In 2020, schools and businesses shut down and people were encouraged to remain at home due to the COVID-19 pandemic. This study assessed whether different types of COVID-19 pandemic exposures were associated with cannabis use by adolescents and young adults (AYA) seen at general and specialty care clinics.
Between March 2020 and May 2021, electronic surveys were administered to AYA enrolled in an ongoing longitudinal cohort study that drew on AYA receiving care in either a general adolescent or a specialty care chronic illness setting. AYA reported about past year cannabis use, pandemic experiences, mental health, and socio-demographic factors. Pandemic experiences were assed via the COVID-19 Exposure and Family Impact Survey (CEFIS) for AYA. The CEFIS exposure scale (range: 0-32) is the sum of COVID-19 related social and economic stressors, including direct COVID-19 experiences in family members. The CEFIS impact scale (range:1-4) assesses the mean impact on personal, emotional and physical wellbeing and family interaction. Logistic regression were used to assess the association between past 12-month cannabis use and COVID-19 related exposure, impact, and distress, adjusting for age, sex, ethnicity, household composition, anxiety and depression. Analyses were performed on the total sample, and after stratifying the sample into general adolescent and subspecialty care groups given the potential for the pandemic to differentially affect AYA with underlying chronic conditions.
Our sample was comprised of N=458 participants, including n=203 adolescents seen at an urban adolescent medicine clinic and n=255 youth with chronic medical conditions (YCMC), including type 1 diabetes, inflammatory bowel disease, and rheumatic disease, seen at specialty clinics. The mean score for CEFIS exposure was 9.2 (SD 3.9), CEFIS impact score was 2.9 (SD 0.6), and CEFIS distress score was 5.9 (SD 2.3). The average age of study participants was 19.3 years (SD: 1.6), 69% were female and 58.0% were white non-Hispanic. Compared to non-cannabis users, youth reporting past year cannabis use were older (19.7 vs 19.0, p<0.001), reported more past year alcohol use (90.7% vs 38.8%, p<0.001) and were more likely to screen positive for potential major depressive disorder (i.e PHQ-2 score ≥ 3; 25.8% vs 12.7%, p<0.001) and anxiety disorder (i.e GAD-2 score ≥ 3; 34.1% vs 21.7%, p=0.003). In unadjusted models, past 12-month cannabis use was significantly associated the CEFIS impact (OR 1.75 95%CI: 1.25-2.46) and CEFIS Distress scale (OR 1.10 95%CI: 1.01-1.19) in the combined sample. When adjusting for covariates, the CEFIS scales were no longer significantly associated with past 12-month cannabis use. Past 12-month cannabis use was significantly associated with CEFIS impact among YCMC (adjusted OR 1.76 95%CI: 1.01 3.08), but not among AYA in the general adolescent medicine cohort (AOR 1.07 95%CI: 0.63-1.82).
Past year cannabis use was associated with the impact of the pandemic in YCMC but not in a general adolescent clinic population. Findings raise questions about whether the disruption in specialized treatment during the pandemic increased the potential for YCMC to use cannabis in an attempt to alleviate disease symptoms or side effects.
Sources of Support
Conrad N. Hilton Foundation, 18455.
© 2022 Published by Elsevier Inc.