Cannabis and alcohol use, and the developing brain

Untreated Allergy Among Middle School Students: Associations with Socioeconomic Adversities and Academic, Behavior, and Health Difficulties

BACKGROUND

Many adolescents with allergy do not receive physician treatment (allergyuntreated). We explored its association with socioeconomic adversities and academic-behavior-health difficulties, which remain unaddressed.

METHODS

This cross-sectional school-based-population study compared the above factors of middle-school adolescents with allergyuntreated and those with treated allergy (allergytreated) (mean age = 13.5 ± 1.2) from north-eastern France. Participants completed a questionnaire collecting socioeconomic adversities (nonintact family, low parents' education, insufficient family income, poor social support, suffered verbal/physical violence, and sexual abuse), low academic performance, excessive screen time, substance use, sleep difficulty, poor physical health, depressive symptoms, suicide attempt, poor quality of life, and allergytreated/allergyuntreated.

RESULTS

Logistic regression models showed that allergyuntreated was associated with all the factors considered (sex-age-class-level-adjusted odds ratio (saclOR) reaching 3.94, p < .001) and the risk score (number of main criteria: suffered sexual abuse, excessive screen time, poor quality of life, cannabis use, low parents' education, and poor social support): saclOR 4.75, 9.23, 15.64, and 31.73 (p < .001) for risk scores 1, 2, 3, and ≥4, versus risk score = 0 (pseudo-R2 = 11.1%).

CONCLUSIONS

Socioeconomic adversities and academic-behavior-health difficulties may be used to detect adolescents with allergyuntreated for care.

The PEERCARE peer led programme for college students: A qualitative evaluation of a "chill-out" harm reduction space

Aims: Harmful patterns of alcohol consumption, such as binge drinking, are prevalent among the student population at universities. Despite the risks of this behaviour, few secondary prevention programmes have been created to meet the specific needs of this population. The PEERCARE programme is a peer-based prevention programme that seeks harm reduction for alcohol overuse in party environments, among other goals. To do so, a "chill-out" space is created by peer educators in party environments to limit the risks associated with alcohol overuse. This study sought to examine peer educators' experience with a chill-out space to identify their specific actions, difficulties and needs, and to consider possibilities for improvement. Methods: Nine engineering students from one French grandes écoles campus trained as peer educators (six men and three women; mean age 21 years) participated. Semi-structured interviews were used for data collection. Results: The thematic analysis showed that the peer educators were highly engaged with this programme in response to alcohol overuse on their campus. The chill-out space was lauded for its non-judgemental and non-moralising nature. In addition, the numerous risk reduction activities that were enacted confirmed the benefits of these spaces during parties. The peer educators' experience was positive, and acting as managers of the chill-out space seemed to answer to a sense of competence recognitiontion. Conclusion: This study confirms the relevance of utilising chill-out spaces during parties and provides preliminary data on the deployment and management of peer-led chill-out space approaches. Expanding the implementation of such spaces to more educational institutions is recommended.

Developmental stasis, sensitivity, and disturbance: Linking concepts to analytic methods using impulsivity and alcohol use

The goals of this article are to (a) describe and contrast conceptual characteristics of periods of developmental sensitivity, disturbance, and stasis, and (b) translate these concepts to testable analytic models with an example dataset. Although the concept of developmental sensitivity is widely known, the concepts of developmental stasis and disturbance have received less attention. We first define the concepts and their principles and then, using repeated measures data on impulsivity and alcohol use from adolescence to young adulthood, propose the dual latent change score (LCS) growth model as one analytic approach for evaluating evidence for key characteristics of these developmental concepts via examination of intraindividual time-varying associations.

No evidence for a reciprocal relationship between daily self-control failures and addictive behavior in a longitudinal study

Introduction

We all experience occasional self-control failures (SCFs) in our daily lives, where we enact behaviors that stand in conflict with our superordinate or long-term goals. Based on the assumption that SCFs share common underlying mechanisms with addictive disorders, we tested the hypothesis that a generally higher susceptibility to daily SCFs predicts more addictive behavior, or vice versa.

Methods

At baseline, 338 individuals (19-27 years, 59% female) from a community sample participated in multi-component assessments. These included among others (1) a clinical interview on addictive behaviors (quantity of use, frequency of use, DSM-5 criteria; n = 338) and (2) ecological momentary assessment of SCFs (n = 329, 97%). At the 3-year and 6 year follow-up, participation rates for both assessment parts were 71% (n = 240) and 50% (n = 170), respectively.

Results

Controlling for age, gender, IQ, and baseline addiction level, random-intercept cross-lagged panel models revealed that participants who reported more SCFs also showed pronounced addictive behavior at the between-person level, but we found no evidence of a predictive relationship at the within-person level over time.

Discussion

A higher rate of SCFs is associated with more addictive behavior, while there is no evidence of an intraindividual predictive relationship. Novel hypotheses suggested by additional exploratory results are that (1) only addiction-related SCFs in daily life are early markers of an escalation of use and thus for addictive disorders and that (2) an explicit monitoring of SCFs increases self-reflection and thereby promotes the mobilization of cognitive control in response to goal-desire conflicts.

Lifetime use of alcohol and cannabis among U.S. adolescents across age: Exploring differential patterns by sex and race/ethnicity using the 2019 NSDUH data

Background

Early use of alcohol and cannabis is associated with health and social problems. It is unclear how lifetime use changes for each additional year of age during adolescence, and whether this change varies by sex and race/ethnicity. This study characterized lifetime rates of alcohol and cannabis use by age among 12- to 17-year-old American youth and explored differential patterns by sex and race/ethnicity.

Methods

Data were obtained from the 2019 National Survey on Drug Use and Health. Analyses were restricted to 12-17-year-olds who were non-Hispanic White, non-Hispanic Black, or Hispanic/Latino (n = 11,830). We estimated the increase in lifetime use of alcohol and cannabis by age for the full sample and stratified by sex and race/ethnicity. Slopes of the regression lines were compared to assess differential patterns across groups.

Results

In these cross-sectional analyses, reported lifetime use increased substantially from age 12 to 17 for alcohol (6.4 % to 53.2 %) and cannabis (1.3 % to 35.9 %). The increase in lifetime alcohol use was slightly, but not significantly, steeper among girls than boys (F1,8 = 3.40, p = 0.09). White and Latino youth showed similar rates of increase in lifetime alcohol use, which was significantly flatter among Black youth (F2,12=21.26, p<0.0001). Latino youth had a slightly, but not significantly, steeper increase in lifetime cannabis use than White and Black youth (F2,12=3.17, p = 0.07).

Conclusions

Reports of lifetime alcohol and cannabis use substantially increase from age 12 to 17 and the rates are different according to sex and race/ethnicity, highlighting the need for early and tailored substance use prevention in adolescents.

Substance Use Among Middle School Adolescents: Association with Family Members' and Peers' Substance Use and the Mediating Role of School and Mental Difficulties

OBJECTIVE

We assessed the associations of substance (alcohol, tobacco, cannabis, and other illicit drugs) use of adolescents with that of their family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers, and the mediating role of school and mental difficulties (SMDs) which remained insufficiently addressed.

METHODS

This cross-sectional population-based study included 1,559 middle-school adolescents in France (mean age = 13.5 ± 1.3, 778 boys, 781 girls). They completed a questionnaire including socioeconomic features (nationality, family structure and parents' education, occupation, and income), substance use, cumulative number of substance use of family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers (noted familySUcn and peerSUcn), SMDs (grade repetition, suffered physical/verbal violence, sexual abuse, lack of family/peer support, depressive symptoms, suicide attempt, and age at onset). Data were analyzed using logistic regression models and Kaplan-Meier estimates.

RESULTS

Most adolescents had familySUcn 1-2, 3-5, and ≥ 6 (39.1%, 23.0%, and 4.5%, respectively) and peerSUcn 1-2 and ≥ 3 (36.1% and 13.0%, respectively). Strong dose-effect associations were found between all substance use and familySUcn and peerSUcn (odds ratio adjusted for sex, age, and socioeconomic features reaching 13.44 and 9.90, respectively, most with p < .001). SMDs explained more the associations of all substance use with familySUcn than with peerSUcn (contributions reaching 69% and 34%, respectively). The proportion of subjects without each substance use decreased with age more quickly among the adolescents with higher familySUcn or peerSUcn.

