Historical trends in the grade of onset and sequence of cigarette, alcohol, and marijuana use among adolescents from 1976-2016: Implications for "Gateway" patterns in adolescence

Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial

BACKGROUND

Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors.

OBJECTIVE

This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition.

METHODS

A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models.

RESULTS

In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI -0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only.

CONCLUSIONS

Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623.

Adolescent Polysubstance Use and Co-Occurring Weapon Carrying, Bullying Victimization, and Depressive Symptomology: Patterns and Differences in the United States

Adolescent substance use commonly co-occurs with poor mental health, bullying victimization and risky behaviors that may lead to violence. The purpose was to describe the United States (US) national prevalence of polysubstance use and co-occurring characteristics and associated demographic characteristics among youth. Middle and high school students in the 2019 CDC YRBS survey reported their demographics and current ( ≥ 1 days in the last 30 days) substances used (alcohol, cigarette, e-cigarette, cannabis); polysubstance combinations were generated. Cross-sectional weighted logistic regression estimated odds of polysubstance use and frequent use ( ≥ 6 days in the last 30 days) by weapon carrying, depressive symptoms, bullying victimization, and demographics. Mean age of the sample was 16 years, 51% were boys, 51% were non-Hispanic White. While accounting for 21% of the sample, 22-40% of Multiracial youth reported polysubstance use and frequent use. Odds of frequent polysubstance use (all combinations) were highest for weapon carrying youth.

Age patterns and predictors of cannabis initiation among biracial and monoracial U.S. youth

Background: Understanding cannabis initiation is essential for effective prevention but remains understudied, especially for biracial youth who are disproportionately affected by substance use.Objectives: This study examined age patterns and predictors of cannabis initiation across eight monoracial and biracial groups and explored whether predictor effects varied by age, racialized group, and sex.Methods: Add Health data (n = 12,941, 50% male, baseline mean age = 15.5) were analyzed using discrete-time survival analyses to estimate cannabis initiation probabilities from ages 10-24 by age, racialized group, and other predictors.Results: Cannabis initiation probability followed a quadratic age pattern, increasing from age 10-16 and declining thereafter, with differences by racialized group (p < .05). The highest probabilities of new initiations (at age 16) ranged from lowest to highest as follows: Asian (0.08), Black (0.10), Hispanic (White) (0.12), White (0.15), Biracial White-Indigenous (0.16), Indigenous (0.18), Biracial White-Black (0.19), and Biracial White-Asian (0.25). Age- and race-varying effects were found for peer substance use and parental control (joint Wald test, p < .05). Specifically, peer substance use was positively associated with cannabis initiation during adolescence, peaking in mid-adolescence, with stronger effects for Biracial White-Black and Biracial White-Asian youth than their monoracial peers. The effects of parental control showed complex, group-specific patterns. Family support and religiosity slightly lowered cannabis initiation across racialized groups.Conclusion: These findings highlight distinct cannabis initiation patterns across racialized groups, along with variations in the effects of peer substance use and parental control by age and racialized group.

Disaggregating Trends in Alcohol Involvement Among Hispanic, Black, and White Female and Male U.S. Adolescents: 2002 to 2019

OBJECTIVE

Alcohol involvement is declining among U.S. adolescents; however, studies examining population-level trends in alcohol involvement among females and males from diverse racial and ethnic backgrounds are scarce. Therefore, the current study examined alcohol involvement from 2002 to 2019 among Hispanic, Black, and White U.S. adolescent females and males.

METHOD

Data were from the National Survey on Drug Use and Health, years 2002-2019. Participants were between 12 and 17 years old and Hispanic, non-Hispanic Black, or non-Hispanic White. Annualized change estimates within each subgroup were analyzed separately for the following four alcohol variables: (a) lifetime alcohol use; (b) age at alcohol initiation; (c) past-year drinking days; and (d) respondent's perceived risk of alcohol misuse.

RESULTS

Lifetime alcohol use decreased for all groups, and the decrease was strongest for Hispanic males. Age at alcohol initiation similarly increased for Hispanic and White females and males, with no change in age at alcohol initiation for Black adolescents. Past-year drinking days declined for all groups but was not significant for Black females. Perceiving alcohol misuse as a "great risk" increased only for Hispanic males and females.

CONCLUSIONS

Although alcohol involvement is declining among U.S. adolescents, results from this study highlight that engaging with alcohol is normative among many adolescent groups. Also, when considering sex as well as race and ethnicity, there are important distinctions in patterns of decline in alcohol involvement that should be accounted for to inform future research and screening.

Cannabis use and associated longitudinal transitions in electronic nicotine delivery systems use among young adults in the United States

OBJECTIVE

Cannabis is increasingly the first substance used by young people and research indicates that cannabis use may precede the onset of tobacco use. Little is known, however, about the role of cannabis use in stages of electronic nicotine delivery systems (ENDS) uptake and progression across young adulthood. This study examined the associations between past 30-day (P30D) cannabis use frequency and transitions in ENDS use among young adults.

METHODS

5,018 18-29-year-olds (64.2% female) were recruited from 24 Texas colleges to participate in a multi-wave study across a 4.5-year period from 2014 to 2019. A continuous time, multi-state Markov model was used to assess associations between P30D cannabis use frequency and three ENDS use transitions, spanning at least six months 1) never to P30D use (initiation); 2) P30D to non-P30D use (desistance); and 3) non-P30D to P30D use (re-uptake). The model also included socio-demographic and time-varying intrapersonal (other tobacco use, alcohol use, sensation seeking, depressive symptoms) and interpersonal (peer ENDS use) confounding factors.

RESULTS

Past 30-day cannabis use frequency was associated with an increased probability of ENDS initiation and decreased probability of desistance in the model adjusted for socio-demographic and confounding factors. Past 30-day cannabis use frequency was not associated with an increased probability of ENDS re-uptake in the adjusted model.

CONCLUSIONS

Cannabis use is associated with the uptake and continuation of ENDS use. Findings are concerning given that the most popular ENDS devices used by young adults contain high concentrations of nicotine that increase the risk for nicotine dependence and lifelong use.

The relationship between cannabis and nicotine use: A systematic review and meta-analysis

BACKGROUND AND AIMS

Cannabis and nicotine (tobacco or e-cigarettes) use commonly co-occurs and understanding their relationship can help to inform public health strategies to prevent their harms. We conducted a systematic review and meta-analysis to estimate the association of cannabis use given prior nicotine use and vice versa.

METHODS

PubMed, Embase, PsycINFO, Google Scholar and a hand-search were conducted in 2023 for longitudinal studies of the general population with no restrictions in settings (locations). Random-effects meta-analysis was conducted to estimate odds ratios between cannabis and nicotine use in both directions. The impact of unmeasured confounding was assessed using E-values.

RESULTS

From 5387 identified records, we included 20 studies. Among cannabis-naïve youths, baseline use of any nicotine products was positively associated with initiation of any cannabis use at follow-up [odds ratio (OR) = 5.39, 95% confidence interval (CI) = 3.19, 9.11; adjusted OR (aOR) = 2.59, 95% CI = 2.01, 3.32]. In nicotine-naïve participants (youths + adults), baseline cannabis use was positively associated with the initiation of any nicotine use at follow-up (OR = 4.08, 95% CI = 2.05, 8.11; aOR = 2.94, 95% CI =1.54, 5.61). There were no significant associations between baseline cannabis use and subsequent initiation of any nicotine (aOR = 3.29, 95% CI = 0.85, 12.76) or daily nicotine use (aOR = 2.63, 95% CI = 0.41, 16.95) among youths. The median E-values were 5.5 for nicotine exposure and cannabis use initiation and 4.1 for cannabis exposure and nicotine use initiation, indicating that substantial unmeasured confounding would need to have a strong association with both outcomes to fully explain away the cannabis and nicotine relationship.

CONCLUSION

Although the evidence for associations between cannabis use and tobacco use is mixed, a majority of studies to date have found that cannabis use is associated with prior nicotine use and vice versa.

