Adolescent Cannabis Use Research Articles

Cannabis reduction among adolescents as spillover from successful tobacco control

BackgroundNational programs that reduce adolescent cannabis use warrant renewed attention in light of current discussions to reform cannabis legislation, including the possibility of legalization for recreational use. This study measures the size of a decrease in a country's prevalence of adolescent cannabis use that accompanies a decrease in its prevalence of adolescents who had ever smoked a cigarette. MethodsData are from the European School Survey Project on Alcohol and Other Drugs (ESPAD), which is a collaborative effort of more than 40 European countries to surveil adolescent substance use. This study uses data from the seven survey administrations in 1995, 1999, 2003, 2007, 2011, 2015, and 2019. The main analysis is a fixed-effect regression analysis of country-level, four-year changes in adolescent lifetime cannabis use prevalence on country-level, four-year changes in adolescent lifetime cigarette use prevalence. ResultsDecreases in the national prevalence of adolescents who had ever smoked a cigarette were accompanied by decreases half as large in national prevalence of adolescent lifetime cannabis use. ConclusionFor European countries considering the legalization of adult recreational cannabis use, tobacco control can offer a tool to help counter potential increases in cannabis use among adolescents.

From subcultural to mainstream? The evolving meaning of cannabis use among youth in a restrictive policy context

Background Cannabis liberalization trends are challenging traditional cannabis markets, opinions, cultures, and ultimately, the paradigms for understanding these social phenomena. Up-to-date studies across various socio-cultural and policy settings of how young people perceive and give meaning to their cannabis use are thus highly relevant for novel prevention and harm reduction strategies. Methods Individual interviews with 28 students (13 girls, 15 boys, 16–19 years) from Norway who had used cannabis. Investigation was based on the sociological concept of framing and thematic analysis. Results Participants tended to emphasize social equivalence between cannabis users and nonusers, and of cannabis and alcohol use in social settings. However, unlike alcohol, cannabis was also framed as a means for providing sleep, or for relieving depressive moods and ADHD symptoms. These framings markedly diverge from the traditional understandings of youths’ cannabis use in nonliberalized settings as either subcultural and opposition-oriented or recreational and normalized. Conclusions Our results indicate that even in a strict drug policy context like Norway, adolescent cannabis use is increasingly given meaning within a mainstream, rather than within a subcultural, frame. In addition, a medicinal discourse seems to be gaining foothold. Findings should be of relevance for various drug strategies aimed toward adolescents.

Cannabis use among hospitalised adolescents before and after decriminalisation in South Africa.

Cannabis is the most widely used substance worldwide, and its use is much higher among adolescents. However, adolescents are at higher risk of negative sequelae secondary to this use, including the possible development of mental disorders. On 31 March 2017, the South African High Court ruled that cannabis use by an adult in a private dwelling should be decriminalised. This study aimed to determine the clinical profile of adolescents who use cannabis, who use, who present to a tertiary hospital in Cape Town, South Africa, before and after the high court ruling in 2017. Folder review of adolescents admitted at Groote Schuur Hospital (GSH) in the Emergency Psychiatric Unit. This study was a retrospective folder review of adolescents admitted from April 2015 to March 2019. Cannabis was the most commonly used substance in the study, with increased use seen post-ruling. The most common frequency of cannabis use reported was daily. A significantly higher proportion of patients who used cannabis pre-ruling had psychotic disorder (p < 0.001) and cannabis use disorder (p = 0.01). Post-ruling, the results were statistically significant (p < 0.001) for both. The study showed an increasing prevalence of cannabis use in adolescents admitted with mental illness after the high court ruling in 2017. This study also demonstrates that adolescents remain a vulnerable population to the effects of cannabis and highlights the need for further research. The findings of this study call for more focussed adolescent interventions and services.

