to address issues that have bearing on the health of the population and the treatment prescribed and thereby on the financials implications of the healthcare industry.
College Student Perceptions of Marijuana 2015SarahMartin33
This marketing research project was created to better understand college students perceptions on marijuana. In this paper we cover background research concerning legalization of marijuana and behavior. After identifying questions that were not answered during our research, we administered a survey via Qualtrics and received over 700 responses from college students in different colleges in the nation. We took their responses and analyzed our data over SPSS. We discovered that most of our hypotheses held true.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Decision makers in the healthcare field like doctors, patients and policy makers need access to clinical evidence to address issues that have bearing on the health of the population and the treatment prescribed and thereby on the financials implications of the healthcare industry.
What do the Latest Studies Say on the Elderly and Weed?Cannabis News
What are the latest studies on marijuana and seniors, read this https://cannabis.net/blog/news/what-do-the-latest-studies-say-about-the-elderly-using-cannabis
TRENDS AND PATTERNS OF GEOGRAPHIC VARIATIONS IN OPIOID PRESCRIBINGwith Wind
Opioid Prescribing Practices published by JAMA OPEN ACCESS. Objective Journalism. There is an opioid crisis in North America. There is a systemic issue that must be cut off at the head. Healthcare Dissolution is paramount - not just for the millennial and generation Z future leaders - but our childrens's children - and their grandchildren. Stop with the lies and brainwashed propaganda for the love that of all that is true and holy. PLEASE! I BEG OF YOU!
NOTES FOR TWO MORE RESEARCH ARTICLES1The Effe.docxkendalfarrier
NOTES FOR TWO MORE RESEARCH ARTICLES 1
The Effects of Smoking on Lung Cancer Rates among Adults in New York
Pulla Rao Uppatala
MSc in Computer Science, King Graduate School
KG 604: Graduate Research & Critical Analysis
Dr. Aditi Puri
14 Nov 2022
New Research Article 1
Who: The assessment of cost-utility analysis of lung cancer screening and the paybacks on integrating smoking cessation interventions was performed by Villanti et al.
Why: This study aimed to assess whether LDCT screening for lung cancer among commercially insured individuals between 50 and 64 years at high risk for this disorder is turning out to be cost-effective. The authors also strived to quantify the extra payback of integrating smoking cessation solutions within lung cancer screening programs.
When: The authors analyzed their study in 2012 assuming that all existing smokers and half of the prior smoker population aged between 50 and 64 years were eligible for screening, with the minimum being set at least thirty packs –years of smoking.
Where: The researchers used data from National Health Interview Survey on cigarette smoking conditions for individuals between 45 and 64 years who were making 30% of active smokers across the United States at the time. The cancer treatment costs were acquired from New York's taxpayer database, which provided information including physician, hospital, drug and ancillary costs eligible for insurer reimbursement.
How: The authors used qualitative research methods to build up on the prior simulation model to determine the utility cost of yearly, recurring LDCT screenings for the last 15 years within an assumed high-risk population of 18 million adults aged between 50 and 64 years. It specifically involved those who have consumed over 30 packs within their smoking history. The authors' findings indicate that the recurring yearly lung cancer screening within the high-risk population has been effective. Providing smoking cessation strategies within the yearly screening program has increased the cost-effectiveness of the disorder by between 40 and 45%.
New Research Article 2
Who: The study on Using a smoking cessation quitline to promote lung cancer screening was performed by Sharma et al.
Why: The goal of their study was to compare two alternatives to dispense information concerning lung cancer screening. This included a quitline, a mailed brochure pinned with in-depth messaging facilitated by a quitline coach. Therefore, the authors focused on assessing the strategy that will be effective and have a significant impact on the participants searching for information about lung cancer screening. The authors thus hypothesized that the individuals who received the brochure would repo.
Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - C...ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed)
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Evidence-Based Public Health Tobacco Use Prevention.docxSANSKAR20
Evidence-Based Public Health Tobacco Use Prevention
Joseph Toole
Evidence-Based Public Health
6 February 2017
The purpose of this research paper is to provide justification for the need of evidence based public health for tobacco usage, more specifically, smoking in Alaskan adults who are 18 years of age and older. In providing research for this justification, it will discuss the specific health condition or health risk. By discussing, it will provide information regarding tobacco usage and some of the health related risks surrounding it. It will also cover the target population of those being affected by tobacco usage as well as the size and scope of the issues revolving around tobacco usage. This research paper will conclude with some prevention opportunities and potential stakeholders.
Tobacco use can take place in a variety of forms such as cigarettes, cigars, hookah and smokeless tobacco also known as chew or dip. It has been discovered that there are at least 250 of the 4000 chemicals identified in cigarette smoke alone which is the form of tobacco usage this research is primarily focused on. In regards to cigarette smoking, it has been found that some of the most toxic chemical associated with it are hydrogen cyanide which is a chemical primarily found in weapons. Another toxic chemical associated with cigarette smoking is carbon monoxide which is a chemical primarily found in automobile exhaust. Additional toxic chemical found in cigarette smoke include formaldehyde which is embalming fluid used to preserve the death of loved ones, ammonia which is found in common household cleaners and toluene which is used in paint thinners (Oregon State University, 2015). Tobacco use is considered to be the leading cause in preventable illness as well as death in the United States. It has be known to cause a wide variety of cancers which also include chronic lung disease such as bronchitis and emphysema. It also causes pregnancy related complications, heart disease and can potentially cause other serious health issues (Department of Health and Human Services, 2017). As mentioned, the reproductive effects include ectopic pregnancy, premature birth, low birth weight, reduced fertility in women, stillbirth, erectile dysfunction in men, birth defects which include clept lip and or cleft palate. Other effects associated with smoking tobacco include type 2 diabetes, age related macular degeneration, rheumatoid arthritis, cataracts, blindness, impaired immune functions, hip fractures, periodontitis and just an overall diminished health status (Healthy People 2020, 2017). The same causes are found in Alaskans. Research shows that on an annual basis, more Alaskans die from the direct effects of smoking tobacco then HIV/AIDS, homicide, motor vehicle crashes, chronic liver disease and cirrhosis combined. In 2012, it was reported that tobacco usage in Alaska cost an estimated $538 million dollars in medical expenditures as well as an additional $231 m ...
A study published in the American Journal of Preventive Medicine today finds that more than 2 million Americans who misused opioids between 2012 and 2014 also identified as binge drinkers. Overall, binge drinkers had nearly twice the odds of misusing opioids compared to non-drinkers.
The finding alarmed researchers, who noted that one in five prescription opioid deaths in recent years also involved alcohol. "Combining alcohol and opioids can significantly increase the risk of overdoses and deaths," CDC Director Robert Redfield said in a statement.
Similar to A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017 (20)
The world stands to lose close to 10% of total economic value by mid-century if climate change stays on the currently-anticipated trajectory, and the Paris Agreement and 2050 net-zero emissions targets are not met.
Many emerging markets have most to gain if the world is able to rein in temperature gains. For example, action today to get back to the Paris temperature rise scenario would mean economies in southeast Asia could prevent around a quarter of the gross domestic product (GDP) loss by mid-century that they may otherwise suffer. Our analysis in this report is unique in explicitly simulating for the many uncertainties around the impacts of climate change. It shows that those economies most vulnerable to the potential physical risks of climate change stand to benefit most from keeping temperature rises in check. This includes some of the world's most dynamic emerging economies, the engines of global growth in the years to come. The message from the analysis is clear: no action on climate change is not an option.
Promise and peril: How artificial intelligence is transforming health careΔρ. Γιώργος K. Κασάπης
AI has enormous potential to improve the quality of health care, enable early diagnosis of diseases, and reduce costs. But if implemented incautiously, AI can exacerbate health disparities, endanger patient privacy, and perpetuate bias. STAT, with support from the Commonwealth Fund, explored these possibilities and pitfalls during the past year and a half, illuminating best practices while identifying concerns and regulatory gaps. This report includes many of the articles we published and summarizes our findings, as well as recommendations we heard from caregivers, health care executives, academic experts, patient advocates, and others.
This report covers the judicial use of the death penalty for the period January to December 2020.
As in previous years, information is collected from a variety of sources, including: official figures; judgements; information from individuals sentenced to death and their families and representatives; media reports; and, for a limited number of countries, other civil society organizations.
Amnesty International reports only on executions, death sentences and other aspects of the use of the death penalty, such as commutations and exonerations, where there is reasonable confirmation. In many countries governments do not publish information on their use of the death penalty. In China and Viet Nam, data on the use of the death penalty is classified as a state secret. During 2020 little or no information was available on some countries – in particular Laos and North Korea (Democratic People’s Republic of Korea) – due to restrictive state practice.
