Gender Norms, Roles and Relations and Cannabis-Use Patterns: A Scoping Review

Beliefs About Cannabis Use Among Male and Female Andalusian Adolescents

Objectives: This study assessed potential differences between girls and boys in the prevalence rates of cannabis use, sociodemographic factors, and beliefs about cannabis use. Methods: 1,896 Andalusian adolescents aged 14-18 participated in an online survey based on the I-Change model. The survey assessed their beliefs about cannabis use, including attitudes, social influences, self-efficacy, action planning, and intention to use. Multivariate analyses of variance were then conducted to examine potential gender differences in these beliefs, while controlling for last month's cannabis use. Results: Significantly more boys used cannabis in the last month, had boyfriends/girlfriends, and had more pocket money compared to girls. Additionally, girls - in comparison to boys - were more convinced of the disadvantages of cannabis use, but were also more convinced of some of the advantages (such as freedom from boredom, and medicinal use), reported having less favorable social norms for cannabis use, had more female best friends using cannabis, and felt pressure to use cannabis from their female peers. Conclusion: These findings highlight the need for cannabis prevention programs to consider gender differences in beliefs about cannabis use. Programs should not only address general risk factors for cannabis use but also evaluate if their interventions effectively target beliefs that are particularly important for girls and boys.

Watch the tone of your voice! An exploration of dehumanization of women by gender nonconformity based on tone of voice, occupation and appearance

Dehumanization refers to the act of likening others to objects or animals. This, in turn, mitigates feelings of conscience, guilt, and moral obligation in the face of behaviors such as violence, mistreatment, or discrimination against the dehumanized individuals. The aim of this study is to determine the extent of which women with mismatching vocal tone, occupation and appearance to their gender expectations are dehumanized by others. To achieve this, we conducted a between-groups factorial design experiment. In the experiment, participants looked at the photo and listened to the voice of a target woman with either a gender congruent or incongruent vocal tone, occupation, or appearance. Participants indicated the extent to which human attributes were appropriate for this individual. The results revealed that the main effects of vocal tone and occupation were significant for both mechanistic and animalistic dehumanization. A target woman with a mismatched vocal tone and occupation was more dehumanized compared to those with a matched vocal tone and occupation. However, the interaction effect of vocal tone, occupation type, and appearance was found to be significant only for mechanistic dehumanization. Our study provides evidence to recent concerns that women may experience dehumanization due to their vocal tone and occupation.

Masculine depression and its problem behaviors: use alcohol and drugs, work hard, and avoid psychiatry!

The gender role influences vulnerability to mental illness. Substance use, even critical in scale, is perceived as masculine, just like hard (over-)work, while not seeking help. With the ongoing separation between gender and sex, masculine norms become more relevant also to females' mental health. The male depression concept highlights the role of male symptoms in affective disorders. However, the empirical evidence is still limited. Here, we use the denomination 'masculine depression' to open the category for female patients and tested substance use patterns, health services' utilization, and working hours as predictors in a case-control study of 163 depressed in-patients (44% women; masculine vs. non-masculine depression according to a median split of the Male Depression Rating Scale-22) and 176 controls (51% women). We assessed higher depression severity in patients with masculine (vs. non-masculine) depression. Masculine depression (vs. non-masculine depression and vs. no depression) was predicted by more frequent and critical use of alcohol (including binge drinking), tobacco, and illicit drugs, and by longer working times. Moreover, fewer health services contacts due to mental complaints during the previous year were associated with masculine (vs. non-masculine) depression. Alarmingly, even critical substance misuse was not significantly associated with more frequent health services contacts; however, the higher the depression severity, the more contacts the patients reported. Here, we provide evidence that patients with masculine depression are highly burdened and undertreated, which applies equally to female and male patients. This study identified promising targets to establish specialized care offers.

Investigating the Impact of Cannabis Consumption on Hospital Outcomes in Patients With Primary Spontaneous Pneumothorax: A Nationwide Analysis

Introduction Existing data suggest an association between primary spontaneous pneumothorax (PSP) and cannabis consumption, although evidence remains controversial. Methods This study used the 2016-2019 National Inpatient Sample Database to examine inpatients with PSP, categorizing them as cannabis users and non-users. Multivariate regression analyzed continuous variables, chi-square assessed categorical variables, and logistic regression models were built. Propensity score matching (PSM) mitigated the confounding bias. Results A total of 399,495 patients with PSP were admitted during the study period (13,415 cannabis users and 386,080 non-cannabis users). Cannabis users were more likely to be younger (p<0.001) and male (p<0.001) with a lower risk of baseline comorbidities than non-users. Cannabis users had a lower risk of sudden cardiac arrest, vasopressor use, the development of acute kidney injury, venous thromboembolism, the requirement for invasive and non-invasive mechanical ventilation, hemodialysis, ventilator-associated pneumonia, and the need for a tracheostomy. Cannabis use was associated with a 3.4 days shorter hospital stay (p<0.001), as confirmed by PSM analysis (2.3 days shorter, p<0.001). Additionally, cannabis users showed a lower risk of in-hospital mortality (p<0.001), a trend maintained in the PSM analysis (p<0.001). Conclusions Our study revealed correlations suggesting that cannabis users with PSP might experience lower in-hospital mortality and fewer complications than non-cannabis users.

The Differential Role of Perceived Same-Gender and Gender-Neutral Norms in Emerging Adult Risk Behavior

Background: Normative perceptions are strongly related to risk behaviors among emerging adults but the role of gender-specific normative perceptions remain unclear. Objectives: The current study examined the differential effects of same-gender and gender-neutral normative perceptions on self-reported substance use and sexual risk behavior. College students (n = 389, ages 18-25) reported binge drinking, cannabis use and prescription drug misuse, sexual risk behavior, and the perceived frequency of these behaviors by both the average- and same-gender adult. Results: Binge drinking was positively associated with same-gender norms only, whereas cannabis use and sexual risk behavior were also positively associated with gender-neutral norms perceptions. For binge drinking only, same-gender norms explained more variance in behavior than gender-neutral norms. Conclusions: Findings indicate perceptions of same-gender norms play a particularly important role in binge drinking during this developmental period. Interventions targeting emerging adult risk behavior should include within-group normative perceptions related to demographic and social group characteristics.

In-Home Cannabis Smoking Among a Cannabis-Using Convenience Sample from the Global Drug Survey: With Weighted Estimates for U.S. Respondents

Introduction: Secondhand and thirdhand tobacco smoke exposure most often occur at home, but little is known about occurrences of in-home cannabis smoking. We ascertained in-home cannabis smoking reported by all cannabis-using (i.e., used in the last 12 months) respondents to the Global Drug Survey (GDS; international-GDS sample), and among U.S. cannabis-using respondents (US-GDS sample). Materials and Methods: We used data collected November 2019-January 2020 for the 2020 GDS, an annual anonymous, cross-sectional survey; respondents were 16+ years old, from 191 countries. We estimated any and daily in-home cannabis smoking in the last 30 days among international-GDS respondents (n=63,797), using mixed effects logistic regression. US-GDS respondents (n=6,580) were weighted to the covariate distribution of the nationally representative 2018 National Survey on Drug Use and Health cannabis-using sample, using inverse odds probability weighting, to make estimates more generalizable to the U.S. cannabis-using population. Results: For the international-GDS cannabis-using respondents, any in-home cannabis smoking was reported by 63.9% of men, 61.9% of women, and 68.6% of nonbinary people; and by age (<25 years old=62.7%, 25-34 years old=65.0%, and 35+ years old=62.8%). Daily in-home cannabis smoking was highest among nonbinary (28.7%) and respondents 35+ years of age (28.0%). For the weighted US-GDS cannabis-using respondents, any in-home cannabis smoking was reported by 49.8% of males and 61.2% of females; and by age (<25 years old=62.6%, 25-34 years old=41.8%, 35+ years old=57.9%). Weighted daily in-home smoking was 23.2% among males and 37.1% among females; by age (<25 years old=34.8%, 25-34 years old=27.8%, and 35+ years old=21.6%). Conclusions: There was high daily cannabis smoking in homes of international-GDS and US-GDS respondents who used cannabis in the last 12 months. In part, due to cannabis legalization, the number of users worldwide has increased over the past decade. Criminal stigma historically associated with cannabis continues to drive those users indoors. In this context, our findings support further investigation of cannabis use behavior to understand how often people are exposed to secondhand and thirdhand cannabis smoke and the consequences of that exposure.

The theory of planned behavior and alcohol protective behavioral strategies: a prospective study examining the role of habit and gender invariance

OBJECTIVES

Alcohol Protective Behavioral Strategies (PBS) have consistently shown to be effective in reducing alcohol use and its associated consequences. We aimed to examine the explanatory value of the Theory of Planned Behavior (TPB) for using five PBS, studying the role of habit, and its potential variation across genders.

METHODS

Targeted sampling was used to recruit 339 young adults in the community (women = 50.7%; mean age = 2.21[SD = 2.21]), who completed baseline and 2-month follow-up questionnaires.