CONCLUSIONS

Early prevention reducing familySUcn, peerSUcn and SMDs among adolescents and their families may reduce efficiently initiation and regular use of substances during adolescents' life course.

Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States

BACKGROUND

Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents.

OBJECTIVES

To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents.

METHODS

We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm.

RESULTS

807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001).

CONCLUSIONS

Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.

A 2-year follow-up of the effects of combined binge drinking and cannabis consumption on academic performance and adjustment in Spanish third-year university students

Introduction

The study was based on 2-year follow-up of the effects of binge drinking and cannabis co-consumption on academic performance and adjustment in Spanish Third-Year University Students and to further explore the impact of academic adjustment on this relationship.

Methods

A total of 144 students (aged 19-20 years) enrolled in the third year of university completed the study. The students were recruited during in first academic year (T1) via a survey that included items regarding the use of alcohol (AUDIT-C), cannabis and other drugs and demographic variables. Then, participants meeting the study criteria were then selected and invited by e-mail to a clinical (face-to face) structured interview. The participants completed a calendar of alcohol consumption during the 6 months prior to the interview (Alcohol Timeline Follow back), and recorded cannabis consumption in 3 months prior to the interview. To examine the effects of alcohol and cannabis co-consumption on the outcome variables, we categorized participants into three consumption groups (i.e., control, BD, and BDCA) based on the number of BD days and cannabis unit scores.

Results

Binge drinking and cannabis co-consumption in first-year students was significantly associated with poor academic performance and adjustment after 2 years of undergraduate study. Relative to controls, co-consumers (BDCA) reported significantly lower academic and personal-emotional adjustment to university as well as poorer performance. Mediation analysis showed that academic adjustment explains the mechanism by which BDCAs perform less well, mediating the relationship between co-consumption and academic performance, with an indirect effect representing 64.61% of the total effect. Furthermore, the mediating effect of academic adjustment was maintained after controlling for academic adjustment and baseline grade point average (T1).

Conclusion

This prospective follow-up study helps to further our knowledge of how combined binge drinking and cannabis consumption may affect university adjustment and academic success in Spanish university students Overall, the study results should encourage health professionals, educational psychologists and academic institutions to take ownership of the need for support and involvement in prevention, as well as for provision of guidelines for implementing appropriate intervention strategies.

Associations between School-Behavior-Health Difficulties and Subsequent Injuries among Younger Adolescents: A Population-based Study

Objective: School-behavior-health difficulties (SBHDs) may alter physical/mental capabilities and consequently increase injury risk during daily activities. This study assessed the associations of potential SBHDs and their cumulative number (SBHDcn) with various injury types among younger adolescents. Methods: The study population included 1,559 middle-school adolescents in France (10-18 years, 98% under 16,778 boys and 781 girls). They completed a questionnaire at school-year end collecting socioeconomic features (nationality, family structure, parents' education/occupation/income), school/out-of-school injuries during the school-year (dependent variables), and SBHDs starting before the school-year (low academic performance, alcohol/tobacco/cannabis/other-illicit-drugs use, physical/verbal violence, sexual abuse, perpetrated violence, poor social support, poor general health status, sleep difficulty, depressive symptoms, and suicide attempt). Data were analyzed using logistic regression models and Kaplan-Meier estimates. Results: Injuries were frequent during school-physical/sports-training (10.9%), other-school-training (4.7%), school-free-time (7.4%), out-of-school-sports-activity (16.5%), and traffic (2.2%). Single injury (one injury all injury types combined) and ≥2 injury types affected 23.3 and 7.9% of subjects, respectively. The proportion of adolescents without SBHDs decreased with age more quickly among those with each injury type than among those without injury. Various SBHDs were associated with most injury types, single injury, and ≥2 injury types (sex-age-adjusted odds/relative-risk ratios reaching 11, p < .001). A dose-effect association was found between SBHDcn 1-2/3-5/≥6 and both single injury and ≥2 injury types (sex-age adjusted relative risk ratios reaching 12.66, p < .001, vs. SBHDcn = 0). Socioeconomic features had a moderate confounding role in these associations. Conclusions: SBHDs strongly predict injuries among adolescents. Our findings may inform healthcare providers about their prominent role in detecting/reducing SBHDs and injuries.

Cannabis in Adolescence: Lasting Cognitive Alterations and Underlying Mechanisms

Cannabis consumption during adolescence is an area of particular concern, owing to changes in the social and political perception of the drug, and presents a scientific, medical, and economic challenge. Major social and economic interests continue to push toward cannabis legalization as well as pharmaceutical development. As a result, shifting perceptions of both legal and illicit cannabis use across the population have changed the collective evaluation of the potential dangers of the product. The wave of cannabis legalization therefore comes with new responsibility to educate the public on potential risks and known dangers associated with both recreational and medical cannabis. Among these is the risk of long-term cognitive and psychological consequences, particularly following early-life initiation of use, compounded by high-potency and/or synthetic cannabis, and heavy/frequent use of the drug. Underlying these cognitive and psychiatric consequences are lasting aberrations in the development of synaptic function, often secondary to epigenetic changes. Additional factors such as genetic risk and environmental influences or nondrug toxic insults during development are also profound contributors to these long-term functional alterations following adolescent cannabis use. Preclinical studies indicate that exposure to cannabinoids during specific windows of vulnerability (e.g., adolescence) impacts neurodevelopmental processes and behavior by durably changing dendritic structure and synaptic functions, including those normally mediated by endogenous cannabinoids and neuronal circuits.

E-Cigarette and Cannabis Use Patterns, Depression, and Suicide Behaviors Among US Youth: Analysis of 2019 Youth Risk Behavior Survey Data

PURPOSE

To examine the associations of current electronic cigarette and cannabis use patterns with depression symptoms and suicidal ideation and behavior overall and stratified by sex among U.S. high school students.

DESIGN

Quantitative, cross-sectional study.

SETTING

The 2019 National Youth Risk Behavior Survey.

SUBJECTS

12,401 high school students in 9th-12th grade.

MEASURES

Dependent variables were depression symptoms, suicidal ideation, suicide plan, suicide attempt, and suicide attempt-related injury. Independent variables were past 30 day e-cigarette and cannabis use patterns. Covariates included demographics, grade level, and other tobacco product use.

ANALYSIS

Multivariable logistic regression models.

RESULTS

Approximately 15.7% of students were exclusive e-cigarette users, 4.5% were exclusive cannabis users, and 16.4% were concurrent e-cigarette and cannabis users. Exclusive e-cigarette and cannabis users, and concurrent users were at increased odds (P < .05) of having depression symptoms, seriously considered attempting suicide, planning suicide, suicide attempt, and having suicide attempt-related injury compared to non-users. Female users, especially concurrent users, had higher odds of reporting depression symptoms (P < .01) and all suicidal ideation and behavior outcomes (P < .01) than female non-users, but results varied for male students.

CONCLUSION

E-cigarette and cannabis use patterns significantly predicted depression symptomatology and suicidal ideation and behavior, with female students having higher odds. Results suggest the need for tailored interventions to address mental health and suicidality among U.S. adolescents, and especially female students.

Task-based co-activation patterns reliably predict resting state canonical network engagement during development

Neurodevelopmental research has traditionally focused on development of individual structures, yet multiple lines of evidence indicate parallel development of large-scale systems, including canonical neural networks (i.e., default mode, frontoparietal). However, the relationship between region- vs. network-level development remains poorly understood. The current study tests the ability of a recently developed multi-task coactivation matrix approach to predict canonical resting state network engagement at baseline and at two-year follow-up in a large and cohort of young adolescents. Pre-processed tabulated neuroimaging data were obtained from the Adolescent Brain and Cognitive Development (ABCD) study, assessing youth at baseline (N = 6073, age = 10.0 ± 0.6 years, 3056 female) and at two-year follow-up (N = 3539, age = 11.9 ± 0.6 years, 1726 female). Individual multi-task co-activation matrices were constructed from the beta weights of task contrasts from the stop signal task, the monetary incentive delay task, and emotional N-back task. Activation-based predictive modeling, a cross-validated machine learning approach, was adopted to predict resting-state canonical network engagement from multi-task co-activation matrices at baseline. Note that the tabulated data used different parcellations of the task fMRI data ("ASEG" and Desikan) and the resting-state fMRI data (Gordon). Despite this, the model successfully predicted connectivity within the default mode network (DMN, rho = 0.179 ± 0.002, p < 0.001) across participants and identified a subset of co-activations within parietal and occipital macroscale brain regions as key contributors to model performance, suggesting an underlying common brain functional architecture across cognitive domains. Notably, predictive features for resting-state connectivity within the DMN identified at baseline also predicted DMN connectivity at two-year follow-up (rho = 0.258). These results indicate that multi-task co-activation matrices are functionally meaningful and can be used to predict resting-state connectivity. Interestingly, given that predictive features within the co-activation matrices identified at baseline can be extended to predictions at a future time point, our results suggest that task-based neural features and models are valid predictors of resting state network level connectivity across the course of development. Future work is encouraged to verify these findings with more consistent parcellations between task-based and resting-state fMRI, and with longer developmental trajectories.