Aviva’s first How We Live report was published in September 2020 when the world was firmly in the grip of a global pandemic. In the UK the vaccination programme is well underway and the mood of the nation is hopeful. This latest How We Live report looks at the long-term effects of the Coronavirus outbreak and considers its impact on our future behaviours.
We interviewed 4,000 adults across the UK to gather their views on a wide range of lifestyle decisions including property priorities, home-working, green living, career paths, vehicle choices and holiday plans. We also asked whether people had experienced any positive outcomes from the Covid pandemic. This report considers the practical and emotional skills which have been fostered as a result. Since the beginning of 2020, the UK has seen immense change. As we look forward to a sense of “normality” it remains to be seen which aspects of life will return to their previous states, and where we can expect changes to become permanent fixtures.
The life insurance industry provides protection against the financial consequences of the premature death of a family breadwinner, disability, or outliving one’s retirement assets. But how are life insurance products actually designed and priced?
Product committees comprising agents, underwriters, actuaries, and senior management sit and discuss what new products should be offered. The agents have vast experience visiting with policyholders to determine their needs. Underwriters set the guidelines on which policyholders will be accepted and/or rated. Smart actuaries (while most would find this redundant, some would call it an oxymoron) assess the potential risks in these products and set a potential price. Senior management listens to agents, underwriters, and actuaries and helps finalize the product design, the guidelines for accepting risks, and the price. The programmers will also have to be contacted to determine the cost of administering the products. Many iterations of these discussions may take place before a product is ready for sale. The entire process could take up to a year.
Some of these products are quite complex, taking into account long-term interest rates and probabilities of death/survival, disability, and lapse. With this lengthy and rigorous process, one would imagine that few mistakes are made. However, this is not the case. What follows are a few examples of major product mistakes which cost the life insurance industry a lot of time, money, and bad publicity.
The COVID-19 pandemic and subsequent lockdowns forced many insurers to accelerate the transition to digital business models. In many countries, this transition has been remarkably successful, however, the crisis also highlighted the critical role played by national regulatory frameworks in both hindering and facilitating the shift to digitalisation in the insurance industry. COVID-19 lockdowns highlighted the critical role of national regulatory frameworks in both hindering and facilitating the shift to digitalisation in the insurance industry. Digitalisation is not a goal in itself, but provides insurers and their customers with benefits that are particularly useful in situations where in-person interactions cannot take place, played out in its fullest form during the COVID-19-induced lockdowns. Digitalisation drives an increase in speed and efficiency, irrespective of where the customer is located, and promises improved customer service and satisfaction.
The Internet of Things (IoT) has been developing over the last 20 years and is often referred to as Industry 4.0 or the “fourth industrial revolution.” It is an umbrella term for all the digital assets and entities connected to the internet. Many of these are intangibles, such as data, human capital via artificial intelligence (AI), intellectual property (IP), and cyber; as such, they need to be made tangible to address value on a balance sheet. Others are connected entities, such as sensor devices, collecting and receiving information in an intelligent fashion across networks.
The rapid rise of online political campaigning has made most political financing regulations obsolete, putting transparency and accountability at risk. Seven in 10 countries worldwide do not have any specific limits on online spending on election campaigns, with six out of 10 not having any restrictions on online political advertising at all.
Highlights
• On average, concerns over Innovation was ranked highest, followed by Implications of Covid-19 • Respondents indicated innovation is important, but are mostly in process
• Respondents were mostly confident in implementing their innovation plans.
• Nearly half of respondents indicated their focus was on the customer experience • Most respondents expect some negative impact from Covid-19, with decreased profit indicated most, followed by decreased sales effectiveness, which are likely related
• The most common change in response to the Covid-19 impact were workplace and staffing changes, followed by technology investments
• Of the respondents, 92% indicated cyber security was important or very important.
• Continuous effort was ranked highest, and Mitigating internal threats, Identifying external threats, and Prioritizing identifying cyber risks were ranked next.
• While 95% of respondents indicated emerging threats were important or very important, 28% Indicated they were very good at responding to them
• For resiliency and sustainability, corporate ESG and R&S for internal operations were ranked as the highest priorities
iis the institutes innovation covid-19
What North America’s top finance executives are thinking - and doingΔρ. Γιώργος K. Κασάπης
Each quarter (since 2Q10), CFO Signals has tracked the thinking and actions of CFOs representing many of North America’s largest and most influential companies. All respondents are CFOs from the US, Canada, and Mexico, and the vast majority are from companies with more than $1 billion in annual revenue. The 1Q 2021 survey was open from February 8-19, 2021. A total of 128 CFOs participated, 69% from public companies and 31% from privately held companies.
Democratic watchdog organization Freedom House has released its annual ranking of the world's most free and most suppressed nations.
The report is a key barometer for global democracy and this year's edition found that global freedom has declined for the 15th straight year. 2020 was a turbulent year with the pandemic, violent conflict and economic and physical insecurity leading to democracy's defenders sustaining heavy losses against authoritarian foes which has resulted in a shift in the internatioal baance in favor of tyranny.
A total of 195 countries and 15 territories were analyzed on their levels of access to political rights and civil liberties with the number experiencing a deterioration in their freedom scores exceeding the number that saw improvement by the widest margin since 2006. In 2020, nearly 75 percent of the world's population lived under a government that saw its democracy score decline in the past year.
Women, Business and the Law 2021 is the seventh in a series of annual studies measuring the laws and regulations that affect women’s economic opportunity in 190 economies. Amidst a global pandemic that threatens progress toward gender equality, the report identifies barriers to women’s economic participation and encourages reform of discriminatory laws. This year, the study also includes important findings on government responses to the COVID-19 crisis and pilot research related to childcare and women’s access to justice.
Strong competition undoubtedly contributes to a country’s productivity and economic growth. The primary objective of a competition policy is to enhance consumer welfare by promoting competition and controlling practices that could restrict it. More competitive markets stimulate innovation and generally lead to lower prices for consumers, increased product variety and quality, more entry and enhanced investment. Overall, greater competition is expected to deliver higher levels of welfare and economic growth.
Long-erm Care and Health Care Insurance in OECD and Other CountriesΔρ. Γιώργος K. Κασάπης
This report carries out a stocktaking of what systems have in OECD and non-OECD countries for longterm care and health care, as well as the types of insurance products that are made available in these countries. It is part of a broader project that examines the complementarity of the social security network with the private insurance market, which examines how insurance could support the public sector longterm care and health care systems, as well as considering the financing of long-term care and health care.
This tenth edition of Global Insurance Market Trends provides an overview of market trends to better understand the overall performance and health of the insurance market. This monitoring report is compiled using data from the OECD Global Insurance Statistics (GIS) exercise. The OECD has collected and analysed data on insurance in OECD countries, such as the number of insurance companies and employees, insurance premiums and investments by insurance companies, dating back to the 1980s. Over time, the framework of this exercise has expanded and now includes key items of the balance sheet and income statement of direct insurers and reinsurers.
Does AI threaten and undermine human value in the workplace more than any other technology? There have been significant advances in AI, but will their impact really be different this time?
This literature review takes stock of what is known about the impact of artificial intelligence on the labour market, including the impact on employment and wages, how AI will transform jobs and skill needs, and the impact on the work environment. The purpose is to identify gaps in the evidence base and inform future research on AI and the labour market.
The OECD has estimated that 14% of jobs are at high risk of automation.
•Despite this, employment grew in nearly all OECD countries over the period 2012-2019.
•At the country level, a higher risk of automation was associated with higher employment growth over the period. This might be because automation promotes employment growth by increasing productivity, although other factors are also at play.
•At the occupational level, however, employment growth was much lower in occupations at high risk of automation (6%) than in occupations at low risk (18%).
•Low-educated workers were more concentrated in high-risk occupations in 2012 and have become even more concentrated in these occupations since then.
•The low growth in jobs in high risk occupations has not led to a drop in the employment rate of low-educated workers. This is largely because the number of workers with a low education has fallen in line with the demand for these workers.
•Going forward, however, the risk of automation is increasingly falling on low-educated workers and the COVID-19 crisis is likely to accelerate automation, as companies reduce reliance on human labour and contact between workers, or re-shore some production.
Prescription drug prices in U.S. more than 2.5 times higher than in other cou...Δρ. Γιώργος K. Κασάπης
Prescription drugs cost an average of 2.56 times more in the United States than they do in 32 other countries, according to a new report from RAND Corporation.
That disparity is even greater for brand name drugs, with U.S. prices averaging 3.44 times those in comparison nations. The study also found that prices for unbranded generic drugs — which account for 84% of drugs sold in the United States by volume but only 12% of U.S. spending — are slightly lower in the United States than in most other countries.
