Cannabis Use Research Articles

Cannabis Use Among Cancer Patients During Active Treatment: Findings From a Study at an NCI-Designated Cancer Center.

This study aims to describe patterns, sources, and reasons for cannabis use among cancer patients during active treatment (+CDTX) compared to no-use during active treatment (-CDTX). Data are from 385 surveys collected via REDCap during phase I of an ongoing study among adult cancer patients seen at an NCI-designated comprehensive cancer center within the last 5 years of treatment. A harmonized survey was created with 11 other NCI centers to assess cannabis use patterns, sources, and reasons for use. Sociodemographics and cancer details were also collected via self-report. Descriptive statistics were calculated and stratified by +/-CDTX. Chi-squared tests were conducted to compare proportions between groups. Among the sample [49.5 years (SD 15.9); 53.0% male; and 41.6% Hispanic/Latino], 41.0% + CDTX and 59.0% -CDTX. A majority (71.8%) of +CDTX initiated use before diagnosis versus 44.1% in -CDTX (p < 0.0001); patients diagnosed with stage 4 cancer had a statistically significant higher prevalence of +CDTX (60.0%; p = 0.003); 53.3% in radiation reported +CDTX compared to 42.8% in chemotherapy, and 36.4% in immunotherapy. Dispensaries and local dealers were the top sources of cannabis in both groups. Among +CDTX, 44.3% consumed cannabis at least once a day DTX, dominant cannabinoids used were CBD (35.2%), Delta-8-THC (18.3%), and CBD + THC ratio (14.1%); 12.7% were unsure what they consumed. Joints were the most common inhalation method (61.5%), and store-bought candy was the most common edible (39.2%). Depression/mood, pain, and enjoyment were the top three reasons for +CDTX compared to enjoyment, depression/mood, and nausea/upset stomach in -CDTX (p = 0.02). Patterns, sources, and reasons for cannabis use varied between +CDTX and -CDTX. Future studies should examine the impacts of cannabis and specific cannabinoids on cancer treatment, drug interactions, survival outcomes, and quality of life.

Concentrations of Delta 9-tetrahydrocannabinol (THC) in oral fluid at different time points after use: An individual participant meta-analysis

BackgroundDelta 9-tetrahydrocannabinol (THC) concentrations in oral fluid (OF) at different time points after cannabis administration and factors related to these concentrations have not been previously described in a meta-analysis. This information is critical for better understanding of these tests for detection of prior cannabis use and cannabis impairment. Objectives1: To describe the summary statistics of THC concentrations at different time points after cannabis administration. 2: To describe the relationship between the variables of dose of THC, frequency of using cannabis, route of administration (i.e., inhaled or ingested), OF collection device and sex, with THC concentrations in OF, based on bivariate analyses. 3: To describe the independent contribution of each of the variables in Objective 2, based on a multivariate analysis of THC concentrations. MethodsA meta-analysis of studies from two databases (PubMed and Scopus) was conducted. Our inclusion criteria included published empirical articles that administered natural cannabis to subjects in a controlled setting, with OF drug tests showing the exact THC concentrations in OF for each subject (i.e., raw data) for at least two time points after cannabis administration using confirmatory methods. Seven studies of tests with published raw data for OF THC after cannabis administration met these criteria (n observations=1157). ResultsSummary statistics showed OF THC concentrations by time after use were highly dispersed at every time point, positively skewed, and declined over time. Many positive OF THC concentrations were found after 24-hours in one study, but most studies did not conduct observations past 24 hours. In a multivariate analysis, we found that increased dose, increased frequency of cannabis use, and inhaled (versus ingested) cannabis were statistically related to higher OF THC concentrations. OF collection with the intercept DOA device was significantly higher than expectorant (i.e. saliva) and being male (versus female) were only significant in a bivariate analysis. Too little data existed to reliably analyze the possible influence of other variables of age, race and body mass index (BMI) on OF THC concentrations. DiscussionFalse negatives exist when the tests are used to detect prior use. OF test results are related to confounders of frequency of cannabis use and inhaled (versus ingested) cannabis. OF tests can produce positives at a cut-off 1.0 ng/mL well beyond 24 hours. The tests are not valid to detect cannabis impairment. More information is needed on the influence of potential confounders for OF concentrations. We do not have a good idea of the degree to which the subjects in these studies are representative of persons who use cannabis. Overall, more research is needed for these tests to be used in workplace settings.

