Hemp-derived cannabinoid use among young adults in Lexington, Kentucky in 2024

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Cprek, Krystle A. Lang Kuhs, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9108504/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Introduction : The availability and use of hemp-derived cannabinoids (HDCs), such as delta-8-THC and CBD, have increased rapidly due to changes in US cannabis policy and their federally legal status. The health effects of HDCs remain largely unknown. Limited data exists on patterns and motivations for HDC use among young adults. This study examined prevalence, modes, and motivations for use of these products among young adults in Lexington, Kentucky. Methods A cross-sectional survey was completed by adults aged 18–30 living in or near Lexington, Kentucky, between February and March 2024 to assess demographic characteristics, traditional marijuana use, and HDC use, including type, frequency, modes, and motivations. Data were analyzed using descriptive statistics, chi-squared and Fisher’s exact tests, and logistic regression via SAS 9.4, with significance set at α = 0.05. Results The final analytic sample included 99 participants. Most were between 21 and 30 years old (77.8%), female (66.3%), white (81.3%), and had used marijuana at least once (81.8%). Lifetime use of HDCs was common (67.7%), with 24.2% of participants reporting past-month use. The most common modes of consumption were edibles (89.6%), followed by smoking (70.1%), and vaping (64.2%). The most frequently reported motivations for use were “for the high” (77.4%), followed by anxiety (63.3%) and trouble sleeping (57.2%). Those who had ever used marijuana were 4.3 times more likely to report any HDC use, even after adjusting for income and sex (aPR: 4.34, 1.54–12.28), and 10.4 times more likely to report past-month HDC use (PR: 10.35, 2.12-∞) than those who had never used marijuana. Conclusion This study is among the first to examine HDC use among young adults. Future studies with larger sample sizes are needed to further investigate patterns of use and examine disparities. Hemp-derived cannabinoids cannabidiol (CBD) tetrahydrocannabinol (THC) delta-8 delta-10 THC-A cannabis marijuana Kentucky Figures Figure 1 Figure 2 Figure 3 Introduction Rapid changes in cannabis policy and social perceptions of use in recent years have led to popularization and greater accessibility of cannabinoid products (Bhamra et al. 2021 ; Cerino et al. 2021 ; McDonagh et al. 2022 ). In the United States (US), according to the Agriculture Nutrition Improvement Act of 2018—also known as the 2018 Farm Bill— Cannabis sativa plants that contain 0.3% delta-9-tetrahydrocannabinol (delta-9-THC) or above are considered illegal marijuana, while all other plants and related products are considered legal hemp (US Forest Service 2022). The term “hemp-derived cannabinoids” (HDCs) is used when referring to any legal hemp-derived product containing cannabinoids other than delta-9-THC. To avoid confusion, the term “marijuana” is used when referring to traditional, federally illegal delta-9-THC. Some HDCs, like cannabidiol (CBD), are not psychoactive, meaning that they do not produce the traditional “high” associated with marijuana (Malone 2021 ). The 2018 Farm Bill does not explicitly address psychoactive isomers of marijuana that are created using CBD, or other legal cannabinoids, such as delta-8-THC (Johnson et al. 2023 ; Leas 2021 ). Unlike CBD, delta-8-THC has intoxicating effects similar to marijuana and thus, some people may use delta-8-THC or other HDCs as legal alternatives (LoParco et al. 2023 ). While the potential health effects remain unknown, it has been estimated that past-month delta-8-THC use of 12th grade students in the US in 2023 was 11.4% (Miech et al. 2024 ). Concerns about the regulations (or lack thereof) and marketing of HDC products have been noted in the literature (Leas 2021 ; Berg et al. 2023 ). In many states, a comprehensive range of these products have been accessible at pharmacies, health stores, vape shops, and online: edibles, drinks, vaporizers, concentrates, topicals, and others (Berg et al. 2022 ; Spindle et al. 2019 ). In Kentucky, the General Assembly passed House Bill 544 (HB 544) in March of 2023, which regulates delta-8-THC and other intoxicating hemp-derived products with age limits (21 + only), product testing, labeling, and retail restrictions, placing oversight with the state Cabinet for Health and Family Services (Kentucky General Assembly, 2023; BillTrack50, 2023 ). Many of these regulations, however, had already been implemented in Governor Beshear’s Executive Order 2022 − 799, issued in November 2022 shortly after the Kentucky Supreme Court ruled that possession and sale of products containing delta-8-THC was not prohibited. Therefore, HDCs have been de facto regulated in Kentucky since November 2022—and hence inaccessible to those under 21—though additional provisions included in HB 544 went into effect in August 2023. However, despite evidence suggesting widespread access to these products in recent years, there are few reports in the literature regarding the epidemiology of HDC product use. Prevalence studies of marijuana use can provide some guidance (National Conference of State Legislatures 2024 ). In the US, for example, it is known that marijuana use is prevalent and increasing; for the first time in 2022, there were more daily or near daily marijuana users than daily or near daily alcohol users (Jeffers et al. 2021 ; Caulkins 2024 ). Young adults are more likely to report using multiple kinds of marijuana products (Jeffers et al. 2021 ; Doggett et al. 2021 ). Among those ages 19–30 years old, prevalence of past year use was 43.6%, past-month use was 28.8%, and daily use was 11.3% in 2022 (Patrick et al. 2023 ). Cannabinoids are utilized in clinical practice as therapeutics for a wide range of medical conditions and, as of 2024, 38 states had legalized medical marijuana (National Conference of State Legislatures 2024 ). Substantial evidence demonstrates products containing marijuana can be an effective treatment for chronic pain, nausea and vomiting, and multiple sclerosis (National Academies of Sciences, E., & Medicine 2017 ). Likewise, health-related benefits such as pain relief, management of anxiety, and sleep improvement are commonly cited among those who use CBD (Bhamra et al. 2021 ; Wheeler et al. 2020 ). In addition to CBD, there is evidence that people are using delta-8-THC and/or other HDCs for medical purposes, with one study finding 51% of participants used delta-8-THC to treat physical or mental health conditions (Kruger & Kruger 2023 ). The primary aim of this study was to conduct a survey examining HDC use among young adults in Lexington, Kentucky, including modes of and motivations for use. The hypothesis was that respondents who used marijuana in the past would be more likely to report using HDCs and that most respondents would cite medical reasons for use. A secondary aim of this study was to compare characteristics of those who have used HDCs and marijuana. Methods The survey was administered via REDCap software and examined the prevalence of lifetime and past-month HDC use, including types of HDCs used, modes of use, motivations for use, and related demographic characteristics. The study was open for enrollment between February 3rd and March 1st of 2024 and was advertised on flyers with QR codes that were displayed in two local businesses. These businesses were a coffee shop and a juice bar, both within one mile of the University of Kentucky campus. A link to the survey was also shared through in-person recruitment in public spaces adjacent to these places, and on the Facebook social media application. Upon opening the QR code/link, those interested were provided more detailed information about the study and asked for their consent to participate. Eligibility was restricted to those aged 18–30 years old who resided in Kentucky. Individuals were invited to take the survey regardless of previous marijuana or HDC use. This cross-sectional study was reviewed and approved by the University of Kentucky Medical Institutional Review Board (IRB) (protocol #91639). Measures The online questionnaire included 11 to 23 items depending on branching logic. Of the 23 total potential items, 8 measured demographic characteristics, 1 to 3 measured marijuana use, and 1 to 12 measured HDC use. A paragraph was included before any questions about marijuana and HDC use to disambiguate the two and remind participants that their responses will be kept strictly confidential. For all participants, the questionnaire closed with an open-ended question asking for any other information they would like to provide about their use of marijuana or HDCs. For some questions, participants were prompted to include an alternate response if none of the responses provided were applicable. For example, participants were asked to select all HDC they have ever used at any point from a pre-defined list. If the participant chose the answer “other”, they were prompted to specify other cannabinoids they have used that were not offered as answer options. Demographic characteristics included age; sex: female, male, other; race: American Indian or Alaskan Native (AI/AN), Asian, Black or African American, Native Hawaiian or Pacific Islander (NH/PI), White, Other, Prefer not to answer; ethnicity: yes/no to identifying as Hispanic or Latino; annual household income: $ 100,000, Don’t know/Not sure; and county of residence with all Kentucky counties listed as answer options. The race and ethnicity categories were combined and collapsed into three categories for analysis; White and Black remained categories of their own, while those who identified as Hispanic/Latino (regardless of race), AI/AN, Asian, NH/PI and/or “other” race were combined to create an overall “other” race/ethnicity category. We also combined the two highest income groups to collapse the annual household income variable from five to four categories for analysis. Following the demographics, all participants were asked “ Have you ever, even once, used marijuana (Delta-9-THC) ?”, as previous marijuana use was considered likely to be associated with HDC use. If an affirmative response was given, participants were then asked their age at the time of first use and frequency of use over the last 30 days. Additional clarifying text in the survey identified key differences in products containing traditional marijuana and products containing HDCs. Following the questions assessing marijuana use, participants were asked if they had ever used HDCs. If an affirmative response was given, the participants answered an additional 10 items assessing HDC use. Similar to marijuana, participants were asked for their age at the time of first use and frequency of use over the last 30 days. Participants were asked to select all cannabinoids they have ever used and then asked to select one cannabinoid that they use most often. The cannabinoids explicitly mentioned as options in the survey were cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG), delta-6-THC, delta-8-THC, delta-10-THC, delta-11-THC, hexahydrocannabinol (HHC) or hexacore (HXC), and tetrahydrocannabinolic acid (THC-A), while other types could be listed under an “other” response. Similarly, they were asked to select all ways (modes) they have ever used HDCs, then which ways they use most often. Modes of use that were explicitly mentioned as answer options were smoke, eat (edibles), drink, vaporize, dab, topicals (creams, lotions, ointments), and some other way; however, participants were allowed to select multiple modes that they currently use most often. The remaining items assessing HDC use included questions about reasons for use and side effects experienced. Participants were asked for their main and all secondary reasons for current or past use of HDCs, with answer options pain, anxiety, depression, poor appetite, headache, inflammation, trouble sleeping, for the high (pleasure, recreational), other. They