Factors associated with cannabis use change in youth: Evidence from the COMPASS study

Development and initial validation of the cannabis-related psychosis risk literacy scale (CPRL): a multinational psychometric study

BACKGROUND

Public education efforts to address and reduce potential harms from cannabis use in Arab countries are either slow or inexistent, and do not follow the steadily increasing trends of cannabis use in Arab youth. Several decades of research on substance use, it can be suggested that being aware of, and knowing about, psychosis risk related to cannabis can at least limit the consumption of the substance. Motivated by a lack of measures specifically designed to measure literacy about cannabis-related psychosis risk in younger populations, and based on an extensive literature review, we aimed to create and validate a new self-report scale to assess the construct, the Cannabis-related Psychosis Risk Literacy Scale (CPRL), in the Arabic language.

METHOD

A cross-sectional study was carried-out during the period from September 2022 to June 2023, enrolling 1855 university students (mean age of 23.26 ± 4.96, 75.6% females) from three Arab countries (Egypt, Kuwait and Tunisia).

RESULTS

Starting from an initial pool of 20 items, both Exploratory Factor Analysis and Confirmatory Factor Analysis suggested that the remaining 8 items loaded into a single factor. The scale demonstrated good internal consistency, with both McDonald omega and Cronbach's alpha values exceeding 0.7 (omega = 0.85 / alpha = 0.85). The CPRL showed measurement invariance across gender and country at the configural, metric, and scalar levels. Concurrent validity of the CPRL was established by correlations with less favourable attitudes towards cannabis (r = -.14; p <.001). In addition, higher literacy levels were found in students who never used cannabis compared to lifetime users (4.18 ± 1.55 vs. 3.44 ± 1.20, t(1853) = 8.152, p <.001).

CONCLUSION

The newly developed CPRL scale offers a valid and reliable instrument for assessing and better understanding literacy about cannabis-related psychosis risk among Arabic-speaking young adults. We believe that this new scale is suitable as a screening tool of literacy, as an instrument for measuring the effect of public education interventions aimed at promoting cannabis-related psychosis risk literacy among young people, and as a research tool to facilitate future studies on the topic with a wider application.

Social media interventions addressing physical activity among emerging adults who use cannabis: A pilot trial of feasibility and acceptability

PURPOSE

Cannabis use is common among emerging adults (ages 18-25), yet few prevention interventions have targeted this unique developmental period. Physical activity (PA) is an under-utilized intervention target for cannabis use, despite research showing its potential utility. Based on prior promising social media-delivered interventions targeting cannabis and PA separately, we developed and piloted, in a randomized controlled feasibility trial (NCT04901910), interventions for emerging adults who use cannabis that focused on PA.

PROCEDURES

Using social media, we recruited 60 emerging adults (Mean age=21.7 years; 63.3% female sex) who used cannabis (>=3 times/week for the past month) and could engage in PA. We randomized participants into one of 3 conditions (PA-Only; PA+Cannabis, Attention-Control) that each lasted 8 weeks and were delivered in secret Facebook groups by health coaches. We collected follow-up data at 3- and 6-months post-group start. Outcomes are presented descriptively given the pilot nature and limited sample size.

RESULTS

The interventions were rated favorably, with ratings of the content in each condition averaging around 3 on a 5-point scale. Both intervention groups demonstrated larger reductions in cannabis consequences and cannabis-impaired driving over time than the control condition. Findings were mixed regarding patterns of change in cannabis use in the intervention conditions. Proportions of group members reporting increased PA ranged from 38.9% to 80.0% across time.

CONCLUSIONS

Interventions targeting PA and delivered via social media to emerging adults who regularly use cannabis offer a novel intervention target. These interventions warrant future investigation in larger trials over a longer follow-up period.

Identifying changes in e-cigarette use among a longitudinal sample of Canadian youth e-cigarette users in the COMPASS cohort study, 2017/18-2018/19

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Those who use e-cigarettes may increase, decrease, or keep the same frequency of use.

