Latent transition analysis of time-varying cannabis use motives to inform adaptive interventions.

OBJECTIVE: The rising prevalence of daily cannabis use among older adolescents and young adults in the United States has significant public health implications. As a result, more individuals may be seeking or in need of treatment for adverse outcomes (e.g., cannabis use disorder) arising from excessive cannabis use. Our objective was to explore the potential of self-reported motives for cannabis use as a foundation for developing adaptive interventions tailored to reduce cannabis consumption over time or in certain circumstances. We aimed to understand how transitions in these motives, which can be collected with varying frequencies (yearly, monthly, daily), predict the frequency and adverse outcomes of cannabis use. METHOD: We conducted secondary analyses on data collected at different frequencies from four studies: the Medical Cannabis Certification Cohort Study (n = 801, biannually), the Cannabis, Health, and Young Adults Project (n = 359, annually), the Monitoring the Future Panel Study (n = 7,851, biennially), and the Text Messaging Study (n = 87, daily). These studies collected time-varying motives for cannabis use and distal measures of cannabis use from adolescents, young adults, and adults. We applied latent transition analysis with random intercepts to analyze the data. RESULTS: We identified the types of transitions in latent motive classes that are predictive of adverse outcomes in the future, specifically transitions into or staying in classes characterized by multiple motives. CONCLUSIONS: The identification of such transitions has direct implications for the development of adaptive interventions designed to prevent adverse health outcomes related to cannabis use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Medicinal cannabis use among young adults during California's transition from legalized medical use to adult-use: a longitudinal analysis.

Background: In 2016, California transitioned from legalized medical cannabis use to adult-use. Little is known about how this policy change affected medicinal cannabis use among young adults.Objectives: To identify longitudinal groups of medicinal cannabis users and concurrent changes in health- and cannabis use-related characteristics among young adults in Los Angeles between 2014 and 2021.Methods: Cannabis users (210 patients and 156 non-patients; 34% female; ages 18-26 at baseline) were surveyed annually across six waves. Longitudinal latent class analysis derived groups from two factors - cannabis patient status and self-reported medicinal use. Trajectories of health symptoms, cannabis use motives, and cannabis use (daily/near daily use, concentrate use, and problematic use) were estimated across groups.Results: Three longitudinal latent classes emerged: Recreational Users (39.3%) - low self-reported medicinal use and low-to-decreasing patient status; Recreational Patients (40.4%) - low self-reported medicinal use and high-to-decreasing patient status; Medicinal Patients (20.3%) - high self-reported medicinal use and high-to-decreasing patient status. At baseline, Medicinal Patients had higher levels of physical health symptoms and motives than recreational groups (p < .05); both patient groups reported higher level of daily/near daily and concentrate use (p < .01). Over time, mental health symptoms increased in recreational groups (p < .05) and problematic cannabis use increased among Recreational Patients (p < .01).Conclusions: During the transition to legalized adult-use, patterns of medicinal cannabis use varied among young adults. Clinicians should monitor increases in mental health symptoms and cannabis-related problems among young adults who report recreational - but not medicinal - cannabis use.

Mental and Physical Health-Related Cannabis Motives Mediate the Relationship between Childhood Trauma and Problematic Cannabis Use over Time among Emerging Adult Cannabis Users.

BACKGROUND: While growing evidence has identified mental and physical health-related cannabis use motives as significant mechanisms between childhood trauma and problematic cannabis use (PCU) for emerging adults (EA), there is a need to understand the longitudinal stability of these pathways and how they impact PCU as cannabis users age into later adulthood. METHODS: The current study extends an analysis examining the impact of childhood trauma (e.g., emotional abuse, sexual abuse) on multiple indicators of PCU through a range of cannabis use motives. 339 medical cannabis patient and non-patient EA users from the Los Angeles area were sampled at baseline (mean age = 21.23; SD = 2.48). The present analysis used four waves of follow-up data collected from 2016 to 2018 (W3, W4) and 2019-2020 (W5, W6). RESULTS: Use of cannabis to cope with nausea, sleep, pain, and emotional distress mediated the relationships between some types of childhood abuse and PCU at W4, though most associations attenuated by later adulthood (W6). Specifically, greater emotional distress and nausea motives were associated with greater PCU in models of emotional abuse and neglect and sexual abuse, with emotional distress continuing to mediate at W6. Conversely, sleep and pain motives were associated with lower PCU in models for emotional neglect. CONCLUSIONS: Mental and physical health-related motives reflect potential intervenable factors that predict PCU in emerging adulthood among EA cannabis users with histories of childhood trauma. Results highlight the importance of and value for assessing a wide range of motives and PCU outcomes to target and address areas for intervention.

