Abstract
Cannabis legalization and commercialization have introduced novel alternative cannabis products, including edible and vaporized cannabis that might appeal to youth and be associated with polyuse (ie, use of ≥2 different products). To investigate the prevalence, patterns, and sociodemographic correlates of cannabis product use across combustible, edible, and vaporized administration methods, including polyuse of cannabis via multiple administration methods. This cross-sectional survey study included 10th-grade students from 10 Los Angeles, California, area high schools from January 2 through October 6, 2015. Students were recruited from respondents in the Happiness and Health Study, an ongoing prospective cohort study in the 10 high schools. Students not in school during administration of the pencil-and-paper survey completed abbreviated surveys by telephone, internet, or mail. Data were analyzed from July 17, 2017, through July 12, 2018. Self-reported sex, race/ethnicity, and socioeconomic status (SES). Students with high SES had parents who attained college or a higher educational level and were ineligible for free or subsidized lunch; those with low SES had parents with lower educational attainment or were eligible for free or subsidized lunch. Self-report of ever use (yes or no) and past 30-day use (yes or no) status and frequency of use (days in past 30 days) of combustible, edible, and vaporized cannabis. The sample included 3177 tenth-grade students (93.5% of study enrollees); among these students, 1715 (54.0%) were girls and the mean (SD) age was 16.1 (0.4) years. Among those with available demographic data, respondents were diverse in race/ethnicity (537 [17.2%] Asian; 149 [4.8%] black; 1510 [48.3%] Hispanic; 507 [16.2%] white; 207 [6.6%] multiethnic/multiracial; and 216 [6.9%] other) and included 1654 (60.1%) with a low SES. Prevalence of ever use was highest for combustible products (993 [31.3%]), followed by edible (676 [21.3%]) and vaporized (333 [10.5%]) products. A similar pattern was found for past 30-day use (426 [13.4%] for combustible, 249 [7.8%] for edible, and 156 [4.9%] for vaporized cannabis). Among participants who reported using cannabis in the past 30 days, mean frequency of use of combustible cannabis was higher by 2.65 days (95% CI, 1.40-3.91 days, P = .001) than the mean frequency of use for edible cannabis and 1.75 days higher (95% CI, 0.59-2.90 days, P = .003) than frequency of use for vaporized cannabis. Most cannabis users (665 [61.7%]) used multiple administration methods, and 260 (8.2%) used all 3 methods. Boys had higher prevalence of ever use for vaporized (170 [11.6%] vs 163 [9.5%]) but not combustible (459 [31.4%] vs 534 [31.1%]) or edible (303 [20.7%] vs 373 [21.7%]) cannabis. Respondents with low SES had higher prevalence of ever use for combustible (614 [37.1%] vs 242 [22.0%]) and edible (408 [24.7%] vs 166 [15.1%]) but not vaporized (186 [11.2%] vs 93 [8.5%]) cannabis. Among 10th-grade students in Los Angeles, use of cannabis via alternative administration methods was of appreciable prevalence, predominately reported in conjunction with other cannabis products and unequally distributed across sociodemographic strata. Prevention programs and regulatory restrictions addressing the spectrum of cannabis products might benefit pediatric public health.
Highlights
Adolescent cannabis use poses a substantial public health burden
Among participants who reported using cannabis in the past 30 days, mean frequency of use of combustible cannabis was higher by 2.65 days than the mean frequency of use for edible cannabis and 1.75 days higher than frequency of use for vaporized cannabis
Among 10th-grade students in Los Angeles, use of cannabis via alternative administration methods was of appreciable prevalence, predominately reported in conjunction with other cannabis products and unequally distributed across sociodemographic strata
Summary
Adolescent cannabis use poses a substantial public health burden. Adolescent cannabis use is associated with increased risk for chronic cannabis use throughout adulthood, cannabis use disorder, impairment of cognitive development, and lower educational attainment.[1,2,3,4] In the United States, increasing trends of social normalization of cannabis use, perceptions of reduced harm, and legalization of medical and recreational cannabis use raise new concerns for pediatric health, including an expanding marketplace for novel, noncombustible alternative cannabis products that might attract youth.[5,6,7]The manufacture of commercially available cannabinoid-infused edibles (eg, gummy bears treated with cannabinoid extracts) and drinks (eg, energy drinks with tetrahydrocannabinol [THC; the principal addictive compound in cannabis]) have diversified the types of ingestible cannabis products that might appeal to adolescents.[6]. Adolescent cannabis use is associated with increased risk for chronic cannabis use throughout adulthood, cannabis use disorder, impairment of cognitive development, and lower educational attainment.[1,2,3,4] In the United States, increasing trends of social normalization of cannabis use, perceptions of reduced harm, and legalization of medical and recreational cannabis use raise new concerns for pediatric health, including an expanding marketplace for novel, noncombustible alternative cannabis products that might attract youth.[5,6,7]. In addition to devices for vaping dry cannabis plant material, the electronic cigarette (e-cigarette) industry has expanded to commercial cannabis products, including the sales of cannabinoid-infused e-cigarette liquids that are available in youth-oriented flavors (eg, bubble gum) and that use marketing strategies that might attract adolescents.[7]
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