Marijuana Legislation: Identifying the Impact on the Oral Healthcare Provider

Objectives/Aims: Since the mid-2000s, the United States has seen a surge in legislation involving the legalization of marijuana, both recreationally and medicinally. The relaxed laws translated into an increase of marijuana consumption and thereby a potential increase in the number of patients a provider will see that are cannabis users. The purpose of this review is to illustrate how the providers begin to see pathologies related to cannabis use more frequently, and how they will need to be prepared for ways this can be addressed. Additionally, oral healthcare providers will face ethical dilemmas and legal challenges when treating patients and their ability to give informed consent. Methods: Research reviewed in this paper was compiled from scholarly articles and peer-reviewed journals, including PubMed and CINAHL, published within the last five years. Studies were analyzed on the impact legalization and decriminalization laws have had on marijuana use. Additional research reviewed numerous pathologies related to marijuana use in the dental cavity. Results: Based on current proposals, it is expected that 40 states will legalize marijuana by the end of 2020. Studies conducted in states such as Oregon, Colorado and Alaska have shown an increase in marijuana usage since legalization has occurred. Research reviewed showed multiple conditions related to marijuana use. Periodontitis, xerostomia, oral cancer, and staining are several of the associated pathologies. Conclusion: Research suggests an anticipated increase of marijuana users in states that will soon pass legalization. Studies have also shown that there is a higher prevalence of pathologies of the oral cavity in cannabis users versus non cannabis users. The oral healthcare provider will treat more pathologies related to cannabis use and deal with the legal challenges presented to them surrounding informed consent.https://scholarscompass.vcu.edu/denh_student/1016/thumbnail.jp

Predictive and External Validity of a Pre-Market Study to Determine the Most Effective Pictorial Health Warning Label Content for Cigarette Packages

INTRODUCTION: Studies examining cigarette package pictorial health warning label (HWL) content have primarily used designs that do not allow determination of effectiveness after repeated, naturalistic exposure. This research aimed to determine the predictive and external validity of a pre-market evaluation study of pictorial HWLs. METHODS: Data were analyzed from: (1) a pre-market convenience sample of 544 adult smokers who participated in field experiments in Mexico City before pictorial HWL implementation (September 2010); and (2) a post-market population-based representative sample of 1765 adult smokers in the Mexican administration of the International Tobacco Control Policy Evaluation Survey after pictorial HWL implementation. Participants in both samples rated six HWLs that appeared on cigarette packs, and also ranked HWLs with four different themes. Mixed effects models were estimated for each sample to assess ratings of relative effectiveness for the six HWLs, and to assess which HWL themes were ranked as the most effective. RESULTS: Pre- and post-market data showed similar relative ratings across the six HWLs, with the least and most effective HWLs consistently differentiated from other HWLs. Models predicting rankings of HWL themes in post-market sample indicated: (1) pictorial HWLs were ranked as more effective than text-only HWLs; (2) HWLs with both graphic and "lived experience" content outperformed symbolic content; and, (3) testimonial content significantly outperformed didactic content. Pre-market data showed a similar pattern of results, but with fewer statistically significant findings. CONCLUSIONS: The study suggests well-designed pre-market studies can have predictive and external validity, helping regulators select HWL content

Testing and Evaluation of MASH TL-3 Transition Between Guardrail and Portable Concrete Barriers

Three full-scale vehicle crash tests were conducted according to the Manual for Assessing Safety Hardware (MASH) Test Level 3 (TL-3) safety performance criteria on a transition between the Midwest Guardrail System (MGS) and a portable concrete barrier (PCB) system. The transition system utilized for test nos. MGSPCB-1 through MGSPCB-3 consisted of a standard MGS that overlapped a series of F- shape PCB segments that approached the MGS at a 15H:1V flare. In the overlapped portion of the barrier systems, uniquely-designed blockout holders and a specialized W-beam end shoe mounting bracket were used to connect the systems. In test no. MGSPCB-1, a 5,079-lb (2,304-kg) pickup truck impacted the barrier at 63.2 mph (101.8 km/h) and 25.3 degrees. The barrier captured and redirected the 2270P vehicle, and the vehicle decelerations were within the recommended occupant risk limits. In test no. MGSPCB-2, a 2,601-lb (1,180-kg) car impacted the barrier at 65.1 mph (104.8 km/h) and 24.0 degrees. The barrier captured and redirected the 1100C vehicle, and the vehicle decelerations were within the recommended occupant risk limits. In test no. MGSPCB-3, a 5,177-lb (2,348-kg) pickup truck impacted the barrier at 63.1 mph (101.5 km/h) and 24.6 degrees. For this test, the system was impacted in the reverse direction. The barrier captured and redirected the 2270P vehicle, and the vehicle decelerations were within the recommended occupant risk limits. Based on the results of these successful crash tests, it is believed that the transition design detailed herein represents the first MASH TL- 3 crashworthy transition between the MGS and PCBs