Initiation of high-intensity drinking and subsequent substance use in young adulthood

High-intensity drinking (HID; 10+ drinks/occasion) is associated with acute and long-term risks, including use of other substances. Earlier HID initiation is associated with high-risk alcohol use in young adulthood. Less is known about when HID initiation occurs relative to other substances and how it is associated with subsequent substance use. This study examined survey data from 468 respondents (35.5% female, 65.5% non-Hispanic white) who reported initiating HID by age 20. Weighted descriptive statistics of year of initiation for HID, marijuana, and nicotine were obtained. Weighted linear and logistic regressions examined associations between year and order of HID initiation and age 20 substance use (i.e., nicotine vaping, cigarette use, other tobacco use, marijuana use, marijuana vaping, simultaneous alcohol and marijuana use, and other illicit drug use) and alcohol use disorder (AUD) symptoms. Over half of participants initiated HID after marijuana (54.6%) and nicotine (54.4%). Later HID initiation was associated with fewer AUD symptoms and lower odds of all outcomes except marijuana and other illicit drug use. Initiating HID before marijuana was associated with lower odds of marijuana use outcomes and other illicit drug use at age 20. Initiating HID before nicotine was associated with lower odds of all substance use outcomes at age 20. Earlier HID initiation was associated with risk for subsequent substance use, but initiating HID earlier than other substances was not. Given its association with both alcohol-related outcomes and other substance use in young adulthood, earlier HID initiation is an important target for screening and intervention.

Decreasing brain activity caused by acute administration of ketamine and alcohol - A randomized, controlled, observer-blinded experimental study

Introduction

Substance abuse is a major public health problem. In recent years, ketamine, which is a parenteral anesthetic, has been consumed increasingly as an illicit drug together with alcohol, although little is known of how this association alters brain activity. The present study investigated the influence of progressive doses of ketamine, associated with alcohol, on electrophysiological activity.

Methods

For this, 72 late-adolescent (8-10-week-old) male Wistar rats received either ketamine only, at low (10 mg/kg), intermediate (20 mg/kg) or high (30 mg/kg) doses via intraperitoneal injection, or alcohol (2 mL/100 g) via oral gavage followed by ketamine (at low, intermediate, and high doses). Electroencephalograms (EEG) and electromyographic recordings were obtained 5 min after the final application of the drug.

Results

When administered alone, ketamine resulted in an increase in delta, theta, beta, and gamma brainwaves, with a more pronounced effect being detected at the highest dose (30 mg/kg) in the case of the delta, beta, and gamma waves. The amplitude of the alpha brainwaves was reduced at all doses of ketamine, but less intensively at the highest dose. When administered alone, alcohol reduced all the brainwaves, with the reduction in the alpha waves being exacerbated by ketamine at all doses, and that of the theta and beta waves being boosted at the lowest dose. The intermediate dose of ketamine (20 mg/kg) reverted the alcohol-induced reduction in the theta and gamma waves, whereas the high dose increased delta, theta, beta, and gamma bandpower.

Discussion

Overall, then, while ketamine enhances the depressant effects of alcohol on the alpha brainwave at all doses, a low dose intensified this effect on the theta and beta 175 waves, whereas a high dose produces neuronal hyperexcitability in the theta and 176 gamma bandpower.

Enjoyment in Sport and Alcohol Use among Adolescents: Examining the Mediating Role of Engagement

BACKGROUND

Alcohol consumption among young people is a significant public health concern. Previous studies have indicated that participation in sports, through the positive experiences it offers, may function as a protective factor against alcohol intake. This study aimed to examine the influence of enjoyment and personal fulfillment on adolescent alcohol use, exploring the role of engagement with sports as a mediating variable.

METHODS

A total of 370 adolescents (mean age = 15.08; SD = 1.48) participated in the study and completed the Alcohol Use Disorder Identification Test, the Enjoyment in Sports Scale, and the Athlete Engagement Questionnaire.

RESULTS

The results demonstrated that enjoyment is related to lower alcohol consumption through personal fulfillment and engagement in sporting activity.

CONCLUSIONS

It is crucial to facilitate positive experiences in sport that promote engagement and generate a sense of personal fulfillment, as these factors may reduce the likelihood of risky alcohol consumption.

Early Drinking Onset and Subsequent Alcohol Use in Late Adolescence: a Longitudinal Study of Drinking Patterns

PURPOSE

The age of drinking onset is a central concept for both policy and prevention of alcohol-related harm, yet evidence on the predictive value of the age of onset is lacking. This study compares alcohol outcomes of adolescents who started to drink early with those who started later, and tests if associations are moderated by other explanatory factors.

METHODS

Data from a two-wave longitudinal prospective cohort survey with a Swedish nationwide sample of 4,018 adolescents aged 15/16 years at baseline (T1) and 17/18 years at follow-up (T2) were used. Outcome variables at T2 were Alcohol Use Disorders Identification Test (AUDIT)-C, risky drinking, and binge drinking monthly or more often. A vast number of explanatory factors at T1 were controlled for.

RESULTS

Early drinking onset predicted later higher AUDIT-C scores (β = 0.57, p value < .001), and higher probability of risky drinking (odds ratio = 1.95, 95% confidence interval = 1.56-2.44), and binge drinking (odds ratio = 1.38, confidence interval = 1.06-1.81), controlled for other explanatory factors. If binge drinking frequency at T1 was included, the associations remained for AUDIT-C and risky drinking, but not for binge drinking at T2. No significant interactions between early drinking onset and the explanatory factors were found.

DISCUSSION

Early drinking onset predicts subsequent higher alcohol consumption in late adolescence. Adolescents who had an early drinking onset drank more after 2 years than their peers who started later. The age of drinking onset is an independent predictor of alcohol use outcomes, beyond the effect of age of binge drinking onset.

First Comes Substance Use, Then Comes Social Media Posts? Examining the Temporal Ordering and Relative Strength of Relations Across Alcohol, Tobacco and Marijuana Use and Posting Behavior

Social media posts represent a major route by which youth share their substance use cognitions and experiences with others. Extant research has primarily examined relations between alcohol-related posts and posters' own alcohol use, yet little is known about the role of social media in the use of less socially accepted substances, namely tobacco and marijuana. Our study represents the first to examine the relative strength of this relation across alcohol, tobacco, and marijuana. The current research used a one-month time lag to tease apart the temporal ordering of substance-use-posting and participants' own substance use. A sample of 282 15-20-year-olds (Mage = 18.4, SD = 1.3, 52.9% female) in the United States completed two self-report surveys, one month apart. Results of a cross-lagged panel model revealed significant effects of alcohol and marijuana consumption on subsequent alcohol- and marijuana-related posting, respectively (i.e., selection effects). However, reverse relations (i.e., self-effects) were not significant. Further, we found no differences in the strength of selection effects across substances, suggesting they are similar for both more (alcohol) and less (marijuana and tobacco) socially acceptable substances. Results point to the importance of using young people's social media posts as a way to help identify individuals at risk for heightened substance use and social media as a mechanism for targeted prevention programming.

Understanding youth drinking decline: Similarity and change in the function and social meaning of alcohol use (and non-use) in adolescent cohorts 20 years apart

INTRODUCTION

Qualitative research aimed at understanding the decline in youth drinking has so far been hampered by a lack of baseline data for comparison. This New Zealand study overcomes this limitation by comparing archival qualitative data collected at the height of youth drinking (1999-2001) with contemporary data collected for this study (June-October 2022). The aim is to explore changes in the function and social meaning of alcohol use (and non-use) for two cohorts about 20 years apart.

METHODS

Both archival and contemporary data were collected from 14 to 17 year old secondary school students (years 10-12) through individual and small-group/pair interviews in matched suburban co-ed schools. Interviews explored friendships, lifestyles, romantic relationships and experiences and perceptions of substance use and non-use.

RESULTS AND DISCUSSION

Comparative analysis highlighted changes that may help to explain the decline in youth drinking, including an increased value placed on personal choice and acceptance of diversity; decreased face-to-face socialising and the emergence of social media as a central feature of adolescent social life, perhaps displacing key functions of drinking and partying; increased pervasiveness of risk discourses and increased awareness of health and social risks of alcohol; and increased framing of alcohol use as a coping mechanism by both drinkers and non-drinkers.

CONCLUSIONS

Collectively, these changes appear to have shifted the social position of drinking from an almost compulsory component of adolescent social life in 1999-2001, to an optional activity that many contemporary adolescents perceive to have high risks and few benefits.