Associations between school difficulties and family type and the role of socioeconomic, behavior and health-related difficulties in early adolescents: a population-based study

OBJECTIVES

Nowadays many early adolescents are living in non-intact families (parents divorced/separated, reconstructed families or single parents) and have many school difficulties (learning difficulty, skipping school, school absence due to family problems, grade repetition, low school performance, and school dropout ideation). This study assessed the associations between school difficulties and family type which remain little addressed and the confounding role of socioeconomic adversities and behavior, social support and health-related difficulties (BSSHDs).

METHODS

The study population included 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed at the end of school-year a questionnaire gathering socioeconomic adversities, school difficulties and BSSHDs (being obese, substances use, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt; cumulated number noted BSSHD_CM). Data was analyzed using logistic regression models.

RESULTS

The adolescents with parents divorced/separated, reconstructed families or single parents had a much higher risk for various school difficulties than those in intact families (sex-age-adjusted odds ratios 1.60-4.70, mostly with p < 0.001). These risks were robust and remained significant (often with p < 0.01/0.001) after adjustment for socioeconomic adversities and BSSHD_CM. The contributions of socioeconomic adversities plus BSSHD_CM to the risks were mostly elevated (>40%, reaching 65%) while those of socioeconomic adversities alone were mostly moderate (<30%, but reaching 52%).

CONCLUSIONS

Family type plays a strong role in school difficulties among early adolescents, mainly due to socioeconomic adversities and BSSHD_CM. Our results may help primary care providers identify at-risk adolescents and their problems and establish timely prevention and care.HighlightsLearning difficulty, school absence, grade repetition, low academic performance, and school dropout ideation are common in early adolescents.The adolescents with parents divorced/separated, reconstructed families or single parents have up to 4.7-time higher risk for these school difficulties than those in intact families.These risks are robust after adjustment for socioeconomic, behavior and health-related difficulties which explain up to 65% of the risks.School-difficulty prevention should consider family features and include early monitoring behavior and health-related difficulties in adolescents.

Daily-level associations between sleep duration and next-day alcohol and cannabis craving and use in young adults

STUDY OBJECTIVES

To examine the effects of sleep duration on next-day alcohol and cannabis craving and use among young adults.

METHOD

A community sample of young adults who reported recent simultaneous alcohol and cannabis use at screening (N = 409; Mage = 21.61; 50.9% female) completed twice daily surveys (morning and afternoon) for five 14-day sampling bursts (i.e., 70 days total). Daily measurements included sleep duration, alcohol and cannabis craving, and alcohol and cannabis use (i.e., number of drinks, hours high). Multilevel models enabled examining associations between sleep duration and substance use/craving at three distinct levels: daily-level, burst-level, and person-level.

RESULTS

At the day-level, sleep duration was inversely associated with craving for both alcohol and cannabis: Stronger craving was reported on mornings and afternoons after relatively shorter sleep duration. At the burst-level, sleep duration was inversely associated with morning and afternoon alcohol craving indicating stronger alcohol craving, but not cannabis craving, during two-week periods when young adults have accumulated shorter sleep duration. Pertaining to alcohol and cannabis use, no daily-level effects were found, but the burst-level effect showed that participants engaged in greater alcohol use during two-week bursts with shorter sleep duration.

CONCLUSIONS

Based on a non-clinical sample of young adults reporting substance use, results suggest shorter sleep duration may be a modifiable risk factor as it pertains to substance use and cravings. Results highlight day-level effects of shorter sleep duration on substance use cravings and adverse effects of cumulative sleep deficit on alcohol use.

Cannabis smoking increases the risk of suicide ideation and suicide attempt in young individuals of 11-21 years: A systematic review and meta-analysis

BACKGROUND

Cannabis is the most frequently consumed drug around the world. Its use has been associated with increased suicide behaviors; nonetheless, the association of cannabis smoking and suicide behaviors in adolescents has not yet been established. The aim of this systematic review and meta-analysis was to evaluate the risk of suicide attempt, suicidal ideation or suicide planning in individuals of 11-21 years of age who smoke cannabis.

METHODS

We performed an online searched using PubMed, EBSCO and Science Direct databases, up to July 2021. We calculated odds ratio with 95% confidence intervals to evaluate the association between suicide attempt, suicidal ideation or suicide planning and cannabis smoking in individuals of 11-21 years of age.

RESULTS

Twenty studies reported suicide attempts in 34,859 young individuals, suicidal ideation in 26, 937 individuals, and suicide planning in 9054 young individuals. We found an increased risk of suicide attempt in cannabis smokers than in non-cannabis users (OR: 2.33; 95% CI: 1.78-3.05; Z p value; <0.0001; I² = 97.12%), as well as a significant association between cannabis smoking and suicidal ideation (OR: 2.04; 95%CI: 1.64-2.53; Z p value: <0.001; I²: 94.88) and suicide planning (OR: 1.674; 95% CI: 1.554-1.804; Z p value: 0.000; I²: 92.609). Subgroup analyses showed that American teens have an increased risk of suicidal ideation; the meta-regression analysis revealed that age was negatively associated with the risk of suicide attempt.

CONCLUSIONS

This meta-analysis shows that cannabis smoking increased the risk of suicide attempt, suicidal ideation and suicide planning in young individuals of 11-21 years of age. The high risk of suicide behaviors could vary depending on the population studied; therefore, more studies are necessary to corroborate the risk of presenting suicide behaviors in individuals of 11-21 years of age who smoke cannabis.

Sex-specific effects of adolescent intermittent ethanol exposure-induced dysregulation of hippocampal glial cells in adulthood

Adolescent alcohol abuse is a significant public health concern, with approximately 4.3 million U.S. adolescents reporting monthly binge drinking. Excessive ethanol consumption during adolescence has been linked to dysregulation of the neuroimmune system, particularly in the hippocampus. Because there are sex differences in both neuroimmune responses and ethanol's pharmacologic actions, this study tested whether there were disparate effects based on sex in glial cells and neurodegeneration in adulthood after the adolescent intermittent ethanol (AIE) model. Male and female adolescent Sprague-Dawley rats underwent AIE. In adulthood, immunohistochemical techniques were utilized to determine the effects of AIE on astrocytes and microglia, and Fluoro-Jade C (FJC) was used to assess neurodegeneration in the hippocampus. AIE exposure significantly increased astrocyte activation in the cornu ammonis 1 (CA1), CA2/3, and dentate gyrus (DG) in both male and female rats with no discernible sex differences in immunoreactivity. Likewise, the number of GFAP + cells was significantly increased by AIE across the hippocampus. In our microglial assessment, AIE only led to increased Iba1 immunoreactivity in the CA1 but not CA2/3 or DG regions. However, the number of Iba1+ cells was increased by AIE in both the CA1 and DG subregions. In the DG, the ethanol effect was observed in both sexes, but in the CA1, AIE-induced increased Iba1 cells were only observed in females. In regard to neurodegeneration, there were no persisting AIE effects on FJC + cells. These findings indicate that AIE alters hippocampal glial cells in adulthood, in the absence of active neurodegeneration. However, while AIE induced long-term elevation of astroglial measures in both males and females, persisting AIE-induced microglial activation was more sparse and sex-dependent. While the majority of these findings suggest that AIE has similar effects on glial morphology and number between males and females, additional work should determine whether there are molecular differences as well as innate sex differences in glial interaction with AIE's influence on glial functions in behavior.

