Papers by Kelly Young-wolff
JAMA Network Open
This cross-sectional study uses data from the Kaiser Permanente Northern California health care s... more This cross-sectional study uses data from the Kaiser Permanente Northern California health care system with universal screening via self-report and urine toxicology at prenatal care entrance to examine trends in cocaine and methamphetamine use among pregnant individuals from 2011 to 2019.
JAMA Network Open
ImportanceAs rates of prenatal cannabis use increase and cannabis legalization spreads across the... more ImportanceAs rates of prenatal cannabis use increase and cannabis legalization spreads across the US, studies are needed to understand the potential impacts of legalization from the perspectives of pregnant individuals who use cannabis.ObjectiveTo characterize pregnant individuals’ perspectives on legalization of cannabis for adult use in California (effective in 2018) in relation to prenatal cannabis use behaviors and beliefs.Design, Setting, and ParticipantsThis qualitative study was conducted in Kaiser Permanente Northern California, a large health care system with universal screening for self-reported cannabis use at entrance to prenatal care. Eighteen semistructured focus groups were conducted from November 17 to December 17, 2021, using a secure video conferencing platform with Black and White pregnant participants who self-reported cannabis use during early pregnancy. Data were analyzed from March to June 2022.Main Outcomes and MeasuresVideo-recorded interviews were transcrib...
Preventive Medicine Reports, 2015
Prior to the 2013 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening... more Prior to the 2013 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening, the American Cancer Society released interim guidance recommending physicians discuss lung cancer screening with high risk patients. We included a question on patient-provider discussions about lung cancer screening on a statewide population-based survey to establish baseline prevalence for surveillance and to identify subpopulation disparities. Methods. We analyzed the 2012/2013 Kansas Adult Tobacco Survey to assess patient-provider discussions about lung cancer screening. Weighted prevalence estimates and adjusted odds ratios were calculated to examine characteristics associated with discussing screening. Results. The prevalence of patient-provider discussions about lung cancer screening among current and former smokers aged 55 to 74 years was 31.0% (95% CI 27.0-35.0). The adjusted prevalence odds of having these discussions was higher among males, adults aged 65 to 74 years, adults living with a disability, as well as those who saw a health professional in the past year and had their smoking status assessed or were advised to quit. Conclusions. The current study is unique as it is the first to assess patient-provider discussions about lung cancer screening using a statewide survey. These results may inform strategies to increase patient-provider discussions about lung cancer screening among high risk Kansans.
International Journal of Public Health, May 4, 2022
Objective: This study evaluated whether COVID-19 pandemic-related health, healthcare and economic... more Objective: This study evaluated whether COVID-19 pandemic-related health, healthcare and economic factors during pregnancy are associated with prenatal depression and anxiety. Methods: We conducted a cross-sectional study of 6,628 pregnant members of Kaiser Permanente Northern California who responded to a survey between 22 June and 30 September 2020. The survey included questions about depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder) symptoms and COVID-19related health and healthcare (e.g., had COVID-19) and economic (e.g., food insecurity) factors. Results: Over one third of individuals reported depression (25% mild, 8% moderate, 3% severe) or anxiety (22% mild, 8% moderate, 5% severe) symptoms. In multivariable analyses, COVID-19 during pregnancy, employment with greater risk of COVID-19, distress over changes in prenatal care, job loss, changes in childcare and food insecurity were associated with greater odds of prenatal depression or anxiety. Conclusion: Findings suggest the COVID-19 pandemic may have severe mental health repercussions for pregnant individuals. Support services for pregnant individuals experiencing these COVID-19-related factors and monitoring of those who had moderate/severe prenatal depression and anxiety symptoms during the COVID-19 pandemic is warranted.
JAMA Network Open
Expanding legalization and increasing social acceptability and accessibility of cannabis may pote... more Expanding legalization and increasing social acceptability and accessibility of cannabis may potentially be associated with increased use of cannabis among women of reproductive age. Using repeated cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) between 2004 and 2018, Skelton and colleagues 1 compared maternal cannabis use at 2 time points during the preconception, prenatal, and postpartum periods among women living in 2 states that legalized recreational use (Maine and Alaska) and 2 that legalized only medicinal use or decriminalized recreational use (Vermont and New Hampshire). The authors used a difference-indifference analysis over time, contrasting changes in intervention and comparison states, an important strength compared with earlier studies on this topic. Consistent with prior research, results indicated that the prevalence of cannabis use before and during pregnancy increased over time in both intervention and comparison states. In the 2 states that legalized recreational cannabis use, preconception and postpartum cannabis use, but not prenatal use, increased significantly compared with states that did not legalize recreational use.