RESULTS

The explained variance of the TPB ranged from 58-68% for intention to use PBS, and 18-50% for behavior. The inclusion of habit produced increases of 17-26% in explained variance in intention, while explained variance in behavior remained similar. Habit was the strongest predictor of intention to use PBS, followed by attitude. Except for one behavior (drinking slowly), habits did not moderate the intention-behavior relationship, and the explanatory value of the TPB did not differ across genders.

CONCLUSIONS

Our findings support the utility of the TPB as an explanatory model of alcohol PBS, along with the need to include habits within the framework of dual-process models. Interventions aimed at promoting alcohol PBS could be optimized by targeting attitudes towards PBS and habits.

Using Latent Profile Analysis to Examine Cannabis Use Contexts: Associations with Use, Consequences, and Protective Behaviors

OBJECTIVE

College students represent a large portion of the population, and report high rates of cannabis use and related negative outcomes, including interpersonal problems, risky behaviors, or physical dependency. The contexts in which students use cannabis (e.g., at a party, when feeling down or depressed, after a fight with a loved one) likely affect their risk of experiencing consequences. We aimed to discern profiles of cannabis use contexts and compare profiles on use frequency, consequences, and the use of cannabis protective behavioral strategies (PBS).

METHOD

College students were surveyed regarding their cannabis use contexts, frequency, consequences, and PBS use (n = 265; female = 72.8%). We used Latent Profile Analysis to identify patterns of cannabis use contexts and auxiliary testing to compare profiles on use frequency, consequences, and PBS use.

RESULTS

Our examination revealed three latent profiles of cannabis use. The Social Use Profile was associated with use in predominantly social/uplifting contexts. The Physical & Emotional Pain Profile was also associated with use in these contexts but was defined by additional use in response to pain. The All Contexts Profile was associated with frequent use in all contexts, including those that were least endorsed by the other profiles. Profiles differed in cannabis use frequency, PBS use, and the number of consequences experienced, such that profiles were more likely to be associated with more frequent cannabis use, higher risk of experiencing use-consequences, and using fewer PBS as the number of use contexts increased across the profiles.

CONCLUSIONS

The contexts in which people use cannabis are associated with cannabis risk and protection. Prevention and intervention efforts may benefit from considering contexts of cannabis use.

Framing substance use as "recreational" is neither accurate nor helpful for prevention purposes

This debate paper discusses six reasons why the term "recreational substance use" should be avoided. (1) Social norms and beliefs are drivers of behavior; therefore, the normalized use of the term conveys injunctive norms of a fully socially acceptable substance. Injunctive norms are the most important drivers of initiation into substance use. (2) The illusion of being in control, suggesting that if consumed for leisure and recreation it can easily be controlled; (3) Idealized social representations that fuel an idealized image of an alternative glamourous or mindful consumption culture; (4) Downplaying potential harms; (5) The implicit promise of everyday pleasure, the ever-growing potency of cannabis products does not fit the narrative of its use for recreation; (6) Industry as a trojan horse branding discourse of the concept of medical cannabis to normalize the image of non-medical use: to complement "therapeutic" with "recreational". "Recreational use" is a subjective ill-defined term. This debate paper aims to find a better terminological solution, honestly denominating with a neutral, unbiased, and objective connotation what is now called "recreational use". Thus, we propose using the term "non-therapeutic" use.

Social norms of college students engaging in non-medical prescription drug use to get high: What's sex got to do with it?

Background: Relationships exist between perceived peer and own use of alcohol, cannabis, and tobacco, particularly when peers and participants are sex-matched. We investigated sex influences on social norms effects for college students' non-medical prescription drug use (NMPDU). Methods: N = 1986 college students reported on their perceptions of male and female peers' NMPDU frequency and their own past-month NMPDU. Results: Approximately 3% of students self-reported past month NMPDU, with no sex differences. In a linear mixed model, participants who engaged in NMPDU perceived significantly more frequent peer use. Female participants perceived more frequent peer NMPDU than did male participants, particularly when perceiving male peers' NMPDU. Significant positive correlations were found between perceived peer NMPDU frequency and participants' own NMPDU for all peer-participant sex combinations, with no evidence for stronger correlations with sex-matched pairs. Conclusions: While social norm interventions may be effective for college student NMPDU, sex-matching of these interventions is likely unnecessary.

Binge Drinking and Cannabis Use among Transgender and Gender-Diverse Young Adults in Michigan

Substance use rates are higher among transgender and gender-diverse people than cisgender people. Rates of substance use are also higher among young adults compared with other age groups. However, little research examines substance use among transgender and gender-diverse young adults. This study examines factors associated with binge drinking and cannabis use among transgender and gender-diverse young adults in Michigan. Participants (N = 78; ages 18-25) completed an online survey that included demographics and substance use and related characteristics. Race, stimulant misuse, and sedative misuse were associated with more frequent binge drinking. Older age and past-year pain reliever misuse were associated with less frequent cannabis use. Past-year stimulant use and using cannabis alone were associated with more frequent cannabis use. These findings suggest that additional marginalized identities may increase the risk for maladaptive substance use. Future research should examine substance use behaviors and correlates to inform interventions among this population.

Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample

BACKGROUND

Brief cannabis screening followed by standardized assessment of symptoms may support diagnosis and treatment of cannabis use disorder (CUD). This study tested whether the probability of a medical provider diagnosing and treating CUD increased with the number of substance use disorder (SUD) symptoms documented in patients' EHRs.

METHODS

This observational study used EHR and claims data from an integrated healthcare system. Adult patients were included who reported daily cannabis use and completed the Substance Use Symptom Checklist, a scaled measure of DSM-5 SUD symptoms (0-11), during routine care 3/1/2015-3/1/2021. Logistic regression estimated associations between SUD symptom counts and: 1) CUD diagnosis; 2) CUD treatment initiation; and 3) CUD treatment engagement, defined based on Healthcare Effectiveness Data and Information Set (HEDIS) ICD-codes and timelines. We tested moderation across age, gender, race, and ethnicity.

RESULTS

Patients (N=13,947) were predominantly middle-age, male, White, and non-Hispanic. Among patients reporting daily cannabis use without other drug use (N=12,568), the probability of CUD diagnosis, treatment initiation, and engagement increased with each 1-unit increase in Symptom Checklist score (p's<0.001). However, probabilities of diagnosis, treatment, and engagement were low, even among those reporting ≥2 symptoms consistent with SUD: 14.0% diagnosed (95% CI: 11.7-21.6), 16.6% initiated treatment among diagnosed (11.7-21.6), and 24.3% engaged in treatment among initiated (15.8-32.7). Only gender moderated associations between Symptom Checklist and diagnosis (p=0.047) and treatment initiation (p=0.012). Findings were similar for patients reporting daily cannabis use with other drug use (N=1379).

CONCLUSION

Despite documented symptoms, CUD was underdiagnosed and undertreated in medical settings.

Emerging adult perceptions of cannabis consumption: Examining changes in perceptions from pre-legalization to post-legalization

BACKGROUND

Emerging adults (EAs) have the highest rates of cannabis consumption in Canada and are vulnerable to the potential impacts of frequent cannabis consumption. This study assessed EAs' perceived risk of cannabis consumption across multiple domains of potential harm based on the age (14-year-old, 21-year-old, or 28-year-old) and sex (male or female) of the vignette character, time-point (pre- or post-legalization), and participant's gender.

METHODS

Secondary analyses were conducted on data from a pre-legalization study and post-legalization replication. Participants included EAs between 18 and 25 years of age and living in Newfoundland and Labrador. Participants from the pre- and post-legalization studies were matched based on demographic variables and the assigned vignette character. Participants responded to seven items of perceived risk based on their assigned vignette character's (varied by age or sex) almost daily cannabis consumption.

RESULTS

Participants (N = 689) viewed cannabis consumption to have greater risks for a 14-year-old compared to a 21- or 28-year-old in all domains except for social life. Prior to legalization, participants who identified as a woman felt that cannabis had more detrimental impacts on social life than participants who identified as a man. Findings also suggested that pre-legalization cannabis consumption by a female was perceived as more detrimental to their social life than pre-legalization consumption by a male and post-legalization consumption by a female.

CONCLUSION

EAs do not fully appreciate the risks of cannabis consumption, suggesting that it is imperative for public health strategies to promote increased awareness of the risks of frequent cannabis consumption, and improve cannabis health literacy in this population.

Emerging adult perceptions of higher-risk cannabis consumption behaviours

BACKGROUND

Emerging adults have the highest cannabis consumption rates in Canada and are among the most vulnerable to cannabis-related harms. Since certain cannabis consumption behaviours carry greater risks of harm, the Lower-Risk Cannabis Use Guidelines (LRCUG) provide harm reduction strategies. To address a critical gap in the literature, the current study examined emerging adults' awareness of the guidelines and perceptions of higher-risk cannabis consumption behaviours identified within the LRCUG.