Association between screen time and cumulating school, behavior, and mental health difficulties in early adolescents: A population-based study

Early adolescents may daily spend excessive screen-time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) while its association with cumulating several school-behavior-mental-health difficulties (SBMDs) (poor-academic-performance, being obese, alcohol/tobacco/cannabis/other-illicit-drugs use, suffered violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt) is poorly addressed. We investigated this association among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, daily screen-time for various screen-based activities (coded 1=<2/2=2-4/3=≥5 h; daily-total-screen-time level DSA_total was defined as their sum and categorized into 4 levels: 6-7/8-9/10-12/≥13), various SBMDs and the time of their onset during the life course (their cumulated number SBMD_score was categorized into 5 levels: 0/1/2/3-4/≥5). Logistic regression modeling showed that the DSA_total was strongly associated with all SBMDs (gender-age-adjusted odds ratio reaching 8.28, p < 0.001) and SBMD_score (gender-age-adjusted relative risk reaching 11.60, p < 0.001, pseudo R² = 0.039). These associations remained strongly significant when controlling for socioeconomic adversities (contributions 20-38%). The proportion of subjects without each SBMD steadily decreased with age according to DSA_total levels. These findings help to understand the impacts of high DSA_total on SBMDs in early adolescents and identify at-risk adolescents for prevention and care.

The Unplugged program in Chile (“Yo Sé Lo Que Quiero”) for substance use prevention among early adolescents: study protocol for a randomized controlled trial

Background

Substance use is among the main contributors to disease among children and adolescents in the Americas region. The call for effective prevention of substance use among adolescents has resulted in numerous school-based programs, and particularly the Unplugged program has been proved to be successful in reducing the prevalence of different substances in seven European countries. The purpose of this study is to test the effectiveness of the Unplugged program in Chile (“Yo Sé Lo Que Quiero”).

Methods

This is a cluster randomized controlled trial, parallel-group type, where “Yo Sé Lo Que Quiero” is compared to standard school preventive curricula in control schools. A total of 70 schools and 8400 adolescents are expected to be randomized with 1:1 allocation. During formative work, the Unplugged program was culturally adapted to Chile, and the instrument to assess the primary and secondary outcomes was validated. The effectiveness of this program will be assessed using the European Drug Addiction Prevention Trial Questionnaire (EU-Dap), measuring substance use prevalence and risk and protective factors in baseline, post-intervention, and four months after the end of the intervention.

Discussion

The proposed study will be the first to test the effectiveness of a school-based substance use prevention program in Chile in a cluster randomized control trial and the first study evaluating the Unplugged program in Spanish-speaking Latin America. A model for disseminating the Unplugged program inside Europe already exists and has been implemented successfully in several countries. Thus, if the effects of the program are positive, wide implementation in Chile and Latin American countries is possible soon.

Trial registration

ClinicalTrials.govNCT04236999. Registered on January 17, 2020.

History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND

OBJECTIVE

To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later.

METHOD

A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later.

RESULTS

Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND.

CONCLUSIONS

For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.

Changes in alcohol use by cannabis use status among adolescents and young adults in the United States: Emerging evidence for both substitution and complementarity

BACKGROUND

The majority of adolescents and young adults (AYA) who use cannabis also use alcohol. Although cannabis use is increasing in the United States (US), it is not known whether the increase contributes to either increased co-use of alcohol and cannabis (e.g., complementarity) or replacement of alcohol with cannabis (e.g., substitution). The current study estimated the prevalence of alcohol use by cannabis use status among US AYA ages 12 to 25 in 2018 and trends in alcohol use by cannabis use status from 2002 to 2018.

METHODS

Data were drawn from the 2002 to 2018 National Survey on Drug Use and Health public use data files. The analytic sample included AYA ages 12 to 25 (2018 sample, n = 26,924; total combined sample 2002 to 2018, n = 576,053). Linear and logistic regression models were used to estimate past-month alcohol use, daily alcohol use, and average quantity of alcohol consumed among AYA with and without past-month cannabis use from 2002 to 2018.

RESULTS

In 2018, any alcohol use and daily alcohol use were significantly more common among AYA who used cannabis use than those who did not use cannabis. Overall, any alcohol use, daily alcohol use, and average drinks per day declined from 2002 to 2018 among AYA irrespective of recent cannabis use. However, the decline in any alcohol use, daily alcohol use, and average alcohol drinks per day was more rapid among AYA who used cannabis (daily and nondaily) than those who did not use cannabis. The rate of decline in average alcohol drinks per day was also higher among AYA with daily compared to nondaily cannabis use.

CONCLUSIONS

Even with declines in alcohol use over time, drinking is much more common among AYA who report cannabis than those without recent cannabis use, which is consistent with complementarity. Yet, because the decline in alcohol use has been more rapid among AYA who use cannabis, there is also evidence of substitution. Thus, the current data on alcohol and cannabis use are consistent with both complementarity and substitution. However, these relationships may change as cannabis legalization expands over time.

Validation of the European Drug Addiction Prevention Trial Questionnaire (EU-Dap) for substance use screening and to assess risk and protective factors among early adolescents in Chile

BACKGROUND

Substance use is highly prevalent among Chilean adolescents, and the damage it causes at the neurobiological, psychological, and social levels is known. However, there are no validated screening instruments that also assess risk and protective factors for this population in Chile, which is essential for evaluating future prevention interventions.

OBJECTIVE

To determine the psychometric properties of the European Drug Addiction Prevention Trial Questionnaire (EU-Dap) questionnaire.

METHODS

A cross-sectional study was carried out in 13 schools in the city of Santiago de Chile. The sample included 2261 adolescents ranging from 10 to 14 years old. Linguistic and cultural adaptation was assessed using focus groups with adolescents, the construct validity was evaluated using confirmatory factor analysis, and measures of its reliability were also determined. Furthermore, the associations regarding risk and protective factors with substance use were explored.

RESULTS

Substance use questions were well understood and seemed to adequately capture the consumption of different drugs. Regarding the subscales of risk and protective factors, the analyses showed that most subscales had good psychometric properties, and few needed some degree of improvement (e.g., some items were removed). After the changes, most final subscales had good or adequate goodness of fit adjustments and good or acceptable internal consistency. Finally, the main associated factors with the substance use outcomes were: future substance use and school bonding for tobacco use; negative beliefs about alcohol, future substance use, school bonding and refusal skills for alcohol use; and negative beliefs about marihuana, positive attitudes towards drugs, risk perception, and substance abuse index for marihuana use. Normative beliefs increased the risk for all substances use.

CONCLUSIONS

The current findings suggest that the EU-Dap is a valid and reliable instrument, and it may help to evaluate the effectiveness of drug use prevention interventions.

Trajectories of brain development reveal times of risk and factors promoting resilience to alcohol use during adolescence

Alcohol use disorder (AUD) is recognized as harmful for the developing brain. Numerous studies have sought environmental and genetic risk factors that predict the development of AUD, but recently identified resilience factors have emerged as protective. This chapter reviews normal processes of brain development in adolescence and emerging adulthood, delineates disturbed growth neurotrajectories related to heavy drinking, and identifies potential endogenous, experiential, and time-linked brain markers of resilience. For example, concurrent high dorsolateral prefrontal activation serving inhibitory control and low nucleus accumbens activation serving reward functions engender positive adaptation and low alcohol use. Also discussed is the role that moderating factors have in promoting risk for or resilience to AUD. Longitudinal research on the effects of all levels of alcohol drinking on the developing brain remains crucial and should be pursued in the context of resilience, which is a promising direction for identifying protective biomarkers against developing AUDs.