were also asked to rate on a 5-point Likert scale how beneficial HDCs were for the main reason indicated. The side effects explicitly named were cough, sputum or phlegm, wheezing, anxiety, depression, and paranoia, with the option to specify others. Data Analysis Participant characteristics—including demographic factors and marijuana use—were tabulated overall and relative to use of HDCs over their lifetime (i.e., “ever”) and over the past month. We also tabulated participant characteristics relative to lifetime and past-month marijuana use. Significance was determined using Fisher’s Exact tests where cell sizes less than 5 were present and Chi-squared tests otherwise, set at α = 0.05. Bar charts were created to aid in the visualization of the frequency of types of HDCs used and modes of consumption. To estimate the strength of association between participant characteristics and HDC and marijuana use, we used Poisson regression models with robust standard errors to estimate both crude and covariate-adjusted prevalence ratios (PRs), including covariates that were significant in bivariate analysis. All data analyses were conducted using SAS 9.4 (SAS Institute Inc., Cary, NC). Results The final analytic sample included 99 participants, with a summary of demographic characteristics provided in Table 1 . Most participants were between 21 and 30 years old (77.8%), female (66.3%), white (81.3%), resided in Fayette County (76.8%), and had used marijuana at least once (81.8%) (Table 1 ). Participants who said “prefer not to answer” for race or household income (n = 6), which included the one “other” gender, are reported in Table 1 but were excluded from all statistical analyses. In the final analytical sample, female (66.3% of sample vs. 49.8% of population) and non-Hispanic White (81.3% vs. 65.4%) individuals were over-represented compared to 2024 Census population estimates for a similar age range (ages 20–29) (Kentucky State Data Center 2024 ). Table 1 Lifetime & past-month use rates of hemp-derived cannabinoids (HDCs) and marijuana (MJ) by participant demographics, 2024 HDC use MJ Use Total Sample (N = 99) Lifetime (n = 67) Past-month (n = 24) Lifetime (n = 81) Past-month (n = 50) Age 18–20 22 (22.2) 15 (68.2) 8 (36.4) 18 (81.8) 15 (68.2) 21–30 77 (77.8) 52 (67.5) 16 (20.8) 63 (81.8) 35 (45.5) Sex Female 65 (66.3) 39 (60.0) 16 (24.6) 52 (80.0) 32 (49.2) Male 33 (33.7) 27 (81.8) 8 (24.2) 28 (84.9) 18 (54.6) Other^ 1 1 0 1 0 Race/Ethnicity Black, non-Hispanic 5 (5.2) 2 (40.0) 0 (0) 3 (60.0) 1 (20.0) White, non-Hispanic 78 (81.3) 54 (69.2) 21 (26.9) 65 (83.3) 43 (55.1) Other* 13 (13.5) 9 (69.2) 3 (23.1) 11 (84.6) 6 (46.2) Prefer not to answer^ 3 2 0 2 0 Household Income $ 24,999 or below 37 (38.5) 21 (56.8) 10 (27.0) 27 (73.0) 18 (48.7) $ 25,000- $ 49,999 24 (25.0) 17 (70.8) 4 (16.7) 21 (87.5) 10 (41.7) $ 50,000- $ 74,999 17 (17.7) 14 (82.4) 6 (35.3) 16 (94.1) 13 (76.5) $ 75,000+ 18 (18.8) 13 (72.2) 3 (16.7) 14 (77.8) 7 (38.9) Don’t know/not sure^ 3 2 1 3 2 KY County Fayette 76 (76.8) 52 (68.4) 18 (23.7) 66 (86.8) 39 (51.3) Other 23 (23.2) 15 (65.2) 6 (26.1) 15 (65.2) 11 (47.8) Ever Used Marijuana Yes 81 (81.8) 64 (79.0) 24 (29.6) 81 (100.0) 50 (61.7) No 18 (18.2) 3 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) Note: Totals may not add to 100% even due to rounding. Groups with statistically significant differences are bolded . Statistical significance was determined using Fisher’s exact test if a cell count < 5 was present and Chi-squared test statistic otherwise. Statistical significance for lifetime groups was determined by comparing to those who never used HDCs/marijuana, and the past-month groups were compared to all participants reporting no use in the past month. *Other category included participants who are American Indian/Alaskan Native, Asian, and/or Hispanic/Latino. ^Not included in statistical analysis (n = 6) Use of HDCs & marijuana In total, 67.7% of the sample (n = 67) reported lifetime use of HDCs and 24.2% had used a HDC in the past month (Table 1 ). Participants who reported any lifetime use represented 81.8% of males, 69.2% of white, non-Hispanic participants, and more than 70% of those with an annual household income of at least $ 25,000. Of participants with any lifetime HDC use, 35.8% reported past-month use. Only 16.7% of participants who had never used marijuana reported any HDC use, with zero reporting past-month use. Participants who reported past-month use represented 36.4% of those aged 18–20 years old, 26.9% of white, non-Hispanic participants, and 29.6% of those who had ever used marijuana. Among those who used HDCs over the past month, there was a mean value of 10 days of use per month (mode: 10.0, median: 7.5). Use of marijuana—whether lifetime or past-month—was more common than HDC use overall (81.8% vs. 67.7%), and for every group defined by participant characteristics. Types and Modes Overall, 86.6% of those with lifetime use of HDCs reported ever using delta-8-THC, 77.6% had used CBD, 38.8% had used delta-10-THC, and 34.3% had used THC-A (Fig. 1 ). Over half of participants who had ever used delta-8-THC declared that it was their most frequently used cannabinoid. As mentioned earlier, some HDCs are not psychoactive; CBD and CBG are the only two we specifically mention that are not (Martínez et al. 2020 ). Among those who had used HDCs, 89.6% reported ever using edibles, 70.1% reported smoking, 64.2% reported vaporizing, 32.8% reported dabbing, 20.9% reported topicals, and 13.4% reported drinks (Fig. 2 ). Vaping and smoking were the most prevalent modes used in the past month (45.5% each), while edibles were also frequently reported (42.4%). For these measures, participants were asked which HDCs they have ever used at any point in the past (lifetime use) and which HDCs they use most often (most frequently used); both questions were select all that apply. For these measures, participants were asked to select all ways (modes) they have ever used HDCs, then to select the one way they use HDCs most often. Motivations Overall, including primary and secondary motivations, the most frequently reported motivations for HDC use were “for the high” (77.4%), followed by anxiety (63.3%) and trouble sleeping (57.2%) (Fig. 3 ). In total, 73.1% of participants with lifetime use of HDCs reported at least one health-related motivation for use, with 55.4% reporting a health-related reason as their primary motivation. Among those who cited anxiety as a main reason for use, 42.9% found the cannabinoids they used extremely helpful for anxiety, and an additional 50.0% stated that they helped “some” or “a lot” (Table 2 ). For trouble sleeping, 33.3% of participants reported that HDCs were extremely helpful, and the remaining 66.7% said they helped “some” or “a lot” (Table 2 ). Of those with lifetime use, 24.6% said they only use HDCs for the primary reason reported. The number of secondary reasons reported ranged from 0 to 9, with a mode of 0 and both mean and median of 2. For these measures, participants were asked to indicate the main reason they are using or have used HDCs, then to select all other reason(s) are using or have used HDCs for. Table 2 Frequencies of primary motivations for hemp-derived cannabinoid use and their ratings of effectiveness for main motivation for use (n = 65) n (%) Main Reason Extremely helpful Helps a lot Helps some Helps a little Not helpful For the high 29 (45.3) 9 (31.0) 5 (17.2) 9 (31.0) 2 (6.9) 3 (10.3) Anxiety 14 (21.9) 6 (42.9) 5 (35.7) 2 (14.3) - 1 (7.2) Trouble sleeping 9 (14.1) 3 (33.3) 5 (55.6) 1 (11.1) - - Depression 7 (10.9) 1 (14.3) 4 (57.1) 2 (28.6) - - Nausea 3 (4.7) 2 (66.7) 1 (33.3) - - - Headache 1 (1.6) - - 1 (100) - - Pain 1 (1.6) - 1 (100) - - - Appetite 1 (1.6) 1 (100) - - - - Totals may not add up to 100% even due to rounding. Two participants who reported lifetime use of HDCs did not report their main reason for use and were not included. Adjusted Analysis of HDC & marijuana Use Males were 36% more likely to report lifetime use of HDCs than females (PR: 1.36, 1.06–1.76), but this association did not remain significant after adjusting for lifetime use of marijuana and household income (aPR: 1.20, 0.96–1.51) (Table 3 ). Lifetime prevalence of marijuana was high among the total sample (81.8%) and was significantly associated with both lifetime use of HDCs (PR: 4.74, 1.66–13.40), even after adjusting for income and sex (aPR: 4.56, 1.61–12.90), and past-month use (PR: 10.35, 2.12-∞). Household income did not remain significant after adjusting for lifetime prevalence of marijuana use, but those in the $ 50,000- $ 74,999 income category were 45% more likely to use HDCs in the unadjusted lifetime use model (PR: 1.45, 1.02–2.07). Since only one significant characteristic (previous marijuana use) was identified using unadjusted logistic regression for past-month use, an additional adjusted regression was not performed. Table 3 Crude and adjusted prevalence ratios and 95% confidence intervals of association between selected characteristics and both lifetime and past-month use of hemp-derived cannabinoids. Hemp-Derived Cannabinoids Marijuana Any Lifetime Use Any Past-Month Use Any Lifetime Use Any Past-Month Use Crude PR (95% CI) Adjusted* PR (95% CI) Crude PR (95% CI) Crude PR (95% CI) Crude PR (95% CI) Age 18–20 1.01 (0.73, 1.40) - 1.73 (0.93, 3.24) 1.00 (0.80, 1.25) 1.50 (1.11, 2.03) 21–30 Ref - Ref Ref Ref Sex Female Ref Ref Ref Ref Ref Male 1.36 (1.06, 1.76) 1.20 (0.96, 1.51) 0.72 (0.36, 1.44) 1.06 (0.88, 1.28) 1.04 (0.74, 1.48) Race/Ethnicity White non-Hispanic Ref - Ref Ref Ref Black or AA, non-Hispanic 1.00 (0.68, 1.48) - 0.42 (0.00, 2.40) + 0.60 (0.29, 1.23) 0.33 (0.07, 1.65) Other 0.58 (0.20, 1.71) - 0.82 (0.13, 3.60) + 0.85 (0.67, 1.07) 0.55 (0.32, 0.94) Household Income $ 24,999 or below Ref Ref Ref Ref Ref $ 25,000- $ 49,999 1.25 (0.85, 1.83) 0.98 (0.72, 1.32) 0.62 (0.22, 1.74) 0.88 (0.75, 1.02) 0.47 (0.30, 0.75) $ 50,000- $ 74,999 1.45 (1.02, 2.07) 1.08 (0.80, 1.46) 1.31 (0.57, 3.01) 0.94 (0.84, 1.06) 0.81 (0.64, 1.03) $ 75,000 or above 1.27 (0.85, 1.90) 1.02 (0.74, 1.41) 0.62 (0.19, 1.97) 0.78 (0.61, 1.00) 0.50 (0.30, 0.84) KY County Fayette Ref - Ref Ref Ref Other 0.95 (0.68, 1.33) - 1.18 (0.57, 2.44) 0.75 (0.55, 1.03) 1.25 (0.86, 1.81) Ever Used Marijuana No Ref Ref Ref - - Yes 4.74 (1.68, 13.40) 4.34 (1.54, 12.28) 10.35 (2.12, ∞) + - - Past-month Marijuana Use No Ref - Ref - - Yes 1.27 (0.97, 1.66) - 11.23 (1.63, 77.61) - - *Adjusted for sex, household income, and lifetime marijuana use + Calculated using exact logistic regression due to cell count of 0 Bolded values have p-value < 0.05 Discussion This study is among the first to examine HDC use among young adults. Overall, there were nine cannabinoid types, six modes of use, and nine motivations for use observed among the responses, demonstrating that young adults use these substances in diverse ways for a variety of reasons similar to marijuana use. The findings of this study are to be interpreted within the context of a rapidly evolving policy and commercial landscape surrounding marijuana products in the US; product availability, marketing practices, and consumer behaviors are likely to change. These factors highlight the importance of continued surveillance and adaptive public health strategies to respond to shifting legal frameworks. Smoking is commonly cited as the most prevalent mode of marijuana use (Romm et al. 2021 ; Steigerwald et al. 2018 ) with estimates as high as 93%-97% among those who reported current marijuana use in a study from 2012 to 2021 (Doggett et al. 2021 ). Alternatively, while smoking and vaporizing were the most commonly reported modes of past-month HDC use in this study (45.5% for each), the most common mode ever tried by respondents was edibles (90.9%). Prevalence of edible use was greater than what has been found among online delta-8-THC consumers where 64% reported edible use (Kruger & Kruger 2023 ). There is evidence that young adults’ preference of mode is influenced by convenience, desired effects of the high, and cost, and that modes other than smoking may be used