Pre-Post Cannabis Legalization for Adult Use: A Trend Study of Two Cohorts of Young Adult Cannabis Users in Los Angeles.

Cannabis was legalized for adult use in California in 2016 for individuals 21 and older. Among 18-20-years-olds, who can possess cannabis legally as medical cannabis patients (MCP) but not as non-patient cannabis users (NPU), the impact of adult use legalization (AUL) on cannabis and other substance use is unknown. Two cohorts of 18-20-year-old cannabis users (MCP and NPU) were surveyed, one in 2014-15 (n = 172 "pre-AUL") and another in 2019-20 (n = 139 "post-AUL"), using similar data collection methods in Los Angeles, California. Logistic and negative binomial regressions estimated cohort and MCP differences for cannabis and other drug use outcomes based on past 90-day use. In both pre- and post-AUL cohorts, MCP were more likely to self-report medical cannabis use (p < .001) while the post-AUL cohort reported greater use of edibles (p < .01), but fewer mean days of alcohol (p < .05) and cigarette (p < .01) use in multivariate models. Notably, frequency of cannabis use (days or hits per day) did not significantly differ between the pre- and post-AUL cohorts, except for greater use of edibles, despite potentially greater access to cannabis.

Understanding Changes in Social Cannabis Use among Young Adults During the COVID-19 Pandemic: A Social Network Analysis.

Introduction: As the COVID-19 pandemic has caused historic morbidity and mortality and disrupted young people's social relationships, little is known regarding change in young adults' social cannabis use following social distancing orders, or other factors associated with such changes before and during the pandemic. Methods: 108 young adult cannabis users in Los Angeles reported on their personal (egocentric) social network characteristics, cannabis use, and pandemic-related variables before (July 2019 - March 2020) and during the COVID-19 pandemic (August 2020 - August 2021). Multinomial logistic regression identified factors associated with increasing or maintaining the number of network members (alters) participants used cannabis with before and during the pandemic. Multilevel modeling identified ego- and alter-level factors associated with dyadic cannabis use between each ego and alter during the pandemic. Results: Most participants (61%) decreased the number of alters they used cannabis with, 14% maintained, and 25% increased. Larger networks were associated with a lower risk of increasing (vs. decreasing); more supportive cannabis-using alters was associated with a lower risk of maintaining (vs. decreasing); relationship duration was associated with a greater risk of maintaining and increasing (vs. decreasing). During the COVID-19 pandemic (August 2020 - August 2021), participants were more likely to use cannabis with alters they also used alcohol with and alters who were perceived to have more positive attitudes towards cannabis. Conclusions: The present study identifies significant factors associated with changes in young adults' social cannabis use following pandemic-related social distancing. These findings may inform social network interventions for young adults who use cannabis with their network members amid such social restrictions.

COVID-19 Vaccine Uptake and Attitudes Within Two Cohorts of Younger Adult Cannabis Users.

It is crucial to understand COVID-19 vaccine uptake and attitudes among young adult cannabis users given the lowest vaccination rates among young adults and negative association between cannabis use and willingness to get vaccinated. 18-21-year-old and 26-33-year-old cohorts of cannabis users, recruited in California, were surveyed about the COVID-19 vaccine uptake/attitudes between March-August 2021. Cannabis use/demographic differences were investigated by vaccination status. Vaccine attitudes data were categorized and presented descriptively. 44.4% of the older and 71.8% of the younger cohorts were vaccinated. Non-Hispanic Black/African American race/ethnicity, lack of health insurance, and medicinal orientation towards cannabis use were negatively associated with vaccine receipt within the older cohort. For both cohorts, top reasons for vaccine hesitancy and rejection were concerns about speed of development, potential side effects, natural immunity, and lack of trust of vaccines. Our results highlight greater vaccine hesitance/rejection and need for targeted interventions among mid-20's-early-30's cannabis users.

Egocentric Network Characteristics and Cannabis Use in a Sample of Young Adult Medical Cannabis Patients and Nonpatient Users.

