A Comparison of Lichen Sclerosus and Vulvodynia Content Across Social Media Platforms: What Is Trending Over Time.

OBJECTIVES: Vulvovaginal diseases are common gynecologic complaints and patients often turn to social media (SM) for medical information. The objective of this study is to examine vulvovaginal content on SM and how it has changed over time. MATERIALS AND METHODS: Four SM platforms were searched (i.e., Facebook, Instagram, Twitter, and YouTube) at 2 time points from March 30 to May 7, 2021, and again from November 24 to December 10, 2022. Newer SM platforms became popular during this time interval and thus TikTok and Reddit were included in the search in 2022. This study focused on 2 common vulvovaginal conditions: lichen sclerosus and vulvodynia. The SM platforms were searched for content on these conditions and the type of content, language, and country of origin were assessed. RESULTS: A total of 1228 SM accounts, posts, and pages were assessed. Lichen sclerosus content on SM was mostly informational (32.6%), whereas vulvodynia content was mostly personal experience (30.5%). Patient support groups were significantly more popular in 2021 compared with 2022 and professional groups were more common in 2022 compared with 2021 ( p < .001). Overall, Facebook and Instagram consisted mostly of patient support groups, YouTube had both informational and professional videos, TikTok had mostly personal experiences and healthcare professional videos, and Reddit was mostly discussions about patient personal experiences. CONCLUSIONS: The current study highlights the content and quantifies user engagement of lichen sclerosus and vulvodynia on SM.

Cannabis use during lactation may alter the composition of human breast milk.

BACKGROUND: Cannabis is often used by women to manage symptoms of morning sickness during pregnancy, and postpartum stress and anxiety. While exclusive breastfeeding has been recommended for the first 6 months of an infant's life, the presence of cannabinoids in the milk of cannabis users complicates this recommendation. The objective of this study was to investigate the effect of maternal cannabis use on changes in the levels of macronutrients and bioactive factors in breast milk. METHODS: Milk was collected from women who were 6-8 weeks postpartum and were either using cannabis post-delivery, had used cannabis during pregnancy, or were non-users. Levels of cannabinoids, macronutrients, lactose, and SIgA were assessed in the milk of all subjects. RESULTS: THC was detected in the milk of women who reported cannabis use during lactation (n = 13, median: 22 ng/mL). Carboxy-THC, 11-hydroxy-THC, CBD, and CBN were also detected in the milk of women who used cannabis postpartum. Relative to non-users (n = 17), lactose levels were higher and SIgA levels were significantly lower in the milk of subjects who used cannabis during lactation (n = 14). CONCLUSIONS: The presence of cannabinoids, along with altered lactose and SIgA levels in the milk of cannabis users, may have implications for infant health. IMPACT: Metabolites of cannabis are found in breast milk and can accumulate in higher concentrations with ongoing consumption, which is concerning for potential exposure among infants born to mothers who consume cannabis. This work reports that lactose levels are increased and SIgA levels are decreased in the breast milk of cannabis users, relative to the milk of non-users. Change in levels of lactose and SIgA in the milk of cannabis users may have significant implications on infant health, which must be investigated in the future to better inform mothers.

Perceived support for medical cannabis use among approved medical cannabis users in Canada.

INTRODUCTION AND AIMS: Very little is known about the social experience of medical cannabis use, including the experience of stigma among approved users. The current study examined perceptions of support from physicians, family and friends as well as the prevalence of 'hiding' medicinal cannabis use. DESIGN AND METHODS: An online cross-sectional survey (N = 276) was conducted from 29 April to 8 June 2015. No public sampling frame was available from which to sample approved medical cannabis users (MCU). Eligible respondents were approved MCUs, aged 18 years or older, and reported cannabis use in the past 30 days for health reasons. Logistic regression analyses were used to assess aspects of stigma, including perceived support from their immediate social environment as well as behaviours reflecting a perceived social disapproval. RESULTS: Approximately one-third of respondents (32.6%) reported that their physician had refused to provide a medical document, and the vast majority of respondents (79.3%) reported hiding their medical cannabis use, most commonly to avoid judgement. Fewer than half of approved users perceived that their doctor was 'supportive' (38%), whereas two-thirds perceived support from family (66.3%) and friends (66.3%). Perceptions of support were similar across most socio-demographic sub-groups. DISCUSSION AND CONCLUSIONS: Substantial proportions of approved MCUs in Canada report a lack of support and most have made some effort to conceal their medical cannabis use. Overall, the findings suggest that social norms around medical cannabis use remain unfavourable for many users, despite that fact that medical cannabis has been legal in Canada for more than a decade.

Medical cannabis use in Canada: vapourization and modes of delivery.

BACKGROUND: The mode of medical cannabis delivery-whether cannabis is smoked, vapourized, or consumed orally-may have important implications for its therapeutic efficacy and health risks. However, there is very little evidence on current patterns of use among Canadian medical cannabis users, particularly with respect to modes of delivery. The current study examined modes of medical cannabis delivery following regulatory changes in 2014 governing how Canadians access medical cannabis. METHODS: A total of 364 approved adult Canadian medical cannabis users completed an online cross-sectional survey between April and June 2015. The survey examined patterns of medical cannabis use, modes of delivery used, and reasons for use. Participants were recruited through a convenience sample from nine Health Canada licensed producers. RESULTS: Using a vapourizer was the most popular mode of delivery for medical cannabis (53 %), followed by smoking a joint (47 %). The main reason for using a vapourizer was to reduce negative health consequences associated with smoking. A majority of current vapourizer users reported using a portable vapourizer (67.2 %), followed by a stationary vapourizer (41.7 %), and an e-cigarette or vape pen (19.3 %). Current use of a vapourizer was associated with fewer respiratory symptoms (AOR = 1.28, 95 % CI 1.05-1.56, p = 0.01). CONCLUSIONS: The findings suggest an increase in the popularity of vapourizers as the primary mode of delivery among approved medical users. Using vapourizers has the potential to prevent some of the adverse respiratory health consequences associated with smoking and may serve as an effective harm reduction method. Monitoring implications of such current and future changes to medical cannabis regulations may be beneficial to policymakers.