METHODS

Emerging adults (N = 653) between the ages of 18-25 years were recruited from across Canada. Participants were presented with five vignettes depicting a character's cannabis consumption behaviours. Each vignette focused on a unique aspect of the character's consumption (frequency, polysubstance use, family history of mental illness, method of consumption, and potency). Participants were randomly assigned to one of three conditions within each of the five vignettes that were altered to capture varying levels of risk (e.g. weekly, almost daily, or daily consumption). Following each vignette, participants were asked to respond to four items relating to overall risk of harm, cognitive health, physical health, and mental health.

RESULTS

Participants perceived: (1) frequent consumption to be associated with greater risks than less frequent consumption; (2) simultaneous consumption of cannabis and tobacco as being associated with higher risk of harm, yet no difference between simultaneous consumption of cannabis and alcohol or cannabis consumption alone; (3) consuming cannabis with a family history of psychosis or substance use disorder as being associated with greater overall risk than consumption with no family history; (4) smoking and vaping cannabis as associated with more risk than ingesting edibles; and (5) higher-potency THC-dominant strains as being associated with more risk than lower-potency CBD-dominant strains, yet no difference between the two higher-potency THC-dominant strains.

CONCLUSIONS

While emerging adults seemed to appreciate the risks associated with some cannabis consumption behaviours, they had difficulty identifying appropriate levels of harm of other higher-risk behaviours. Through an improved understanding of emerging adult perceptions, effective education campaigns should be designed to improve the awareness of cannabis risks and encourage the uptake of harm reduction awareness and strategies.

Extending Gender- and Sex-Based Analyses in Cannabis Research: Findings from an Online Sample of Gender Diverse Young Adult Consumers

Background: Gender and sex can influence cannabis behaviors and consequences (Cannabis Use Disorder [CUD]). Research typically examines sex and gender independently. Gender analyses often exclude transgender and gender diverse (TGD) populations. The objectives of this study were to (a) replicate less frequent cannabis use among TGD young adults compared to cisgender counterparts (b) compare severity of CUD, and (c) examine the role of sex on cannabis outcomes. Method: Online survey participants between 18 and 34 (N=1213) from the United States who reported past-week cannabis consumption provided information on cannabis practices and CUD from February to April 2022. Bivariate analyses explored gender differences across frequency (daily frequency across routes of administration [ROAs]; daily use of 2+ ROAs, use throughout the day) and CUD. Adjusted regression models provided model-estimated marginal probabilities and means to examine differences across four gender-by-sex categories (cisgender men: n=385; cisgender women: n=681; male-at-birth TGD: n=26; female-at-birth TGD: n=121). Benjamini-Hochberg adjustments (10% false discovery rate) were applied. Results: Among past-week consumers, female-at-birth TGD participants demonstrated lower probability of daily flower smoking compared to cisgender men (0.54 vs. 0.67). Cisgender men reported greater probability of daily concentrate vaping (0.55) compared to cisgender women (0.45) and female-at-birth TGD participants (0.27); they were also more likely to report daily use of 2+ ROAs (cisgender men: 0.51 vs. cisgender women: 0.39 and female at-birth TGD: 0.27). TGD participants reported greater CUD severity compared to cisgender counterparts, t(1096)=-3.69, p=0.002. Model-estimated means found lower severity among cisgender women compared to cisgender men and female-at-birth TGD participants. Stratified regression models support positive associations between daily cannabis use and CUD in both TGD in cisgender groups. Among cisgender participants, greater severity was predicted by male sex, younger age, and younger age of onset. Conclusions: The present study replicates and extends a prior finding that among past-week cannabis consumers, TGD young adults report less frequent use than cisgender counterparts. Despite this, TGD participants demonstrated greater severity of CUD. While analyses were limited by the small sample of male-at-birth TGD participants, the article highlights the importance of expanding sex- and gender-focused analyses. Future work is expanding efforts to target hard-to-reach consumers.

Sex Differences in the Safety and Subjective Effects of Two Oral Δ9-Tetrahydrocannabinol-Containing Cannabis Products over Multiple Doses Among Healthy Adults

Introduction: A growing number of females report consuming cannabis products. There is a paucity of data on sex differences in safety and subjective effects after repeated use of varying oral doses of Δ9-tetrahydrocannabinol (THC; the primary psychoactive constituent of cannabis). Materials and Methods: Data were from two randomized, double-blind, placebo-controlled, multiple-dose, between-subject trials of two THC-containing oral cannabis products. Healthy adults received placebo, low-dose THC (∼2.5 or ∼5 mg per dose), or high-dose THC (∼7.5 or ∼10 mg per dose) twice daily for 7 days. There were 38 males (8 placebo, 17 low-dose THC, 13 high-dose THC) and 46 females (8 placebo, 17 low-dose THC, 21 high-dose THC). Analyses compared adverse events (AEs) and subjective effects between males and females, by THC dose. Results: In the placebo and low-dose THC groups, there were no sex differences in the relative rate of AEs. In the high-dose THC group, females versus males reported 3.08 (95% confidence interval [CI]=1.31-8.33) times as many AEs. There were no significant interactions of sex×low-dose THC group for any subjective effect. In the high-dose THC group, females versus males reported greater "relaxed" ratings (b=15.14, 95% CI=1.44-28.84, p=0.027), whereas in the placebo group, males versus females reported greater ratings of "liking the effect" (b=-30.01, 95% CI=2.77-57.26, p=0.028). Although analyses were underpowered to assess the sex×THC dose×day interaction, the initial sex disparity in AEs and some subjective effects in the high-dose THC group appeared to shrink after the first day. Conclusions: In this exploratory analysis, sex differences in some responses to oral THC were nuanced. Females appeared more sensitive than males to AEs and some subjective effects at higher but not lower doses. Males reported higher ratings than females on some subjective effects in response to placebo. Initial sex differences in response to higher doses of oral THC tended to diminish over 7 days of dosing. If replicated, findings could help inform sex-specific dosing strategies of medical cannabis products and could help educate medical cannabis patients on any temporality of effects.

Attitudes, beliefs, and knowledge regarding medical cannabis among healthcare students in the Republic of Cyprus: a cross-sectional descriptive correlational study

Background

Although international research-based literature from the last 2 decades seems to favor the use of medical cannabis (MC), there is a lack of evidence concerning healthcare students' education on MC in the Republic of Cyprus and across the world. Therefore, this study explores healthcare students' attitudes, beliefs, and knowledge regarding the use of MC. We paid special attention to differences across specific sociodemographic (gender, age, and religion status) and educational (level of study and study field) characteristics.

Methods

A descriptive cross-sectional study was conducted between November 2019 and March 2020. All active undergraduate and postgraduate healthcare students (nurses, physiotherapists, speech therapists, pharmacists, and occupational therapists; N = 900) studying in public and private universities in the Republic of Cyprus were eligible to participate (final sample: N = 819, response rate = 91%). To collect data on the attitudes, beliefs and knowledge of the participants, we used the Medical Cannabis Questionnaire (MCQ). To analyze the data, we employed the Pearson's chi-square test for group differences, in addition to assessing the descriptive and inferential statistics.

Results

Approximately 82.2% believed that MC education should be integrated into the clinical practice requirements. Statistically significant differences were observed between genders in terms of beliefs/risk associated with the use of MC, with males being more likely to believe that there are significant mental-health benefits associated with using ΜC compared to females (84.9% vs. 76.2%, p<0.05). Females were more likely than males to believe that using MC poses serious physical (76.8% vs. 60.6%, p<0.001) and mental-health (77.9% vs. 66%, p<0.001) risks. Moreover, participants who received formal education about MC during their study/training were more prepared to answer patient/client questions about ΜC (p < 0.001). In addition, participants who received formal education had more frequently friends (p < 0.001) or family members who used MC (p < 0.005).

Conclusion

This study provides useful information for curriculum development, educational changes, and policy decisions related to cannabis use for medical purposes in the Republic of Cyprus. The results showed that the majority of the healthcare students who participated in the study favored MC use. However, the participants reported a lack of knowledge and recommended additional evidence-based research and education to enhance their knowledge about MC use. Therefore, we recommend the implementation of formal education on MC among healthcare students in the Republic of Cyprus during their study and clinical training. Furthermore, it is important to include MC-related theoretical and clinical/laboratory courses during studies and clinical practice.

Income inequality and daily use of cannabis, cigarettes, and e-cigarettes among Canadian secondary school students: Results from COMPASS 2018-19

INTRODUCTION

Cannabis, cigarette, and e-cigarette use among Canadian adolescents is a major public health concern. Income inequality has been associated with adverse mental health among youth and may contribute to the risk of frequent cannabis, cigarette, and e-cigarette use. We tested the association between income inequality and the risk of daily cannabis, cigarette, and e-cigarette use among Canadian secondary school students.

METHODS

We used individual-level survey data from Year 6 (2018/19) of Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary Behavior (COMPASS) and area-level data from the 2016 Canadian Census. Three-level logistic models were used to assess the relationship between income inequality and adolescent daily and current cannabis use, cigarette smoking, and e-cigarette use.