Parental Monitoring and Its Association With Alcohol, Tobacco Cigarettes, and Cannabis Initiation in the United States Adolescent Population

PurposeLimiting time with friends (LTWF), a facet of parental monitoring, may be protective for newly incident adolescent alcohol, tobacco cigarette, and cannabis use. MethodsWe extended epidemiological evidence based on estimates from nationally representative samples of US adolescents aged 12–17 years, across 18 years of independent samples of the National Survey on Drug Use and Health (2002–2019). We estimated the prevalence of always LTWF, and odds ratios examining incident alcohol, tobacco cigarette, and cannabis use by LTWF within age and cohort. ResultsThe prevalence of always LTWF decreased with older age within study year and cohort. The odds of alcohol initiation were lower among youth reporting their parents were always LTWF. The odds of tobacco cigarette and cannabis initiation were lower among younger youth reporting their parents were always LTWF. DiscussionFuture research is needed to fully understand the influence of LTWF on incident substance use, particularly for older adolescents.

Trends in Driving Under the Influence of Alcohol and Cannabis Among Young Adults in Washington State From Before to During the COVID-19 Pandemic.

Objectives. To examine trends in young adult self-reported driving under the influence of alcohol (DUI-A), cannabis (DUI-C), and simultaneous alcohol and cannabis use (DUI-AC) in a state with legalized nonmedical cannabis use from before to during the COVID-19 pandemic. Methods. We used logistic regression and annual statewide data from the Washington Young Adult Health Survey to assess DUI behaviors from 2016 to 2021. Results. Both prepandemic yearly changes in prevalence and deviations from those trends during the pandemic years were small and not statistically significant. However, prevalence estimates were alarming: 12.0% of participants reported DUI-A, 12.5% reported DUI-C, and 2.7% reported DUI-AC. Exploratory moderation analyses indicated a relative increase in DUI-A during 2020 among 4-year college students relative to young adults not attending 4-year colleges. Conclusions. Young adults in Washington State continued to engage in risky DUI behaviors during the pandemic. College students may have increased their likelihood of DUI-A during COVID-19. Public Health Implications. Young adults, for whom vehicle crashes remain a leading cause of death, showed little change in DUI behaviors during the COVID-19 pandemic. There is continued need for young adult DUI prevention efforts. (Am J Public Health. 2024;114(S8):S698-S701. https://doi.org/10.2105/AJPH.2024.307767).

Self-Medication Paths: A Descriptive Study Unveiling the Interplay Between Medical and Nonmedical Cannabis in Chronic Pain Management.

Cannabis is used by one-third of people living with chronic pain to alleviate their symptoms despite warnings from several organizations regarding its efficacy and safety. We currently know little about self-medication practices (use of cannabis for therapeutic purposes without guidance), mainly since the legalization of recreational cannabis in countries such as Canada has expanded the scope of this phenomenon. This study aimed to describe legal cannabis self-medication for pain relief in people living with chronic pain and to explore perceptions of the effectiveness and safety of cannabis. A cross-sectional descriptive study was performed among 73 individuals living with chronic pain and using cannabis (Quebec, Canada). Data collection using telephone interviews occurred in early 2023. Results indicated that 61.6% of participants reported using cannabis without the guidance of a health care professional (self-medication). Surprisingly, among those, 40.0% held a medical authorization. Overall, 20.6% of study participants were using both medical and legal nonmedical cannabis. Different pathways to self-medication were revealed. Proportion of women versus men participants self-medicating were 58.2% versus 70.6% ( P =0.284). In terms of perceptions, 90.4% of the sample perceived cannabis to be effective for pain management; 72.6% estimated that it posed no or minimal health risk. Cannabis research is often organized around medical versus nonmedical cannabis but in the real-world, those 2 vessels are connected. Interested parties, including researchers, health care professionals, and funding agencies, need to consider this. Patients using cannabis feel confident in the safety of cannabis, and many of them self-medicate, which calls for action.

Medical Misinformation and Quality of Public Video Content on Cannabis for Chronic Pain Management: A Cross-Sectional Analysis of the YouTube Platform.

