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

项目概要/摘要 青少年使用大麻越来越被认为是一个重要的公共卫生问题， 有害健康的后果。大麻合法化（RCL）有很高的潜力增加风险， 青少年大麻使用和与大麻有关的健康状况。然而，RCL对青少年的影响 是未知的。通过对近100万青少年（N= 90万）的高代表性样本进行定期 在Kaiser Permanente北方加州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， 以及加州州的RCL和地方监管计划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。我们将使用一个准实验中断时间序列 旨在测试青少年大麻使用，大麻相关的健康状况（例如，大麻使用 疾病、其他物质使用、呼吸道症状、精神健康问题、大麻相关事故、 急性大麻中毒，大麻素呕吐综合征），和大麻相关的保健使用（例如， 急诊科，成瘾治疗）和RCL后上升。我们还将研究本地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 用于映射零售商位置的信息系统方法（例如，从家庭住址到最近的零售商的距离） 在临床护理中收集的个人水平的电子健康记录数据，以测试RCL的影响是否 在那些生活在地方政策限制较少的社区的人中， 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 在RCL之后，大麻使用和大麻相关健康状况的风险可能最大。获得 进一步的临床洞察我们的定量数据和指导下一步，我们将进行焦点小组， 青少年和成瘾医学临床医生，儿科医生和急诊科的采访 医生深入了解RCL如何影响青少年大麻使用和成瘾治疗需求， 患者和提供者的观点。总之，结果将立即产生公共卫生和临床 影响，提供迫切需要的数据，以确定未来政策调整的潜在行动领域 并协助公共卫生实践的决策，以减少青少年大麻使用和大麻相关 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.