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Half of current youth e-cigarette users increased their frequency of use.

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One third of current youth e-cigarette users decreased their frequency of use.

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E-cigarette use patterns differed by gender and ethnicity.

Objectives

There are few studies describing longitudinal changes in vaping patterns among current youth e-cigarette users. The objective of this study was to identify-one-year changes in e-cigarette use patterns among a longitudinal sample of Canadian youth e-cigarette users between 2017/18 and 2018/19.

Methods

The longitudinal sample included n = 4,071 current (past 30-day) e-cigarette users in grades 9–11 attending schools in four Canadian provinces. Students reported the number of days they used e-cigarettes in the past 30 days in 2017/18 and 2018/19. Based on responses, students could have escalated, reduced, stopped, or maintained their level of vaping. The prevalence of each e-cigarette use pattern was identified across demographic characteristics and regression models identified significant predictors of each use pattern.

Results

Over one year, 49.2% of current youth e-cigarette users escalated, 12.8% reduced, 20.2% stopped, and 17.8% maintained their frequency of e-cigarette use. Baseline e-cigarette use frequencies varied according to use pattern. Current youth e-cigarette users with higher baseline vaping frequencies had lower odds of escalating and stopping e-cigarette use and higher odds of reducing e-cigarette use relative to maintaining the same frequency of use.

Conclusions

While about half of current youth e-cigarette users increased their frequency of e-cigarette use over a 1-year period, a significant number also decreased or stopped vaping at a time when the prevalence of youth e-cigarette use increased rapidly in Canada. There is a need for longitudinal data to monitor and evaluate changes to e-cigarette use patterns that may be in response to changing public health policies.

Exploring Youths’ Cannabis Health Literacy Post Legalization: A Qualitative Study

Legalization of non-medical cannabis in Canada was intended to protect youth health and safety by limiting access and raising awareness of safety and risks. The purpose of this qualitative research was to explore youths’ perceptions of their cannabis health literacy and future educational needs. A convenience sample of youth aged 13 to 18 residing in Newfoundland and Labrador, Canada who may or may not have consumed cannabis were included. A qualitative study using virtual focus groups with semi-structured interview questions was conducted. Ethics approval was obtained. All sessions were audio-recorded and transcribed. Inductive thematic analysis used a social-ecological framework for adolescent health literacy. Six focus groups ( n = 38) were conducted with youth of all ages and from rural and urban areas. Three main themes were identified: (i) micro influences (age, gender, and beliefs), (ii) meso influences, (family, peers, and school enforcement), (iii) macro influences (cannabis legalization and social media), and (iv) evidence informed information (harm reduction and cannabis properties). They desired evidence-informed education using harm-reduction principles, integrated early, and interactive. The findings provide support for a cannabis health literacy framework that will inform youth cannabis education programs. Interactive approaches with real-world application should support their autonomy, share knowledge, and minimize stigma.

Patterns of Cannabis Use among Canadian Youth over Time; Examining Changes in Mode and Frequency Using Latent Transition Analysis

Background: Historically substance use literature has focused on smoking as the main mode of cannabis consumption, so there are knowledge gaps surrounding current understanding of edibles and vaping. These alternative modes of cannabis use are already common among Canadian youth; however, little is known about how these cannabis use patterns change over time. Methods: This study examined the mode (smoking, eating/drinking, vaping) and frequency of cannabis use among a large sample of Canadian youth who participated in 2017-2018 and 2018-2019 data collection waves of the COMPASS study. Using latent transition analysis, this sample consisting of 18,824 youth in grades 9-12 were categorized into cannabis use classes stratified by sex, and their transition between these classes over the one-year period was examined. Results: Three cannabis use classes were identified (occasional multimode, regular multimode, and smoking) alongside one nonuse class. Among youth who reported cannabis use at baseline, transitioning to a multimode group, and/or increasing frequency of multimode use was likely over the one-year period. Conclusions: These findings may highlight a key leverage point for harm-reduction strategies which aim to prevent cannabis related harms associated with high frequency use.

