The impact of an alcohol policy change on developmental trajectories of youth alcohol use: examination of a natural experiment in Canada

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.

The intersection of internalizing symptoms and alcohol use during the COVID-19 pandemic: A prospective cohort study

Given the well-established relationship between alcohol and internalizing symptoms, potential increases in depression and anxiety during the COVID-19 pandemic may lead to increases in alcohol consumption and binge drinking. This study examines this association from before to during two phases of the pandemic in a cohort of Canadian youth. We used linked data from a sub-sample of 1901 secondary school students who participated in three consecutive school years of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study between 2018/19 and 2020/21. Separate multilevel logistic regression models examined the association between depression and anxiety symptoms with odds of escalation and reduction (vs. maintenance) and initiation (vs. abstinence) of alcohol consumption. Results show that depression and anxiety symptoms significantly increased over the three years, and these changes were moderated by changes in alcohol consumption and binge drinking. Students with increased depression symptoms were less likely to reduce their alcohol consumption in the early pandemic (Adjust odds ratio [AOR] 0.94, 95% CI:0.90-0.98), more likely to initiate alcohol consumption in the ongoing pandemic period (AOR 1.03, 95% CI: 1.01-1.05), and more likely to initiate binge drinking in both periods. The depression-alcohol use association was stronger among females than males. This study demonstrates a modest association between internalizing symptoms and alcohol use, particularly for depression symptoms and in females. The identified depression-alcohol use association suggests that preventing or treating depression might be beneficial for adolescent alcohol use and vice versa.

A scoping review of school-level risk and protective factors of youth cannabis use: An application of the socio-ecological model

Risk and protective factors for cannabis use exist at various levels of influence, and the school environment can play a key role in preventing cannabis use and initiation as most youth. By using the socio-ecological model to hierarchically characterize school-specific risk and protective factors, a wholistic approach to school-based cannabis use prevention can be demonstrated. This study uses scoping review methodology to describe current research on school-level risk and protective factors of youth cannabis use. The socio-ecological model was used as a guiding framework to characterize the literature. PubMed, Embase, and Scopus were used to retrieve original research articles published between 2010 and 2020 that examined cannabis use as a main outcome of interest. Articles that examined school-related risk and protective factors within participants who were 18 years old or younger were included. Articles that met the pre-established criteria were extracted and categorised by theme based on levels of the socio-ecological framework. Four levels of risk and protective factors related to the school environment were identified (individual, interpersonal, community, and societal). A majority of school-based research examined individual and societal factors that influenced youth cannabis use. Our findings suggest most available research has focused on individual and societal school-level factors of cannabis use. A number of consistent themes were identified, however, findings were mixed and demonstrate the need for a more critical examination of research in order to understand which risk and protective factors are most influential among youth.

Cannabis use and suicidal ideation among youth: Can we democratize school policies using digital citizen science?

BACKGROUND

School policies and programs are important in preventing Cannabis use among youth. This study uses an innovative digital citizen science approach to determine the association between Cannabis use and suicidal ideation among youth while investigating how school health policies mediate this association.

METHODS

The study engaged 818 youth (aged 13-18 years) and 27 educators as citizen scientists via their own smartphones. Youths responded to time-triggered validated surveys and ecological momentary assessments to report on a complex set of health behaviours and outcomes. Similarly, educators' reported on substance misuse and mental health school policies and programs. Multivariable logistic regression modeling and mediation analyses were employed.

RESULTS

412 youth provided data on substance misuse and suicidal ideation. Cannabis use and other factors such as bullying, other illicit drug use, and youth who identified as females or other gender were associated with increased suicidal ideation. However, school policies and programs for substance misuse prevention did not mediate the association between Cannabis use and suicidal ideation.

CONCLUSIONS

In the digital age, it is critical to reimagine the role of schools in health policy interventions. Digital citizen science not only provides an opportunity to democratize school policymaking and implementation processes, but also provides a voice to vulnerable youth.