Drexel University has received a grant for a five-year study of medical marijuana and its impact on drug use and physical and psychological health among young adults in Los Angeles. It is the first large-scale NIH project funded to directly investigate medical marijuana use among young adults aged 18 to 26.

The study, “Medical Marijuana, Emerging Adults & Community: Connecting Health and Policy,” is being led by Dr. Stephen Lankenau, an associate professor in Drexel’s School of Public Health, who was awarded an R01 grant from the National Institutes of Health for $3.3 million over five years, beginning July 1. Ultimately, Lankenau hopes the study’s findings can guide medical marijuana policies at local, state and national levels to result in the most positive health outcomes for young adults and communities.

Lankenau aims to determine the impact of medical marijuana policies in Los Angeles on young adults’ physical and psychological health. A core focus is understanding the significance and influence of dispensaries – storefronts that sell medical marijuana – on health.

“Dispensaries are a relatively new and unusual institution, and they haven’t been studied much,” Lankenau said. One study hypothesis is that dispensaries, which often provide social support in addition to medical marijuana, may provide the basis for better physical and psychological outcomes for medical marijuana users, compared to non-medical users who purchase the drug on the black market.

The study emerged out of preliminary findings from an earlier NIH-funded project, which examined non-medical prescription drug use among high-risk young adults in two cities. Among Los Angeles participants, Lankenau observed key differences in patterns of drug use and health between those who had a physician recommendation for medical marijuana, and those who used marijuana without a recommendation.

Guided by these findings, his new study has three specific aims:

1. Determine the basis for medical marijuana patient status and its impact on trajectories of physical and psychological health among emerging adults.
2. Determine the impact of medical marijuana patient status on patterns of drug use among emerging adults, including intensity of marijuana use and misuse of alcohol, prescription drugs and illicit drugs.
3. Describe the natural history of marijuana use in Los Angeles among medical marijuana patients and non-medical users.

“The young adults we recruit into this study represent an important group,” Lankenau said. This population will have many years of their lives ahead to experience the consequences, whether positive or negative, of policies that allow for medical marijuana use.

Young adult patients were not the norm when medical marijuana first became legal in California in 1996. At that time, most patients who qualified for a physician recommendation for the drug were older adults with chronic conditions or seeking palliative care, Lankenau said. But the list of health conditions eligible to receive a medical recommendation for marijuana in California has since grown to over 200, including conditions such as anxiety and insomnia. A growing number of younger people are receiving access to the drug with a medical recommendation.

California is one of 18 states, plus the District of Columbia, where medical use of marijuana is allowed under state law. Several other states have medical marijuana legislation pending, and two states have legalized non-medical use of marijuana.

Federal funding of medical marijuana research has been minimal to date likely because under federal law the drug remains a Schedule 1 controlled substance, a category that includes other drugs such as heroin, LSD and ecstasy. Lankenau noted that, as a result, most existing studies are smaller in scale, or involve secondary analysis of survey data without direct recruitment of medical marijuana-using populations.

Lankenau’s study will recruit 380 young medical marijuana patients and young non-medical marijuana users in natural settings and will use qualitative and quantitative methods. Lankenau and co-investigator Ellen Iverson at Children’s Hospital Los Angeles will enroll a diverse set of participants this fall and expect to complete baseline interviews and surveys by early 2014. Participants will then complete annual follow-up interviews for three years.

In addition to broadly characterizing the role medical and non-medical use of marijuana has in the lives of young adults, Lankenau is also interested in specific aspects of the relationship between drug policy, drug usage and health in this population. Some of the relevant issues include: how the “gateway” concept applies to young medical marijuana patients; the basis for medical marijuana recommendations among young adults in Los Angeles, including the role of criminal justice issues; and the influence of medical marijuana on patterns of use among young non-medical users, including the problem of drug diversion.

– See more at: http://drexel.edu/now/archive/2013/July/Medical-Marijuana-Public-Health-Study/

If all medical errors were counted together as a single cause, they would likely rank as the third leading cause of death in the United States. As health care personnel race to improve the quality of their care to save lives and prevent unneeded harm, a new study indicates there is more they can do to learn about what errors are occurring and why.

Researchers from the Drexel University School of Public Health demonstrated a systematic analysis of hospital administrative data for patient safety at a population level, in a recent paper in the Journal of Healthcare Risk Management. They say that health care organizations have an untapped opportunity to use their own administrative data in this way as a “springboard to problem identification” at the leading edge of preventing even those medical errors that are not yet preventable.

“For example, a patient may receive a drug in the Emergency Department and develop an allergic reaction, but did not have any known allergies at the time of treatment,” said Dr. Jennifer Taylor, an associate professor at Drexel who led the study. “While such events may not be deemed to be preventable now, we need to start tracking them so our research and development colleagues know what’s next in the prevention pipeline.”

Based on this premise, that preventing medical errors requires a good understanding of when and where all such errors, or so-called “patient safety events” occur – including those that are nonfatal, those that are not yet preventable and even those that do not cause noticeable harm – Taylor and colleagues analyzed large-scale data on hospital stays (recorded in discharge data) in Pennsylvania during one year. They compared hospital stays with and without patient safety events, to describe patterns, demographics and differences associated with such events.

They found that nine percent of the hospital discharges in Pennsylvania in 2006 were for stays with a patient safety event. On average, patients who experienced an adverse event were older, white and male; patient safety events added an average of $35,000 to the cost, and three days to the length, of a hospital stay.

“The percentage of discharges that had a patient safety event is in the range of other studies we’ve seen in the United States and around the world,” said Taylor. “While this figure may be a bit startling, it is not a cause for alarm, in that many of the events that we found are adverse events for which there are no known prevention strategies,” as in the example of the unexpected allergic reaction.

