Whether they used cannabis or not, results showed that students who had the lowest executive and memory scores were more addicted to tobacco and had higher trait anxiety. An association with tobacco use has been shown to be prevalent in both BD and cannabis users . In another context, chronic tobacco smoking was found to be related to neuropsychological impairment, notably for memory and flexibility . Like tobacco, anxiety can represent a risk factor for neuropsychological impairments, above all by affecting executive functioning . In the present study, college students who exhibited cognitive impairments tended to be more anxious. Students used alcohol to cope, especially those with higher levels of anxiety . The relationship between BD, cannabis use, and anxiety remains unclear, especially in college students . Tobacco and a high anxiety level, added to BD and/or cannabis use, may worsen the cognitive impairments highlighted in our study, as they seem to impair the same cognitive areas. Although the nature of our study did not allow us to establish any causal relationship between these variables, our results do suggest that they should be taken into account in prevention. The circularity of the possible risk factors for developing cognitive impairments between substance use, anxiety, and substance use to cope with anxiety is alarming, especially so regarding the current health context. With the SARS-CoV-2 pandemic, students have had to contend with high levels of anxiety . Regardless of context, these findings highlight the importance of prevention, so that students can be identified and psychologically supported at an early stage-even before they indulge in BD or substance use, or develop anxiety. Complementary analyses suggested that students with neuropsychological impairments spent more money on cannabis than those with preserved performance .
Even if this result has yet to be properly analyzed, it highlights the problem of how to measure cannabis intake. Unlike alcohol, with its standard drink units, cannabis lacks a precise measure that would reflect the actual amount consumed, and this issue needs to be further explored. One limitation of this study is that some patterns of students’ consumption were not represented in our sample, and consumption was self-reported. We chose to divide participants into three groups, based on available data, mobile grow system in order to examine the impact of co-occurring BD and cannabis use on neuropsychological profiles. However, the study sample did not encompass students who consumed cannabis without BD, as this profile is scarce in college students, and was particularly lacking in our sample. Future studies will therefore have to be conducted among cannabis users without BD to further focus on the aggravating effects of combined BD and cannabis use. Moreover, the three groups in our sample differed in size, which may have influenced statistical power and Type I errors. Furthermore, the neuropsychological assessment we used in this study was a screening test with multicomponent tasks that rely on executive and memory abilities. This tool was designed to screen alcohol-related neuropsychological impairments and was not initially intended to assess cannabis consumption. However, the fact that alcohol and cannabis share the same cognitive impairment spectrum encouraged researchers to extend its use. The present study nonetheless represents a first step in understanding the neuropsychological consequences of BD and cannabis co-use. Further research is required to perform more detailed and extended neuropsychological assessments to overcome the above-mentioned limitations. This could be the opportunity to adapt the BEARNI’s cut-offs and psychometrics to educated young people. The assessment of neuropsychological impairment among college students engaging in BD associated with cannabis use demonstrated that these two practices have an additive effect, especially for memory and executive impairments.
They seem to have specific harmful effects on students’ cognition and consumption patterns. As BD and cannabis co-use can lead to cognitive impairments, it may partly explain the reduced academic success reported in the literature . Clinical practice could greatly benefit from this information, as it emphasizes the need to better characterize the different consumption and psychological profiles, especially in young students. As we know that neuropsychological impairments can hinder the motivation to quit or reduce consumption and may also diminish the efficiency of prevention protocols, asking BD if they also use cannabis could be highly beneficial in clinical practice, for both prevention and research. Furthermore, it could allow prevention and care strategies to be adapted to each person’s neuropsychological profile. This study suggests that future prevention programs should take memory and executive impairments into account, as well as consumption profiles and anxiety levels, in order to improve the impact and efficiency of these programs in college students. In 2018, Canada became the second country in the world to legalize adult recreational cannabis use , following its legalization for medical use in 2001 . Canada’s Cannabis Act dictates that cannabis policies should “keep cannabis out of the hands of youth”, “keep profits out of the pockets of criminals” and “protect public health and safety by allowing adults access to legal cannabis” . Canada’s emphasis on youth cannabis prevention or delayed initiation is evidence-based. Earlier and more frequent adolescent cannabis use is associated with greater risk of harm to the developing brain and multiple adverse outcomes including impaired neurocognitive functioning,affective problems,suicidality,psychosis, cannabis dependence syndrome, and cannabis-related morbidity in later years.With the legalization of adult recreational cannabis use, however, adolescents may experience increased cannabis availability, increased social acceptance of cannabis, and confusing messages about whether cannabis use is safe . Evidence regarding the effects of adult cannabis legalization on adolescents is mixed.Although research surrounding the impact of recreational cannabis legalization on youth in Canada is scarce, national survey data show a gradual increase in cannabis use among youth coinciding with increased public discourse on the topic . The extent to which Canada’s shift towards more liberal cannabis policies, practices and culture will impact youth cannabis attitudes, intentions, and use are largely unknown. A key influence on youth cannabis attitudes, beliefs, expectancies, and intentions to use, is cannabis-related marketing . Though it is illegal to market cannabis products to youth in Canada, recent studies , and a long history of research on other age-restricted substances with abuse potential , demonstrate that companies ignore these laws and intentionally target their products to youth .
