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Abstract
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AIMS: To examine adolescent cannabis use -- both at the national and individual level -- by deconstructing it into its necessary conditions of realistic use opportunities and willingness to use the drug given such opportunities.
DESIGN: Nationally-representative, repeated cross-sectional survey. SETTING: Norway. PARTICIPANTS: A total of 8,818 16-year olds who participated in the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2007, 2011, and 2015. MEASUREMENTS: Adolescent reports concerning their lifetime "cannabis use" and "possibilities to use cannabis" were used to assess: a) overall cannabis use, b) exposure to realistic cannabis use opportunities, and c) cannabis use among those exposed to use opportunities. Logistic regression models were used to estimate national trends since 2007 in these indicators, and to identify individual-level factors associated with cannabis use vs. non-use among youth exposed to concrete use opportunities.
FINDINGS: Prevalence of lifetime cannabis use remained stably low averaging 6.4% across the three surveys. Lifetime exposure to cannabis use opportunities significantly decreased (ORESPAD Assessment =.90, 95%CI.84 -.07, p =.006), yet cannabis use among adolescents with such opportunities steadily increased (ORESPAD Assessment = 1.17, 95%CI 1.03 - 1.34, p =.02) since 2007. After controlling for a range of other risk factors, abstinence from alcohol intoxication and cigarette use, as well as the perceptions of even infrequent cannabis use as risky remained the factors most robustly associated with lower likelihood of cannabis use among youth with realistic use opportunities.
CONCLUSIONS: Approaches accounting for realistic use opportunities proved critical in our understanding of underage cannabis use, both at the national and individual level, and may be informative for development of prevention strategies in the era of cannabis liberalization. In addition, delineation of realistic opportunities from behaviors conditioned upon such opportunities is generalizable to a range of public health issues.
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Language: en |