OBJECTIVE: Social factors play an important role in young adults' substance use behaviors, but little is known about how egocentric social network factors are related to young adults' cannabis use. Young adults also report medicinal and recreational uses of cannabis, which may alter the strength of these relationships. Therefore, medical cannabis patient status and medicinal/recreational orientation toward cannabis were examined as moderators of these relationships. METHOD: Young adult medical cannabis patients (n = 182) and nonpatient users (n = 157) were surveyed in Los Angeles in 2015-2016 about their cannabis use, orientation (medicinal and/or recreational), and egocentric networks (cannabis use network size, social support network size, descriptive and injunctive norms). Regression models examined associations between network characteristics and past-90-day use and problematic use, and tested interactions between network characteristics and both patient status and cannabis use orientation. RESULTS: Only descriptive norms (adjusted incidence rate ratio [aIRR] = 1.19, 95% confidence interval [CI] [1.06, 1.33]) were associated with more frequent use, but not problematic use. Descriptive norms interacted with cannabis use orientation: descriptive norms were positively associated with cannabis use days among medicinally oriented users (aIRR = 1.22, 95% CI [1.02, 1.46]). However, this relationship was stronger for recreationally oriented users (aIRR = 1.62, 95% CI [1.31, 2.01]). No interactions were found predicting problematic use. CONCLUSIONS: Descriptive cannabis use norms among one's personal network members are an important variable predicting young adults' cannabis use, but not problematic use. Perceived descriptive norms may be a stronger motivator to use for recreational users than medicinal users.

COVID-19's Impact on Substance Use and Well-Being of Younger Adult Cannabis Users in California: A Mixed Methods Inquiry.

Few qualitative studies have examined the impact of COVID-19 on cannabis and alcohol use, and overall well-being among cannabis users. Cannabis users (aged 26-32) were surveyed quantitatively (n=158) and interviewed qualitatively (n=29) in April 2020-May 2021 in Los Angeles. 63.3% of the quantitative sample reported increasing use of either cannabis (29.1%) or alcohol (15.2%) or both (19.0%) following the COVID-19 outbreak. Qualitative data revealed that increases in cannabis and alcohol use were largely attributed to changes in employment and staying at home resulting in fewer impediments and boredom. Themes of loneliness and utilization of various coping strategies were more pronounced among those who increased cannabis and/or alcohol use. For some, increases in cannabis/alcohol use were temporary until participants adjusted to "a new normal" or embraced more adaptive coping strategies. Results suggest monitoring cannabis/alcohol use trends and identifying coping strategies to reduce the pandemic's impact on substance use and mental health.

Linking health education, civic engagement, and research at a large Federally Qualified Health Center to address health disparities.

OBJECTIVE: To develop a framework for patient-centered research in a community health center. STUDY SETTING: Primary organizational case-study data were collected at a large Federally Qualified Health Center (FQHC) in Southern California from 2019 to 2021. STUDY DESIGN: Thirty stakeholders, including patients, community leaders, students, medical providers, and academic partners, participated in community-engagement capacity-building exercises and planning. These activities were guided by Community Based Participatory Principles and were part of an initiative to address health disparities by supporting patient and community-engaged research. DATA COLLECTION: The study included an iterative development process. Stakeholders participated in a total of 44 workgroup meetings and 7 full-group quarterly convenings. The minutes of the meetings from both workgroups and quarterly convenings were used to document the evolution of the initiative. PRINCIPLE FINDINGS: Stakeholders concluded that health equity research needs to be part of a larger engagement ecosystem and that, in some ways, engagement on research projects may be a later-stage form of engagement following patient/community and staff/researcher coeducation and cocapacity building efforts. CONCLUSIONS: Community health center stakeholders viewed successful engagement of community members in patient-centered health equity research as involving a web of longitudinal, evolving internal and external relationships rather than discrete, time-limited, and single-project-based dyadic connections.

Coping Motives Mediate the Association of Trauma History with Problematic Cannabis Use in Young Adult Medical Cannabis Patients and Non-Patient Cannabis Users.

Background: Despite evidence of the contribution of childhood trauma to the development of problematic cannabis use, its mediating pathways are largely unknown. Given the link between cannabis motives with trauma and problematic cannabis use, motives of use may represent a construct through which trauma impacts problematic cannabis use. Methods: A sample of 339 medical cannabis patient and non-patient young adult users from the Los Angeles area were sampled at baseline and one year later. The current study examined the impact of childhood trauma on problematic use through a variety of cannabis use motives. Results: Controlling for age, socioeconomic status, perceived stress, and baseline problematic use, endorsing the use of cannabis to cope with distress at baseline uniquely mediated the associations between different childhood trauma types (e.g., physical abuse, neglect, sexual trauma) and problematic use one year later. Experience of any childhood trauma was positively associated with coping motives, whereas emotional and physical abuse were positively associated with pain motives, and sexual abuse was positively associated with sleep motives. Using cannabis for coping and increasing attention/focus were also positively associated with higher problematic use, whereas using cannabis for sleep was inversely associated with problematic use one year later. Conclusions: The motives of coping with distress and inattention may represent intermediate constructs through which trauma leads to later problematic cannabis use. Results highlight the need to clarify the pathways between health and non-health-oriented motives and cannabis use over time.