Ansatzpunkte für die Prävention frühen jugendlichen Alkoholkonsums

Zusammenfassung. Ziele: In der vorliegenden Studie werden sowohl frühkindliche als auch elterliche Risikofaktoren, die jugendliche Trinkmotivation und die Übereinstimmung zwischen den Müttern und Jugendlichen hinsichtlich des jugendlichen Alkoholkonsums zur Ableitung von präventiven Ideen ausgewertet. Methodik: Die Daten von 239 Familien aus dem längsschnittlichen deutschen Projekt Zukunft Familie wurden vom Kindergartenalter ( M = 4.5 Jahre) bis in das Jugendalter ( M = 14 Jahre) erhoben. Mittels binär logistischer Regressionsmodelle wurden die Zusammenhänge zwischen psychischen Auffälligkeiten im Kindesalter, der soziodemographischen Situation sowie Verhaltensweisen der Eltern und dem Alkoholkonsum der Kinder zehn Jahre später analysiert. Ergebnisse: Kinder von Müttern mit einer höheren Schulbildung und aus Familien mit einem höheren sozialen Status hatten ein erhöhtes Risiko, schon vor dem gesetzlich erlaubten Mindestalter, regelmäßig Alkohol zu trinken. Bei den im Durchschnitt 4.5-jährigen Kindern erwiesen sich internalisierende Auffälligkeiten als Schutzfaktor vor einem frühzeitigen jugendlichen Konsum. Alkohol wurde im Jugendalter vor allem aus sozialen und Verstärkungsmotiven getrunken. Mütter unterschätzten signifikant den Konsum ihrer Kinder um das Vier- bis Fünffache. Schlussfolgerung: Präventionsmaßnahmen könnten den Jugendlichen Alternativen aufzeigen, um die sozialen und verstärkenden Motivationen auf risikofreien Wegen zu erreichen. Zur verbesserten Einschätzung des kindlichen Konsums, könnten Mütter in Hinweisen geschult werden, die auf einen übermäßigen Konsum hindeuten. Das erhöhte Risiko von Kindern aus Familien mit einem höheren sozialen Status könnte dabei berücksichtigt werden.

Structural correlates of sensorimotor dysfunction in heavy cannabis users

Sensorimotor dysfunction has been previously reported in persons with cannabis dependence. Such individuals can exhibit increased levels of neurological soft signs (NSS), particularly involving motor coordination and sensorimotor integration. Whether such abnormalities may also apply to non-dependent individuals with heavy cannabis use (HCU) is unknown, as much as the neural correlates underlying such deficits. In this study, we investigated associations between NSS and gray matter volume (GMV) in males with HCU and male controls. Twenty-four persons with HCU and 17 controls were examined using standardized assessment of NSS and structural magnetic resonance imaging (MRI) at 3 T. GMV was calculated using voxel-based morphometry algorithms provided by the Computational Anatomy Toolbox (CAT12). Individuals with HCU showed higher NSS total scores compared to controls. In particular, significant NSS-subdomain effects were found for "motor coordination" (MoCo), "complex motor tasks" (CoMT), and "hard signs" (HS) expression in HCU (p < 0.05, Bonferroni-corrected). Compared to controls, persons with HCU showed significant NSS/GMV interactions in putamen and inferior frontal cortex (MoCo), right cerebellum (CoMT) and middle and superior frontal cortices, and bilateral precentral cortex and thalamus (HS). In between-group analyses, individuals with HCU showed lower GMV in the right anterior orbital and precentral gyrus, as well as higher GMV in the right superior frontal gyrus and left supplementary motor cortex compared to controls. The data support the notion of abnormal sensorimotor performance associated with HCU. The data also provide a neuromechanistic understanding of such deficits, particularly with respect to aberrant cortical-thalamic-cerebellar-cortical circuit.

Trends and Factors Related to Blunt Use in Middle and High School Students, 2010-2020

BACKGROUND AND OBJECTIVES

Blunt use is a popular mode of marijuana consumption among adolescents in the United States, but little is known about how its prevalence has changed over time or factors associated with its use. With this study, we assessed trends and correlates of past (ever used but not in the past 30 days) and current (used in past 30 days) blunt use among adolescents in Florida.

METHODS

We analyzed data from 2010-2020 cross-sectional, statewide representative Florida Youth Tobacco Surveys that comprised 461 706 middle and high schoolers using Joinpoint to calculate annual percentage change (APC) in the weighted prevalence of past and current blunt use. A weighted multivariable regression model was developed by using 2019-2020 Florida Youth Tobacco Survey data to examine the factors associated with past and current blunt use.

RESULTS

Whereas the prevalence of past (APC = -5.32%) and current (APC = -5.28%) blunt use significantly decreased from 2010 to 2015, an increasing trend in current use prevalence (APC = 14.91%) was observed from 2015 to 2018 and has been approximately constant ever since. Similar increasing trends were observed in current blunt use among female students (APC = 14.92%), middle schoolers (19.57%), and non-Hispanic (NH) white students (APC = 11.12%) from 2016 to 2020. Several factors were consistently associated with greater odds of both past and current blunt use for both middle and high schoolers, including older age, being NH Black (versus NH white), past and current use of cigarettes, electronic cigarettes, hookah, cigars, and ever vaping marijuana.

CONCLUSIONS

Although blunt use among Florida youth decreased from 2010 to 2015, substantial increases were observed since 2015, suggesting that existing tobacco control programs should incorporate marijuana (and blunt) modules into existing tobacco and nicotine prevention programs.

Lay Public View of Neuroscience and Science-Based Brain Health Recommendations in Slovenia

Background: Brain health is one of the cornerstones of a long and full life. Active care for brain health and reduction of lifestyle-related risks for brain disorders may be a key strategy in tackling the growing prevalence of mental and neurological illnesses. Public knowledge, perception, and preventive behavior need to be considered in the planning of effective strategies for brain health promotion. Our research is the first effort aimed at assessing Slovenian lay public knowledge, search and use of scientific information about the brain, and care for brain health.

Methods: An online survey was used to gather data for descriptive and associative statistical analyses of a sample of the Slovenian public (n = 2568) in August 2017. Participants with formal brain-related education were excluded, leaving the remaining sample of the lay public (n = 1012). Demographic characteristics and information regarding the perceived importance and knowledge of brain health and engagement in preventive behaviors of participants were collected, and key associative analyses were carried out.

Results: The majority of respondents (89%) considered brain health to be important. Over one-third (39%) considered their knowledge of the brain as sufficient relative to their needs. Most of the respondents identified science-recommended practices to be important for brain health. No recommendation was followed daily by the majority of the respondents, primarily due to declared lack of time (59%), and lack of information (32%). Information was obtained primarily from television (38%), followed by newspapers and magazines (31%), the Internet (31%), and direct conversations (27%). However, the highest-rated, preferred source of information was lectured by experts. One-third of our sample struggled with the trustworthiness of information sources. Female gender and older age were associated with a higher frequency of healthy practices. Personal or familial diagnoses of brain disorders were not associated with a higher frequency of the behavior in favor of brain health, but did affect available time and perceived value of preventive practices.

Conclusions: Our research provides an initial insight into the perceptions, knowledge, and brain health-promoting behavior of the Slovenian lay public. Our findings can inform future strategies for science communication, public education and engagement, and policy-making to improve lifelong active care for brain health.

Padrões de Uso de Drogas e Problemas Associados em Adolescentes Judicializados

Resumo Objetivou-se caracterizar uma amostra de adolescentes em conflito com a lei em relação ao consumo de substâncias e possíveis problemas associados. Participaram 120 adolescentes do sexo masculino, entre 13 e 18 anos, custodiados na Unidade de Atendimento Inicial da Fundação CASA, que responderam ao Drug Use Screening Inventory - Revised (DUSI-R). Análises descritivas indicaram que a maioria dos adolescentes teria feito uso de maconha (84%) e álcool (54%). Em relação ao padrão de consumo, 52% foram categorizados em uso abusivo ou de provável dependência. Quanto aos problemas associados ao consumo, os participantes possuem densidade média superior aos da população normativa nos dez domínios investigados pelo DUSI-R, com destaque aos Transtornos (M = 42), Escola (M = 50) e Pares (M = 55). Vale observar que 37% da amostra se declararam abstêmios, e que os desvios das densidades de problemas sugerem alta heterogeneidade nos níveis de necessidades/dificuldades, o que implica ultrapassar discursos que propalam a uniformidade dessa população.

[Changes in binge drinking among adolescents and young adults in Germany depending on educational level and migration background]

BACKGROUND

Studies show that the prevalence of binge drinking among young people in Germany is declining overall. This change is usually studied in more detail based on age and gender. This paper expands on these analyses and examines whether the decline in binge drinking among young people differs as a function of educational level and migration background.

METHODS

Based on representative surveys conducted by the Federal Center for Health Education (BZgA), 30-day prevalences of binge drinking were determined for Germany between 2008 and 2019 for male and female 12- to 17-year-old adolescents and 18- to 25-year-old young adults. Logistic regression analyses were used to estimate trend patterns for the period from 2008 to 2019. This was also done as a function of education level and migration background.