RESULTS

The analytic sample included 74,501 students aged 12-19. Students were most likely to report being male (50.4%), white (69.1%), and having weekly spending money over $100 (23.5%). We found that a standard deviation unit increase in Gini coefficient was significantly associated with increased likelihood of daily cannabis use (OR=1.25, 95% CI = 1.01-1.54) when adjusting for relevant covariates. We found no significant relationship between income inequality and daily smoking. While Gini was not significantly associated with daily e-cigarette use, we observed a significant interaction between Gini and gender (OR=0.87, 95% CI= 0.80-0.94), indicating that increased income inequality was associated with higher risk of reporting daily e-cigarette use among females only.

DISCUSSION

An association between income inequality and the likelihood of reporting daily cannabis use across all students and daily e-cigarette use in females were observed. Schools in higher income inequality areas may benefit from targeted prevention and harm reduction programs. Results emphasize the need for upstream discussion on policies that can mitigate the potential effects income inequality.

Impacts of recreational cannabis legalization on use and harms: A narrative review of sex/gender differences

Legalization of cannabis use for non-medical (recreational) purposes is changing the global cannabis landscape. As attitudes toward cannabis use become more positive and prevalence of use increases in complex ways, concerns emerge about the potential for increased cannabis-attributable harms. Understanding the who, why, and when of this likely increase in cannabis-attributable harms is thus an important public health priority. Both sex and gender contribute to variability in the use, effects, and harms of cannabis and thus sex/gender considerations are important when evaluating the impacts of cannabis legalization. The goal of this narrative review is to broadly discuss sex/gender differences in attitudes toward and prevalence of cannabis use, whether there are sex/gender differences in the impacts of cannabis legalization, and why these sex/gender differences might exist. One of our strongest conclusions is that men have always been more likely to use cannabis than women, yet the sex/gender gap in prevalence of cannabis use has narrowed over time, and this might be partly due to cannabis legalization. The existing evidence suggests that there have also been sex/gender differences in the impacts of legalization on cannabis-attributable harms such as cannabis-involved motor vehicle collisions and hospitalizations, though these results are more variable. The body of literature reviewed has focused almost exclusively on samples of cisgender research participants, and thus future research should encourage inclusion of transgender and gender-diverse participants. More consideration of sex- and gender-based analysis in research evaluating long-term impacts of cannabis legalization is a clear research priority.

Emerging Adult Perceptions of Cannabis Consumption Post-Legalization: Considering Age and Sex Differences

PURPOSE

Increased access to legalized non-medical cannabis has led to growing concern over the potential adverse health impacts of cannabis consumption among youth and emerging adults. This study explored emerging adult perceptions of cannabis consumption and if perceptions changed based on the age and sex of the cannabis consumer.

METHODS

Canadian emerging adults between the ages of 18 and 25 years (N = 1,424, Mean = 21.23) were randomly assigned to one of six vignettes that varied by age (14 years, 21 years, and 28 years) or sex (male, female) of the cannabis consumer. Participants were asked to rate seven single-item measures on perceived dangerousness, problematic consumption, negative impacts, and level of disapproval related to the vignette character's almost daily cannabis consumption.

RESULTS

The results of seven 2 × 3 factorial analyses of variance revealed a main effect of age on six of seven items, no main effects of sex, and no interactions. Except for social life, participants noted significant differences in harms of cannabis consumption by 14-year-olds, compared to 21-year-olds and 28-year-olds. There were no significant differences in overall perceived dangerousness, problematic consumption, or impact on mental or cognitive health between 21-year-olds and 28-year-olds. Participants perceived cannabis consumption by a 21-year-old to be more harmful to brain development and reported greater disapproval than consumption by a 28-year-old.

DISCUSSION

Emerging adults may appreciate the impacts of cannabis consumption within their age cohort on brain development and perceive greater risks for youth. Further education should focus on the potential cognitive and mental health impacts of cannabis in emerging adults.

Cannabis use in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND AND AIMS

The most available data on the prevalence of cannabis use come from population surveys conducted in high-income countries in North America, Oceania and Europe. Less is known about the prevalence of cannabis use in Africa. This systematic review aimed to summarize general population-level cannabis use in sub-Saharan Africa since 2010.

METHODS

A comprehensive search was conducted in PubMed, EMBASE, PsycINFO and AJOL databases in addition to Global Health Data Exchange and grey literature without language restriction. Search terms related to 'substance', 'Substance-Related Disorders' and 'Prevalence' and 'Africa South of the Sahara' were used. Studies that reported cannabis use in the general population were selected, while studies from clinical populations and high-risk groups were excluded. Prevalence data on cannabis use in the general population of adolescents (10-17 years) and adults (≥ 18 years) in sub-Saharan Africa were extracted.

RESULTS

The study included 53 studies for the quantitative meta-analysis and included 13 239 participants. Among adolescents, the life-time, 12-month and 6-month prevalence of cannabis use were 7.9% [95% confidence interval (CI) = 5.4-10.9%], 5.2% (95% CI = 1.7-10.3%) and 4.5% (95% CI = 3.3-5.8%), respectively. The corresponding life-time, 12-month and 6-month prevalence of cannabis use among adults were 12.6% (95% CI = 6.1-21.2%), 2.2% (95% CI = 1.7-2.7%, with data only available from Tanzania and Uganda) and 4.7% (95% CI = 3.3-6.4%), respectively. The male-to-female life-time cannabis use relative risk was 1.90 (95% CI = 1.25-2.98) among adolescents and 1.67 (CI = 0.63-4.39) among adults.

CONCLUSIONS

Life-time cannabis use prevalence in sub-Saharan Africa appears to be approximately 12% for adults and just under 8% for adolescents.

Cannabis in Adolescence: Lasting Cognitive Alterations and Underlying Mechanisms

Cannabis consumption during adolescence is an area of particular concern, owing to changes in the social and political perception of the drug, and presents a scientific, medical, and economic challenge. Major social and economic interests continue to push toward cannabis legalization as well as pharmaceutical development. As a result, shifting perceptions of both legal and illicit cannabis use across the population have changed the collective evaluation of the potential dangers of the product. The wave of cannabis legalization therefore comes with new responsibility to educate the public on potential risks and known dangers associated with both recreational and medical cannabis. Among these is the risk of long-term cognitive and psychological consequences, particularly following early-life initiation of use, compounded by high-potency and/or synthetic cannabis, and heavy/frequent use of the drug. Underlying these cognitive and psychiatric consequences are lasting aberrations in the development of synaptic function, often secondary to epigenetic changes. Additional factors such as genetic risk and environmental influences or nondrug toxic insults during development are also profound contributors to these long-term functional alterations following adolescent cannabis use. Preclinical studies indicate that exposure to cannabinoids during specific windows of vulnerability (e.g., adolescence) impacts neurodevelopmental processes and behavior by durably changing dendritic structure and synaptic functions, including those normally mediated by endogenous cannabinoids and neuronal circuits.

Development of scales to measure Lebanese university students’ perceived knowledge about and attitudes about cannabis use: initial psychometric properties

Background

For a long period, cannabis in Lebanon was categorized as an illegal psychoactive substance criminalized by law, despite being the 3rd largest producer of cannabis resin after Morocco and Afghanistan. The current available literature on the topic in Lebanon is scarce, as perceived knowledge towards cannabis use in the general population is not well established, and public health policies are absent. In the context of future legalization of cannabis for both medical and recreational purposes, what is the public’s perception of cannabis perceived knowledge about and attitude against cannabis use? The objectives of this study were to create two scales to assess perceived knowledge towards cannabis use and attitude against cannabis use and check their psychometric properties in a sample of Lebanese university students.

Methods

The study was designed as a cross-sectional study involving 415 Lebanese university students aged between 18 and 30 years. Students were only recruited from one university and were sent an email with a brief description of the study and a link to the questionnaire. The questionnaire items covered perceived knowledge and attitude about cannabis use, recovered and adapted from available literature.

Results

Perceived knowledge items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 64% of the variance (factor 1 = perceived knowledge about cannabis quality of life improvement; factor 2 = perceived knowledge about cannabis psychiatric use; factor 3 = perceived knowledge about cannabis risks; factor 4 = perceived knowledge about cannabis neurological use). Attitude items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 58.2% of the variance (factor 1 = negative attitude about cannabis use; factor 2 = positive attitude about cannabis use). Good Cronbach’s alpha values were found for the perceived knowledge and attitude scales (α = 0.78 and α = 0.73 respectively). Greater perceived knowledge was found in male participants and in those who have tried cannabis for recreational purposes. Greater perceived knowledge was also associated with stronger attitude about cannabis use and older age. Furthermore, greater mean attitude about cannabis use scores were significantly found in male participants and in those who have tried cannabis for recreational or medicinal purposes.

Conclusion

Primary results showed acceptable psychometric properties for the perceived knowledge towards and attitudes about cannabis use scale. Further studies are needed in order to validate them among the general population and assess more psychometric properties of these scales.

Validity of the Single-Item Screen-Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care

Importance

Cannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition.

Objective

To evaluate the Single-Item Screen-Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD.

Design, Setting, and Participants

This diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022.