as an addition to smoking rather than as a substitution (Doggett et al. 2021 ; Thompson et al. 2024 ). Participants in this study cited similar motivations for using HDCs as are commonly cited for marijuana products. While the most prevalent reason for use was “for the high” (77.4%), 73.1% of participants with lifetime use of HDCs reported at least one health-related motivation for use. These rates are similar to recent work examining use of marijuana in Kentucky and elsewhere (Lankenau et al. 2018 ), which found that citing both medical and recreational reasons for use is more prevalent than either reason alone (Shafer et al. 2024 ). Furthermore, this study’s findings were consistent with those examining the use of marijuana for specific medical purposes, with anxiety, trouble sleeping, and depression frequently cited as reasons for use by participants. Similarly, literature examining online consumers of delta-8-THC found that delta-8-THC is being used to treat a range of mental health symptoms including anxiety and panic attacks, stress, and depression or bipolar disorder (Kruger & Kruger 2023 ). Marijuana products are often marketed using health-related messages which have been found to influence the perceptions of those who use them (Willoughby et al. 2024 ; Winstock et al. 2021 ). Additionally, the majority of marijuana products are perceived as having little health risk or potential for addiction (Romm et al. 2021 ). Further research should examine the effects of health-related advertisements and messaging for HDCs and evaluate the efficacy of them for commonly stated medical purposes. In this sample, lifetime prevalence of both HDC and marijuana use were high at 67.7% and 81.8%, respectively. Past-month marijuana use (50.5%) was higher than past-month HDC use (24.3%). Among people reporting past-month use of each substance, marijuana use occurred on more days per month on average than HDC use (18.8 vs. 10 days, respectively). Previous research suggests that 16.0% of young adults ages 18–34 years in Kentucky indicated past-month marijuana use (Shafer et al. 2024 ). In our study, the prevalence of past-month marijuana use was significantly higher with 50.5% of the analytical sample indicating past-month use. Previous work has also found a mean of 9.84 days of delta-8-THC use per month among those who use marijuana, and, similar to our study, found that edibles and vaping were frequent primary methods (Livne et al. 2022 ). While our study did not measure past-month use of delta-8-THC specifically, prevalence of lifetime use (86.6%) and those electing delta-8-THC as their most frequently used HDC (44.8%) were high. A crowdsourcing study indicates that weekly use of delta-8-THC was reported by 35.7% of participants (Bergeria et al. 2023 ). Wheeler et al., 2020 determined that about 40% of young adults report lifetime use of CBD. Our study found higher rates of CBD prevalence with 77.6% of the sample reporting lifetime use. Limitations and Future Directions The results of this study have limited generalizability to young adults in Kentucky or potentially the US due to the cross-sectional design and small sample size. There were some key demographic differences between the study sample and the target population. For example, non-White and male individuals were underrepresented in the sample compared to the target population (US Census Bureau 2022 ). Further, it is likely that a large portion of the sample were students, since the study was conducted near a university campus. This could contribute to sampling bias as college students are using marijuana at historically high rates (Miech et al. 2024 ). It is likely that those who have used HDCs were more likely to participate in this research despite attempts to recruit those who did not use them. The rates of use shown in Table 1 , therefore, potentially overestimate the actual prevalence of HDC use among young adults in this population. This sample nevertheless provides some insight into motivations for HDC use and preferred modes of use during a period of minimal regulation. Given the use of self-reported data, it is possible that participants may not be entirely honest in their responses, especially regarding illicit substance use. Recall bias may be present, particularly for the questions about lifetime use. Although verbiage was included in the survey to disambiguate marijuana and HDCs, general knowledge of cannabinoids may be incomplete. This could also have caused certain cannabinoids to be under- or over-reported. A major challenge in this research is disambiguation of HDCs and the current state-by-state regulatory landscape. Data collection for this study occurred after Kentucky Governor Beshear’s Executive Order that initiated HDC regulation, including the age 21 + restriction, but participants may have been able to purchase HDC products as a minor prior to November 2022—or even after if a store employee was not well informed. Federal policy changes flowing from Public Law 119 − 37, Continuing Appropriations and Extensions Act (signed into law in November 2025 and taking effect in November 2026), however, will restrict THC limits to 0.4 mg of total THC per container. The act also redefines “THC” to include HDCs such as delta-8-THC and THC-A (Congressional Research Service, 2024 ). These policy shifts indicate a broader movement toward increased regulation of intoxicating HDC products in the United States. Conclusion This small study contributes to early findings related to HDC use in young adults and may be used to generate hypotheses for further research. Future studies with larger sample sizes are needed to further investigate use patterns and examine disparities, though recent changes to federal and state regulations may have a substantial impact on patterns of use. Abbreviations United States (US), tetrahydrocannabinol (THC), cannabidiol (CBD), Institutional Review Board (IRB), cannabinol (CBN), cannabigerol (CBG), hexahydrocannabinol (HHC) or hexacore (HXC), and tetrahydrocannabinolic acid (THC-A), prevalence ratio (PR), hemp-derived cannabinoid (HDC), marijuana (MJ) Declarations Ethics Approval and Consent to Participate This cross-sectional study was reviewed and approved by the University of Kentucky Medical Institutional Review Board (IRB) (protocol #91639). Consent for Publication Not Applicable Availability of Data and Materials The dataset generated and analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests Statement All authors declare no conflicts of interest. Funding This study was unfunded. CRediT Author Statement Victoria Hamilton: Conceptualization, Methodology, Data curation, Writing – Original draft.Sydney Shafer: Methodology, Writing – Review & editing, Formal analysis, Visualization.Ava Hess: Writing – Literature Review.Sarah E. Cprek: Methodology, Writing – Review, Supervision.Krystle A. Lang Kuhs: Methodology, Writing – Review, Supervision.Kathleen Winter: Methodology, Writing – Review, Supervision.W. Jay Christian: Conceptualization, Methodology, Writing – Review, Supervision. Acknowledgements Not Applicable References Berg, C.J., Melena, A., Wittman, F.D., Robles, T., & Henriksen, L. (2022). The Reshaping of the E-Cigarette Retail Environment: Its Evolution and Public Health Concerns. Int J Environ Res Public Health, 19(14). Berg, C.J., Romm, K.F., Pannell, A., Sridharan, P., Sapra, T., Rajamahanty, A., Cui, Y., Wang, Y., Yang, Y.T., & Cavazos-Rehg, P.A. (2023). Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities. Addict Behav, 143, 107696. Bergeria, C.L., Strickland, J.C., Spindle, T.R., Kalaba, M., Satyavolu, P.U., Feldner, M., Vandrey, R., Bonn-Miller, M., Peters, E.N., & Weerts, E. (2023). A crowdsourcing survey study on the subjective effects of delta-8-tetrahydrocannabinol relative to delta-9-tetrahydrocannabinol and cannabidiol. Exp Clin Psychopharmacol, 31(2), 312-317. https://doi.org/10.1037/pha0000565 Bhamra, S.K., Desai, A., Imani-Berendjestanki, P., & Horgan, M. (2021). The emerging role of cannabidiol (CBD) products; a survey exploring the public's use and perceptions of CBD. Phytotherapy Research, 35(10), 5734-5740. https://doi.org/10.1002/ptr.7232 BillTrack50. (2023). Kentucky HB544 | 2023 | Regular session. BillTrack50 .https://www.billtrack50.com/billdetail/1583143 Caulkins, J.P. (2024). Changes in self‐reported cannabis use in the United States from 1979 to 2022. Addiction , 119 (9), 1648-1652. https://doi.org/10.1111/add.16519 Cerino, P., Buonerba, C., Cannazza, G., D'Auria, J., Ottoni, E., Fulgione, A., Di Stasio, A., Pierri, B., & Gallo, A. (2021). A Review of Hemp as Food and Nutritional Supplement. Cannabis Cannabinoid Res, 6(1), 19-27. Congressional Research Service. (2024). Changes to the definition of hemp and related policy considerations (IN12620). U.S. Congress. https://www.congress.gov/crs-product/IN12620 Doggett, A., Battista, K., & Leatherdale, S.T. (2021). Modes of cannabis use among Canadian youth in the COMPASS study; using LCA to examine patterns of smoking, vaping, and eating/drinking cannabis. Drugs: Education, Prevention and Policy, 28(2), 156-164. https://doi.org/10.1080/09687637.2020.1769560 Jeffers, A.M., Glantz, S., Byers, A., & Keyhani, S. (2021). Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US. JAMA Netw Open, 4(11), e2136571. Johnson, L., Malone, M., Paulson, E., Swider, J., Marelius, D., Andersen, S., & Black, D. (2023). Potency and safety analysis of hemp delta-9 products: the hemp vs. cannabis demarcation problem. Journal of Cannabis Research, 5(1), 29. https://doi.org/10.1186/s42238-023-00197-6 Kentucky State Data Center. State and County Estimates 2024: Five-Year Age, Sex, Race, and Hispanic Origin — Adair to Knott County. Louisville (KY): University of Louisville; 2024 [cited 2026 Mar 27]. Available from: https://louisville.widen.net/s/dszjhwxtbt/stcoest_2024_fyasrh_adair-knott Kruger, D.J., & Kruger, J.S. (2023). Consumer Experiences with Delta-8-THC: Medical Use, Pharmaceutical Substitution, and Comparisons with Delta-9-THC. Cannabis Cannabinoid Res, 8(1), 166-173. https://doi.org/10.1089/can.2021.0124 Lankenau, S.E., Ataiants, J., Mohanty, S., Schrager, S., Iverson, E., & Wong, C.F. (2018). Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev, 37(2), 237-246. Leas, E.C. (2021). The Hemp Loophole: A Need to Clarify the Legality of Delta-8-THC and Other Hemp-Derived Tetrahydrocannabinol Compounds. American Journal of Public Health, 111(11), 1927-1931. https://doi.org/10.2105/ajph.2021.306499 Livne, O., Budney, A., Borodovsky, J., Walsh, C., Shmulewitz, D., Fink, D.S., Struble, C.A., Habib, M., Aharonovich, E., & Hasin, D.S. (2022). Delta-8 THC use in US adults: Sociodemographic characteristics and correlates. Addictive Behaviors, 133, 107374. https://doi.org/10.1016/j.addbeh.2022.107374 LoParco, C.R., Rossheim, M.E., Walters, S.T., Zhou, Z., Olsson, S., & Sussman, S.Y. (2023). Delta-8 tetrahydrocannabinol: a scoping review and commentary. Addiction, 118(6), 1011-1028. https://doi.org/https://doi.org/10.1111/add.16142 Malone, T. (2021). CBD, marijuana and hemp: What is the difference among these cannabis products, and which are legal? https://msutoday.msu.edu/news/2021/cbd-marijuana-and-hemp Martínez, V., Iriondo De-Hond, A., Borrelli, F., Capasso, R., del Castillo, M.D., & Abalo, R. (2020). Cannabidiol and other non-psychoactive cannabinoids for prevention and treatment of gastrointestinal disorders: Useful nutraceuticals? International Journal of Molecular Sciences , 21 (9), 3067. https://doi.org/10.3390/ijms21093067 McDonagh, M.S., Morasco, B.J., Wagner, J., Ahmed, A.Y., Fu, R., Kansagara, D., & Chou, R. (2022). Cannabis-Based Products for Chronic Pain. Annals of Internal Medicine, 175(8), 1143-1153. https://doi.org/10.7326/M21-4520 Miech, R. A., Johnston, L. D., Patrick, M. E., O’Malley, P. M., & Bachman, J. G.;. (2024). Monitoring the Future national survey results on drug use, 1975–2023: Overview and detailed results for secondary school students (Monitoring the Future Monograph Series., Issue. https://monitoringthefuture.org/results/annual-reports/ National Academies of Sciences, E., & Medicine. (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. The National Academies Press. https://doi.org/10.17226/24625 National Conference of State Legislatures. (2024). State Medical Cannabis Laws. https://www.ncsl.org/health/state-medical-cannabis-laws Patrick, M.E., Miech, R.A., Johnston, L.D., & O’Malley, P.M. (2023). Monitoring the Future Panel Study annual report: National data on substance use among adults ages 19 to 60, 1976-2022 (Monitoring the Future Monograph Series, Issue. https://monitoringthefuture.org/wp-content/uploads/2023/07/mtfpanel2023.pdf Romm, K.F., West, C.D., & Berg, C.J. (2021). Mode of Marijuana Use among Young Adults: Perceptions, Use Profiles, and Future Use. Subst Use Misuse, 56(12), 1765-1775. SAS Institute Inc. (2023) SAS 9.4 (Computer Software) Cary, NC: SAS Institute Inc. Shafer, S., Kennedy, G., & Christian, W.J. (2024). Population-based cross-sectional analysis of cannabis use among Kentucky adults, 2020–21. Journal of Cannabis Research, 6(1), 44. https://doi.org/10.1186/s42238-024-00251-x Spindle, T.R., Bonn-Miller, M.O., & Vandrey, R. (2019). Changing landscape of cannabis: Novel products, formulations, and methods of administration. Current Opinion in Psychology , 30 , 98-102. https://doi.org/10.1016/j.copsyc.2019.04.002 Steigerwald, S., Wong, P.O., Cohen, B.E., Ishida, J.H., Vali, M., Madden, E., & Keyhani, S. (2018). Smoking, Vaping, and Use of Edibles and Other Forms of Marijuana Among U.S. Adults. Ann Intern Med, 169(12), 890-892. Thompson, K., Thibault, T., & Peters, A.L. (2024). A better high? Understanding mode preferences among young adult cannabis users. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement , 56 (3), 327-331. https://doi.org/10.1037/cbs0000368 US Census Bureau. (2022). Population by Sex, Age Group, Race and Hispanic Orgin. http://ksdc.louisville.edu/data-downloads/estimates/ U.S. Congress. (2023). H.R. 544: An act relating to hemp-derived products. Kentucky General Assembly. https://apps.legislature.ky.gov/record/23RS/hb544.html US Forest Service. (2022, January). The agriculture improvement act of 2018 (2018 farm bill). https://www.fs.usda.gov/managing-land/farm-bill. Wheeler, M., Merten, J.W., Gordon, B.T., & Hamadi, H. (2020). CBD (Cannabidiol) Product Attitudes, Knowledge, and Use Among Young Adults. Substance Use & Misuse, 55(7), 1138-1145. https://doi.org/10.1080/10826084.2020.1729201 Willoughby, J.F., Hust, S.J.T., Li, J., & Couto, L. (2024). Exposure to Pro and Anti-Cannabis Social Media Messages and Teens' and College Students' Intentions to Use Cannabis. Health Commun, 39(1), 183-194. https://doi.org/10.1080/10410236.2022.2162707 Winstock, A.R., Lynskey, M.T., Maier, L. J., Ferris, J.A., & Davies, E.L. (2021). Perceptions of cannabis health information labels among people who use cannabis in the U.S. and Canada. International Journal of Drug Policy, 91, 102789. https://doi.org/10.1016/j.drugpo.2020.102789 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers invited by journal 01 Apr, 2026 Submission checks completed at journal 31 Mar, 2026 First submitted to journal 31 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9108504","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616236191,"identity":"5ca300fc-1bf9-4fc3-bfe5-e1c315acc616","order_by":0,"name":"Victoria Hamilton","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"","lastName":"Hamilton","suffix":""},{"id":616236196,"identity":"33c615fd-0c0e-400f-84b8-a6098631be8d","order_by":1,"name":"Sydney Shafer","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Sydney","middleName":"","lastName":"Shafer","suffix":""},{"id":616236197,"identity":"feee3abb-4b5e-4ef2-a939-1d17e204344e","order_by":2,"name":"Ava Hess","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Ava","middleName":"","lastName":"Hess","suffix":""},{"id":616236198,"identity":"3719913f-1369-4e60-b642-41939434d1e6","order_by":3,"name":"Sarah E. Cprek","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"E.","lastName":"Cprek","suffix":""},{"id":616236199,"identity":"ed16391f-3f68-4232-9736-713e8fee310e","order_by":4,"name":"Krystle A. Lang Kuhs","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Krystle","middleName":"A. Lang","lastName":"Kuhs","suffix":""},{"id":616236202,"identity":"b4294dfd-b510-417f-862c-8d8d5e67e050","order_by":5,"name":"Kathleen Winter","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Kathleen","middleName":"","lastName":"Winter","suffix":""},{"id":616236203,"identity":"c400266f-f5c3-430f-8db6-a78ddbd0ca34","order_by":6,"name":"W. Jay Christian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYBACxgYIwQNhVjAYgEQliNPCBmKeIUILQh8biNFGhBbm9jMGDD933JORn9/c+Llw3mFjgwPMB2/z4LOgJ8eAsfdMMY/BMcZm6ZnbDpsZHGBLtsarpSHHgJmxLYHHAOgXad5th20MDvCYSePV0v8GokW+jbH5N+8ckBb+b/i1zIDawnCMsU2atwHkMB42AlqeFRzsBTnsWGKbNc+xdGPJw2zGlnPwaDHsT9744Gdbgr188/HHt3lqrA37jjc/vPEGn5YGDoMDKCIKh/EoBwF5BvYHaCINBLSMglEwCkbBiAMAj3dKWM5m1xkAAAAASUVORK5CYII=","orcid":"","institution":"University of Kentucky","correspondingAuthor":true,"prefix":"","firstName":"W.","middleName":"Jay","lastName":"Christian","suffix":""}],"badges":[],"createdAt":"2026-03-12 22:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9108504/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9108504/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106403774,"identity":"19f6fb93-91fb-4850-aede-a98e30027d17","added_by":"auto","created_at":"2026-04-08 09:14:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52780,"visible":true,"origin":"","legend":"\u003cp\u003eProportion using each hemp-derived cannabinoid (HDC) type (n=67)\u003c/p\u003e\n\u003cp\u003eFor these measures, participants were asked which HDCs they have ever used at any point in the past (lifetime use) and which HDCs they use most often (most frequently used); both questions were select all that apply.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9108504/v1/49d01769b8f104b8facc559b.jpg"},{"id":106309572,"identity":"57b1a2ec-66e4-4e6a-b16b-6cf118f1f356","added_by":"auto","created_at":"2026-04-07 10:18:25","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46888,"visible":true,"origin":"","legend":"\u003cp\u003eProportions for lifetime use and most frequently used hemp-derived cannabinoid (HDC) modes (n=67)\u003c/p\u003e\n\u003cp\u003eFor these measures, participants were asked to select all ways (modes) they have ever used HDCs, then to select the one way they use HDCs most often.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9108504/v1/57b60ac082c0e35583ce87bf.jpg"},{"id":106309573,"identity":"53921911-e5fe-4678-bd88-b9412deaccba","added_by":"auto","created_at":"2026-04-07 10:18:25","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":56180,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of main and secondary reasons reported by those who reported any hemp-derived cannabinoid (HDC) use (n=67)\u003c/p\u003e\n\u003cp\u003eFor these measures, participants were asked to indicate the main reason they are using or have used HDCs, then to select all other reason(s) are using or have used HDCs for.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9108504/v1/28e1d4443668bc393e07ef4a.jpg"},{"id":106405864,"identity":"2ed84dd5-c5ef-4a40-b5cc-75e628f3bb30","added_by":"auto","created_at":"2026-04-08 09:28:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1222676,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9108504/v1/3ee05c86-9155-42d7-8e75-2849be4cdb2c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hemp-derived cannabinoid use among young adults in Lexington, Kentucky in 2024","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRapid changes in cannabis policy and social perceptions of use in recent years have led to popularization and greater accessibility of cannabinoid products (Bhamra et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Cerino et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; McDonagh et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In the United States (US), according to the Agriculture Nutrition Improvement Act of 2018\u0026mdash;also known as the 2018 Farm Bill\u0026mdash;\u003cem\u003eCannabis sativa\u003c/em\u003e plants that contain 0.3% delta-9-tetrahydrocannabinol (delta-9-THC) or above are considered illegal marijuana, while all other plants and related products are considered legal hemp (US Forest Service 2022). The term \u0026ldquo;hemp-derived cannabinoids\u0026rdquo; (HDCs) is used when referring to any legal hemp-derived product containing cannabinoids other than delta-9-THC. To avoid confusion, the term \u0026ldquo;marijuana\u0026rdquo; is used when referring to traditional, federally illegal delta-9-THC.\u003c/p\u003e \u003cp\u003eSome HDCs, like cannabidiol (CBD), are not psychoactive, meaning that they do not produce the traditional \u0026ldquo;high\u0026rdquo; associated with marijuana (Malone \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The 2018 Farm Bill does not explicitly address psychoactive isomers of marijuana that are created using CBD, or other legal cannabinoids, such as delta-8-THC (Johnson et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Leas \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Unlike CBD, delta-8-THC has intoxicating effects similar to marijuana and thus, some people may use delta-8-THC or other HDCs as legal alternatives (LoParco et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). While the potential health effects remain unknown, it has been estimated that past-month delta-8-THC use of 12th grade students in the US in 2023 was 11.4% (Miech et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConcerns about the regulations (or lack thereof) and marketing of HDC products have been noted in the literature (Leas \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Berg et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In many states, a comprehensive range of these products have been accessible at pharmacies, health stores, vape shops, and online: edibles, drinks, vaporizers, concentrates, topicals, and others (Berg et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Spindle et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In Kentucky, the General Assembly passed House Bill 544 (HB 544) in March of 2023, which regulates delta-8-THC and other intoxicating hemp-derived products with age limits (21\u0026thinsp;+\u0026thinsp;only), product testing, labeling, and retail restrictions, placing oversight with the state Cabinet for Health and Family Services (Kentucky General Assembly, 2023; BillTrack50, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Many of these regulations, however, had already been implemented in Governor Beshear\u0026rsquo;s Executive Order 2022\u0026thinsp;\u0026minus;\u0026thinsp;799, issued in November 2022 shortly after the Kentucky Supreme Court ruled that possession and sale of products containing delta-8-THC was not prohibited. Therefore, HDCs have been de facto regulated in Kentucky since November 2022\u0026mdash;and hence inaccessible to those under 21\u0026mdash;though additional provisions included in HB 544 went into effect in August 2023.