Background: Despite cannabis use increasing among adults in recent years, cannabis smoke exposure among children is understudied. This study assessed exposure and clinical correlates of biochemically measured cannabis smoke exposure among Midwestern pediatric patients ages 0-17 years.\n
Methods: We assessed data from 87 pediatric emergency department and urgent care patients who presented to a large, U.S. Midwestern children’s hospital and participated in a parental smoking cessation randomized controlled trial. We analyzed children’s urine for Δ9-tetrahydrocannabinol (THC) and its major metabolites of 11-hydroxy-Δ9-tetrahydrocannabinol (OH-THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (COOH-THC), which were summed to calculate total THC equivalents (TTE). Logarithmical transformation of biomarkers was performed to control for nonnormality and unequal variances, and missing data were imputed prior to analyses. We conducted multivariable linear regression analyses to assess TTE with clinical correlates.
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Results: Sixteen percent of 0-17-year-olds had detectable TTE. Children who presented with a chief complaint of difficulty breathing/wheezing had higher TTE (geometric mean [GeoM]=0.016, p=0.025) compared to children without this complaint (GeoM=0.001). Conversely, children with a viral/other infectious disease discharge diagnosis (GeoM=0.002, p=0.008), bacterial diagnosis (GeoM=0.001, p=0.014), or pulmonary diagnosis (GeoM=0.001, p=0.008) had lower TTE compared to children with an allergic/inflammatory or other diagnosis (GeoM=0.023). Children living with two cannabis smokers (GeoM=0.014, p=0.038) had higher TTE compared to children living with no smokers (GeoM=0.001). Older children had higher TTE (β^=0.001, p=0.031).
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Conclusions: This study provides preliminary evidence that respiratory issues are associated with cannabis smoke exposure among children. Findings also support that children living with cannabis smokers have higher TTE exposure.
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