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Rivera-Aguirre A, Castillo-Carniglia A, Laqueur HS, Rudolph KE, Martins SS, Ramírez J, Queirolo R, Cerdá M. Does recreational cannabis legalization change cannabis use patterns? Evidence from secondary school students in Uruguay. Addiction 2022; 117:2866-2877. [PMID: 35491741 DOI: 10.1111/add.15913] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS In 2013, Uruguay became the first country to legalize and regulate the production and distribution of cannabis for recreational use. We measured whether Uruguay's non-commercial model of recreational cannabis legalization was associated with changes in the prevalence of risky and frequent cannabis use among secondary school students. DESIGN We used data from repeated cross-sectional surveys of secondary students in Uruguay and Chile (2007-2018). Using a difference-in-difference approach, we evaluated changes in the prevalence of past-year, past-month, any risky and frequent cannabis use following enactment (2014) and implementation (2016) of cannabis legalization among the full sample of secondary students and among students who reported past-year/month use. We examined changes separately for students ages 12 to 17, and students for whom cannabis became legally accessible, ages 18 to 21. SETTING Uruguay and Chile (2007-2018). PARTICIPANTS Secondary school students in 8th, 10th and 12th grade (n = 204 730). MEASUREMENTS Past-year and past-month cannabis use; any risky cannabis use measured with the Cannabis Abuse Screening Test (CAST); and frequent cannabis use (10+ days in the past-month). FINDINGS We found a decrease in past-year and past-month use following enactment or implementation. Among students ages 18 to 21, post-enactment, we observed a transitory increase in 2014 that decreased thereafter for: any risky use among those who reported past-year use (prevalence difference [PD] = 13.5%; 95% CI: 2.0, 24.9), frequent use in the full sample (PD = 4.5%; 95% CI: 1.0, 8.1), and frequent use among those who reported past-month use (PD = 16.8%; 95% CI: 1.9, 31.8). CONCLUSION The legalization of recreational cannabis in Uruguay was not associated with overall increases in either past-year/past-month cannabis use or with multi-year changes in any risky and frequent cannabis use among young people.
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Affiliation(s)
- Ariadne Rivera-Aguirre
- Department of Population Health, Division of Epidemiology, NYU Grossman School of Medicine, New York, USA.,Millennium Nucleus for the Evaluation and Analysis of Drug Policies, nDP, Santiago, Chile
| | - Alvaro Castillo-Carniglia
- Department of Population Health, Division of Epidemiology, NYU Grossman School of Medicine, New York, USA.,Millennium Nucleus for the Evaluation and Analysis of Drug Policies, nDP, Santiago, Chile.,Society and Health Research Center and School of Public Health, Universidad Mayor, Santiago, Chile
| | - Hannah S Laqueur
- Violence Prevention Research Program, Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, USA
| | - Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Silva S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Jessica Ramírez
- National Drug Observatory of Uruguay, National Drug Board, Montevideo, Uruguay
| | - Rosario Queirolo
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies, nDP, Santiago, Chile.,Department of Social Sciences, Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Magdalena Cerdá
- Department of Population Health, Division of Epidemiology, NYU Grossman School of Medicine, New York, USA
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Schleimer JP, Smith N, Zaninovic V, Keyes KM, Castillo-Carniglia A, Rivera-Aguirre A, Cerdá M. Trends in the sequence of initiation of alcohol, tobacco, and marijuana use among adolescents in Argentina and Chile from 2001 to 2017. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103494. [PMID: 34666217 DOI: 10.1016/j.drugpo.2021.103494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/08/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Variation in drug policies, norms, and substance use over time and across countries may affect the normative sequences of adolescent substance use initiation. We estimated relative and absolute time-varying associations between prior alcohol and tobacco use and adolescent marijuana initiation in Argentina and Chile. Relative measures quantify the magnitude of the associations, whereas absolute measures quantify excess risk. METHODS We analyzed repeated, cross-sectional survey data from the National Surveys on Drug Use Among Secondary School Students in Argentina (2001-2014) and Chile (2001-2017). Participants included 8th, 10th, and 12th grade students (N = 680,156). Linear regression models described trends over time in the average age of first use of alcohol, tobacco, and marijuana. Logistic regression models were used to estimate time-varying risk ratios and risk differences of the associations between prior alcohol and tobacco use and current-year marijuana initiation. RESULTS Average age of marijuana initiation increased and then decreased in Argentina and declined in Chile. In both countries, the relative associations between prior tobacco use and marijuana initiation weakened amid declining rates of tobacco use; e.g., in Argentina, the risk ratio was 19.9 (95% CI: 9.0-30.8) in 2001 and 11.6 (95% CI: 9.0-13.2) in 2014. The relative association between prior alcohol use and marijuana initiation weakened Chile, but not in Argentina. On the contrary, risk differences (RD) increased substantially across both relationships and countries, e.g., in Argentina, the RD for tobacco was 3% (95% CI: 0.02-0.03) in 2001 and 12% (95% CI: 0.11-0.13) in 2014. CONCLUSION Diverging trends in risk ratios and risk differences highlight the utility of examining multiple measures of association. Variation in the strength of the associations over time and place suggests the influence of environmental factors. Increasing risk differences indicate alcohol and tobacco use may be important targets for interventions to reduce adolescent marijuana use.