Exposures

The SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients' medical records.

Main Outcomes and Measures

The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population.

Results

Of 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%.

Conclusions and Relevance

In this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.

Sex Differences in the Neuropsychiatric Effects and Pharmacokinetics of Cannabidiol: A Scoping Review

Cannabidiol (CBD) is a non-intoxicating cannabinoid compound with diverse molecular targets and potential therapeutic effects, including effects relevant to the treatment of psychiatric disorders. In this scoping review, we sought to determine the extent to which sex and gender have been considered as potential moderators of the neuropsychiatric effects and pharmacokinetics of CBD. In this case, 300 articles were screened, retrieved from searches in PubMed/Medline, Scopus, Google Scholar, PsycInfo and CINAHL, though only 12 met our eligibility criteria: eight studies in preclinical models and four studies in humans. Among the preclinical studies, three suggested that sex may influence long-term effects of gestational or adolescent exposure to CBD; two found no impact of sex on CBD modulation of addiction-relevant effects of Δ⁹-tetrahydrocannabinol (THC); two found antidepressant-like effects of CBD in males only; and one found greater plasma and liver CBD concentrations in females compared to males. Among the human studies, two found no sex difference in CBD pharmacokinetics in patient samples, one found greater plasma CBD concentrations in healthy females compared to males, and one found no evidence of sex differences in the effects of CBD on responses to trauma recall in patients with post-traumatic stress disorder (PTSD). No studies were identified that considered the role of gender in CBD treatment effects. We discuss potential implications and current limitations of the existing literature.

Gender inequality in incivility: Everyone should be polite, but it is fine for some of us to be impolite

Civility is formed by social norms that guide our behavior and allow us to interact appropriately with others. These norms affect everyone and are learned through the socialization process. However, in the same process, people also learn gender norms that dictate how men and women should behave, leading to gender stereotypes and differentiated behavioral characteristics. The purpose of this research is to examine the relationship between gender and civility, and how we react to those who behave uncivilly given their gender. The results of Study 1 (N = 153) showed that even in a fictional and gender-neutral society, uncivil behaviors were associated with stereotypically masculine characteristics, and those who behaved uncivilly were dehumanized. In Study 2 (N = 144), gender differences were observed in incivility. Women were harsher when facing uncivil transgressors than men, especially if the transgressor was another woman. Our findings support the notion that gender norms are applied to civility, leading those supposedly equal social norms to unequal perceptions and evaluations.

Impact of the COVID-19 Pandemic on the Evolution of Prevalence and Patterns of Cannabis Use among First-Year University Students in Spain-UniHcos Project

Among university students there has been evidence that the COVID-19 pandemic increased their psychological distress, exacerbated by social restrictions. The main objective of this study was to explore the impact of the COVID-19 pandemic on the prevalence and patterns of cannabis use among university students, in contrast to previous trends since 2012. Data from 10,522 first-year university students (73.3% female, M_age 19 (SD = 1.6)) from eleven Spanish universities collected between 2012 and May 2022 was analysed. Prevalences of cannabis use and their differences by sex were studied, as well as changes in patterns of use and its use for coping during the pandemic. It was found that during lockdown, all prevalence rates of cannabis use decreased in both sexes, showing no statistically significant differences and increasing again in the new normal period in both. Among regular cannabis users, 79.7% reported maintaining or increasing their cannabis use during the pandemic, and of these, half reported using cannabis to cope. Moreover, cannabis use in the usual household increased during the lockdown. These results show that although the overall prevalence of cannabis use was reduced during the lockdown, regular users tended to maintain or increase cannabis use. This could imply two different patterns of use among students, one social and occasional versus the other regular, providing new lines of research for prevention and the implementation of social policies.

Rates of Tobacco Use Disorder, Pharmacologic Treatment, and Associated Mental Health Disorders in a Medicaid Claim Review Among Youth in Indiana, USA

Purpose

This study delineates a number of Medicaid youth with tobacco use disorder (TUD), prescribing habits for treatment, and associated externalizing disorders.

Methods

Youth Medicaid claims from 2007-2017 processed in a large Midwestern city were analyzed for a diagnosis of TUD, related pharmacotherapy, and externalizing mental health and substance use disorders.

Results

Claims connected 6541 patients with 42 890 visits. Mean age was 16.4 with 40% female. 1232 of the 6541 charts contained a TUD diagnosis equating to 1848 visits. A comorbid diagnosis of ADHD, cannabis use, and conduct disorder were more common in males (3.9% vs 1.3% in females; 3.4% vs .8%; and 2.8% vs .8%; P < .05). 808 scripts were provided to 152 of the 1232 youths, with 4.7% of those scripts a nicotine replacement product.

Conclusions

Pharmacotherapy is underutilized in this Medicaid claims data set. Certain externalizing factors were associated with males with TUD more than females.

Exposure to substance and current substance among school-going adolescents in Timor-Leste

Few studies have examined how exposure to substance influences adolescent's use of substance in Timor-Leste. We assessed this relationship using nationally representative data from Timor-Leste to address this gap. Data was pulled from the 2015 Timor-Leste Global school-based student health survey. Data of students aged 13-17years (N = 3700) from class 7-11 across schools in Timor-Leste were analyzed for this study. Second-hand smoking exposure (AOR = 1.57 [1.31, 1.89] and parental tobacco use, AOR = 1.94 [1.54, 2.44]) was significantly related to in-school adolescent's current use of substance after adjusting for covariates. Current substance use was also positively associated with being male, being in class 10-12, and being food insecure and negatively associated with having at least three close friends and benefiting from parental supervision. To reduce substance use among in-school adolescents, policymakers must consider the inclusion of all models in the social learning environment of adolescents in Timor-Leste.

Older adults experiences of using recreational cannabis for medicinal purposes following legalization

BACKGROUND AND OBJECTIVES

Legalization of recreational, or non-medical, cannabis in Canada in 2018 was followed by significant increase in use among older adults. Non-medical cannabis is often used medicinally in this population for issues such as pain, insomnia, and appetite stimulation. The purpose of this study was to explore new cannabis use among older adults within an evolving socio-legal context.

RESEARCH DESIGN AND METHODS

Normalization theory provided the theoretical foundation and qualitative description was the guiding methodology. A convenience sample of twelve participants (ten women, two men) aged 71 to 85 years old was recruited. Data were collected using semi-structured interviews and analyzed thematically.

RESULTS

Findings illustrate factors that influenced participants' beliefs and contributed to their decisions to begin using cannabis in later life. The most important factor was legalization, which sparked a shift in beliefs around using cannabis and shaped the beginning of de-stigmatization around using this substance. Increasing acceptance in their social networks and visibility of cannabis in the media also informed decision-making. However, using cannabis for non-medicinal or social reasons remained stigmatized.

DISCUSSION AND IMPLICATIONS

This research indicates that older adults' beliefs about cannabis use are shifting and this is likely related to legalization and broader social acceptance of cannabis. As a consequence, increased public health education is needed to improve health literacy about cannabis use during this stage of the life-course.

Cannabis Use Increases the Risk of Sickness Absence: Longitudinal Analyses From the CONSTANCES Cohort

Aims

To examine the longitudinal associations between cannabis use and risks of short (<7 days), medium (7-28 days), and long (>28 days) sickness absences at one-year follow-up.

Methods

87,273 participants aged 18-65 years from the French CONSTANCES cohort reported their frequency of cannabis use at inclusion between 2012 and 2018. Sickness absences occurring during one year of follow-up were collected from national medico-administrative registries. Multivariable generalized linear regressions were used to compute the Odds Ratios (OR) with their 95% Confidence Intervals (CI) of having at least one sickness absence at follow-up compared to no sickness absence, while controlling for sociodemographic factors, chronic conditions and occupational factors.

Results

Cannabis use more than once a month was associated with an increased risk of short (OR, [95% CI]: 1.56 [1.32–1.83]) and medium (1.29 [1.07–1.54]) sickness absences at one-year follow-up, with dose-dependent relationships for short sickness absences (1.13 [1.08–1.18], p-for-trend <0.001). In stratified analyses, cannabis use was associated with an increased risk of sickness absences in older individuals, men, participants with good self-rated health, living or having lived as a couple, and having an open-ended contract.

Conclusions

Cannabis use prospectively increased the risk of short and medium sickness absences, even from once a month and with a dose-dependent relationship for short sickness absences. These findings should be considered in information and prevention public health campaigns to alert the general population and workers to this increased risk.

Attitudes, beliefs and knowledge about medical cannabis among nurses and midwives in Cyprus: a cross-sectional descriptive correlational study

BACKGROUND

There is a lack of evidence on healthcare professionals' attitudes, knowledge, and beliefs about medical cannabis in Cyprus and across the world. Therefore, the present study aimed to explore the attitudes, beliefs, and knowledge about MC use among nurses and midwives in Cyprus. Special focus was given to differences across gender, age, religion, marital status, and years of work experience.

