Participation in Team Sports and Alcohol and Marijuana Use Initiation Trajectories

Cannabis Use in Adolescent and Young Adult Athletes: A Clinical Review

CONTEXT

Cannabis use among the general population has increased over time, in part due to decriminalization of use and greater social acceptance of cannabis use. These changes have contributed to increased availability of cannabis products, thus raising the likelihood that a subset of adolescent and young adult athletes will use cannabis. Therefore, it is imperative that clinicians and other providers working with young athletes have a thorough understanding of the impact cannabis can have on the athletic performance and overall health of a young athlete.

EVIDENCE ACQUISITION

PubMed (Medline), CINAHL, PsycINFO, and SportDiscus databases were used to perform a literature search of articles published between January 1, 2010 and December 31, 2022. Additional articles were reviewed based on references obtained from initial articles.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Survey studies suggest that up to 1 in 4 athletes have used cannabis at least once in the last year. Age, sex, race, sexual orientation, level of competition, and country of residence of an athlete all contribute to differing rates of cannabis use among athletes. The scientific literature does not support using cannabis for athletic performance, and multiple studies have demonstrated notable impairments in objective athletic performance measures. Cannabis use can also negatively impact an athlete's overall health via cardiovascular, gastrointestinal, and mental health symptoms and disorders.

CONCLUSION

Cannabis use among adolescent and young adult athletes is common, and rates of use are influenced by many different factors. Current evidence suggests that cannabis use can worsen sport performance, negatively impact an athlete's general health, and contribute to negative mental health outcomes.

Multilevel Risk and Protective Factors for Frequent and Nonfrequent Past-30-Day Marijuana Use: Findings From a Representative Sample of High School Youth

OBJECTIVE

Research has identified many factors associated with past-30-day (P30D) marijuana use among youth but has not assessed factors that may differentiate youth who use frequently from youth who do not. We took a multilevel approach to identify and compare risk and protective factors associated with frequent and nonfrequent P30D marijuana use among high school students.

METHOD

Individual-level data were obtained from the 2019 Nevada Youth Risk Behavior Survey (completed by 4,980 high school youth from 99 schools); school-level data were obtained from the state's Department of Education. A multinomial, multilevel model was used to estimate the association between risk and protective factors at the individual and school levels and a three-level frequency of use outcome: no P30D use (0 times), nonfrequent P30D use (1-19 times), and frequent P30D use (≥20 times).

RESULTS

At the individual level, other P30D substance use, exposure to adverse childhood experiences (ACEs), perceived ease of access, and perceived risk were associated with both frequent and nonfrequent use, but the relationships were generally stronger for frequent use. P30D nonprescription drug use and school connectedness were associated with frequent use only. At the school level, number of students with individualized education programs, number of incidents involving possession of controlled substances, and school type were associated with frequent use only.

CONCLUSIONS

Individual and school-based interventions designed to address the factors uniquely or strongly associated with frequent marijuana use may prevent escalation from occasional use to more frequent use among high school youth.

Does Sport Participation Protect Adolescents from Alcohol Consumption? A Scoping Review

(1) Background: Participation in youth sports is believed to protect against alcohol consumption. Although this concept has been questioned for over 40 years, the review of methodologically reliable evidence data is scarce. This review summarizes the state of knowledge on the association between practicing sports and alcohol consumption among adolescents (10-19 years old) and its moderators. (2) Methods: The review covers only random-sample-based and population research. A systematic search was conducted on Scopus, PubMed, and WoS, for articles published between 2000 and 2021. From the 1944 identified records, 139 advanced to the full-text review, and 32 to the final data extraction and quality review. (3) Results: About two-thirds of the studies, including all the longitudinal ones, showed a positive association between sport participation and alcohol consumption. The most common mediators were gender (males were at higher risk), discipline (odds for team sports were higher, but professionalization could reduce it), and race, which intersected with gender, putting white males at the highest risk. (4) Conclusions: Further longitudinal research based on random samples using standardized indicators, including psychological and social variables, may provide more consistent outcomes and allow for the identification of mediating mechanisms.

Comorbidity Between Internalising and Externalising Disorders Among Adolescents: Symptom Connectivity Features and Psychosocial Outcome

Internalising disorders are highly prevalent conditions in adolescence and tend to co-occur with externalising disorders. The present study used a symptom network approach to examine the interplay between symptoms of internalising disorders among adolescents with comorbid internalising and externalising disorders. Data comes from the National Comorbidity Survey-Adolescent Supplement, a nationally representative survey of adolescents aged 13 to 18 years. The most central symptoms across the disorders in the network were poor self-esteem and worry. The comorbidity between anxiety and depression increases the probability of having comorbid externalising disorders. Adolescents with both internalising and externalising disorders had the highest rate of health service utilisation. Comorbidity group, lifestyle factors, deficits in cognitive and academic competence and coping skills were significant covariates of the mental health outcomes. Understanding comorbidity profile of internalising and externalising disorders and central symptoms that bridge these disorders could have important clinical implications.