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Affiliation(s)
- Julia P Schleimer
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis School of Medicine, 2315 Stockton Blvd., Sacramento, CA 95817, USA.
| | - Nathan Smith
- Department of Psychology, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - ViniNatalie Zaninovic
- Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032, New York, NY, USA
| | - Alvaro Castillo-Carniglia
- Society and Health Research Center, Universidad Mayor, Badajoz 130, Las Condes, Santiago, Chile; School of Public Health, Universidad Mayor, Jose Toribio Medina #38, Santiago, Chile; Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Ariadne Rivera-Aguirre
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA
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Lobato Concha ME, Sanderman R, Pizarro E, Hagedoorn M. Parental protective and risk factors regarding cannabis use in adolescence: A national sample from the Chilean school population. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:642-650. [PMID: 32865053 DOI: 10.1080/00952990.2020.1775238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Research has increased our understanding of the parental factors associated with the initiation and development of cannabis use disorder in adolescents, but few studies about this have been performed in middle- or low-income countries. Objective: First, to examine whether perceived past parental drug use, parental monitoring, and attitude toward adolescent cannabis use are associated with general and problematic cannabis use in Chilean adolescents. Second, to explore whether perceived past parental drug use weakens the associations of protective factors with general and problematic adolescent cannabis use. Methods: Regression analyses were performed on cross-sectional data from a multistage probabilistic sample stratified by clusters (municipalities, school and grade) of 43,060 students (47% male, mean age 15.5 years) from grades 8 to 12, which was collected from the Chilean National School Survey on Drug Use (2013). Results: Perceived past parental drug use increased the likelihood of adolescent cannabis use in general, but not its problematic use. Parental monitoring of adolescents' whereabouts and parental opposition to adolescent cannabis use decreased the likelihood of adolescent cannabis use in general, as well as problematic use. Perceived past parental drug use only interacted with parental monitoring of school activities. Conclusions: In line with research from the United States, the Netherlands and Spain, parental monitoring of adolescents' whereabouts and a strong parental opposition to cannabis use appear to be protective factors, irrespective of past parental use. However, the effectiveness of monitoring adolescents' school activities seems to decrease when parents are perceived as having used drugs in the past.
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Affiliation(s)
| | - Robbert Sanderman
- Health Psychology, University Medical Center, University of Groningen , Groningen, Netherlands.,Health Psychology, Health & Technology, University of Twente , Enschede, Netherlands
| | - Esteban Pizarro
- Research Department, National Service for Prevention and Rehabilitation of Drug and Alcohol Use (SENDA) , Santiago, Chile
| | - Mariët Hagedoorn
- Health Psychology, University Medical Center, University of Groningen , Groningen, Netherlands
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Perlmutter AS, Rivera-Aguirre AE, Mauro PM, Castillo-Carniglia A, Rodriguez N, Cadenas N, Cerdá M, Martins SS. Sex differences in nonmedical prescription tranquilizer and stimulant use trends among secondary school students in Argentina, Chile, and Uruguay. Drug Alcohol Depend 2019; 205:107607. [PMID: 31606591 PMCID: PMC6943976 DOI: 10.1016/j.drugalcdep.2019.107607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about recent nonmedical prescription tranquilizer and stimulant use trends in Latin America. We tested whether recent trends among students in three South American countries differed by sex over time. METHODS Three countries independently collected National School Students Survey on Drugs. Students in 8th, 10th, and 12th grades were sampled in Argentina (2007-2014, N = 328,202), Chile (2007-2015, N = 136,379), and Uruguay (2007-2016, N = 32,371). Weighted linear regression models predicted the prevalences and trends over time of past-year nonmedical tranquilizer and stimulant use by country, and tested whether trends differed by sex, adjusting for school type and grade. RESULTS In Argentina from 2007 to 2014, past-year nonmedical prescription tranquilizer (girls: 2.8 to 2.6%, boys: 2.5 to 2.3%) and stimulant (girls: 1.7 to 1.3%, boys: 1.9 to 1.5%) use trends did not differ by sex. In Chile from 2007 to 2015, nonmedical prescription tranquilizer use trends significantly differed comparing girls (3.9 to 10%) with boys (3.2 to 6.9%); stimulant use trends did not differ comparing girls (1.6 to 2.0%) with boys (2.0 to 1.3%). In Uruguay from 2007 to 2014 and 2014-2016, past-year nonmedical prescription tranquilizer (girls: 5.1 to 6.6%; boys: 2.8 to 4.2%) and stimulant (girls: 1.8 to 0.7%; boys: 1.8 to 0.7%) use trends did not differ by sex. CONCLUSIONS Trends of nonmedical prescription tranquilizer use recently increased in Chile and Uruguay, widening by sex over time in Chile only. The drivers of increasing tranquilizer use among girls in Chile and Uruguay merit further investigation.
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Affiliation(s)
- Alexander S Perlmutter
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA; Université Paris Descartes UMR1153, Hôpital Hôtel-Dieu, 1 Place du Parvis Notre-Dame, Paris, 75004, France.
| | - Ariadne E Rivera-Aguirre
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA; Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Pia M Mauro
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Alvaro Castillo-Carniglia
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA; Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Badajoz 30, Santiago, Chile
| | - Nicolás Rodriguez
- Research Department, National Service for Prevention and Rehabilitation of Drug and Alcohol Use (SENDA), Agustinas 1235, 9th floor, Santiago, Chile
| | - Nora Cadenas
- Dirección de Epidemiologia, Observatorio Argentino de Drogas, Calle Sarmiento 546, Ciudad Autónoma de Buenos Aires, C1041AAL, Argentina
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA; Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
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