METHODS

A descriptive, cross-sectional correlational study with internal comparisons was conducted during the 26^th Nurses and Midwives Congress in Cyprus. All active nurses and midwives (convenience sampling), from the private and national healthcare services (n = 526) were eligible to participate. To analyze the data, the Pearson Chi-square test for group differences was employed, and descriptive and inferential statistics were assessed.

RESULTS

The final sample population consisted of 232 nurses and midwives (response rate of 46.4%). In total, 67(28.9%) participants were male, and 165(71.1%) were female. Cypriot nurses and midwives reported lack of knowledge regarding the risks and benefits about MC use to patients. However, specific number of participants believed MC use was considered acceptable for the patients with persistent muscle spasms, insomnia/sleeping disorders, mental health conditions, and terminal illnesses. The vast majority of the participants believed that formal training on MC should be integrated into academic programs, and expressed the necessity of urgent training under the current curriculum, as well as, educational training programs about MC use should be integrated into the practice/clinical practice. Concerning the socio-demographic characteristics of the participants, gender had a statistically significant positive effect on participants' attitudes and beliefs about MC (p < 0.01, 26.8% vs. 13.4%). Male and unmarried participants reported higher frequency about cannabis use for recreational purposes, compared with female group (p < 0.01, 22.8%Vs 11.4%). Unmarried participants agreed that using cannabis might develop serious mental health risks compared with married participants group (p < 0.05, 77.9% vs. 66.8%).

CONCLUSIONS

The conclusions seem to be rather recommending in favor of MC use. Participants proposed enriching nursing curricula with theoretical and clinical/laboratory courses about MC during studies and clinical practice. Additional tailoring interventions should be established to decrease recreational cannabis use among Cypriot nurses and midwives.

Examining vulnerability and resilience in maternal, newborn and child health through a gender lens in low-income and middle-income countries: a scoping review

INTRODUCTION

Gender lens application is pertinent in addressing inequities that underlie morbidity and mortality in vulnerable populations, including mothers and children. While gender inequities may result in greater vulnerabilities for mothers and children, synthesising evidence on the constraints and opportunities is a step in accelerating reduction in poor outcomes and building resilience in individuals and across communities and health systems.

METHODS

We conducted a scoping review that examined vulnerability and resilience in maternal, newborn and child health (MNCH) through a gender lens to characterise gender roles, relationships and differences in maternal and child health. We conducted a comprehensive search of peer-reviewed and grey literature in popular scholarly databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar. We identified and analysed 17 published studies that met the inclusion criteria for key gendered themes in maternal and child health vulnerability and resilience in low-income and middle-income countries.

RESULTS

Six key gendered dimensions of vulnerability and resilience emerged from our analysis: (1) restricted maternal access to financial and economic resources; (2) limited economic contribution of women as a result of motherhood; (3) social norms, ideologies, beliefs and perceptions inhibiting women's access to maternal healthcare services; (4) restricted maternal agency and contribution to reproductive decisions; (5) power dynamics and experience of intimate partner violence contributing to adverse health for women, children and their families; (6) partner emotional or affective support being crucial for maternal health and well-being prenatal and postnatal.

CONCLUSION

This review highlights six domains that merit attention in addressing maternal and child health vulnerabilities. Recognising and understanding the gendered dynamics of vulnerability and resilience can help develop meaningful strategies that will guide the design and implementation of MNCH programmes in low-income and middle-income countries.

Cannabis Use, Use Motives and Cannabis Use Disorder Among Berlin College Students

This study described cannabis use behavior among college students in Berlin, in particular, differences in use motives between subjects with frequent use and those with signs of cannabis use disorder (CUD). Cross-sectional data were collected via an online survey among Berlin college students ( N=9350; 50.7% women; Mage=24.4). Motivation scales were computed based on an exploratory factor analysis. Effects of these motive scales were compared using multivariate regression models, where the dependent variable was use intensity (ordinal), frequent use (twice or more per week, binary) or a positive substance use disorder screening test (binary). Cannabis use is known to be particularly prevalent among Berlin college students, which was confirmed by our data. The most frequent use motive was enhancement, which, however, was not associated with frequent use or CUD. The motives predicting frequent use (sociability) are different from motives predicting CUD (coping), even when controlling for a wide array of covariates.

Directive clinique no 425a : Le cannabis aux différentes périodes de la vie des femmes - Partie 1 : Fertilité, contraception, ménopause et douleur pelvienne

OBJECTIF

Fournir aux fournisseurs de soins de santé les meilleures données probantes sur l'utilisation de cannabis et la santé des femmes. Les domaines d'intérêt sont : les profils généraux d'utilisation du cannabis ainsi que la sécurité de la consommation; les soins aux femmes qui utilisent le cannabis; la stigmatisation; le dépistage, l'intervention brève et l'orientation vers le traitement; les effets sur la régulation hormonale; la santé reproductive, y compris la contraception et la fertilité; la fonction sexuelle; les effets sur les symptômes périménopausiques et postménopausiques; et l'utilisation dans le traitement des syndromes de douleur pelvienne chronique.

POPULATION CIBLE

La population cible comprend toutes les femmes qui consomment ou utilisent du cannabis ou qui envisagent de le faire. RéSULTATS: Un dialogue ouvert et fondé sur des données probantes relativement à l'utilisation et la consommation de cannabis, dialogue qui mènera à l'amélioration des soins aux patientes. BéNéFICES, RISQUES ET COûTS: L'exploration de l'utilisation et de la consommation de cannabis par une approche basée sur la connaissance des traumatismes donne l'occasion au fournisseur de soins et à la patiente de créer une solide alliance thérapeutique collaborative. Cette alliance permet aux femmes de faire des choix éclairés sur leurs propres soins. Elle facilite également le diagnostic et le traitement possible des troubles de l'usage du cannabis. Il ne faut pas stigmatiser la consommation, car la stigmatisation nuit à l'alliance thérapeutique (c'est-à-dire le partenariat entre la patiente et le fournisseur de soins). Plusieurs effets indésirables de la consommation de cannabis peuvent être confondus avec d'autres problèmes de santé. À l'heure actuelle, l'utilisation du cannabis pour traiter les problèmes de santé féminine n'est pas financée par le secteur public; par conséquent, les utilisatrices doivent assumer les coûts directs. Les coûts indirects de l'utilisation de cannabis sont inconnus. Ainsi, les fournisseurs de soins et les patientes doivent comprendre le rôle du cannabis dans les problèmes de santé féminine de sorte que les femmes puissent prendre des décisions éclairées. DONNéES PROBANTES: Des recherches ont été effectuées dans PubMed, Embase et la littérature grise pour recenser des études publiées entre le 1^er janvier 2018 et le 18 février 2021 concernant l'utilisation du cannabis et ses effets sur l'infertilité, la contraception, les symptômes périménopausiques et postménopausiques et la douleur pelvienne. Toutes les publications des types suivants ont été incluses : essais cliniques, études observationnelles, revues (y compris les revues systématiques et les méta-analyses), directives cliniques et déclarations de conférences de consensus. Un survol des publications a été effectué pour en confirmer la pertinence. Les termes de recherche ont été définis à l'aide des termes MeSH (Medical Subject Headings) et mots clés (et variantes) suivants : cannabis, cannabinoids, marijuana, dexanabinol, dronabinol et tetrahydrocannabinol. À ces termes ont été combinés les termes suivants afin de cerner la santé des femmes : estrogen, estradiol, medroxyprogesterone acetate, vaginal contraception, oral contraceptives, fertilization, amenorrhea, oligomenorrhea, pelvic pain, dysmenorrhea, endometriosis, interstitial cystitis, vulvodynia et menopause. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant l'approche d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins de santé qui prodiguent des soins aux femmes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

Sex, Gender, and Alcohol Use: Implications for Women and Low-Risk Drinking Guidelines

Alcohol use is coming under increasing scrutiny with respect to its health impacts on the body. In this vein, several high-income countries have issued low-risk drinking guidelines in the past decade, aiming to educate the public on safer levels of alcohol use. Research on the sex-specific health effects of alcohol has indicated higher damage with lower amounts of alcohol for females as well as overall sex differences in the pharmacokinetics of alcohol in male and female bodies. Research on gender-related factors, while culturally dependent, indicates increased susceptibility to sexual assault and intimate partner violence as well as more negative gender norms and stereotypes about alcohol use for women. Sex- and gender-specific guidelines have been issued in some countries, suggesting lower amounts of alcohol consumption for women than men; however, in other countries, sex- and gender-blind advice has been issued. This article reports on a synthesis of the evidence on both sex- and gender-related factors affecting safer levels of drinking alcohol with an emphasis on women’s use. We conclude that supporting and expanding the development of sex- and gender-specific low-risk drinking guidelines offers more nuanced and educative information to clinicians and consumers and will particularly benefit women and girls.

Unpacking the Layers: Dismantling Inequities in Substance Use Services and Outcomes for Racially Minoritized Adolescents

Minoritized youth have lower prevalence rates of substance use disorders (SUD) compared with White peers, but proportionally those that are diagnosed are less likely to engage in specialized care and there are few culturally responsive treatments or programs available. We examine social determinants of SUD, with emphasis on the impact of trauma, including racial trauma, and include an intersectional approach incorporating race, ethnicity, and gender. This review of the literature highlights evidence-based effective clinical practice as examples for the field in developing therapeutic approaches to SUD for this population.

