Given the exploratory and cross-sectional nature of this study, we could not examine a causal relationship between perceived risks/benefits and cannabis use behavior. Longitudinal studies have found a bidirectional relationship between perceptions and tobacco use, in which perceived risks and benefits predicted adolescent cigarette smoking , and on the other hand, AYAs’ personal smoking experience decreased their perceived risks and increased their perceived benefits of cigarette use over time ; however, less is known for the longitudinal relationship between perceptions and AYA cannabis use. In addition, we did not collect data on potential confounders which may have affected participants’ perceived risks and benefits of cannabis use. Longitudinal and more comprehensive data are needed to better understand how the perceptions impact initiation and continued use of cannabis among AYAs. Findings from our small school-based sample in California may not generalize to other young populations or geographic locations that have different demographic characteristics and cannabis-related policies. Self-reported data might be subject to recall and social desirability biases. The small sample size did not allow us to examine perceived risks and benefits in a more comprehensive set of user categories . Future research should examine perceived risks and benefits among these groups of cannabis users to elucidate an association between cannabis-related perceptions and use patterns. In conclusion, this study indicated that AYAs’ perceptions of risks and benefits differ by cannabis product and use status, with greater perceived risks and benefits for combustible cannabis and blunts than for vaporized and edible cannabis. Prevention efforts should take into account perceptions of both risks and benefits and tailor educational messages to specific products to prevent all forms of AYA cannabis use. The coronavirus disease 2019 pandemic has had wide-ranging impacts on society, particularly among vulnerable populations. People who misuse substances may be particularly susceptible to social isolation and other pandemic-related hardships.
A recent U.S. report found that 13% of adults started or increased substance use to cope with COVID-19. The stress of the pandemic,cannabis growing systems combined with the social isolation resulting from essential public health strategies to contain transmission, may contribute to worsening mental health and/or increased substance misuse. Prior work has identified links between social isolation and these outcomes. Increased negative emotions due to the pandemic are also likely, which could increase coping-related substance use motives that precipitate use. Other than alcohol and tobacco, cannabis is the most commonly consumed drug in the U.S., with prevalence typically highest among emerging adults , who may be especially impacted by social isolation. Given that smoking is a primary method of cannabis consumption, individuals who consume cannabis may also have higher risk for respiratory and pulmonary complications of COVID-19 infection. To date, studies examining smoking and COVID-19 have focused on tobacco rather than cannabis. It remains crucial to examine the association between substance use and other related behaviors among broad samples of cannabis-using emerging adults during this pandemic, with most research to date focusing solely on college students or other age groups. For example, in a survey of college students, both binge drinking and illicit drug use declined after COVID- 19 onset. Another study of university students in Russia and Belarus found that one-fifth to one-third reported pandemic related increases in tobacco, alcohol, cannabis, and other drugs. Among Canadian adolescents , recent 3 week prevalence of binge drinking, cannabis use, and vaping were lower compared to the 3 weeks prior to the pandemic, with increases in mean alcohol and cannabis use days. Importantly, findings for pandemic-related changes in substance use may differ among higher risk samples engaging in regular substance use or misuse.
Therefore, to contribute to the nascent literature on COVID-19 among vulnerable substance-using populations of youth, we examined self-reported perceptions of changes in cannabis and alcohol use and other psychosocial outcomes, among emerging adults who regularly use cannabis. We collected data as part of an ongoing cannabis intervention study initiated just before the COVID- 19 pandemic hit the U.S. Given the limited prior literature, we had no a priori hypotheses and rather sought to provide a descriptive exploration to inform future research and prevention services. Note that we examine perceptions of behaviors before/ during the pandemic and do not examine outcomes relative to the pilot randomized controlled trial as follow-ups are ongoing.The present data were collected within an ongoing pilot RCT of an online cannabis intervention for emerging adults; all procedures occurred online. We recruited participants using social media ads that led to an online consent and screening survey to determine RCT eligibility 3+ times per week. Advertisements included photos and headlines, such as: “Use weed? Participate in a research study, earn $$$. See if you’re eligible, click here!” and participants were recruited regardless of their intentions to change cannabis use. The RCT involves group-based intervention and control conditions conducted separately by age and residence ; eligibility criteria were the same regardless of state residence. Recruitment procedures paralleled prior work and took place in two waves. Wave 1 was recruited in February 2020 prior to full emergence of COVID-19 in the U.S. Wave 2 recruitment occurred in May 2020 . This study was approved by our institutional review board and we received a standard Certificate of Confidentiality from the National Institutes of Health.As the pilot RCT is ongoing, we cannot examine outcomes. Currently, we focus on data related to COVID-19 only; nonetheless, we provide a brief description of the study conditions for context. Participants in each wave were randomized to either an 8 week intervention or control group, separated by age group. The 8 week intervention occurred in secret private groups on Facebook, moderated by health coaches who posted content for 56 days straight .
