Background: Cannabis is increasingly used for management of chronic pain; however, the benefits and harms of this therapy remain uncertain. We conducted a systematic review to inform harms associated with inhaled cannabis for chronic pain. Methods: We searched MEDLINE, EMBASE, PsychInfo, and Web of Science for non-randomized studies reporting on harms associated with inhaled cannabis use, from inception to October 6, 2021. We used random-effects models for meta-analyses and assessed the certainty of evidence using the GRADE approach. Results: We identified 29 eligible studies enrolling 174,562 participants that reported 145 adverse events. Moderate certainty evidence suggests inhaled cannabis use is probably associated with dry mouth (prevalence: 56%; 95%CI 49 to 64), thirst (prevalence: 44%; 95% CI 33 to 55), fatigue (prevalence: 38%; 95%CI 31 to 45), nausea (prevalence: 17%; 95%CI 8 to 27), increased appetite (prevalence: 13%; 95%CI 9 to 18), dizziness (prevalence: 10%; 95%CI 6 to 14), diarrhea (prevalence: 9%; 95%CI 3 to 18), confusion (prevalence: 9%; 95%CI 5 to 13), mood changes (prevalence: 8%; 95%CI 4 to 15), hallucinations (prevalence: 7%; 95%CI 4 to 10), amnesia (prevalence: 6%; 95%CI 3 to 11), impaired coordination (prevalence: 5%; 95%CI 4 to 6), and disorientation (prevalence: 3%; 95%CI 1 to 7). Moderate certainty evidence shows that, compared to non-users, inhaling cannabis is probably associated with increased risk of shortness of breath (risk difference [RD]: 7%; 95%CI 4 to 10). Conclusions: Our review found moderate certainty evidence that dry mouth, thirst, and fatigue are probably frequently experienced with inhaled cannabis use. Several other adverse events are also probable associated with inhaled cannabis use but were less common. Rigorously conducted cohort studies are needed to inform harms associated with inhaled medical cannabis for chronic pain. / Thesis / Master of Science (MSc) / Increasing recognition of harms associated with long-term opioid therapy for management of chronic pain has generated enthusiasm for alternatives, including medical cannabis which is often consumed through inhalation. This review assesses the harms associated with the use of inhaled cannabis for management of chronic pain. Among serious adverse events, we found that inhaled cannabis is likely associated with amnesia, disorientation, impaired coordination, hallucinations, confusion, dizziness, chronic wheeze, and shortness of breath. Inhaled cannabis may be associated with palpitations, paranoia, anxiety, and cannabis dependence. The effects of inhaled cannabis on lung cancer, depression, and psychosis were uncertain. Among less serious adverse events, we found that inhaled cannabis is likely associated with thirst, fatigue, increased appetite, nausea, mood changes, diarrhea, and dry mouth. Inhaled cannabis may be associated with red eyes, vomiting, phlegm, asthma, and cough. The effects of inhaled cannabis on euphoria and irritability were uncertain.

The prevalence rate of childhood obesity has increased rapidly worldwide. The childhood obesity epidemic is associated with many adverse health consequences in children as well as a financial burden for a nation’s economy. A meta-analysis was conducted to investigate the effectiveness of school-based childhood obesity prevention programs in preventing childhood obesity. The objectives of this study were to 1) identify the most effective childhood obesity prevention programs through effect size comparison, and 2) identify important program components that affect the effectiveness of the intervention through subgroup analysis. The Comprehensive Meta-Analysis (CMA) program was used for all statistical analyses. Results of the meta-analysis demonstrated that the summary effect size was small (d = 0.039, 95% confidence interval). The school-based program identified in the meta-analysis as the most effective had a d value of 0.368. Subgroup analyses were performed because this meta-analysis study was heterogeneous (Q = 167.774, p = 0.001) with an I2 value of 68.410%. The subgroup moderators were length of program duration, age of participants, nutrition, physical activity, parental involvement, specialist involvement, and theory based versus non-theory based intervention programs. Subgroup analyses demonstrated that significant differences (p < 0.05) occurred among the moderator components. Programs that targeted younger children less than ten years old and programs that were theory based were more effective. The meta-analysis study contained publication bias because the funnel plot was skewed and smaller studies were missing. To further explore the publication bias problem, Classic fail-safe N and Duval and Tweedie’s trim and fill analyses were performed. Classic fail-safe N indicated that two programs were missing from the present study to achieve a non-biased result. The Duval and Tweedie’s trim and fill analysis demonstrated that a small mean effect size difference was detected between the present observed studies and the unbiased effect size. The small mean effect size difference indicated that the results and the reported effect sizes in this meta-analysis study were valid.

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