Impact of Changing Cannabis Laws on Cannabis Use Disorders, Serious Mental Illness, and Mortality Outcomes in US Youth: A Narrative Review

Abstract: Youth cannabis use is a major public health crisis. Cannabis laws carry significant health implications for American youth. Relaxing of these laws – through decriminalization, medical and recreational legalization – by a majority of states in the United States (US) over the past 25 years has dramatically shifted societal perceptions and adult use. How cannabis policy changes have affected the population-wide health of US youth and downstream public health implications of cannabis laws remain topics of significant debate. Cannabis is the most commonly used federally-illicit drug by US adolescents and the main drug for which US teens obtain substance use treatment. Adolescent cannabis use is associated with negative long-term consequences for mental health, risk-taking behaviors, and academic/job achievement. As of January 2023, 37 states and the District of Columbia (DC) have enacted medical cannabis laws; of these, 21 states and DC have recreational cannabis laws. Multiple studies have assessed the association between cannabis laws and youth cannabis use; results indicate mostly null effects for medical laws and mixed effects for recreational laws. Little is known about the effects of cannabis laws on mental health and mortality outcomes for American youth. Methodological limitations have made the interpretation of this literature difficult. This article presents a narrative review of current scientific literature investigating the impact of changing cannabis policies on cannabis and other drug use, mental health, and mortality outcomes in US youth. Implications are framed within a larger discussion on national trends in youth drug use, effects of adolescent cannabis exposure on health outcomes, and research-based policymaking.

The influence of peer's social networks on adolescent's cannabis use: a systematic review of longitudinal studies.

A systematic review was performed to summarize the key findings of the peer influence on cannabis use through Social Network Analysis (SNA) studies and identify limitations and gaps with the purpose of informing future research and practice. Longitudinal studies were included since they provide robust information about social relationships change over time. Adolescents' cannabis use is a global problem, which has awakened an interest in its determinants such as social influences. Research has shown the importance of these influences on cannabis uptake and use. SNA is an useful relational approach to examine socialization mechanisms related to the onset of cannabis use in adolescents. A search was conducted in PyscINFO, PubMed, Scopus and Web of Science for longitudinal articles published until February 2023, to examine cannabis use and peer's social networks. We focus on peers' influence of peers on cannabis use. Additionally, information about effect of cannabis use for peer selection was collected. The results of the included studies (n = 8) showed that friends' cannabis use was most often/strongly associated with cannabis use. There was also an increase of cannabis use when the adolescent did not feel close to the school's peers, had a higher proportion of friendships relative to the total number of ties in the neighborhood, had a central position, did not belong to any group but had ties to members of two or more groups, had cannabis user friends (especially in early ages), and lived in a neighborhood where cannabis was used. Cannabis use is mainly related to friends' use. Yet, future studies are warranted to control for relevant selection effects to further knowledge on network effects on cannabis use, improving the design, and improving the modeling of the network. This systematic review may inform about the critical aspects of preventing cannabis use among adolescents, taking into consideration their complex social environment.

Proximity to Cannabis Retailers and Recent Cannabis Use among a Diverse Sample of California Adolescents

Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors (N = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018–2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935–0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926–0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820–0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers.

Associations Between Cannabis Use and Mental Distress in Young People: A Longitudinal Study

PurposeDespite a large number of studies on the relation between cannabis use and mental distress in adolescence, results are inconclusive regarding the nature of this association. The aim of the present study is to expand this body of research by analyzing the within-person association between changes in cannabis use and changes in mental distress among young people. MethodsWe used longitudinal data from a national sample of young people in Norway. The cohort was assessed in 1992 (T1), 1994 (T2), 1999 (T3), and 2005 (T4). The cumulative response rate was 60%. Respondents who participated in all four waves, aged 11–18 years at T1 (N = 1,988) were analyzed. Within-person association between changes in cannabis use and changes in mental distress in terms of symptoms of depression, anxiety, suicidal ideation, and deliberate self-harm were estimated by applying fixed-effects modeling. ResultsFor males, an increase in cannabis use from no use to more than 10 times/year was significantly associated with increased risk for anxiety (relative risk [RR]: 1.72, p = .009), depressed mood (RR: 1.49, p < .001), and suicidal ideation (RR: 3.43, p = .012). For females, the corresponding increase in cannabis use yielded an increased risk for anxiety (RR: 1.38, p = .023) and suicidal ideation (RR: 2.47, p = .002). DiscussionIncreased cannabis use during adolescence and young adulthood seem to increase the risk for symptoms of mental distress. Although the associations appear to be more pronounced among males, it was only for depression that there was a statistically significant gender difference in the association.