‘A circular nightmare’: Short-staffed nursing homes spark Covid-19 outbreaks,...Δρ. Γιώργος K. Κασάπης
Nursing homes have suffered grievously in the coronavirus pandemic. Chronically understaffed, that’s getting worse, a new US Pirg Education Fund analysis says. The shortage of direct-care workers rose from 20% of U.S. nursing homes in May to 23% in December. Too few workers raises stress among staff, the authors argue, making them and the residents they care for more vulnerable to Covid-19 infections, reducing staff further in “a circular nightmare.”
Keeping the lights on, the water running, and the landlord at bay could turn out to be good ways to control Covid-19 infection, a new NBER (National Bureau of Economic Research) analysis suggests, based on the idea that social distancing is easier for people who can stay home. When utility shutoffs and evictions were halted, Covid-19 cases in certain counties across the country fell by 8% from March through November 2020, the report says. The study can't prove cause and effect, but the authors venture that if such measures had been implemented nationwide, eviction moratoria would have resulted in a 14% decrease in Covid-19 cases and up to a 40% decrease in deaths. Utility shutoff moratoria would have cut infections by 9% and deaths by 15%, the study estimates.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
How to Give Better Lectures: Some Tips for Doctors
A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017
1. Original Investigation | Substance Use and Addiction
A National Survey of Marijuana Use Among US Adults
With Medical Conditions, 2016-2017
Hongying Dai, PhD; Kimber P. Richter, PhD
Abstract
IMPORTANCE The number of states legalizing marijuana for medical and recreational use is
increasing. Little is known regarding how or why adults with medical conditions use it.
OBJECTIVES To report the prevalence and patterns of marijuana use among adults with and without
medical conditions, overall and by sociodemographic group, and to further examine the associations
between current marijuana use and the types and number of medical conditions.
DESIGN, SETTING, AND PARTICIPANTS This survey study used a probability sample of US adults
aged 18 years and older from the 2016 and 2017 Behavioral Risk Factor Surveillance System, a
telephone-administered survey that collects data from a representative sample of US adult residents
across the states regarding health-related risk behaviors, chronic health conditions, and use of
preventive services.
MAIN OUTCOMES AND MEASURES Current (past month) and daily (Ն20 days in the last 30 days)
marijuana use.
RESULTS The study sample included 169 036 participants (95 780 female [weighted percentage,
52.0%]). Adults with medical conditions had higher odds of reporting current marijuana use than
those without medical conditions (age 18-34 years: adjusted odds ratio, 1.8 [95% CI, 1.5-2.1]; age
35-54 years: adjusted odds ratio, 1.4 [95% CI, 1.2-1.7]; age Ն55 years: adjusted odds ratio, 1.6 [95% CI,
1.3-2.0]), especially among those with asthma, chronic obstructive pulmonary disease, arthritis,
cancer, and depression. Among those with medical conditions, the prevalence of marijuana use
decreased with increasing age, ranging from 25.2% (95% CI, 22.0%-28.3%) for those aged 18 to 24
years to 2.4% (95% CI, 2.0%-2.8%) for those aged 65 years or older for current marijuana use and
from 11.2% (95% CI, 8.7%-13.6%) to 0.9% (95% CI, 0.7%-1.2%), respectively, for daily marijuana use.
Most adults who used marijuana (77.5%; 95% CI, 74.7%-80.3%), either with or without medical
conditions, reported smoking as their primary method of administration. Adults with medical
conditions were more likely than those without medical conditions to report using marijuana for
medical reasons (45.5% [95% CI, 41.1%-49.8%] vs 21.8% [95% CI, 17.8%-25.7%]; difference, 23.7%
[95% CI, 17.8%-29.6%]) and less likely to report using marijuana for recreational purposes (36.2%
[95% CI, 32.1%-40.3%] vs 57.7% [95% CI, 52.6%-62.9%]; difference, −21.5% [95% CI, −28.1%
to 14.9%]).
CONCLUSIONS AND RELEVANCE This study found that marijuana use was more common among
adults with medical conditions than those without such conditions. Notably, 11.2% of young adults
with medical conditions reported using marijuana on a daily basis. Clinicians should screen for
marijuana use among patients, understand why and how patients are using marijuana, and work with
patients to optimize outcomes and reduce marijuana-associated risks.
JAMA Network Open. 2019;2(9):e1911936. doi:10.1001/jamanetworkopen.2019.11936
Key Points
Question What are the prevalence and
patterns of marijuana use among adults
with medical conditions?
Findings This survey study using data
from 169 036 participants in the 2016
and 2017 Behavioral Risk Factor
Surveillance System surveys found that,
compared with adults without medical
conditions, adults with medical
conditions had a significantly higher
prevalence of current and daily
marijuana use, were more likely to
report using marijuana for medical
reasons, and were less likely to report
using marijuana for recreational
purposes. Among respondents with
medical conditions, 11.2% of young
adults reported using marijuana on a
daily basis, and the prevalence of
marijuana use decreased with
increasing age.
Meaning Clinicians should discuss
marijuana use with their patients to
optimize medical outcomes.
+ Supplemental content and Audio
Author affiliations and article information are
listed at the end of this article.
Open Access. This is an open access article distributed under the terms of the CC-BY License.
JAMA Network Open. 2019;2(9):e1911936. doi:10.1001/jamanetworkopen.2019.11936 (Reprinted) September 20, 2019 1/13
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2. Introduction
Public opinion on marijuana has changed dramatically over the last 2 decades. Support for
legalization has doubled since 2010, and currently, 62% of US adults support marijuana use.1
Although marijuana is still classified as a schedule I drug at the federal level, as of June 2019, 33 states
and the District of Columbia have legalized 1 or more forms of marijuana; 11 states and the District of
Columbia have approved marijuana for both medical and recreational uses.2
In the meantime,
current (past-month) marijuana use has increased from 6.2% in 2002 to 9.6% in 2017 among
persons aged 12 years or older in the United States.3
In 2017, 24.4 million US adults aged 18 years or
older were current users of marijuana; young adults aged 18 to 25 years had the highest prevalence
(22.7%).3
Although much policy change has focused on the medical use of marijuana, very little is known
regarding whether or how it is actually used for medical purposes, including whether patients are
using nonprescribed marijuana for medical purposes (ie, self-medicating) or obtaining marijuana in
accordance with physician recommendations. Few studies have examined the characteristics of
marijuana users and the prevalence of use among populations with different medical conditions.
Those who use marijuana believe that its benefits include pain management, ameliorating chronic
conditions such as epilepsy and multiple sclerosis, and relieving anxiety, stress, and depression.4
Current research suggests that both short- and long-term marijuana use are associated with several
adverse health outcomes, including respiratory symptoms, cognitive decline, neurological changes,
and psychiatric conditions including addiction.5
Other potential long-term health consequences
include cancer, chronic obstructive pulmonary disease (COPD), and heart disease.5
A previous study6
found that individuals who used marijuana in the past year were less likely
than nonmarijuana users to have diabetes but more likely to have depression. The prevalence of
marijuana use was not significantly different among those with and without multiple medical
conditions.6
However, that study was limited to marijuana use of middle-aged and older adults (ie,
those aged Ն50 years) in the past year.
The fundamental pattern of the use of marijuana among patients with medical conditions
remains unknown. Hence, it is not clear how many patients with medical conditions are using
marijuana or how they are using it, and this is a critical knowledge gap. Clinicians should know
whether marijuana use is prevalent among their patients with chronic illness, to implement screening
and counseling regarding potential health risks and benefits. Policy makers should know whether
highly vulnerable patient populations are using marijuana to determine whether heightened
surveillance is needed to determine the associations of marijuana use with medical care and
outcomes.
To begin to address this knowledge gap, we used a probability sample by combining the 2016
and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys—the nation’s largest health
survey—to assess the prevalence of current (past-month) and daily (Ն20 days in the last 30 days)
marijuana use across key sociodemographic groups. We further examined the associations between
current marijuana use and the types and number of medical conditions, stratified by 3 age groups
(18-34, 35-54, and Ն55 years). This study also determined the method of administration by which
participants primarily use marijuana and assessed whether they used marijuana for medical or
recreational purposes.