Content addressed cannabis use directly as well as upstream motives for cannabis use and prevention of related consequences using a motivational interviewing style where participants and coaches interacted. Consistent with MI, participants were informed that any changes they might consider making to cannabis use or other health behaviors would be completely up to them. The control group was parallel in length and format, except coaches posted entertaining social media content unrelated to substance use or mental health.COVID-19 items were designed to assess the prevalence of COVID-19 and perceived impacts. We modified available items to assess whether participants experienced COVID-19 symptoms , contacted a health care provider due to symptoms, and if they engaged in pandemic-related quarantine or isolation. We developed items to assess the following: COVID-19 hospitalization, known infections in participants’ households and social networks, changes in employment status, lost childcare and school closures, and dates of quarantine/social isolation . Among those reporting isolation, we asked about their cannabis use during isolation compared to their usual use of cannabis in the 3 months before the pandemic affected their geographic area . We asked participants about their emotions and behaviors in the 30 days before the pandemic came to their area relative to the past 30 days . Emotions assessed included feeling: lonely, stressed, anxious, depressed, hopeful, and happy. Among those who endorsed each of the following in the past year, we queried changes in: cannabis smoking, vaporizing, dabbing, and eating; using cannabidiol , drinking alcohol, smoking tobacco, vaping nicotine, and exercising. We assessed changes in eating and social activities. Participants rated the degree to which they agreed or disagreed that COVID-19 had impacted their lives in positive and negative ways . We asked an open-ended question, “please describe the ways that the coronavirus pandemic has or has not affected your life,”flood table which is presented in the qualitative analysis below.Participants completed an online Timeline Follow Back assessing past 30 day cannabis and alcohol use days. Items regarding past 30 day cannabis use methods, medical cannabis certification, sources of cannabis acquisition, hours high per day, and time to first use upon waking were adapted from prior work. When answering questions about cannabis, participants were prompted to respond about products containing THC and to exclude reporting on “CBD-only” products.We provide quantitative data in the form of means, standard deviations , and proportions of participants. After using chi-squared and t-tests for preliminary examination to conclude that Wave 1 and Wave 2 participants did not substantially differ on demographics and cannabis use indicators , we pooled data from the two cohorts for this descriptive paper since each group completed measures close in time . We used chi-square analyses to examine relationships between perceived changes in cannabis consumption and negative emotions. We conducted content analysis of responses to the single qualitative item. The first author reviewed ~50% of responses and noted emerging themes for a code book of potential response categories, then incorporated the last author’s feedback. The first author trained the second and third authors in the coding scheme. The two coders independently coded 10 responses, then resolved discrepancies and clarified code definitions with the first author. Next, they coded 15 responses and met with the first author to resolve discrepancies and refine code definitions prior to coding the remaining responses. The first author reviewed this coding and resolved discrepancies, which, out of 291 codes applied , occurred on 70 occasions . Codes were enumerated to assess the prevalence of themes in participants’ responses.
Participants’ agreement with the statement “The coronavirus pandemic has impacted my life in positive ways” was as follows: 6.4% strongly agreed, 29.8% agreed, 22.7% were neutral, 21.3% disagreed, and 19.9% strongly disagreed. Their ratings for a parallel statement focused on negative impacts were: 30.5% strongly agree, 46.1% agree, 18.4% neutral, 3.6% disagree, and 1.4% strongly disagree. Table 5 provides exemplar quotes from openended responses about the impact of the pandemic on participants’ lives. Overall, themes reflecting negative impacts were most prevalent, although positive aspects were mentioned. Negative impacts on employment and finances , social isolation , and stress or negative emotions, including worsening mental health were most frequently mentioned. Perhaps of interest given the developmental age of the sample, uncertainty about the future and lost opportunities or milestones came up less frequently. Among positive themes, employment and finances were mentioned most frequently with some participants having increased income due to stimulus checks and federal unemployment benefits during the initial pandemic response. Very few spontaneously mentioned changes in cannabis use as a positive or negative impact of the pandemic, although they had already reported on this in the quantitative survey.We have provided a unique snapshot of the perceived impact of the COVID-19 pandemic on the lives of emerging adults across the USA who regularly use cannabis. A few months into the events of the pandemic unfolding in the USA, many of these emerging adults were experiencing significant changes, including ongoing social isolation, increased loneliness, anxiety, and depression, lost wages or jobs, and/or changes in school or residence. Many participants felt that their use of cannabis increased during the pandemic, particularly when socially isolated , with rates similar to those reported previously. Descriptively, there were more participants reporting perceived increases in cannabis use than there were reporting increased alcohol or tobacco/nicotine use, which was consistent across cannabis consumption methods. It is possible that the minority of the sample who felt their cannabis consumption decreased had limited access to cannabis during the pandemic; however, nearly all participants reported accessing cannabis in the prior month . Perhaps most concerning are the third to half of the sample who felt they increased their cannabis consumption due to the pandemic, given that greater frequency of consumption is correlated with greater severity of cannabis use disorder , which has a mean age of onset around 21 years and is associated with greater risk for depression and anxiety disorders. However, we did not assess the diagnosis of CUD, which should be included in future research to characterize the severity of cannabis use. Nonetheless, the clinical features of the sample and the large proportions reporting increased depressive feelings raise alarm given the association between mood disorders and escalation of cannabis use disorder severity. Although we could not examine causal effects in these one-time COVID-19 survey questions, because the majority of participants reported changing their cannabis use in the wake of the pandemic, it seems clear that COVID-19 has far-reaching impacts on other areas of public health beyond disease transmission. This concern is underscored by the finding that pandemic-related increases in negative emotional states coincided with reports of increased cannabis smoking in particular.