Psychometric properties of the family assessment task parental monitoring scenario among adolescents receiving substance use treatment

IntroductionThe Family Assessment Task (FAsTask) is an observer-rated parent-child interaction task used in adolescent substance use intervention. The parental monitoring component of the FAsTask is thought to provide an objective assessment of parental monitoring that can guide treatment planning and circumvent the potential limitations of self-report measures. Yet, the factor structure, measurement invariance, and concurrent validity of the parental monitoring FAsTask has not been evaluated; doing so is essential to effectively guide clinical care. This study examined if the parental monitoring FAsTask can be reliably administered across adolescent age and sex, and to identify which components of the parental monitoring FAsTask are most consistently associated with adolescent substance use. MethodsThe study pooled data from 388 adolescent-caregiver dyads across six separate clinical trials (adolescents [Mage = 15.7, 57.5% male, 61.9% White, 31.2% Latine]; caregivers [Mage = 42.14, 88.7% female, 72.7% White, 24.2% Latine]). Dyads completed the FAsTask and the Timeline Followback at baseline, prior to randomization. Analyses proceeded in three steps. First, exploratory factor analysis (EFA) was conducted in half of the sample, followed by a confirmatory factor analysis (CFA) in the second half of the sample. Second, measurement invariance was tested as a function of adolescent age and biological sex. Third, a series of structural equation models were used to assess the associations of each factor with alcohol use, binge drinking, and cannabis use. ResultsEFA and CFA indicated the presence of four factors (labeled Supervised/Structured, Active Monitoring, Task Engagement, and Parental Rules/Strategies). Evidence of measurement invariance was found across adolescent age and sex. The Supervision/Structure was negatively associated with adolescent alcohol use, binge drinking, and cannabis use. ConclusionsThe parental monitoring FAsTask demonstrates validity and retains its structure across adolescent age and sex. Items focused on parental supervision and structure are most strongly associated with adolescent substance use and may best inform clinical care for adolescent substance use.

Cannabis use and neurocognitive performance at 13–14 Years-Old: Optimizing assessment with hair toxicology in the Adolescent brain cognitive development (ABCD) study

ObjectiveCannabis is widely used, including in early adolescence, with prevalence rates varying by measurement method (e.g., toxicology vs. self-report). Critical neurocognitive development occurs throughout adolescence. Given conflicting prior brain-behavior results in cannabis research, improved measurement of cannabis use in younger adolescents is needed. MethodsData from the Adolescent Brain Cognitive Development (ABCD) Study Year 4 follow-up (participant age: 13–14 years-old) included hair samples assessed by LC-MS/MS and GC–MS/MS, quantifying THCCOOH (THC metabolite), THC, and cannabidiol concentrations, and the NIH Toolbox Cognitive Battery. Youth whose hair was positive for cannabinoids or reported past-year cannabis use were included in a Cannabis Use (CU) group (n = 123) and matched with non-using Controls on sociodemographics (n = 123). Standard and nested ANCOVAs assessed group status predicting cognitive performance, controlling for family relationships. Follow-up correlations assessed cannabinoid hair concentration, self-reported cannabis use, and neurocognition. ResultsCU scored lower on Picture Memory (p = .03) than Controls. Within the CU group, THCCOOH negatively correlated with Picture Vocabulary (r = -0.20, p = .03) and Flanker Inhibitory Control and Attention (r = -0.19, p = .04), and past-year cannabis use was negatively associated with List Sorting Working Memory (r = -0.33, p = .0002) and Picture Sequence Memory (r = -0.19, p = .04) performances. ConclusionsYouth who had used cannabis showed lower scores on an episodic memory task, and more cannabis use was linked to poorer performances on verbal, inhibitory, working memory, and episodic memory tasks. Combining hair toxicology with self-report revealed more brain-behavior relationships than self-report data alone. These youth will be followed to determine long-term substance use and neurocognition trajectories.

Interactive effect of adverse child experiences and suicidal thoughts and behaviors on adolescent alcohol and cannabis use frequency.

