Section 1

Monitoring Changes in Marijuana Use Patterns Chapter 2

Child Health Survey (CHS) 2014-2015 Survey Results

Retail Marijuana Public Health Advisory Committee

Section 1: Child Health Survey (CHS)

Authors Daniel I. Vigil, MD, MPH Manager Marijuana Health Monitoring and Research Program, Colorado Department of Public Health and Environment Katelyn E. Hall, MPH Statistical Analyst Marijuana Health Monitoring and Research Program, Colorado Department of Public Health and Environment Elyse Contreras, MPH Coordinator Marijuana Health Monitoring and Research Program, Colorado Department of Public Health and Environment Ashley Juhl, MSPH Maternal and Child Health Epidemiologist Health Surveys and Evaluation Branch, Colorado Department of Public Health and Environment Anne Schiffmacher, MPH Maternal and Child Health Epidemiologist Health Surveys and Evaluation Branch, Colorado Department of Public Health and Environment Allison Grace Bui, MPH Epidemiologist Health Surveys and Evaluation Branch, Colorado Department of Public Health and Environment Rickey Tolliver, MPH Chief Health Surveys and Evaluation Branch, Colorado Department of Public Health and Environment Mike Van Dyke, PhD, CIH Chief Environmental Epidemiology, Occupational Health, and Toxicology Branch, Colorado Department of Public Health and Environment

Reviewer Ashley Brooks-Russell, PhD, MPH Assistant Professor Injury Prevention, Education and Research Program, Colorado School of Public Health

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The CHS survey and marijuana-related behaviors in Colorado Since 2004, the Colorado Department of Public Health and Environment has conducted the Child Health Survey (CHS). This annual survey provides data on a wide range of health issues and risk factors affecting children and youth in Colorado for children ages 1-14. The CHS is conducted as a telephone survey among respondents to the Behavioral Risk Factor Surveillance System (BRFSS) Survey who have children ages 1-14 years old. Data from the CHS help to identify areas where education, resources to assist parents, policy changes or other data-informed actions can improve the health of Colorado’s children.1 Since 2014, questions about marijuana use and storage in the home have been included in the survey (Table 1). The presence of marijuana in or around the home was evaluated using question 1, and was asked of all survey participants. Participants who answered ‘YES’ to this question were asked how their marijuana is stored, in question 2. Marijuana being used in the home was evaluated using question 3, and was asked of all survey participants. Participants who answered ‘YES’ to this question were asked how the marijuana was used inside the home in question 4. Results enable CDPHE to estimate the number of children in Colorado who may be exposed to secondhand marijuana smoke or unintentional ingestion due to unsafe storage of marijuana products in the home. For additional survey details and information about analysis methods, see Appendix C.

Survey questions Table 1. Child Health Survey questions about marijuana storage or use in or around the home, 2014-2015. 1. Is there any marijuana or marijuana product in or around your home right now? Yes No 2. Where is the marijuana that is currently in or around your home being stored? For each of the following methods please say yes if it does apply or no if it does not apply. In a childproof container or packaging In a locked container such as a cabinet, drawer or safe In a location your child cannot access (such as out of reach) Someplace else? (specify) 3. During the past 30 days, has anyone- including yourself, used marijuana or hashish inside your home? Yes No 4. How was the marijuana that was used inside your home consumed? For each of the following methods please say yes if it does apply or no if it does not apply. It was vaporized (e-cigarette-like vaporizer) It was smoked (in a joint, bong, pipe, blunt) It was eaten in food (in brownies, cakes, cookies, candy) It was consumed in a beverage (tea, cola, alcohol) It was used in some other way (specify) It was dabbed (response option was added in 2015)

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Section 1: Child Health Survey (CHS)

Definitions Dabbing – a method of marijuana use where a "dab" (small amount) of marijuana concentrate is placed on a pre-heated surface, creating concentrated marijuana vapor to be inhaled. Possible exposure to second-hand marijuana smoke or vapor within the home - defined by combining three responses from question 4: it was vaporized; it was smoked; and it was dabbed. Dabbing was added as a response in 2015; therefore, this category could be underrepresented in 2014 because respondents who dabbed within the home may have indicated it was used in some other way. Safe storage of marijuana - defined by combining three responses from question 2: in a childproof container or packaging; in a locked container such as a cabinet, drawer, or safe; and in a location your child cannot access. The response someplace else was considered potentially unsafe storage and a risk for unintentional ingestion. Vaping (vaporization of marijuana) - a method of marijuana use where marijuana vapor, rather than smoke, is inhaled. Marijuana flower or concentrate is heated in a vaporizing device (vaporizer) to a temperature below the point of combustion, to produce vapor.

How to interpret survey results Respondents to the Child Health Survey are a sample of Colorado adults with children 1-14 years old. The percent of survey respondents selecting a specific answer might not be exactly the same as if all adults with children 1-14 years old in Colorado were surveyed. Therefore, the survey results are estimates, and each has a range of possible values (also called margin of error, confidence interval, or 95% CI). These ranges are very important when comparing two estimates, and the following terms are used throughout this report: ‘Not statistically different’- Typically, if the ranges of possible values overlap for two different survey results (like two different years, or male vs. female), we cannot be confident that there is a true difference between the two (also called ‘not statistically significant.’) In some cases, an additional statistical test is done to confirm. ‘Statistically higher’ or ‘statistically lower’- If the ranges of possible values do not overlap for two different results, we CAN be confident that there is a true difference between the two (also called ‘statistically significant.’) On the figures in this report, these ranges of possible values are indicated by black bars. In footnotes, they are referred to by the statistical term ‘95% CI.’

