Applying a social determinants of health perspective to early adolescent cannabis use – An overview

Cannabis Use and Its Impact on Mental Health in Youth in Australia and the United States: A Scoping Review

Cannabis is a widely used substance among the youth population, with an estimated 2.8% currently smoking cannabis. Its popularity is growing due to the perception of its harmless nature and lack of dependence. However, this increase in use has been linked to mental health issues, especially since its partial decriminalisation in some part of the United States and Australia. The objective of this scoping review was to investigate the mental health impact of cannabis use among young people in Australia and the United States. A scoping review was conducted according to the Joanna Briggs Institute (JBI) protocol, and articles were searched from ProQuest Central and EBSCO Host (MEDLINE and CINAHL databases). A total of 24 articles were analysed, including systematic reviews, meta-analyses, and cohort, longitudinal, and cross-sectional studies. The findings indicate that cannabis use is associated with depression, psychosis, suicide, cannabis use disorder, dependence, decline in cognitive function, and the development of externalising behaviour, particularly attention deficit hyperactivity disorder. However, the relationship between cannabis use and anxiety is equivocal. Mental health issues were more prevalent with increased frequency, duration, intensity, and type of use. Female, minority, LGBTQI, African American, Aboriginal, and Torres Strait Islander youth and the age of onset of cannabis use were significant factors for the development of mental health problems. The increasing prevalence of cannabis use among high school and college students suggests the need for intervention by teachers, parents, and community health professionals to make them aware of its potential negative mental health outcomes. Moreover, policy-level interventions by the government are required to discourage young people from using cannabis.

Patterns of cannabis use, perception of harm, and perceived impact of legislative change in an online sample of young adults from Lebanon: insight on recreational users versus dual motive users

BACKGROUND

Lebanon remains as one of the major sources of cannabis worldwide. In 2020, its government passed a legislation enabling the cultivation of local medicinal cannabis. This first study following the legislative change examines the overlapping use of cannabis for recreational/medicinal purposes and characteristics of the distinct cannabis user types.

METHODS

A total of 1230 young adults (18-24 years) filled an anonymous online survey in early 2020.

RESULTS

Young adults in the sample were distributed as follows: 33% 18-20 years; 60% males; 94% Lebanese; 75% students; and 89% living with family. The older young adults (21-24), males, those employed, living with non-family members, and who perceived themselves as being a little/lot richer than most were statistically significantly more present in the cannabis user subtypes (recreational only or recreational/medicinal) than non-cannabis users. When dual recreational/medicinal users are compared to recreational users only, the latter seemed to have a more conservative profile of behaviours, attitudes, and perceptions and acts of harm. The prevalence ratio comparing the prevalence of users supporting consuming cannabis "once or twice" in dual motive users vs. recreational users only was 1.13 for "once or twice", 1.25 for "occasionally", 1.64 for "regularly", and 2.4 for "daily". Any other illicit drug use was reported by 1% of the non-cannabis users, 36% of the recreational users only, and 58% of the recreational/medicinal users (p-value < 0.01). Similarly, any prescription drug use was reported by 3% of the non-cannabis users, 16% of the recreational users only, and 28% of both recreational/medicinal users (p-value < 0.01).

CONCLUSION

The interface between recreational and medicinal cannabis use is complex. Dual motive users may warrant special attention as a subpopulation of cannabis users. This is relevant to contexts experiencing medicinal cannabis legislation changes, such as Lebanon, as policymakers and implementers should be sensitized to the emerging evidence for more data-informed policy changes.

Adolescent Cannabis Misuse Scale: Longitudinal Associations with Substance Use, Mental Health, and Social Determinants of Health in Early Adulthood

BACKGROUND

Some patterns of cannabis use may presage risk for long-term negative effects. We examined associations between a novel adolescent cannabis misuse scale and early-adult life course outcomes.

METHODS

We performed a secondary data analysis of a cohort of Los Angeles, CA high school students from grade 9 through age 21. Participants reported baseline individual demographic and family characteristics at grade 9, adolescent cannabis misuse (8-items) and alcohol misuse (12-items) at grade 10, and outcomes at age 21. We used multivariable regression to model the associations of cannabis misuse scale score with problem substance use (defined as any of: 30-day illegal drug use, 30-day use of another's prescription to get high, hazardous drinking) and several secondary outcomes (behavioral, mental health, academic, social determinants of health), adjusting for covariates. Parallel analyses were conducted for alcohol misuse.

RESULTS

The 1,148 participants (86% retention) were 47% male, 90% Latinx, 87% US born, and 40% native English speakers. Approximately 11.4% and 15.9% of participants reported at least one item on the cannabis and alcohol misuse scales, respectively. At age 21, approximately 6.7% of participants reported problem substance use, which was associated with both Cannabis and Alcohol Misuse Scales (OR 1.31, 95%CI[1.16, 1.49] and OR 1.33, 95%CI[1.18, 1.49], respectively). Both scales were similarly associated with outcomes in all four categories.

CONCLUSIONS

The Adolescent Cannabis Misuse Scale is a promising tool for identifying early patterns of substance use that predict future negative outcomes and enabling early intervention at a critical period in youth development.

