(71) Cognitive, Behavioral, and Emotional Outcomes of Severe Cannabis Use in Adolescents

Background: Cannabis, following tobacco, is the second most commonly used substance in the United States among adolescents, with use extending from occasional recreational use to abuse [1-3]. There is a gap in comprehensive assessments of cognitive, behavioral, and emotional deficits, along with predictors that may be linked to the severity of cannabis use in high school-aged adolescents.

Objectives: This study aims to examine the relationship between the severity of cannabis use and outcomes in cognitive, behavioral, and emotional domains among a population-based sample of US high school-aged adolescents, and assess the demographic predictors and risk factors that contribute to the psychiatric outcomes of severe cannabis use.

Methods: We conducted a cross-sectional study by using the 2019 Youth Risk Behavior Survey (YRBS) data. We included 8,996 participants who are a representative sample of US high school students. We performed descriptive statistical analysis to evaluate the impact of demographics on cognition, risk-taking behavior, and substance use among the participants. The linear-to-linear association test is used to compare the differences between non-users and moderate/severe cannabis users. The odds ratio was generated by the logistic regression model and was adjusted for age, gender, race, and psychiatric comorbidities.

Results: The majority of our sample population were females (49.9%) and whites (52.4%). The + 17-year age group had the highest proportion of severe cannabis use (38.1%). Males (OR 2.03; 95% CI 1.50 –2.74) and blacks (OR 2.06; 95% CI 1.31–4.22) had higher odds for severe cannabis use. Severe cannabis use was significantly associated with adverse cognitive, emotional, and behavioral outcomes; difficulty concentrating (52.9%), depressive symptoms (53.1%), sleep problems (77.8%), suicide plan (29%), and injury from a suicide attempt (8%). Risk-taking behaviors (physical fighting at school (17.3%) were higher in severe cannabis users, with higher lifetime stimulants (11%), inhalants (11.9%,), and heroin use (1.5%). Severe cannabis users had a significantly higher likelihood of having poor grades (OR 2.74), using illegal drugs at school (OR 2.33), having multiple sex partners (+3 people)( OR 7.61), and comorbid substance use (cigarette (+10 days/month ) (OR 8.72), alcohol (1-9 days/month) (OR 3.18), and electronic vapor product (OR 15.72).

Conclusion: Severe cannabis use among high school students in the United States is associated with significant adverse cognitive, behavioral, and emotional outcomes. Early identification of patterns and predictors of severe cannabis use among adolescents would have a significant impact on mitigating suicidality in youth and reducing burdens on individuals and society. The better understanding gained from population-based data among adolescent groups on outcomes associated with severe cannabis use can be beneficial in creating prospective educational programs, increasing access to health care, and providing an important path for future evidence-based policies.

References
1) Hasin DS. US Epidemiology of cannabis use and associated problems. Neuropsychopharmacology. 2018;43(1):195‐212.
2) Barber PA, Pridmore HM, Krishnamurthy V, et al. Cannabis, ischemic stroke, and transient ischemic attack: a case‐control study. Stroke. 2013;44(8):2327‐2329.
3) Charilaou P, Agnihotri K, Garcia P, et al. Trends of cannabis use disorder in the inpatient: 2002 to 2011. Am J Med. 2017;130(6):678‐687.

Diversity, Equity, and Inclusion: Our study will provide a better understanding of predictors and social determinants of psychiatric outcomes associated with severe cannabis use among adolescent groups to increase access to health care, contribute to creating prospective educational programs for healthcare disparities, and provide an important path for future evidence-based policies.