In Pearson-Dennett et al.’s study the average population age was between 24 and 25 years; however, in our study the average population was 45.4 years and any subtle walking gait changes observed in younger individuals may become more significant with aging due to age related changes in postural control, leading to balance disturbances. We also found that HIV+ individuals reported more balance disturbances and were more likely to have polyneuropathy signs and to use specific medications , both of which are strongly associated with balance disturbances. The interaction between HIV sero status and chronic cannabis use persisted after adjustment for these potential confounding factors. Our findings are consistent with previous research showing that higher rates of falls among HIV+ individuals are related to multiple comorbidities and the use of opiates, sedatives, and antihy pertensive medications . Those using cannabis were more likely to use these balance-affecting medications, increasing the risk of drug-drug interactions or synergistic toxicities. A meta-analysis looking at the association between medication classes and fall risk showed the respective odd ratios: 1.24 [1.01–1.50] for antihypertensive agents, 1.47 [1.35–1.62] for sedatives and hypnotics, and 0.96 [0.78– 1.18] for narcotics . Participants with history of diabetes, along with a higher prevalence of chronic distal polyneuropathy were more likely to have balance disturbances as well.Therefore, our findings might indicate that HIV+ individuals might be less susceptible to cannabis’ effect on balance. The proportion of participants who ever used cannabis did not differ among HIV+ and HIV− individuals. The proportion of virologic suppression in HIV+ individuals on treatment was low in our population; however, it did not affect the primary outcome . A positive urine toxicology for THC was not significantly more common in participants with balance disturbances.
Urine toxicology is not a good proxy for recency of use or intoxication, since the test may remain positive for up to 30 days. There are limitations to this study. First, data were based on a retrospectively self-reported data. Second, the cross-sectional design cannot show a causal relationship between cannabis use and balance disturbances. Nevertheless,vertical grow system a recent comparison of fall recall and prospective fall collection among 600 older adults in Germany found nearly identical incidence rate of falls, supporting the validity of retrospective fall history . Also, we did not collect any information about cannabis route of administration or whether cannabis use was recreational or prescribed, which factors may moderate cannabis-balance association.Tobacco and cannabis use among adolescents and young adults is a public health concern. Nicotine alters normal brain development in adolescents and young adults, possibly impairing cognitive development and long-term functioning. Cannabis use is linked to adverse health outcomes including impaired short-term memory and attention, and risk for cannabis dependence. To combat adolescent and young adult tobacco and cannabis use, health communication campaigns have been deployed in the past; however, their success in preventing use of these substances has varied. Health communication strategists have turned to social media platforms to promote campaign ads, target their intended audience with tailored messages, and track ad performance in real-time. However, each social media platform offers unique user experiences and audience engagement with ads vary across platforms even for identical messages. As such, characterizing platform-specific health communication strategies could be vital to enhance ad performance. For example, the United States Food and Drug Agency , Center for Tobacco Products is charged with ‘identifying effective messages, message components and communication channels to prevent initiation and countering uptake of ENDS by youth’ and Snapchat provides one such communication channel to evaluate effective messages. . Snapchat is a popular platform among adolescents and young adults in the U.S.
The platform allows its users to post ephemeral “snaps” to their followers. While advertisers have taken advantage of Snapchat’s younger audience through targeted ads , and real-time metrics that track ad impressions, there has been no research on the content of tobacco and cannabis-related ads on the platform. This study used a publicly available library of ads from Snapchat in 2019, with the objective of content-analyzing tobacco and cannabis-related ads targeted towards two age-groups: adolescents and young adults . By documenting themes, performance , and type of sponsoring organization , this study will inform future social media health education campaigns. The Snapchat Ad Library also provided metrics pertaining to audience targeting and ad performance. Separate dichotomous variables pertaining to each of the Target audience groups comprised of: Adolescents and Young adults , which were not mutually exclusive categories because Snapchat advertisers can target anyone under or over a specific age. For example, if an advertiser chose to target those under 21 years old, the ads reached adolescents and young adults. Sponsoring Organizations were categorized in terms of Government and Advocacy organizations based on the information listed on the organization’s official website. Ad Impressions and Ad Spend were also included. Data collection and analyses were approved by the Institutional Review Board of the senior author’s university. This study characterized tobacco and cannabis-related ads targeted towards adolescents and young adults on Snapchat. Health Consequences was a common theme among tobacco ads followed by Quitting and Industry Tactics. Health Consequences was a predominant theme among cannabis ads followed by Policy Advocacy and Financial and Legal Consequences. Most of the tobacco and cannabis ads received more than a million impressions. Government organizations sponsored none of the tobacco-related ads targeted at adolescents and none of the cannabis related ads targeted at adolescents were sponsored by advocacy organizations, which may indicate future priority age groups for health education campaigns sponsored by these organizations.
