Cannabis use during adolescence can have harmful consequences, including poor educational outcomes, neurocognitive defects, and an increased risk of addiction to other drugs, such as tobacco, ...alcohol, and opioids. Perceived family and social network cannabis use is a risk factor for use among adolescents. It is not currently known whether there is an association between perceived family/social network cannabis use and adolescent cannabis use in the context of legalization. The purpose of this study was to examine associations between adolescent perceptions of parent, sibling, and best friend medical and/or recreational cannabis use and adolescents’ own use and whether the association changed pre-legalization and post-legalization in Massachusetts.
We analyzed responses from surveys administered to students at 2 high schools in Massachusetts before legalization in 2016 (wave 1) and after legalization but before the start of regulated retail cannabis sales in 2018 (wave 2). We used χ2 tests and multiple logistic regression to examine associations between adolescent perception of parent, sibling, and best friend use and adolescent past 30-day cannabis use before and after legalization.
In this sample, no statistically significant differences were found in the prevalence of past 30-day cannabis use before and after legalization among adolescents. There was an increase in the proportion of adolescents who reported any perceived parent cannabis use from before to after legalization (18% before legalization to 24% after legalization; P = 0.018). Perceived parent, sibling, and best friend medical and recreational cannabis use were all associated with an increased odds of adolescent use, with the highest increase in odds found for perceived best friend use (adjusted odds ratio, 17.2; 95% CI, 12.4–24.0).
Adolescent perceptions of their parents as cannabis users increased after legalization, even before state-regulated retails sales began. Parent, sibling, and best friend cannabis use is each independently associated with increased odds of adolescent's own use. These findings from 1 Massachusetts district should be explored in larger and more representative populations and motivate additional attention to interventions that consider family and friend influences when seeking to address adolescent cannabis use.
Parents of children with rare diseases often face uncertainty about diagnosis, treatment, and costs associated with healthcare for their child. Health insurance status impacts each of these areas, ...but no U.S. study has explored parents' perceptions of the health insurance impacts on their child's care. This study aimed to qualitatively explore how these parents navigate the complex health insurance system for their children and their experiences in doing so.
Semi-structured interviews were conducted with parents of children with metachromatic leukodystrophy (MLD) and spinal muscular atrophy (SMA), chosen for specific disease characteristics and orphan drug status. Participants were recruited via e-mail through patient advocacy organizations between September and December 2018. Interviews were conducted via Skype, were recorded, and professionally transcribed. Modified grounded theory was utilized as a methodology to analyze transcripts in an iterative process to determine themes and sub-themes based on participant described experiences.
Major themes and subthemes that emerged across the 15 interviews included: (1) difficulties obtaining secondary insurance based on state eligibility criteria; (2) difficulty accessing needed healthcare services; and (3) need for repeated interactions with insurance representatives. The absence of clearly documented or widely recognized clinical guidelines exacerbated the difficulty accessing care identified as necessary by their healthcare team, such as therapy and equipment. An explanatory model for parent's experiences was developed from the themes and subthemes. The model includes the cyclical nature of interacting with insurance for redundant reauthorizations and the outside support and financial assistance that is often necessary to address their child's healthcare needs.
With complex health conditions, small setbacks can become costly and disruptive to the health of the child and the life of the family. This study suggests that patients with rare diseases may benefit from time limits for processing coverage decisions, increasing transparency in the claims and preauthorization processes, and more expansive authorizations for on-going needs. Additional studies are needed to understand the full scope of barriers and to inform policies that can facilitate better access for families living with rare diseases.
Harlow et al found that 11% of US high school seniors (ie, 12th grade) reported using Δ8-tetrahdyrocannabinol (Δ8-THC) in the past 12 months based on a 2023 survey. This study is a reminder that ...there is a diverse set of cannabis products on the market that vary in their legal and regulatory status and potential for harm. Δ8-THC is a psychoactive cannabinoid that can be derived from hemp. It was introduced to the retail market in 2018 and there are indications that its use is on the rise. There is little regulatory oversight of production and sales of Δ8-THC and some evidence of adverse outcomes after use.
Facebook is a popular social media Web site that has been hypothesized to exert potential influence over users' attitudes, intentions, or behaviors. The purpose of this study was to develop a ...conceptual framework to explain influential aspects of Facebook. This mixed methods study applied concept mapping methodology, a validated five-step method to visually represent complex topics. The five steps comprise preparation, brainstorming, sort and rank, analysis, and interpretation. College student participants were identified using purposeful sampling. The 80 participants had a mean age of 20.5 years, and included 36% males. A total of 169 statements were generated during brainstorming, and sorted into between 6 and 22 groups. The final concept map included 13 clusters. Interpretation data led to grouping of clusters into four final domains, including connection, comparison, identification, and Facebook as an experience. The Facebook Influence Concept Map illustrates key constructs that contribute to influence, incorporating perspectives of older adolescent Facebook users. While Facebook provides a novel lens through which to consider behavioral influence, it can best be considered in the context of existing behavioral theory. The concept map may be used toward development of potential future intervention efforts.
The objective of this study was to examine adolescents' self-reported exposure to cannabis marketing in states with legalized cannabis and its association with past-year cannabis use.
We conducted a ...cross-sectional, online panel survey of 469 adolescents aged 15–19 years residing in four states with legal retail cannabis for adult use. Adolescents self-reported exposure to cannabis marketing on social or traditional media (i.e., outdoor or print) and past-year cannabis use. Logistic regression generated estimated odds of youths' past-year cannabis use by marketing exposure after adjusting for demographic factors and cannabis-related social norms.