Trends in alcohol-related harm among Swedish youth: Do in-patient care registry data match drinking trends?

INTRODUCTION

Youth drinking has been declining in Sweden since the year 2000. There is a paucity of studies examining trends in alcohol-related harm during this period. The overall aim of the present study is to examine how trends in alcohol-related harm match trends in drinking among Swedish youths during 2000-2021.

METHODS

Measures of alcohol use were obtained from national school surveys. Prevalence rates of any alcohol use and heavy episodic drinking were used. Alcohol-related harm indicators were obtained from registry information from the National Board of Health and Welfare. Annual trends in harm indicators were tested with linear regression models and correlations between alcohol use and alcohol-related harm indicators were assessed using Pearson's correlation on annual data.

RESULTS

Statistically significant negative trends were observed for all alcohol-related harm indicators for the period 2000-2021. Significant correlations were found for both measures of alcohol use and all alcohol-related harm indicators.

DISCUSSION AND CONCLUSIONS

The levels of alcohol-related harm have declined among youths in Sweden during the period 2000-2021. The trends in harm seem to reflect the decline in youth drinking that has occurred during the same period.

Geographic Variation, Economic Activity, and Labor Market Characteristics in Trajectories of Suicide in the United States, 2008-2020

Suicide rates in the United States have increased over the past 15 years, with substantial geographic variation in these increases; yet there have been few attempts to cluster counties by the magnitude of suicide rate changes according to intercept and slope or to identify the economic precursors of increases. We used vital statistics data and growth mixture models to identify clusters of counties by their magnitude of suicide growth from 2008 to 2020 and examined associations with county economic and labor indices. Our models identified 5 clusters, each differentiated by intercept and slope magnitude, with the highest-rate cluster (4% of counties) being observed mainly in sparsely populated areas in the West and Alaska, starting the time series at 25.4 suicides per 100,000 population, and exhibiting the steepest increase in slope (0.69/100,000/year). There was no cluster for which the suicide rate was stable or declining. Counties in the highest-rate cluster were more likely to have agricultural and service economies and less likely to have urban professional economies. Given the increased burden of suicide, with no clusters of counties improving over time, additional policy and prevention efforts are needed, particularly targeted at rural areas in the West.

Tribal Reservation Adolescent Connections Study: A study protocol using mixed methods for examining social networks and associated outcomes among American Indian youth on a Northern Plains reservation

BACKGROUND

Rich cultural and traditional practices make interpersonal relationships vital for American Indian (AI) youth. Social relations and multigenerational networks (i.e., peer, family, kinship, and community) remain a salient fixture of AI culture, survival and thriving in reservation communities. Research in other populations has demonstrated how social networks impact youth risk and resilience, but data are lacking on AI adolescent networks. Intergenerational trauma from settler colonialism leads some AI youth to early initiation of substance use and subsequent substance misuse, along with disproportionately high risk for suicide and vulnerability to witnessing and experiencing violence. Using network data to develop prevention strategies among this population is a promising new avenue of research. In this study protocol paper, we describe the rationale and methodology of an exploratory study to be conducted with American Indian 9th and 10th graders at three schools on a Northern Plains reservation.

METHODS

This mixed methods study will collect quantitative social network surveys (N = 300) and qualitative interviews (n = 30). The study will examine the extent to which existing social network theories and data metrics adequately characterize AI youth networks or how they may need to be expanded for this population. Associations of network characteristics with risk and protective factors for substance use, exposure to violence, and suicide will also be examined.

DISCUSSION

This innovative methodological approach holds promise for informing the development of effective preventive approaches to address co-occurring risks for substance use, violence and suicide among AI adolescents. Understanding processes that impact social networks among AI adolescents can promote culturally resonant social relationships that may support better outcomes for youth.

A Systematic Review of Qualitative Studies on Factors Associated With Smoking Cessation Among Adolescents and Young Adults

OBJECTIVE

To summarize findings from qualitative studies on factors associated with smoking cessation among adolescents and young adults.

DATA SOURCES

We searched Pubmed, Psychinfo, CINAHL, Embase, Web of Science, and SCOPUS databases, as well as reference lists, for peer-reviewed articles published in English or French between January 1, 2000, and November 18, 2020. We used keywords such as adolescents, determinants, cessation, smoking, and qualitative methods.

STUDY SELECTION

Of 1724 records identified, we included 39 articles that used qualitative or mixed methods, targeted adolescents and young adults aged 10-24, and aimed to identify factors associated with smoking cessation or smoking reduction.

DATA EXTRACTION

Two authors independently extracted the data using a standardized form. We assessed study quality using the National Institute for Health and Care Excellence checklist for qualitative studies.

DATA SYNTHESIS

We used an aggregative meta-synthesis approach and identified 39 conceptually distinct factors associated with smoking cessation. We grouped them into two categories: (1) environmental factors [tobacco control policies, pro-smoking norms, smoking cessation services and interventions, influence of friends and family], and (2) individual attributes (psychological characteristics, attitudes, pre-quitting smoking behavior, nicotine dependence symptoms, and other substances use). We developed a synthetic framework that captured the factors identified, the links that connect them, and their associations with smoking cessation.

CONCLUSIONS

This qualitative synthesis offers new insights on factors related to smoking cessation services, interventions, and attitudes about cessation (embarrassment when using cessation services) not reported in quantitative reviews, supplementing limited evidence for developing cessation programs for young persons who smoke.

IMPLICATIONS

Using an aggregative meta-synthesis approach, this study identified 39 conceptually distinct factors grouped into two categories: Environmental factors and individual attributes. These findings highlight the importance of considering both environmental and individual factors when developing smoking cessation programs for young persons who smoke. The study also sheds light on self-conscious emotions towards cessation, such as embarrassment when using cessation services, which are often overlooked in quantitative reviews. Overall, this study has important implications for developing effective smoking cessation interventions and policies that address the complex factors influencing smoking behavior among young persons.

Association of cannabis, cannabidiol and synthetic cannabinoid use with mental health in UK adolescents

BACKGROUND

Cannabis has been associated with poorer mental health, but little is known of the effect of synthetic cannabinoids or cannabidiol (often referred to as CBD).

AIMS

To investigate associations of cannabis, synthetic cannabinoids and cannabidiol with mental health in adolescence.

METHOD

We conducted a cross-sectional analysis with 13- to 14-year-old adolescents across England and Wales in 2019-2020. Multilevel logistic regression was used to examine the association of lifetime use of cannabis, synthetic cannabinoids and cannabidiol with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations.

RESULTS

Of the 6672 adolescents who participated, 5.2% reported using of cannabis, 1.9% reported using cannabidiol and 0.6% reported using synthetic cannabinoids. After correction for multiple testing, adolescents who had used these substances were significantly more likely to report a probable depressive, anxiety or conduct disorder, as well as auditory hallucinations, than those who had not. Adjustment for socioeconomic disadvantage had little effect on associations, but weekly tobacco use resulted in marked attenuation of associations. The association of cannabis use with probable anxiety and depressive disorders was weaker in those who reported using cannabidiol than those who did not. There was little evidence of an interaction between synthetic cannabinoids and cannabidiol.

CONCLUSIONS

To our knowledge, this study provides the first general population evidence that synthetic cannabinoids and cannabidiol are associated with probable mental health disorders in adolescence. These associations require replication, ideally with prospective cohorts and stronger study designs.

Experience with dronabinol consumption facilitated a stimulant effect of alcohol and affected alcohol-related changes in frontal cortical endocannabinoid levels in male rats

Combined use of cannabis and alcohol is common in adolescents. However, the extent to which such polydrug exposure affects the brain and behaviors remains under-investigated in preclinical studies. This study tested the hypothesis that combined exposure of Δ-9-tetrahydrocannabinol (THC), the main psychoactive constituent of cannabis, and alcohol will have additive effects on cognitive impairments and altered endocannabinoid levels in the hippocampus and frontal cortex. Male Long Evans rats were provided with daily access to cookies laced with oil or dronabinol, a synthetic THC, during adolescence. Three days after discontinuation of edible THC, the effect of orally administered 3 g/kg alcohol on Barnes maze performance was assessed. The results showed that experience with edible THC facilitated the occurrence of increased moving speed on the maze induced by repeated alcohol administration. However, contrasting to the hypothesis, the combined THC and alcohol exposure did not lead to additive deficits in learning and memory on the Barnes maze. While little effect on endocannabinoid levels was observed in the hippocampus, acute abstinence from alcohol significantly reduced endocannabinoid levels in the frontal cortex. In particular, reduction of N-oleoyl ethanolamine (OEA) and N-stearoyl ethanolamine (SEA) were robust and had an interactive effect with discontinuation from edible THC. These findings add to the scarce literature on THC and alcohol associated changes in endocannabinoid levels and provide insights to future investigations on the roles of OEA and SEA on physiology and behaviors following THC and alcohol co-exposure during adolescence.