As cannabis legalization expands nationally and globally, its use for chronic pain increases, prompting people to seek information on social media platforms like YouTube. This study evaluates the accuracy and quality of information of popular YouTube videos on cannabis for chronic pain. Using search terms related to cannabis for pain, the top 66 videos by view count were selected. Each video was classified as useful, misleading, or neither. The quality and reliability of each video were assessed using the modified DISCERN, mDISCERN, score and the Global Quality Scale, GQS. The video characteristics, usefulness classification, mDISCERN scores, and GQS scores were summarized. Continuous and categorical outcomes were compared using t-test and chi-square, respectively. Of the 66 videos, 22.73% (n=15) were classified as useful, and 77.27% (n=51) were classified as neither. Of useful videos, 40.00% (n=6) were uploaded by physicians, 40.00% (n=6) were uploaded by corporations, and 6.67% (n=1) were uploaded by an independent user. Of videos classified as neither useful nor misleading, news sources uploaded 27.45% (n=14) of these videos (P=0.02). Physicians uploaded 37.50% (n = 18) of videos with a GQS score ≥3 (P=0.04), while independent users uploaded significantly more videos with a mDISCERN score <3 (22.20%, P=0.02). Useful videos had a mean GQS of 4.00 ± 0.65 compared to a mean GQS of 2.76 ± 0.86 for videos deemed neither (P<0.0001). This study suggests a moderate quality of YouTube content on cannabis use for chronic pain. Given cannabis's growing popularity and potential for misinformation on popular social media platforms, healthcare professionals and organizations should consider uploading educational videos on this topic on YouTube.

Daily associations between resilience factors, substance use, and affect among sexual minority youth.

Past research has highlighted that sexual minority youth (SMY) are at particular risk for heightened substance use compared to their heterosexual peers; however, few studies have investigated the associations between resilience factors and substance use among SMY. In the present preregistered study, we examined the associations among three different forms of resilience factors (i.e., general social support, lesbian, gay, bisexual, transgender, and queer (LGBTQ)-identity affirmation, LGBTQ community involvement) and alcohol, nicotine, and cannabis use, as well as on positive and negative affect. SMY (n = 82, ages 15-19, 56.1% cisgender women, 84.4% White) completed a baseline assessment then a 30-day ecological momentary assessment study. Multilevel regression models evaluated within-day and between-person associations between resilience factors and odds of substance use (alcohol, nicotine, cannabis), substance use quantity on use days (alcohol, cannabis), positive affect, and negative affect. On the day level, general social support was associated with greater positive affect, lesser negative affect, and greater drinks on drinking days. LGBTQ-identity affirmation was associated with greater positive affect, lesser negative affect, and greater odds of nicotine use. LGBTQ community involvement was associated with greater positive affect. These results highlight the nuanced ways that resilience may engender more positive affect and reduce negative affect while simultaneously promoting substance use. Future research disentangling the mechanisms connecting resilience and substance use among SMY is necessary. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Concurrent and long-term effects of early pubertal timing on alcohol, cigarette, and cannabis use from adolescence to adulthood.

Early pubertal timing is a risk factor for substance use during adolescence. Fewer studies investigated whether early pubertal timing continues to predict substance use in late adolescence and adulthood, suggesting that long-term effects of pubertal timing vary across substances and by biological sex. Finally, existing studies on pubertal timing and substance use in adulthood involved predominantly White samples. Thus, this longitudinal study examined the concurrent and long-term effects of pubertal timing on alcohol, cigarette, and cannabis use together with sex differences in predominantly Black youth from the United States. The sample included 603 youth (52% male, 80% Black) who were interviewed in early adolescence (mean age: 13.2), late adolescence (mean age: 17.6), and young adulthood (mean age: 27.7). During early adolescence, youth self-reported their physical maturation based on Tanner scores, which were adjusted for age and used as indicators of pubertal timing. Youth self-reported their substance use at each time point. Early pubertal timing was associated with higher odds of alcohol use during early adolescence but did not predict alcohol use during late adolescence or adulthood. While early pubertal timing did not predict cigarette use at any time point, early pubertal timing predicted greater odds for cannabis use during early adolescence and higher rates of cannabis use in adulthood. Moreover, early pubertal timing predicted greater risk for couse of alcohol, cigarettes, and cannabis in adulthood. No effects differed by sex. These findings suggest that links between pubertal timing and substance use vary across substances and developmental periods. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Use and co-use of tobacco and cannabis before, during, and after pregnancy: A longitudinal analysis of waves 1-5 of the Population Assessment of Tobacco and Health (PATH) study.