Exposure to cannabis marketing on Facebook, Twitter, and Instagram was associated with increased odds of past-year cannabis use of 96% (95% confidence interval CI: 15%–234%), 88% (95% CI: 11%–219%), and 129% (95% CI: 32%–287%), respectively. Odds of past-year cannabis use increased by 48% (95% CI: 16%–87%) with each additional social media platform where adolescents reported exposure.
Despite restrictions that prohibit cannabis advertising on social media, adolescents are exposed to cannabis marketing via social media, and this exposure is associated with recent cannabis use. States should consider further regulation of cannabis marketing on social media.
This study assessed marijuana-related content posted by adolescents on Twitter and examined content variation before and after the 2012 U.S. election legalizing recreational use in two states. For ...two 3-week periods occurring 6 months before and after the election, a 1% random sample was obtained of all tweets matching a set of marijuana-related queries. Original content was separated from reposted content (retweets), and foreign language tweets and those not related to marijuana were excluded. Using a structured codebook, tweet content was categorized (e.g., mention of personal marijuana use, parents' views, perceived effects.) Self-reported age was extracted from tweet metadata when available. Chi-square tests were used to assess differences in content by whether the user self-identified as an adolescent and to compare content pre- versus post-election. The full sample consisted of 71,901 tweets. After excluding nonrelevant tweets and separating original tweets from retweets, the analytic sample included 36,969 original tweets. A majority (65.6%) of original tweets by adolescents (n=1,928) reflected a positive attitude toward marijuana, and 42.9% indicated personal use. Of adolescents' tweets that mentioned parents, 36.0% of tweets indicated parental support for the adolescent's marijuana use. Tweets about personal marijuana use increased from 2012 to 2013, as did positive perceptions about the drug. Adolescents and others on Twitter are exposed to positive discussion normalizing use. Over the study period, Twitter was increasingly used to disclose marijuana use.
Purpose of Review
This review examines the challenges of measuring the effect of acute cannabis use as it relates to injury risk. This is relevant for researchers, particularly those studying ...drug-impaired driving, and practitioners such as those measuring impairment in workplaces or at the roadside.
Recent Findings
Emerging research clarifies the challenges of linking drug levels of tetrahydrocannabinol (THC) in the body to the level of psychomotor and neurocognitive impairment, given individual differences in drug effects and tolerance. Without knowing more about the individual, such as information about the pattern of cannabis use, the levels of THC in the blood do not provide an indication of impairment, and therefore, do not indicate the relationship between drug use and injury risk.
Summary
Future research should focus on measuring drug impairment, beyond drug detection, and identify novel ways of measuring impairment that have application for injury prevention.
IMPORTANCE Driving after marijuana use increases the risk of a motor vehicle crash. Understanding this behavior among young drivers and how it may differ from alcohol-related driving behaviors could ...inform prevention efforts. OBJECTIVE To describe the prevalence, sex differences, and risk factors associated with underage college students’ driving after using marijuana, driving after drinking alcohol, or riding with a driver using these substances. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional telephone survey of a random sample of 315 first-year college students (aged 18-20 years) from 2 large public universities, who were participating in an ongoing longitudinal study. At recruitment, 52.8% of eligible individuals consented to participate; retention was 93.2% one year later when data for this report were collected. MAIN OUTCOMES AND MEASURES Self-reported past-28-day driving after marijuana use, riding with a marijuana-using driver, driving after alcohol use, and riding with an alcohol-using driver. RESULTS In the prior month, 20.3% of students had used marijuana. Among marijuana-using students, 43.9% of male and 8.7% of female students drove after using marijuana (P < .001), and 51.2% of male and 34.8% of female students rode as a passenger with a marijuana-using driver (P = .21). Most students (65.1%) drank alcohol, and among this group 12.0% of male students and 2.7% of female students drove after drinking (P = .01), with 20.7% and 11.5% (P = .07), respectively, reporting riding with an alcohol-using driver. Controlling for demographics and substance use behaviors, driving after substance use was associated with at least a 2-fold increase in risk of being a passenger with another user; the reverse was also true. A 1% increase in the reported percentage of friends using marijuana was associated with a 2% increased risk of riding with a marijuana-using driver (95% CI, 1.01-1.03). Among students using any substances, past-28-day use of only marijuana was associated with a 6.24-fold increased risk of driving after substance use compared with using only alcohol (95% CI, 1.89-21.17). CONCLUSIONS AND RELEVANCE Driving and riding after marijuana use is common among underage, marijuana-using college students. This is concerning given recent legislation that may increase marijuana availability.
Health consequences of commercializing nonmedical cannabis remain unclear, but data suggest that youth may encounter unintended risks. This study examined whether cannabis marketing exposure and ...engagement are associated with problematic cannabis use among adolescents.
The analytic sample included 172 lifetime cannabis users (15-19 years old) who lived in one of six states with legalized nonmedical cannabis in 2018. Predictors included having exposure to or engagement with cannabis marketing on Facebook or Instagram, seeing cannabis billboards, owning/likely to own cannabis-branded merchandise, and reporting a favorite cannabis brand. Logistic regression assessed whether these predictors were associated with weekly cannabis use, high-intensity cannabis use, and cannabis use disorder (CUD).
Adolescents who saw billboards rarely/sometimes had 5 times the odds of CUD, whereas youth who saw them most/all of the time had 7 times the odds of weekly use and 6 times the odds of CUD. Adolescents who owned/were likely to own branded merchandise had nearly 23 times the odds of weekly use, and those with a favorite brand had 3 times the odds of weekly use and CUD. Adolescents who reported seeing promotions on Instagram rarely/sometimes had 85% lower odds of weekly use, and those who saw them most/all of the time had 93% lower odds.
The ways cannabis businesses market their products, especially branding, may affect patterns of underage cannabis use. Future research should test whether these associations persist in longitudinal designs. In the interim, states should consider an approach that offers youth additional means to protect them from cannabis marketing.
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