Guideline No. 425a: Cannabis Use Throughout Women's Lifespans - Part 1: Fertility, Contraception, Menopause, and Pelvic Pain

OBJECTIVE

To provide health care providers with the best evidence on cannabis use with respect to women's health. Areas of focus include general patterns of cannabis use as well as safety of use; care for women who use cannabis; stigma; screening, brief intervention, and referral to treatment; impact on hormonal regulation; reproductive health, including contraception and fertility; sexual function; effects on perimenopausal and menopausal symptoms; and use in chronic pelvic pain syndromes.

TARGET POPULATION

The target population includes all women currently using or contemplating using cannabis.

OUTCOMES

Open, evidence-informed dialogue about cannabis use, which will lead to improvement in patient care.

BENEFITS, HARMS, AND COSTS

Exploring cannabis use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of cannabis use disorders. Use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Multiple side effects of cannabis use may be mistaken for other disorders. Currently, use of cannabis to treat women's health issues is not covered by public funding; as a result, individual users must pay the direct cost. The indirect costs of cannabis use are unknown. Thus, health care providers and patients must understand the role of cannabis in women's health issues, so that women can make knowledgeable decisions.

EVIDENCE

PubMed, EMBASE, and grey literature were searched to identify studies of "cannabis use and effect on infertility, contraception, perimenopause and menopausal symptoms, and pelvic pain" published between January 1, 2018 and February 18, 2021. All clinical trials, observational studies, reviews (including systematic reviews and meta-analyses), guidelines, and conference consensus statements were included. Publications were screened for relevance. The search terms were developed using the Medical Subject Headings (MeSH) terms and keywords (and variants), including cannabis, cannabinoids, marijuana, dexanabinol, dronabinol, tetrahydrocannabinol; the specific terms to capture women's health were estrogen, estradiol, medroxyprogesterone acetate, vaginal contraception, oral contraceptives, fertilization, amenorrhea, oligomenorrhea, pelvic pain, dysmenorrhea, endometriosis, interstitial cystitis, vulvodynia, and menopause.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

INTENDED AUDIENCE

All heath care providers who care for women.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Cannabis edibles packaging: Communicative objects in a growing market

BACKGROUND

Cannabis edibles were legalized for recreational use across Canada in October 2019. The Canadian Cannabis Act requires legally produced edibles to be sold in plain single-color packages with limited branded elements and prominent health warning labels, serving size and nutritional information, and product ingredients including amounts of cannabis compounds. Little research, however, assesses what consumers think of standardized packaging, and how product packaging influences perceptions of cannabis edibles.

METHODS

Eight focus groups with young adults (ages 18-24; n = 57) were conducted in November 2018. Participants were recruited from a Canadian university, and asked to assess sample images of cannabis packaging approved by Health Canada. They then discussed the information they would like to see on packages. Focus group discussions were transcribed and analyzed using a descriptive, qualitative approach following methods of process evaluation and inductive coding.

RESULTS

Discussions generally pertained to four main themes: dosage and consumption recommendations; food and nutritional information; concerns for children; and health warning labels. Participants suggested improvements for cannabis packaging, including standardized THC units, non-numerical consumption instructions, and unit-dose packaging. Instead of recommending packaging that deters consumption, participants requested packaging features that promote safe consumption by adults while also protecting children. Findings reveal how packages function as communicative objects that convey meanings about safety and risk, yet these meanings may not resonate with Canadian young adults' perceptions of cannabis as relatively safe.

CONCLUSIONS

While the packaging regulated for use in Canada may be assumed, due to its plain, standardized format, to communicate "little", we highlight tensions in the meanings of such packaging to young adults-especially around competing ideas related to safety and risk.

Sex differences in acute cannabis effects revisited: Results from two randomized, controlled trials

Some evidence suggests that males and females may differ in their responses to acute cannabis effects, including subjective drug effects and behavioural effects, and cannabinoid pharmacokinetics. This is significant given current changes to cannabis-related policies and, in consequence, increased cannabis accessibility. The present study combines data from two randomized controlled trials to investigate possible differences among males (n = 21) and females (n = 19) in the acute effects of vaporized cannabis containing 13.75 mg Δ9-tetrahydrocannabinol (THC), with and without cannabidiol (CBD; 13.75 mg). To control for differences in the timing of assessments, peak (or peak change from baseline) scores were calculated for a range of measures including subjective drug effects, cognitive performance, cardiovascular effects, and plasma concentrations of THC, CBD, and their respective primary metabolites. While THC elicited robust and significant changes in all but one outcome measure relative to placebo, relatively few sex differences were observed after controlling for BMI and plasma THC concentrations. Relative to females, males performed better overall on a divided attention task (DAT) and had higher peak plasma concentrations of 11-nor-9-carboxy-THC (11-COOH-THC). Males and females did not differ with respect to plasma concentrations of any other analyte, subjective drug effects, or cardiovascular measures. These data indicate an absence of systematic sex differences in acute cannabis effects given a moderate dose of vaporized cannabis. They do not preclude the possibility that sex differences may emerge with higher THC doses or with other commonly used routes of administration (e.g., orally administered oils or edibles).

Characteristics that influence purchase choice for cannabis products: a systematic review

Introduction

When non-medical cannabis use became legal, government regulators implemented policies to encourage safer consumption through access to a regulated market. While this market is growing, sales still occur through unregulated channels. This systematic review identifies factors influencing cannabis purchasing to help policymakers understand why consumers still purchase illicit market cannabis (registered with PROSPERO CRD42020176079).

Methods

A comprehensive search strategy included databases in health, business, and social science fields (inception to June 2020). Studies were eligible for inclusion if they were conducted with persons who purchase cannabis and examine at least one attribute that would influence purchase choice and were published in the English language. Studies could be of any methodological design. Two independent reviewers completed two levels of screening, and all extraction was verified by a second reviewer. A qualitative synthesis of the findings was completed. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool.

Results

Of the 4839 citations screened, 96 were eligible for full-text review and 35 were included in the final synthesis. Aspects of price were the most common factors (27 studies). Twenty studies measured price elasticity; most studies found that demand was price inelastic. Many other attributes were identified (e.g., product quality, route of administration, product recommendations, packaging), but none were explored in depth. Eleven studies addressed aspects of product quality including demand elasticity based on quality, potency, and aroma. Studies also explored consumer-perceived “quality” but provided no definition; differences in quality appeared to impact consumer choice. Smoking cannabis appeared to be the preferred route of administration but was only examined in three studies. There was insufficient data to understand in the impact of other attributes on choice. There appeared to be preference heterogeneity for different attributes based on the consumer’s experience, reason for use, and gender.

Conclusion

While price influences choices, demand is relatively inelastic. This suggests that consumers may be seeking lowest-cost, unregulated cannabis to avoid reducing consumption. Beyond price, there is a significant gap in our understanding of consumer choices. Perceived quality does appear to impact choice; however, more research is needed due to the lack of a recognized definition for cannabis quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42238-022-00117-0.

The impact of cannabis legalization for recreational purposes on youth: A narrative review of the Canadian experience

Cannabis legalization for non-medical purposes (subsequently referred to as "cannabis legalization" or "legalization") took place in Canada in October 2018. One of the federal government's stated goals with cannabis legalization was to protect Canadian youth from cannabis-related harms. The main objective of this narrative review is to describe the impact of cannabis legalization on Canadian youth. To that end, we discuss the regulation of the Canadian cannabis market, outline changes in the epidemiology and parameters of cannabis use (modes of use, potency of cannabis) among youth, and discuss prevention and education initiatives related to cannabis. The Canadian model differs from other jurisdictions that legalized recreational cannabis use, especially with regard to a higher degree of government regulation of the cannabis market. Another difference is the development and endorsement of lower-risk cannabis use guidelines to educate the public and health professionals. The results available for this review cover only 3 years post-legalization. Cannabis legalization in Canada brought an apparent increase in use among Canadian older than 25. However, results for youth are mixed, with the majority of studies showing no pronounced increase. Notably, the trend of a decrease in adolescents' cannabis use seen pre-legalization may have reversed. Emerging evidence also suggests that cannabis-related hospitalizations and emergency department visits among Canadian youth may have increased due to cannabis legalization. Data about changes in the age of initiation, the influence of legalization on sex and gender, and race/ethnicity are limited, with evidence suggesting that the age of initiation slightly increased. So far, there is limited data about the impact of cannabis legalization on Canadian youth. Further long-term monitoring and research to assess the effects of cannabis legalization on Canadian youth.