Methods
Data
The BRFSS is a telephone-administered survey that collects data from a representative sample of US
adult residents across the states regarding health-related risk behaviors, chronic health conditions,
and use of preventive services. The survey uses a random digital dialing technique with no incentive
for participation.7
The BRFSS completes more than 400 000 adult interviews each year, and the
JAMA Network Open | Substance Use and Addiction A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017
JAMA Network Open. 2019;2(9):e1911936. doi:10.1001/jamanetworkopen.2019.11936 (Reprinted) September 20, 2019 2/13
Downloaded From: https://jamanetwork.com/ by Giorgos Kassapis on 09/22/2019
3. combined 2016 and 2017 BRFSS included a total of 936 945 respondents (486 303 in 2016 and
450 642 in 2017). The overall median response rates for participating states and territories were
47.1% and 45.9% for the 2016 and 2017 BRFSS, respectively.8
Survey items on marijuana use were
first added to the BRFSS in 2016 as an optional module in select US states and territories (Table 1).
Our analysis includes respondents who were administered the marijuana use module in the 2016 and
2017 BRFSS surveys. Informed consent was obtained from all participants before the interview. A
detailed description of the BRFSS survey design, questionnaires, and data collection can be found on
the BRFSS website.7,9
Because the BRFSS provides publicly available deidentified data, this study
Table 1. Prevalence of Current and Daily Marijuana Use in Select Geographic US Regions by Medical Condition Using Combined
2016 and 2017 Behavioral Risk Factor Surveillance System Surveysa
Characteristic
Current Marijuana Use Daily Marijuana Use
Weighted % (95% CI)b
P Valuec
Adjusted
P Valued
Weighted % (95% CI)b
P Valuec
Adjusted
P Valued
No Medical Condition
(n = 64 808)
Medical Condition
(n = 104 228)
No Medical Condition
(n = 64 808)
Medical Condition
(n = 104 228)
Overall 8.3 (7.8-8.8) 8.8 (8.3-9.2) .21 <.001 3.6 (3.3-4.0) 3.9 (3.6-4.3) .27 <.001
Sex
Male 11.3 (10.5-12.1) 11.1 (10.4-11.9) .76 <.001 5.4 (4.8-6.0) 5.2 (4.7-5.7) .62 <.001
Female 5.0 (4.4-5.6) 6.9 (6.3-7.5) <.001 <.001 1.7 (1.4-2.1) 2.9 (2.5-3.4) <.001 <.001
Race/ethnicity
Non-Hispanic white 8.9 (8.2-9.6) 8.3 (7.8-8.8) .14 <.001 4.0 (3.5-4.5) 3.7 (3.3-4.0) .27 <.001
Non-Hispanic black 10.7 (9.1-12.4) 9.9 (8.3-11.6) .49 .04 5.5 (4.2-6.7) 4.8 (3.5-6.1) .50 .39
Hispanic 6.3 (5.2-7.3) 9.3 (7.7-10.9) .001 <.001 2.4 (1.7-3.1) 4.1 (2.9-5.3) .01 <.001
Other 7.3 (5.5-9.1) 11.5 (8.8-14.2) .008 <.001 2.5 (1.6-3.5) 4.9 (2.7-7.1) .02 <.001
Education
Less than high school 7.5 (5.5-9.5) 7.4 (6.3-8.5) .95 .02 3.6 (2.4-4.8) 3.6 (2.8-4.4) .97 .04
High school graduate 9.1 (8.2-10.1) 8.9 (8.0-9.8) .77 <.001 4.5 (3.8-5.2) 4.5 (3.7-5.2) .91 <.001
Some college 10.6 (9.5-11.6) 10.8 (9.8-11.8) .81 <.001 4.7 (3.9-5.4) 4.8 (4.1-5.5) .80 <.001
College graduate 5.6 (5.0-6.2) 6.7 (6.0-7.4) .02 <.001 1.8 (1.5-2.1) 2.3 (1.9-2.6) .07 .001
Income, $US
<25 000 8.8 (7.7-9.9) 10.1 (9.3-11.0) .06 <.001 4.3 (3.5-5.2) 4.7 (4.1-5.3) .53 .002
25 000-49 999 9.3 (8.3-10.4) 7.6 (6.8-8.4) .01 .005 4.3 (3.6-5.1) 3.8 (3.2-4.4) .28 <.001
50 000-74 999 8.3 (6.9-9.7) 8.8 (7.5-10.0) .63 <.001 4.0 (3.0-4.9) 4.1 (3.1-5.0) .83 .001
≥75 000 8.3 (7.2-9.3) 9.3 (8.2-10.5) .17 <.001 3.1 (2.5-3.8) 3.7 (2.9-4.5) .29 .002
Employment status
Employed 9.1 (8.4-9.7) 10.9 (10.1-11.7) <.001 <.001 4.1 (3.7-4.6) 5.1 (4.6-5.6) .006 <.001
Unemployed 11.4 (9.1-13.8) 16.3 (13.8-18.8) .006 <.001 5.6 (3.9-7.4) 7.0 (5.4-8.6) .26 .08
Not in workforce 5.6 (4.8-6.4) 6.2 (5.6-6.8) .30 <.001 2.0 (1.4-2.5) 2.6 (2.1-3.1) .07 <.001
Home ownership
Own 6.1 (5.5-6.7) 6.3 (5.7-6.8) .66 <.001 2.5 (2.2-2.9) 2.4 (2.1-2.8) .73 .008
Rent 12.1 (11.1-13.2) 15.1 (14.1-16.2) <.001 <.001 5.6 (4.8-6.4) 7.9 (7.1-8.7) <.001 <.001
Other 13.3 (10.8-15.8) 15.1 (12.6-17.7) .32 .006 5.8 (3.8-7.8) 6.6 (4.8-8.5) .57 .13
Marijuana legalization
statuse
No 6.9 (6.4-7.4) 6.3 (5.9-6.7) .05 <.001 3.2 (2.8-3.6) 2.8 (2.5-3.1) .06 <.001
Medical 6.1 (5.5-6.6) 7.1 (6.5-7.7) .01 <.001 2.5 (2.2-2.9) 2.7 (2.3-3.0) .66 .009
Recreational 11.3 (10.0-12.6) 14.2 (12.9-15.5) .003 <.001 4.7 (3.9-5.6) 6.6 (5.6-7.5) .005 <.001
a
In 2016, 10 states (Alaska, Colorado, Florida, Idaho, Minnesota, Mississippi, Nebraska,
Ohio, Tennessee, and Wyoming) participated in the optional marijuana use module. In
2017, 9 states (Alaska, California, Georgia, Idaho, Minnesota, New Hampshire, South
Carolina, Tennessee, and Wyoming) and 2 territories (Guam and Puerto Rico)
participated in the optional marijuana use module.
b
Weighted percentages and 95% CIs were reported by taking the complex sampling
design into account.
c
A Rao-Scott χ2
test was performed for the univariate analysis of the difference in
marijuana use by medical condition.
d
Multivariable logistic regression was performed for the multivariate analysis of the
difference in marijuana use by medical condition. The analysis was adjusted by age, sex,
race/ethnicity, education, income, survey year, and state.
e
In 2016, medical marijuana use was legal in Minnesota and recreational use was legal in
Alaska and Colorado. In 2017, medical use was legal in Minnesota, and recreational use
was legal in Alaska and California.
JAMA Network Open | Substance Use and Addiction A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017
JAMA Network Open. 2019;2(9):e1911936. doi:10.1001/jamanetworkopen.2019.11936 (Reprinted) September 20, 2019 3/13
Downloaded From: https://jamanetwork.com/ by Giorgos Kassapis on 09/22/2019
4. was determined to be nonhuman subjects research by the University of Nebraska Medical Center
institutional review board.
Measures
Marijuana Use
Marijuana use was assessed by the question, “During the past 30 days, on how many days did you use
marijuana or hashish?” Those who responded that they used it 1 day or more were categorized as
current marijuana users, and those who responded that they used it 20 to 30 days were categorized
as daily marijuana users.10
Of the 170 271 respondents who were administered marijuana use
questions, we excluded those who answered “don’t know or not sure” (515 participants) or refused
to answer (720 participants).
Method of Administration and Reasons to Use Marijuana
Method of administration was assessed by the question, “During the past 30 days, how did you
primarily use marijuana?” with response options of “smoke it (for example, in a joint, bong, pipe, or
blunt),” “eat it (for example, in brownies, cakes, cookies, or candy),” “drink it (for example, in tea, cola,
or alcohol),” “vaporize it (for example, in an e-cigarette-like vaporizer),” “dab it (for example, using
butane hash oil, wax, or concentrates),” and “use it some other way.” Because the 2016 BRFSS item
directed participants to endorse all that apply, whereas the 2017 BRFSS item directed participants to
provide only 1 answer, we limited our analyses of the method of administering marijuana to the 2017
BRFSS data. We classified the participants into 6 groups: smoke it, eat it, vaporize it, drink it, dab it,
and other way.