\u003c/p\u003e \u003cp\u003eHowever, despite evidence suggesting widespread access to these products in recent years, there are few reports in the literature regarding the epidemiology of HDC product use. Prevalence studies of marijuana use can provide some guidance (National Conference of State Legislatures \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In the US, for example, it is known that marijuana use is prevalent and increasing; for the first time in 2022, there were more daily or near daily marijuana users than daily or near daily alcohol users (Jeffers et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Caulkins \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Young adults are more likely to report using multiple kinds of marijuana products (Jeffers et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Doggett et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Among those ages 19\u0026ndash;30 years old, prevalence of past year use was 43.6%, past-month use was 28.8%, and daily use was 11.3% in 2022 (Patrick et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCannabinoids are utilized in clinical practice as therapeutics for a wide range of medical conditions and, as of 2024, 38 states had legalized medical marijuana (National Conference of State Legislatures \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Substantial evidence demonstrates products containing marijuana can be an effective treatment for chronic pain, nausea and vomiting, and multiple sclerosis (National Academies of Sciences, E., \u0026amp; Medicine \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Likewise, health-related benefits such as pain relief, management of anxiety, and sleep improvement are commonly cited among those who use CBD (Bhamra et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Wheeler et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In addition to CBD, there is evidence that people are using delta-8-THC and/or other HDCs for medical purposes, with one study finding 51% of participants used delta-8-THC to treat physical or mental health conditions (Kruger \u0026amp; Kruger \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe primary aim of this study was to conduct a survey examining HDC use among young adults in Lexington, Kentucky, including modes of and motivations for use. The hypothesis was that respondents who used marijuana in the past would be more likely to report using HDCs and that most respondents would cite medical reasons for use. A secondary aim of this study was to compare characteristics of those who have used HDCs and marijuana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe survey was administered via REDCap software and examined the prevalence of lifetime and past-month HDC use, including types of HDCs used, modes of use, motivations for use, and related demographic characteristics. The study was open for enrollment between February 3rd and March 1st of 2024 and was advertised on flyers with QR codes that were displayed in two local businesses. These businesses were a coffee shop and a juice bar, both within one mile of the University of Kentucky campus. A link to the survey was also shared through in-person recruitment in public spaces adjacent to these places, and on the Facebook social media application. Upon opening the QR code/link, those interested were provided more detailed information about the study and asked for their consent to participate. Eligibility was restricted to those aged 18\u0026ndash;30 years old who resided in Kentucky. Individuals were invited to take the survey regardless of previous marijuana or HDC use.\u003c/p\u003e \u003cp\u003e This cross-sectional study was reviewed and approved by the University of Kentucky Medical Institutional Review Board (IRB) (protocol #91639).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eThe online questionnaire included 11 to 23 items depending on branching logic. Of the 23 total potential items, 8 measured demographic characteristics, 1 to 3 measured marijuana use, and 1 to 12 measured HDC use. A paragraph was included before any questions about marijuana and HDC use to disambiguate the two and remind participants that their responses will be kept strictly confidential. For all participants, the questionnaire closed with an open-ended question asking for any other information they would like to provide about their use of marijuana or HDCs. For some questions, participants were prompted to include an alternate response if none of the responses provided were applicable. For example, participants were asked to select all HDC they have ever used at any point from a pre-defined list. If the participant chose the answer \u0026ldquo;other\u0026rdquo;, they were prompted to specify other cannabinoids they have used that were not offered as answer options.\u003c/p\u003e \u003cp\u003eDemographic characteristics included age; sex: female, male, other; race: American Indian or Alaskan Native (AI/AN), Asian, Black or African American, Native Hawaiian or Pacific Islander (NH/PI), White, Other, Prefer not to answer; ethnicity: yes/no to identifying as Hispanic or Latino; annual household income: \u0026lt;\u003cspan\u003e$\u003c/span\u003e25,000, \u003cspan\u003e$\u003c/span\u003e25,000-\u003cspan\u003e$\u003c/span\u003e49,000, \u003cspan\u003e$\u003c/span\u003e50,000-\u003cspan\u003e$\u003c/span\u003e74,999, \u003cspan\u003e$\u003c/span\u003e75,000-\u003cspan\u003e$\u003c/span\u003e100,000, \u0026gt;\u003cspan\u003e$\u003c/span\u003e100,000, Don\u0026rsquo;t know/Not sure; and county of residence with all Kentucky counties listed as answer options. The race and ethnicity categories were combined and collapsed into three categories for analysis; White and Black remained categories of their own, while those who identified as Hispanic/Latino (regardless of race), AI/AN, Asian, NH/PI and/or \u0026ldquo;other\u0026rdquo; race were combined to create an overall \u0026ldquo;other\u0026rdquo; race/ethnicity category. We also combined the two highest income groups to collapse the annual household income variable from five to four categories for analysis.\u003c/p\u003e \u003cp\u003eFollowing the demographics, all participants were asked \u0026ldquo;\u003cem\u003eHave you ever, even once, used marijuana (Delta-9-THC)\u003c/em\u003e?\u0026rdquo;, as previous marijuana use was considered likely to be associated with HDC use. If an affirmative response was given, participants were then asked their age at the time of first use and frequency of use over the last 30 days. Additional clarifying text in the survey identified key differences in products containing traditional marijuana and products containing HDCs. Following the questions assessing marijuana use, participants were asked if they had ever used HDCs. If an affirmative response was given, the participants answered an additional 10 items assessing HDC use. Similar to marijuana, participants were asked for their age at the time of first use and frequency of use over the last 30 days.\u003c/p\u003e \u003cp\u003eParticipants were asked to select all cannabinoids they have ever used and then asked to select one cannabinoid that they use most often. The cannabinoids explicitly mentioned as options in the survey were cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG), delta-6-THC, delta-8-THC, delta-10-THC, delta-11-THC, hexahydrocannabinol (HHC) or hexacore (HXC), and tetrahydrocannabinolic acid (THC-A), while other types could be listed under an \u0026ldquo;other\u0026rdquo; response. Similarly, they were asked to select all ways (modes) they have ever used HDCs, then which ways they use most often. Modes of use that were explicitly mentioned as answer options were smoke, eat (edibles), drink, vaporize, dab, topicals (creams, lotions, ointments), and some other way; however, participants were allowed to select multiple modes that they currently use most often.\u003c/p\u003e \u003cp\u003eThe remaining items assessing HDC use included questions about reasons for use and side effects experienced. Participants were asked for their main and all secondary reasons for current or past use of HDCs, with answer options pain, anxiety, depression, poor appetite, headache, inflammation, trouble sleeping, for the high (pleasure, recreational), other. They were also asked to rate on a 5-point Likert scale how beneficial HDCs were for the main reason indicated. The side effects explicitly named were cough, sputum or phlegm, wheezing, anxiety, depression, and paranoia, with the option to specify others.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eParticipant characteristics\u0026mdash;including demographic factors and marijuana use\u0026mdash;were tabulated overall and relative to use of HDCs over their lifetime (i.e., \u0026ldquo;ever\u0026rdquo;) and over the past month. We also tabulated participant characteristics relative to lifetime and past-month marijuana use. Significance was determined using Fisher\u0026rsquo;s Exact tests where cell sizes less than 5 were present and Chi-squared tests otherwise, set at α\u0026thinsp;=\u0026thinsp;0.05. Bar charts were created to aid in the visualization of the frequency of types of HDCs used and modes of consumption. To estimate the strength of association between participant characteristics and HDC and marijuana use, we used Poisson regression models with robust standard errors to estimate both crude and covariate-adjusted prevalence ratios (PRs), including covariates that were significant in bivariate analysis. All data analyses were conducted using SAS 9.4 (SAS Institute Inc., Cary, NC).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe final analytic sample included 99 participants, with a summary of demographic characteristics provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Most participants were between 21 and 30 years old (77.8%), female (66.3%), white (81.3%), resided in Fayette County (76.8%), and had used marijuana at least once (81.8%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants who said \u0026ldquo;prefer not to answer\u0026rdquo; for race or household income (n\u0026thinsp;=\u0026thinsp;6), which included the one \u0026ldquo;other\u0026rdquo; gender, are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e but were excluded from all statistical analyses. In the final analytical sample, female (66.3% of sample vs. 49.8% of population) and non-Hispanic White (81.3% vs. 65.4%) individuals were over-represented compared to 2024 Census population estimates for a similar age range (ages 20\u0026ndash;29) (Kentucky State Data Center \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLifetime \u0026amp; past-month use rates of hemp-derived cannabinoids (HDCs) and marijuana (MJ) by participant demographics, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eHDC use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMJ Use\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Sample (N\u0026thinsp;=\u0026thinsp;99)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLifetime (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePast-month (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLifetime (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePast-month (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (68.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (66.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e39 (60.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (49.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e27 (81.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (84.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (54.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther^\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/Ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack, non-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (20.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite, non-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43 (55.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (46.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to answer^\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e24,999 or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (48.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e25,000-\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (41.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000-\u003cspan\u003e$\u003c/span\u003e74,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (76.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e75,000+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (38.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know/not sure^\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKY County\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFayette\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e66 (86.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (51.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e15 (65.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (47.