title: Associations Between Cannabis Use and Physical Health Problems in Early Midlife: A Longitudinal Comparison of Persistent Cannabis vs Tobacco Users.
abstract: OBJECTIVE
  After major policy changes in the United States, policymakers, health care professionals, and the general public seek information about whether recreational cannabis use is associated with physical health problems later in life.
  
  
  OBJECTIVE
  To test associations between cannabis use over 20 years and a variety of physical health indexes at early midlife.
  
  
  METHODS
  Participants belonged to a representative birth cohort of 1037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38 years, with 95% retention (the Dunedin Multidisciplinary Health and Development Study). We tested whether cannabis use from ages 18 to 38 years was associated with physical health at age 38, even after controlling for tobacco use, childhood health, and childhood socioeconomic status. We also tested whether cannabis use from ages 26 to 38 years was associated with within-individual health decline using the same measures of health at both ages.
  
  
  METHODS
  We assessed frequency of cannabis use and cannabis dependence at ages 18, 21, 26, 32, and 38 years.
  
  
  METHODS
  We obtained laboratory measures of physical health (periodontal health, lung function, systemic inflammation, and metabolic health), as well as self-reported physical health, at ages 26 and 38 years.
  
  
  RESULTS
  The 1037 study participants were 51.6% male (n = 535). Of these, 484 had ever used tobacco daily and 675 had ever used cannabis. Cannabis use was associated with poorer periodontal health at age 38 years and within-individual decline in periodontal health from ages 26 to 38 years. For example, cannabis joint-years from ages 18 to 38 years was associated with poorer periodontal health at age 38 years, even after controlling for tobacco pack-years (β = 0.12; 95% CI, 0.05-0.18; P <.001). Additionally, cannabis joint-years from ages 26 to 38 years was associated with poorer periodontal health at age 38 years, even after accounting for periodontal health at age 26 years and tobacco pack-years (β = 0.10; 95% CI, 0.05-0.16; P <.001) However, cannabis use was unrelated to other physical health problems. Unlike cannabis use, tobacco use was associated with worse lung function, systemic inflammation, and metabolic health at age 38 years, as well as within-individual decline in health from ages 26 to 38 years.
  
  
  CONCLUSIONS
  Cannabis use for up to 20 years is associated with periodontal disease but is not associated with other physical health problems in early midlife.
authors.affiliation: Department of Psychology, Arizona State University, Tempe.
authors.forename: Madeline H
authors.initials: MH
authors.lastname: Meier
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Durham, North Carolina3Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina4Social, Genetic, and Developmental Psychiatry Centre, Institute of.
authors.forename: Avshalom
authors.initials: A
authors.lastname: Caspi
authors.affiliation: Department of Emergency Medicine, Violence Prevention Research Program, University of California, Davis.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cerdá
authors.affiliation: Department of Prevention and Social Medicine, Dunedin School of Medicine, Dunedin, New Zealand.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hancox
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Durham, North Carolina3Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: HonaLee
authors.initials: H
authors.lastname: Harrington
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Durham, North Carolina3Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: Renate
authors.initials: R
authors.lastname: Houts
authors.affiliation: Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand.
authors.forename: Richie
authors.initials: R
authors.lastname: Poulton
authors.affiliation: Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Ramrakha
authors.affiliation: Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand.
authors.forename: W Murray
authors.initials: WM
authors.lastname: Thomson
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Durham, North Carolina3Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina4Social, Genetic, and Developmental Psychiatry Centre, Institute of.
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Moffitt
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse / Q000150:complications* / Q000453:epidemiology*; D009520:New Zealand; D010510:Periodontal Diseases / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment / Q000706:statistics & numerical data; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D055815:Young Adult