Adolescent simultaneous use of alcohol and marijuana by trends in cigarette and nicotine vaping from 2000 to 2020

BACKGROUND

Simultaneous alcohol and marijuana (SAM) use is associated with adverse consequences for youth. While SAM use is overall declining among youth, prior studies indicate increasing marijuana use among US adolescents who ever used cigarettes, suggesting possible moderation of the alcohol-marijuana relationship by cigarette use.

METHODS

We included 43,845 12-th grade students participating in Monitoring the Future data (2000-2020). A 5-level alcohol/marijuana measure was used, including past-year SAM, alcohol-only, marijuana-only, non-simultaneous alcohol and marijuana, or no use. Multinomial logistic regressions estimated associations between time periods (categorized based on sample size: 2000-2005, 2006-2009, 2010-2014, 2015-2020) and the 5-level alcohol/marijuana measure. Models adjusted for sex, race, parental education and survey mode and included interactions of time periods and lifetime cigarette or vaped nicotine use.

RESULTS

While overall SAM among 12th graders decreased from 23.65% to 18.31% between 2000 and 2020, SAM increased among students who never used cigarettes or vaped nicotine (from 5.42% to 7.03%). Among students who ever used cigarettes or vaped nicotine, SAM increased from 39.2% in 2000-2005-44.1% in 2010-2014 then declined to 37.8% in 2015-2020. Adjusted models controlling for demographics indicated that among students with no lifetime cigarette or vaped nicotine use, students in 2015-2020 had 1.40 (95% C.I. 1.15-1.71) times the odds of SAM, and 5.43 (95% C.I. 3.63-8.12) times the odds of marijuana-only (i.e., no alcohol use) compared to students who used neither in 2000-2005. Alcohol-only declined over time in both students who ever and never used cigarettes or nicotine vape products.

CONCLUSION

Paradoxically, while SAM declined in the overall adolescent US population, the prevalence of SAM increased among students who have never smoked cigarettes or vaped nicotine. This effect arises because of a substantial decline in the prevalence of cigarette smoking; smoking is a risk factor for SAM, and fewer students smoke. Increases in vaping are offsetting these changes, however. Preventing adolescent use of cigarettes and nicotine vaped products could have extended benefits for other substance use, including SAM.

Marijuana, e-cigarette, and tobacco product use in young adults who underwent pediatric bariatric surgery

BACKGROUND

The postoperative course after pediatric metabolic and bariatric surgery (MBS) cuts across a developmental phase when substance-use behaviors emerge as significant public health concerns.

OBJECTIVE

We examined use of marijuana, conventional cigarettes, and alternate tobacco products/devices (e.g., e-cigarettes, hookah, smokeless, dissolvable) in young adults (YA) to 6 years postsurgery.

SETTING

Five academic medical centers.

METHODS

In a prospective observational cohort series, 139 surgical (Mage = 16.9, Mbody mass index [BMI] = 51.5, 80% female, 66% white) and 83 nonsurgical comparisons (Mage = 16.1, MBMI = 44.9, 82% female, 54% white) completed assessments at presurgery/baseline and postsurgery years 2, 4, and 6 (year 6 [2014-2018]: surgical n = 123 [89%], Mage = 23.0, MBMI = 39.8; nonsurgical n = 63 [76%], Mage = 22.4, MBMI = 53.6). Lifetime and current (past 30 days) use were reported.

RESULTS

Consistent with national YA trends (2014-2018), the most commonly used were (1) conventional cigarettes (30% surgical, 41% nonsurgical, nonsignificant [ns]); (2) marijuana (25% surgical, 27% nonsurgical, ns); and (3) e-cigarettes (12% surgical, 10% nonsurgical). A sizable minority (26% surgical, 18% nonsurgical) used one or more alternate tobacco product/device. Many YA reported persistent and/or heavy use (e.g., >50% marijuana at year 6 and year 2 or 4; ≈50% ≥.5 pack/d of cigarettes), suggesting more established (versus intermittent) health risk behaviors. For the surgical group at year 6, current tobacco product/device use was associated with lower BMI (P < .001) and greater percent weight loss (P = .002).

CONCLUSIONS

Pediatric MBS demonstrates promise in lowering risks for adult chronic disease, which may be diminished by age-typical health risk behaviors. Developmentally salient and holistic pediatric postoperative care guidelines are needed.

Abstainers and Drinkers - Two Sides of the Same Coin?

This commentary discusses a recently published literature review focussing on the growing trend of young people abstaining from drinking alcohol. Despite the recent increase in research on the decline in youth drinking, the review only identified 10 papers that explicitly examined abstainers. The inclusion criteria used thus excluded and overlooked the vast literature available on the decline in youth drinking. This commentary discusses the implications of this and raises the issue of how the adolescent abstainer should be viewed in research; is it a distinct social phenomenon with unique determinants or are abstainers merely the flip side of drinkers?

Associations of alternative cannabis product use and poly-use with subsequent illicit drug use initiation during adolescence

RATIONALE

Specific cannabis products may differentially increase risk of initiating non-cannabis illicit drug use during adolescence.

OBJECTIVE

To determine whether ever- and poly-use of smoked, vaporized, edible, concentrate, or blunt cannabis products are associated with subsequent initiation of non-cannabis illicit drug use.

METHODS

High school students from Los Angeles completed in-classroom surveys. The analytic sample (N = 2163; 53.9% female; 43.5% Hispanic/Latino; baseline M age = 17.1 years) included students who reported never using illicit drugs at baseline (spring, 11th grade) and provided data at follow-up (fall and spring, 12th grade). Logistic regression models assessed associations between use of smoked, vaporized, edible, concentrate, and blunt cannabis at baseline (yes/no for each product) and any non-cannabis illicit drug use initiation-including cocaine, methamphetamine, psychedelics, ecstasy, heroin, prescription opioids, or benzodiazepines-at follow-up.

RESULTS

Among those who never used non-cannabis illicit drugs at baseline, ever cannabis use varied by cannabis product (smoked = 25.8%, edible = 17.5%, vaporized = 8.4%, concentrates = 3.9%, and blunts = 18.2%) and patterns of use (single product use = 8.2% and poly-product use = 21.8%). After adjustment for baseline covariates, odds of illicit drug use at follow-up were largest for baseline ever users of concentrates (aOR [95% CI] = 5.74[3.16-10.43]), followed by vaporized (aOR [95% CI] = 3.11 [2.41-4.01]), edibles (aOR [95% CI] = 3.43 [2.32-5.08]), blunts (aOR [95% CI] = 2.66[1.60-4.41]), and smoked (aOR [95% CI] = 2.57 [1.64-4.02]) cannabis. Ever use of a single product (aOR [95% CI] = 2.34 [1.26-4.34]) or 2 + products (aOR [95% CI] = 3.82 [2.73-5.35]) were also associated with greater odds of illicit drug initiation.

CONCLUSIONS

For each of five different cannabis products, cannabis use was associated with greater odds of subsequent illicit drug use initiation, especially for cannabis concentrate and poly-product use.

Associations between early childhood adversity and behavioral, substance use, and academic outcomes in childhood through adolescence in a U.S. longitudinal cohort

BACKGROUND

Childhood adversity is strongly associated with adolescent substance use, but few epidemiologic studies have investigated early childhood adversity (ECA) before age 5. This study investigated pathways by which ECA is associated with adolescent alcohol and cannabis use and high school completion through childhood behavioral and academic mediators and their reciprocal effects.

