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The prevalence of opioid use disorder has increased across the United States, but the rural population of Appalachia has been disproportionately impacted. Concurrently, the slow, but steady progress in the legalization of marijuana may be affecting perception of marijuana use in pregnancy. However, marijuana use in pregnancy has been associated with adverse perinatal outcomes. Concomitant use of opioids and marijuana in pregnancy has not been evaluated.The primary aim of the study was to evaluate the association between confirmed marijuana use in late pregnancy and preterm birth in opioid-exposed pregnancies.A retrospective chart review was conducted that included all births from July 2011 to June 2016 from 6 delivery hospitals in South-Central Appalachia. Out of 18,732 births, 2368 singleton pregnancies indicated opioid use and met remaining inclusion criteria, with 108 of these mothers testing positive for marijuana at delivery. Independent sampleNeonates born to marijuana-positive women in opioid-exposed pregnancy were more likely to be born preterm, small for gestational age, have low birth weight, and be admitted to NICU. After statistically controlling for parity, marital status, tobacco and benzodiazepine use, preterm birth and low birth weight remained statistically significant with aOR of 2.35 (1.30-4.24) and 2.01 (1.18-3.44), respectively.Maternal use of marijuana in any opioid-exposed pregnancy may increase risk of preterm birth and low-birth weight infants. Prospective studies need to examine the dose and timing of marijuana and opioid use in pregnancy to better delineate perinatal effects. Nonetheless, pregnant women using opioids, including recommended medication assisted treatment for opioid use disorder, should be educated about the risks of concurrent marijuana use during pregnancy and may need to be counseled to abstain from marijuana use during pregnancy for an optimal outcome.

A culturally competent survey currently does not exist to characterize the burden of Adverse Childhood Experiences (ACEs) among a HIV/AIDS population receiving care at a local Center of Excellence (COE). A qualitative study was conducted including 11 interviews involving opinions on national surveillance questions to develop a culturally competent survey. Purposive sampling, reactive probing, and analysis of transcribed interviews were completed using structured coding to determine which questions were kept, modified, or removed��� in the final survey. The final 55-question survey contained more generalized ACE questions, topics pertaining to barriers to HIV care, and a list that patients could select from to indicate what they need to improve their HIV care. The final survey provided the opportunity to characterize the burden of ACEs at a COE. Future directions involve piloting the survey as a quality improvement tool with the goal of increasing retention rates through more individualized HIV care.