Assessing the impact of sports and recreation facility density within school neighbourhoods on Canadian adolescents' substance use behaviours: quasi-experimental evidence from the COMPASS study, 2015-2018

OBJECTIVES

There has been relatively little exploration to date of potential protective effects within school neighbourhoods, such as those conferred by facilities that seek to promote health with respect to substance use and related harms. This study examined how the density of sports and recreation facilities in the school neighbourhood is associated with the likelihood of binge drinking, e-cigarette use, cigarette smoking and cannabis use among Canadian secondary school students.

DESIGN

Longitudinal data from the COMPASS study on Canadian youth health behaviours from 2015/2016 to 2017/2018 was linked with school neighbourhood data capturing the number of sports and recreation facilities within a 1500 m radius of schools.

SETTING

Secondary schools and school neighbourhoods in Alberta, British Columbia, Ontario and Quebec who participated in the COMPASS study.

PARTICIPANTS

16 471 youth who participated in the COMPASS study over three school years (2015/2016-2017/2018).

PRIMARY AND SECONDARY OUTCOME MEASURES

Binge drinking, e-cigarette use, cigarette use, cannabis use.

RESULTS

Logistic regression models using generalised estimating equations identified that greater density of sports and recreation facilities within the school neighbourhood was significantly associated with lower likelihood of binge drinking and e-cigarette use but was not associated with cigarette smoking or cannabis use.

CONCLUSIONS

This research can help to support evidence-informed school community-based efforts to prevent substance-related harms among youth.

A longitudinal examination of alcohol cessation and academic outcomes among a sample of Canadian secondary school students

INTRODUCTION

The negative effects of alcohol consumption on learning ability and intellectual development of youth may be recovered after cessation. This study explored to what extent reduction or complete cessation of alcohol consumption affects school performance of secondary school students.

METHODS

Alcohol use was self-reported by 37,223 grade 9-12 students attending 89 secondary schools across Ontario (n = 79) and Alberta (n = 10), Canada, participating in the COMPASS study over four years (school years 2013-14 to 2016-17). Measures included past-year frequency of drinking and frequency of binge drinking. A first-order autoregressive multinomial logistic regression was used to establish the impact of reduction or cessation of alcohol use on school performance.

RESULTS

During follow-up, 1465 (6.4%) reductions and 1903 (8.3%) cessations in alcohol consumption, and 1447 (10.1%) reductions and 2147 (14.9%) cessations of binge drinking were reported. Male students reported more cessation in both drinking (9.7% male vs 7.1% female) and binge drinking (15.6% male vs 14.4% female), though female students had higher rates of reductions. Students who quit or reduced their drinking or binge drinking were less likely to skip classes, leave their homework incomplete, or expect to get or to aspire to educational qualifications above a high school diploma compared to those who continued their alcohol use.

CONCLUSIONS

Aside from health benefits, reduction or cessation of alcohol use may improve students' academic rigor. Prioritising school-based alcohol prevention efforts may therefore be beneficial for aspects of academic performance.

Examining the impact of the early stages of the COVID-19 pandemic period on youth cannabis use: adjusted annual changes between the pre-COVID and initial COVID-lockdown waves of the COMPASS study

Background

Given the high rates of cannabis use among Canadian youth and that adolescence is a critical period for cannabis use trajectories, the purpose of this paper was to examine the effect of the early stages of the COVID-19 pandemic period on youth cannabis use in the context of a natural experiment.

We used 3-year linked data from the COMPASS study, including 7653 Canadian (Quebec, Ontario) adolescents from which 1937 completed all 3 survey waves (pre-COVID-19 [2018, 2019] and online [2020] during the early pandemic period [May–July 2020]). Structural equation modeling (SEM) and double difference (DD) models were used to estimate pre-COVID-19 to initial COVID-19 pandemic period change (2019–2020) in cannabis use (monthly, weekly, daily) compared to 2018 to 2019 change to adjust for age-related effects. Models were adjusted for age of entry into the cohort and sociodemographic characteristics.

