What Does Adolescent Substance Use Look Like During the COVID-19 Pandemic? Examining Changes in Frequency, Social Contexts, and Pandemic-Related Predictors

Impact of the COVID-19 Pandemic on Youth Substance Use and Substance-Related Risk Factors and Outcomes: Implications for Prevention, Treatment, and Policy

Youth substance use and substance use disorders (SUD) are major public health issues associated with significant societal cost. The coronavirus SARS-CoV-2 (COVID-19) pandemic and pandemic-related lockdowns, school closures, and social distancing dramatically impacted the daily lives of young people worldwide, resulting in major disruptions to normal developmental trajectories and complex (and at times opposing effects) on different SUD risk and protective factors, which contributed to inconsistent outcomes. During the COVID-19 pandemic, substance use prevalence rates decreased in the general population of US youth, but increased for certain vulnerable subgroups. Additionally, overdose deaths related to fentanyl rose significantly among US youth.

Investigating Substance Use as a Coping Strategy Among Adolescent Psychiatric Inpatients: A Comparative Analysis Before and During the COVID-19 Pandemic

The COVID-19 pandemic resulted in significant changes in daily life, potentially impacting mental health and substance use behavior. Research on COVID-related changes in adolescent substance use have yielded mixed findings. The current cross-sectional chart review study compared rates of past-year substance use before and during COVID-19 among adolescent psychiatric inpatients, and investigated how motives for coping with COVID-19 changes were related to psychiatric acuity, and past-year substance use. Count models assessed if the number of past-year days of alcohol and cannabis use was higher among adolescents (n = 491, 11-18 years, 61% female) hospitalized during COVID-19 (3/14/20 to 4/5/21) versus adolescents hospitalized before COVID-19 (8/30/2019 to 3/13/20). For a subsample of COVID-19 inpatients (n = 124; 75% female), we evaluated psychiatric correlates of endorsing substances to cope with COVID-19 changes/rules. Results indicated adolescents admitted during COVID-19 reported significantly more past-year alcohol and cannabis use days than adolescents admitted before COVID-19. Adolescents endorsed using alcohol (19%), cannabis (33%), and e-cigarettes/vaping (25%) to cope with COVID-19. E-cigarette/vaping to cope with COVID-19 was significantly related to lifetime suicide attempt. Endorsing alcohol or cannabis to cope with COVID-19 was associated with a significantly greater number of past-year use days for each respective substance. Adolescent psychiatric inpatients admitted during COVID-19 reported more substance use days than adolescents admitted before COVID-19. Using substances to cope was linked to psychiatric correlates (e.g., suicidality). Assessing the presence and function of substance use in this population may be important to identify, treat, and prevent compounding negative outcomes during times of community stress.

Drinking among college student athletes during the COVID-19 pandemic

Objective: To investigate demographics, sport type, athletic identity, and COVID-19 sport season cancelation in relation to alcohol consumption among college student athletes shortly after the pandemic emerged. Participants: College student athletes recruited from U.S. athletic departments. Methods: Survey data were collected from 5,915 college student athletes in April/May 2020. Results: Being female, Latinx, and in a relationship were associated with lower alcohol consumption. Among males, team sport participation was related to greater alcohol consumption. Among females, athletic identity was inversely related to drinking, which was moderated by sport type, such that alcohol consumption was lower as athletic identity strengthened in individual (vs. team) sport athletes. However, we did not find a relationship of COVID-19 sport season cancelation with drinking. Conclusions: Our gender-specific findings are novel and generalizable based on a large, national sample of college student athletes, and may inform strategies for alcohol consumption education among college team sport athletes.

Victims of drug facilitated sexual assault aged 13-24: a cross sectional study on the pool of users of a sexual violence relief centre in Northern Italy

This cross-sectional study aimed to assess the association between drugs and alcohol intake and sexual abuse in adolescents, otherwise defined as Drug Facilitated Sexual Assault (DFSA). We considered the survivors who accessed care at the Centre "Soccorso Violenza Sessuale" (SVS - Sexual Violence Relief Centre) in Turin (Italy), between May 2003 and May 2022. We found that 973 patients aged 13-24 among which 228 were victims of DFSA. Epidemiological and anamnestic aspects of the episode of sexual violence were examined, with a specific focus on investigating the alcohol and/or drug intake as reported by the victim, along with the results of the toxicological analysis. the study further accounts for the variations caused by the COVID-19 pandemic on DFSA-related accesses. Our findings show that 23% of adolescents accessing care at SVS were subjected to DFSA. Six out ten adolescents knew their aggressor, at times a partner (10%) oran acquaintance (43%). In 12% of cases violence was perpetrated by a group of people (12%). Almost 90% of young victims described alcohol consumption, while 37% reported drug use at the time of the assault. Alcohol taken alone or in combination with other substances was the most detected drug in our sample throughout the period considered. Given the large use of psychoactive substances among adolescents, it is imperative to implement harm reduction strategies alongside educational activities aimed at fostering awareness about consent. Health personnel should be trained to manage the needs of victims of DFSA clinically and forensically.

Sexual Orientation and Gender Identity Reporting in Highly Cited Current Alcohol Research

Purpose: This study aimed to measure the frequency of high-quality and transparent sexual orientation and gender identity (SOGI) data collection and reporting in highly cited current alcohol use research, using the extant literature to identify community-informed priorities for the measurement of these variables. Methods: A single search to identify alcohol use literature was conducted on PubMed with results restricted to primary research articles published between 2015 and 2022. The 200 most highly cited studies from each year were identified and their titles and abstracts reviewed against inclusion criteria after deduplication. After full-text review, study characteristics and data indicating quality of SOGI reporting were extracted. The fidelity of the results was verified with a random sample before analyses. Results: The final sample comprised 580 records. Few studies reported gender identity (n = 194; 33.4%) and, of these, 7.2% reported the associated gender identity measure. A two-stage approach to measure gender was adopted in 3 studies, one study used an open-ended question with a free-text response option, and 13 studies recorded nonbinary gender identities (reported by 0.9% of the whole sample). Nineteen (3.3%) studies reported sexual orientation and more than half of these provided the sexual orientation measure. Eight of the 20 studies that reported sexual orientation and/or gender identity measures were classified as sexual and gender minority specialist research. Conclusions: Culturally competent SOGI reporting is lacking in highly cited current alcohol research. SOGI measures should be disclosed in future research and should provide free-text response options.

Understanding youth and young adult cannabis use in Canada post-legalization: a scoping review on a public health issue

BACKGROUND

Canada legalized recreational cannabis in 2018, and one of the primary objectives of the Cannabis Act was to protect youth by reducing their access to cannabis and providing public education. Canada has the highest prevalence of cannabis use worldwide, particularly among youth and young adults under the age of 25. Cannabis use is linked with many adverse effects for youth and young adults including psychosis, anxiety, depression, respiratory distress, cannabinoid hyperemesis syndrome, and impaired cognitive performance. Despite the high prevalence of cannabis use and the evolution of policies in Canada and globally, significant knowledge and research gaps remain regarding youth and young adult cannabis use. The aim of this scoping review is to map the extent, nature, and range of evidence available on youth and young adult cannabis use in Canada since its legalization, in order to strengthen policies, services, treatments, training, and public education strategies.

METHODS

Using a scoping review framework developed by Arksey and O'Malley, along with the PRISMA-ScR guidelines, we conducted a rigorous search in five academic databases: MEDLINE, Embase, APA PsycINFO, CINAHL and Web of Science Core Collection. We included empirical studies that collected data in Canada after the legalization of recreational cannabis (October 2018) and focused on youth or young adults < 30. Two reviewers independently screened articles in two stages and extracted relevant information from articles meeting the inclusion criteria.