Evaluating the Outcomes of the Menthol Cigarette Ban in England by Comparing Menthol Cigarette Smoking Among Youth in England, Canada, and the US, 2018-2020

Importance: Menthol cigarettes were prohibited in England in May 2020 and nationally in Canada in October 2017 but remain permitted in the US. Evidence on the outcomes of menthol cigarette bans among youth outside of Canada, and the characteristics of youth smokers, is lacking. Objectives: To evaluate the outcomes of menthol cigarette bans on youth menthol cigarette smoking and to characterize youth menthol cigarette smokers in terms of demographics and cigarette consumption and dependence. Design, Setting, and Participants: This survey study uses data from online repeat cross-sectional International Tobacco Control Youth Tobacco and Vaping Surveys conducted in 2018, 2019, February 2020, and August 2020. Participants included past 30-day smokers aged 16 to 19 years. Data analysis was performed from March 2021 to January 2022. Main Outcomes and Measures: Usually smoke a brand of cigarettes that was menthol, including capsule. Exposures: Menthol cigarette ban, comparing 3 countries over time: Canada, where a ban already existed, England, where a ban was implemented during the study, and the US, where no national ban was present. Age, sex, race, and consumption and dependence were also examined by menthol smoking in each country, and in England before vs after the ban. Results: The analytical sample comprised 7067 participants aged 16 to 19 years, of whom 4129 were female and 5019 were White. In England, the weighted percentage of youth smokers who reported smoking a menthol or capsule cigarette brand was stable in the 3 survey waves before the menthol ban (2018 to February 2020, 9.4% vs 12.1%; adjusted odds ratio [AOR], 1.03; 95% CI, 0.99-1.06; P = .15) but decreased to 3.0% after the ban (February 2020 vs August 2020, AOR, 1.07; 95% CI, 1.04-1.10; P 5 vs 1, AOR, 1.10; 95% CI, 1.03-1.18; P = .007), or had urges to smoke every or most days (AOR, 1.08; 95% CI, 1.02-1.14; P = .006); and among smokers in Canada who perceived themselves as addicted to cigarettes (AOR, 1.02; 95% CI, 1.00-1.03; P = .01). Conclusions and Relevance: In this survey study, the proportion of youth smokers who smoke menthol (including capsule) cigarettes decreased substantially after the menthol ban in England. This association was consistent across all demographic groups. Perceived addiction among menthol smokers was also lower where menthol cigarettes were banned

Ghrelin is an Osteoblast Mitogen and Increases Osteoclastic Bone Resorption In Vitro

Ghrelin is released in response to fasting, such that circulating levels are highest immediately prior to meals. Bone turnover is acutely responsive to the fed state, with increased bone resorption during fasting and suppression during feeding. The current study investigated the hypothesis that ghrelin regulates the activity of bone cells. Ghrelin increased the bone-resorbing activity of rat osteoclasts, but did not alter osteoclast differentiation in a murine bone marrow assay nor bone resorption in ex vivo calvarial cultures. Ghrelin showed mitogenic activity in osteoblasts, with a strong effect in human cells and a weaker effect in rat osteoblasts. The expression of the human ghrelin receptor, GHSR, varied among individuals and was detectable in 25–30% of bone marrow and osteoblast samples. However, the rodent Ghsr expression was undetectable in bone cells and cell lines from rat and mouse. These data suggest that elevated levels of ghrelin may contribute to the higher levels of bone turnover that occurs in the fasted state