RESULTS

Across all surveys, more young adults than adolescents, more male than female young people, and more young people without a migration background get drunk. Between 2008 and 2019, the 30-day prevalence of binge drinking decreased overall among adolescents (male: from 23.0 to 16.4%; female: from 17.7 to 10.7%) and young men (from 53.0 to 43.9%), and it did not change statistically significantly among young women (2008: 28.1%; 2019: 24.5%). The trend analyses depending on the level of education and migration background show that at least among young women without a (technical) higher education entrance qualification there is a decrease in binge drinking.

DISCUSSION

The decline in binge drinking may differ depending on social characteristics. Such differences should be taken into account in the prevention of binge drinking. In particular, young women with a higher level of education must be reached with prevention offers.

A systematic review of neuroimaging and acute cannabis exposure in age-of-risk for psychosis

Acute exposure to cannabis has been associated with an array of cognitive alterations, increased risk for neuropsychiatric illness, and other neuropsychiatric sequelae including the emergence of acute psychotic symptoms. However, the brain alterations associating cannabis use and these behavioral and clinical phenotypes remains disputed. To this end, neuroimaging can be a powerful technique to non-invasively study the impact of cannabis exposure on brain structure and function in both humans and animal models. While chronic exposure studies provide insight into how use may be related to long-term outcomes, acute exposure may reveal interesting information regarding the immediate impact of use and abuse on brain circuits. Understanding these alterations could reveal the connection with symptom dimensions in neuropsychiatric disorders and, more specifically with psychosis. The purpose of the present review is to: 1) provide an update on the findings of pharmacological neuroimaging studies examining the effects of administered cannabinoids and 2) focus the discussion on studies that examine the sensitive window for the emergence of psychosis. Current literature indicates that cannabis exposure has varied effects on the brain, with the principal compounds in cannabis (delta-9-tetrahydrocannabinol and cannabidiol) altering activity across different brain regions. Importantly, we also discovered critical gaps in the literature, particularly regarding sex-dependent responses and long-term effects of chronic exposure. Certain networks often characterized as dysregulated in psychosis, like the default mode network and limbic system, were also impacted by THC exposure, identifying areas of particular interest for future work investigating the potential relationship between the two.

Associations of socio-demographic characteristics, well-being, school absenteeism, and substance use with recreational nitrous oxide use among adolescents: A cross-sectional study

PURPOSE

A rapid increase of recreational nitrous oxide use (i.e. laughing gas, N2O) has been reported in several countries, while it has received limited attention in scientific research. We aimed to study the association of socio-demographic characteristics, mental well-being, sickness absence, truancy, and substance use with the frequency of lifetime nitrous oxide use among adolescents.

METHODS

We used self-reported questionnaire data of adolescents (N = 555) attending secondary schools to cross-sectionally assess the frequency of nitrous oxide use and potential factors associated with nitrous oxide use, such as gender, mental well-being, and binge drinking. Ordinal logistic regression models were applied with lifetime nitrous oxide use (never, once, ≥ two times) as the outcome variable.

RESULTS

Adolescents were on average 15.6 years old (SD = 0.83, range 14-18), 47.0% were female. In total, 86 (15.6%) adolescents had used nitrous oxide at least once in their life. In the multivariable ordinal regression model, the risk of having a higher category of lifetime nitrous oxide use was associated with a non-Dutch ethnic background (OR = 2.10, 95% CI 1.22; 3.61), attending pre-vocational education (OR = 1.88, 95% CI 1.06; 3.34), a higher score on the scale of externalizing problems (OR = 1.10, 95% CI 1.01; 1.20), binge drinking twice or more in the past four weeks (OR = 2.49, 95% CI 1.25; 4.94), and cannabis use (OR = 1.98, 95% CI 1.03; 3.79).

CONCLUSIONS

Youth Health Care professionals should be aware of nitrous oxide use in adolescents, especially among adolescents with a non-Dutch ethnic background, lower education levels, externalizing problems, frequent binge drinking, and cannabis use.

Association between daily and non-daily cannabis use and depression among United States adult cancer survivors

BACKGROUND

Cancer survivors are vulnerable to Cannabis Use (CU) and at increased risk for depression. Yet, the relationship between CU and depression among cancer survivors is unknown.

PURPOSE

The purpose of this study was to estimate the prevalence of daily/non-daily CU, investigate the association between CU and depression and evaluate CU reasons and methods of administration among cancer survivors.

METHOD

Population-based, nationally representative sample of cancer survivors aged ≥18 (n = 10,799) from 2018 Behavioral Risk Factor Surveillance System Survey was used. Weighted descriptive statistics and multivariate logistic regression were conducted.

FINDINGS

Overall, 4.2% reported daily and 4.1% non-daily CU. Those who self-reported depression had higher prevalence of daily and non-daily CU than those not reporting depression. Daily CU was associated with 120% increased odds of depression (odds ratio = 2.2, 95% confidence interval [1.3, 3.7]) compared with none-users.

DISCUSSION

Efforts to improve open communications and evidence-informed discussions regarding benefits and risks of CU and reasons for using cannabis between clinicians and cancer survivors are imperative.

Cognition and Cortical Thickness in Heavy Cannabis Users

INTRODUCTION

Acute and long-term adverse effects of heavy cannabis use (HCU) on neurocognitive function have been suggested, as much as regional changes of brain volume. However, little is known about the relationship between impaired cognition and brain structure in individuals with HCU.

OBJECTIVE

Here, we investigated associations between cognition and cortical thickness (CT) in males with HCU and male controls.

METHODS

Twenty-six individuals with HCU and 20 controls were examined using a comprehensive neuropsychological test battery and high-resolution structural MRI at 3T. CT was calculated using the Computational Anatomy Toolbox (CAT12).

RESULTS

Individuals with HCU differed from controls with respect to verbal learning performance and verbal working memory only. Individuals with HCU showed reduced CT in medial temporal, orbitofrontal, and cingulate regions, as well as in areas of the middle temporal and fusiform cortex (peak voxel family-wise error-corrected p < 0.001, followed by empirically determined correction for spatial extent) compared to HC. Verbal learning performance was associated with right entorhinal and left orbitofrontal CT reductions. Entorhinal CT was also significantly associated with amount and frequency of current weekly cannabis use.

CONCLUSIONS

The data support the notion of domain-specific cognitive impairment in individuals with HCU and provide a neuromechanistic understanding of such deficits, particularly with respect to abnormal CT in brain areas associated with long-term memory processing.

Neurodevelopmental Effects of Cannabis Use in Adolescents and Emerging Adults with ADHD: A Systematic Review

OBJECTIVE

Systematically review the scientific literature to characterize the effects of cannabis use on brain structure, function, and neurodevelopmental outcomes in adolescents and young adults with ADHD.

METHOD

Systematic review following PRISMA guidelines utilizing PubMed, Embase, PsycINFO, and Cochrane CENTRAL trials register from inception until 1 January 2020. Articles that examined the impact of cannabis use on youth with ADHD were included.

RESULTS

Eleven studies were identified that compared outcomes for individuals with ADHD who used cannabis or synthetic cannabinoids against those with ADHD who did not. Seven of these studies used neuroimaging techniques, including fMRI, structural MRI, and SPECT. Differential regions of activation were identified, including the right hippocampus and cerebellar vermis, and bilateral temporal lobes. Morphological differences were identified in the right precentral and postcentral gyri, left nucleus accumbens, right superior frontal and postcentral gyri. No study identified any additive or ADHD × cannabis use interaction on neuropsychological tasks of executive function. Two studies found adverse differential impacts of early-onset cannabis use in this population.

CONCLUSION

A dearth of evidence is available on the impact of cannabis use on the developing brain and functioning for individuals with ADHD, despite the elevated risk for substance use in this population. The limited, potentially underpowered evidence does not support the hypothesis that cannabis use has a deleterious impact on neuropsychological tasks in transitional age youth with ADHD. Larger and longer-term studies are needed, however, to better inform clinicians and patients as to the impacts of cannabis use in youth with ADHD.

