Screen time and sweet consumption in preschool children: a cross-sectional study.

A growing number of older adults are using medical cannabis (MC) to treat or manage conditions including chronic pain, sleep disturbance, anxiety, cancer, and Parkinson’s disease [–]. Additionally, many older adults perceive MC to be safer than other medications []. In terms of products, older adults seem to prefer sublingual tincture or capsule versus other consumption methods and start at lower THC levels compared to younger adults; however, all age groups tend to escalate to higher THC levels over time [, ]. Of increasing concern, medical and non-MC products have reached unprecedented concentrations of THC [, ], which are associated with adverse effects in older adults []. Given the greater prevalence of chronic pain in older adults [] and growing interest in MC, it is important to understand the factors that might motivate its initiation among older adults with chronic pain. Not surprisingly, the National Academies of Sciences, Engineering, and Medicine [] have designated the health effects of MC on older adults with chronic conditions like pain a national priority research area, necessitating strong research designs like the gold-standard RCT or controlled cohort studies to inform public health policy and clinical practice []. A recent scoping review on the effects of medical and non-MC use on the health of older adults [] concluded that MC effects on chronic pain in this population are mixed and uncertain. Quality of evidence was limited, given that “studies often were small, did not consistently assess harms, and (p. 2, emphasis added).” Confounding, defined as bias due to common causes of treatment and outcome, is often considered the major weakness of observational studies compared to RCTs. Given the challenges of conducting clinical trials with MC, uncontrolled confounding in observational MC research with chronic pain can constrain the evidence needed to guide clinical practice and policy recommendations. Moreover, the absence of high-quality information creates misleading expectations of safety and efficacy for a growing, medically complex segment of the US population. Theory and previous research point to several factors that may motivate MC treatment seeking, such as pain, sleep, or mental health symptom severity, interest in replacing other medications, sociodemographics, and previous cannabis use. Symptom severity can increase the urgency of any pain treatment initiation [, ], which along with sleep impairment and anxiety are among the top medical reasons for cannabis use [, –]. Similarly, Buonomano et al. [] noted that people referred to MC in the state of Pennsylvania reported lower quality of life compared to the general population norms in the domains of role limitations due to physical and emotional health, fatigue, and pain at baseline. In addition, Brown et al. [] described that more than 1 in 5 of early adopters of MC in the state of Florida also used antidepressants, anxiolytics and benzodiazepines, opioids, and cardiovascular agents. Further, older adults who use opioid medications for chronic pain may be motivated to replace them with MC due to lower perceived risk of addiction [, ].