METHODS

Data were from the National Longitudinal Survey of Youth 1979-Child/Young Adult Cohort which surveyed children born 1984-1999 and followed through 2016 (n = 5521). Outcomes included alcohol and cannabis use frequency at ages 15-18, and high school completion by age 19. ECA at ages 0-4 was a cumulative score of maternal heavy drinking/drug use, low emotional support, low cognitive stimulation, and household poverty. Multilevel path models were conducted with ECA, childhood mediators (behavioral (externalizing and internalizing problems) and academics (reading and math scores), accounting for demographics and confounders.

RESULTS

ECA was indirectly associated with adolescent cannabis frequency through mediators of externalizing/internalizing problems, low academics, and early cannabis onset before age 14. ECA was also indirectly associated with alcohol frequency via the same mediators, but not early alcohol onset. Greater behavioral problems elevated substance use risk; whereas, low academics reduced risk. Reciprocal effects were evident between childhood behavioral problems and cannabis frequency to high school completion.

CONCLUSION

Adversity from birth to age 4 is associated with childhood behavioral problems and lower academics, which increased adolescent alcohol and cannabis use and lowered high school completion. Early childhood interventions with parents and preschools/daycare may reduce early onset and adolescent substance use.

Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis aims to synthesize the efficacy of culturally sensitive prevention programs for substance use outcomes among U.S. adolescents of color (aged 11 to 18 years old) and explore whether the intervention effects vary by participant and intervention characteristics. Eight electronic databases and grey literature were searched for eligible randomized controlled trials through September 2022. Robust variance estimation in meta-regression was used to synthesize treatment effect size estimates and to conduct moderator analysis. After screening, 30 unique studies were included. The average treatment effect size across all substance use outcomes (including 221 effect sizes) was Hedges's g = -0.20, 95% CI = [-0.24, -0.16]. The synthesized effect sizes were statistically significant across types of substances (alcohol, cigarette, marijuana, illicit and other drugs, and unspecified substance use), racial/ethnic groups (Hispanic, Black, and Native American), and different follow-ups (0-12 months, >12 months). Very few studies reported substance use consequences as outcomes and the synthesized effect size was non-significant. Meta-regression findings suggest that the intervention effects may vary based on the type of substance. This meta-analysis found supportive evidence of culturally sensitive prevention programs' efficacy in preventing or reducing substance use among Black, Hispanic, and Native American adolescents. More substance use prevention efforts and evidence is needed for Asian American, Pacific Islander, and multiracial adolescents.

The relationship between age at first drink and later risk behaviours during a period of youth drinking decline

AIMS

Alcohol consumption among teenagers in many high-income countries has steadily declined since the early 2000s. There has also been a steady increase in the average age at first drink, a reliable marker of later alcohol problems. This study measured whether young people who initiated drinking early were at increased risk of alcohol problems in young adulthood in recent cohorts where early initiation was comparatively rare.

DESIGN

Analysis of six waves of a repeated cross-sectional household survey (2001-16).

SETTING

Australia.

PARTICIPANTS

A total of 9576 young adults (aged 20-25 years) who had initiated drinking before the age of 20 years.

MEASUREMENTS

Respondents were classified into three groups based on their self-reported age at first drink (< 16, 16-17, 18-19 years). Outcome variables were self-reported experiences of memory loss while drinking, risky and delinquent behaviour while drinking and monthly or more frequent drinking occasions of 11 or more 10-g standard drinks.

FINDINGS

Later initiators reported lower levels of all outcomes [e.g. odds ratios (ORs) for memory loss were 0.56, 95% confidence interval (CI) = 0.50, 0.63] for those who first drank at 16 or 17 years compared with those who first drank at age 15 or younger). Significant interactions between age at first drink and survey year showed that early initiation was more strongly associated with harms (e.g. for memory loss, OR = 0.97, 95% CI = 0.94, 0.99 for 18-19 versus 15 or younger) in young adulthood for recent cohorts where early drinking was less common.

CONCLUSIONS

The decline in youth drinking may have contributed to a concentration of risk of alcohol problems among those young people who consume alcohol in early adolescence. Early initiation of drinking may be an increasingly important marker of broader risk taking as alcohol becomes less normative for teenagers.

Possible role of caffeine in nicotine use onset among early adolescents: Evidence from the Young Mountaineer Health Study Cohort

BACKGROUND

Preventing nicotine use onset among children and youth is an important public health goal. One possible contributor that has received little empirical investigation is caffeine use. The goal of this study was to examine the possible contribution of caffeine to nicotine onset during early adolescence.

METHODS

We used data from the Young Mountaineer Health Study Cohort. Survey data were collected from 1,349 (response rate: 80.7%) 6th grade students (mean age at baseline 11.5 years) in 20 middle schools in West Virginia during the fall of 2020 and spring of 2021. We limited our analyses to students reporting never having used any form of nicotine at baseline. Logistic regression was employed in analyses.

RESULTS

Approximately 8% of participants reported having used nicotine at least once between baseline and the follow-up, and 4.7% reported solely using electronic nicotine delivery systems (ENDS) and no other forms of nicotine. In multivariable analyses, we controlled for many environmental, social, and behavioral variables known to influence nicotine use such as alcohol use, peer substance use, and perceived access to nicotine. We formulated our main independent variable, caffeine consumption, as continuous deciles. Any nicotine use, as well as ENDS use only at follow-up, were modeled as dependent variables. Caffeine was significantly associated with nicotine use in both models with ORs of 1.15 (1.04-1.27) and 1.13 (1.00-1.28).

CONCLUSIONS

Caffeine consumption among 6th grade non-nicotine users was associated with nicotine use at approximately 6-months follow-up.

The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade?

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

Systematic mining of patterns of polysubstance use in a nationwide population survey

OBJECTIVES

To identify patterns of association and transition in polysubstance use based on National Survey of Drug Use and Health (NSDUH) in the United States.

METHODS

We developed a new computational platform for PolySubstance Use data Mining for Associations and Transitions (PSUMAnT). It is based on the computation of weighted support, a measure of popularity, for the use of every combination of one or more substances, termed as a drugset, over a period of 5 decades (1965-2014) based on NSDUH data. It uses an efficient bitstring representation with exact and approximate string matching capabilities to search for patterns of association between drugsets and demographics of user groups at different time-intervals. Moreover, it introduces a quantitative definition of a rule of transition between pairs of substances used within a given time-interval, and provides a function for mining them.

RESULTS

We identified the frequent drugsets from individual substance use database, and determined their representation among different demographic groups at different intervals. An interesting pattern of use of pain relievers and tranquilizers was detected for the age-group of 26-34 years. In addition, transition rules for heroin use in the last decade (2004-2015) of the given data were mined.

CONCLUSIONS

Computation of weighted supports over time for every possible combination of substances in the survey, and their association with specific user groups, allows PSUMAnT to generate and test novel, interesting hypotheses in polysubstance use. PSUMAnT can be used for mining combinations of substances used among diverse demographic groups including those that have received less attention in this problem.

Cannabis-only use in the USA: prevalence, demographics, use patterns, and health indicators

Background

The prevalence of adults who consume cannabis while abstaining from other substances is not known in the USA. This study used nationally representative data to estimate the prevalence and explore the demographic characteristics, cannabis use behaviors, and self-reported health of US adults with past 30-day cannabis-only use, as compared with adults who used cannabis as well as other substances.

Methods

Data came from adults 18 years and older who responded to the 2017 or 2018 National Survey on Drug Use and Health and reported past 30-day cannabis use (n = 12,143). Cannabis-only use was defined as past 30-day cannabis use with no past 30-day use of other substances (alcohol, tobacco, other illicit substances, non-prescribed controlled medications). Weighted frequencies and 95% confidence intervals (CI) were computed for all sociodemographic and cannabis-related variables, overall, and across the two categories of cannabis consumers, stratified by age.

Results

The prevalence of past 30-day cannabis-only use among US adults was 0.9% (95% CI: 0.8, 1.0) and varied by age (2.0% of 18–25 years old; 0.7% of 26–49 year olds, and 0.6% of those ≥ 50 years). Among adults with any past 30-day cannabis use, 8.4% (95% CI: 7.6, 9.2; n = 980) reported cannabis-only use. Age was significantly associated with past 30-day cannabis-only use, with adults 18–25 years and 26–49 years having higher odds of cannabis-only use compared with older adults. Past year cannabis dependence was lowest among cannabis-only consumers aged ≥ 50 years (0.2%; 95% CI: 0.1, 0.5) and highest among young adult cannabis and other substance consumers (16.7%; 95% CI: 15.3, 18.2). Past year prevalence of any mental illness was generally similar across cannabis use groups and by age.