Adolescents with adverse childhood experiences (ACEs) and suicidality may engage in high levels of substance use to alleviate distress. Most studies of associations among ACEs, suicidality, and substance use rely on retrospective reports by adults. Comparatively less is known about concurrent relationships between ACEs, suicide risk, and substance use in adolescents, which is important for prevention. This study tested if the associations between ACEs and drinking and between ACEs and cannabis use would be even stronger among youth with suicidal ideation or attempt, relative to youth without suicidal ideation or attempt. High schoolers (N = 1,625; 50.8% male; 47.1% female; 2% nonbinary) from western New York completed the Youth Risk Behavior Survey. Ordinal regressions tested main effects and interactions of the number of ACEs and suicidal ideation/behavior (i.e., none, ideation/plan, attempt) on categories of past-month drinking and cannabis days of use, controlling for age, gender, and race/ethnicity. Significant ACEs by suicide interactions on adolescent drinking indicate that the association between ACEs and drinking was stronger for adolescents with suicide attempt adjusted odds ratio (AOR = 2.63) compared to youth with no ideation or attempt (AOR = 1.56) and suicidal ideation/planning only (AOR = 1.58). Main effects of ACEs (AORs = 1.95-2.08) and suicide attempt (vs. no suicidal ideation/attempt [AOR = 2.11] and suicidal ideation/plan [AOR = 2.11]) were associated with greater cannabis use; interactions were not significant. Associations between ACEs and drinking were particularly strong for adolescents with suicide attempt. Conversely, ACEs and suicide attempt were independently associated with cannabis use. Mitigating against ACEs may reduce both adolescent alcohol and cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cannabis craving in response to alcohol cues in the laboratory and in daily life among adolescents ages 15-17 years.

Most adolescents who drink alcohol also use cannabis, and adolescents who use both substances experience worse long-term outcomes than adolescents who use only one or the other. Recent clinical trials with adolescents and emerging adults show that alcohol cues are associated with elevated cannabis craving in the natural environment but not in the laboratory, highlighting cross-cue reactivity as a potential intervention target. This study extends this work to a younger sample of adolescents at an earlier stage of substance use to examine the generalizability of prior findings and inform etiological mechanisms. Participants were 81 adolescents aged 15-17 years who endorsed past-month alcohol and lifetime cannabis use. They completed a laboratory cue reactivity protocol where they rated their cannabis craving during alcohol cue and control conditions. They also completed 24 days of ecological momentary assessment where they reported multiple times per day on their cannabis craving and whether alcohol cues were visible. Mixed models demonstrated lower cannabis craving following alcohol cue presentation in the laboratory compared to control cues, but higher cannabis craving during moments when alcohol was visible in daily life compared to moments when alcohol was not visible. Frequency of cannabis use at baseline was associated with greater cannabis craving in the laboratory and in daily life regardless of cue type or alcohol visibility, and cannabis craving following alcohol cue presentation in the laboratory was positively related to daily life cannabis craving across contexts. This study adds to prior work suggesting that daily life cannabis craving is elevated when alcohol cues are visible. This cross-cue reactivity may be one factor that drives and maintains alcohol and cannabis use in adolescence.

Impact of Recreational Cannabis Legalization on Adolescent Cannabis Use in Washington State

An important public concern about the impact of recreational cannabis legalization is how it may affect adolescent cannabis use. Prior research on this issue has primarily focused on the implications of medical cannabis legalization for adolescents and used data that cover a relatively short post-legalization period. This study extends this line of research by examining the relationship between recreational cannabis legalization and adolescent cannabis use in Washington State, using the National Survey of Drug Use and Health (NSDHU) data from 2005 to 2019. Based on a quasi-experimental research design, this study found some evidence suggesting a positive effect of recreational legalization on the prevalence of adolescent cannabis use and cannabis initiation. Findings suggest the need to create a cannabis regulatory environment that minimizes adolescent access to this drug.