Early-onset smoking and vaping of cannabis: Prevalence, correlates and trends in New Zealand 14-15-year-olds

INTRODUCTION

Initiating cannabis use at an early age elevates risk of harm. Cannabis vaping is an emerging issue, and it is unknown whether the patterning and correlates of early-onset cannabis vaping differ from those of cannabis smoking.

METHODS

We used repeat cross-sectional data from a nationally representative biennial survey (2012-2018) of students aged 14-15 years in New Zealand (N = 11,405), response rate 65% (2012), 64% (2014-2016) and 59% (2018).

RESULTS

Between 2012 and 2018 lifetime cannabis use decreased, but regular use (past month, weekly, daily) was stable. Prevalence of past month, weekly and daily use in 2016-2018 (pooled) was 8.6%, 3.4% and 1.5%, respectively. Cannabis vaping was reported by 24% of past month cannabis users. The demographic profile of early-onset cannabis smokers and vapers was similar, with elevated use of both modes among Māori (Indigenous), same- or both-sex attracted students and those in low decile (high-deprivation) schools. Correlates were similar for both modes. Cannabis use was strongly associated with tobacco and alcohol use. The next strongest associations (after adjustment) were exposure to second-hand smoke at home, student income >$50/week and low parental monitoring of whereabouts. Past week social media use, psychological distress and low parental monitoring of spending were also associated with both modes.

DISCUSSION AND CONCLUSIONS

Early-onset cannabis use is much higher in structurally disadvantaged groups, and among those who use tobacco and alcohol. Comprehensive multisubstance approaches to prevention are indicated in this age group. Efforts to reduce socio-economic inequity and exposure to other risk factors may reduce cannabis-related harm.

Exploring Youths’ Cannabis Health Literacy Post Legalization: A Qualitative Study

Legalization of non-medical cannabis in Canada was intended to protect youth health and safety by limiting access and raising awareness of safety and risks. The purpose of this qualitative research was to explore youths’ perceptions of their cannabis health literacy and future educational needs. A convenience sample of youth aged 13 to 18 residing in Newfoundland and Labrador, Canada who may or may not have consumed cannabis were included. A qualitative study using virtual focus groups with semi-structured interview questions was conducted. Ethics approval was obtained. All sessions were audio-recorded and transcribed. Inductive thematic analysis used a social-ecological framework for adolescent health literacy. Six focus groups ( n = 38) were conducted with youth of all ages and from rural and urban areas. Three main themes were identified: (i) micro influences (age, gender, and beliefs), (ii) meso influences, (family, peers, and school enforcement), (iii) macro influences (cannabis legalization and social media), and (iv) evidence informed information (harm reduction and cannabis properties). They desired evidence-informed education using harm-reduction principles, integrated early, and interactive. The findings provide support for a cannabis health literacy framework that will inform youth cannabis education programs. Interactive approaches with real-world application should support their autonomy, share knowledge, and minimize stigma.

A cross-sectional survey: Exploring future healthcare workers' intention to use cannabis through extended theory of planned behavior

Cannabis is the most extensively abused drug, leading to multiple health burdens such as traffic accidents and psychosis. There is a global wave of legalization of recreational and medical cannabis. This study aimed to understand future healthcare workers' intention to use cannabis through extended Theory of Planned Behavior (TPB). An online cross-sectional survey on cannabis, including validated survey tools and questions on demographics, knowledge, and constructs of the TPB was designed, and distributed during virtual classes in late 2020. Responses were obtained from the Faculty of Medicine of a local university. Nine hundred ninety-six responses were collected, of which 629 were complete and analysed. Age was the only demographic variable associated with cannabis use intention (p = 0.029). Respondents with intention had better knowledge of cannabis. All TPB and additional constructs, including perceived behavioral control (COR = 3.44, 95% CI 2.72-4.35, p < 0.001), descriptive norm (COR = 2.24, 95% CI 1.81-2.77, p < 0.001), injunctive norm (COR = 0.51, 95% CI 0.42-0.61, p < 0.001), attitude (COR = 1.23, 95% CI 1.18-1.28, p < 0.001), knowledge (COR = 1.08, 95% CI 1.03-1.14), and perceived availability (COR = 2.75, 95% CI 2.22-3.40, p < 0.001) were individually associated with intention. In the final multiple logistic regression model adjusted for age, only attitude (AOR = 1.19, 95% CI 1.13-1.25, p < 0.001) and perceived availability (p = 0.004) showed statistically significant associations with intention. Descriptive norm (standardized coefficient = 0.570) had better explanatory power than the injunctive norm (standardized coefficient = -0.143) in the model. Perceived behavioral control was associated with intention among respondents with negative to neutral attitudes towards cannabis (AOR = 2.48, 95% CI 1.63-3.77, p < 0.001), but not among those with positive attitudes. All TPB constructs positively correlated with the intention to use cannabis. Changing the attitudes and perceived control on cannabis use may be useful in preventing cannabis use.