An item assessing reasons for using marijuana was included only in the 2017 BRFSS. It was
assessed by the question, “When you used marijuana or hashish during the past 30 days, was it for
medical reasons to treat or decrease symptoms of a health condition, or was it for non-medical
reasons to get pleasure or satisfaction (such as: excitement, to ‘fit in’ with a group, increased
awareness, to forget worries, for fun at a social gathering)?” Participants were classified into 3 groups
on the basis of their response: medical reasons, nonmedical reasons, and both.
Medical Comorbidity
Chronic health conditions were assessed by the question, “Has a doctor, nurse, or other health
professional ever told you that you had any of the following?” with answers including stroke, heart
attack, angina or coronary heart disease, asthma, COPD, diabetes, arthritis, kidney disease, skin
cancer, depressive disorder, and other types of cancer. Those who responded as having at least 1
chronic health condition were classified as having medical conditions.
Covariates
Several covariates were included in the analysis to adjust for confounding influences. These
covariates included sex (male and female), race/ethnicity (non-Hispanic white, non-Hispanic black,
Hispanic, and non-Hispanic other), education level (less than high school, high school graduate, some
college, or college graduate), annual income (<$25 000, $25 000-$49 999, $50 000-74 999,
Ն$75 000), and age (18-24, 25-34, 35-44, 45-54, 55-64, and Ն65 years).
Statistical Analysis
Weighted estimates of current and daily marijuana use by medical condition were calculated by
taking the survey stratum and sampling weights into account, both overall and by sociodemographic
factors, for the combined 2016 and 2017 BRFSS data. Group differences between those with and
without medical conditions were detected by a Rao-Scott χ2
test in the univariate analysis and the
logistic regression model in the multivariable analysis. We further performed separate logistic
regressions to examine the associations between marijuana use and the types and number of
medical conditions. In the multivariable analysis, sex, age, education, income, race/ethnicity, and
JAMA Network Open | Substance Use and Addiction A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017
JAMA Network Open. 2019;2(9):e1911936. doi:10.1001/jamanetworkopen.2019.11936 (Reprinted) September 20, 2019 4/13
Downloaded From: https://jamanetwork.com/ by Giorgos Kassapis on 09/22/2019
5. state were included as covariates. The 2017 BRFSS data were used to report the method of
administration and reasons to use marijuana among current marijuana users. Statistical analyses
were performed using SAS statistical software version 9.4 (SAS Institute), and 2-tailed P < .05 was
considered statistically significant.
Results
The study sample included 169 036 participants from the combined 2016 and 2017 BRFSS surveys
(95 780 female [weighted percentage, 52.0%]; non-Hispanic white, 60.9%; non-Hispanic black,
11.0%; Hispanic, 19.9%; college graduate, 26%; annual income Ն$50 000, 46.7%). Overall, 53.7% of
adults reported at least 1 medical comorbidity. Compared with those without medical conditions,
adults who reported any medical conditions were more likely to be older, female, non-Hispanic
white, have less than a high school education, have annual income less than $15 000, and own a
home and were less likely to be employed. The eTable in the Supplement compares
sociodemographic characteristics of adults with and without medical conditions.
Table 1 presents the prevalence of current and daily marijuana use by medical condition and
sociodemographic characteristics. Overall, 8.8% (95% CI, 8.3%-9.2%) of adults with medical
conditions reported current marijuana use, and 3.9% (95% CI, 3.6%-4.3%) reported daily marijuana
use. Among adults without medical conditions, 8.3% (95% CI, 7.8%-8.8%) reported current
marijuana use and 3.6% (95% CI, 3.3%-4.0%) reported daily use. In the univariate analysis, current
marijuana use among adults with medical conditions (vs those without medical conditions) was
higher among women (6.9% [95% CI, 6.3%-7.5%] vs 5.0% [95% CI, 4.4%-5.6%]; difference, 1.9%
[95% CI, 1.1%-2.8%]), Hispanic individuals (9.3% [95% CI, 7.7%-10.9%] vs 6.3% [95% CI, 5.2%-7.3%];
difference, 3.1% [95% CI, 1.2%-5.0%]) and those of other races/ethnicities (nonwhite, nonblack, and
non-Hispanic, 11.5% [95% CI, 8.8%-14.2%] vs 7.3% [95% CI, 5.5%-9.1%]; difference, 4.2% [95% CI,
1.0%-7.5%]), college graduates (6.7% [95% CI, 6.0%-7.4%] vs 5.6% [95% CI, 5.0%-6.2%];
difference, 1.1% [95% CI, 0.2%-2.0%]), those employed (10.9% [95% CI, 10.1%-11.7%] vs 9.1% [95%
CI, 8.4%-9.7%]; difference, 1.9% [95% CI, 0.8%-2.9%]), those who were unemployed (16.3% [95%
CI, 13.8%-18.8%] vs 11.4% [95% CI, 9.1%-13.8%]; difference, 4.9% [95% CI, 1.5%-8.2%]), renters
(15.1% [95% CI, 14.1%-16.2%] vs 12.1% [95% CI, 11.1%-13.2%]; difference, 3.0% [95% CI, 1.5%-4.5%]),
and those residing in states where marijuana was legal for either medical (7.1% [95% CI, 6.5%-7.7%]
vs 6.1% [95% CI, 5.5%-6.6%]; difference, 1.0% [95% CI, 0.2%-1.8%]) or recreational (14.2% [95% CI,
12.9%-15.5%] vs 11.3% [95% CI, 10.0%-12.6%]; difference, 2.9% [95% CI, 1.0%-4.7%]) purposes.
After adjusting for covariates, adults with medical conditions had a higher prevalence of current
marijuana use than those without medical conditions across all subgroups.
The prevalence of current and daily marijuana use decreased with increasing age (eFigure in the
Supplement). Across age groups, adults who reported medical conditions had a higher prevalence
of current and daily marijuana use than those without medical conditions except for those aged 65
years or older. For instance, among those aged 18 to 24 years, the prevalence of current (25.2% [95%
CI, 22.0%-28.3%] vs 14.2% [95% CI, 12.7%-15.8%]; difference 10.9% [95% CI, 7.4%-14.4%]) and daily
(11.2% [95% CI, 8.7%-13.6%] vs 5.3% [95% CI, 4.4%-6.2%]; difference, 5.9% [95% CI, 3.2%-8.5%])
marijuana use was much higher for those with medical conditions than those without medical
conditions. Among those aged 65 years and older with medical conditions, the prevalence was 2.4%
(95% CI, 2.0%-2.8%) for current marijuana use and 0.9% (95% CI, 0.7%-1.2%) for daily
marijuana use.
The state-specific prevalence of marijuana use by age group and medical condition is presented
in the Figure. There was a large variation in marijuana use across US states and territories. For
instance, Alaska had the highest prevalence of current marijuana use among adults aged 18 to 34
years with medical conditions (38%; 95% CI, 30.1%-46.7%), more than 4 times higher than the
prevalence among their counterparts in Guam (9%; 95% CI, 2.1%-16.3%).
