Adolescent Marijuana Use and Related Risk Behaviors, National Findings From 2015 to 2017

Investigating Cannabis-Use Among Students Attending High Schools Within the Cherokee Nation Reservation 2017 and 2019

Oklahoma's medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9-12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis.

Risk-Taking, Social Support, and Belongingness Contribute to the Risk for Cannabis Use Frequency in University Students

Background: Cannabis use and misuse is known to be associated with a variety of negative health, academic, and work-related outcomes; therefore, it is important to study the factors that contribute to or moderate its use. Objectives: The aim of this study was to determine whether risky behavior, belongingness and social support as clustering variables play a role in cannabis use frequency. Method: In a university student sample, participant data on risky behavior, belongingness and social support were used to generate vulnerability profiles through cluster analysis (low vulnerability with low risk, low vulnerability with high belonging, moderate vulnerability, and high vulnerability). Using an analysis of variance, the vulnerability profiles were compared with respect to cannabis use frequency and quantity. Through chi-square tests we assessed whether these profiles are overrepresented in certain demographics. Results: The cluster analysis yielded four groups, which differed in their vulnerability for cannabis use. The most vulnerable cluster group had higher cannabis use frequency relative to the two least vulnerable groups. Low income vs. high income was also associated with high vulnerability group membership. International students were overrepresented in the low vulnerability with high belonging group relative to the low vulnerability with low-risk group. The opposite was observed for domestic students. Conclusions: This research adds to the expanding body of literature on cannabis use and misuse in Canada, which may contribute to public health policy and the prevention and treatment of cannabis addiction by providing new insight on who may be at risk.

Using a Syndemic Framework and Structural Equation Modeling to Assess the Co-occurrence and Mutual Impact of Violence Experiences and Substance Use Behaviors Among Adolescents

Adolescents are at particular risk for multiple violence experiences and substance use behaviors. The extent to which the two clusters of experiences correlate with each other remains unclear. The purpose of this study is to assess the co-occurrence and mutual impact of violence experiences and substance use behaviors in adolescents using structural equation modeling (SEM) based on syndemic theory. This study utilized data collected by 2019 Youth Risk Behavior Survey from a nationally representative sample (N = 13,677). Bivariate associations and correlations between four forms of violence experiences (weapon threats, sexual violence, dating violence, and bullying) and three types of substance use behaviors (e-cigarette smoking, alcohol drinking, and marijuana use) were examined. Two SEM models were built to measure the correlation between the two clusters of variables. The results showed that 36.8% of adolescents experienced at least one form of violence in the past year (22.0% one form, 8.9% two forms, and 5.9% three or more forms) and 42.4% reported one or more types of substance use in the past month (16.3% one type, 14.0% two types, and 12.1% three types). Youths with multiple violence experiences were three to four times more likely to report substance use, and those using three types of substances were two to six times more likely to report violence victimization. All examined associations and correlations between violence experiences and substance use behaviors were statistically significant. In the final SEM model, the four violence variables indicated a syndemic factor and the three substance use variables indicated another syndemic factor. The two syndemic factors were positively correlated (β = .43, p < .05), with 19% of variance being explained by each other. Findings in this study highlight the needs for comprehensive prevention efforts to address the co-occurring and mutually reinforced situation between violence experiences and substance use behaviors in the youth population. Targeted intervention programs and mental health services are needed for adolescents with multiple violence experiences and concurrent substance use behaviors.

Demographics and Reported Symptoms Associated With Marijuana Use Among Adolescents and Young Adults