RESULTS

Of the 47 articles meeting our inclusion criteria, 92% used quantitative methods, 6% were qualitative, and 2% used a mixed-methods approach. Over two-thirds (68%) used secondary data. These studies were categorized into six focus areas: (1) prevalence, patterns, and trends, (2) cannabis-related injuries and emergency department (ED) visits, (3) rates and patterns during the pandemic, (4) perceptions of cannabis use, (5) prevention tools, and (6) cannabis-related offenses. Key findings from the studies reviewed include an increase in cannabis use among 18-24-year-olds post-legalization, with mixed results for youth under 18. ED visits for intentional and unintentional cannabis-related injuries have increased in young children and teens. Perception studies show a mix of concern and normalization of cannabis use. Though limited, prevention studies are promising in raising awareness. A decline in cannabis-related offenses was noted by one study. The review highlights several research gaps, including the need for more qualitative data, disaggregation of demographic data, intervention research, and comprehensive studies on the physical and mental health impacts of cannabis use among youth and young adults.

CONCLUSION

Maintaining a public health approach is critical, with a focus on reducing the high prevalence of cannabis use among youth and young adults. This involves implementing prevention strategies to minimize harms, enhancing public education, minimizing commercialization, reducing youth access to cannabis, promoting guidelines for lower-risk cannabis use and harm reduction strategies, and increasing training for healthcare providers.

Advancing equitable access to digital mental health in the Asia-Pacific region in the context of the COVID-19 pandemic and beyond: A modified Delphi consensus study

The COVID-19 pandemic had an unprecedented impact on global mental health and well-being, including across the Asia-Pacific. Efforts to mitigate virus spread led to far-reaching disruption in the delivery of health and social services. In response, there was a rapid shift to the use of digital mental health (DMH) approaches. Though these technologies helped to improve access to care for many, there was also substantial risk of access barriers leading to increased inequities in access to mental health care, particularly among at-risk and equity-deserving populations. The objective of this study was to conduct a needs assessment and identify priorities related to equitable DMH access among at-risk and equity-deserving populations in the Asia Pacific region during the first year of the COVID-19 pandemic. The study consisted of a modified Delphi consensus methodology including two rounds of online surveys and online consultations with stakeholders from across the region. Study participants included policy makers, clinicians and service providers, and people with lived experience of mental health conditions. Results demonstrate that vulnerabilities to negative mental health impacts and access barriers were compounded during the pandemic. Access barriers included a lack of linguistically and culturally appropriate DMH options, low mental health literacy and poor access to technological infrastructure and devices, low levels of awareness and trust of DMH options, and lack of policies and guidelines to support effective and equitable delivery of DMH. Recommendations to improve equitable access include ensuring that diverse people with lived experience are engaged in research, co-design and policy development, the development and implementation of evidence-based and equity-informed guidelines and frameworks, clear communication about DMH evidence and availability, and the integration of DMH into broader health systems. Study results can inform the development and implementation of equitable DMH as its use becomes more widespread across health systems.

Engagement, Mental Health, and Substance Use Under In-Person or Remote School Instruction During the COVID-19 Pandemic

BACKGROUND

Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID-19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health-related outcomes within an adolescent cohort followed during the pandemic.

METHODS

During 3 semi-annual follow-up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self-efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting.

RESULTS

Relative to in-person instruction, students in remote instruction reported lower academic self-efficacy (Beta: -0.11; 95% confidence interval [CI]: -0.22, -0.01) and school connectedness (Beta: -0.37; 95% CI: -0.48, -0.25), greater odds of past 30-day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30-day e-cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86).

CONCLUSIONS

Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources.

Risk and protective factors for substance use and media addictive behaviors in adolescents during the COVID-19 pandemic

OBJECTIVE

This study examined the long-term effects of the COVID-19 pandemic on adolescents' substance use, digital media use, and symptoms of internet, gaming, and social media addiction.

METHOD

A nationally representative longitudinal cohort of 1665 Israeli teens and preteens, aged 9-16, completed questionnaires assessing substance use prevalence, daily screen time, symptoms of media addiction, and potential risk and protective factors. Data were collected before the pandemic (October 2019), after the second wave lockdown (November 2020), and after the fifth wave (April 2022) in Israel.

RESULTS

The analysis documented significant increases in substance use, daily screen time, and social media addiction indices over time. Gratitude, life satisfaction, positive emotions, future orientation, grit, and secure attachment emerged as significant protective factors. Sensation-seeking, negative emotions, and mental health symptoms were identified as risk factors.

CONCLUSIONS

These findings highlight the importance of educational and public mental health services in addressing the pandemic's long-term impact on the mental health and addictive behaviors of adolescents. They also emphasize the significance of enhancing protective factors and reducing risk factors to effectively mitigate substance and digital media abuse among adolescents.

Cannabis use among adolescents and young adults during the COVID-19 pandemic: A systematic review

Background

A systematic review of the literature was performed to summarize cannabis use among adolescents and young adults during the COVID-19 pandemic. Special focus was given to the prevalence of cannabis use during COVID-19, as well as factors that may explain changes in cannabis consumption patterns.

Methods

The protocol of this systematic review was registered. Articles from seven publication databases were searched in January 2022. The inclusion criteria for studies were as follows: 1) published in English; 2) study instruments needed to include items on COVID-19; 3) conducted after January 1st, 2020; 4) published in a peer-reviewed journal, dissertation, or thesis; 5) study population ≤25 years of age; 6) study designs were limited to observational analytical studies; 7) measured cannabis use. This review excluded other reviews, editorials, and conference abstracts that were not available as full text manuscripts. Independent review, risk of bias assessment, and data abstraction were performed by two authors.

Results

Fifteen articles from the United States (n=11) and Canada (n=4) were included in this review. The findings of this review showed that the prevalence of cannabis use during the pandemic among adolescents and young adults were mixed. Some mental health symptoms, including depression and anxiety, were identified as the most commonly reported reasons for increased cannabis use during the pandemic.

Conclusions

This review highlights the inconsistencies in the prevalence of cannabis use among adolescents and young adults during the pandemic. Therapeutic interventions for mental health and continued public health surveillance should be conducted to understand the long-term effects of cannabis use among adolescents and young adults.

"An escape from the isolation": Youth thoughts about the impact of COVID-19 on adolescent sexual behavior and alcohol use

INTRODUCTION

The COVID-19 pandemic likely affected adolescent sexual behaviors and alcohol use, although how is not well understood.

METHOD

Youth were sampled from the national, online longitudinal Growing up with Media study. They responded via text messaging to open-ended questions about how the COVID-19 pandemic may have impacted the sexual behavior and alcohol use of adolescents. Conventional content analysis summarized open-ended responses.

RESULTS

416 responses were analyzed from 335 participants (aged 15-30, US residents), 81 of whom provided data for both topics. Participants suggested that the pandemic affected some youths' sexual health precautions (increased and varying) and attitudes about sex (positive and negative). They discussed how adolescents met partners during the pandemic, including increased use of online platforms. Participants also suggested researchers investigate sexual risk in the realm of COVID-19 transmission and the practice of "safe sex." Many participants believed adolescents were drinking alcohol more as a result of the pandemic, both alone and with friends; however, others perceived adolescents were drinking less. Participants proposed researchers investigate adolescent drinking habits during the pandemic, as well as how this compares to before the pandemic and the type and quantity of alcohol consumed.

CONCLUSIONS

Young people believe adolescent sexual relationships and drinking behaviors changed due to the pandemic, though how varied. Future research could examine the contexts and individual differences that shape these varying behaviors. Overall, this study highlights the importance of directly asking youth about their pandemic experiences and the diversity of views on how the pandemic has influenced adolescent behavior.

Changes associated with the COVID-19 pandemic on postpartum screening results in Ontario, Canada: The healthy babies healthy children screening tool

BACKGROUND

Research on the impact of the COVID-19 pandemic on mothers/childbearing parents has mainly been cross-sectional and focused on psychological symptoms. This study examined the impact on function using ongoing, systematic screening of a representative Ontario sample.

METHODS

An interrupted time series analysis of repeated cross-sectional data from a province-wide screening program using the Healthy Babies Healthy Children (HBHC) tool assessed changes associated with the pandemic at the time of postpartum discharge from hospital. Postal codes were used to link to neighborhood-level data. The ability to parent or care for the baby/child and other psychosocial and behavioral outcomes were assessed.