Journal of Pediatric Health Care, 2021
INTRODUCTION To examine associations between patient characteristics and adverse childhood experi... more INTRODUCTION To examine associations between patient characteristics and adverse childhood experiences (ACEs) in a population-based sample of pediatric primary care patients, using electronic health records and clinical, administrative data. METHOD An observational study was conducted in an integrated health care delivery system. Children ages 1-5 years (N = 13,370) were screened for ACEs at routine well-child visits between September 1, 2018 and May 31, 2019 in three pediatrics clinics. Multivariate models examined associations between patient characteristics (age, gender, race/ethnicity, insurance type, neighborhood income and education level, physical, mental health and developmental diagnoses, weight status) and any ACEs, and ≥ 3 ACEs exposure. RESULTS Prevalence and severity of ACE exposure varied by race/ethnicity. Older age, Medicaid insurance, epilepsy/seizure disorder, sleeping disorders, adjustment disorders, and feeding disorders were associated with higher odds of ACEs exposure, higher-income with lower odds. DISCUSSION Understanding relationships between ACEs and patient features can provide information to clinicians for early detection and appropriate interventions.
JAMA Network Open, 2021
National studies 1,2 indicate that rates of alcohol use during pregnancy have remained stable in ... more National studies 1,2 indicate that rates of alcohol use during pregnancy have remained stable in the US since 2002, whereas rates of prenatal cannabis and prescription opioid use have increased. However, little is known about changes in substance use during pregnancy and post partum in subpopulations that are particularly vulnerable to poor outcomes. People living with HIV have a higher risk of adverse perinatal outcomes compared with those without HIV infection. Substance use can further increase the risk of adverse outcomes during pregnancy and post partum for people living with HIV, including suboptimal viral control and perinatal transmission of HIV infection. Using data from the Surveillance Monitoring for Antiretroviral Toxicity Study (SMARTT) of the Pediatric HIV/AIDS Cohort Study, Yee and colleagues 3 examined trends in use of cannabis, alcohol, and opioids during pregnancy and 1 year post partum in a large sample of people living with HIV (mean age, 29 years; 64% non-Hispanic Black and 28% Hispanic) who gave birth between 2007 and 2019 at 22 US sites. Results indicated that the risk of cannabis use during pregnancy and post partum Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Young-Wolff KC et al. JAMA Network Open.
Annals of Internal Medicine, 2018
Journal of Women's Health, 2017
International journal of environmental research and public health, Apr 13, 2017
Tobacco and alcohol use are strongly associated. This cross-sectional study examined the relation... more Tobacco and alcohol use are strongly associated. This cross-sectional study examined the relationship of smoke-free law coverage and smoke-free bar law coverage with hazardous drinking behaviors among a representative sample of U.S. adult drinkers (n = 17,057). We merged 2009 National Health Interview Survey data, American Nonsmokers' Rights Foundation U.S. Tobacco Control Laws Database, and Census Population Estimates. Hazardous drinking outcomes included heavy drinking (>14 drinks/week for men; >7 drinks/week for women) and binge drinking (≥5 drinks on one or more days during past year). Chi-square tests compared hazardous drinking by sociodemographic factors. Multivariable logistic regression models were used to examine if smoke-free law and bar law coverages were associated with hazardous drinking, controlling for sociodemographics and smoking status. Subset analyses were conducted among drinkers who also smoked (n = 4074) to assess the association between law coverage...
Behavior Genetics, 2011
The study investigated the genetic and environmental etiology of schizotypal personality traits i... more The study investigated the genetic and environmental etiology of schizotypal personality traits in a non-selected sample of adolescent twins, measured on two occasions between the ages of 11 and 16 years old. The 22-item Schizotypal Personality Questionnaire-Child version (SPQ-C) was found to be factorially similar to the adult version of this instrument, with three underlying factors (Cognitive-Perceptual, Interpersonal-Affective, and Disorganization). Each factor was heritable at age 11-13 years (h 2 = 42-53%) and 14-16 years old (h 2 = 38-57%). Additive genetic and unique environmental influences for these three dimensions of schizotypal personality acted in part through a single common latent factor, with additional genetic effects specific to both Interpersonal-Affective and Disorganization subscales at each occasion. The longitudinal correlation between the latent schizotypy factor was r = 0.58, and genetic influences explained most of the stability in this latent factor over time (81%). These longitudinal data demonstrate significant genetic variance in schizotypal traits, with moderate stability between early to middle adolescence. In addition to common influences between the two assessments, there were new genetic and non-shared environmental effects that played a role at the later assessment, indicating significant change in schizotypal traits and their etiologies throughout adolescence.