Purpose Marijuana use has been increasing in the adolescent population. Our objective was to examine the prevalence of marijuana use among a sample of adolescents and young adults, determine an association with risk-taking behaviors, identify reported medical symptoms, and delineate common beliefs about marijuana use. Methods A questionnaire was administered to a sample of patients aged between 12 and 23 years old presenting to the emergency department of Penn State Hershey Medical Center, Hershey, Pennsylvania. Data were stratified by marijuana users and non-users, and further stratified by traditional (vape, pipe, edibles) and non-traditional (oils/concentrates, topical creams) use. Results The analysis was based on 200 questionnaires. Thirty-nine percent (n=78) reported marijuana use. Marijuana users were more likely to report previous sexual intercourse (79.5% vs. 32.8%; p=<0.0001), as well as the use of alcohol (50.0% vs. 10.7%; p=<0.0001), cigarettes (41% vs. 8.2%; p=<0.0001), prescription pain medications (20.5% vs. 4.1%; p=0.002), and cocaine (14.1% vs. 0.8%; p=0.0017). Users more likely reported texting while driving (41.0% vs. 13.1%; p=0.005) and experienced physical or electronic victimization due to bullying (43.6% vs. 19.7%; p=0.002). Users were more likely to report gastroesophageal reflux disease (GERD), attention deficit disorder (ADD), anxiety, and depression. The most common symptoms associated with marijuana use were anxiety (65.4%), headache (61.6%), nausea/vomiting (53.8%), cough (51.3%), and abdominal pain (47.4%). Sixty-nine percent of respondents believed marijuana was "safer than other drugs". Conclusion Based on our sample, we identified risk-taking behaviors, medical symptoms, and beliefs associated with marijuana use. Healthcare professionals may use these data to provide screening and anticipatory guidance to adolescents who use marijuana and consider marijuana use in their differential diagnosis.

Opioid use as a proximal risk factor for suicidal behavior in young adults

INTRODUCTION

There is a concomitant rise in suicide rates with the prevalence of opioids involved in overdose deaths, especially among adolescents and young adults. However, there are limited studies on whether opioid use prospectively predicts suicidal behavior in youth.

METHODS

Our sample included 183 psychiatric patients (18-30 years) admitted for a suicide attempt (SA), have current suicidal ideation (SI), and psychiatric controls without ideation or attempt (PC). Suicidal behavior was assessed using the Columbia Suicide Severity Rating Scale. We also recruited a healthy control group (HC; n = 40). Patients and controls were followed over a year. ANOVA, regression, and cox regression were used.

RESULTS

Suicide attempt (β = 0.87, CI [0.1-1.6], p = 0.02) and SI [(β = 0.75, CI [0.03-1.5], p = 0.04) were significantly more likely than HCs to have used opioids in the past year at baseline. Opioid use was associated with increased anxiety symptoms (β = 0.75, CI [0.001-1.5], p = 0.05), PTSD symptoms (β = 3.90, CI [1.1-6.7], p = 0.01), and aggression (β = 0.02, CI [0.01-0.04], p = 0.02). Opioid use in the month prior to hospitalization predicted SA at 6 months (OR = 1.87, CI [1.06-3.31], p = 0.032).

CONCLUSIONS

Opioid use is a proximal predictor for SA. These findings may help clinicians better identify patients at risk for suicidal behavior, allowing for more personalized treatment approaches.

Evaluating Long-Term Outcomes of a High School-Based Impaired and Distracted Driving Prevention Program

Motor vehicle crashes are one of the leading causes of death among teenagers. Many of these deaths are due to preventable causes, including impaired and distracted driving. You Drink, You Drive, You Lose (YDYDYL) is a prevention program to educate high school students about the consequences of impaired and distracted driving. YDYDYL was conducted at a public high school in Southern Nevada in March 2020. A secondary data analysis was conducted to compare knowledge and attitudes of previous participants with first-time participants. Independent-samples-t test and χ2 test/Fisher’s exact test with post-contingency analysis were used to compare pre-event responses between students who had attended the program one year prior and students who had not. Significance was set at p < 0.05. A total of 349 students participated in the survey and were included for analysis; 177 had attended the program previously (50.7%) and 172 had not (49.3%). The mean age of previous participants and first-time participants was 16.2 (SD ± 1.06 years) and 14.9 (SD ± 0.92 years), respectively. Statistically significant differences in several self-reported baseline behaviors and attitudinal responses were found between the two groups; for example, 47.4% of previous participants compared to 29.4% of first-time participants disagreed that reading text messages only at a stop light was acceptable. Students were also asked how likely they were to intervene if a friend or family member was practicing unsafe driving behaviors; responses were similar between the two groups. The baseline behaviors and attitudes of participants regarding impaired and distracted driving were more protective among previous participants compared to first-time participants, suggesting the program results in long-term positive changes in behaviors and attitudes. The results of this secondary retrospective study may be useful for informing the implementation of future impaired and distracted driving prevention programs.