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver Used Marijuana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e64 (79.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e24 (29.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e81 (100.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e50 (61.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3 (16.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0 (0.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0 (0.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0 (0.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: Totals may not add to 100% even due to rounding. Groups with statistically significant differences are \u003cb\u003ebolded\u003c/b\u003e. Statistical significance was determined using Fisher\u0026rsquo;s exact test if a cell count\u0026thinsp;\u0026lt;\u0026thinsp;5 was present and Chi-squared test statistic otherwise. Statistical significance for lifetime groups was determined by comparing to those who never used HDCs/marijuana, and the past-month groups were compared to all participants reporting no use in the past month.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Other category included participants who are American Indian/Alaskan Native, Asian, and/or Hispanic/Latino.\u003c/p\u003e \u003cp\u003e^Not included in statistical analysis (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\n\u003ch3\u003eUse of HDCs \u0026 marijuana\u003c/h3\u003e\n\u003cp\u003eIn total, 67.7% of the sample (n\u0026thinsp;=\u0026thinsp;67) reported lifetime use of HDCs and 24.2% had used a HDC in the past month (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants who reported any lifetime use represented 81.8% of males, 69.2% of white, non-Hispanic participants, and more than 70% of those with an annual household income of at least \u003cspan\u003e$\u003c/span\u003e25,000. Of participants with any lifetime HDC use, 35.8% reported past-month use. Only 16.7% of participants who had never used marijuana reported any HDC use, with zero reporting past-month use. Participants who reported past-month use represented 36.4% of those aged 18\u0026ndash;20 years old, 26.9% of white, non-Hispanic participants, and 29.6% of those who had ever used marijuana. Among those who used HDCs over the past month, there was a mean value of 10 days of use per month (mode: 10.0, median: 7.5).\u003c/p\u003e \u003cp\u003eUse of marijuana\u0026mdash;whether lifetime or past-month\u0026mdash;was more common than HDC use overall (81.8% vs. 67.7%), and for every group defined by participant characteristics.\u003c/p\u003e\n\u003ch3\u003eTypes and Modes\u003c/h3\u003e\n\u003cp\u003eOverall, 86.6% of those with lifetime use of HDCs reported ever using delta-8-THC, 77.6% had used CBD, 38.8% had used delta-10-THC, and 34.3% had used THC-A (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Over half of participants who had ever used delta-8-THC declared that it was their most frequently used cannabinoid. As mentioned earlier, some HDCs are not psychoactive; CBD and CBG are the only two we specifically mention that are not (Mart\u0026iacute;nez et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Among those who had used HDCs, 89.6% reported ever using edibles, 70.1% reported smoking, 64.2% reported vaporizing, 32.8% reported dabbing, 20.9% reported topicals, and 13.4% reported drinks (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Vaping and smoking were the most prevalent modes used in the past month (45.5% each), while edibles were also frequently reported (42.4%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor these measures, participants were asked which HDCs they have ever used at any point in the past (lifetime use) and which HDCs they use most often (most frequently used); both questions were select all that apply.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor these measures, participants were asked to select all ways (modes) they have ever used HDCs, then to select the one way they use HDCs most often.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMotivations\u003c/h2\u003e \u003cp\u003eOverall, including primary and secondary motivations, the most frequently reported motivations for HDC use were \u0026ldquo;for the high\u0026rdquo; (77.4%), followed by anxiety (63.3%) and trouble sleeping (57.2%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In total, 73.1% of participants with lifetime use of HDCs reported at least one health-related motivation for use, with 55.4% reporting a health-related reason as their primary motivation. Among those who cited anxiety as a main reason for use, 42.9% found the cannabinoids they used extremely helpful for anxiety, and an additional 50.0% stated that they helped \u0026ldquo;some\u0026rdquo; or \u0026ldquo;a lot\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). For trouble sleeping, 33.3% of participants reported that HDCs were extremely helpful, and the remaining 66.7% said they helped \u0026ldquo;some\u0026rdquo; or \u0026ldquo;a lot\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of those with lifetime use, 24.6% said they only use HDCs for the primary reason reported. The number of secondary reasons reported ranged from 0 to 9, with a mode of 0 and both mean and median of 2.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor these measures, participants were asked to indicate the main reason they are using or have used HDCs, then to select all other reason(s) are using or have used HDCs for.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequencies of primary motivations for hemp-derived cannabinoid use and their ratings of effectiveness for main motivation for use (n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMain Reason\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExtremely helpful\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHelps a lot\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHelps some\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHelps a little\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNot helpful\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFor the high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (10.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (7.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrouble sleeping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppetite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTotals may not add up to 100% even due to rounding. Two participants who reported lifetime use of HDCs did not report their main reason for use and were not included.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAdjusted Analysis of HDC \u0026 marijuana Use\u003c/h3\u003e\n\u003cp\u003eMales were 36% more likely to report lifetime use of HDCs than females (PR: 1.36, 1.06\u0026ndash;1.76), but this association did not remain significant after adjusting for lifetime use of marijuana and household income (aPR: 1.20, 0.96\u0026ndash;1.51) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Lifetime prevalence of marijuana was high among the total sample (81.8%) and was significantly associated with both lifetime use of HDCs (PR: 4.74, 1.66\u0026ndash;13.40), even after adjusting for income and sex (aPR: 4.56, 1.61\u0026ndash;12.90), and past-month use (PR: 10.35, 2.12-\u0026infin;). Household income did not remain significant after adjusting for lifetime prevalence of marijuana use, but those in the \u003cspan\u003e$\u003c/span\u003e50,000-\u003cspan\u003e$\u003c/span\u003e74,999 income category were 45% more likely to use HDCs in the unadjusted lifetime use model (PR: 1.45, 1.02\u0026ndash;2.07). Since only one significant characteristic (previous marijuana use) was identified using unadjusted logistic regression for past-month use, an additional adjusted regression was not performed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCrude and adjusted prevalence ratios and 95% confidence intervals of association between selected characteristics and both lifetime and past-month use of hemp-derived cannabinoids.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eHemp-Derived Cannabinoids\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMarijuana\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAny Lifetime Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAny Past-Month Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAny Lifetime Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAny Past-Month Use\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude PR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted* PR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCrude PR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCrude PR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCrude PR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.73, 1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.73 (0.93, 3.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00 (0.80, 1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.50 (1.11, 2.03)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.36 (1.06, 1.76)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.20 (0.96, 1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72 (0.36, 1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06 (0.88, 1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.04 (0.74, 1.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/Ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite non-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or AA, non-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.68, 1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42 (0.00, 2.40)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.60 (0.29, 1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33 (0.07, 1.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.58 (0.20, 1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82 (0.13, 3.60)\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85 (0.67, 1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.55 (0.32, 0.94)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e24,999 or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e25,000-\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25 (0.85, 1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98 (0.72, 1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62 (0.22, 1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.88 (0.75, 1.02)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.47 (0.30, 0.75)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000-\u003cspan\u003e$\u003c/span\u003e74,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.45 (1.02, 2.07)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08 (0.80, 1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.31 (0.57, 3.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.94 (0.84, 1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81 (0.64, 1.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e75,000 or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.27 (0.85, 1.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02 (0.74, 1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62 (0.19, 1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.78 (0.61, 1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.50 (0.30, 0.84)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKY County\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFayette\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.68, 1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.18 (0.57, 2.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75 (0.55, 1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.25 (0.86, 1.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver Used Marijuana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.74 (1.68, 13.40)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.34 (1.54, 12.28)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e10.35 (2.12, \u0026infin;)\u003c/b\u003e\u003csup\u003e\u003cb\u003e+\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast-month Marijuana Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.27 (0.97, 1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.23 (1.63, 77.