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Open Access Publications from the University of California

Scholarly Works (10 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2022)

BACKGROUND: The COVID-19 pandemic and related state policy has had varying effects on economic, social, and behavioral factors especially among marginalized populations such as sexual minority (SM) groups. Of specific interest is how cannabis use and cannabis behaviors have been influenced during the COVID-19 pandemic. This dissertation examines changes in sharing of prepared cannabis and cannabis-related paraphernalia (a risk factor for COVID-19 infection) due to the COVID-19 pandemic and COVID-19 state policy among a sample of United States adults who report cannabis use. This dissertation also assess cannabis use and sharing of cannabis among sexual minority and non-sexual minority individuals in the United States. We define sharing of cannabis as sharing of prepared cannabis (cigarettes/joints/blunts) and cannabis-related paraphernalia (pipes/water pipes/rigs/vaporizers/ e-cigarettes/vapes).METHODS: Chapters 2, 3, and 4 use data collected as part of the COVID-19 Cannabis Survey, supported by US National Institute on Drug Abuse and Semel Charitable Foundation. This anonymous cross-sectional web-based survey was among US adults (18 years or older), who reported non-medical cannabis, medical cannabis, or cannabidiol (CBD) use in the last 12 months. The survey was sent out in August - September 2020 where 2,000 respondents were recruited and 1,883 remained eligible after exclusion criteria were applied. Recruitment was based on a convenience sample of respondents on internet-based platforms including Reddit, Bluelight (forum for illicit drug use), Craigslist, and Twitter. This survey included cannabis (non-medical/medical) and CBD frequency of use, reasons for changing cannabis use during the COVID-19 pandemic, sharing behaviors of prepared cannabis and cannabis-related paraphernalia, education, sex, age, sexual orientation, and geographical location (ascertained by collected zip code and state residency). Cannabis use behaviors were assessed in this single survey for a three-month timeframe before the COVID-19 pandemic (January-March 2020) and a three-month timeframe during the COVID-19 pandemic (June-August 2020). Chapter 2 descriptively assessed changes in sharing of prepared cannabis and cannabis-related paraphernalia before and during the COVID-19 pandemic and evaluated the association of non-medical cannabis frequency of use during the pandemic on cannabis sharing. Chapter 3 assessed the association of sexual orientation (sexual minority compared to non-sexual minority respondents) on cannabis use and cannabis sharing during the pandemic. Finally, chapter 4 utilized a semi-individual study design to assess the association of state’s COVID-19 policy on sharing of prepared cannabis and cannabis-related paraphernalia. COVID-19 state policy was drawn from the Kaiser Family Foundation’s (KFF) State COVID-19 Data and Policy Actions for June, July, and August 2020. We scored policies by strength using a standardized coding method ranging from 0 (no policy action) to 5 (very high/all actions prohibited). RESULTS: Overall, there was an absolute change of 12.7% for no sharing, 4.2% change for sometimes sharing, 2.3% change in sharing about half the time, 8.1% change in sharing most of the time, and 2.6% change in always sharing of prepared cannabis and cannabis-related paraphernalia between the two time periods (before and during the COVID-19 pandemic). Moreover, after adjusting for age, education, tobacco use, and alcohol use, the odds of daily/weekly cannabis use among SM respondents was 0.55 (95% CI 0.41, 0.72) times that of non-SM respondents. After adjusting for age, education, and tobacco use, the odds of any sharing during the pandemic among SM respondents was 1.60 (95% CI 1.13, 2.26) compared to non-SM respondents. Finally, state’s COVID-19 policy was associated with sharing of prepared cannabis and cannabis-related paraphernalia. After adjusting for state’s cannabis regulation, COVID-19 infection prevalence, state’s percent urbanicity, age, sex, and education, the odds of any sharing given COVID-19 state policy in June, July, and August were 0.77 (95% CI 0.60, 0.97), 0.80 (95% CI 0.66, 0.96) and 0.82 (95% CI 0.67, 0.98) respectively per every 5-unit increase in score. CONCLUSION: There was a decrease in sharing of prepared cannabis and cannabis related-paraphernalia during the COVID-19 pandemic compared to before the pandemic which varied across levels of cannabis frequency of use before the pandemic and sex. SM individuals were less likely to use cannabis daily/weekly but more likely to share prepared cannabis and cannabis-related paraphernalia compared to non-SM respondents during the pandemic. Furthermore, those in states with more stringent COVID-19 policies were less likely to share prepared cannabis and cannabis-related paraphernalia compared to those in states with less stringent policies. Public health messaging and education toward sharing practices of prepared cannabis and cannabis-related paraphernalia may be useful for future COVID-19 resurgence and with other respiratory infections such as during the cold and influenza season for individuals who use cannabis in the United States.

    Cover page: Connections through cannabis: Assessing cannabis behaviors and their association with the COVID-19 pandemic and related state policy
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2022)
    Background: During the SARS-CoV-2 pandemic, cannabis dispensaries in the United States (US) reported increased sales.Objectives: This study assessed changes in cannabis use before to during the pandemic; it was hypothesized that cannabis use increased during the pandemic.Methods: A US-based survey of adults assessed patterns of use before and during the pandemic. Participants recruited via social media from 8/2020 to 9/2020 self-reported medical and non-medical cannabis use. Use was categorized as ≤ monthly, weekly, and daily/almost daily; adjusted logistic regressions determined associations between cannabis use before the pandemic with change in frequency during the pandemic.Results: Of 1,886 respondents (63% male),1,113 reported non-medical and 603 medical use of cannabis. Those reporting ≤monthly non-medical use before the pandemic had higher odds of increasing use during the pandemic than those using weekly before the pandemic (AOR 3.2 [95% CI 2.2-4.5]). Those reporting ≤ monthly and daily medical cannabis use before the pandemic had higher odds of increasing use during the pandemic than those using weekly before the pandemic (AOR 2.3 [95% 1.3, 3.9]; AOR 2.4 [95% CI 1.2, 5.1] respectively).Conclusions: The most notable increases in cannabis use during the pandemic were among those who reported using cannabis least frequently before the pandemic (two to three times odds of increased use among ≤ monthly use compared to weekly). These findings have important implications for potential health consequences related to increased cannabis use both during and after the pandemic, even in populations thought to be protected by minimal use prior to the pandemic.
      Cover page: Changes in medical and non-medical cannabis use among United States adults before and during the COVID-19 pandemic
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2023)
      Purpose: Cannabis behaviors during the COVID-19 pandemic among sexual minority (SM) individuals in the United States remain understudied. This study assessed the prevalence and correlates of cannabis use and cannabis sharing, a potential risk for COVID-19 transmission, among SM and heterosexual-identified individuals in the United States during the COVID-19 pandemic. Methods: This cross-sectional study used data from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020. Included participants reported past-year nonmedical cannabis use. Associations between frequency of cannabis use and sharing behaviors by sexual orientation were evaluated using logistic regression analysis. Results: Overall, 1112 respondents reported past-year cannabis use; mean age 33 years (standard deviation = 9.4), 66% male identified (n = 723), and 31% SM identified adults (n = 340). Increased cannabis use during the pandemic was similar among SM (24.7%; n = 84) and heterosexual (24.9%; n = 187) respondents. Any sharing during the pandemic was 81% for SM adults (n = 237) and 73% for heterosexual adults (n = 486). In the fully adjusted models, the odds of daily/weekly cannabis use and the odds of any cannabis sharing among SM respondents were 0.56 (95% confidence interval [CI] = 0.42-0.74) and 1.60 (95% CI = 1.13-2.26), respectively, compared with heterosexual respondents. Conclusions: SM respondents were less likely to use cannabis with high frequency during the pandemic but more likely to share cannabis compared with heterosexual respondents. Sharing cannabis was high overall, which may increase COVID-19 risk. Public health messaging around sharing may be important during COVID-19 surges and respiratory pandemics especially as cannabis becomes more widely available in the United States.
        Cover page: Cannabis Use and Sharing Practices Among Sexual Minority and Heterosexual Individuals During the COVID-19 Pandemic
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2023)

        Background

        Prior to the COVID-19 pandemic, cannabis use social practices often involved sharing prepared cannabis (joints/blunts/cigarettes) and cannabis-related paraphernalia. Previous studies have demonstrated that sharing paraphernalia for cannabis, tobacco, and crack cocaine is a risk factor for respiratory viral and bacterial infections. Although COVID-19 is a respiratory viral infection that spreads through droplets and airborne transmission, it is unclear if many individuals adopted harm reduction practices around sharing cannabis. This study: quantifies the prevalence of sharing prepared non-medical cannabis and cannabis-related paraphernalia reported before and during the pandemic; assesses changes in sharing of non-medical cannabis from before to during the pandemic; assess the association between frequency of non-medical cannabis use and sharing of cannabis during the pandemic; and describes how respondents obtained their cannabis and the reasons for changing their cannabis use during the pandemic to explain differences in sharing patterns.

        Methods

        This cross-sectional study used data collected from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020 (n = 1833). Participants were included if they reported using a mode of inhalation for non-medical cannabis consumption. We calculated proportional changes in sharing cannabis before/during the COVID-19 pandemic. Associations between frequency of cannabis use and cannabis sharing during the COVID-19 pandemic were assessed using logistic regression analysis.

        Results

        Overall, 1,112 participants reported non-medical cannabis use; 925 (83.2%) reported a mode of cannabis inhalation. More respondents reported no sharing during (24.9%) than before the pandemic (12.4%; p < 0.01); less respondents shared most of the time (19.5% before; 11.2% during; p < 0.01) and always during the pandemic (5.2% before; 3.1% during; p < 0.01). After adjusting for covariates, the odds of any sharing during the pandemic for those who reported ≥ weekly cannabis use was 0.53 (95% CI 0.38, 0.75) compared to those who reported ≤ monthly.

        Conclusions

        Sharing of prepared cannabis and cannabis-related paraphernalia decreased during the COVID-19 pandemic compared to before the pandemic. This finding suggests potential risk mitigation strategies taken by participants for COVID-19 prevention either directly through behavior change or indirectly through adherence to COVID-19 prevention recommendations. Harm reduction messaging around sharing of cannabis during surges of COVID-19 or other respiratory infections may provide benefit in reducing infection among those who use cannabis, especially as cannabis use in the USA continues to increase.
          Cover page: Puff, Puff, Don’t Pass: harm reduction for cannabis use during a viral respiratory pandemicCreative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2023)
          The coronavirus disease 2019 (COVID-19) pandemic has had widespread impacts on mental health and substance use. Increases in cannabis use have been documented in the United States, but little is known about how other substance use has changed among people who use cannabis. We sought to examine changes in alcohol, tobacco, opioid, and stimulant use during COVID-19 and explore how these changes relate to patterns of cannabis use. Data were obtained from a web-based survey of adults in the United States who use cannabis (n = 1,471) administered in September 2020. Using data reported in retrospective (prepandemic) and time-of-survey assessment periods, we explored changes in the prevalence of regular (≥ weekly) alcohol, tobacco, opioid, and stimulant use during COVID-19 among respondents who used medical and nonmedical cannabis. We used modified Poisson regression to examine cannabis-related correlates of increasing or decreasing secondary substance use during the pandemic. There was a slight but significant increase in ≥weekly alcohol use in the medical use group only (41.4%-47.0%, p = .034). ≥ Weekly tobacco, opioid, and stimulant use did not change significantly. Pandemic-concurrent shifts in secondary substance use depended on interacting cannabis-related factors including medical cannabis use, prepandemic cannabis frequency, and pandemic-concurrent frequency changes. For example, ≥ weekly prepandemic cannabis use was significantly and positively associated with decreasing opioid use frequency among the medical cannabis use group only. Assessments of the pandemic's effects on substance use should consider relationships between cannabis and other substances, which may differ according to cannabis-specific behaviors, motives, and contexts of use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
            Cover page: Changes in Secondary Substance Use After the Onset of the COVID-19 Pandemic Among People Who Use Cannabis: Findings From a Web-Based Sample of Adults in the United States
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2022)
              Cover page: High proportions of rectal and pharyngeal chlamydia and gonorrhoea cases among cisgender men are missed using current CDC screening recommendations
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2023)
              Background: The COVID-19 pandemic has had widespread impacts on mental health and substance use. While increases in nonmedical cannabis use during COVID-19 have been documented among people who use cannabis across a diversity of settings, changes in specific medical applications of cannabis during the COVID-19 pandemic have not been characterized. We sought to examine changes in the prevalence, frequency, and mode of use of medical cannabis for a range of commonly treated conditions and symptoms during COVID-19. Methods: Data were obtained from an online survey of a sample of adults in the United States who use cannabis (n=1886), administered in September 2020. This study was restricted to participants who self-reported past-year medical cannabis use (n=598). Using data reported in a retrospective (pre-COVID) and current assessment period, we examined changes in cannabis use prevalence, frequency, and inhalation as the primary mode of administration for 11 commonly treated conditions. Results: There were slight but statistically significant increases in weekly (from 21.4% to 23.4%) and daily (from 16.2% to 20.7%) self-reported medical cannabis use during COVID-19 (p<0.001). Anxiety was the only specific therapeutic purpose for which daily cannabis use increased statistically significantly during COVID-19 (18.5% to 25.4%; p=0.004). In multivariable logistic regression, the odds of increasing cannabis use for anxiety during COVID-19 were statistically significantly higher for women, respondents from Western states, and states with legal medical and nonmedical cannabis. Discussion: We detected slight shifts toward higher frequencies of medical cannabis use during COVID-19. Disaggregated by therapeutic indication, daily cannabis use to manage anxiety increased during the pandemic. There is a need to assess whether changes in cannabis use that coincided with the pandemic will be sustained over time, and how these changes are connected to mental health outcomes, particularly among women.
                Cover page: Selective Changes in Medical Cannabis Use Early in the COVID-19 Pandemic: Findings from a Web-Based Sample of Adults in the United States
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2024)

                Background

                Cannabis use before the COVID-19 pandemic for many involved sharing prepared cannabis for inhalation, practices that were less prevalent during the pandemic. State-level COVID-19 containment policies may have influenced this decrease. This study examined the extent to which the intensity of state-level COVID-19 policies were associated with individual-level cannabis sharing. Findings have the potential to guide harm reduction policies for future respiratory pandemics and seasonal respiratory virus waves.

                Methods

                This study used cross-sectional individual-level data from the COVID-19 Cannabis Study, an anonymous U.S.-based web survey on cannabis use disseminated during the early phase of the pandemic (Full sample N = 1,883). We combined individual-level data with state-level policy data from Kaiser Family Foundation's State COVID-19 Data and Policy Actions for three time-points from June to August 2020 that overlapped with the survey period. Cannabis sharing was dichotomized as any versus no sharing. We adapted a previously published coding framework to score the intensity of COVID-19 policies implemented in each U.S. state and averaged the policy score across the time period. We then used Poisson regression models to quantify the associations of the average state-level COVID-19 policy score with cannabis sharing during the pandemic.

                Results

                Participants (n = 925) reporting using inhalation as a mode for cannabis use were included in this analysis. Most respondents were male (64.1%), non-Hispanic White (54.3%), with a mean age of 33.7 years (SD 8.8). A large proportion (74.9%) reported sharing cannabis during the pandemic. Those who shared cannabis more commonly lived in states with a lower average policy score (16.7, IQR 12.3-21.5) compared to those who did not share (18.6, IQR 15.3-25.3). In adjusted models, the prevalence ratio of any cannabis sharing per every 5-unit increase in the average COVID-19 policy score was 0.97 (95% CI 0.93, 1.01).

                Conclusions

                Fewer individuals shared cannabis in states with more intense COVID-19 containment policies compared to those in states with less intense policies. Individuals who use cannabis may be willing to make changes to their behavior and may further benefit from specific and directed public health messaging to avoid sharing during respiratory infection outbreaks.
                  Cover page: Associations of U.S. state-level COVID-19 policies intensity with cannabis sharing behaviors in 2020
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2023)

                  Background

                  The Ending the HIV Epidemic initiative in the United States relies on HIV hotspots to identify where to geographically target new resources, expertise, and technology. However, interventions targeted at places with high HIV transmission and infection risk, not just places with high HIV incidence, may be more effective at reducing HIV incidence and achieving health equity.

                  Objective

                  We described the implementation and validation of a web-based activity space survey on HIV risk behaviors. The survey was intended to collect geographic information that will be used to map risk behavior hotspots as well as the geography of sexual networks in Los Angeles County.

                  Methods

                  The survey design team developed a series of geospatial questions that follow a 3-level structure that becomes more geographically precise as participants move through the levels. The survey was validated through 9 cognitive interviews and iteratively updated based on participant feedback until the saturation of topics and technical issues was reached.

                  Results

                  In total, 4 themes were identified through the cognitive interviews: functionality of geospatial questions, representation and accessibility, privacy, and length and understanding of the survey. The ease of use for the geospatial questions was critical as many participants were not familiar with mapping software. The inclusion of well-known places, landmarks, and road networks was critical for ease of use. The addition of a Google Maps interface, which was familiar to many participants, aided in collecting accurate and precise location information. The geospatial questions increased the length of the survey and warranted the inclusion of features to simplify it and speed it up. Using nicknames to refer to previously entered geographic locations limited the number of geospatial questions that appeared in the survey and reduced the time taken to complete it. The long-standing relationship between participants and the research team improved comfort to disclose sensitive geographic information related to drug use and sex. Participants in the cognitive interviews highlighted how trust and inclusive and validating language in the survey alleviated concerns related to privacy and representation.

                  Conclusions

                  This study provides promising results regarding the feasibility of using a web-based mapping survey to collect sensitive location information relevant to ending the HIV epidemic. Data collection at several geographic levels will allow for insights into spatial recall of behaviors as well as future sensitivity analysis of the spatial scale of hotspots and network characteristics. This design also promotes the privacy and comfort of participants who provide location information for sensitive topics. Key considerations for implementing this type of survey include trust from participants, community partners, or research teams to overcome concerns related to privacy and comfort. The implementation of similar surveys should consider local characteristics and knowledge when crafting the geospatial components.
                    Cover page: Novel Location-Based Survey Using Cognitive Interviews to Assess Geographic Networks and Hotspots of Sex and Drug Use: Implementation and Validation Study
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2020)

                    Background

                    Human papillomavirus (HPV) is a common sexually transmitted infection. Men who have sex with men (MSM) and transgender women (TGW) are at high risk for anal HPV infection and subsequent anal cancer. This study assessed the association of partner discordances with prevalent high-risk anal HPV (HRAHPV) among MSM and TGW.

                    Methods

                    Participants were enrolled in the cross-sectional young men's HPV study of gay, bisexual, and other MSM, and TGW, aged 18 to 26 years, from 2 cities. Participants completed a confidential standardized computer-assisted interview and provided self-collected anal swabs for type-specific HPV DNA testing. Multivariate analyses were conducted for 3 discordances of interest (i.e., partner age, race/ethnicity, and concurrent partner) to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

                    Results

                    Eight hundred sixty-two participants were included for partner race/ethnicity discordance, 601 for partner age discordance, and 581 for concurrent partner analysis. Most reported being older than 21 years, cisgender male, and gay. Adjusted odds of HRAHPV were not significantly increased among participants reporting partner age discrepancy >10 years (aOR, 0.89; 95% CI, 0.51-1.56), partner race/ethnicity discordance (aOR, 0.88; CI, 0.62-1.24), or partner with concurrent partners (aOR, 0.85; 95% CI, 0.50-1.42), compared with those who did not.

                    Conclusions

                    This analysis did not identify any partner discordances associated with HRAHPV. Because HPV infection can persist for years, sexual mixing patterns with early partners might be more relevant than the most recent sex partner. Prevalence of HRAHPV was high and could be preventable by preexposure vaccination, as recommended for everyone through age 26 years including MSM and TGW.
                      Cover page: Sexual Mixing Patterns and Anal Human Papillomavirus Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in 2 Cities in the United States, 2012-2014.
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