RESULTS

The co-primary outcomes of inability to parent or care for the baby/child were infrequently observed in the pre-pandemic (March 9, 2019-March 15, 2020) and initial pandemic periods (March 16, 2020-March 23, 2021) (parent 209/63,006 (0.33%)-177/56,117 (0.32%), care 537/62,955 (0.85%)-324/56,086 (0.58%)). Changes after pandemic onset were not observed for either outcome although a significant (p = 0.02) increase in slope was observed for inability to parent (with questionable clinical significance). For secondary outcomes, worsening was only seen for reported complications during labor/delivery. Significant improvements were observed in the likelihood of being unable to identify a support person to assist with care, need of newcomer support, and concerns about money over time.

CONCLUSIONS

There were no substantive changes in concerns about ability to parent or care for children. Adverse impacts of the pandemic may have been mitigated by accommodations for remote work and social safety net policies.

Trends in the nonmedical misuse of benzodiazepines and Z-hypnotics among school-aged adolescents (2016-2021): gender differences and related factors

BACKGROUND

The misuse of psychotropic medication has increased during the past decade, especially among adolescents. The aim of our study was to describe the prevalence and patterns of the nonmedical use of benzodiazepines (BDZ) and Z-hypnotics among school-aged adolescents through the lens of sex. In addition, we sought to analyze the temporal evolution of the nonmedical use of these drugs during the period 2016-2021.

METHODS

The temporal evolution of the nonmedical use of these drugs was analyzed based on survey data collected in 2016, 2018 and 2021, which includes the first years of the COVID-19 pandemic. To assess the possible effect of the COVID-19 pandemic, the year at survey was conducted was introduced as a categorical variable. We used data from the Spanish State Survey on Drug Use in Secondary Education, which covers drug use among students aged 14-18 years. Using multivariate logistic regression models, we estimated the independent effect of different variables (sociodemographic data, use of other psychoactive substances, risk perception and availability) on the nonmedical use of BDZ and Z-hypnotics.

RESULTS

In total, survey data from 95,700 adolescents were included in our analysis. The nonmedical use of BDZ and Z-hypnotics increased among adolescents during the study period. The adjusted odds ratio (AOR) from 2016 to 2018 was 1.11 (95% CI 0.94-1.31) and from 2018 to 2021 the AOR was 1.26 (95% CI 1.08-1.46), using 2016 and 2018, respectively, as reference years. The nonmedical use of BDZ and Z-hypnotics was more likely in adolescent girls than boys (AOR = 2.11). The nonmedical use of prescription opioids (AOR = 3.44), novel psychoactive substances and other illicit psychoactive drugs (AOR = 4.10) were risk factors for the nonmedical use of BDZ and Z-hypnotics in both sexes. Use of cannabis (AOR = 1.38) was a predictor of nonmedical use in female adolescents only.

CONCLUSIONS

This study shows that the trend of the nonmedical use of BDZ and Z-hypnotics among school-aged adolescents in Spain increased between 2016 and 2021. Among adolescents aged 14 to 18, the probability of nonmedical use of these psychoactive substances was twice as high for female adolescents as for male adolescents.

Factors Associated With the Changes in Smoking and Electronic cigarette use in Adolescents During the COVID-19 Pandemic: A Longitudinal Analysis

PURPOSE

Explore the factors associated with the changes in smoking and electronic cigarette (e-cigarette) use and susceptibility among adolescents during the COVID-19 pandemic.

METHODS

We surveyed a cohort of students (7th-12th grade) from private schools in Guatemala. Baseline (May-September 2019) was conducted in-person and follow-up (June-November 2020) online during the lockdown. Separate Generalized Estimating Equations logistic models regressed current smoking (n = 3,729), current e-cigarette use (n = 3,729), smoking susceptibility among never-smokers (n = 2,596), and susceptibility to e-cigarette use among never-users (n = 1,597) on online ad exposure, visiting stores, social network smoking/e-cigarette use, substance use (alcohol, marihuana, and cigarette or e-cigarette), perceived harm of using cigarettes/e-cigarettes, sociodemographic characteristics, and survey wave. Interactions were assessed between time and ad exposures, friends smoking and e-cigarette use.

RESULTS

Frequency of store visits, exposure to online ads, and the use of cigarette and e-cigarette lowered at follow-up. Online e-cigarette ads, having family and friends who smoke, and current e-cigarette use increased the likelihood of being a current smoker. Frequent exposure to online e-cigarette ads, having family who use e-cigarettes, and being a current smoker were associated with higher likelihood of current e-cigarette use. Exposure to either online ads or having friends that smoke or use e-cigarettes, increased susceptibility to using either product. Interaction results showed that high exposure to online e-cigarette ads overtime increased the susceptibility to use e-cigarettes.

DISCUSSION

Exposure to online ads and friends and family cigarette and e-cigarette use increased adolescent consumption and susceptibility during the pandemic.

The longitudinal impact of the COVID-19 pandemic on adolescents' internalizing symptoms, substance use, and digital media use

The present study examined the long-term effects of the COVID-19 pandemic on adolescent internalizing symptoms, substance use, and digital media use before and during the pandemic. A nationally representative longitudinal cohort of 3718 Israeli adolescents aged 12-16 at baseline completed measures of internalizing symptoms (anxiety, depression, and somatization), the prevalence of substance use (i.e., previous 30-day use of tobacco, alcohol, and cannabis), and average daily use of internet/television, video games, and social media. Social support and daily routines were assessed as potential protective factors for mental health. Data were collected in 10 public schools at four measurement points: before the Covid-19 outbreak (September 2019), after the first wave lockdown (May 2020), after the third wave lockdown (May 2021), and after the fifth wave of the pandemic (May 2022). Multi-level mixed models were used to analyze the longitudinal data. The results showed significant increases in internalizing symptoms, substance use (tobacco, alcohol, and cannabis), and daily screen time from the start of the study to the 33-month follow-up. Social support and daily routines moderated the increases in internalizing symptoms and digital media use. These findings highlight the need for public and educational mental health services to address the continuing impact of the pandemic on adolescents.

Risk factors associated with driving after marijuana use among West Virginia college students during the COVID-19 pandemic

OBJECTIVES

The purpose of this study was to assess sociodemographic and behavioral risk factors associated with driving after marijuana use (DAMU) among West Virginia college students.

METHODS

Participants were recruited from West Virginia University between September and November 2022. The study sample was restricted to students who were ≥18 years of age; reported recently driving; possessed a current, valid driver's license from any US state; and were enrolled for at least one credit hour in the Fall 2022 semester.

RESULTS

Among respondents (N = 772), 28.9% reported DAMU. Students who had a GPA of B (adjusted odds ratio [AOR]: 2.17, 95% confidence interval [CI]: 1.06-4.42), smoked or ingested marijuana in the past year (AOR: 26.51, 95% CI: 10.27-68.39), drove after drinking (AOR: 2.38, 95% CI: 1.18-4.79), and used both marijuana and alcohol concurrently and then drove (AOR: 10.39, 95% CI: 2.32-46.54) associated with DAMU. Individuals who felt the behavior was somewhat dangerous or not dangerous or thought their peers approved of DAMU showed significant associations with DAMU.

CONCLUSIONS

As DAMU was prevalent, future interventions that raise awareness of the danger and potential consequences of DAMU may be needed to reduce this risky behavior on college campuses.

Substance use and adolescent mental health during the COVID-19 pandemic in Brazil: a longitudinal approach

OBJECTIVE

To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology.

METHODS

A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conducted in 73 public middle schools in three Brazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; Mage = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention).

RESULTS

The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems.

CONCLUSIONS

Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations.

An Examination of Bidirectional Associations Between Alcohol Use and Internalizing Symptoms Among Adolescents During the COVID-19 Pandemic

PURPOSE

This study explores the bidirectional association between internalizing symptoms and alcohol use over three years of the COVID-19 pandemic to examine whether alcohol consumption is associated with higher internalizing symptoms in the next year and vice versa.

METHODS

We used linked data from a sample of 2,136 secondary school students who participated in three consecutive waves (2019-2020 [T1], 2020-2021 [T2], and 2021-2022 [T3]) of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour study during the pandemic. A random-intercept cross-lagged panel model was used to characterize reciprocal linear relations between internalizing symptoms and alcohol use.