Data were drawn from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Prepregnancy, pregnancy, and postpartum data were captured and stacked over three intervals (Waves 1-3, 2-4, and 3-5). Participants were N = 686 U.S. women (72% White, 46% age 25-34) who were currently pregnant during the middle wave of an interval. Rates of tobacco-only use, cannabis-only use, and tobacco and cannabis co-use at all three time points were examined. Generalized estimating equation models demonstrated that pregnant women who reported prepregnancy tobacco and cannabis co-use (vs. tobacco-only or cannabis-only use) were more likely to continue to use tobacco and/or cannabis during pregnancy and relapse in postpartum (p < .05). Among women who endorsed prepregnancy co-use and continued to use tobacco and/or cannabis in pregnancy, about half transitioned to tobacco-only use (45.16%). Findings underscore the need for further clinical and empirical focus on dynamic patterns of use/co-use of tobacco and cannabis across the perinatal period, including cessation interventions to reduce tobacco and cannabis use in pregnancy and protect against relapse in postpartum. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study

BackgroundResearch has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors. MethodsWe analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours. ResultsACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours. ConclusionsChildren who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

Associations Between Psychedelic Use and Cannabis Use Disorder in a Nationally Representative Sample

Associations Between Psychedelic Use and Cannabis Use Disorder in a Nationally Representative Sample

Acute Stress Effect on Delay Discounting and Cannabis Demand among Individuals Endorsing High-frequency Cannabis Use

Acute Stress Effect on Delay Discounting and Cannabis Demand among Individuals Endorsing High-frequency Cannabis Use

Mobile phone ownership, social media use, and substance use at ages 11–13 in the ABCD study

IntroductionThere is ongoing concern about the impact of increasing use of social media and digital devices on unhealthy behaviors such as substance use in youth. Mobile phone and social media use have been associated with substance use in adolescent and young adult samples, but few studies have evaluated these relationships in younger samples. MethodsThis secondary analysis of data drawn from the ABCD Study examined associations between youth-reported mobile phone ownership and social media use at age 11–12 and use of alcohol, nicotine/tobacco, and cannabis over the next 18 months. ResultsLongitudinal logistic regression was used to test the hypothesis that phone ownership and social media use at age 11–12 would predict substance use over time. Phone ownership was associated with greater odds of alcohol and nicotine/tobacco use, and social media use was associated with greater odds of using nicotine/tobacco and cannabis. ConclusionsThese findings suggest that pre-teen youth who own mobile phones and those who use social media may be at greater risk for substance use. Further research is needed to specify mechanisms by which this association occurs and thus inform prevention and intervention efforts.

Predictors of perinatal cannabis use in colorado and the association with depression during pregnancy.

To evaluate the prevalence and predictors of cannabis use and reasons for use during and/or after pregnancy among Colorado birthing individuals. To determine the independent association of self-reported depression during pregnancy and cannabis used. Data from Health eMoms, a statewide perinatal longitudinal electronic surveillance system were analyzed. Perinatal cannabis use was defined as any use during and/or after pregnancy. Bivariate associations of birthing individual and infant characteristics with use were estimated using chi-square tests. Multivariable logistic regression was used to assess the independent relationship between depression and reported cannabis use versus no reported cannabis use. A weighted sample of 117,812 birthing individuals was analyzed from survey responses between 2018-2021. Among the 15,585 (13.3%) who reported perinatal cannabis use, 35.5% reported use during pregnancy and 87.3% reported post-partum use. Individuals with depression during pregnancy had 2.2 times higher adjusted odds (95% CI: 1.5. 3.3) of any perinatal cannabis use compared to those without depression. Among those who had any perinatal cannabis use, reported use for medical reasons was 92% during pregnancy, while 43% cited this as the reason for use 12-14months post-partum. Self-reported cannabis use during the perinatal period in a state with legalized recreational use was over 1 in 10. Use varied significantly by demographics and social factors with inconsistent perinatal guidance provided by healthcare professionals. Depression during pregnancy was significantly associated with use, illustrating the need for comprehensive mental health screening and therapeutic evidence-based interventions to support these individuals.

