Assessing the Impact of Cannabis Legalization on Adolescent Cannabis Use and Cannabis-Related Health Conditions

项目摘要/摘要 青少年使用大麻日益被认为是一个重要的公共卫生问题， 对健康不利的后果。娱乐性大麻合法化(RCL)极有可能增加 青少年吸食大麻和与大麻有关的健康状况。然而，RCL对青少年的影响 都是未知的。定期对近100万名青少年(N=90万)进行具有高度代表性的样本 在Kaiser Permanente North California的大型综合医疗服务中筛查大麻使用情况 从2015年到2023年，这项多方法研究将解决紧迫的公共卫生问题，即 以及加利福尼亚州RCL和当地监管方案的异质性如何影响青少年的风险 大麻使用和与大麻有关的健康状况。我们将使用准实验中断时间序列 旨在测试青少年是否使用大麻、与大麻有关的健康状况(例如，使用大麻 疾病，其他药物使用，呼吸道症状，精神健康问题，与大麻有关的事故， 急性大麻中毒、大麻素类剧吐综合症)和与大麻有关的医疗用途(例如， 急诊科、成瘾治疗)和RCL术后上升。我们还将研究当地的RCL政策 (零售商禁令或上限、产品和广告限制、税收、健康警告)和使用地理位置 绘制零售商位置地图的信息系统方法(例如，从家庭地址到最近的零售商的距离) 对个人层面收集的电子健康档案数据进行临床护理，以检验RCL的效果 在那些生活在当地政策限制较少的社区中，针对RCL之前的情况进行调整的人更强 医用大麻政策。我们将进行假设驱动的适度分析，以确定子组 其大麻使用和与大麻相关的健康状况的风险可能是继RCL之后最大的。为了获得 进一步深入了解我们的量化数据并指导下一步行动，我们将通过以下方式开展焦点小组 青少年和成瘾医学临床医生、儿科医生和急诊科医生的访谈 医生将深入了解RCL如何影响青少年大麻使用和成瘾治疗需求 从患者和提供者的角度来看。总之，结果将立即对公共卫生和临床产生影响 影响，提供迫切需要的数据，以确定未来政策调整的潜在可操作领域 以及协助公共卫生做法的决策，以减少青少年使用大麻和与大麻有关的行为 伤害。

PROJECT SUMMARY/ABSTRACT Adolescent cannabis use is increasingly recognized as an important public health problem with significant adverse health consequences. Recreational cannabis legalization (RCL) has high potential to increase risk for adolescent cannabis use and cannabis-related health conditions. However, the effects of RCL on adolescents are unknown. With a highly representative sample of nearly 1 million adolescents (N=900,000) regularly screened for cannabis use in Kaiser Permanente Northern California’s large integrated healthcare delivery system from 2015 to 2023, this multi-method study will address the pressing public health questions of whether and how California state RCL and heterogeneity of local regulatory schemes impact the risk of adolescent cannabis use and cannabis-related health conditions. We will use a quasi-experimental interrupted time series design to test whether adolescent cannabis use, cannabis-related health conditions (e.g., cannabis use disorder, other substance use, respiratory symptoms, mental health problems, cannabis-related accidents, acute cannabis intoxication, cannabinoid hyperemesis syndrome), and cannabis-related healthcare use (e.g., emergency department, addiction treatment) and rise post-RCL. We will also examine local RCL policies (retailer bans or caps, product and advertising restrictions, taxes, health warnings) and use geographic information systems methods to map retailer location (e.g., distance from home address to the closest retailer) onto individual-level electronic health record data collected in clinical care to test whether the effects of RCL are stronger among those who live in communities with less restrictive local policies, adjusting for pre-RCL medical cannabis policies. We will conduct hypothesis-driven moderation analyses to identify sub-groups whose risk for cannabis use and cannabis-related health conditions may be greatest following RCL. To gain further clinical insight into our quantitative data and guide next steps, we will conduct focus groups with adolescents and interviews with addiction medicine clinicians, pediatricians, and emergency department physicians to gain insight into how RCL impacts adolescent cannabis use and addiction treatment need from the perspective of both patients and providers. Together, results will have immediate public health and clinical implications, providing urgently needed data to identify potentially actionable areas for future policy adaptations and aid decision making for public health practices to reduce adolescent cannabis use and cannabis-related harms.