How Cannabis Users Obtain and Purchase Cannabis: A Comparison of Cannabis Users from European Countries with Different Cannabis Policies

Objective: This study examines the role of cannabis policy in how cannabis users obtain and purchase cannabis. Methods: A survey was conducted in the Dutch coffeeshops among current cannabis users (n = 1255) aged 18-40 from seven European countries with different cannabis policies. This study investigated whether acquisition methods and supply sources were associated with national cannabis policy, controlling for gender, age, and frequency of use. Results: Cross-national differences notwithstanding, cannabis was easily available to current cannabis users in Europe. Within and across countries, users acquired cannabis in various ways and buyers purchased it from various sources, representing a mixture of open, closed, and semi-open retail markets. Buying cannabis was the most common method of acquisition. Among participants who reported buying their cannabis (n = 929), buying from friends was the most common source of supply, followed by street dealers, home dealers, and delivery services. The vast majority of Dutch participants reported buying cannabis from coffeeshops. Contrariwise, French buyers were more likely to buy cannabis from street dealers and delivery services, and Greek buyers to buy it from home dealers and friends. Overall, the Internet played a marginal role in purchasing cannabis. Conclusion: Our findings confirm the significant role of social supply across Europe. Although cross-national differences were rather common in cannabis acquisition and supply, yet they were not unidirectionally linked with the punitiveness of national cannabis policy. Findings suggest a differentiated normalization of the cannabis retail market, with users often preferring to buy cannabis in a regulated or legal market.

Patterns of Cannabis Use among Canadian Youth over Time; Examining Changes in Mode and Frequency Using Latent Transition Analysis

Background: Historically substance use literature has focused on smoking as the main mode of cannabis consumption, so there are knowledge gaps surrounding current understanding of edibles and vaping. These alternative modes of cannabis use are already common among Canadian youth; however, little is known about how these cannabis use patterns change over time. Methods: This study examined the mode (smoking, eating/drinking, vaping) and frequency of cannabis use among a large sample of Canadian youth who participated in 2017-2018 and 2018-2019 data collection waves of the COMPASS study. Using latent transition analysis, this sample consisting of 18,824 youth in grades 9-12 were categorized into cannabis use classes stratified by sex, and their transition between these classes over the one-year period was examined. Results: Three cannabis use classes were identified (occasional multimode, regular multimode, and smoking) alongside one nonuse class. Among youth who reported cannabis use at baseline, transitioning to a multimode group, and/or increasing frequency of multimode use was likely over the one-year period. Conclusions: These findings may highlight a key leverage point for harm-reduction strategies which aim to prevent cannabis related harms associated with high frequency use.

Changes in alcohol use by cannabis use status among adolescents and young adults in the United States: Emerging evidence for both substitution and complementarity

BACKGROUND

The majority of adolescents and young adults (AYA) who use cannabis also use alcohol. Although cannabis use is increasing in the United States (US), it is not known whether the increase contributes to either increased co-use of alcohol and cannabis (e.g., complementarity) or replacement of alcohol with cannabis (e.g., substitution). The current study estimated the prevalence of alcohol use by cannabis use status among US AYA ages 12 to 25 in 2018 and trends in alcohol use by cannabis use status from 2002 to 2018.

METHODS

Data were drawn from the 2002 to 2018 National Survey on Drug Use and Health public use data files. The analytic sample included AYA ages 12 to 25 (2018 sample, n = 26,924; total combined sample 2002 to 2018, n = 576,053). Linear and logistic regression models were used to estimate past-month alcohol use, daily alcohol use, and average quantity of alcohol consumed among AYA with and without past-month cannabis use from 2002 to 2018.

RESULTS

In 2018, any alcohol use and daily alcohol use were significantly more common among AYA who used cannabis use than those who did not use cannabis. Overall, any alcohol use, daily alcohol use, and average drinks per day declined from 2002 to 2018 among AYA irrespective of recent cannabis use. However, the decline in any alcohol use, daily alcohol use, and average alcohol drinks per day was more rapid among AYA who used cannabis (daily and nondaily) than those who did not use cannabis. The rate of decline in average alcohol drinks per day was also higher among AYA with daily compared to nondaily cannabis use.

CONCLUSIONS

Even with declines in alcohol use over time, drinking is much more common among AYA who report cannabis than those without recent cannabis use, which is consistent with complementarity. Yet, because the decline in alcohol use has been more rapid among AYA who use cannabis, there is also evidence of substitution. Thus, the current data on alcohol and cannabis use are consistent with both complementarity and substitution. However, these relationships may change as cannabis legalization expands over time.

The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic

OBJECTIVES

The SARS-CoV-2 (COVID-19) pandemic has had profound physical and mental health effects on populations around the world. Limited empirical research has used a gender-based lens to evaluate the mental health impacts of the pandemic, overlooking the impact of public health measures on marginalized groups, such as women, and the gender diverse community. This study used a gender-based analysis to determine the prevalence of psychosocial symptoms and substance use (alcohol and cannabis use in particular) by age, ethnicity, income, rurality, education level, Indigenous status, and sexual orientation.

METHODS

Participants in the study were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Those who agreed to participate were asked to self-report symptoms of depression, anxiety, pandemic stress, loneliness, alcohol use, and cannabis use across five phases of the pandemic as well as retrospectively before the pandemic.

RESULTS

For all psychosocial outcomes, there was a significant effect of time with all five phases of the pandemic being associated with more symptoms of depression, anxiety, stress, and loneliness relative to pre-COVID levels (p < .0001). Gender was significantly associated with all outcomes (p < .0001) with men exhibiting lower scores (i.e., fewer symptoms) than women and gender diverse participants, and women exhibiting lower scores than the gender diverse group. Other significant predictors were age (younger populations experiencing more symptoms, p < .0001), ethnicity (Chinese/Taiwanese individuals experiencing fewer symptoms, p = .005), and Indigenous status (Indigenous individuals experiencing more symptoms, p < .0001). Alcohol use and cannabis use increased relative to pre-pandemic levels, and women reported a greater increase in cannabis use than men (p < .0001).

CONCLUSIONS

Our findings highlight the need for policy makers and leaders to prioritize women, gender-diverse individuals, and young people when tailoring public health measures for future pandemics.

Sex differences in the association between parental monitoring and substance use initiation among adolescents

INTRODUCTION

Parental involvement and supervision (i.e., "parental monitoring;" PM) is generally inversely associated with substance use among youth; yet, specific features of this association remain unclear. This study examined PM as a prospective predictor of substance use initiation across adolescence and whether associations generalize across a range of substances and by sex.

METHODS

Participants were enrolled in a longitudinal cohort study of high school students from Southern California. We assessed, among never-users at baseline (2014; participants were in 10th grade), the role of PM in 8 substance use initiation outcomes (initiation of 7 individual substances or categories of substances: alcohol, cigarettes, electronic (e-) cigarettes, cigars, marijuana, stimulants, or opioids, as well as the total number of substances initiated) at follow-up (2017; 12th grade), controlling for sociodemographic characteristics. Multiplicative interactions assessed differences by sex.

RESULTS

In adjusted main effects models, PM was associated with lower odds of initiation of all substances (OR range: 0.60 for cigarettes to 0.82 for alcohol) and male sex was associated with increased odds of initiating use of cigarettes (OR = 1.33, 95% CI = 1.02, 1.73) and cigars (OR = 1.82, 95% CI = 1.32, 2.52) over follow-up. There were also significant PM × sex interactions for cigarettes (p = 0.038), e-cigarettes (p = 0.042), and marijuana (p = 0.044), whereby lower PM was associated with greater odds of initiation among females, compared to males.

CONCLUSIONS

PM is associated with reduced odds of initiating use of multiple substances among adolescents, particularly for females. Future research of the mechanisms underlying these associations can point towards intervention targets to prevent or delay substance use initiation among youth with low PM.

Using the Theory of Reasoned Action to examine grandparent and maternal substance use on the cannabis use of children of teen mothers

BACKGROUND

Parental cannabis use is associated with increased risks of cannabis use among offspring, yet few studies have explored the mechanisms influencing intergenerational continuity in cannabis use. To understand the mechanism by which intergenerational cannabis use is influenced, this work explores cannabis use across three generations using a family expansion of the Theory of Reasoned Action (TRA).

METHODS

Data come from the Young Women and Child Development Study which began when teen mothers were pregnant and followed mother-child dyads for 17 years (N = 240). Constructs include cannabis use of grandparents, mothers, and teens, and TRA constructs of behavioral and normative beliefs, intention, and behavior. Hypotheses were tested using Structural Equation Modeling.

RESULTS

Grandfather's cannabis use was significantly linked to mother's normative beliefs (β = .22, p = .006), but not attitudes (β = .12, p = .182). Teen mothers' attitude was associated with intention (β = .79, p < .001); intention predicted cannabis behavior (β = .61, p < .001). Teen mothers' cannabis use was predictive of adolescent's attitude (β = .21, p = .002); attitude predicted intention (β = .73, p < .001) and intention predicted behavior (β = .60, p < .001).

DISCUSSION

Parents play an influential role in the cannabis use behaviors of adolescents. Future work should consider interventions that target both parent and adolescents, increasing knowledge and skills related to parent-child communication, parental monitoring, and positive parental role modeling to reduce intergenerational continuity of cannabis use.