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Adjusted for sex, household income, and lifetime marijuana use\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e+\u003c/sup\u003eCalculated using exact logistic regression due to cell count of 0\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eBolded values\u003c/b\u003e have p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is among the first to examine HDC use among young adults. Overall, there were nine cannabinoid types, six modes of use, and nine motivations for use observed among the responses, demonstrating that young adults use these substances in diverse ways for a variety of reasons similar to marijuana use. The findings of this study are to be interpreted within the context of a rapidly evolving policy and commercial landscape surrounding marijuana products in the US; product availability, marketing practices, and consumer behaviors are likely to change. These factors highlight the importance of continued surveillance and adaptive public health strategies to respond to shifting legal frameworks.\u003c/p\u003e \u003cp\u003eSmoking is commonly cited as the most prevalent mode of marijuana use (Romm et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Steigerwald et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) with estimates as high as 93%-97% among those who reported current marijuana use in a study from 2012 to 2021 (Doggett et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Alternatively, while smoking and vaporizing were the most commonly reported modes of past-month HDC use in this study (45.5% for each), the most common mode ever tried by respondents was edibles (90.9%). Prevalence of edible use was greater than what has been found among online delta-8-THC consumers where 64% reported edible use (Kruger \u0026amp; Kruger \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). There is evidence that young adults\u0026rsquo; preference of mode is influenced by convenience, desired effects of the high, and cost, and that modes other than smoking may be used as an addition to smoking rather than as a substitution (Doggett et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Thompson et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParticipants in this study cited similar motivations for using HDCs as are commonly cited for marijuana products. While the most prevalent reason for use was \u0026ldquo;for the high\u0026rdquo; (77.4%), 73.1% of participants with lifetime use of HDCs reported at least one health-related motivation for use. These rates are similar to recent work examining use of marijuana in Kentucky and elsewhere (Lankenau et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), which found that citing both medical and recreational reasons for use is more prevalent than either reason alone (Shafer et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Furthermore, this study\u0026rsquo;s findings were consistent with those examining the use of marijuana for specific medical purposes, with anxiety, trouble sleeping, and depression frequently cited as reasons for use by participants. Similarly, literature examining online consumers of delta-8-THC found that delta-8-THC is being used to treat a range of mental health symptoms including anxiety and panic attacks, stress, and depression or bipolar disorder (Kruger \u0026amp; Kruger \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Marijuana products are often marketed using health-related messages which have been found to influence the perceptions of those who use them (Willoughby et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Winstock et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Additionally, the majority of marijuana products are perceived as having little health risk or potential for addiction (Romm et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Further research should examine the effects of health-related advertisements and messaging for HDCs and evaluate the efficacy of them for commonly stated medical purposes.\u003c/p\u003e \u003cp\u003eIn this sample, lifetime prevalence of both HDC and marijuana use were high at 67.7% and 81.8%, respectively. Past-month marijuana use (50.5%) was higher than past-month HDC use (24.3%). Among people reporting past-month use of each substance, marijuana use occurred on more days per month on average than HDC use (18.8 vs. 10 days, respectively). Previous research suggests that 16.0% of young adults ages 18\u0026ndash;34 years in Kentucky indicated past-month marijuana use (Shafer et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In our study, the prevalence of past-month marijuana use was significantly higher with 50.5% of the analytical sample indicating past-month use. Previous work has also found a mean of 9.84 days of delta-8-THC use per month among those who use marijuana, and, similar to our study, found that edibles and vaping were frequent primary methods (Livne et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). While our study did not measure past-month use of delta-8-THC specifically, prevalence of lifetime use (86.6%) and those electing delta-8-THC as their most frequently used HDC (44.8%) were high. A crowdsourcing study indicates that weekly use of delta-8-THC was reported by 35.7% of participants (Bergeria et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Wheeler et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e determined that about 40% of young adults report lifetime use of CBD. Our study found higher rates of CBD prevalence with 77.6% of the sample reporting lifetime use.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e \u003cp\u003eThe results of this study have limited generalizability to young adults in Kentucky or potentially the US due to the cross-sectional design and small sample size. There were some key demographic differences between the study sample and the target population. For example, non-White and male individuals were underrepresented in the sample compared to the target population (US Census Bureau \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Further, it is likely that a large portion of the sample were students, since the study was conducted near a university campus. This could contribute to sampling bias as college students are using marijuana at historically high rates (Miech et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). It is likely that those who have used HDCs were more likely to participate in this research despite attempts to recruit those who did not use them. The rates of use shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, therefore, potentially overestimate the actual prevalence of HDC use among young adults in this population. This sample nevertheless provides some insight into motivations for HDC use and preferred modes of use during a period of minimal regulation.\u003c/p\u003e \u003cp\u003eGiven the use of self-reported data, it is possible that participants may not be entirely honest in their responses, especially regarding illicit substance use. Recall bias may be present, particularly for the questions about lifetime use. Although verbiage was included in the survey to disambiguate marijuana and HDCs, general knowledge of cannabinoids may be incomplete. This could also have caused certain cannabinoids to be under- or over-reported.\u003c/p\u003e \u003cp\u003eA major challenge in this research is disambiguation of HDCs and the current state-by-state regulatory landscape. Data collection for this study occurred after Kentucky Governor Beshear\u0026rsquo;s Executive Order that initiated HDC regulation, including the age 21\u0026thinsp;+\u0026thinsp;restriction, but participants may have been able to purchase HDC products as a minor prior to November 2022\u0026mdash;or even after if a store employee was not well informed. Federal policy changes flowing from Public Law 119\u0026thinsp;\u0026minus;\u0026thinsp;37, Continuing Appropriations and Extensions Act (signed into law in November 2025 and taking effect in November 2026), however, will restrict THC limits to 0.4 mg of total THC per container. The act also redefines \u0026ldquo;THC\u0026rdquo; to include HDCs such as delta-8-THC and THC-A (Congressional Research Service, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These policy shifts indicate a broader movement toward increased regulation of intoxicating HDC products in the United States.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis small study contributes to early findings related to HDC use in young adults and may be used to generate hypotheses for further research. Future studies with larger sample sizes are needed to further investigate use patterns and examine disparities, though recent changes to federal and state regulations may have a substantial impact on patterns of use.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUnited States (US), tetrahydrocannabinol (THC), cannabidiol (CBD), Institutional Review Board (IRB), cannabinol (CBN), cannabigerol (CBG), hexahydrocannabinol (HHC) or hexacore (HXC), and tetrahydrocannabinolic acid (THC-A), prevalence ratio (PR), hemp-derived cannabinoid (HDC), marijuana (MJ)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was reviewed and approved by the University of Kentucky Medical Institutional Review Board (IRB) (protocol #91639). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eCompeting Interests Statement\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was unfunded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eCRediT Author Statement\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eVictoria Hamilton: Conceptualization, Methodology, Data curation, Writing \u0026ndash; Original draft.Sydney Shafer: Methodology, Writing \u0026ndash; Review \u0026amp; editing, Formal analysis, Visualization.Ava Hess: Writing \u0026ndash; Literature Review.Sarah E. Cprek: Methodology, Writing \u0026ndash; Review, Supervision.Krystle A. Lang Kuhs: Methodology, Writing \u0026ndash; Review, Supervision.Kathleen Winter: Methodology, Writing \u0026ndash; Review, Supervision.W. Jay Christian: Conceptualization, Methodology, Writing \u0026ndash; Review, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBerg, C.J., Melena, A., Wittman, F.D., Robles, T., \u0026amp; Henriksen, L. (2022). The Reshaping of the E-Cigarette Retail Environment: Its Evolution and Public Health Concerns. Int J Environ Res Public Health, 19(14).\u003c/li\u003e\n\u003cli\u003eBerg, C.J., Romm, K.F., Pannell, A., Sridharan, P., Sapra, T., Rajamahanty, A., Cui, Y., Wang, Y., Yang, Y.T., \u0026amp; Cavazos-Rehg, P.A. (2023). Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities. Addict Behav, 143, 107696.\u003c/li\u003e\n\u003cli\u003eBergeria, C.L., Strickland, J.C., Spindle, T.R., Kalaba, M., Satyavolu, P.U., Feldner, M., Vandrey, R., Bonn-Miller, M., Peters, E.N., \u0026amp; Weerts, E. (2023). A crowdsourcing survey study on the subjective effects of delta-8-tetrahydrocannabinol relative to delta-9-tetrahydrocannabinol and cannabidiol. Exp Clin Psychopharmacol, 31(2), 312-317. https://doi.org/10.1037/pha0000565\u003c/li\u003e\n\u003cli\u003eBhamra, S.K., Desai, A., Imani-Berendjestanki, P., \u0026amp; Horgan, M. (2021). The emerging role of cannabidiol (CBD) products; a survey exploring the public\u0026apos;s use and perceptions of CBD. Phytotherapy Research, 35(10), 5734-5740. https://doi.org/10.1002/ptr.7232 \u003c/li\u003e\n\u003cli\u003eBillTrack50. (2023). Kentucky HB544 | 2023 | Regular session. BillTrack50 .https://www.billtrack50.com/billdetail/1583143 \u003c/li\u003e\n\u003cli\u003eCaulkins, J.P. (2024). Changes in self‐reported cannabis use in the United States from 1979 to 2022. \u003cem\u003eAddiction\u003c/em\u003e, \u003cem\u003e119\u003c/em\u003e(9), 1648-1652. https://doi.org/10.1111/add.16519\u003c/li\u003e\n\u003cli\u003eCerino, P., Buonerba, C., Cannazza, G., D\u0026apos;Auria, J., Ottoni, E., Fulgione, A., Di Stasio, A., Pierri, B., \u0026amp; Gallo, A. (2021). A Review of Hemp as Food and Nutritional Supplement. Cannabis Cannabinoid Res, 6(1), 19-27.