1. 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 Conference Vail, CO September 17, 2015

2. 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

3. States with Legalized Recreational and Medical Marijuana Source: http://wtvr.com/2014/11/05/legal-marijuana-cities-and-states

4. 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

5. 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

6. 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

7. 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

8. 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

9. Results Total of 1,749 surveys completed 1,308 English surveys completed 441 Spanish surveys completed Response rate – 60.2%

10. Age of WIC Clients compared to WIC Survey Respondents AgeWIC clientsSurvey respondents 18-20 years8%10% 21-25 years26%27% 26-30 years26%25% 31-35 years21% 36-40 years13%12% Over 40 years6%5% WIC Marijuana Survey, Tri-County Health Department, 2014

11. Race/Ethnicity of WIC Client Population compared to Survey Respondents Race/EthnicityWIC Clients Survey 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

12. Do you plan to talk to child about health effects of Marijuana? WIC Marijuana Survey, Tri-County Health Department, 2014

13. Prevalence of Requested Education Materials WIC Marijuana Survey, Tri-County Health Department, 2014

14. Prevalence of Requested Education Materials (continued) WIC Marijuana Survey, Tri-County Health Department, 2014

15. Ever use of Marijuana by Race/Ethnicity WIC Marijuana Survey, Tri-County Health Department, 2014

16. Current use of Marijuana by Race/Ethnicity WIC Marijuana Survey, Tri-County Health Department, 2014

17. 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/stress63%28% To help with pain60%21% To help with nausea/vomiting48%17% For fun/recreation39%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

18. 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 pregnancy66%23% Used Marijuana during pregnancy36%5% Used Marijuana since the baby was born41%2% Used Marijuana while Breastfeeding14%<1% WIC Marijuana Survey, Tri-County Health Department, 2014

19. How have you used Marijuana? (check all that apply) WIC Marijuana Survey, Tri-County Health Department, 2014

20. 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

21. Limitations Convenience sample; results may not be generalizable Selection bias possible Recall bias may have occurred Marijuana use may have been underreported

22. 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

23. 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

24. 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