School-Based Health Education Research: Charting the Course for the Future

SHAPE America has identified four goals as part of the 50 Million Strong by 2029 initiative; one of these goals is healthy behavior. School-based health education is uniquely positioned to be a primary route through which this goal can be achieved. Health education is an academic subject included in a well-rounded education, based on health behavior and learning theory, research-based and taught by licensed and trained health educators with adequate instructional time. Health education helps students acquire functional knowledge about a variety of topics and develop health-related skills resulting in personal competence and self-efficacy. The purpose of this paper is to provide an overview of the existing evidence examining school-based health education and to articulate future directions for research that will solidify school-based health education as a necessary and efficacious strategy for improving the health and wellness of youth.

Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements

Background

The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences.

Objective

The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television.

Methods

In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC).

Results

In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively.

Conclusions

The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages.

Rethinking Addiction

Addiction is a complex and challenging condition with many contributing factors. Although addictive behaviors appear to be individual choices, behavior alterations cannot be addressed successfully without considering characteristics of the physical and social environments in which individuals live, work, and play. Exposure to chronic psychosocial stressors and the physiological response of individuals to their external environment activates the brain's neuroendocrine hypothalamic-pituitary-adrenal axis, with profound conditioning effects on behavior. This brief synopsis describes the social determinants of health; examines the interconnectedness of the psychosocial environment, behavior, and subsequent health outcomes; discusses the environment's critical influence on brain plasticity, adaptation and functioning; and explores additional factors that complicate adolescent addiction. Because the environment is both a determinant of behavior and an opportunity for intervention, in the context of addictions, it is important to incorporate these factors in the analysis of risk and design of early interventions for prevention and amelioration of addiction.

ADOLESCENTS´ PERCEPTION OF HARMS, BENEFITS AND INTENTION TO USE MARIJUANA WITHIN THE CONTEXT OF REGULATORY CHANGES IN BELIZE

ABSTRACT Objective: to evaluate the perception of harm and benefits from using marijuana in adolescents’, to determine lifetime, past year and past month prevalence of marijuana use; and to analyze the relationship between marijuana use and the perception of harm and benefits from using marijuana. Methods: multi-centric, quantitative cross sectional survey design method was utilized for this research. Data was collected using structured standardized approved questionnaire. A total of 273 students from three high schools in two cities of the country of Belize participated in the survey conducted in 2015. Results: lifetime prevalence of marijuana use of 41.4% (39.2% past year, 24.9% past 30 days), and average age of onset of 12 years. First time prevalence of marijuana use among students by sex indicated 53.1% male students used marijuana as compared to 46.9% female students with no significant (p>0.05) statistical difference seen between genders. Participants reported that their friends use marijuana (45.1%); while 68.1% of the marijuana users had some friends that use marijuana. 51% of the students surveyed stated that they would not use marijuana, even if it were legally available. The majority (70%) perceived no risk to using marijuana occasionally. Statistical analysis revealed that a high perception of benefits, a low risk perception and friends’ use of marijuana was associated with individual use as well as intention to use in a hypothetical context of regulatory changes. Conclusion: the Belizean school-aged adolescents are more than likely to smoke marijuana because of friends’ influence, low perception of risks and if marijuana is legally available and accessible to them.

PERCEPTION OF HARM AND BENEFITS OF CANNABIS USE AMONG ADOLESCENTS FROM LATIN AMERICA AND CARIBE

ABSTRACT Objective: to investigate the perception of harms and benefits associated with cannabis use among adolescents and how regulatory changes might affect their intention to use marijuana. Method: this multi-centric cross-sectional survey study. participants included 2717 students aged 15-17 from 10 cities in Belize, Brazil, Chile, Colombia, Dominican Republic, Jamaica, Mexico, St. Kitts and Nevis, and Trinidad and Tobago. Results: an average lifetime prevalence of cannabis use of 30.6% (25.8% past year, 15.8% past 30 days). Most participants reported that their closest friends use cannabis (60%); many (55%) stated that they would not use marijuana, even if it were legally available. Conclusion: statistics revealed that a strong perception of benefits, a low perception of risk, and friends’ use of cannabis were associated with individual use as well as intention to use within a hypothetical context of regulatory change.

A common public health-oriented policy framework for cannabis, alcohol and tobacco in Canada?

Support for a public health approach to cannabis policy as an alternative to prohibition and criminalization is gaining momentum. Recent drug policy changes in the United States suggest growing political feasibility for legal regulation of cannabis in other North American jurisdictions. This commentary discusses the outcomes of an interdisciplinary policy meeting with Canadian experts and knowledge users in the area of substance use interventions. The meeting explored possibilities for applying cross-substance learning on policy interventions for alcohol, tobacco and cannabis, towards the goal of advancing a public health framework for reducing harms associated with substance use in Canada. The meeting also explored how the shift in approach to cannabis policy can provide an opportunity to explore potential changes in substance use policy more generally, especially in relation to tobacco and alcohol as legally regulated substances associated with a heavy burden of illness. Drawing from the contributions and debates arising from the policy meeting, this commentary identifies underlying principles and opportunities for learning from policy interventions across tobacco, alcohol and cannabis, as well as research gaps that need to be addressed before a public health framework can be effectively pursued across these substances.