For their analysis, Taylor and co-authors used standard International Classification of Disease (ICD-9-CM) diagnosis codes that indicate each patient’s primary and secondary diagnoses and causes of injury in hospital discharge data. These discharge data are typically used for billing, but are also used for some public health surveillance efforts such as reporting on communicable disease. The ICD-9-CM codes provided a population-level picture of many preventable and non-preventable adverse events. The researchers combined this data source with an algorithmic patient safety indicator developed by the Agency for Healthcare Research and Quality (AHRQ), which has been demonstrated as a useful indicator of specific adverse events for which known prevention strategies are available.

Taylor and colleagues point out that hospital discharge data sources such as these are easily accessible to administrators and safety personnel and can be a useful source of information for patient safety. By describing patient safety events at the population level, their method capitalizes on the consistent standardized information the discharge data provide, and could be used by any health care entity across the United States and the world that utilizes the ICD system for coding.

Nationwide, patient safety efforts and innovations in health care are already accelerating due to financial implications of the Affordable Care Act, which limits reimbursement to facilities when specific known-preventable errors occur during a patient’s treatment. Improved population-level surveillance of all errors, Taylor suggested, can help guide safety innovators to take the next steps forward.

Taylor noted that some of Pennsylvania’s additional patient safety data sources make it a promising location to take the population-level analysis even deeper: “Pennsylvania has a strong commitment to patient safety and reporting,” said Taylor. “Many great data sources exist such as the Pennsylvania Health Care Cost Containment Commissioner’s state hospital discharge data and the Patient Safety Authority’s Patient Safety Reporting System. In our paper we recommend that these two systems be explored to discover how Pennsylvania can make even more advances in understanding the scope of the problem and how we should leverage our unique commitment to data into prevention opportunities.”

For patients concerned about preventing medical errors in their own care, Taylor recommends using the resources and fact sheets available from the National Patient Safety Foundation.

– See more at: http://drexel.edu/now/archive/2013/July/Medical-Error-Prevention-Population-Data/

Some days, Barbie Izquierdo said she read pizza menus and looked at the pictures of food to distract herself from hunger pains while she went without eating so her two young children could have enough. Izquierdo, a young single mother in Philadelphia, earned too little to put healthy food on the table, even with the help of assistance programs such as food stamps.

Izquierdo is a protagonist in a new documentary film, A Place at the Table, which chronicles three individuals’ stories to bring to light the often-hidden realities of hunger in America.

The film, premiering March 1, 2013 in theaters, on iTunes and On Demand, interweaves these personal stories with insights from experts, ordinary citizens and anti-hunger activists.

Izquierdo’s story begins with her challenges feeding her children, dealing with health problems and trying to build a better life for her family. Her story goes beyond the day-to-day struggles, however, because Izquierdo is a participant in “Witnesses to Hunger,” a community-based participatory research and advocacy project developed by Dr. Mariana Chilton at Drexel University’s School of Public Health to document the complex issues surrounding food insecurity, poverty and children’s health.

Above: Film trailer video for A Place at the Table

Izquierdo was one of the initial 40 women to join “Witnesses” at its launch in Philadelphia in 2008. Chilton formed this group to encourage participation of people who have experienced food insecurity and hunger first-hand. These mothers use digital cameras to frame the issues most important to them and their children. They use photographs and testimony to inform policymakers and make changes in their communities.

The film documents Izquierdo’s trip in 2009 with Chilton and a group of Witnesses to Washington, D.C., where they testified before legislators and displayed their photos at the nation’s capital.

Above: Witnesses to Hunger 2009 Congressional briefing

Chilton, an associate professor and director of the Center for Hunger-Free Communities in the Drexel University School of Public Health, also provided expert commentary in A Place at the Table and consulted with the film’s producers as an expert during its development.

“Chilton’s vision to give cameras, and a voice, to the women of Witnesses to Hunger inspired us in our own effort to give those families a voice in the national dialogue,” said co-director/producer Kristi Jacobson in press materials prepared for A Place at the Table.

Chilton acted as a conduit for the filmmakers to connect with many women struggling with food insecurity, including Izquierdo. Jacobson added that a key moment for the filmmakers was when one of the associate producers, Julie Kohn, watched footage of Izquierdo and began to cry. “They were the same age,” said Jacobson. “And Julie was so moved by Barbie’s struggle. She related to her, despite their different backgrounds. It helped us to see how relatable Barbie was as a young person facing daunting obstacles.”

The film also features Chilton’s research as the principal investigator of the Philadelphia site of Children’s HealthWatch, a multi-site surveillance study that monitors the health and well-being of young children under the age of four. In this age range, children are in a period of rapid brain growth and development. Therefore, even mild-to-moderate under-nutrition can have long term negative consequences.

Above: Barbie Izquierdo talks about participating in the film, at the White House in 2012

Through stories like Izquierdo’s, and those of Rosie, a fifth-grade student in Colorado, and Tremonica, a second-grade student in Mississippi, the film reveals the serious economic, social and cultural implications hunger poses in the United States and the systemic issues that cause inequality of access to healthy food. Moreover, the film shows that this is a problem that America has solved in the past, and can solve again.

A Place at the Table was co-directed and produced by Jacobson and Lori Silverbush. The film’s executive producers are Tom Colicchio (TV’s Top Chef), Participant Media’s Jeff Skoll and Diane Weyermann and Christina Weiss Lurie and Jeffrey Lurie (owners of the Philadelphia Eagles).

Related Resources:

• A Place at the Table press kit
• A Place at the Table social action site

– See more at: http://drexel.edu/now/archive/2013/February/Witness-to-Hunger-in-A-Place-at-the-Table-Documentary/