Conclusions

The prevalence of adult cannabis-only use in the US is low — most cannabis consumers report using other substances in the past 30 days as well. While cannabis-only use among older adults is rare, it does not appear to be accompanied by a high prevalence of dependence. These findings should guide future research and policymaking.

Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia

Background

In developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation.

Methods

Three cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms.

Results

Lifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]).

Conclusion

Lifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.

Cannabis use for sleep aid among high school students: Concurrent and prospective associations with substance use and sleep problems

INTRODUCTION

Adolescents are at risk for both sleep problems and cannabis use. Despite emerging evidence for college students' self-medication with cannabis to help sleep, generalizability to earlier developmental stages remains unknown. This study remedied this literature gap by characterizing high school students' cannabis sleep aid use in terms of psychosocial correlates and prospective associations with substance use and sleep.

METHODS

Data were drawn froma longitudinal urban adolescent health behavior study, Project Teen, including 4079th-11thgraders(Year 1 Mage = 16.00 [SD = 1.08, range = 13-19]; 58% female; 41% Black, 22% White, 18% Asian, 17% multiracial,2% Native Hawaiian or other Pacific Islander, 1% American Indian or Alaska Native; 12% Hispanic/Latinx). Students completed two web-based surveys (Minterval = 388.89 days [SD = 27.34]) assessingsubstance use and sleep at Year 1 (Y1) and Year 2 (Y2).

RESULTS

Students reporting lifetime cannabis sleep aid use (8%) endorsed greater depression and anxiety symptoms at Y1, as well as greater cannabis, alcohol, and cigarette use (but not insomnia symptoms or sleep durations) at Y1 and Y2, compared to non-using peers. Over one year, cannabis sleep aid use was associated with increased cannabis dependence symptoms among students using cannabis, past-2-week binge drinking among students using alcohol, and lifetime cigarette use. However, cannabis sleep aid use was not prospectively associated with changes in insomnia symptoms or sleep durations.

CONCLUSIONS

Although replication is needed, cannabis sleep aid use among high school students may be associated with exacerbated cannabis dependence symptoms and increased binge drinking and cigarette use over time, without the intended sleep benefit.

Frequency of adolescent cannabis smoking and vaping in the United States: Trends, disparities and concurrent substance use, 2017-19

AIM

To quantify the trends in frequent and occasional cannabis vaping, demographic differences and concurrent nicotine and alcohol use.

DESIGN

Observational study. Survey-weighted multinomial logistic regression models assessed trends and disparities in past 30-day cannabis use. Trends were assessed overall and by sex, race/ethnicity, parental education and urbanicity. Multinomial logistic regression models also estimated associations of cannabis use (none, use without vaping, use with vaping) with past 2-week binge drinking and past 30-day nicotine/tobacco use.

SETTING

United States, 2017-19.

PARTICIPANTS

Participants in the national Monitoring the Future (n = 51 052) survey.

MEASUREMENTS

Past 30-day frequent cannabis use (six or more times/30 days) and past 30-day occasional use (one to five times/30 days), with and without vaping.

FINDINGS

Past 30-day frequent cannabis use with vaping and occasional use with vaping rose from 2017 to 2019. Past 30-day frequent and occasional cannabis use without vaping declined. Certain groups, such as Hispanic/Latino or lower socio-economic status adolescents, experienced particularly notable increases in frequent cannabis use with vaping (e.g. prevalence among Hispanic/Latino adolescents). Adolescents who reported smoking and vaping nicotine, and 10+ occasions of binge drinking, were 42.28 [95% confidence interval (CI) = 33.14-53.93] and 10.09 (95% CI = 4.51-22.53) times more likely to report past 30-day cannabis use with vaping, respectively, compared with no use.

DISCUSSION

Cannabis use without vaping appears to be declining among adolescents in the United States, while cannabis use with vaping is accelerating; frequent cannabis vaping is especially increasing, with consistent increases across almost all adolescent demographic groups. Cannabis use among US adolescents remains highly associated with other substance use.

A network approach to relationships between cannabis use characteristics and psychopathology in the general population

Cannabis use characteristics, such as earlier initiation and frequent use, have been associated with an increased risk for developing psychotic experiences and psychotic disorders. However, little is known how these characteristics relate to specific aspects of sub-clinical psychopathology in the general population. Here, we explore the relationships between cannabis use characteristics and psychopathology in a large general population sample (N = 2,544, mean age 29.2 years, 47% women) by employing a network approach. This allows for the identification of unique associations between two cannabis use characteristics (lifetime cumulative frequency of cannabis use, age of cannabis use initiation), and specific psychotic experiences and affective symptoms, while controlling for early risk factors (childhood trauma, urban upbringing). We found particularly pronounced unique positive associations between frequency of cannabis use and specific delusional experiences (persecutory delusions and thought broadcasting). Age of cannabis use initiation was negatively related to visual hallucinatory experiences and irritability, implying that these experiences become more likely the earlier use is initiated. Earlier initiation, but not lifetime frequency of cannabis use, was related to early risk factors. These findings suggest that cannabis use characteristics may contribute differentially to risk for specific psychotic experiences and affective symptoms in the general population.

Declining drinking among adolescents: Are we seeing a denormalisation of drinking and a normalisation of non-drinking?

BACKGROUND

In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (ages between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population.

ARGUMENT

Hypotheses examining individual factors fail adequately to provide the necessary 'big picture' thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries.

CONCLUSIONS

Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking.

Long-term trends in adolescent alcohol, tobacco and cannabis use and emerging substance use issues in Aotearoa New Zealand

This narrative review summarises the latest evidence on the causes and consequences of substance use in adolescence and describes long-term trends in adolescent alcohol, tobacco and cannabis use in Aotearoa. Adolescence is a time of rapid brain development when young people are uniquely vulnerable to the risks of substance use. It is a major cause of health and social harm in this age group and can affect adult outcomes and the health of the next generation. Therefore, substance use trends are central to understanding the current and future state of child and youth wellbeing in Aotearoa. Adolescent use of alcohol, tobacco and cannabis peaked in the late 1990s/early 2000s, then declined rapidly, and prevalence is now much lower than 20 years ago. However, levels of adolescent binge drinking remain high by international standards and disparities in tobacco and cannabis use by ethnicity and socioeconomic status are wide. Evidence suggests we may again be at a turning point, with-long term declines stalling or reversing in the past 2-5 years, and vaping emerging as a new risk. Greater investment in primary prevention is indicated, including restrictions on alcohol marketing and availability, and alleviation of poverty, racism and marginalisation.

Electronic cigarette use in adolescence is associated with later cannabis use

BACKGROUND

Research is needed to determine whether e-cigarette use during adolescence is associated with higher odds of subsequent cannabis use, net of tobacco cigarette use and childhood confounders.

METHODS

Multivariable logistic regressions predicting using cannabis by age 17 based upon prospective, intergenerational data from 10,251 youth in a nationally representative UK birth cohort followed from infancy who had not used cannabis by age 14. The focal predictor is e-cigarette use by age 14 in the context of the potential confounder tobacco cigarette use. Regressions include sociodemographic background and risk factors assessed at age 11 (e.g., alcohol initiation, problem behaviors, parental and peer smoking) and during early childhood (e.g., maternal smoking during pregnancy, parental substance use).

RESULTS

Youth use of e-cigarettes by age 14 was associated with 2.8 times higher odds of subsequent cannabis use by age 17 [OR 2.75; 95% CI 1.82,4.15], net of tobacco cigarette smoking and childhood confounders. Similarly, use of e-cigarettes by age 14 was associated with 2.5 times higher odds [OR 2.46; 95% CI 1.48,4.08] of frequent cannabis use at age 17 (>10 times in prior year). If youth used both e-cigarettes and tobacco cigarettes by age 14, the probabilities of cannabis initiation were 75% and of frequent use was 25% by age 17, compared to probabilities of 23% and 6%, respectively, among youth who had used neither product.

