Physical exertion at work and addictive behaviors: tobacco, cannabis, alcohol, sugar and fat consumption: longitudinal analyses in the CONSTANCES cohort

We examined the prospective association of physical exertion at work with subsequent tobacco, cannabis, alcohol use, and sugar and fat consumption. Volunteers of the French population-based CONSTANCES cohort currently employed were included from 2012 to 2017 for tobacco and cannabis outcomes (n = 100,612), and from 2012 to 2016 for alcohol and sugar and fat outcomes (n = 75,414). High level of physical exertion at work was defined as a score ≥ 12 at the Rating Perceived Exertion Borg scale. Substance use was self-reported and diet rich in sugar and fat was obtained from principal component analysis and analyzed as quartiles. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline physical exertion at work, while adjusting for sociodemographic factors, depressive symptoms and baseline level of consumption. High physical exertion was associated with tobacco use with dose-dependent relationships. It was also associated with increased odds of cannabis use at least once per month compared to no use in the past and with increased odds of diet rich in sugar and fat. Hence, the role of physical exertion at work on tobacco and cannabis use and diet rich in sugar and fat should be tackled for information and prevention strategies.

Student-, Study- and COVID-19-Related Predictors of Students’ Smoking, Binge Drinking and Cannabis Use before and during the Initial COVID-19 Lockdown in The Netherlands

Tobacco, alcohol and cannabis are commonly used among university students. However, student lives and their substance use have changed dramatically since the start of the COVID-19 pandemic. This study investigated the impact of COVID-19 on (trends in) weekly smoking, weekly binge drinking and weekly cannabis use in Dutch university students and investigated associated student-, study- and COVID-19-related characteristics. Between April and June 2020, several Dutch higher educational institutes invited their students to participate in an online survey. Data of 9967 students (Mage = 22.0 (SD = 2.6); Nfemale = 7008 (70.3%)) were available for analyses. Overall, weekly smoking remained stable (±11.5%), weekly binge drinking decreased (from 27.8% to 13.9%) and weekly cannabis use increased (from 6.7% to 8.6%). Male gender, not living with parents, being a bachelor student, having less financial resources and less adherence to the COVID-19 measures were found to increase the risk of substance use (before/during the first COVID-19 lockdown). Additionally, male gender, not living with parents, being a bachelor student, not being born in the Netherlands and having a student loan contributed to the likelihood of increased substance use during COVID-19. Patterns of characteristics contributing to the likelihood of decreased weekly substance use during COVID-19 were less clear. The risk factors male gender, not living with parents and being a bachelor student do not only contribute to the likelihood of using substances but also contribute to the likelihood of increased use during a lockdown. Prevention and intervention programs should especially target these risk groups.

Changes in cannabis policy and prevalence of recreational cannabis use among adolescents and young adults in Europe—An interrupted time-series analysis

Background Cannabis policy varies greatly across European countries, but evidence of how such policy impacts on recreational cannabis use among young people is conflicting. This study aimed to clarify this association by investigating how changes in cannabis legislation influenced cannabis use. Methods Available data on self-reports of recreational cannabis use among individuals aged 15–34 years was retrieved from EMCDDA. Information on cannabis policy changes was categorized as more lenient (decriminalisation or depenalisation) or stricter (criminalisation, penalisation). Countries that had implemented changes in cannabis legislation or had information on prevalence of use for at least eight calendar years, were eligible for inclusion. We used interrupted time-series linear models to investigate changes in country-specific trajectories of prevalence over calendar time and in relation to policy changes. Results Data from Belgium, Czech Republic, Germany, Italy, Netherlands, Norway, Portugal, Slovakia, Spain, Sweden and United Kingdom, for 1994–2017 was available for analyses. Cannabis use varied considerably over the study period and between countries. On average, use was stable or weakly increasing in countries where legislation was not changed or changed at the extremes of the study period (+0.08 percent per year [95% CI -0.01, 0.17 percent]). In contrast, the pooled average use decreased after changes in legislation, regardless of whether it had become more lenient (-0.22 [-1.21, 0.77]) or stricter (-0.44 [-0.91, 0.03]). Conclusions Our findings do not support any considerable impact of cannabis legislation on the prevalence of recreational cannabis use among youth and young adults in Europe.

Prevalence and self-reported reasons of cannabis use for medical purposes in USA and Canada

Rationale There has been increasing attention on cannabis use for medical purposes, but there is currently a lack of data on its epidemiology. Objectives To examine the epidemiology of self-reported cannabis use for medical purposes by (1) estimating its prevalence, (2) comparing gender and age differences, and (3) investigating what reasons they were used to manage. Methods Participants included 27,169 respondents (aged 16–65) who completed Wave 1 of The International Cannabis Policy Study (ICPS) conducted across Canada and the USA in 2018 via online surveys. Cannabis policy conditions were “US legal–recreational” (legal for both recreational and medical uses), “US legal–medical only”, “US illegal”, and “Canada–medical only”. Results The overall prevalence of self-reported ever cannabis use for medical purposes was 27%, with similar rates by sex and the highest prevalence in young adults. Prevalence was higher in US legal–recreational states (34%) than US illegal states (23%), US legal–medical only states (25%), and Canada (25%). The most common physical health reasons include use to manage pain (53%), sleep (46%), headaches/migraines (35%), appetite (22%), and nausea/vomiting (21%). For mental health reasons, the most common were for anxiety (52%), depression (40%), and PTSD/trauma (17%). There were 11% who reported using cannabis for managing other drug or alcohol use and 4% for psychosis. Conclusions A substantial proportion of the North American population self-reported cannabis use for medical purposes for a variety of medical reasons, including those living in jurisdictions without legal markets. Further research is needed to understand the safety and efficacy of these forms of medical cannabis use.