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