JAMA Network Open | Substance Use and Addiction A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017
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6. Figure. Prevalence of Current Marijuana Use by Select State and Medical Conditions, Combined 2016 and 2017 Behavioral Risk Factor Surveillance System Surveys
Adults aged 18-34 years with medical conditionA
5%-9.9%
10%-14.9%
15%-19.9%
20%-24.9%
25%-29.9%
≥30%
NA
HI
AK
(38%)
OK
TX
AZ
NV
NM
CO (28%)
UT
WY
(18%)
MT
ME
CA
(31%)
ID (17%)
OR
WA
IL IN
OH
(18%)
NY
PA
VAWV
NC
SC
(10%)
LA
FL
(19%)
GA
(19%)
AL
WI
AR
MS
(15%)
MI
IA
MO
ND
SD
KY
TN (20%)
MN
(18%)
DC
CT
RI
MA
NH (24%)
VT
DE
MD
NJ
KS
NE (15%)
PR (14%)GUAM (9%)
Adults aged 18-34 years with no medical conditionB
5%-9.9%
10%-14.9%
15%-19.9%
20%-24.9%
NA
HI
AK
(20%)
OK
TX
AZ
NV
NM
CO (19%)
UT
WY
(12%)
MT
ME
CA
(17%)
ID (7%)
OR
WA
IL IN
OH
(12%)
NY
PA
VAWV
NC
SC
(10%)
LA
FL
(12%)
GA
(13%)
AL
WI
AR
MS
(12%)
MI
IA
MO
ND
SD
KY
TN (10%)
MN
(11%)
DC
CT
RI
MA
NH (16%)
VT
DE
MD
NJ
KS
NE (8%)
PR (6%)GUAM (9%)
Adults aged 35-54 years with medical conditionC
<5% 5%-9.9% 10%-14.9% 15%-19.9% NA <5% 5%-9.9% 10%-14.9% NA
HI
AK
(19%)
OK
TX
AZ
NV
NM
CO (15%)
UT
WY
(9%)
MT
ME
CA
(15%)
ID (8%)
OR
WA
IL IN
OH
(9%)
NY
PA
VAWV
NC
SC
(5%)
LA
FL
(10%)
GA
(7%)
AL
WI
AR
MS
(5%)
MI
IA
MO
ND
SD
KY
TN (6%)
MN
(8%)
DC
CT
RI
MA
NH (12%)
VT
DE
MD
NJ
KS
NE (5%)
PR (3%)GUAM (10%)
Adults aged 35-54 years with no medical conditionD
HI
AK
(14%)
OK
TX
AZ
NV
NM
CO (11%)
UT
WY
(7%)
MT
ME
CA
(8%)
ID (4%)
OR
WA
IL IN
OH
(7%)
NY
PA
VAWV
NC
SC
(4%)
LA
FL
(6%)
GA
(7%)
AL
WI
AR
MS
(5%)
MI
IA
MO
ND
SD
KY
TN (5%)
MN
(4%)
DC
CT
RI
MA
NH (10%)
VT
DE
MD
NJ
KS
NE (2%)
PR (3%)GUAM (3%)
Adults aged ≥55 years with medical conditionE
<5% 5%-9.9% 10%-14.9% NA <5% 5%-9.9% NA
HI
AK
(11%)
OK
TX
AZ
NV
NM
CO (8%)
UT
WY
(3%)
MT
ME
CA
(8%)
ID (2%)
OR
WA
IL IN
OH
(3%)
NY
PA
VAWV
NC
SC
(2%)
LA
FL
(3%)
GA
(3%)
AL
WI
AR
MS
(1%)
MI
IA
MO
ND
SD
KY
TN (1%)
MN
(3%)
DC
CT
RI
MA
NH (4%)
VT
DE
MD
NJ
KS
NE (2%)
PR (1%)GUAM (2%)
Adults aged ≥55 years with no medical conditionF
HI
AK
(7%)
OK
TX
AZ
NV
NM
CO (7%)
UT
WY
(1%)
MT
ME
CA
(5%)
ID (2%)
OR
WA
IL IN
OH
(1%)
NY
PA
VAWV
NC
SC
(1%)
LA
FL
(3%)
GA
(2%)
AL
WI
AR
MS
(1%)
MI
IA
MO
ND
SD
KY
TN (1%)
MN
(2%)
DC
CT
RI
MA
NH (3%)
VT
DE
MD
NJ
KS
NE (1%)
PR (0%)GUAM (1%)
Maps show percentage of current marijuana use among adults in the following
categories: aged 18 to 34 years with a medical condition (A), aged 18 to 34 years without
a medical condition (B), aged 35 to 54 years with a medical condition (C), aged 35 to 54
years without a medical condition (D), aged 55 years and older with a medical condition
(E), and aged 55 years and older without a medical condition (F). At the time of the
survey, medical marijuana use was legal in Minnesota, and recreational was legal in
Alaska, Colorado, and California. NA indicates not applicable.
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7. Table 2 presents the prevalence and adjusted odds ratios (AORs) of current marijuana use by
age group and medical condition. Across age groups, adults who reported any medical condition had
higher odds of current marijuana use than those who reported no medical conditions (AORs, 1.8
[95% CI, 1.5-2.1] for adults aged 18-34 years, 1.4 [95% CI, 1.2-1.7] for adults aged 35-54 years, and 1.6
[95% CI, 1.3-2.0] for adults aged Ն55 years). Adults with multiple medical conditions were more
likely to report current marijuana use than those with only 1 medical condition. Among young adults
aged 18 to 34 years, ever having a stroke (AOR, 2.5; 95% CI, 1.2-5.1), heart attack (AOR, 2.7; 95% CI,
1.2-6.1), asthma (AOR, 1.6; 95% CI, 1.3-1.9), COPD (AOR, 3.4; 95% CI, 2.3-4.9), arthritis (AOR, 2.0; 95%
CI, 1.6-2.6), cancer other than skin cancer (AOR, 2.8; 95% CI, 1.7-4.6), or depression (AOR, 2.8; 95%
CI, 2.3-3.4) was associated with higher odds of reporting current marijuana use compared with those
without chronic medical conditions. Among adults aged 35 to 54 years, ever having asthma (AOR,
1.5; 95% CI, 1.2-2.0), COPD (AOR, 1.8; 95% CI, 1.3-2.5), arthritis (AOR, 1.5; 95% CI, 1.2-1.8), kidney
disease (AOR, 2.7; 95% CI, 1.3-5.7), cancer other than skin cancer (AOR, 2.2; 95% CI, 1.6-3.2), or
depression (AOR, 2.0; 95% CI, 1.6-2.5) was associated with increased odds of current marijuana use.
Among adults aged 55 years and older, ever having a heart attack (AOR, 1.7; 95% CI, 1.2-2.5), coronary
heart disease (AOR, 1.6; 95% CI, 1.1-2.2), asthma (AOR, 2.1; 95% CI, 1.5-2.8), COPD (AOR, 2.1; 95% CI,
1.6-2.9), arthritis (AOR, 1.5; 95% CI, 1.2-1.9), kidney disease (AOR, 1.7; 95% CI, 1.0-2.9), skin cancer
(AOR, 1.5; 95% CI, 1.1-2.1), other cancer (AOR, 1.9; 95% CI, 1.4-2.8), or depression (AOR, 2.8; 95% CI,
2.3-3.4) was associated with higher odds of reporting current marijuana use compared with those
without chronic medical conditions.
Table 3 presents the distribution of primary ways to use marijuana among current marijuana
users. In 2017, most current marijuana users (77.5%; 95% CI, 74.7%-80.3%) reported that they
primarily smoked marijuana, followed by eating it (9.0%; 95% CI, 7.0%-10.9%), vaporizing it (9.0%;
95% CI, 7.1%-10.9%), dabbing it (3.1%; 95% CI, 2.0%-4.2%), other ways (1.1%; 95% CI, 0.6%-1.6%),
and drinking it (0.4%; 95% CI, 0.1%-0.7%). Daily marijuana users were more likely than nondaily
marijuana users to report smoking marijuana (83.0% [95% CI, 79.3%-86.7%] vs 72.8% [95% CI,
Table 2. Prevalence of Current Marijuana Use by Age Group and Medical Condition, Combined 2016 and 2017 Behavioral Risk Factor Surveillance System Surveys
Characteristic
Aged 18-34 y (n = 24 739) Aged 35-54 y (n = 45 373) Aged ≥55 y (n = 98 924)
Weighted % (95% CI)a
AOR (95% CI)b
Weighted % (95% CI)a
AOR (95% CI)b
Weighted % (95% CI)a
AOR (95% CI)b
Medical condition
No 13.1 (12.1-14.1) 1 [Reference] 6.5 (5.7-7.3) 1 [Reference] 3.0 (2.5-3.5) 1 [Reference]
Any 21.9 (20.2-23.7) 1.8 (1.5-2.1) 9.9 (8.8-10.9) 1.4 (1.2-1.7) 4.1 (3.7-4.5) 1.6 (1.3-2.0)
No. of medical conditions
1 21.1 (19.0-23.1) 1.9 (1.6-2.2) 8.2 (6.9-9.5) 1.3 (1.0-1.6) 3.5 (2.9-4.0) 1.3 (1.0-1.6)
2 23.8 (19.7-27.9) 2.1 (1.6-2.7) 11.6 (9.7-13.4) 1.9 (1.5-2.4) 4.8 (3.9-5.7) 2.0 (1.5-2.7)
≥3 25.7 (19.5-31.9) 3.1 (2.0-4.9) 12.6 (9.7-15.5) 1.8 (1.4-2.3) 4.1 (3.5-4.8) 1.8 (1.4-2.4)
Type of medical condition
Stroke 22.4 (10.8-34.0) 2.5 (1.2-5.1) 8.6 (5.1-12.1) 1.0 (0.6-1.7) 3.9 (2.9-4.9) 1.5 (1.0-2.2)
Heart attack 26.9 (13.2-40.6) 2.7 (1.2-6.1) 11.6 (7.2-16.0) 1.6 (1.0-2.5) 3.8 (2.8-4.8) 1.7 (1.2-2.5)
Angina or coronary heart disease 11.2 (4.1-18.3) 1.2 (0.5-2.8) 8.6 (4.9-12.4) 1.3 (0.8-2.2) 3.8 (2.8-4.8) 1.6 (1.1-2.2)
Asthma 19.8 (17.3-22.2) 1.6 (1.3-1.9) 10.9 (8.6-13.1) 1.5 (1.2-2.0) 5.2 (4.1-6.3) 2.1 (1.5-2.8)
Chronic obstructive pulmonary disease 30.7 (24.0-37.3) 3.4 (2.3-4.9) 13.0 (10.3-15.7) 1.8 (1.3-2.5) 5.1 (4.1-6.1) 2.1 (1.6-2.9)
Diabetes 11.4 (6.1-16.7) 0.9 (0.5-1.7) 5.2 (3.7-6.7) 0.8 (0.6-1.2) 2.3 (1.7-2.9) 1.0 (0.7-1.3)
Arthritis 20.2 (16.7-23.7) 2.0 (1.6-2.6) 10.2 (8.6-11.8) 1.5 (1.2-1.8) 3.5 (3.1-4.0) 1.5 (1.2-1.9)
Kidney disease 20.0 (9.7-30.3) 1.4 (0.6-3.2) 14.3 (6.3-22.3) 2.7 (1.3-5.7) 4.1 (2.4-5.9) 1.7 (1.0-2.9)
Skin cancer 14.8 (2.9-26.7) 1.5 (0.5-4.4) 10.5 (4.3-16.7) 1.3 (0.8-1.9) 3.9 (3.1-4.8) 1.5 (1.1-2.1)
Other cancer 23.7 (14.9-32.5) 2.8 (1.7-4.6) 11.3 (8.3-14.3) 2.2 (1.6-3.2) 4.4 (3.3-5.5) 1.9 (1.4-2.8)
Depression 26.7 (24.0-29.4) 2.8 (2.3-3.4) 12.7 (11.2-14.1) 2.0 (1.6-2.5) 6.9 (5.9-8.0) 2.8 (2.2-3.7)
Abbreviation: AOR, adjusted odds ratio.