Microglial cannabinoid receptor type 1 mediates social memory deficits in mice produced by adolescent THC exposure and 16p11.2 duplication

Adolescent cannabis use increases the risk for cognitive impairments and psychiatric disorders. Cannabinoid receptor type 1 (Cnr1) is expressed not only in neurons and astrocytes, but also in microglia, which shape synaptic connections during adolescence. However, the role of microglia in mediating the adverse cognitive effects of delta-9-tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis, is not fully understood. Here, we report that in mice, adolescent THC exposure produces microglial apoptosis in the medial prefrontal cortex (mPFC), which was exacerbated in a model of 16p11.2 duplication, a representative copy number variation (CNV) risk factor for psychiatric disorders. These effects are mediated by microglial Cnr1, leading to reduction in the excitability of mPFC pyramidal-tract neurons and deficits in social memory in adulthood. Our findings suggest the microglial Cnr1 may contribute to adverse effect of cannabis exposure in genetically vulnerable individuals.

Concerns Related to the Consequences of Pediatric Cannabis Use: A 360-Degree View.

Cannabis, a plant known for its recreational use, has gained global attention due to its widespread use and addiction potential. Derived from the Cannabis sativa plant, it contains a rich array of phytochemicals concentrated in resin-rich trichomes. The main cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with CB1 and CB2 receptors, influencing various physiological processes. Particularly concerning is its prevalence among adolescents, often driven by the need for social connection and anxiety alleviation. This paper provides a comprehensive overview of cannabis use, its effects, and potential health risks, especially in adolescent consumption. It covers short-term and long-term effects on different body systems and mental health and highlights the need for informed decision making and public health initiatives, particularly regarding adolescent cannabis use.

Is there a gender paradox in the association between conduct problems and cannabis use? A cohort-study among Swedish adolescents.

Conduct problems (CP) predict cannabis use prospectively but the research is mixed as to whether this association is stronger among girls. A stronger association among girls would suggest a 'gender paradox' as both CP and cannabis use is less common in this group. This study aimed to assess whether the longitudinal association between CP and cannabis use in Swedish adolescents is stronger among girls. Data from two waves of a nationally representative cohort study of Swedish adolescents born in 2001 were used. Baseline measurements were collected in 9th grade (at age 15-16) and follow-up measures at 11th grade (at age 17-18). CP at baseline were significantly associated with cannabis use at follow-up adjusted for hyperactivity problems, emotional problems, socio-demographics, parental monitoring, school grades and truancy at baseline (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06-1.24) but not when also adjusting for substance use at baseline. Boys were more likely to have used cannabis during the past year, even when controlling for prior substance use (OR 2.29, 95% CI 1.76-2.98). The association between CP and cannabis use was significantly weaker for boys (OR 0.83, 95% CI 0.72-0.95 in the fully adjusted model). The predicted probability of cannabis use was stable at 0.13 for boys across levels of CP, but ranged from 0.05 to 0.16 for girls. The longitudinal association between CP and cannabis use was stronger among girls. The findings are indicative of a 'gender paradox' in the association between CP and cannabis use.

The association between traumatic experiences and substance and behavioral addictions in late adolescence: A role for PTSD and cPTSD as potential mediators

Background & aimTraumatic experiences (TEs) are a risk factor for behavioral and substance addictions (SBAs). However, the role of post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD) deserves further elucidation. The present study assesses the association between different types of TEs on cannabis, alcohol, gambling, and problematic internet use in late adolescents. Furthermore, this study aims at evaluating the role of PTSD and cPTSD as potential mediators. MethodsAn observational cross-sectional study was conducted on one thousand ten late adolescents (510 males, 498 females; age: mean = 18.7, SD = 0.65). Data regarding intentional (iTEs) and unintentional TEs (uTEs), cannabis, alcohol, gambling and problematic use of the internet (PIU), PTSD, and cPTSD were collected. Association between TEs, SBAs, and PTSD/cPTSD symptoms were explored by means of logistic regressions. Mediation was assessed using a path analysis. ResultsuTEs were associated with cannabis use (OR = 1.34 [1.13,1.59]) and alcohol use (OR = 1.21 [1.10,1.35]), iTEs were associated with cannabis use (OR = 1.15 [1.06,1.25]), alcohol use (OR = 1.08 [1.02,1.13]), and PIU (OR = 1.17 [1.10,1.24]). PTSD was associated with alcohol use (OR = 1.59 [1.03,2.46]) and PIU (OR = 1.92 [1.18,3.13]). cPTSD was associated with cannabis use (OR = 3.54 [1.56,8.04]) and PIU (OR = 5.13 [2.71,9.70]). cPTSD mediated 58.75% of the total effect of iTEs on cannabis. Regarding PIU, PTSD mediated 68.18% of the effect of uTEs; the effect of iTEs on PIU was mediated by 65.5% via cPTSD and 34.45% via PTSD. ConclusioncPTSD and SBAs show a complex pattern of association. A thorough assessment of stress-related conditions, including cPTSD, is of pivotal importance in treating SBAs.