RESULTS

The findings suggest that students who reported higher levels of alcohol use at T1 experienced increased levels of depression and anxiety in the subsequent year (T2). However, this association was not observed from T2 to T3. Throughout the three-year period, depression and anxiety were not associated with later alcohol use. In males, alcohol use at T1 was a predictor of higher internalizing symptoms at T2 but not from T2 to T3.

DISCUSSION

These results suggest time-sensitive impacts and notable gender differences in the relationship between internalizing symptoms and alcohol use over the pandemic. Given the complexity of impacts, ongoing evaluation of the impact of the pandemic on youth health behaviours is necessary to elucidate these unfolding relationships, especially as the pandemic continues to affect various psychosocial risk factors.

Solitary Cannabis Use and Related Consequences Among College Students During the COVID-19 Pandemic

Solitary cannabis use has been associated with greater cannabis problems than social use and may be increasingly prevalent due to pandemic-related isolation. However, little is known about patterns, correlates, and consequences of solitary cannabis use. This study sought to characterize solitary cannabis use since pandemic onset, examine psychosocial risk factors, and examine interactions between solitary and social cannabis use frequency on cannabis consequences. College students (N = 168) who were lifetime cannabis users at a private, northeastern university in the US completed an online cross-sectional survey in fall of 2020. Past-year solitary cannabis use was common among life-time cannabis users (42% past year, 29% monthly or more), especially among past-year regular cannabis users (85% monthly or more). Solitary use frequency was associated with interpersonal sensitivity and pandemic-related stress. Further, solitary use attenuated associations of social use frequency with cannabis consequences, such that social use frequency was associated with greater consequences only among exclusively social users. In contrast, regardless of social use frequency, solitary users reported greater cannabis consequences than exclusively social users. Findings suggest solitary cannabis use is concurrently associated with greater cannabis consequences, and affective risk factors (interpersonal sensitivity, pandemic stress) should be considered for prevention and intervention strategies.

Tracking Changes in the Endorsement of Injunctive Drinking Norms in Response to the COVID-19 Pandemic Using Longitudinal Alignment Analysis

The onset of the pandemic saw shifts in messaging around the acceptability of alcohol consumption at different times and contexts. A psychometric analysis of responses to injunctive norms may reveal important differences in specific aspects of norms that were influenced by the pandemic. Study 1 used alignment analysis to evaluate measurement invariance in low- and high-risk injunctive norms across samples of Midwestern college students from 2019 to 2021. Study 2 used an alignment-within-confirmatory factor analysis (CFA) approach to replicate the solution from Study 1 in an independent longitudinal sample (N = 1,148) who responded between 2019 and 2021. For Study 1, the latent mean for high-risk norms was significantly higher in 2021, and the endorsement of four specific norms also differed. In Study 2, increases in latent means for low- and high-risk norms were observed across 2020 and 2021, and differential endorsement emerged for one high-risk norm item. Examining scale-level changes in injunctive drinking norms provides insight into how college students' perceptions changed in response to the COVID-19 pandemic.

Doomscrolling: Prospective associations between daily COVID news exposure, internalizing symptoms, and substance use among sexual and gender minority individuals assigned female at birth

Cross-sectional studies have demonstrated associations between COVID news exposure, anxiety, and depression. However, longitudinal research examining the directionality of these associations is extremely limited. Further, most studies have focused on the general population and neglected sexual and gender minority individuals (SGM), a population disproportionately impacted by the pandemic. To address these limitations, the current study utilized data from a 30-day diary study of SGM assigned female at birth (N = 429). We examined concurrent and prospective associations between COVID news exposure, depressed and anxious affect, COVID distress, substance use, and motives for use. Further, we examined associations between cumulative COVID news exposure across the diary period and prospective changes in anxiety, depression, and COVID distress. When participants were exposed to more COVID news, they experienced more depressed and anxious affect, more COVID distress, less positive affect, and were more likely to use alcohol and cannabis to cope. Further, when participants were exposed to more COVID news, they experienced subsequent increases in depressed affect, decreases in positive affect, and increases in the likelihood of using cannabis to cope. Findings also provided evidence of bi-directional prospective associations between COVID news exposure and COVID distress and of a cumulative impact of COVID news exposure on anxiety, depression, and COVID distress. Findings suggest that individuals should balance the need to remain informed about the pandemic and their own mental health when considering how much COVID news to consume.

Changes in substance use among adolescents before and during the COVID-19 pandemic in Guatemala

Objectives

Due to the COVID-19 pandemic, on March 16th, schools had to be closed in Guatemala and went to online teaching. We sought to analyze the change in substance use among high school students in Guatemala associated with the lockdown.

Methods

Data from two surveys (2019, n=2096, and 2020, n=1606) of a student cohort in private high schools in Guatemala City was used. Logistic models for past 30-day cigarette, e-cigarette, marijuana, and alcohol (including binge drinking) were used, regressing these on survey wave, while adjusting for sex, scholastic performance, high school year of student, parental education, substance use, and household member tobacco use.

Results

Prevalence declined for smoking (10% to 3%, p<0.001), e-cigarette (31% to 14%, p<0.001), marijuana (4.3% to 1.9%, p<0.001), and alcohol use (47% to 38.5%, p<0.001), and binge drinking (24% to 13%, p<0.001). Adjusted models showed wave 2 associated with lower odds of using cigarettes (AOR=0.44, 95%CI=0.32-0.62), e-cigarettes (AOR=0.41, 95% CI=0.35-0.49, p<0.001), and binge drinking (AOR=0.73, 95%CI=0.59-0.89; p=0.002).

Conclusion

Among Guatemalan adolescents, COVID-19 restrictions were associated with a significant decrease in smoking, e-cigarette use, and binge drinking.

Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use

BACKGROUND

Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic.

METHODS

Data was sourced from a nationally representative sample of U.S. 9th-12th students (n = 3241) who completed the CDC's 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson's chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents.

RESULTS

This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05).

CONCLUSION

Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.

Factors Associated With Indirect Exposure to and Knowledge of Fentanyl Among Youth

PURPOSE

Using data from an online assessment of youth in the United States, this study examined factors associated with youth's indirect exposure to fentanyl; factors related to youth's level of knowledge of fentanyl; and sources of substance use information obtained by youth.

METHODS

This is a secondary analysis of data from a cross-sectional online assessment of youth ages 13 to 18 in the United States in 2022. Participants self-reported on substance use knowledge and concerns, indirect exposure to substance use, access to substance use information and resources, the extent to which youth discussed drug use harms with someone, and COVID-related stress.

RESULTS

Analyses revealed that most youth did not have knowledge of fentanyl even though they reported indirect likely exposure to fentanyl. Youth concerned about alcohol or drug use in their own life were less likely to have knowledge of fentanyl and more likely to know someone who, if using drugs, would likely be exposed to fentanyl. A significant risk factor of indirect likely exposure to fentanyl was COVID-related stress. Prevalent sources of information included the internet, social media, friends or peers, and school classes.

DISCUSSION

While youth may have close proximity to fentanyl exposure and a degree of understanding of fentanyl, there is a general lack of knowledge of the substance, a critical gap that future substance use prevention initiatives could fill.

A preliminary characterization of cannabis oil use and vaporization among individuals who use for medical purposes: A pilot study

Little is known about the naturalistic use of cannabis oil vaporization, a high-potency product with the ability to be administered discreetly. This pilot study evaluated the feasibility of utilizing a "smart" vaporizer and application to assess the timing, frequency, socioenvironmental factors, and substance use involved in cannabis oil vaporization. Adults with a medical cannabis registration card were recruited from a dispensary in Rhode Island and completed a 2-week study monitoring period using the Gram1 vaporizer, followed by a poststudy qualitative interview. The sample included nine adults who were predominantly male (89%), 100% White, and 100% non-Hispanic. The Gram1 collected topographical vaping data, and the cellphone application utilized ecological momentary assessment (EMA) to assess socioenvironmental factors and other substance use. Qualitative interview data were coded, and illustrative quotations were selected to support quantitative findings. A total of 224 vaping sessions were recorded reflecting 76.4% of the study monitoring period. There was an average of 1.79 vaping sessions per day across all days. Participants took 8.76 puffs on average (SD = 8.23) per vaping session, and the session lasted 2.59 min on average (SD = 4.19). Regular vaporization was exhibited across days of the week and hours of the day. EMA reports indicated that smoking cannabis flower was the most common additional mode of cannabis administration. This study utilized a naturalistic design with novel topographical data and EMA to characterize cannabis oil vaporization. These findings establish the feasibility of collecting objective, momentary data to better understand use behaviors which are critical to informing safe consumption. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trends in vaping and smoking behavior before and during the COVID-19 pandemic in Canada: Beneficial and potentially detrimental changes

INTRODUCTION

E-cigarette and cigarette use may have changed during the COVID-19 pandemic, however, there is no consensus in existing literature, and current Canadian studies have not used representative samples. Thus, there is a need for robust national estimates.