Association of Physical Activity, Sports, and Screen Time With Adolescent Behaviors in Youth Who Visit the Pediatric Emergency Department

Moderate to vigorous physical activity (MVPA), sports, and reduced screen time are associated with favorable youth risk profiles. We evaluated the association of MVPA, sports, and screen time with adolescent behaviors among pediatric emergency department youth. Adolescents were assessed for alcohol/drug use, risky behavior, conduct disorder, and depressive mood. MVPA was activity for ≥5 days/week and ≥60 minutes/day. Increased screen time was ≥3 hours/day computer/TV use for non-schoolwork. Multivariable regression studied association between MVPA, sports, and increased screen time and outcomes adjusting for demographics and academic achievement. Older age and lower academic achievement were significantly associated with risky behaviors, conduct disorder, and depression. Youth who endorsed MVPA and sports participation had less depression (odds ratio [OR] = 0.76; confidence interval [CI] = 0.66-0.87). Increased screen time was associated with conduct disorder (OR = 1.6; CI = 1.3-2.1), depression (OR = 1.2; CI = 1.0-1.4), and drug use (OR = 1.8; CI = 1.1-2.8). In pediatric emergency department youth, MVPA and sports participation is associated with less depression. Increased screen time is associated with conduct disorders, depression, and drug use.

Heavy Drinking among High School Student Athletes and Non-Athletes: Do Differences Emerge as Early as the Ninth Grade?

High school athletes have been identified as a high-risk group for heavy drinking. Little is known, however, about the timing of when student athlete heavy drinking begins to diverge from that of non-athletes. Objectives: The aim of the current study is to examine differences in changes in heavy drinking among ninth grade student athletes and non-athletes across the academic year. We hypothesized that student athletes would report greater increases in heavy drinking compared to non-athletes from fall to spring semester. Ninth grade students (N = 217) aged 13 to 15 completed questionnaires on heavy drinking indices, quantity of peak drinking, frequency of binge drinking, and estimated blood alcohol concentration (eBAC) during the fall and spring semesters. Consistent with our hypothesis, student athletes reported significantly greater increases in heavy drinking compared to non-athletes from fall to spring semester. Additionally, there was a significant increase in all three indices of heavy drinking for student athletes, whereas there were no significant changes for non-athletes. Results demonstrate divergence in the quantity and frequency of heavy drinking between student athletes and non-athletes during the ninth grade. These findings indicate the optimal timing of preventive intervention programs may be different for student athletes and non-athletes. Results also suggest that preventive intervention program targeting heavy drinking should be implemented for high school student athletes as early as the fall semester of the ninth grade when students are transitioning to high school.

Risk factors for hazardous drinking in university students from South Africa and Belgium: a cross-cultural comparison study

Background

Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultural and geographical differences exist regarding alcohol use.

Objectives

To determine whether or not there was a difference in hazardous drinking between Belgian and South African university students and to establish the risk factors that contribute to hazardous drinking in university students (calculated using the AUDIT-C) from a developing country (South Africa) and a developed country (Belgium).

Methods

An online survey assessing hazardous drinking among university students in South Africa (University of KwaZulu-Natal, UKZN) and Belgium (University of Antwerp, UoA) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). Risk factors in males and females for hazardous drinking were explored using multivariate logistic regression analysis.

Results

In total, 499 students were included in the study (250 UoA and 249 UKZN students). A significant higher amount of male (94.8%) as well as female (92.4%) UoA students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) UKZN students (p<0.001). Additionally, a significant higher amount of UoA students were hazardous drinkers, compared to the UKZN students (p<0.001). Multivaiate analysis showed that male UoA students were almost 6 times more likely to be hazardous drinkers than male UKZN students (OR=5.611, p=0.005). Female UoA students were more than twice as likely to be hazardous drinkers than female UKZN students (OR=2.371, p=0.016).

Conclusion

This study found a significant difference in hazardous drinking between Belgian and South African university students.

Reducing Alcohol Use among High School Athletes: A Randomized Controlled Trial of a Brief, Web-Based Personalized Normative Feedback Intervention

High school athletes are at risk for heavy alcohol use, which is associated with consequences that may negatively impact performance and eligibility to participate in sports. This study evaluated the efficacy of a web-based personalized normative feedback (PNF) intervention on reducing alcohol use among high school athletes in their senior year. Class periods were randomized to the intervention or an assessment-only control group. Athletes completed surveys at baseline and a 6-week follow-up. Athletes were classified as high-risk or low-risk drinkers based on baseline reports of binge drinking. Results indicated for athletes classified as high-risk drinkers, those in the intervention group reported significantly greater reductions in quantity of weekly drinking and peak drinking quantity compared to those in the assessment-only control group. There were no significant intervention effects for frequency of alcohol use. Findings provide support the efficacy of web-based PNF intervention for reducing alcohol use among high school senior athletes.