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Section 1: Child Health Survey (CHS)

Results Results are displayed in Figures 1-3 below.

Marijuana in or around the home and safe storage In 2015, 7.9% of adults with children 1-14 years old in the home reported having marijuana or marijuana products in or around the home (Figures 1 & 2). In 82.2% of these homes, marijuana was stored safely, while in 17.8% the marijuana was potentially stored unsafely (Figure 2). It was estimated that approximately 14,000 homes in Colorado with children 1-14 years old had marijuana in the home with potentially unsafe storage. Comparing across years, there were no statistical differences from 2014 to 2015 in the prevalence of marijuana or marijuana products in or around the home (6.9%, 7.9%; Figure 1) or safe storage in homes with marijuana (86.0%, 82.2%; Figure 2). There were no differences in marijuana being in or around the home by child’s age, highest household education, or household income, or difference from 2014 to 2015 (data not shown).

Marijuana used inside the home and secondhand smoke exposure For 2014 and 2015 together, 3.2% of adults with children 1-14 years old in the home reported marijuana being used inside the home (Figure 3). Of these, 83.2% reported the marijuana was smoked, vaporized, or dabbed (Figure 3). It was estimated that approximately 16,000 homes in Colorado had children 1-14 years old with possible exposure to secondhand marijuana smoke or vapor in the home. Comparing across years, there were no statistical differences from 2014 to 2015 in the prevalence of marijuana being used inside the home (3.9%, 2.6%; Figure 1).

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Section 1: Child Health Survey (CHS)

Figure 1. Presence of marijuana in or around the home or used in the home where children live, 2014-2015.

Produced by: EEOHT, CDPHE 2016 *Black bars indicate margins of error (95% Confidence Intervals). †Data Source: Colorado Child Health Survey 2014-2015 a call-back survey from BRFSS for adults with children 14 years old or younger in the home.

Major findings 

The prevalence of marijuana or marijuana products in or around homes where children live was not statistically different between 2014 and 2015.a



The prevalence of marijuana being used inside homes where children live was not statistically different between 2014 and 2015.b

a

Marijuana or marijuana products in or around the home: 2014 6.9% (95% CI 4.9-8.9%), 2015 7.9% (95% CI 4.9-10.9%)

b

Marijuana used inside the home: 2014 3.9% (95% CI 2.4-5.4%), 2015 2.6% (95% CI 0.8-4.4%)

For an explanation of terms, see “How to interpret survey results” above. For statistical methods, see Appendix C. For data, see Appendix C, Table C.1.

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Figure 2. Percent of adults with children and marijuana in or around the home who store their marijuana in a safe place, 2014-2015. 2014 Marijuana storage in or around the home

Marijuana in or around the home

*

2015 Marijuana in or around the home

Marijuana storage in or around the home

*

Produced by: EEOHT, CDPHE 2016 *Statistically different due to non overlapping 95% confidence intervals (95% CI). †Black bars indicate margins of error (95% Confidence Intervals) ‡Data Source: Colorado Child Health Survey 2014-2015 a call-back survey from BRFSS for adults with children 14 years or younger in the home. §Safe storage included a childproof container, a locked container, or a location a child cannot access.

Major findings: 

The prevalence of marijuana being stored safely in homes where children live was not statistically different between 2014 and 2015.c

Marijuana safe storage: 2014 86.0% (95% CI 76.4-95.6%), 2015 82.2% (95% CI 70.1-94.2%)

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Section 1: Child Health Survey (CHS)

Figure 3. Methods of marijuana use among adults with children in the home, 20142015 (years combined). 2014-2015 Marijuana use in the home

Methods of marijuana use in the home

*

Produced by: EEOHT, CDPHE 2016 *Statistically different due to non overlapping 95% confidence intervals (95% CI). †Black bars indicate margins of error (95% CI) ‡Dabbing was added as a response in 2015. § Data Source: Colorado Child Health Survey 2014-2015 a call-back survey from BRFSS for adults with children 14 years or younger in the home.

Major findings 

Among adults who use marijuana in a home where children live, the prevalence of ‘smoked, vaporized or dabbed’ was statistically higher than ‘ate or drank’.d

For an explanation of terms, see “How to interpret survey results” above. For statistical methods, see Appendix C. For data, see Appendix C, Table C.2. d For 2014-2015 combined years: smoked, vaporized or dabbed 83.2% (95% CI 64.3-100.0%), ate or drank 24.0% (95% CI 5.2-42.7%) For an explanation of terms, see “How to interpret survey results” above. For statistical methods, see Appendix C. For data, see Appendix C, Table C.3.

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References 1. Colorado Department of Public Health and Environment. Maternal and Child Health Data, Colorado Child Health Survey Data. 2016; http://www.chd.dphe.state.co.us/topics.aspx?q=Maternal_Child_Health_Data. Accessed January 1, 2017.

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