Insights from this study add to the growing literature documenting characteristics of tobacco and cannabis ads appearing on social media platforms. While this study found that Health Consequences and Quitting were predominant themes for tobacco-related ads, prior research, investigating tobacco-related ads on Facebook and Instagram, found that tobacco regulations, addiction, and flavors were common themes. Additionally, this study used objective ad metrics such as Ad Impressions and Ad Spend, overcoming limitations from instrument and recall bias that were present in prior ad evaluations. Collectively, these studies demonstrate that data from publicly available social media ad libraries can be used to provide an understanding of ad performance and cost by theme and inform tobacco and cannabis use prevention strategies. For example, the US FDA Center for Tobacco Products could use evidence-based narrative health communication strategies to develop snaps offering a meaningful narrative that could be a part of a series of other similar snaps in a campaign. For example, snaps could include narration of individuals’ personal experience with smoking and resulting health effects Similarly, nonprofit public health organizations can create health education campaigns that include snaps of adolescents sharing their experience with vape cessation support offered by these organizations. Campaigns supported federal agencies or advocacy organizations could also evaluate their campaign’s reach using similar methods described in this study. Tobacco and cannabis-related ads on Snapchat received impressions in the millions. Our findings could serve as baseline data for future ad campaigns. According to Snapchat’s policy, ads that “promote cigarettes , cigars, vaping products, tobacco, nicotine, or related products of any kind” are prohibited. Leveraging Snapchat’s platform features can help monitor and amplify the reach of health education campaigns. For instance, incorporating Snapcodes in health messages can link members of the audience to additional evidence-based resources related to cessation. As indicated by past work, use of geofencing to deliver tailored messages to adolescents and young adults in specific geographic locations could improve the impact of the messages.
More generally, ad targeting features are available on most social media platforms suggesting that communication strategists could deploy similar messaging across platforms and evaluate exposure and engagement by target population. This may be crucial while considering hard to-reach populations or those who may be priority populations for tobacco or cannabis use prevention. Government and advocacy organizations may turn to Snapchat for targeted reach for their tobacco and cannabis-related ads. Using a public dataset, the present study demonstrated how a communication strategist could collect and analyze ad metrics to inform future efforts. For example, a campaign may find that highlighting health consequences of poly-use of cannabis and tobacco may outperform a campaign that highlights legal consequences. Future research should explore determining factors shaping ad performance metrics on the adoption of sponsored social media health education campaigns. Findings may not generalize to other social media platforms or other time periods. This study could not determine if each ad was viewed in its entirety or viewed passively. This study was unable to determine whether all tobacco or cannabis-related ads were captured in the library or perform significance testing between themes and other categories of ads due to sample size. Additionally, we were unable to compare characteristics of ads sponsored on Snapchat and other platforms during 2019,cannabis grow equipment which limits the interpretability of the findings. However, a prior study suggests that a million views or impressions is considered large on social media platforms.Cannabis has been associated with adverse social outcomes which may impact EDs and patient health. The large cohort study of Swedish men drafted at age 18-20 and followed to age 40 showed increased risk of unemployment and need for welfare assistance in those using cannabis greater than 50 times.These results were repeated in a longitudinal birth cohort study in New Zealand to 25 years old, which found high levels of cannabis use correlated with statistical significance to poorer educational outcomes, lower income, greater welfare dependence and unemployment, and lower relationship and life satisfaction. This cohort was classified into six levels of cannabis use, and found that as cannabis use increased, the odds ratio of adverse outcome increased.Both of these studies adjusted for confounding factors including socioeconomic background of the family, family functioning and exposure to adversity, exposure to child sexual and physical abuse, childhood and adolescent adjustment, academic achievement in early adolescence, comorbid mental health disorders, and other substance use. A prospective cohort study from upstate New York found that, compared with cannabis nonusers or minimal users , chronic users and users who began use in early adulthood and then tapered off use into later adulthood, had a significantly higher likelihood of unemployment at mean age, even after controlling for covariates.
The NASEM review stated that there was a limited level of evidence of impaired academic achievement and education outcomes, increased rates of unemployment and/ or low income, and impaired social functioning or engagement in developmentally appropriate social roles.10 The report stated that although there was evidence to suggest these outcomes, it was difficult to document a direct link between cannabis use and these outcomes because other variables played a role. Social outcome data for cannabis users specifically in Colorado are currently unavailable and could be an area for further research.A number of review articles on cannabis have described adverse effects on brain imaging.These findings may help establish a mechanistic link between the epidemiological studies on the adverse effects of cannabis. Structural, functional, and chemical changes to the brain have been established. These include both the gray matter and white matter.Structural changes to the brain include reductions in the hippocampus and amygdala volumes in cannabis users. Several studies also identified reductions in volume of specific areas of the prefrontal cortex,as well as functional magnetic resonance imaging studies demonstrating reduced functional connectivity in the prefrontal networks responsible for executive function and the subcortical networks, which process habits and routines.Other fMRI studies show reduced connectivity in the fimbriae of the hippocampus and commissural fibers extending to the precuneus, and suggest that this disturbed brain connectivity in cannabis users may underlie cognitive impairment and vulnerability to psychosis, depression, and anxiety disorders.Multiple other areas of the brain have also been shown to demonstrate changes on fMRI studies in response to cannabis and include the orbitofrontal cortex, anterior cingulate cortex, striatum, amygdala, hippocampus, and cerebellum. In general, these changes on both structural and functional MRI studies corresponded with frequency of use and earlier age of onset of use .Changes to neurotransmitters in the brain have also been well described in systematic reviews and include disruptions in glutamate,47 dopamine,48 N-acetylaspartate,49 myo-inositol,49 choline,49 and γ-aminobutyric acid .Taken together, these changes may underlie the clinical features being observed in observational and epidemiological studies demonstrating increases in psychosis, impulsivity, depression, anxiety, suicidality, decreases in cognition, IQ, and executive function, abnormalities in habits, routines, decision making capacity, and deficits in learning, memory, attention, and social interaction.