Towards a New Dynamic Interaction Model of Adolescent CUD Manifestation, Prevention, and Treatment: A Narrative Review.

Cannabis is one of the most popular drugs of the 21st century, especially among adolescents and young adults. Evidence of a variety of lasting neuropsychological deficits as a result of chronic cannabis use has increased. Furthermore, regular cannabis use is found to be a predictor of mental health problems, less motivation in school, and school dropout. Our goal is to propose a theoretical model of adolescent cannabis use disorder (CUD) based on Zinberg's drug, set, and setting model and explicated by a review of the literature on adolescent cannabis use to improve the prevention and treatment of CUD for adolescents. PubMed and Web of Science were searched for relevant publications as part of a hypothesis-based and model-generating review. Individual (set) and environmental (setting) risk factors play important roles in the development of CUD in adolescents. School performance, motivation, and attendance can be negatively influenced by persistent cannabis use patterns and adolescent brain development can consequently be impaired. Thus, cannabis use can be understood as both being the cause of poor school performance but also the consequence of poor school performance. To prevent and reduce adolescent CUD the drug, set, and setting must all be considered. It is important to notice that the multiple feedback loops (indicated in our dynamic interaction model) are not mutually exclusive, but offer important intervention focus points for social workers, addiction professionals, parents, and other care takers. We argue that the three dimensions of drug, set, and setting contribute significantly to the eventual manifestation of CUD. Based on our dynamic interaction model, recommendations are made for possible preventive and therapeutic interventions for the treatment of adolescents and young adults with CUD.

Cannabis use disorder, suicide attempts, and self-harm among adolescents: A national inpatient study across the United States.

Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents. To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents. We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm. 807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001). Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.

Anxiety as a predictor of the age of initiation of tobacco and cannabis use in adolescents and young adults

BackgroundPrevious research has shown important links between anxiety and the use of tobacco and cannabis. However, it remains unclear whether anxiety leads youth to start using tobacco and cannabis at an earlier age. MethodsData were drawn from Texas Adolescent Tobacco and Marketing Surveillance System for the years 2019–2021(Waves 9–14). Participants were in 10th-grade, 12th-grade, and two years post-high school at baseline. The outcomes were the age of first use of cigarettes, e-cigarettes, and cannabis. Interval-censoring Cox proportional hazards models were fit to examine the differences in the estimated age of initiation of tobacco and cannabis use by anxiety. ResultsAmong the 10th-grade cohort, participants with anxiety had an increased risk of an earlier age of cigarette [AHR = 2.29(1.63–3.23)], e-cigarette [AHR = 1.53(1.17–2.00)], and cannabis [AHR = 1.59(1.23–2.05)] initiation. Among the 12th-grade cohort, participants with anxiety had an increased risk of an earlier age of cigarette [AHR = 1.52(1.21–1.90), e-cigarette [1.25(1.01–1.60)] and cannabis [AHR = 1.35(1.09–1.67] initiation. Among the post-high school cohort, the only significant association found was for cannabis initiation [AHR = 1.33(1.11–1.58). Between ages 18-to-19 years in the 10th-grade cohort, and between ages 20–21 years in the 12th-grade cohort, cumulative incidence of each of the three outcomes initiation doubled among anxious youth. ConclusionsThis study's findings show that anxiety symptoms can increase the risk of substance use initiation at an earlier age, especially among the youngest adolescent cohort (∼15-to-16-year-olds). These findings highlight the importance of early screening and treatment of anxiety symptoms as a preventive measure to delay or prevent the onset of substance use initiation.

15.2 Learning and Striatal-Cortical Functional Connectivity in Adolescent Alcohol and Cannabis Use Conduct the Passive Avoidance Task

15.2 Learning and Striatal-Cortical Functional Connectivity in Adolescent Alcohol and Cannabis Use Conduct the Passive Avoidance Task