Assessing the structure of the CAST (Cannabis Abuse Screening Test) in 13 European countries using multigroup analyses

Country and sex measurement invariance of the Cannabis abuse screening test (CAST) in European Youth

BACKGROUND

Monitoring the prevalence of problematic cannabis use is an important public health issue. International surveys need invariant measurement tools to allow reliable comparisons across countries and between sexes. The Cannabis abuse screening test (CAST) has been developed for this purpose. This study is the first assessing its country and sex invariance in a sample of European pupils.

METHODS

The data come from the self-administered questionnaires completed in 2019 by pupils aged 15-16 in the European school survey project (Espad). The analytical sample was restricted to the 17 countries where at least 300 pupils reported a previous-year cannabis use (n = 8740); multigroup confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the CAST toward country and sex in the 2019 Espad release.

RESULTS

Configural, metric and scalar invariance toward country hold for the 17 countries: Austria, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Italia, Latvia, Poland, Portugal, Slovakia, Slovenia and Spain. Scalar invariance toward sex was met in the 17 countries as a whole and in 11 of the 12 countries where the test could be run. Scalar invariance toward country was met with 6 additional countries comprising at least 250 respondents: Ireland, Lithuania, Malta, Montenegro, the Netherlands and Norway.

CONCLUSION

The CAST is a suitable test for comparing the measurement of problematic cannabis use amongst adolescents in Europe.

Psychometric properties of CAST for early detection of problematic cannabis use in Spanish adolescents

The high prevalence rates of cannabis use in adolescents and its early onset constitutes a major public health problem, raising the need for its early detection. The availability of validated tools to analyze early cannabis use is essential to detect problematic use at an early age. The Cannabis Abuse Screening Test (CAST) (Legleye et al., 2007) is widely applied in Europe; however, the CAST cut-off scores vary according to the setting, the screening objective, and the correction version (CAST-f or CAST-b), creating therefore confusion in its application. Moreover, the psychometric properties of the CAST as a tool for detecting problematic cannabis use are understudied. To fill this gap, such psychometric properties have been analyzed in a sample of Spanish adolescents while using different cut-off scores for CAST-f and CAST-b. Based on our findings, the optimal cut-off scores are 2 points for CAST-b and 4 points for CAST-f. The internal reliability of CAST-f (α = 0.83) and CAST-b (KR-20 = 0.80) are satisfactory. Factorial analysis suggested the assumption of a one-dimension model. The CAST seems to be a valid and reliable tool for early screening of problematic cannabis use in Spanish adolescents.

The association of type of cannabis product used and frequency of use with problematic cannabis use in a sample of young adult cannabis users

Research exploring patterns and predictors of problematic cannabis use behaviors among young adults is limited. This knowledge is essential for intervening to prevent abuse and dependence outcomes.

METHODS

Young adult cannabis users (Mage = 19.2[SD = 0.8]) in Southern California (N = 1007) were classified by patterns of problematic cannabis use from the Cannabis Abuse Screening Test, using Latent Class Analysis. Multinomial regression evaluated the association of frequency of use (no past 30 day use, infrequent [use on 1-2 of past 30 days], semi-frequent [use on 3-9 of the past 30 days], and frequent [use on 10 or more of the past 30 days]) for each cannabis product type (combustible, edible, vaporized, concentrate, blunt) with class membership.

RESULTS

Four distinct classes of cannabis-related problems were identified: "non-symptomatic" (no problems; 33.8 %), "non-recreational use" (before noon and when alone; 34.5 %), "moderate use problems" (before noon, alone, and memory problems; 8.0 %), and "severe cannabis problems" (all 6 problems; 23.7 %). Semi-frequent (AOR range: 1.85-4.63;ps<0.05) and frequent (AOR range: 9.18-24.2;ps<0.05) use of combustible and vaporized cannabis, frequent blunt use (AORs range: 4.03-10.3;ps<0.05), and semi-frequent, but not frequent edible use (AOR range: 2.57-2.73;ps<0.05) was associated with higher odds of classification in any problematic use class (vs. non-symptomatic).

CONCLUSIONS

Differences in cannabis use problems across these classes and their predictors reveal the heterogeneity in cannabis-related problems experienced by young people. Combustible cannabis, vaporized cannabis, and blunt cannabis use may confer the most risk for cannabis abuse and dependency outcomes, with more frequent days of use contributing to increased patterns of risk.