\u003c/li\u003e\n\u003cli\u003eCongressional Research Service. (2024). Changes to the definition of hemp and related policy considerations (IN12620). U.S. Congress. https://www.congress.gov/crs-product/IN12620\u003c/li\u003e\n\u003cli\u003eDoggett, A., Battista, K., \u0026amp; Leatherdale, S.T. (2021). Modes of cannabis use among Canadian youth in the COMPASS study; using LCA to examine patterns of smoking, vaping, and eating/drinking cannabis. Drugs: Education, Prevention and Policy, 28(2), 156-164. https://doi.org/10.1080/09687637.2020.1769560\u003c/li\u003e\n\u003cli\u003eJeffers, A.M., Glantz, S., Byers, A., \u0026amp; Keyhani, S. (2021). Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US. JAMA Netw Open, 4(11), e2136571.\u003c/li\u003e\n\u003cli\u003eJohnson, L., Malone, M., Paulson, E., Swider, J., Marelius, D., Andersen, S., \u0026amp; Black, D. (2023). Potency and safety analysis of hemp delta-9 products: the hemp vs. cannabis demarcation problem. Journal of Cannabis Research, 5(1), 29. https://doi.org/10.1186/s42238-023-00197-6\u003c/li\u003e\n\u003cli\u003eKentucky State Data Center. State and County Estimates 2024: Five-Year Age, Sex, Race, and Hispanic Origin \u0026mdash; Adair to Knott County. Louisville (KY): University of Louisville; 2024 [cited 2026 Mar 27]. Available from: https://louisville.widen.net/s/dszjhwxtbt/stcoest_2024_fyasrh_adair-knott\u003c/li\u003e\n\u003cli\u003eKruger, D.J., \u0026amp; Kruger, J.S. (2023). Consumer Experiences with Delta-8-THC: Medical Use, Pharmaceutical Substitution, and Comparisons with Delta-9-THC. Cannabis Cannabinoid Res, 8(1), 166-173. https://doi.org/10.1089/can.2021.0124\u003c/li\u003e\n\u003cli\u003eLankenau, S.E., Ataiants, J., Mohanty, S., Schrager, S., Iverson, E., \u0026amp; Wong, C.F. (2018). Health conditions and motivations for marijuana use among young adult medical marijuana patients and non-patient marijuana users. Drug Alcohol Rev, 37(2), 237-246.\u003c/li\u003e\n\u003cli\u003eLeas, E.C. (2021). The Hemp Loophole: A Need to Clarify the Legality of Delta-8-THC and Other Hemp-Derived Tetrahydrocannabinol Compounds. American Journal of Public Health, 111(11), 1927-1931. https://doi.org/10.2105/ajph.2021.306499\u003c/li\u003e\n\u003cli\u003eLivne, O., Budney, A., Borodovsky, J., Walsh, C., Shmulewitz, D., Fink, D.S., Struble, C.A., Habib, M., Aharonovich, E., \u0026amp; Hasin, D.S. (2022). Delta-8 THC use in US adults: Sociodemographic characteristics and correlates. Addictive Behaviors, 133, 107374. https://doi.org/10.1016/j.addbeh.2022.107374\u003c/li\u003e\n\u003cli\u003eLoParco, C.R., Rossheim, M.E., Walters, S.T., Zhou, Z., Olsson, S., \u0026amp; Sussman, S.Y. (2023). Delta-8 tetrahydrocannabinol: a scoping review and commentary. Addiction, 118(6), 1011-1028. https://doi.org/https://doi.org/10.1111/add.16142\u003c/li\u003e\n\u003cli\u003eMalone, T. (2021). CBD, marijuana and hemp: What is the difference among these cannabis products, and which are legal? https://msutoday.msu.edu/news/2021/cbd-marijuana-and-hemp\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute;nez, V., Iriondo De-Hond, A., Borrelli, F., Capasso, R., del Castillo, M.D., \u0026amp; Abalo, R. (2020). Cannabidiol and other non-psychoactive cannabinoids for prevention and treatment of gastrointestinal disorders: Useful nutraceuticals? \u003cem\u003eInternational Journal of Molecular Sciences\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(9), 3067. https://doi.org/10.3390/ijms21093067 \u003c/li\u003e\n\u003cli\u003eMcDonagh, M.S., Morasco, B.J., Wagner, J., Ahmed, A.Y., Fu, R., Kansagara, D., \u0026amp; Chou, R. (2022). Cannabis-Based Products for Chronic Pain. Annals of Internal Medicine, 175(8), 1143-1153. https://doi.org/10.7326/M21-4520\u003c/li\u003e\n\u003cli\u003eMiech, R. A., Johnston, L. D., Patrick, M. E., O\u0026rsquo;Malley, P. M., \u0026amp; Bachman, J. G.;. (2024). Monitoring the Future national survey results on drug use, 1975\u0026ndash;2023: Overview and detailed results for secondary school students (Monitoring the Future Monograph Series., Issue. https://monitoringthefuture.org/results/annual-reports/ \u003c/li\u003e\n\u003cli\u003eNational Academies of Sciences, E., \u0026amp; Medicine. (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. The National Academies Press. https://doi.org/10.17226/24625 \u003c/li\u003e\n\u003cli\u003eNational Conference of State Legislatures. (2024). State Medical Cannabis Laws. https://www.ncsl.org/health/state-medical-cannabis-laws \u003c/li\u003e\n\u003cli\u003ePatrick, M.E., Miech, R.A., Johnston, L.D., \u0026amp; O\u0026rsquo;Malley, P.M. (2023). Monitoring the Future Panel Study annual report: National data on substance use among adults ages 19 to 60, 1976-2022 (Monitoring the Future Monograph Series, Issue. https://monitoringthefuture.org/wp-content/uploads/2023/07/mtfpanel2023.pdf \u003c/li\u003e\n\u003cli\u003eRomm, K.F., West, C.D., \u0026amp; Berg, C.J. (2021). Mode of Marijuana Use among Young Adults: Perceptions, Use Profiles, and Future Use. Subst Use Misuse, 56(12), 1765-1775. \u003c/li\u003e\n\u003cli\u003eSAS Institute Inc. (2023) SAS 9.4 (Computer Software) Cary, NC: SAS Institute Inc. \u003c/li\u003e\n\u003cli\u003eShafer, S., Kennedy, G., \u0026amp; Christian, W.J. (2024). Population-based cross-sectional analysis of cannabis use among Kentucky adults, 2020\u0026ndash;21. Journal of Cannabis Research, 6(1), 44. https://doi.org/10.1186/s42238-024-00251-x\u003c/li\u003e\n\u003cli\u003eSpindle, T.R., Bonn-Miller, M.O., \u0026amp; Vandrey, R. (2019). Changing landscape of cannabis: Novel products, formulations, and methods of administration. \u003cem\u003eCurrent Opinion in Psychology\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e, 98-102. https://doi.org/10.1016/j.copsyc.2019.04.002\u003c/li\u003e\n\u003cli\u003eSteigerwald, S., Wong, P.O., Cohen, B.E., Ishida, J.H., Vali, M., Madden, E., \u0026amp; Keyhani, S. (2018). Smoking, Vaping, and Use of Edibles and Other Forms of Marijuana Among U.S. Adults. Ann Intern Med, 169(12), 890-892. \u003c/li\u003e\n\u003cli\u003eThompson, K., Thibault, T., \u0026amp; Peters, A.L. (2024). A better high? Understanding mode preferences among young adult cannabis users. \u003cem\u003eCanadian Journal of Behavioural Science / Revue canadienne des sciences du comportement\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(3), 327-331. https://doi.org/10.1037/cbs0000368 \u003c/li\u003e\n\u003cli\u003eUS Census Bureau. (2022). Population by Sex, Age Group, Race and Hispanic Orgin. http://ksdc.louisville.edu/data-downloads/estimates/\u003c/li\u003e\n\u003cli\u003eU.S. Congress. (2023). H.R. 544: An act relating to hemp-derived products. Kentucky General Assembly. https://apps.legislature.ky.gov/record/23RS/hb544.html\u003c/li\u003e\n\u003cli\u003eUS Forest Service. (2022, January). The agriculture improvement act of 2018 (2018 farm bill). https://www.fs.usda.gov/managing-land/farm-bill. \u003c/li\u003e\n\u003cli\u003eWheeler, M., Merten, J.W., Gordon, B.T., \u0026amp; Hamadi, H. (2020). CBD (Cannabidiol) Product Attitudes, Knowledge, and Use Among Young Adults. Substance Use \u0026amp; Misuse, 55(7), 1138-1145. https://doi.org/10.1080/10826084.2020.1729201\u003c/li\u003e\n\u003cli\u003eWilloughby, J.F., Hust, S.J.T., Li, J., \u0026amp; Couto, L. (2024). Exposure to Pro and Anti-Cannabis Social Media Messages and Teens\u0026apos; and College Students\u0026apos; Intentions to Use Cannabis. Health Commun, 39(1), 183-194. https://doi.org/10.1080/10410236.2022.2162707\u003c/li\u003e\n\u003cli\u003eWinstock, A.R., Lynskey, M.T., Maier, L. J., Ferris, J.A., \u0026amp; Davies, E.L. (2021). Perceptions of cannabis health information labels among people who use cannabis in the U.S. and Canada. International Journal of Drug Policy, 91, 102789. https://doi.org/10.1016/j.drugpo.2020.102789\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cannabis-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcan","sideBox":"Learn more about [Journal of Cannabis Research](https://jcannabisresearch.biomedcentral.com/)","snPcode":"42238","submissionUrl":"https://submission.springernature.com/new-submission/42238/3","title":"Journal of Cannabis Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hemp-derived cannabinoids, cannabidiol (CBD), tetrahydrocannabinol (THC), delta-8, delta-10, THC-A, cannabis, marijuana, Kentucky","lastPublishedDoi":"10.21203/rs.3.rs-9108504/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9108504/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003e: The availability and use of hemp-derived cannabinoids (HDCs), such as delta-8-THC and CBD, have increased rapidly due to changes in US cannabis policy and their federally legal status. The health effects of HDCs remain largely unknown. Limited data exists on patterns and motivations for HDC use among young adults. This study examined prevalence, modes, and motivations for use of these products among young adults in Lexington, Kentucky.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was completed by adults aged 18\u0026ndash;30 living in or near Lexington, Kentucky, between February and March 2024 to assess demographic characteristics, traditional marijuana use, and HDC use, including type, frequency, modes, and motivations. Data were analyzed using descriptive statistics, chi-squared and Fisher\u0026rsquo;s exact tests, and logistic regression via SAS 9.4, with significance set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe final analytic sample included 99 participants. Most were between 21 and 30 years old (77.8%), female (66.3%), white (81.3%), and had used marijuana at least once (81.8%). Lifetime use of HDCs was common (67.7%), with 24.2% of participants reporting past-month use. The most common modes of consumption were edibles (89.6%), followed by smoking (70.1%), and vaping (64.2%). The most frequently reported motivations for use were \u0026ldquo;for the high\u0026rdquo; (77.4%), followed by anxiety (63.3%) and trouble sleeping (57.2%). Those who had ever used marijuana were 4.3 times more likely to report any HDC use, even after adjusting for income and sex (aPR: 4.34, 1.54\u0026ndash;12.28), and 10.4 times more likely to report past-month HDC use (PR: 10.35, 2.12-\u0026infin;) than those who had never used marijuana.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study is among the first to examine HDC use among young adults. Future studies with larger sample sizes are needed to further investigate patterns of use and examine disparities.\u003c/p\u003e","manuscriptTitle":"Hemp-derived cannabinoid use among young adults in Lexington, Kentucky in 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 10:18:21","doi":"10.21203/rs.3.rs-9108504/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-28T03:56:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151278602019330640349243242110619434515","date":"2026-04-06T10:13:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T08:55:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-01T00:39:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cannabis Research","date":"2026-03-31T08:22:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cannabis-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcan","sideBox":"Learn more about [Journal of Cannabis Research](https://jcannabisresearch.biomedcentral.com/)","snPcode":"42238","submissionUrl":"https://submission.springernature.com/new-submission/42238/3","title":"Journal of Cannabis Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccd215d6-ab67-478d-8313-aef8da70cc7e","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T10:18:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 10:18:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9108504","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9108504","identity":"rs-9108504","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}