The health-related determinants of eating pattern of high school athletes in Goiás, Brazil

Background

Athletes put their health at short- and long-term risk and a detailed investigation of health outcomes is important because it should allow the development of more specific interventions. This study aimed to evaluate the health-related determinants of eating pattern of high school athletes.

Methods

The study enrolled 248 Brazilian athletes aged 14–20 years. Eating pattern outcomes included skipping breakfast, vegetable and fruit consumption, and sweets consumption. The following factors were considered as independent variables: sociodemographic, economic, anthropometry, body weight control, psychosocial, sedentary behavior, sleeping time, meals, alcohol and smoking, and strength variables. Data were analyzed using Poisson regression model and the effect measure was the prevalence ratio (PR).

Results

The results showed that 45.6% of the athletes skipped breakfast, 29.8% ate sweets regularly, and only 8.9% consumed vegetables and fruit regularly. Multiple analysis revealed the following positive associations: breakfast skipping and vomiting or using laxatives to lose weight (PR, 1.12; 95% CI, 1.01–1.26); low fruit and vegetable consumption and using pills to lose weight (PR, 1.05; 95% CI, 1.02–1.07); high sweets consumption and female athletes (PR, 1.32; 95% CI, 1.12–1.55); high sweets consumption and more than 2 h spent watching TV (PR, 1.19; 95% CI, 1.02–1.39).

Conclusions

Our findings indicated that sociodemographic, body weight control and sedentary factors are determinants on eating patterns of high school athletes.

Organized Sports for Children, Preadolescents, and Adolescents

Interest and participation in organized sports for children, preadolescents, and adolescents continue to grow. Because of increased participation, and younger entry age, in organized sports, appropriate practice, game schedules, and content become more important, taking into account athlete developmental stage and skills. Parental support for organized sports in general, with focus on development and fun instead of winning, has emerged as a key factor in the athlete's enjoyment of sports. Schools and community sports organizations who support multiple levels of sport (eg, recreational, competitive, elite) can include more youth who want to play sports and combat sport dropout. This report reviews the benefits and risks of organized sports as well as the roles of schools, community organizations, parents, and coaches in organized sports. It is designed to complement the American Academy of Pediatrics clinical reports "Physical Activity Assessment and Counseling in Pediatric Clinical Settings" and "Sports Specialization and Intensive Training in Young Athletes" by reviewing relevant literature on healthy organized sports for youth and providing guidance on organized sport readiness and entry. The report also provides guidance for pediatricians on counseling parents and advocating for healthy organized sports participation.

Recreational and ergogenic substance use and substance use disorders in elite athletes: a narrative review

BACKGROUND

Substances from various classes may be used for recreational purposes, self-treatment or to boost performance. When substance use shifts from occasional to regular, heavy or hazardous use, positive and negative effects can develop that vary by substance class and athlete. Regular use of recreational or performance enhancing substances can lead to misuse, sanctions or use disorders.

OBJECTIVE

To review the prevalence, patterns of use, risk factors, performance effects and types of intervention for all classes of recreational and performance enhancing substances in elite athletes by sport, ethnicity, country and gender.

METHODS

A comprehensive search was conducted to identify studies that compared the prevalence and patterns of substance use, misuse and use disorders in elite athletes with those of non-athletes and provided detailed demographic and sport variations in reasons for use, risk factors and performance effects for each main substance class.

RESULTS

Alcohol, cannabis, tobacco (nicotine) and prescribed opioids and stimulants are the most commonly used substances in elite athletes, but generally used at lower rates than in non-athletes. In contrast, use/misuse rates for binge alcohol, oral tobacco, non-prescription opioids and anabolic-androgenic steroids are higher among athletes than non-athletes, especially in power and collision sports. Cannabis/cannabinoids seem to have replaced nicotine as the second most commonly used substance.

CONCLUSIONS

Substance use in elite athletes varies by country, ethnicity, gender, sport and competitive level. There are no studies on substance use disorder prevalence in elite male and female athletes and few studies with direct comparison groups.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Physical Activity and Mental Disorder Among Adolescents in the United States

OBJECTIVE

To estimate associations between physical activity (PA) and a broad range of lifetime mental disorders among adolescents, and to evaluate whether the context of sports participation impacts these associations.