a
Weighted percentages and 95% CIs were reported by taking the complex sampling
design into account.
b
Multivariable logistic regression was performed to compare the difference in marijuana
use by medical condition. The analysis was adjusted by age, sex, race/ethnicity,
education, income, survey year, and state.
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8. 68.7%-76.8%]) and less likely to report eating marijuana (4.2% [95% CI, 2.4%-5.9%] vs 13.0% [95%
CI, 9.9%-16.2%]). The method of administration was similar between adults with and without
medical conditions.
As shown in Table 4, in 2017, 35.1% (95% CI, 31.9%-38.2%) of current marijuana users reported
that they used marijuana only for medical reasons, 45.6% (95% CI, 42.4%-48.9%) reported that they
used marijuana only for nonmedical purposes, and 19.3% (95% CI, 16.3%-22.2%) reported they used
marijuana for both reasons. Daily marijuana users were less likely than nondaily users to report using
marijuana for nonmedical purposes (35.6% [95% CI, 30.8%-40.3%] vs 53.6% [95% CI,
49.1%-58.1%]) but more likely to report using marijuana for both reasons (26.5% [95% CI, 21.9%-
31.1%] vs 13.6% [9.7%-17.4%]; P < .001). Adults with medical conditions were more likely than those
without medical conditions to report using marijuana for medical reasons (45.5% [95% CI, 41.1%-
49.8%] vs 21.8% [95% CI, 17.8%-25.7%]; difference, 23.7% [95% CI, 17.8%-29.6%]) and less likely to
report using marijuana for nonmedical reasons (36.2% [95% CI, 32.1%-40.3%] vs 57.7% [95% CI,
52.6%-62.9%]; difference, −21.5% [95% CI, −28.1% to 14.9%]) or for both reasons (18.3% [95% CI,
14.8%-21.8%] vs 20.5% [95% CI, 15.6%-25.5%]). The likelihood of reporting use of marijuana for
medical purposes increased by the number of medical conditions (36.1% [95% CI, 30.0%-42.1%] for
1 medical condition vs 68.7% [95% CI, 60.6%-76.8%] for Ն3 conditions; P < .001). Reasons for using
marijuana also varied by type of medical condition. For example, among those using marijuana for
medical purposes, the prevalence ranged from 64.3% (95% CI, 57.6%-70.9%) for those with arthritis
to 43.7% (95% CI, 33.8%-53.6%) for those with COPD.
Table 3. Distribution of Ways to Primarily Use Marijuana Among Current Marijuana Users, 2017 Behavioral Risk Factor Surveillance System Surveys
Characteristic
Ways to Primarily Use Marijuana, Weighted % (95% CI)a
Smoke (n = 2750) Eat (n = 265) Vaporize (n = 214) Drink (n = 23) Dab (n = 62) Other (n = 47)
Overall 77.5 (74.7-80.3) 9.0 (7.0-10.9) 9.0 (7.1-10.9) 0.4 (0.1-0.7) 3.1 (2.0-4.2) 1.1 (0.6-1.6)
Daily marijuana user
No 72.8 (68.7-76.8) 13.0 (9.9-16.2) 10.6 (8-13.2) 0.4 (0.0-1.0) 2.0 (0.7-3.3) 1.2 (0.5-1.9)
Yes 83.0 (79.3-86.7) 4.2 (2.4-5.9) 7.0 (4.3-9.8) 0.4 (0.0-0.7) 4.4 (2.5-6.3) 1.0 (0.3-1.8)
Medical condition
No 77.9 (73.7-82.2) 10.2 (6.8-13.5) 8.9 (6.2-11.6) 0.1 (0.0-0.1) 2.4 (1.1-3.7) 0.6 (0.0-1.2)
Any 77.1 (73.4-80.8) 8.0 (5.8-10.3) 9.0 (6.4-11.6) 0.7 (0.1-1.3) 3.7 (2.0-5.4) 1.5 (0.7-2.3)
No. of medical conditions
1 77.7 (72.4-83.0) 7.9 (4.8-11.0) 9.4 (5.4-13.4) 0.1 (0.0-0.3) 4.2 (1.7-6.7) 0.7 (0.1-1.4)
2 79.2 (72.9-85.6) 6.1 (2.8-9.3) 9.5 (5.1-14.0) 1.5 (0.0-3.5) 2.9 (0.0-6.0) 0.8 (0.1-1.5)
≥3 72.3 (64.1-80.5) 11.2 (4.9-17.6) 7.2 (2.4-12.1) 1.1 (0.0-2.4) 3.3 (0.0-6.6) 4.8 (1.2-8.5)
Type of medical condition
Stroke 88.3 (79.5-97.1) 5.0 (0.0-11.7) 1.2 (0.0.4-2.1) 0.5 (0.0-1.3) 2.5 (0.0-7.1) 2.4 (0.0-5.6)
Heart attack 88.3 (77.2-99.4) 1.7 (0.0-4.4) 1.0 (0.0-2.1) 0.0 (0.0-0.0) 1.9 (0.0-5.6) 7.1 (0.0-17.4)
Angina or coronary heart disease 88.6 (81.7-95.5) 2.6 (0.0-5.4) 2.1 (0.0-4.5) 0.2 (0.0-0.6) 3.0 (0.0-6.9) 3.5 (0.0-7.1)
Asthma 75.7 (69.6-81.8) 7.9 (4.4-11.3) 9.7 (5.2-14.2) 1.4 (0.0-3.1) 2.6 (0.5-4.7) 2.6 (0.6-4.7)
Chronic obstructive pulmonary disease 82.5 (74.2-90.9) 3.5 (0.5-6.6) 4.5 (0.0-9.4) 0.7 (0.0-2.1) 5.3 (0.0-10.5) 3.5 (0.0-7.8)
Diabetes 80.6 (68.4-92.8) 8.5 (0.0-18.8) 3.0 (0.2-5.7) 0.1 (0.0-0.2) 4.6 (0.0-11.5) 3.3 (0.0-6.9)
Arthritis 69.9 (63.5-76.3) 14.2 (8.9-19.6) 9.1 (5.0-13.1) 1.2 (0.1-2.4) 2.4 (0.6-4.2) 3.1 (0.8-5.4)
Kidney disease 68.6 (50.6-86.6) 1.2 (0.0-3.4) 15.1 (1.6-28.5) 1.6 (0.0-4.7) 10.1 (0.0-23.7) 3.5 (0.0-7.4)
Skin cancer 68.3 (53.4-83.2) 15.1 (2.1-28.1) 5.8 (0.2-11.5) 1.8 (0.0-5.1) 7.6 (0.0-16.3) 1.4 (0.0-3.4)
Other cancer 65.9 (52.5-79.3) 10.6 (3.1-18.0) 16.5 (4.3-28.6) 1.1 (0.0-2.6) 3.4 (0.0-9.9) 2.6 (0.0-5.7)
Depression 79.2 (74.5-83.9) 6.6 (3.9-9.3) 8.3 (5.2-11.5) 0.7 (0.0-1.6) 3.5 (1.3-5.7) 1.7 (0.5-3.0)
a
Weighted percentages and 95% CIs were reported by taking the complex sampling design into account.