OBJECTIVE AND METHODS

The primary objective was to describe the 30-day period prevalence of smoking and vaping before and during the COVID-19 pandemic in Canada. This study analyzed three years of the cross-sectional Canadian Tobacco and Nicotine Survey: 2019 (pre-pandemic), 2020 (9 months into the pandemic) and 2021 (21 months into pandemic).

RESULTS

Thirty-day period prevalence of vaping over the 2019, 2020, and 2021 study periods were 4.8 (95%CI: 4.2-5.3), 4.6% (95%CI: 4.1-5.2), and 5.2% (95%CI: 4.7-5.7), respectively. The 30-day period prevalence of smoking over the 2019, 2020, and 2021 study periods were 11.9% (95%CI: 10.9-12.7), 10.3% (95%CI: 9.4-11.2), and 10.3% (95%CI: 9.4-11.1), respectively. Notably, estimates of smoking for females decreased considerably from 2019 (11.0%; 95%CI: 9.9--12.2%) to 2020 (8.6%; 95%CI: 7.5-9.7). Estimates of vaping in those aged 20-24 increased substantially from 2020 (13.0%; 95%CI: 10.9-15.1) to 2021 (17.2%; 95%CI: 15.4-18.9).

CONCLUSIONS

Changes to smoking and vaping were restricted to subsets within the population. In those aged 20-24, there was a modest increase in vaping from 2020 to 2021. In females, there was a decrease in smoking from 2019 to 2020, which persisted in 2021.

Adolescent Alcohol Exposure Produces Sex-Specific Long-term Hyperalgesia via Changes in Central Amygdala Circuit Function

BACKGROUND

Exposure to alcohol during adolescence produces many effects that last well into adulthood. Acute alcohol use is analgesic, and people living with pain report drinking alcohol to reduce pain, but chronic alcohol use produces increases in pain sensitivity.

METHODS

We tested the acute and lasting effects of chronic adolescent intermittent ethanol (AIE) exposure on pain-related behavioral and brain changes in male and female rats. We also tested the long-term effects of AIE on synaptic transmission in midbrain (ventrolateral periaqueductal gray [vlPAG])-projecting central amygdala (CeA) neurons using whole-cell electrophysiology. Finally, we used circuit-based approaches (DREADDs [designer receptors exclusively activated by designer drugs]) to test the role of vlPAG-projecting CeA neurons in mediating AIE effects on pain-related outcomes.

RESULTS

AIE produced long-lasting hyperalgesia in male, but not female, rats. Similarly, AIE led to a reduction in synaptic strength of medial CeA cells that project to the vlPAG in male, but not female, rats. Challenge with an acute painful stimulus (i.e., formalin) in adulthood produced expected increases in pain reactivity, and this effect was exaggerated in male rats with a history of AIE. Finally, CeA-vlPAG circuit activation rescued AIE-induced hypersensitivity in male rats.

CONCLUSIONS

Our findings are the first, to our knowledge, to show long-lasting sex-dependent effects of adolescent alcohol exposure on pain-related behaviors and brain circuits in adult animals. This work has implications for understanding the long-term effects of underage alcohol drinking on pain-related behaviors in humans.

Mental and Psychosomatic Effects of the Coronavirus Disease 2019 Pandemic on Adolescents: A Validation Study

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has had detrimental impacts on both physical and mental health worldwide. In addition to the behavioral effects, it has caused a range of psychological problems such as depression, anxiety, sleep disorders, and anger. Fear and stress have been particularly prevalent in individuals. This study aims to assess the psychometric properties of the Scale for the Evaluation of Mental and Psychosomatic Effects of the COVID-19 Pandemic (COVID-19 PRPEDS) on adolescents and explore the pandemic's psychosomatic effects.

MATERIALS AND METHODS

A total of 503 adolescents between the ages of 14 and 18 years who continue their high school education constituted the study population. The COVID-19 PRPEDS comprising 18 items and 2 subscales (Mental Effects, Psychosomatic Effects), was used in adolescents. The forms were delivered to the students via the Internet, and in addition to the scale, the age and sex of the adolescents were recorded.

RESULTS

A majority of the participants (96.6%, n = 486) had knowledge about COVID-19, 93.8% (n = 472) could differentiate COVID-19 from other diseases, 96.6% (n = 486) were able to explain the transmission ways of COVID-19 and 96% (n = 483) took the necessary precautions to protect themselves from COVID-19. The COVID-19 PRPEDS scores of males were higher than females. The study validation index was above 0.9, which is considered to be acceptable for adolescents.

CONCLUSIONS

Like in the other pandemics, adolescents experienced serious mental health problems during the COVID-19 pandemic. In addition to its psychosomatic effects, the mental issues related to the pandemic were more common in male adolescents. Cite this article as: İnce G, Üzüm Ö, Eliaçik K, Kanık A, Emir B, Helvacı M. Mental and psychosomatic effects of the coronavirus disease 2019 pandemic on adolescents: A validation study. Turk Arch Pediatr. 2024;59(1):60-69.

Predictors and Correlates of Positive Urine Drug Screening in a Retrospective Cohort Analysis of Child and Adolescent Psychiatry Inpatients Throughout the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

Youth substance use is associated with significant psychological, neurological, and medical complications. Risk factors for substance use among children and adolescents in the general population include peer and/or parental substance use, certain psychiatric illnesses (eg, Attention-Deficit/Hyperactivity Disorder, depression), and history of maltreatment. Co-occurring substance use and psychiatric illness have been associated with increased suicidality, but few prior studies have characterized substance use among child/adolescent inpatients. As such, it remains unclear how substance use contributing to acute psychiatric presentations has changed since the start of the COVID-19 pandemic.

METHODS

This is a retrospective cohort study of 816 unique child/adolescent psychiatry inpatients with urine drug screening (UDS) results from a diverse urban setting. Charts of patients hospitalized between June 1, 2018 and November 30, 2021 were reviewed for sociodemographic characteristics, indication for admission, psychiatric history, hospital course, treatment plan, and discharge diagnosis. Differences in sociodemographic and clinical characteristics, such as age, race, and diagnoses, between patients with and without positive UDS were explored throughout various periods of the COVID-19 pandemic. Descriptive and comparative statistics were performed, as well as a logistic regression model to identify the predictors of positive UDS.

RESULTS

Of the study sample, 18% had a positive UDS. Older age, diagnosis of impulsive or behavioral disorder, and a history of violence were found to be predictors of positive UDS. Asian/South Asian or Hispanic/LatinX race and history of a developmental or intellectual disability were found to be negative predictors. The frequency of positive UDS in this population did not change based on COVID-19.

DISCUSSION AND CONCLUSIONS

Multiple factors may predispose children and adolescents to substance use. Though no impact of COVID-19 was found in this sample, longer-term studies are needed.

SCIENTIFIC SIGNIFICANCE

This study identifies independent predictors of active substance use in the child and adolescent psychiatric inpatient population.

Mapping Psychosis Risk States onto the Hierarchical Taxonomy of Psychopathology Using Hierarchical Symptom Dimensions

Clinical high risk for psychosis (CHR) is a transdiagnostic risk state. However, it is unclear how risk states such as CHR fit within broad transdiagnostic models such as the Hierarchical Taxonomy of Psychopathology (HiTOP). In this study, a hierarchical dimensional symptom structure was defined by unfolding factor analysis of self-report data from 3,460 young adults (mage=20.3). A subsample (n=436) completed clinical interviews, 85 of whom met CHR criteria. Regression models examined relationships between symptom dimensions, CHR status, and clinician-rated symptoms. CHR status was best explained by a reality distortion dimension, with contributions from internalizing dimensions. Positive and negative attenuated psychotic symptoms were best explained by multiple psychotic and nonpsychotic symptom dimensions including reality distortion, distress, fear, detachment, and mania. Attenuated psychotic symptoms are a complex presenting problem warranting comprehensive assessment. HiTOP can provide both diagnostic precision and broad transdiagnostic coverage, making it a valuable resource for use with at-risk individuals.

Proximity to Cannabis Retailers and Recent Cannabis Use among a Diverse Sample of California Adolescents

Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors (N = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018-2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935-0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926-0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820-0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers.

Youth perception of difficulty accessing cannabis following cannabis legalization and during the early and ongoing stages of the COVID-19 pandemic: repeat cross-sectional and longitudinal data from the COMPASS study

BACKGROUND

Very little research has examined how perceptions of cannabis access among underage youth in Canada have changed since cannabis was legalized and since the onset of the COVID-19 pandemic. As such, this paper examines the effect of the early and ongoing stages of the COVID-19 pandemic period on youth perceptions of cannabis access over time since the onset of the Cannabis Act in 2018 in a large sample of Canadian youth.

METHODS

Using data from the COMPASS study (T1:2018/19, T2:2019/20, T3:2020/21), we used both repeat cross-sectional data [T1 (n = 38,890), T2 (n = 24,109), and T3 (n = 22,795)] to examine overall trends in perceptions of cannabis access, and sequential cohort longitudinal data [n = 4,677 students linked from T1 to T3] to examine the differential changes in perceptions of cannabis access among students over time.

RESULTS

In the cross-sectional sample, the frequency of students reporting that cannabis was easy to access decreased by 26.7% from T1 (51.0%) to T3 (37.4%), although respondents who have used cannabis were more likely to report access was easy. In the longitudinal sample, perceptions of cannabis access being easy increased over time, especially among cannabis users. Perceived ease of access appears to have been slightly impeded during the initial pandemic period but rebounded during the ongoing pandemic period.

CONCLUSIONS

While the prevalence of youth reporting that cannabis is easy to access has declined since legalization and throughout the early and ongoing pandemic periods, a substantial number of underage youth continue to report that cannabis is easy to access. This suggest that there is an ongoing need for continued cannabis control efforts to address this issue.

Restrictive measures and substance use reporting: New evidence from the COVID-19 pandemic

BACKGROUND

Since the beginning of the COVID-19 pandemic, several studies have been conducted on the impact of lockdown and containment measures on various aspects of individual and social behaviour, including substance use. The increasing body of literature investigating this phenomenon emphasizes the need for additional studies at the local level. We investigate changes in reported illicit drug consumption following changes in public measures limiting individual mobility in the province of Bergamo, one of the regions that faced the most severe consequences in terms of number of cases and death toll in the early stages of the pandemic.

METHODS

The empirical analysis is based on a unique dataset covering all people recorded by police forces as drug users between January 2019 and December 2021 in the province of Bergamo. Data relate to reports for illicit drug consumption and not criminal activities.

RESULTS

Estimates show that, during periods when individual mobility was severely limited, the probability of reported cannabis consumption decreased by 8-9%, while that of reported cocaine use increased by 6-12%. No significant changes emerge in the reported consumption of heroin or polysubstance. Furthermore, while reported cannabis use returned to pre-pandemic levels once the restrictive measures were eased, the increased likelihood of reported cocaine use appears to have been more long-lasting. These findings are robust to alternative estimation strategies and different model specifications. Our study also reveals significant gender, age and housing status disparities in reported drug use.

CONCLUSION

We provide a novel and distinctive perspective on the topic by using previously unexploited administrative data sources. We show that the relationship between restrictions and reported drug use varies by type of substance. Our methodology and findings can support the design of targeted policies for better resource allocation and improved public health outcomes.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics

Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.

Characteristics Associated With Loneliness and Coping Skills Utilization During the COVID-19 Pandemic

Although stay-at-home orders and physical distancing measures are vital to managing the COVID-19 outbreak, there is concern these limitations on in-person contact may increase feelings of loneliness. The present study examined loneliness in relation to living situation, psychiatric symptoms, and coping skills utilization during the COVID-19 pandemic. The aim was to identify demographic and psychological factors that may contribute to greater feelings of loneliness. A sample of 125 adults (18 years and older) completed measures on loneliness, psychiatric symptoms, and coping skills in September 2020. Multiple regression analysis indicated living situation moderates the relationship between hours spent having remote conversations and loneliness. Remote conversation hours were associated with decreased loneliness in those living alone but was not associated with loneliness in those living with others. Multivariate regression analysis indicated that substance use and self-blame were associated with increased loneliness whereas the use of emotional support to cope with pandemic-related stress was associated with decreased loneliness. The current study highlights the importance of finding alternative ways to remain socially connected, particularly for those living alone. Increasing access to videoconferencing technology and promoting help-seeking behaviors may be a promising approach to manage loneliness during times of increased social isolation.

National trends in alcohol and substance use among adolescents from 2005 to 2021: a Korean serial cross-sectional study of one million adolescents

BACKGROUND

Although previous studies have provided data on early pandemic periods of alcohol and substance use in adolescents, more adequate studies are needed to predict the trends of alcohol and substance use during recent periods, including the mid-pandemic period. This study investigated the changes in alcohol and substance use, except tobacco use, throughout the pre-, early-, and mid-pandemic periods in adolescents using a nationwide serial cross-sectional survey from South Korea.

METHODS

Data on 1,109,776 Korean adolescents aged 13-18 years from 2005 to 2021 were obtained in a survey operated by the Korea Disease Control and Prevention Agency. We evaluated adolescents' alcohol and substance consumption prevalence and compared the slope of alcohol and substance prevalence before and during the COVID-19 pandemic to see the trend changes. We define the pre-COVID-19 period as consisting of four groups of consecutive years (2005-2008, 2009-2012, 2013-2015, and 2016-2019). The COVID-19 pandemic period is composed of 2020 (early-pandemic era) and 2021 (mid-pandemic era).

RESULTS

More than a million adolescents successfully met the inclusion criteria. The weighted prevalence of current alcohol use was 26.8% [95% confidence interval (CI) 26.4-27.1] from 2005 to 2008 and 10.5% (95% CI 10.1-11.0) in 2020 and 2021. The weighted prevalence of substance use was 1.1% (95% CI 1.1-1.2) from 2005 to 2008 and 0.7% (95% CI 0.6-0.7) between 2020 and 2021. From 2005 to 2021, the overall trend of use of both alcohol and drugs was found to decrease, but the decline has slowed since COVID-19 epidemic (current alcohol use: βdiff 0.167; 95% CI 0.150-0.184; substance use: βdiff 0.152; 95% CI 0.110-0.194). The changes in the slope of current alcohol and substance use showed a consistent slowdown with regard to sex, grade, residence area, and smoking status from 2005 to 2021.

CONCLUSION

The overall prevalence of alcohol consumption and substance use among over one million Korean adolescents from the early and mid-stage (2020-2021) of the COVID-19 pandemic showed a slower decline than expected given the increase during the prepandemic period (2005-2019).

Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic

BACKGROUND

Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use.

OBJECTIVES

Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption.

DESIGN AND SETTING

A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020.

METHODS

Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9.

RESULTS

Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns.

CONCLUSION

The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

The effectiveness of digital health technologies for reducing substance use among young people: a systematic review & meta-analysis

BACKGROUND

Substance use amongst young people poses developmental and clinical challenges, necessitating early detection and treatment. Considering the widespread use of technology in young people, delivering interventions digitally may help to reduce and monitor their substance use.

AIMS

We conducted a systematic review and two meta-analyses to assess the effectiveness of digital interventions for reducing substance use (alcohol, smoking, and other substances) among young people aged 10 to 24 years old.

METHOD

Embase, Global Health, Medline, PsychINFO, Web of Science and reference lists of relevant papers were searched in November 2020. Studies were included if they quantitatively evaluated the effectiveness of digital health technologies for treating substance use. A narrative synthesis and meta-analysis were conducted.

RESULTS

Forty-two studies were included in the systematic review and 18 in the meta-analyses. Digital interventions showed small, but statistically significant reductions in weekly alcohol consumption compared to controls (SMD= -0.12, 95% CI= -0.17 to -0.06, I2=0%), but no overall effect was seen on 30-day smoking abstinence (OR = 1.12, 95% CI = 0.70 to 1.80, I2=81%). The effectiveness of digital interventions for reducing substance use is generally weak, however, promising results such as reducing alcohol use were seen. Large-scale studies should investigate the viability of digital interventions, collect user feedback, and determine cost-effectiveness.

PRISMA/PROSPERO

This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in November 2020 (CRD42020218442).

"There must be something good": Fair balance and ad appeal of marijuana brands' website

Ever since medical and nonmedical marijuana became legal in parts of the United States in 2012, scholars have cited concerns regarding marijuana advertising's impact on adolescents. The current study aimed to explore how online marijuana websites are utilizing their advertising strategies amid the lack of centralized regulation by qualitatively analyzing 141 websites of marijuana brands in the United States. We found that the common themes they employed were high, professionalism, natural, and adventurous. There was no fair balance between benefit and risk information because most of the brands did not communicate the risk. The use of animated characters was found, along with other appeals that could potentially influence underage users. Areas of concern that need imminent attention from the regulatory body are discussed.

Child and youth mental health and wellbeing before and after returning to in-person learning in secondary schools in the context of COVID-19

Background

As children reintegrate with in-person classroom learning after COVID-19, health and education institutions should remain mindful of students' mental health. There is a paucity of data on changes in students' mental health before, during and after their return to in-person classroom learning.

Methods

We collected and analyzed data on self-reported wellbeing, general mental health, perceived stress, and help-seeking attitudes from grade 7-12 students in a Catholic school division in Canada (n = 258 at baseline; n = 132 at follow-up). Outcomes were compared according to demographic differences such as gender, grade level, experience accessing mental health services, and presence of support staff between baseline and follow-up. Effects of time points and each demographic variable on each outcome and on the prediction of students' mental health were also analyzed.

Results

No significant differences were apparent for outcomes between baseline and follow-up. However, specific subgroups: junior high students, male students, students who had not accessed mental health services, and students who had access to support-staff had better outcomes than their counterparts. From baseline to follow-up, male students reported mental health decline [Mean = 11.79, SD = 6.14; Mean = 16.29, SD = 7.47, F(1, 333) = 8.36, p < 0.01]; students who had not accessed mental health services demonstrated greater stress [Mean = 20.89, SD = 4.09; Mean = 22.28, SD = 2.24, F(1, 352) = 6.20, p < 0.05]; students who did not specify a binary gender reported improved general mental health [Mean = 19.87, SD = 5.89; Mean = 13.00, SD = 7.40, F(1, 333) = 8.70, p < 0.01], and students who did not have access to support-staff improved help-seeking attitudes [Mean = 22.32, SD = 4.62; Mean = 24.76, SD = 4.81; F(1, 346) = 5.80, p < 0.05]. At each time point, students indicated parents, guardians, and close friends as their most-preferred help-seeking sources. High stress predicted lower wellbeing at baseline, but higher wellbeing at follow-up.

Conclusion

Students presented stable mental health. Subgroups with decreased mental health may benefit from extra mental health support through building capacity among teachers and health care professionals to support students following public health emergencies.

Pandemic-Related Changes in the Prevalence of Early Adolescent Alcohol and Drug Use, 2020-2021: Data From a Multisite Cohort Study

PURPOSE

Evaluate changes in early adolescent substance use from May 2020 to May 2021 during the coronavirus disease 2019 pandemic using data from a prospective nationwide cohort: the Adolescent Brain Cognitive Development Study.

METHODS

In 2018-2019, 9,270 youth aged 11.5-13.0 completed a prepandemic assessment of past-month alcohol and drug use, then up to seven during-pandemic assessments between May 2020 and May 2021. We compared the prevalence of substance use among same-age youth across these eight timepoints.

RESULTS

Pandemic-related decreases in the past-month prevalence of alcohol use were detectable in May 2020, grew larger over time, and remained substantial in May 2021 (0.3% vs. 3.2% prepandemic, p <.001). Pandemic-related increases in inhalant use (p = .04) and prescription drug misuse (p < .001) were detectable in May 2020, shrunk over time, and were smaller but still detectable in May 2021(0.1%-0.2% vs. 0% pre-pandemic). Pandemic-related increases in nicotine use were detectable between May 2020 and March 2021 and no longer significantly different from prepandemic levels in May 2021 (0.5% vs. 0.2% prepandemic, p = .09). There was significant heterogeneity in pandemic-related change in substance use at some timepoints, with increased rates among youth identified as Black or Hispanic or in lower-income families versus stable or decreased rates among youth identified as White or in higher-income families.

DISCUSSION

Among youth ages 11.5-13.0 years old, rates of alcohol use remained dramatically reduced in May 2021 relative to prepandemic and rates of prescription drug misuse and inhalant use remained modestly increased. Differences remained despite the partial restoration of prepandemic life, raising questions about whether youth who spent early adolescence under pandemic conditions may exhibit persistently different patterns of substance use.

Examining engagement with and acceptability and usability of REAL Parenting: A brief online parent-based intervention to reduce alcohol use and consequences among high school students

This study is a formative assessment of REAL Parenting (RP): a brief, digital intervention for parents of high school students that encourages parent-teen communication about alcohol and, in turn, aims to prevent teen alcohol use. The aims of this study were to describe engagement with, and acceptability and usability of RP; and to explore the relationship of these measures with each other and with short-term outcomes. Participants were 160 parents randomly assigned to the treatment group who received RP as part of a randomized pilot trial (Mage = 45.43[SD = 7.26], 59.3% female, 56% White, 19% Hispanic). App-based program analytics captured real-time engagement with RP. Parents completed self-report measures of acceptability, usability, perceived communication effectiveness, perceived self-efficacy to communicate, and frequency of communication post-intervention. Descriptive statistics were calculated to describe engagement, acceptability and usability, and zero-order correlations were calculated to examine associations between these and self-report variables. About 75% (n = 118) of parents accessed the intervention and two-thirds (n = 110) accessed at least one module. Self-report ratings of acceptability and usability were neutral to positive, and mothers liked RP more than fathers. Self-report, but not program analytic indicators were associated with short-term outcomes. Findings suggest that, with little incentive, most parents will access an app focused on parent-teen communication about alcohol. While parent feedback was positive, it also highlighted areas for improvement with app content and design. Correlations suggest that analytic metrics of engagement are useful to discern who is and is not using interventions, and self-report measures are important for understanding pathways by which interventions are associated with short-term outcomes.

Drinking behaviors of Chinese adolescents over the past three decades: A systematic review and meta-analysis

Adolescent drinking is a major worldwide public health challenge. China is home to the world's second largest youth population, but relatively little is known about adolescent drinking behaviors. This study examined (1) prevalence rates and sex and age differences in drinking behaviors among Chinese adolescents over the past three decades and (2) whether underage drinking declined following the enactment of a strict national underage drinking policy in 2006. Literature search was conducted in one Chinese and five English databases following the PRISMA guidelines. A total of 186 studies were included in the meta-analyses using random-effects models on nine measures (Ns range: 13,489-755,796, number of studies range: 12-110): lifetime, past month, past year, and weekly drinking; lifetime, past year, and past month drunkenness; past month binge drinking, and age at first drinking (≤ 13 years). Males reported higher prevalence on all drinking behaviors except for weekly drinking and past month drunkenness. High school students reported higher prevalence in lifetime drinking, past year drunkenness, and lifetime drunkenness, than middle school students. No measured drinking behavior showed a significant or reliable decline after 2006. The findings suggest that prevalence rates of drinking behaviors remain high among Chinese adolescents but are lower than among European or North American adolescents. The 2006 Chinese national policy to reduce underage drinking did not measurably alter patterns of underage drinking. Implications for prevention, research, and policy are discussed.

The COVID-19 pandemic and cannabis use in Canada-a scoping review

BACKGROUND

Since the start of the COVID-19 pandemic in Canada, the cannabis industry has adapted to public health emergency orders which had direct and indirect consequences on cannabis consumption. The objective of this scoping review was to describe the patterns of consumption and cannabis-related health and safety considerations during the COVID-19 pandemic in Canada.

METHODS

For this scoping review, we searched four electronic databases supplemented with grey literature. Peer-reviewed or pre-print studies using any study design and grey literature reporting real-world data were included if published in English between March 2020 and September 2021 and focused on cannabis and COVID-19 in Canada. A content analysis was performed.

RESULTS

Twenty-one studies met the inclusion/exclusion criteria. Study designs included cross-sectional surveys (n = 17), ecological study (n = 1), conceptual paper (n = 1), longitudinal study (n = 1), and prospective cohort study (n = 1). Most were conducted solely in Canada (n = 18), and the remaining included global data. Our content analysis suggested that cannabis consumption during the pandemic varied by reasons for use, consumers' age, gender, and method of consumption. Health and safety impacts due to the COVID-19 pandemics included increased mental illness, increased emergency visits, and psychosocial impacts.

DISCUSSION

This scoping review suggested that the impact of the pandemic on cannabis consumption in Canada is more complex than simplistic assumptions of an increase or decrease in consumption and continues to be difficult to measure. This study has explored some of those complexities in relation to reasons for use, age, gender, method of consumption, and health impacts. This scoping review is limited by focusing on the breadth compared to depth.

CONCLUSIONS

Legalizing nonmedical use of cannabis in Canada in 2018 has had its challenges of implementation, one of which has been the changing context of the society. The findings of this study can help inform cannabis policy updates in Canada as the country is reaching its fifth year of legalizing nonmedical use of cannabis.

Dynamic Changes in Drinking Behaviour among Subpopulations of Youth during the COVID-19 Pandemic: A Prospective Cohort Study

OBJECTIVE

Youth drinking is highly heterogenous, and subpopulations representing different alcohol use patterns may have responded differently to the COVID-19 pandemic. This study examined changing patterns of alcohol use in subpopulations of the youth population over the first two years of the pandemic.

METHOD

We used linked survey data from 5367 Canadian secondary school students who participated in three consecutive waves of the COMPASS study between 2018/19 and 2020/21. Latent transition analysis (LTA) was used to identify patterns of alcohol use based on the frequency of drinking and frequency of binge drinking and to estimate the probability of transitioning between identified patterns.

RESULTS

LTA identified five patterns of alcohol use each representing a unique subpopulation: abstainer, occasional drinker-no binging, occasional binge drinker, monthly binge drinker, weekly binge drinker. Probability of being engaged in binge drinking for a subpopulation of occasional drinkers pre-pandemic was 61%, which reduced to 43% during the early-pandemic period. A lower proportion of occasional binge drinkers reported moving to monthly or weekly binge drinking. Female occasional drinkers were more likely to move to binge drinking patterns during the pandemic than males.

CONCLUSIONS

Less frequent drinking and younger students were more likely to reduce their drinking and binge drinking than more established drinkers during the COVID-19 pandemic. Understanding of heterogenous patterns of alcohol drinking and different responses to public health crises may inform future preventive programs tailored to target subpopulations more effectively.

Changes in Quantity Measures of Various Forms of Cannabis Consumption among Emerging Adults in Canada in Relation to Policy and Public Health Developments

Limited research examines changes in quantities of various forms of smoked/vaped cannabis among regular consumers, including emerging adults (EAs; 18 to 29) in Canada. This information is particularly relevant in the current context of emerging cannabis behaviors among EAs related to political amendments (legalization of cannabis), vaping-related lung illnesses (EVALI), and unprecedented pandemics (COVID-19). This study investigated the impact of legalizing recreational cannabis use in Canada, the EVALI epidemic, and the COVID-19 pandemic on the quantity of smoked/vaped forms of cannabis in relation to gender differences. EAs retrospectively self-reported the quantity of herb, hash, concentrates, joint size, and the number of joints and vaping cartridges in relation to three consecutive developments: pre-legalization, post-legalization; pre-EVALI, post-EVALI, pre-COVID-19, and during COVID-19. The quantity of herb use significantly increased among heavy users, and vaping quantity significantly increased among light users. Overall, an increasing incremental trend was observed in the average quantity of cannabis forms used over time. Males consumed higher quantities of all cannabis forms than females. More males than females reported using concentrates (p < 0.05). These findings reveal unique aspects of the amount of various cannabis forms smoked/vaped in relation to gender and provides preliminary evidence of cannabis consumption behaviors in relation to changing social and cultural contexts.

Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations

BACKGROUND

In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use.

METHODS

This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.

RESULTS

The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.

CONCLUSION

Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.

Opportunities and challenges in capturing severe vaping-related injuries among Canadian children and youth

Although the long-term harms associated with vaping remain largely unknown, there have been numerous accounts of acute vaping-related injuries in the paediatric population. The study of vaping-related injuries is an important yet challenging undertaking, complicated by a lack of appropriate reporting mechanisms and the absence of consensus on definitions and diagnostic codes. We discuss the results of a 12-month national cross-sectional study from the Canadian Paediatric Surveillance Program conducted in 2021-2022 and situate these results within the broader context of other Canadian surveillance and reporting mechanisms. Fewer than five cases of vaping-associated injuries were reported, contrasting with previous surveys which had revealed much higher case numbers. Hypotheses for the low case numbers include decreased exposure to vaping in the context of COVID-19, changes in vaping products, increases in public awareness of vaping-related harms, as well as recent modifications in policies related to vaping product marketing and sales. There is a great need for a multi-pronged surveillance approach leveraging multiple data sources, including self-reported provider and consumer data, as well as administrative data to help inform clinicians and policymakers on how to prevent vaping-associated injuries among youth.

Impact of COVID-19 on adolescent health and use of social media

PURPOSE OF REVIEW

The coronavirus disease 2019 (COVID-19) pandemic changed access to healthcare and decreased mental and physical wellbeing. It also significantly altered teens' relationship with social media. This article is a current review of the literature on the impact of COVID-19 on adolescent health overall. In addition, how social media use has both improved and worsened the impact of COVID-19, along with strategies providers should consider in wanting to address social media use with teens.

RECENT FINDINGS

The COVID-19 pandemic has affected adolescents through increased social isolation and decreased access to healthcare resources. Social media use has both positive and negative effects on adolescent health. Positive effects include sustained connection to friends, family and community while negative effects include lower self-esteem and increased incidence of eating disorders.

SUMMARY

Our findings underscore the multifaceted impact of social media on adolescent mental health, physical wellbeing, and healthcare access. Of particular relevance to the physician is the potential of leveraging social media to promote healthy behaviors in vulnerable age groups and populations. Social media can be used to connect teens with reputable websites where they can seek medical or health information that would otherwise not readily be available.

Children and adolescents' mental health in pandemics and confinement: A scoping review of vulnerability factors and repercussions

Children and adolescents are a population at particular risk of experiencing adverse mental health repercussions related to pandemics. To understand vulnerability factors and repercussions of pandemics and related sanitary measures on children and adolescents' mental health, we performed a scoping review to examine and synthesize literature. In total, 66 articles were included. Results present: (1) factors that increase vulnerability to adverse mental health repercussions (e.g., having a pre-existing mental health condition, social isolation, low socio-economic status, parental distress, and overexposure to media content) and (2) specific mental health repercussions (e.g., anxiety, fear, depression, and externalizing behaviors). Addressing concerns underlined in this review could contribute to preventing further negative mental health repercussions of pandemics for children and adolescents and better prepare governments and professionals to address these highly challenging situations. Recommendations for practice include enhancing healthcare professionals' awareness about possible detrimental repercussions pandemics and sanitary measures have on children and adolescents' mental health, assessing changes for those with pre-existing mental health conditions, allocating funding for telehealth research, and providing greater support to healthcare providers.