13 research outputs found
Tobacco use in high-risk populations.
Invited commentary:
As cigarette smoking in the Unites States has declined overall, it has also become more concentrated into high-risk populations, namely among those who are less educated, have fewer resources, and have comorbid psychiatric disorders (both substance-related and non–substance-related). A stark reminder of this health disparity is the extraordinarily high rate of current cigarette smoking found in the sample of rural individuals who inject drugs included in the study by Akhtar and colleagues. While opioid misuse is a critical problem that the country has been mobilized to address, populations that experience opioid use disorder (and other severe addictive disorders) also experience multiple other comorbidities. Addiction to tobacco is one of these important comorbidities, and Akhtar and colleagues document current tobacco smoking among more than 90% of their sample of 986 rural individuals who inject drugs. Akhtar et al also documented very high rates of recent experiences of homelessness (62.5%) and low overall rates of contact with health care (ie, 42.0% of the study population had received any primary care within the previous 6 months), providing clear evidence for the extreme nature of adversity that these individuals experience and the overall lack of engagement with health care systems
Associations of suicidality trends with cannabis use as a function of sex and depression status.
IMPORTANCE: During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood. OBJECTIVE: To determine whether cannabis use and cannabis use disorder (CUD) are associated with a higher prevalence of suicidality among young adults with or without depression and to assess whether these associations vary by sex. DESIGN, SETTING, AND PARTICIPANTS: This survey study examined data from 281 650 adults aged 18 to 34 years who participated in the National Surveys on Drug Use and Health. Data were collected from January 1, 2008, to December 31, 2019. EXPOSURES: Prevalence of past-year daily or near-daily cannabis use (≥300 days in the past year), CUD, and major depressive episode (MDE). Past-year CUD and MDE were based on DSM-IV diagnostic criteria. MAIN OUTCOMES AND MEASURES: Past-year suicidal ideation, plan, and attempt. RESULTS: Among the 281 650 adults aged 18 to 34 (men, 49.9% [95% CI, 49.6%-50.2%]; women, 50.1% [95% CI, 49.8%-50.4%]) included in the analysis, past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. National trends in adjusted prevalence of past-year suicidal ideation, plan, and attempt varied by daily and nondaily cannabis use and CUD among adults with or without MDE. After controlling for MDE, CUD, cannabis use status, and potential confounding factors, the adjusted prevalence of suicidal ideation, plan, and attempt increased 1.4 to 1.6 times from the 2008-2009 to 2018-2019 periods (adjusted risk ratio [ARR] for suicidal ideation, 1.4 [95% CI, 1.3-1.5]; ARR for suicide plan, 1.6 [95% CI, 1.5-1.9]; ARR for suicide attempt, 1.4 [95% CI, 1.2-1.7]), with 2008 to 2009 as the reference period. Past-year CUD, daily cannabis use, and nondaily cannabis use were associated with a higher prevalence of past-year suicidal ideation, plan, and attempt in both sexes (eg, among individuals without MDE, prevalence of suicidal ideation for those with vs without CUD was 13.9% vs 3.5% among women and 9.9% vs 3.0% among men; P < .001), but significantly more so in women than men (eg, suicide plan among those with CUD and MDE was 52% higher for women [23.7%] than men [15.6%]; P < .001). CONCLUSIONS AND RELEVANCE: From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and MDE. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors