UCLA

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.