METHODS

The sample included 6,483 13-18 year-olds from the National Comorbidity Survey Adolescent Supplement. Adolescents completed face-to-face psychiatric interviews and a parent provided diagnostic and other family-level information on the participating adolescent by completing a self-administered questionnaire. PA was measured by adolescent self-report and dichotomized to indicate vigorous exercise several times a week. Nineteen psychiatric disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria. Multiple logistic regression analyses were used to estimate associations of PA with mental disorders, suicidality, and psychological distress.

RESULTS

Two thirds of adolescents reported being physically active. Active adolescents had significantly lower odds of mood disorder (Odds ratio[OR] = .74, 95% confidence interval [CI]=.58-.94), bipolar II disorder (OR = .54, 95% CI=.30-.99), and general psychological distress (OR = .71, 95% CI=.52-.96) than less/inactive adolescents. In contrast, adolescents who engaged in PA were more likely to have lifetime alcohol use disorder (OR = 1.78, 95% CI = 1.11-2.85), bulimia (OR = 5.84, 95% CI = 2.48-13.79), generalized anxiety disorder (OR = 2.04, 95% CI = 1.16-3.58), and posttraumatic stress disorder (OR = 1.65, 95% CI = 1.07-2.55). The direct associations between PA and alcohol use disorder and bulimia appeared to be specific to adolescents who participated in organized sports.

DISCUSSION

Associations between PA and lifetime mental disorder among adolescents may differ according to both disorder type and the context in which PA occurs. Longitudinal studies that assess the context of PA may be able to explain apparent discrepant associations between PA and mental disorder.

Exercise as a Prevention for Substance Use Disorder: A Review of Sex Differences and Neurobiological Mechanisms

PURPOSE OF REVIEW

This report provides an update on clinical and preclinical findings for the efficacy of exercise to prevent substance use disorder with a focus on recent evidence for sex differences and neurobiological mechanisms.

RECENT FINDINGS

Exercise/physical activity is associated with decreased drug use in humans. Preclinical results further indicate that exercise decreases vulnerability to drug use and the development of features of substance use disorder, and suggest that females have an enhanced sensitivity to its reward-substitution effects. However, certain exercise conditions may sensitize the reward pathway and enhance vulnerability suggesting that parallel observations in humans (e.g., increased prescription opioid misuse and heroin use in high-school athletes) may be biologically-based.

SUMMARY

Exercise is a promising prevention strategy for substance use disorder. Further work is needed to establish its efficacy as a sex-specific strategy using larger samples, and to understand the exercise conditions that induce beneficial versus risk-enhancing effects.

Longitudinal association between physical activity engagement during adolescence and mental health outcomes in young adults: A 21-year birth cohort study

OBJECTIVE

Previous studies provide mixed evidence that physical activity engagement (PAE) in adolescence is associated with later mental health outcomes. This study aimed to examine the association between PAE at age 14 and mental health outcomes at age 21 using a large birth cohort study.

MATERIAL AND METHODS

Prospective data from the Mater-University of Queensland Study of Pregnancy, consisting of 3493 young adults, were analyzed. PAE at age 14 was estimated using self-report, and participants were categorized into; (1) frequent, (2) infrequent, or (3) no PAE group. Mental health outcomes at age 21 consisted of; (1) common mental disorders, (2) psychosis-related outcomes, and, (3) emotional and behavioral problems. The association between PAE in adolescence and later mental health outcomes in young adulthood was examined using logistic regression, adjusted for age, sex, body mass index, and adolescent psychopathology.

RESULTS

No PAE at age 14 was associated with the increased likelihood of lifetime diagnosis of any affective disorder, elevated delusional ideation, and endorsement of visual perceptual disturbance at age 21. Conversely, infrequent PAE at age 14 was associated with the decreased likelihood of subsequent lifetime diagnosis of any substance use disorder.

CONCLUSION

Our findings suggest that lack of PAE in adolescence influences some, but not all, later mental health outcomes. Interventions to increase PAE in adolescence may represent an opportunity to prevent future mental health problems.

Understanding how organized youth sport maybe harming individual players within the family unit: a literature review

Within the United States, close to 45 million youths between the ages of 6 and 18 participate in some form of organized sports. While recent reviews have shown the positive effects of youth sport participation on youth health, there are also several negative factors surrounding the youth sport environment. To date, a comprehensive review of the negative physical and psychological effects of organized sport on youth has not been done and little to date has documented the effect organized sport has on other players within a family, particularly on parents and siblings. Therefore the purpose of this paper is to conduct a review of papers on the negative effects of organized sport on the youth athlete and their parents and siblings. Articles were found by searching multiple databases (Physical Education Index and Sociology, Psychology databases (Proquest), SPORTDiscus and Health, History, Management databases (EBSCOhost), Science, Social Science, Arts and Humanities on Web of Science (ISI), SCOPUS and Scirus (Elsevier). Results show the darker side of organized sport for actors within the family unit. Ideas for future research are drawn and recommendations are made to optimize the youth sport experience and family health.