Trends in Cannabis Use and Associated Volatile Organic Compounds: Implications for Public Health Policy Andrew Goulian MPH, Brielle Goldstein, David Bell MD, MPH California Northstate University College of Medicine, Elk Grove, CA Mailman School of Public Health Columbia University, New York, NY

Background The legalization of cannabis has increased its accessibility and use across the United States, raising concerns about public health. This study investigates the trends in cannabis use from 2009 to 2018 and examines the association with volatile organic compounds (VOCs) such as benzene and ethylbenzene, which are found in cannabis smoke. The objective is to understand the impact of these trends on public health and policy.

Methods Data on cannabis use were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018, including a total of 8,912 participants. These data were merged with demographic variables (gender, age, race/ethnicity, education level, household income) and blood levels of VOCs (benzene and ethylbenzene). A survey-weighted logistic regression model was used to examine the associations between cannabis use and these variables. Time-series analysis was conducted to observe trends over the decade.

Results The logistic regression model showed significant associations between cannabis use and several variables. Males had lower odds of cannabis use compared to females (p<0.001). Higher education levels were associated with higher odds of cannabis use (p<0.001), and higher household income was associated with lower odds of cannabis use (p<0.05). Blood levels of benzene were significantly associated with higher odds of cannabis use (p<0.001), while blood levels of ethylbenzene were associated with lower odds of cannabis use (p<0.001). Over the decade of analysis, the number of states that legalized recreational cannabis increased from 0 to 10, reflecting a broader trend of increased cannabis accessibility.

Conclusion and Impact The findings highlight significant demographic and chemical exposure factors associated with cannabis use. The increase in cannabis legalization and its associated VOC exposure pose potential public health risks. Public health policies should address the implications of increased cannabis use and associated VOC exposure, particularly focusing on preventive measures and education to mitigate these risks. The study underscores the need for ongoing surveillance and research to inform evidence-based public health strategies in the context of evolving cannabis legislation. This research is critical for informing policymakers on the health risks of cannabis-related VOC exposure and could shape future regulations to promote health equity and safer cannabis consumption.