Results

In the SEM and DD models, monthly, weekly, and daily cannabis use increased across all waves; however, the expected increases from the pre-COVID-19 wave (2019) to the initial COVID-19 period wave (2020) were lesser relative to the changes seen across the 2018 to 2019 waves. The cross-sectional data from May to July 2020 identified that the majority of youth who use cannabis did not report increased cannabis use due to COVID-19 or using cannabis to cope with COVID-19.

Conclusion

During the early stages of the COVID-19 pandemic period, there does not appear to be a detrimental effect on youth cannabis use, when adjusted for age-related changes. Further prospective research is needed to explore the impact of the ongoing pandemic response on youth cannabis use onset and progression.

Trends in youth cannabis use across cannabis legalization: Data from the COMPASS prospective cohort study

Canada legalized recreational cannabis use for adults on October 17, 2018 with decision-makers emphasising the need to reduce cannabis use among youth. We sought to characterise trends of youth cannabis use before and after cannabis legalization by relying on a quasi-experimental design evaluating cannabis use among high school students in Alberta, British Columbia, Ontario, and Québec who participated in the COMPASS prospective cohort study. Overall trends in use were examined using a large repeat cross-sectional sample (n = 102,685) at two time points before legalization (16/17 and 17/18 school years) and one after (18/19 school year). Further differential changes in use among students affected by legalization were examined using three sequential four-year longitudinal cohorts (n = 5,400) of students as they progressed through high school. Youth cannabis use remains common with ever-use increasing from 30.5% in 2016/17 to 32.4% in 2018/19. In the repeat cross-sectional sample, the odds of ever use in the year following legalization were 1.05 times those of the preceding year (p = 0.0090). In the longitudinal sample, no significant differences in trends of cannabis use over time were found between cohorts for any of the three use frequency metrics. Therefore, it appears that cannabis legalization has not yet been followed by pronounced changes on youth cannabis use. High prevalence of youth cannabis use in this sample remains a concern. These data suggest that the Cannabis Act has not yet led to the reduction in youth cannabis use envisioned in its public health approach.

Disciplinary Approaches for Cannabis Use Policy Violations in Canadian Secondary Schools

The objective of this study was to examine the disciplinary approaches being used in secondary schools for student violations of school cannabis policies. Survey data from 134 Canadian secondary schools participating in the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study were used from the school year immediately following cannabis legalization in Canada (2018/19). Despite all schools reporting always/sometimes using a progressive discipline approach, punitive consequences (suspension, alert police) remain prevalent as first-offence options, with fewer schools indicating supportive responses (counselling, cessation/educational programs). Schools were classified into disciplinary approach styles, with most schools using Authoritarian and Authoritative approaches, followed by Neglectful and Permissive/Supportive styles. Further support for schools boards in implementing progressive discipline and supportive approaches may be of benefit.

Cannabis cessation among youth: rates, patterns and academic outcomes in a large prospective cohort of Canadian high school students

INTRODUCTION

Following cannabis legalization in Canada, a better understanding of the prevalence of unprompted cannabis use reduction and subsequent effects on youth academic outcomes is needed to inform harm reduction and health promotion approaches.

METHODS

We analyzed a longitudinally linked sample (n = 91774) from the COMPASS prospective cohort study of Canadian high school students attending Grades 9-12 in Ontario and Alberta between 2013-2014 and 2016-2017. We investigated the prevalence of spontaneous cannabis use reduction and cessation between grade transitions (Grades 9-10, 10-11, 11-12) and the effect of cessation on academic achievement (current or recent math and English course marks) and rigour (usual homework completion and past-month truancy).