Research on alcohol and tobacco marketing shows strong correlations between youth exposure to marketing and earlier initiation, and higher consumption among those already using . All told, exposure to cannabis marketing could similarly spur youth cannabis use . While emerging research suggests that cannabis marketing puts Canadian youth at risk , preliminary studies are limited because they use inexact measures such as general awareness of marketing and receptivity to marketing that rely on retrospective recall, which are subject to participant recall error and bias . Existing studies also describe marketing exposures in aggregate, obfuscating the context of individual exposures,mobile vertical rack such as when and where exposures occur, and other psychosocial factors which could influence their effects . In particular, existing research does not describe the channels through which cannabis marketing exposures occur, nor the ways in which federal marketing prohibitions are violated. Policymakers also need research that shows whether cannabis marketing of different types and through different channels has varying impacts on youth. Real-time, real-world assessment techniques such as Ecological Momentary Assessment may be used to reduce bias and increase the reliability, accuracy, and acuity of information about adolescents’ exposures to cannabis marketing. In EMA protocols, participants use smartphone technology – that they already use throughout the day in multiple settings – to track a range of phenomena as they occur in participants’ natural environments. Previously, we created an EMA protocol for tracking youth exposure to alcohol and tobacco marketing . Middle- and high-school participants made electronic time-stamped recordings of tobacco and alcohol marketing exposures, demonstrating that exposures primarily occurred in the afternoon, at point-of-sale locations, and on days leading up to the weekend . To our knowledge, no research has similarly documented Canadian adolescent cannabis marketing exposures using an EMA approach. The goal of this pilot study was to assess the feasibility of a 9-day, smartphone-based EMA protocol to obtain a preliminary understanding of the frequency of Canadian adolescents’ exposures to cannabis marketing, their reactions to such exposures, and the context in which exposures occur in the real-world and in real-time. The intent of this research was not to provide a definitive description of how and how often Canadian adolescents are exposed to cannabis marketing, but to provide and test a tool that could facilitate such future research.
With this tool, we also aim to provide preliminary data demonstrating the existence and potential impacts of cannabis advertising on youth. Historical research on other legalized, recreational drugs suggests that Canadian youth are likely cannabis marketing targets, but to date,almost no data exists regarding the scope and impact of cannabis marketing on Canadian youth in a post-legalization context . This study presents some of the very first data that demonstrate that cannabis marketing to youth is actively occurring in Canada, and that researchers and policymakers must begin to take action on the issue in order to protect youth and public health. To our knowledge, this is the very first study to use EMA to capture adolescent cannabis marketing exposures, in Canada or elsewhere. A particular strength of the EMA approach is that it enables detailed data collection about each exposure , and its immediate impacts, that are otherwise obscured or blurred in retrospective self-report. . Thus, the current study provides novel evidence for a powerful tool that researchers and policymakers can use to obtain detailed information about cannabis marketing exposure characteristics , and strategies for assessing their subsequent effect on adolescents’ cannabis-related expectancies and intentions. We recognize that EMA methods overall are not new, and that Shiffman and others have been advancing the science of EMA for more than 30 years. The newness of cannabis legalization in Canada and the associated taboo of cannabis in some communities , however, necessitated this extensive pilot work, not only to demonstrate the concept of the work , but also that our recruitment procedures, messaging, and protections were acceptable to adolescents and their guardians, as all of these components of the study are essential to effectively conduct the research. Overall, our results show that the protocol is feasible. Although overall rates of compliance were slightly lower than previous EMA studies of adolescents, rates among the participants whose app was working well were directly in-line with other work . Unexpectedly, a major task of this pilot research was to resolve software compatibility issues between the Expiwell app and older versions of Android platforms, including identifying device setting issues such as “do not disturb” or “battery saver” mode on individuals’ phones that interfered with participants receiving notifications from the study app. Participant compliance rates were much better among those with newer phones whose platforms were more compatible with the app. Researchers replicating or extending this research will need to consider the pros and cons of allowing participants to use their own devices for data capture as compared to using a study-issued device . Despite it’s feasibility design, this study also provides new, albeit very preliminary knowledge regarding the quantity and characteristics of cannabis marketing currently reaching Canadian adolescents; information that has previously only been described in aggregate, retrospectively, and by self-report. Overall, data showed that nearly all participating adolescents had cannabis marketing exposures during the study period. This included an average of about two cannabis-related marketing exposures per week, substantiating previous research . This finding demonstrates cannabis companies’ success in skirting current cannabis-related marketing laws which categorically prohibit marketing of cannabis products to youth. Our data also showed that most cannabis-related exposures occurred through promotion by public figures and through ads on the internet. This finding is likely influenced by the COVID-19 context in which data were collected, and it is consistent with a significant increase among youth in the use of social media, streaming services, gaming sites and apps . At the same time, previous research has demonstrated that cannabis has an established and sophisticated presence specific to the internet based on creative advertisements designed for social media platforms , regardless of legality or media company policies . Indeed, while alcohol and tobacco industries developed their original marketing campaigns decades ago using traditional media channels , Canada’s sale and legalization of cannabis began in the digital age, and as a result, cannabis companies rely mostly on social media to market their products .