JAMA Network Open
IMPORTANCE Rates of prenatal cannabis use are increasing alongside perceptions that cannabis is a... more IMPORTANCE Rates of prenatal cannabis use are increasing alongside perceptions that cannabis is a harmless therapeutic for pregnancy-related ailments, while rates of prenatal use of alcohol and tobacco are decreasing. It is important to examine whether cannabis use during pregnancy is increasing similarly among patients with and patients without co-occurring substance use. OBJECTIVES To examine trends in cannabis polysubstance use during pregnancy and to test differences in cannabis use over time among pregnant individuals who use only cannabis vs those who use cannabis and other substances. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional time-series study used data from 367 138 pregnancies among 281 590 unique pregnant patients universally screened for prenatal substance use as part of standard care in
JAMA Network Open
IMPORTANCE Rates of prenatal cannabis use are increasing alongside perceptions that cannabis is a... more IMPORTANCE Rates of prenatal cannabis use are increasing alongside perceptions that cannabis is a harmless therapeutic for pregnancy-related ailments, while rates of prenatal use of alcohol and tobacco are decreasing. It is important to examine whether cannabis use during pregnancy is increasing similarly among patients with and patients without co-occurring substance use. OBJECTIVES To examine trends in cannabis polysubstance use during pregnancy and to test differences in cannabis use over time among pregnant individuals who use only cannabis vs those who use cannabis and other substances. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional time-series study used data from 367 138 pregnancies among 281 590 unique pregnant patients universally screened for prenatal substance use as part of standard care in
Nicotine & Tobacco Research
Introduction The relationship between tobacco smoking status and SARS-CoV-2 infection and coronav... more Introduction The relationship between tobacco smoking status and SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) severity is highly debated. We conducted a retrospective cohort study of >2.4 million adults in a large healthcare system to evaluate whether smoking is associated with SARS-CoV-2 infection and disease severity. Aims and Methods This retrospective cohort study of 2,427,293 adults in KPNC from March 5, 2020 (baseline) to December 31, 2020 (pre-vaccine) included smoking status (current, former, never), socio-demographics, and comorbidities from the electronic health record. SARS-CoV-2 infection (identified by a positive PCR test) and COVID-19 severity (hospitalization, ICU admission or death ≤ 30 days of COVID-19 diagnosis) were estimated in time-to-event analyses using Cox proportional hazard regression models adjusting for covariates. Secondary analyses examined COVID-19 severity among patients with COVID-19 using logistic regression. Results During the st...
Journal of Addiction Medicine, 2021
OBJECTIVES The goal of this study was to evaluate the association between pregnancy intentions an... more OBJECTIVES The goal of this study was to evaluate the association between pregnancy intentions and substance use in early pregnancy among pregnant women receiving prenatal care in a large, integrated healthcare system. METHODS The sample comprised 29,787 Kaiser Permanente Northern California pregnant women (12.1% aged <25, 36.4% non-Hispanic White) screened for prenatal substance use in 2018 via a self-reported questionnaire and urine toxicology test given as part of standard prenatal care (at ∼8 weeks gestation). Multivariable logistic regression models tested for associations of pregnancy intentions with prenatal substance use (any use and specific substances) by self-report and/or a positive urine toxicology test. RESULTS Adjusting for covariates, women with an unintended pregnancy (23.9% of the sample) had higher odds of any prenatal substance use than women with an intended pregnancy (28.8% vs 16.1%; adjusted odds ratio [aOR] = 1.80, 95% confidence interval [CI]:1.67-1.93). Having an unintended pregnancy was also associated with higher odds of using alcohol (14.4% vs 10.4%; aOR = 1.73, 95%CI:1.59-1.89), cannabis (15.6% vs 5.6%; aOR = 1.91, 95%CI:1.73-2.11), nicotine (3.8% vs 1.3%; aOR = 2.33, 95%CI:1.92-2.82), pain medication (2.3% vs 1.2%; aOR = 1.64, 95%CI:1.32-2.03), and stimulants (0.8% vs 0.3%; aOR = 1.85, 95%CI:1.23-2.79) early in pregnancy. DISCUSSION Having an unintended pregnancy was associated with higher odds of substance use during early pregnancy. Connecting women of reproductive age with health education about pregnancy prevention and recognition of early signs of pregnancy, effective contraception, and early screening and interventions for prenatal substance use may help to reduce prenatal substance use and its associated consequences.
JAMA Network Open, 2020
had full access to all of the data in the study and take responsibility for the integrity of the ... more had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
JAMA Network Open, 2021
Open Access. This is an open access article distributed under the terms of the CC-BY License.
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Papers by Kelly Young-wolff