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Marijuana Use Among WIC Clients: A Survey Following Legalization of
Recreational Marijuana in Colorado
A Joint Presentation by Christine Demont-Heinrich, MPH & Jill Bonczynski, MS, RD
Public Health in the Rockies ConferenceVail, CO
September 17, 2015
Background
• Recreational Marijuana became legal in Colorado in January 2014
• TCHD WIC has an average monthly caseload of approximately 24,000 clients
• 33% of infants born in Colorado participate on the WIC Program
States with Legalized Recreational and Medical Marijuana
Source: http://wtvr.com/2014/11/05/legal-marijuana-cities-and-states
Health Effects of Marijuana use during Pregnancy on Infant•Moderate Evidence:
• Decreased academic ability• Reduced cognitive function • Decreased IQ • Attention problems• Decreased growth
Source: Monitoring Health Concerns Related to Marijuana in Colorado: 2014; Changes in Marijuana Use Patterns, Systematic Literature Review, and Possible Marijuana-Related Health Effects. (2015); Colorado Department of Public Health and Environment
Health Effects of Marijuana through Breastfeeding on Infant•THC is present in breast milk•Mixed evidence:
• Motor development • Insufficient evidence:
• Sudden Infant Death Syndrome (SIDS)
Source: Monitoring Health Concerns Related to Marijuana in Colorado: 2014; Changes in Marijuana Use Patterns, Systematic Literature Review, and Possible Marijuana-Related Health Effects. (2015); Colorado Department of Public Health and Environment
Survey Objectives
• Understand educational needs of WIC participants
• Understand current prevalence of different types of marijuana use
• Baseline data to allow possible trend assessment over time
Survey Implementation• 10 WIC clinics had iPads for a
two week rotation• WIC clients were asked to
complete the survey after their WIC appointment
• Survey coordinator at each site help to recruit, track iPads and response rate
• Projected sample size n=1,500
Survey Eligibility
• 18 years of age or older• English or Spanish
Speaking• Able to take and read
survey on their own
Courtesy of Denver Relief
Results
• Total of 1,749 surveys completed• 1,308 English surveys completed• 441 Spanish surveys completed
• Response rate – 60.2%
Age of WIC Clients compared to WIC Survey Respondents
Age WIC clients Survey respondents
18-20 years 8% 10%
21-25 years 26% 27%
26-30 years 26% 25%
31-35 years 21% 21%
36-40 years 13% 12%
Over 40 years 6% 5%
WIC Marijuana Survey, Tri-County Health Department, 2014
Race/Ethnicity of WIC Client Population compared to Survey Respondents
Race/Ethnicity WIC ClientsSurvey Respondents
Non-Hispanic Origin
White 27% 29% Black or African American 13% 10% Asian, Native Hawaiian, American Indian 7% 4%Hispanic (of any race) 53% 54%
WIC Marijuana Survey, Tri-County Health Department, 2014
Do you plan to talk to child about health effects of Marijuana?
Don't know/Not sure
No
Already having the conversation
Yes
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
5.9%
1.3%
2.9%
90.0%
WIC Marijuana Survey, Tri-County Health Department, 2014
Prevalence of Requested Education Materials
MJ effects on Driving
MJ use on Parenting
MJ active in Body
Medical vs. Recreational MJ
Health effects on Children
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
50.2%
50.3%
52.8%
53.7%
54.7%
WIC Marijuana Survey, Tri-County Health Department, 2014
Prevalence of Requested Education Materials (continued)
Quit using MJ
MJ use and Pregnancy
MJ use and Breastfeeding
MJ Addiction
Health effects on Adults
Types of MJ products
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
28.2%
41.5%
42.2%
47.1%
49.0%
49.9%
WIC Marijuana Survey, Tri-County Health Department, 2014
Ever use of Marijuana by Race/Ethnicity
WIC Marijuana Survey, Tri-County Health Department, 2014
Other/Multiracial
Asian/Hawaiian/Pac. Isl
Hispanic
Black
White
Total
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
66.7%
15.3%
23.0%
31.1%
45.0%
30.7%
Current use of Marijuana by Race/Ethnicity
WIC Marijuana Survey, Tri-County Health Department, 2014
Other/Multiracial
Asian/Hawaiian/Pac. Isl
Black
Hispanic
White
Total
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
19.0%
0.0%
8.5%
4.2%
9.1%
5.9%
Reasons for using marijuana among Current versus Past Users
Survey respondents – WIC mothers (check all that apply)
Current users (N=95)
Past users (N=375)
To help with depression/anxiety/stress 63% 28%To help with pain 60% 21%To help with nausea/vomiting 48% 17%For fun/recreation 39% 65%Other reason* 14% 16%
*Other reasons included medical conditions such as seizures, migraine headaches and cancer.
WIC Marijuana Survey, Tri-County Health Department, 2014
Timing of marijuana use related to Most Recent Pregnancy
Survey respondents – WIC mothers
Current Users (N=95)
Past Users(N=375)
Used Marijuana 12 months prior to pregnancy 66% 23%
Used Marijuana during pregnancy 36% 5%Used Marijuana since the baby was born 41% 2%
Used Marijuana while Breastfeeding 14% <1%
WIC Marijuana Survey, Tri-County Health Department, 2014
How have you used Marijuana? (check all that apply)
WIC Marijuana Survey, Tri-County Health Department, 2014
Other
Consumed in Beverage
Vaporized
Eaten in Food
Smoked
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
1.8%
5.3%
18.9%
34.0%
92.9%
Conclusions
• Ever Marijuana use 30.7 %• Current Marijuana use 5.9%• Correlated with age, 30 years or younger• Correlated with race and ethnicity, White,
Non-Hispanic• Current Marijuana users regularly used
before, during and after pregnancy
Limitations• Convenience sample; results may not be
generalizable• Selection bias possible• Recall bias may have occurred• Marijuana use may have been
underreported
Data Comparisons• TCHD WIC survey – 3.2% mothers used MJ
during pregnancy• Hawaii PRAMS – 2.6% mothers used MJ
during pregnancy• American College of Obstetricians and
Gynecologists – 2 to 5 % mothers used MJ during pregnancy
TCHD MJ Workgroup• Multidivisional team• All-Staff information
session• Marijuana and Your Child
pamphlet• Resource and referral guide• Partner scan• Field trips
Courtesy of Denver Relief
Questions?Thank you to the following Tri-County Health
Department (TCHD) and Colorado Department of Public Health and Environment (CDPHE) staff
for their help in the survey!
TCHD staff• Michelle Harris• Kathleen Rebollo• Marissa Donovan• Adele Lee• Bernadette Albanese• John M. Douglas, Jr.
CDPHE staff• Karen Trierweiler• Alyson Shupe• Rickey Tolliver• Lynn Ireland