A perspective review of cannabis use and sexual offenses

Substance abuse is an established risk factor for crime and violence, including sexual violence. Nevertheless, the link between cannabis use and sexual offenses remains poorly understood. Cannabis use has a broad effect on sexual functioning and can have both acute and lasting adverse effects on psychological functioning, which in turn can elevate the risk of sexual offending behavior. Yet there is a scarcity of studies that have examined the link between cannabis use and sexual offending. To help fill the gap, this perspective review investigates the link between substance use and crime with a particular emphasis on cannabis use and its effects on sexual and psychological functioning. It then explores how these mechanisms may contribute to sexual offenses and recidivism, with a final discussion on how cannabis use should be conceptualized as a risk factor for sexual violence.

Concurrent Use of E-cigarettes, Combustible Cigarettes, and Marijuana

OBJECTIVE

Subgroups of adolescent single and dual e-cigarette and cigarette users have been identified, but usage patterns have changed in recent years, and there has been an increase in marijuana use. Research is needed with current data to identify subgroups of use including marijuana and determine their behavioral correlates.

METHODS

We cross classified ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among US high school students in the 2019 Youth Risk Behavior Survey (YRBS), providing 8 different groups. Levels of 14 risk and protective factors were compared across groups in general linear models with demographic covariates using omnibus tests, pairwise comparisons, and planned contrasts. Replicability was tested through identical analyses for 2017 YRBS data.

RESULTS

The nonuser group was 43.9% of the sample. The most frequent user groups were triple users (ever-use proportion: 16.9%), dual (e-cigarette and marijuana) users (15.8%), and exclusive e-cigarette users (13.2%). For risk profiles on levels of psychosocial variables, the triple-user group was typically elevated above all other groups. Exclusive e-cigarette users were above nonusers in risk profile but below dual users (both cigarettes and marijuana). Results were similar for ever use and recent use. The patterning of results in 2019 YRBS data were closely replicated in 2017 YRBS data.

CONCLUSIONS

Co-occurrence of e-cigarette, cigarette, and marijuana use is currently substantial among adolescents and is associated with an elevated psychosocial risk profile. This has implications for both epidemiology and prevention studies. Further research is needed to study prevalence and identify pathways to triple use.

COVID-19 vaccine willingness and cannabis use histories

Background

Cannabis use is associated with problematic health-behaviors such as excessive alcohol and tobacco use, and sedentary behavior. Here, we examined the association between cannabis use history and an especially topical health-behavior, willingness to receive a COVID-19 vaccine.

Methods

COVID-19 vaccine willingness was surveyed in a subset of participants from the Tulsa 1000 Study, which is a longitudinal study of psychiatric treatment-seeking and healthy control participants. We identified 45 participants who completed a COVID-19 vaccine questionnaire and reported more than 10 lifetime cannabis uses. Those participants were compared to a group of 45 individuals with very light (<10) cannabis use histories who were propensity score-matched on age, sex, income, and race. Two-group t-tests and Bayes factor analysis on vaccine willingness were conducted between groups. Exploratory correlation analyses were conducted on vaccine willingness and lifetime cannabis use levels within the cannabis group only.

Results

Vaccine willingness did not differ between the two groups (t88=0.33, p=.74; BF01=4.3). However, a negative correlation was identified within the cannabis group, such that higher lifetime cannabis use histories correlated with less willingness to receive a vaccine (rho43= -.33, p=.03).

Conclusions

Although vaccine willingness did not differ between the two matched groups, preliminary evidence suggests that heavy lifetime cannabis use might indicate a reluctance to engage in health-promoting behaviors like receiving a COVID-19 vaccine.