CONCLUSIONS

Findings add to accumulating evidence that adolescent e-cigarette use is associated with higher odds of later cannabis initiation and frequent use, independent of tobacco cigarette use.

Trends in the sequence of initiation of alcohol, tobacco, and marijuana use among adolescents in Argentina and Chile from 2001 to 2017

BACKGROUND

Variation in drug policies, norms, and substance use over time and across countries may affect the normative sequences of adolescent substance use initiation. We estimated relative and absolute time-varying associations between prior alcohol and tobacco use and adolescent marijuana initiation in Argentina and Chile. Relative measures quantify the magnitude of the associations, whereas absolute measures quantify excess risk.

METHODS

We analyzed repeated, cross-sectional survey data from the National Surveys on Drug Use Among Secondary School Students in Argentina (2001-2014) and Chile (2001-2017). Participants included 8th, 10th, and 12th grade students (N = 680,156). Linear regression models described trends over time in the average age of first use of alcohol, tobacco, and marijuana. Logistic regression models were used to estimate time-varying risk ratios and risk differences of the associations between prior alcohol and tobacco use and current-year marijuana initiation.

RESULTS

Average age of marijuana initiation increased and then decreased in Argentina and declined in Chile. In both countries, the relative associations between prior tobacco use and marijuana initiation weakened amid declining rates of tobacco use; e.g., in Argentina, the risk ratio was 19.9 (95% CI: 9.0-30.8) in 2001 and 11.6 (95% CI: 9.0-13.2) in 2014. The relative association between prior alcohol use and marijuana initiation weakened Chile, but not in Argentina. On the contrary, risk differences (RD) increased substantially across both relationships and countries, e.g., in Argentina, the RD for tobacco was 3% (95% CI: 0.02-0.03) in 2001 and 12% (95% CI: 0.11-0.13) in 2014.

CONCLUSION

Diverging trends in risk ratios and risk differences highlight the utility of examining multiple measures of association. Variation in the strength of the associations over time and place suggests the influence of environmental factors. Increasing risk differences indicate alcohol and tobacco use may be important targets for interventions to reduce adolescent marijuana use.

Weeding out the truth: a systematic review and meta-analysis on the transition from cannabis use to opioid use and opioid use disorders, abuse or dependence

BACKGROUND AND AIMS

The idea that cannabis is a 'gateway drug' to more harmful substances such as opioids is highly controversial, yet has substantially impacted policy, education and how we conceptualize substance use. Given a rise in access to cannabis products and opioid-related harm, the current study aimed to conduct the first systematic review and meta-analysis on the likelihood of transitioning from cannabis use to subsequent first-time opioid use, opioid use disorders (OUD), dependence or abuse.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, pubMed/MEDLINE, Scopus, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials and Informit Health Collection were searched for full-text articles assessing the likelihood of transitioning from cannabis to subsequent opioid use, and from opioid use to OUD, abuse or dependence given prior cannabis use. Analysis of subpopulations within studies were discussed narratively, and E-values were calculated to assess the potential influence of unmeasured confounding.

FINDINGS

Six studies provided relevant data from the United States, Australia and New Zealand between 1977 and 2017, a total sample of 102 461 participants. Random-effects analysis of the adjusted pooled effect size indicates that the likelihood of transitioning from cannabis to opioid use, relative to non-cannabis users, is odds ratio (OR) = 2.76, 95% confidence interval (CI) = 2.26-3.36, whereas the likelihood of transitioning from opioid use to OUD, abuse or dependence given prior cannabis use is OR = 2.52, 95% CI = 1.65-3.84. While the evidence was determined to be of low quality with moderate risk of bias, E-values suggest that these findings are robust against unmeasured confounding.

CONCLUSION

A systematic review and meta-analysis found that while people who use cannabis are disproportionately more likely to initiate opioid use and engage in problematic patterns of use than people who do not use cannabis, the low quality of the evidence must be considered when interpreting these findings.

17 Is the New 15: Changing Alcohol Consumption among Swedish Youth

To examine and compare trends in drinking prevalence in nationally representative samples of Swedish 9th and 11th grade students between 2000 and 2018. A further aim is to compare drinking behaviours in the two age groups during years with similar drinking prevalence. Data were drawn from annual surveys of a nationally representative sample of students in year 9 (15-16 years old) and year 11 (17-18 years old). The data covered 19 years for year 9 and 16 years for year 11. Two reference years where the prevalence of drinking was similar were extracted for further comparison, 2018 for year 11 (n = 4878) and 2005 for year 9 (n = 5423). The reference years were compared with regard to the volume of drinking, heavy episodic drinking, having had an accident and quarrelling while drunk. The prevalence of drinking declined in both age groups during the study period. The rate of decline was somewhat higher among year 9 students. In 2018, the prevalence of drinking was the same for year 11 students as it was for year 9 students in 2005. The volume of drinking was lower among year 11 students in 2018 than year 9 students in 2005. No differences were observed for heavy episodic drinking. The decline in drinking has caused a displacement of consumption so that today's 17-18-year-olds have a similar drinking behaviour to what 15-16-year-olds had in 2005.

High Prevalence and Early Onsets: Legal and Illegal Substance Use in an Urban Cohort of Young Adults in Switzerland

INTRODUCTION

Debates about the legalization of illegal substances (e.g., cannabis) continue around the globe. A key consideration in these debates is the adequate protection of young people, which could be informed by current prevalence and age-of-onset patterns. For Switzerland, such information is limited, which is particularly true for women, despite advanced political efforts to legalize cannabis. The objective of the current study was to investigate substance use prevalence rates and ages of onset in a community-representative sample of female and male young adults in Switzerland.

METHODS

Data came from the Zurich Project on the Social Development from Childhood to Adulthood (z-proso). In 2018, participants (N = 1,180, 50.8% females) were ∼20 years old. Lifetime and past-year use of alcohol, tobacco, cannabinoids, stimulants, hallucinogens, opioids, and benzodiazepines were assessed with an extensive substance use questionnaire. Additionally, ages of onsets of the respective substances were estimated by averaging participants' self-reported ages of onsets from ages 13 to 20 (max. 4 assessments).

RESULTS

57% of 20-year-olds had used cannabinoids, 16% stimulants, 15% opioids (mostly codeine), and 8% hallucinogens in the past year. Males had higher prevalence than females for most drugs; nevertheless, females' prevalence rates were notably high. Legal substance use was typically initiated 1.3-2.7 years before legal selling age. Thus, almost half of the sample had consumed alcohol and tobacco by age 14. More than 40% of the total sample had smoked cannabis by age 16. Males initiated use of legal substances and cannabis earlier than females.

DISCUSSION

Our recent community-representative data suggested unexpectedly high levels and early onsets of substance use compared to a previous Swiss surveys and also the European average. Drug policy debates should consider urban substance use patterns when considering legalization efforts.

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.

Correlates of solitary alcohol and cannabis use among American Indian adolescents

BACKGROUND

Solitary substance use, or using substances while alone, is common among adolescents but understudied. This is the first study to examine solitary substance use among American Indian (AI) adolescents. The objective was to examine correlates of solitary alcohol use and solitary cannabis use that occur within the individual, family, school, peer, and cultural domains of the social ecology.

METHOD

Data were from the 2009-2013 Drug Use Among Young American Indians Study, a cross-sectional cohort study. Two sets of hierarchical logistic regressions were conducted to examine solitary alcohol use (getting drunk) among lifetime alcohol users (n = 2082; Mage = 15.12 years; SD = 1.68; 54.2% female) and solitary cannabis use among lifetime cannabis users (n = 2085; Mage = 14.99 years; SD = 1.69; 50.5% female), including adjustment for level of substance involvement.

RESULTS

Prevalence of solitary alcohol use among lifetime drinkers was 24.9%. Among lifetime cannabis users, 53.6% reported solitary cannabis use. Regression analyses for solitary alcohol use showed statistically significant positive associations with coping motive, descriptive norms, violent behavior, depression, peer models for use, and (unexpectedly) peer sanctions against use and a negative association with family sanctions against use. Regression analyses for solitary cannabis use showed statistically significant positive associations with coping motive, violent behavior, and peer models for use and a negative association with family sanctions against use.