The Critical Lack of Data on Alcohol and Marijuana Use by Adolescents on the Autism Spectrum

Alcohol is the most commonly used substance among adolescents, and marijuana is the most commonly used illicit drug. Emerging evidence suggests that at least some autistic individuals may be at increased risk of substance use disorder compared with allistic counterparts, potentially to control social anxiety or facilitate social interaction. However, to the best of our knowledge, U.S. population-based estimates of substance use by autistic youth are limited. The aim of this perspective article was to highlight the lack of data sets that collect information about alcohol and marijuana use by autistic youth in the United States. We used a four-step investigation to identify potential data sources that could provide an estimate of the prevalence of alcohol and/or marijuana use in autistic youth, without regard to whether those estimates would be robust. We identified a total of 19 potential U.S. data sources. Of these, only one included information about both autism and alcohol and/or marijuana by youth. There is too little research on substance use by autistic adolescents, and rigorously collected data would benefit the field. Our recommendations include increased federal funding for data collection from autistic youth on substance use, additional questions on nationally representative surveys that assess autism status in multiple ways, and the use of robust measures of substance use that allow for characterization of substance use according to multiple dimensions. As the number of autistic youth identified increases and these youth transition into adulthood, better understanding of their substance use patterns is critical for developing health promotion efforts that appropriately and fully serve the needs of autistic youth.

Lay summary

Why is this topic important?: Alcohol is the most commonly used substance among adolescents, and marijuana is the most commonly used illicit drug. Previous studies suggest that at least some autistic individuals may be at increased risk of substance use disorder compared with allistic counterparts, potentially to control social anxiety or facilitate social interaction. However, to the best of our knowledge, estimates of substance use by autistic youth in the United States are limited.What is the purpose of this article?: This study was performed to highlight the lack of data sets that collect information about alcohol and/or marijuana use by autistic youth in the United States. We systematically reviewed U.S. data sources on child and/or adolescent health, disability, and/or substance use to identify sources that could generate estimates of the prevalence of substance use among autistic adolescents in the United States, even if those estimates may not be stable due to small sample sizes or other methodological weaknesses.What is the perspective of the authors?: The authors are a team of allistic researchers. M.B.-M. and S.B.-F. are pediatricians. E.F.R. and A.A. are public health researchers. S.B.-F. has an extensive background in providing clinical health care services to children with autism and is an autism researcher. R.A.N.P. and A.C.S.-R. are master's level public health research assistants. E.F.R., A.A., and M.B.-M. are adolescent health research experts. E.F.R. has an adolescent daughter on the autism spectrum. Our collective positionality is that we identify as people who are not autistic and who select to focus on research that we hope will benefit autistic people and society in general.What did the authors find?: Based on our four-step investigation, we identified 19 U.S. data sources that had the potential to generate estimates of the prevalence of alcohol and/or marijuana use in autistic youth. Only one included information about both autism and substance use.What do the authors recommend?: The National Institutes of Health (NIH), and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and National Institute of Drug Abuse (NIDA), specifically, should prioritize funding data collection from autistic youth and adults on alcohol and marijuana use, misuse, hazardous use, dependence, and use disorders. In addition, it is critical that nationally representative surveys and data sources include robust questions on autism and substance abuse. This includes assessing autism status in multiple ways (e.g., self-report, diagnosis by a clinician, neuropsychology reports). Substance use questions should include age of first drink or use, frequency of use, quantity of use per day or within a certain number of hours, expectancies, consequences of use, and indicators of alcohol use disorder.How will these recommendations help autistic individuals?: These findings highlight a critical gap in the literature on substance use among autistic youth. Substance use is recognized as a pressing adolescent health problem, and autistic youth deserve evidence-based substance use prevention strategies. Without an estimate of substance use by autistic youth, it is difficult to justify to funding entities the expenditure of resources on the development of evidence-based substance use prevention strategies to benefit them.

Marijuana and the Pediatric Population

Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.

Realist evaluation of a theory-based life skills programme aiming to prevent addictive behaviours in adolescents: the ERIEAS study protocol

INTRODUCTION

Adolescence is a sensitive life stage during which tobacco, alcohol and cannabis are used as ways to learn and adopt roles. There is a great deal of interest in substance use (SU) prevention programmes for young people that work to change representations of these products and help with mobilisation of life skills. Unfortunately, few existing programmes are evidence-based.In France, a programme called Expériences Animées (EA, Animated Experiences) has been developed, inspired by life skills development programmes that have been proven to be successful. The EA programme uses animated short movies and talks with high school and secondary school pupils about the use of psychoactive substances and addictions. By allowing life skills mobilisation and modifying representations and beliefs about SU, it is aimed at delaying initiation of use of psychoactive substances, preventing adolescents from becoming regular consumers, reducing the risks and harms related to the use of these substances and opening the way for adapted support measures.We are interested in understanding how, under what circumstances, through which mechanisms and among which adolescents the EA programme works. Therefore, we have developed the ERIEAS study ('Evaluation Réaliste de l'Intervention Expériences Animées en milieu Scolaire'; Realist Evaluation of the EA Intervention in Schools).

METHODS AND ANALYSIS

EA will be conducted in 10 schools. A multi-case approach will be adopted with the aim of developing and adjusting an intervention theory. The study comes under the theory-driven evaluation framework. The investigation methodology will include four stages: (i) elaboration of a middle-range theory; (ii) data collection for validating/adjusting the theory; (iii) data analysis; and (iv) refinement and adjustment of the middle-range theory and definition of the programme's key functions.

ETHICS AND DISSEMINATION

The study will provide evidence-based results to health authorities to help in the rollout of health promotion strategies in schools. It will provide knowledge about the strategic configurations most suitable for leading to life skills mobilisation and change young people's representations about SU. The project will be carried out with full respect of current relevant legislation (eg, the Charter of Fundamental Rights of the European Union) and international conventions (eg, Helsinki Declaration). It follows the relevant French legislation of the research category on interventional research protocol involving the human person. The protocol was approved by the Comité et Protection des Personnes (CPP), that is, Committee for the Protection of Persons CPP SUD-EST VI n°: AU 1525 and was reported to the Agence Française de Sécurité Sanitaire des Produits de Santé (ANSM) that is, the French National Agency for the Safety of Health Products. It is in conformity with reference methodology MR003 of Bordeaux University Hospital (CNIL n° 2 026 779 v0).Trial registration detailsThis research has been registered on ClinicalTrials.gov (No. NCT04110626).The research project is registered in the European database ID-RCB (No. 2019-A01003-54).

The impact of cannabis legalization in Uruguay on adolescent cannabis use

BACKGROUND

In 2013, Uruguay became the first country in the world to legalize recreational cannabis, instituting a non-commercial state regulatory model of production and supply. This study provides the first empirical evidence on its impacts on adolescent use of cannabis and related risks.

METHODS

We use a generalization of the synthetic control method (SCM) to estimate the impact of legalization in Uruguay on adolescent past year and month cannabis use, perceived availability of cannabis and perceived risk of cannabis use. We compare biennial high school student self-reported survey data from Montevideo and regions in the interior of Uruguay post-legalization (2014-2018) and post initial implementation (2015-2018) to a synthetic counterfactual constructed using a weighted combination of 15 control regions in Chile.

RESULTS

We find no evidence of an impact on cannabis use or the perceived risk of use. We find an increase in student perception of cannabis availability (58% observed vs. 51% synthetic control) following legalization.

CONCLUSION

Our findings provide some support for the thesis that Uruguay's state regulatory approach to cannabis supply may minimize the impact of legalization on adolescent cannabis use. At the same time, our study period represents a period of transition: pharmacy access, by far the most popular means of access, was not available until the summer of 2017. Additional study will be important to assess the longer-term impacts of the fully implemented legalization regime on substance use outcomes.

Neuropsychological Trajectories Associated with Adolescent Alcohol and Cannabis Use: A Prospective 14-Year Study

OBJECTIVES

Alcohol and cannabis remain the substances most widely used by adolescents. Better understanding of the dynamic relationship between trajectories of substance use in relation to neuropsychological functioning is needed. The aim of this study was to examine the different impacts of within- and between-person changes in alcohol and cannabis use on neuropsychological functioning over multiple time points.

METHODS

Hierarchical linear modeling examined the effects of alcohol and cannabis use on neuropsychological functioning over the course of 14 years in a sample of 175 adolescents (aged 12-15 years at baseline).

