Supplment - The impact of electronic cigarettes (e-cigs) on perinatal immune responsiveness and birth outcomes in Appalachia

ABSTRACT The purpose of this supplemental request is two]fold: 1. to increase number of recruitment sites to bolster recruitment of the EC and dual use groups; and 2. to assess the biological and behavioral effect of cannabis (.9]tetrahydrocannabinol carboxylic acid) on immune responsiveness and birth outcomes. Joshua Lile, PhD, a local expert on the impact of cannabis use will oversee this effort. Specific Aims: 1) To expand recruitment to additional sites, with particular emphasis on recruiting additional EC and dual users. 2) To explore the potential association between first trimester cannabis use on prenatal biomarkers (serum cotinine/nicotine; expired carbon monoxide; serum immune markers: IL]2, IL]6, IL]10, CRP, TNF, MMP]8; and NNAL/NNK) among current tobacco users (conventional, EC, and dual users). 3) To examine the potential association between first trimester cannabis use and birth outcomes (gestational age at birth, birth weight) among current tobacco users (including cigarette smokers, EC, and dual users). Research protocols for the supplement will mirror the parent award in terms of recruitment, enrollment, and biomarker collection. Analysis of the supplemental aims will also be consistent with the parent award, including repeated measures analysis of covariance. Cannabis use will be determined using qualitative and semi]quantitative urinalysis techniques, and related to perinatal immune biomarkers and birth outcomes. We will continue to use the Addiction Severity Index (ASI) to assess substance use in the past 30 days, 9, 10 and have added other cannabis]specific measures in addition to questions that mirror those of EC, dual, and conventional]only tobacco use. Qualitative screening will also assist to determine if non]users initiate or users continue to use.