Effect of cannabis use history on postoperative opioid utilization in lumbar fusion patients: an American retrospective study.

A retrospective cohort study. To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease. Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management. In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All pvalues <0.05 were considered statistically significant. Following examination of 153,500 patient records, 1,216 patients were matched into cannabis user and non-cannabis user cohorts. Cannabis users had lower rates of opioid utilization compared to non-cannabis users as early as 2 months after fusion (47.7% vs. 41.1%, p <0.05), a relationship which persisted at 6 months (46.2% vs. 37.7%, p <0.01). Additionally, cannabis users had lower rates of high-dose opioid utilization (≥100 MME per day) during the initial 14-30 days following surgery (6.91% vs. 3.79%, p <0.05). Patients with a history of cannabis use were less likely to be using opioids as early as 2 months postoperatively and had lower rates of high-dose opioid utilization in the immediate postoperative period. Physicians operating on these patients should consider their cannabis use patterns to provide appropriate titration of pain medication over time.

Effect of Adding Cannabis (Cannabis Sativa) in Balanced Feed as a Growth Promoter in Cobb 500 Broiler Chickens

Objective: The purpose of the research was to evaluate the productive behavior of Cobb 500 Broiler Chickens with the addition of Cannabis in the Balanced Feed. Theoretical Framework: There is a growing interest in the use of cannabis in animal feed, not only for its nutritional contribution but also for the effects of the various compounds present in this plant; cannabis oil and seeds are rich in omega-3 fatty acids, which can be transferred to egg yolks and chicken meat. Method: The research was carried out in the field phase, as a descriptive experimental with the Completely Randomized Experimental Design (C.R.D.), with four treatments and three repetitions. The total sample size was 96 Broiler chickens of the Cobb 500 line. Results and Discussion: The highest feed consumption, initial weight, final weight and economic benefit were reported in the treatment with 10 kg of commercial Balanced Feed + 40 g of Cannabis. Research implications: This study shows that Cannabis as a feed additive can be used as a growth promoter in the diet of Cobb 500 Broiler Chickens. Originality/Value: This study contributes with a new alternative to improve poultry feeding, through the use of Cannabis in the daily diet, which has been shown to be effective in increasing weight gain in chickens.

Development, Content Validation and Usability of a Chatbot for Disseminating Scientific Information About Cannabis Among Young Adults

ABSTRACT Despite the high prevalence of cannabis consumption, there is limited information about cannabis based on scientific evidence available and targeted toward young adults, especially considering accessible language and ease of access. The present study aimed to develop the proof of concept of a chatbot for the dissemination of evidence and scientific information about cannabis, focused on a young adult audience. The proof of concept involved stages of literature review, conversation flow development, content evaluation through a panel of experts (n = 10) and usability analysis using a sample of potential users (young adults, n = 10). The chatbot developed presents information on epidemiology, toxicology, acute and chronic effects of cannabis use, information on cannabis use disorder, and the use of cannabinoids for medicinal purposes. The content evaluation through the Health Education Content Validation Instrument concluded that the tool was considered to have a good structure and content (Content Validity Index > 0,78; overall score = 9.0/10.0). The tool also proved to be functional and highly usable according to the analysis with the System Usability Scale (overall usability score = 9.2/10.0). Digital strategies such as chatbots can help in health education and scientific communication within stigmatized areas, such as the consumption of psychoactive substances.

Preadolescent individual, familial, and social risk factors associated with longitudinal patterns of adolescent alcohol, cannabis, and other illicit drug use in a population-representative cohort.