CONCLUSIONS

Solitary alcohol and cannabis use are prevalent among AI adolescents and might, in particular, reflect attempts to cope with adversity. Findings could help guide the development of screening and prevention efforts.

Instrumental Substance Use Among Youth with Rheumatic Disease-A Biopsychosocial Model

Youth with chronic medical conditions (YCMC) including rheumatic disease use substances and may experience harms from doing so. The chronic illness experience may amplify substance use risks for some YCMC who may use to ameliorate symptoms of disease activity and negative side effects of medications, so-called "instrumental use." This article provides a brief overview of adolescent substance use, its intersection with chronic illness, and pediatric-onset rheumatic disease (PRD). A biopsychosocial model of substance use vulnerability for youth with PRD is presented along with emerging evidence about instrumental use of substances. Implications for PRD clinical practice are discussed.

Changes in cannabis, tobacco, and alcohol use among sexually active female adolescents and young adults over a twelve-year period ending in 2019

BACKGROUND

The United States has experienced an increasing divergence in cannabis, tobacco, and alcohol use among adolescents and young adults (AYA). We assessed the changes in cannabis, tobacco and alcohol use in an inner-city population of predominantly minority AYA females attending a large adolescent-specific health center in New York City.

METHODS

This was a longitudinal study of AYA women recruited and followed over a twelve-year period between 2007 and 2019. Lifetime and past 30-day use were assessed by self-administered questionnaire every six months. In addition, we assessed associations with race, ethnicity, sexual behaviors, receipt of social services, living situation at home (e.g., with or without parents), and use of other drugs.

RESULTS

Participants included 1549 AYA females aged 13-21 at baseline, 95% of whom were youth of color. Use of cannabis increased significantly over the twelve-year period, with frequent cannabis use (≥20 times in 30-days) increasing almost 18% per year (OR = 1.18; 95%CI:1.13-1.23). In contrast, past 30-day tobacco use declined over the same period (OR = 0.86; 95%CI:0.83-0.89). Past 30-day cannabis use was more likely among African Americans (OR = 1.33; 95%CI:1.08-1.63), women who had sex with both men and women compared to with men only (OR = 1.44; 95%CI:1.18-1.75), recent users of tobacco (OR = 2.20; 95%CI:1.92-2.52) and alcohol (OR = 2.84; 95%CI:2.52-3.20), and ever users of other drugs (OR = 1.69; 95%CI:1.44-1.99), independent of age, time and living situation.

CONCLUSIONS

Increasing rates of cannabis use and the association with concurrent tobacco and alcohol use in AYA females underscore the need to screen for unhealthy cannabis use, in addition to tobacco and alcohol, especially among inner-city AYA.

Smoke in the air - Associations between experimentation with cannabis and the use of tobacco and nicotine products among 15-16-year-old school students

BACKGROUND

Cannabis is the most popular illicit drug among adolescents in developed countries, including Finland. The aim of this study was to estimate 1) how cannabis experimentation among Finnish adolescents changed between 2003 and 2019, and 2) whether the associations between cannabis experiments and factors related to it, especially the use of tobacco and nicotine products, changed during the same time period.

METHODS

The analyses are based on the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15 to 16 in 2003, 2007, 2011, 2015, and 2019 (N = 20,630).

RESULTS

Experimentation with cannabis among Finnish adolescents has increased since the beginning of our follow-up. At the same time, alcohol use and smoking have decreased markedly, and attitudes toward cannabis use have become more relaxed. The association between smoking and cannabis experimentation has become weaker over time. However, the use of tobacco and nicotine products, especially polytobacco, is still a strong risk factor for experimentation with cannabis. The higher the number of tobacco or nicotine products used, the higher the probability for cannabis experimentation.

CONCLUSIONS

Experimentation with cannabis has previously been concentrated predominantly on adolescents who smoke, but recently non-smokers are increasingly trying cannabis. It is possible that alternative ways of using cannabis may have increased its use. Despite the strict cannabis policy in Finland, its use has increased, which may be an indication that youth cultures and images of different substances play a significant role in adolescents experimenting with cannabis.

Clustering of health-related behaviours within children aged 11-16: a systematic review

OBJECTIVE

We aimed to systematically review and synthesise evidence on the clustering of a broad range of health-related behaviours amongst 11-16 year olds.

METHOD

A literature search was conducted in September 2019. Studies were included if they used cluster analysis, latent class analysis, prevalence odds ratios, principal component analysis or factor analysis, and considered at least three health-related behaviours of interest among 11-16 year olds in high-income countries. Health-related behaviours of interest were substance use (alcohol, cigarettes and other drug use) and other behavioural risk indicators (diet, physical activity, gambling and sexual activity).

RESULTS

The review identified 41 studies, which reported 198 clusters of health-related behaviours of interest. The behaviours of interest reported within clusters were used to define eight behavioural archetypes. Some included studies only explored substance use, while others considered substance use and/or other health-related behaviours. Consequently, three archetypes were comprised by clusters reporting substance use behaviours alone. The archetypes were: (1) Poly-Substance Users, (2) Single Substance Users, (3) Substance Abstainers, (4) Substance Users with No/Low Behavioural Risk Indicators, (5) Substance Abstainers with Behavioural Risk Indicators, (6) Complex Configurations, (7) Overall Unhealthy and (8) Overall Healthy.

CONCLUSION

Studies of youth health behavioural clustering typically find both a 'healthy' cluster and an 'unhealthy' cluster. Unhealthy clusters are often characterised by poly-substance use. Our approach to synthesising cluster analyses may offer a means of navigating the heterogeneity of method, measures and behaviours of interest in this literature.

Neurocognitive Correlates of Adolescent Cannabis Use: An Overview of Neural Activation Patterns in Task-Based Functional MRI Studies

Adolescence is dynamic and comprises physiological, psychological, and neurocognitive changes. Notably, many developmentally associated neurobiological changes (e.g., synaptic pruning, myelination) coincide with peak substances use prevalence rates, particularly for cannabis use. Cannabis remains the most commonly used illicit drug among adolescents with 23.9% reporting cannabis use in the last year (Johnston et al., 2019). Adolescents who engage in cannabis use often show poorer neurocognitive performance and alterations in structural and functional brain development as compared to their non-using peers (Jacobus & Tapert, 2014). Over the past several decades, the cognitive domains most consistently associated with cannabis use among adolescents are learning and memory and several facets of executive functioning (e.g., inhibitory control, decision-making). Functional magnetic resonance imaging (fMRI) is a non-invasive method for probing the neural substrates underlying possible cannabis-related changes in cognition. This brief review aims to synthesize recent findings on the relationship between adolescent (≤25 years old) cannabis use and neural response during task-based functional magnetic resonance imaging (fMRI). Findings thus far suggest aberrant, often hyperactive, response to task-based stimuli in youth cannabis users. When considering the future directions of fMRI research with cannabis-using youth, review of existing studies also highlights the need for more prospective research with diverse samples.

Detachment, peer pressure, and age of first substance use as gateways to later substance use

BACKGROUND

Prior research using psychosocial developmental models have identified emotional detachment from family and susceptibility to peer pressure as predictors of adolescent substance use. Despite mixed support for the gateway hypothesis, less is known about how these psychosocial developmental factors facilitate adolescent substance use. The purpose of this study was to examine how age of first substance use, emotional detachment from parents, and susceptibility to peer pressure influence the progression from alcohol, marijuana, and tobacco use to other illicit substance use (e.g., cocaine, hallucinogens).

METHOD

Data (N = 5792) were collected from high school students across seven semesters. Latent growth curve modeling was used to examine how age of first use of alcohol, marijuana, and tobacco predicted initial levels and changes in emotional detachment, peer pressure, and other illicit substance use.

RESULTS

Earlier age of first use of alcohol, marijuana, and tobacco predicted detachment, peer pressure, and a greater likelihood of initial use of other illicit substances. More initial emotional detachment was associated with increases in other illicit substance use. Earlier ages of first use of alcohol, marijuana, and tobacco had indirect effects on initial use of other illicit substances through initial emotional detachment.

CONCLUSION

Emotional detachment from parents and peer pressure impact the likelihood of other illicit substance use across the high school years. Prevention programs may benefit by focusing on delaying the onset of first use of substance use and by preventing emotional detachment from parents and peer pressure.