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9. Discussion
To our knowledge, this is the first study to report national estimates of current and daily marijuana use
among adults with medical conditions. Compared with those with no medical conditions, adults with
medical conditions had a significantly higher prevalence of current and daily marijuana use across all
age groups except those aged 65 years or older. Among young adults aged 18 to 24 years with medical
conditions, 25.2% reported current use of marijuana and 11.2% used marijuana on a daily basis.
Confidence in our findings is bolstered by the fact that our findings of marijuana use among the
general population are consistent with previous studies.10
We found that marijuana use decreased
with increasing age and that adults aged 18 to 24 years had the highest prevalence of current
marijuana use (25.2%), more than 10 times higher than those aged 65 years and older (2.4%). We
also found a wide variation across age groups associated with marijuana use among adults with and
without medical conditions. These disparities could be due to differences in perceived harm and
benefits of marijuana use across age groups. For instance, Keyhani et al4
reported that adults aged 65
years or older were more likely to view marijuana as very addictive and harmful compared with adults
in other age groups, partly because of the stigma in past decades that was associated with marijuana
use. However, public opinions on marijuana use have been softening,1
and fewer older adults are
reporting disapproval of marijuana use.11
The increase in public acceptance of marijuana use could
lead older adults to start using marijuana for medical conditions.
This study also identified a large variation of marijuana use among adults with medical
conditions across select US states and territories, with Alaska having a prevalence among those aged
18 to 34 years more than 4 times higher than that in Guam (38% vs 9%). The geographic variation in
marijuana use could be attributable to the availability of marijuana products associated with legal
status as well as variations in perceptions of the risks and benefits of marijuana.
Table 4. Distribution of Reasons to Use Marijuana Among Current Marijuana Users, 2017 Behavioral Risk Factor
Surveillance System Survey
Characteristic
Reasons to Use Marijuana, Weighted % (95% CI)a
Medical (n = 1217) Nonmedical (n = 1763) Both (n = 606)
Overall 35.1 (31.9-38.2) 45.6 (42.4-48.9) 19.3 (16.3-22.2)
Daily marijuana user
No 32.8 (28.6-37.1) 53.6 (49.1-58.1) 13.6 (9.7-17.4)
Yes 37.9 (33.2-42.7) 35.6 (30.8-40.3) 26.5 (21.9-31.1)
Medical condition
No 21.8 (17.8-25.7) 57.7 (52.6-62.9) 20.5 (15.6-25.5)
Any condition 45.5 (41.1-49.8) 36.2 (32.1-40.3) 18.3 (14.8-21.8)
No. of medical conditions
1 36.1 (30.0-42.1) 44.1 (38.1-50.1) 19.8 (14.4-25.3)
2 46.7 (38.8-54.6) 35.7 (27.8-43.6) 17.6 (11.6-23.7)
≥3 68.7 (60.6-76.8) 16.2 (10.1-22.3) 15.1 (9.4-20.8)
Type of medical condition
Stroke 54.3 (37.7-71.0) 30.2 (15.2-45.3) 15.4 (4.2-26.7)
Heart attack 49.8 (32.3-67.4) 37.8 (20.5-55.1) 12.3 (0.0-24.7)
Angina or coronary heart disease 52.6 (35.9-69.3) 29.7 (13.7-45.8) 17.7 (3.8-31.6)
Asthma 45.9 (38.1-53.7) 37.1 (30.0-44.1) 17.0 (12.0-22.1)
Chronic obstructive pulmonary disease 43.7 (33.8-53.6) 33.7 (23.8-43.7) 22.6 (13.6-31.6)
Diabetes 51.7 (38.0-65.4) 33.0 (19.6-46.4) 15.3 (6.4-24.2)
Arthritis 64.3 (57.6-70.9) 23.1 (17.1-29.1) 12.7 (9.0-16.3)
Kidney disease 57.4 (36.3-78.6) 24.2 (6.5-41.8) 18.4 (4.7-32.0)
Skin cancer 62.5 (46.5-78.4) 27.2 (14.3-40.0) 10.4 (2.1-18.6)
Other cancer 47.7 (35.5-59.9) 22.9 (12.3-33.5) 29.4 (16.3-42.5)
Depression 48.9 (43.2-54.5) 31.7 (26.4-37.0) 19.4 (14.3-24.6)
a
Weighted percentages and 95% CIs were reported
by taking the complex sampling design into account.
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10. Consistent with previous studies,12,13
this analysis found that combusted methods of marijuana
administration were most prevalent among US adults. We add to the literature by determining that
the method of administration did not differ between adults with and without medical conditions. It is
of concern that the great majority (77.5%) of current marijuana users with medical conditions
consume marijuana by smoking it. Marijuana smoke contains many chemicals found in cigarette
smoke (eg, carcinogens, carbon monoxide, tar, and bronchial irritants)14,15
and is associated with
adverse outcomes on pulmonary function and increased respiratory symptoms.15,16
Nearly one-half (45.5%) of people with medical conditions reported that they use marijuana
solely for medical purposes. They were more likely to report this than people with no medical
conditions. However, most people with medical conditions were using marijuana recreationally—for
only nonmedical purposes (36.2%) and for both medical and nonmedical reasons (18.3%). In
scenarios where a drug has well-established health benefits, good manufacturing processes, and
minimal risks, the reason that a patient takes a drug is immaterial. For example, it does not matter
that a person with migraine headaches, who also has concerns about aging skin, derives both medical
and cosmetic benefits from Botox therapy. Marijuana, however, can vary widely according to mode
of delivery and is associated with several known adverse health outcomes,5,17
including increased
respiratory symptoms, impaired short-term memory, and increased risk of psychiatric illness and
addiction. It is important for health care professionals to understand whether patients are using
marijuana for medical or recreational purposes, and how patients are consuming their marijuana, to
better advise patients about the adverse health outcomes and potential benefits.
Patients who are using marijuana for a medical condition should be informed of evidence of effi-
cacy and adverse outcomes for that condition. Those who are using marijuana recreationally should
also be informed of the adverse health outcomes and benefits of marijuana consumption. Clinical infor-
mation that might facilitate such patient-clinician discussions includes use and frequency of marijuana,
use and adherence to evidence-based treatment for the chronic condition(s) of the patient, the pa-
tient’s chronic disease control and outcomes, and marijuana-related health outcomes and symptoms.
This study further examined the associations between marijuana use and 11 chronic health
conditions. It is notable that adults with respiratory conditions, such as asthma or COPD, reported a
higher prevalence of current marijuana use than those without these conditions across all age
groups. For instance, adults aged 18 to 34 years with COPD had almost 3 times higher odds of
reporting current marijuana use than their peers without COPD (AOR, 3.4; 95% CI, 2.3-4.9). It is
possible that long-term marijuana use was a contributing factor to their comorbid condition. It is also
possible that these adults were using marijuana for relief from pain, anxiety, stress, or depression.4
The benefits of marijuana in treating chronic pain have been documented in previous studies.18,19
A report from the National Academies of Sciences, Engineering, and Medicine19
concluded that there is
substantive evidence that cannabis is effective for the treatment of chronic pain in adults. One systemic
study18
reviewed 16 studies with 1750 participants and found that the potential benefits of cannabis-
based medicine in chronic neuropathic pain might be outweighed by their potential harms. However,
another systemic review20
of intervention trials and observational trials also found limited or insuffi-
cient evidence that marijuana use may relieve neuropathic pain or other types of chronic pain, and find-
ings on marijuana’s effects on anxiety, stress, and depression are mixed to negative.21
This suggests that
some patients who are using marijuana for these conditions could be better served by evidence-based
psychotherapy or US Food and Drug Administration–approved medications than by continued use of
marijuana. Primary care clinicians and specialists should be aware that patients in their care with medi-
cal conditions, especially young adults, have a high probability of marijuana use. They should screen for
marijuana use and have open conversations regarding the potential adverse health effects and benefits
of marijuana use for patients’ specific conditions.
Limitations
Our findings are subject to several limitations. First, the BRFSS data are cross-sectional; thus, we
were unable to examine causal relationships between medical comorbidity and marijuana use.
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SUPPLEMENT.
eTable. Sociodemographic Comparison of Adults With and Without Medical Conditions, Combined 2016 and 2017
BRFSS
eFigure. Prevalence of Current and Daily Marijuana Use by Medical Condition and Age Group
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