Assessing contraband tobacco in two jurisdictions: a direct collection of cigarette butts.

BACKGROUND: The sale of contraband tobacco allows for tobacco tax evasion, which can undermine the effectiveness of tobacco tax policies in reducing the number of smokers. Estimates of the proportion of contraband vary widely as do the methods used to measure the proportion of contraband being smoked. The purpose of this study is to determine the proportion of contraband use in two different jurisdictions. METHODS: A cross-sectional direct collection of cigarette butts was conducted in Peel and Brantford, Ontario, Canada in 2013 and 2014, respectively. Cigarette butts were collected from a variety of locations within both regions. Cigarette butts were assessed and classified into one of the following categories: contraband, legal Canadian, legal Native, International, unknown, and discards. RESULTS: The overall proportion of contraband cigarettes in Peel was 5.3 %, ranging from 2.8 to 8.6 % by location. In Brantford, the proportion of contraband was 33.0 %, with a range from 32.8 to 33.1 % by location. CONCLUSIONS: The direct collection of cigarette butts was determined to be a feasible method for a local public health unit in determining the proportion of contraband cigarettes. This approach showed that Brantford has a higher proportion of contraband consumption compared to Peel, which may be due to geographic location and proximity to the United States (US)-Canada border and Native Reserves. More research is needed to confirm this geographic association with other jurisdictions.

Retail availability and marketing of electronic cigarettes in Canada.

OBJECTIVES: Canada is among an increasing number of countries with restrictions on the sale of electronic cigarettes (e-cigarettes). In Canada, e-cigarettes containing nicotine have not been approved for sale; however, e-cigarettes that do not contain nicotine and do not make health claims can be sold. To date, there is little empirical evidence assessing the retail availability and marketing of e-cigarettes in countries such as Canada. METHODS: Audits were conducted at 59 brick-and-mortar retail outlets (grocery stores, convenience stores, tobacconist shops and vape shops) in four cities (Vancouver, Toronto, Montreal and Halifax) in August-October 2014. In addition, a total of 21 e-cigarette manufacturer/retailer websites were audited, and inquiries were made as to whether the companies sold nicotine-containing products. RESULTS: Overall, 76% of the retail outlets sold e-cigarette products. Of convenience stores, grocery stores and tobacconist shops with e-cigarettes for sale, the vast majority (94%) sold nicotine-free products only; in contrast, all the vape shops sold at least one nicotine-containing e-cigarette product. Front counter displays were the most common form of in-store promotions and were present in virtually all convenience stores, tobacconist shops and vape shops. Nicotine-containing e-cigarettes were available for purchase at approximately half (52%) of the online e-cigarette retailers surveyed. CONCLUSION: E-cigarettes with and without nicotine are widely available and marketed at a variety of retail outlets in Canada. "Illegal" sales of nicotinecontaining e-cigarettes were predominantly found at vape shops and online outlets, suggesting limited compliance with existing regulations.

E-cigarette use in Canada: prevalence and patterns of use in a regulated market.

OBJECTIVE: Canada is among the few countries in which e-cigarettes containing nicotine are prohibited. To date, there is little evidence on the prevalence and patterns of use of e-cigarettes in markets with product bans. The current study examines e-cigarette use among a sample of non-smokers and smokers in Canada. DESIGN: Online cross-sectional survey. SETTING: Conducted in October 2013 using a commercial panel of Canadians from Global Market Insite, Inc (GMI). PARTICIPANTS: In total, 1095 Canadians were included in the analysis: 311 non-smokers aged 16-24 years (younger non-smokers), 323 smokers aged 16-24 years (younger smokers) and 461 smokers 25 years and older (older smokers). PRIMARY AND SECONDARY OUTCOME MEASURES: E-cigarette ever and current use, types of products used, and reasons for use. RESULTS: Approximately 79% of younger non-smokers, 82% of younger smokers and 81% of older smokers were aware of e-cigarettes. Ever trial of e-cigarettes was reported by 10% of younger non-smokers, 42% of younger smokers and 27% of older smokers. Moreover, current use of an e-cigarette, which was defined as use in the last 30 days, was reported by 0.3% of younger non-smokers, 18% of younger smokers and 10% of older smokers. Among those who had ever tried an e-cigarette, approximately 10% of younger non-smokers, 46% of younger smokers and 43% of older smokers reported trying an e-cigarette that contained nicotine. The most popular e-cigarette flavours were fruit followed by menthol, and the most common reason for using e-cigarettes was to help them quit smoking. CONCLUSIONS: In the context of previous research, it appears that the prevalence of e-cigarette trial has increased in Canada. Although a considerable proportion of non-smokers have tried e-cigarettes, current use is almost entirely concentrated among smokers. Further research should be conducted to monitor e-cigarette use by Canadians.