RESULTS

Only 14.8% of cannabis users decreased their use between grades. Of these, two-thirds made only incremental downward changes, a pattern which held true for all three transitions. Cessation rates from daily and weekly use decreased every year. After cessation, students had better odds than continuing users (OR = 1.23, 95% CI: 1.03- 1.48) and worse odds than never-users (OR = 0.55, 95% CI: 0.31-0.97) for some subcategories of math performance. Students who quit cannabis universally improved class attendance (OR = 2.48, 95% CI: 1.93-3.19) and homework completion (OR = 2.32, 95% CI: 1.85-2.92) compared to continuing users.

CONCLUSION

Increased academic rigour may underlie any improvements seen in academic performance after cannabis cessation. High school students who use cannabis likely need targeted support to facilitate reduction or cessation and subsequent academic recovery. This indicates that a school-based focus on cannabis harm reduction is justified.

An examination of how age of onset for alcohol, cannabis, and tobacco are associated with school outcomes in grade 12

INTRODUCTION

Youth substance use prevention is a key public health priority. There is evidence that delaying substance use can improve health outcomes. While substance use is associated with negative outcomes at school, the benefits of delaying substance use on these outcomes are less well understood.

METHODS

The current study examined the substance use behaviours and school outcomes of 35,221 grade 12 students in Canada. Students were asked to report when they began using alcohol, cannabis, and tobacco products as well as school outcomes including school connectedness, math and English grades, truancy, and post-secondary aspirations and expectations. Regression models were used to examine the relationship between of age of initiation of alcohol, cannabis, and tobacco use and these outcomes.

RESULTS

Students who abstained from substance use throughout high school had higher school connectedness, lower truancy, and higher grades in grade 12 than students who did not. Earlier cannabis use was associated with increased truancy in grade 12. English grades were higher among students who did not use tobacco. Finally, post-secondary educational aspirations and expectations were higher among students who initiated substance use later.

CONCLUSION

Grade 12 school outcomes were the best among students who abstained from substance use throughout high school. However, among students who did engage in substance use, school connectedness, truancy, English grades, and educational aspirations and expectations were more favourable among those who initiated substance use at a later age.

An examination of how age of onset for alcohol, cannabis, and tobacco are associated with physical activity, screen time and BMI as students are preparing to graduate from high school

Introduction

In this study we examined the co-occurrence of alcohol, cannabis, and tobacco among a large cohort of grade 12 students in Canada, and then explored if the age of initiation of these substances was associated with moderate-to-vigorous physical activity (MVPA), screen time, and BMI.

Methods

This cross-sectional study used student-level data from grade 12 students in years 1 to 5 (2012–2016) of the COMPASS study. Random intercept linear regression models were used to examine the impact of age of initiation of alcohol, cannabis, and tobacco use on student average daily physical activity, daily screen time and BMI.

Results

Twenty-eight percent of students had only tried one substance with alcohol being the most reported single substance used (25%). The most common co-occurrence was students reporting having tried all three substances (27%). Nineteen percent of students reported no substance use by grade 12.

Younger age of first use of alcohol was associated with increased MVPA in grade 12. Earlier initiation of cannabis and tobacco were associated with increased screen time in grade 12. Age of first use of alcohol, cannabis and tobacco were not associated with BMI in grade 12.

Conclusion

While no specific cut-off age was identified this study indicates that for every year tobacco and cannabis use are delayed among children, there are subsequent reductions to screen time in grade 12. Early initiation of alcohol was associated with increased MVPA in grade 12. Early initiation of alcohol, cannabis and tobacco were not associated with BMI in grade 12.

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Less than 1 in 5 students reported no substance use by grade 12.

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75% of students had tried alcohol by the end of high school.

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Initiating cannabis and tobacco earlier was associated with increased screen time.

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Age of first use of all substances not associated with BMI in grade 12.

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Initiating alcohol use at a younger age was associated with more MVPA in grade 12.