RESULTS

Time-specific fluctuations in alcohol use (within-person effect) predicted worse performance across time on the Wechsler Abbreviated Scale of Intelligence Block Design subtest (B = -.05, SE = .02, p = .01). Greater mean levels of percent days of cannabis use across time (between-person effect) were associated with an increased contrast score between Delis-Kaplan Executive Function System Color Word Inhibition and Color Naming conditions (B = .52, SE = .14, p < .0001) and poorer performance over time on Block Design (B = -.08, SE = .04, p = .03). Neither alcohol and/nor cannabis use over time was associated with performance in the verbal memory and processing speed domains.

CONCLUSIONS

Greater cumulative cannabis use over adolescence may be linked to poorer inhibitory control and visuospatial functioning performance, whereas more proximal increases in alcohol consumption during adolescence may drive alcohol-related performance decrements in visuospatial functioning. Results from this prospective study add to the growing body of literature on the impact of alcohol and cannabis use on cognition from adolescent to young adulthood.

Neurodevelopmental pathways in bipolar disorder

Aberrations in neurodevelopmental trajectories have been implicated in the neurobiology of several mental disorders and evidence indicates a pathophysiological and genetic overlap of schizophrenia and bipolar disorder (BD). In this narrative review, we summarize findings related to developmental and perinatal factors as well as epidemiological, clinical, neuropsychological, brain imaging, postmortem brain and genomic studies that provide evidence for a putative neurodevelopmental pathogenesis and etiology of BD. Overall, aberrations in neurodevelopmental pathways have been more consistently implicated in the pathophysiology of schizophrenia compared to BD. Nevertheless, an accumulating body of evidence indicates that dysfunctional neurodevelopmental pathways may be implicated in the underlying pathophysiology of at least a subset of individuals with BD particularly those with an early age of illness onset and those exhibiting psychotic symptoms. A heuristic neurodevelopmental model for the pathophysiology of BD based on the findings of this review is proposed. Furthermore, we critically discuss clinical and research implications of this model. Finally, further research directions for this emerging field are provided.

Binge Drinking, Cannabis Co-Consumption and Academic Achievement in First Year University Students in Spain: Academic Adjustment as a Mediator

Little is known about how binge drinking or the combination of binge drinking and cannabis consumption affect academic achievement in students during the transition to university, or about the mechanisms that mediate this relationship. The purpose of this study was to evaluate the association between this pattern of alcohol/cannabis consumption and academic achievement, considering academic adjustment as a possible mediator. A total of 258 Spanish, first-year university students (145 females and 113 males), enrolled in undergraduate degree courses, were categorized into three groups on the basis of their patterns of alcohol/cannabis consumption: control, binge drinkers and co-consumers. The findings showed a significant effect of the combined binge drinking/cannabis consumption, but not of binge drinking alone, upon academic achievement and academic adjustment. Grade point average (GPA) and academic adjustment were lower in the co-consumers than in the other groups. Regarding the mediation effect, 34.33% of the impact of combined alcohol/cannabis use on GPA was mediated by academic adjustment. The combined consumption of alcohol and cannabis led to difficulties in adaptation to academic life, which in turn contributed to poorer performance at university. The implications of the findings are discussed.

Interpersonal Consequences Predicting Adolescent Substance Use: Examining the Role of Temptation Coping, Motivation, and Impulsivity

Background: Adolescent substance use is highly prevalent and problematic; it has been reported as one of the most pertinent leading health concerns in the United States. The current longitudinal study examined the presence of peer and parental interpersonal relationship consequences (IP) as a motivating factor in activating coping skills to decrease the frequency of adolescent substance use, while further evaluating the role of impulsivity within that process. Objectives: Two main hypotheses were proposed: (1) IP will decrease substance use frequency mediated by increases in motivation and temptation coping; and (2) impulsivity will moderate the link between coping and substance use frequency. Participants included 343 adolescents between the ages of 13-19 (M = 16.23) referred to Project READY, a school-based substance use intervention. Assessments were completed during Sessions 1 and 4 of the intervention. Results: Serial mediation analyses indicated temptation coping, baseline alcohol use, and Time 2 marijuana use were the only statistically significant predictors of Time 2 alcohol use. Temptation coping and baseline marijuana use were the only statistically significant predictors of Time 2 marijuana use. Conclusions: Once adolescents' baseline and concurrent substance use were incorporated into the model, there was no statistical significance of the indirect effects. Results provided a stronger examination of the factors related to long-term substance use among adolescents. Knowing that temptation coping and baseline substance use levels were significant predictors of time 2 substance use independent of interpersonal consequences and motivation to change provides a structural frame and highlights need for early intervention.

Regulatory Policies for Alcohol, other Psychoactive Substances and Addictive Behaviours: The Role of Level of Use and Potency. A Systematic Review

The object of this contribution based on a systematic review of the literature is to examine to what degree the level of use and potency play a role in regulatory policies for alcohol, other psychoactive substances and gambling, and whether there is an evidence base for this role. Level of use is usually defined around a behavioural pattern of the user (for example, cigarettes smoked per day, or average ethanol use in grams per day), while potency is defined as a property or characteristic of the substance. For all substances examined (alcohol, tobacco, opioids, cannabis) and gambling, both dimensions were taken into consideration in the formulation of most regulatory policies. However, the associations between both dimensions and regulatory policies were not systematic, and not always based on evidence. Future improvements are suggested.

Association between cumulating substances use and cumulating several school, violence and mental health difficulties in early adolescents

Multiple substances (alcohol, tobacco, cannabis and other illicit drugs (OID)) have been frequently used in early adolescents maybe due to school, violence and mental-health difficulties. We investigated the associations between substance-use patterns and related difficulties among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, school, violence and mental-health difficulties (school grade repetition, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms and suicide attempt; cumulated number noted SVMD_score) and the time of their first occurrence during the life course. Data were analyzed using logistic and negative binomial regression models. Alcohol, tobacco, cannabis and OID use affected 35.2, 11.2, 5.6 and 2.8% of the subjects respectively. The risk of using tobacco only, alcohol and tobacco, alcohol plus tobacco and cannabis, or all alcohol, tobacco, cannabis and OID strongly increased with the SVMD_score (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMD_score. Exposure to several SVMDs may be a transmission vector towards the substance use, starting mostly with alcohol/tobacco, and then shifting to cannabis/OID. These findings help to understand substance-use risk patterns and identify at-risk adolescents.

Investigating how perceived risk and availability of marijuana relate to marijuana use among adolescents in Argentina, Chile, and Uruguay over time

AIMS

Amid changing marijuana policies in the Southern Cone, we examined relationships between marijuana-related risk factors and marijuana use among adolescents in Argentina, Chile, and Uruguay from 2001 to 2016.

METHODS

Using cross-sectional surveys from 8^th, 10^th, and 12^th graders and weighted time-varying effect models, we estimated associations between perceived risk (no/low risk versus moderate/great risk) and perceived availability (easy/very easy versus difficult/very difficult/not able to obtain) of marijuana, and any past-month marijuana use.

RESULTS

In all countries, marijuana use increased over time and adolescents who perceived no/low risk and easy availability had higher odds of use. In Argentina, the bivariate risk/use association weakened from 2001 (OR = 15.24, 95%CI = 9.63, 24.12) to 2004 [OR = 3.86 (2.72, 5.48)] and strengthened until 2011 [OR = 8.22 (7.56, 10.30)]; the availability/use association strengthened from 2005 [OR = 5.32 (4.05, 6.98)] to 2009 [OR = 20.77 (15.57, 27.70)] and weakened until 2014 [OR = 11.00 (9.11, 13.27)]. In Chile, the risk/use association weakened from 2001 [OR = 7.22 (6.57, 7.95)] to 2015 [OR = 5.58 (4.82, 6.48)]; the availability/use association weakened from 2001 [OR = 5.92 (4.96, 7.06)] to 2015 [OR = 4.10 (3.15, 5.34)]. In Uruguay, the risk/use association weakened from 2003 [OR = 34.22 (22.76, 51.46)] to 2016 [OR = 6.23 (4.96, 7.83)]; the availability/use association weakened from 2005 [OR = 29.13 (13.39, 63.39) to 2007 [OR = 9.42 (3.85, 23.07)], and strengthened until 2016 [OR = 22.68 (12.03, 42.76)].

CONCLUSIONS

Overall, the association between risk and use weakened in all countries, suggesting risk perceptions became a weaker determinant of marijuana use. Perceived availability remained strongly associated with use and may become an increasingly important driver of use (particularly in Uruguay and Argentina).