The aim of this exploratory study was to identify developmental patterns of adolescent concurrent alcohol, cannabis, and other illicit drug use and their preadolescent individual, familial, and social risk factors in a population-representative cohort from the province of Quebec, Canada (N = 1,593; 48.4% male). Age 12-17 years self-reports of alcohol, cannabis, and other illicit drug use were collected. Latent growth modeling was used to analyze developmental patterns of single- or polysubstance use (SU/PSU), and multinomial regression examined their association with risk factors assessed at age 10-12 years. Five developmental patterns were revealed, including nonusers (12.8% sample) and four classes reflecting different levels of SU/PSU (5.8%-37.5%), varying in severity based on onset, frequency, and type of substances used. Boys and girls were similarly represented throughout SU/PSU patterns. In comparisons with nonusers, several preadolescent risk factors were associated with increasing severity of SU/PSU. Possibly indexing fearlessness/disinhibition, low internalizing symptoms were common to all adolescent users. An earlier onset of substance use and increasing use of substances throughout adolescence were linked with having deviant peers for all user classes but later-onset users. Preadolescents manifesting externalizing problems and exposed to family adversity in addition to the above risk factors showed the earliest onset and most frequent adolescent SU/PSU, especially those also exposed to less appropriate parenting. Consistent with the developmental model of substance use, the nature, number, and severity of preadolescent risk factors distinguished between the type and severity of SU/PSU patterns in adolescence and call for a consistent strategy of universal, selective, and indicated preventive interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mental Health Experiences Among Undergraduate Nursing Students in a New Zealand Tertiary Institution: A Time for Change.

Nursing students in undergraduate programmes exhibit comparable, sometimes higher, levels of poor mental health and substance use compared to the general population; however, this area remains under-researched in New Zealand. The study involved 172 nursing students enrolled in the Bachelor of Nursing programme at one tertiary institution in Auckland, New Zealand. Employing a mixed-methodology approach, a 29-question survey comprising both open and closed questions was administered to explore the students' experiences with mental health and substance use, as well as their access to support services. Quantitative data were analysed using SPSS version 29 descriptive statistics, while a general inductive approach guided the qualitative analysis. A significant proportion of participants (75%) reported experiencing emotional distress during their studies, with anxiety being the most prevalent (78.5%). A smaller percentage disclosed substance use (8.1%) including excessive alcohol use, cannabis use, nicotine use, vaping cannabis and some refusal to reveal substance use. Surprisingly, less than 1% (n = 0.6) utilised institutional support services. Three qualitative themes were identified including emotional distress and associated effects, emotional and psychological impacts on nursing students' academic journey and tertiary support systems. The findings highlight the urgent need to address the mental health and addiction challenges experienced by nursing students, given their potential adverse effects on academic success and overall well-being. Urgent action is needed to integrate mental health training into the curriculum and provide faculty support. In this study, the underutilisation and inadequacy of institutional support services signal a need for institutional reforms to provide access and personalised mental health support to nursing students. Providing essential skills and support for student success contributes to the overall well-being of the nursing workforce.

Cannabis use and sleep problems among young adults by mental health status: A prospective cohort study.

Young adult cannabis use is common; while cannabis is often marketed as a product that can improve sleep, evidence supporting these claims is limited, and effects may differ for individuals with underlying mental health issues. This study measured the association between cannabis use and sleep problems among young adults and determined whether associations differ by mental health status. Using two waves of a young adult cohort study (baseline: March-September 2020; follow-up: January-June 2021), we measured the association of cannabis use frequency with subsequent sleep problems overall and stratified by baseline sleep quality and mental health status in separate moderation analyses. This study was conducted in Southern California, USA, and included 1926 participants aged 20-23 years (mean age = 21; 61% female, 46% Hispanic). Exposure was baseline cannabis use frequency (never use, prior use, 1-5 days/month, 6-19 days/month, ≥ 20 days/month). The outcome was sleep problems at follow-up (range = 4-24, higher score indicating worse sleep). Models were adjusted for socio-demographic factors, baseline sleep problems, mental health symptoms (depression and/or anxiety versus neither) and past 30-day nicotine or alcohol use. In moderation analyses, models were additionally stratified by mental health symptoms and baseline sleep quality (excellent versus imperfect sleep). Among the young adult sample, 11% used cannabis ≥ 20 days/month at baseline. For participants without baseline anxiety or depression symptoms, using cannabis ≥ 20 days/month (versus never use) was associated with greater sleep problems at follow-up [mean difference (MD) = 1.66, 95% confidence interval (CI) = 0.59-2.74]. Among participants with anxiety and/or depression and pre-existing sleep problems at baseline, using cannabis ≥ 20 days/month (versus never use) was associated with fewer sleep problems at follow-up (MD = -1.42, 95% CI = -2.81 to -0.02). The effects of cannabis use on sleep appear to differ by underlying mental health symptoms. Frequent cannabis use may improve sleep for young adults with depression and/or anxiety who have pre-existing sleep problems, but worsen sleep for young adults without depression and/or anxiety.