Validation of the French version of the Cannabis Use Disorder Identification Test-Revised and comparison with the Cannabis Abuse Screening Test for screening cannabis use disorder in a psychiatric sample

INTRODUCTION

Several questionnaires have been developed for screening cannabis use disorder in clinical populations, but very few studies have compared the screening abilities of the different instruments. Here, we aimed to confirm the psychometric properties of a French version of the Cannabis Use Disorder Identification Test-Revised (CUDIT-R), and to compare its screening abilities with those of the Cannabis Abuse Screening Test (CAST), in subjects consulting in mental health settings.

METHODS

Two hundred and thirteen cannabis smokers who sought treatment for any type of mental disorder, recruited in four French centres, completed the French CUDIT-R (CUDIT-R-Fr) and the full version of the CAST, and were assessed for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria of cannabis use disorder by an addiction specialist. They were retested with the CUDIT-R-Fr after approximately a week. The factorial construct validity, internal consistency and test-retest reliability of the CUDIT-R-Fr were assessed. The compared sensitivity and specificity of the CAST and CUDIT-R-Fr were explored, using the clinician assessment as the reference.

RESULTS

The French CUDIT-R showed a good internal consistency (Cronbach's alpha = 0.89) and an excellent test-retest reliability (ρ = 0.97). The sensitivity and specificity for screening cannabis use disorder were 0.81 and 0.77 for the CUDIT-R, and 0.92 and 0.63 for the CAST, respectively.

CONCLUSIONS

Based on the recommended cut-offs, the CAST appeared more sensitive, while the CUDIT-R was more specific, for screening cannabis use disorder in a population of cannabis users with heterogeneous types of mental health disorders.

Increased Resting State Triple Network Functional Connectivity in Undergraduate Problematic Cannabis Users: A Preliminary EEG Coherence Study

An increasing body of experimental data have suggested that aberrant functional interactions between large-scale networks may be the most plausible explanation of psychopathology across multiple mental disorders, including substance-related and addictive disorders. In the current research, we have investigated the association between problematic cannabis use (PCU) and triple-network electroencephalographic (EEG) functional connectivity. Twelve participants with PCU and 24 non-PCU participants were included in the study. EEG recordings were performed during resting state (RS). The exact Low-Resolution Electromagnetic Tomography software (eLORETA) was used for all EEG analyses. Compared to non-PCU, PCU participants showed an increased delta connectivity between the salience network (SN) and central executive network (CEN), specifically, between the dorsal anterior cingulate cortex and right posterior parietal cortex. The strength of delta connectivity between the SN and CEN was positively and significantly correlated with higher problematic patterns of cannabis use after controlling for age, sex, educational level, tobacco use, problematic alcohol use, and general psychopathology (r_p = 0.40, p = 0.030). Taken together, our results show that individuals with PCU could be characterized by a specific dysfunctional interaction between the SN and CEN during RS, which might reflect the neurophysiological underpinnings of attentional and emotional processes of cannabis-related thoughts, memories, and craving.

Assessing the structure of the CAST (Cannabis Abuse Screening Test) in 13 European countries using multigroup analyses

Our aims are to describe and explain the structure of the Cannabis Abuse Screening Test (CAST) across countries. Standard statistical analyses fail to describe and explain several variables simultaneously while taking account of the group structure of individuals. The 2011 European School Survey Project on Alcohol and other Drugs (ESPAD): 5204 last-year cannabis users aged 15-16 from 13 European countries. Multigroup principal component analysis (mgPCA) and multigroup partial least squares (mgPLS). MgPCA shows that the CAST has a two-dimensional structure (frequency of use/problems and non-recreational use/dependency symptoms). All the countries present a good concordance with the common structure, except Kosovo, Lichtenstein and Romania. MgPLS shows that three explanative variables (in a total of eight) are mainly related with the CAST (the frequencies of cannabis use in the last 12 months and in the last 30 days and the age at first cannabis use) while Kosovo, Lichtenstein and Romania also present specificities. The CAST structure appears stable in the 13 countries except for Kosovo, Lichtenstein and Romania that also show specific relationships between the CAST variables and their determinants.