Jean-Sébastien Fallu

Predictors and consequences of simultaneous alcohol and cannabis use in adolescents

BACKGROUND/AIMS The simultaneous use of alcohol and cannabis is common among adolescents, but has been little studied. In this study, we examine predictors and consequences of this behavior in a population-based sample of high school students. METHOD Self-reports were obtained from students in Quebec (Canada) followed throughout high school (N=6589). Logistic regressions were used to test the association between individual, family, and peer-related predictors in grades 7-8 and simultaneous alcohol and cannabis use in grade 10, as well as between simultaneous alcohol and cannabis use in grade 10 and experiencing 3 or more substance-related problems of various types (legal, physical, etc.) in grade 11. RESULTS Most predictors in grades 7-8 were associated with simultaneous alcohol and cannabis use in grade 10. Only variables reflecting early-onset substance use involvement - alcohol intoxication, cannabis use, and drug use by close friend(s) - remained predictive in a multivariate model. Simultaneous alcohol and cannabis use was associated with increased substance-related problems in grade 11, above and beyond baseline problems and the concurrent use of the two substances in separate episodes in grade 10. CONCLUSIONS Simultaneous alcohol and cannabis use 1) is anticipated by multiple psychosocial risk factors which come together with individual and peer substance use in early high school and 2) is independently predictive of subsequent substance-related problems. Providing adolescents with adequate information regarding the potential harm of simultaneous use may be a useful prevention strategy.

Prospective associations between meth/amphetamine (speed) and MDMA (ecstasy) use and depressive symptoms in secondary school students

Background Research has raised significant concern regarding the affective consequences of synthetic drug use. However, little evidence from well-controlled longitudinal studies exists on these consequences. The aim of this study was to determine whether use of meth/amphetamine (speed) and ±3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is independently predictive of subsequent depressive symptoms in adolescents. Methods A sample of 3880 adolescents from secondary schools in disadvantaged areas of Quebec, Canada, were followed over time (2003–2008). Logistic regression was used to test the association between meth/amphetamine and MDMA use in grade 10 (ages 15–16 years) and elevated depressive symptoms on an abridged Center for Epidemiologic Studies-Depression scale in grade 11, controlling for pre-existing individual and contextual characteristics. Results After adjustment, both MDMA use (OR 1.7, 95% CI 1.1 to 2.6) and meth/amphetamine use (OR 1.6, 95% CI 1.1 to 2.3) in grade 10 significantly increased the odds of elevated depressive symptoms in grade 11. These relationships did not vary by gender or pre-existing depressive symptoms. Increased risk was particularly observed in concurrent usage (OR 1.9, 95% CI 1.2 to 2.9). Conclusions Adolescent use of meth/amphetamine and MDMA (particularly concurrent use) is independently associated with subsequent depressive symptoms. Further enquiry must determine whether these associations reflect drug-induced neurotoxicity and whether adolescence is a period of increased vulnerability to the hazards of synthetic drug exposure.

Adolescent Trajectories of Depressive Symptoms: Codevelopment of Behavioral and Academic Problems

PURPOSE Increasing evidence suggests the existence of heterogeneity in the development of depressive symptoms during adolescence, but little remains known regarding the implications of this heterogeneity for the development of commonly co-occurring problems. In this study, we derived trajectories of depressive symptoms in adolescents and examined the codevelopment of multiple behavioral and academic problems in these trajectories. METHODS Participants were 6,910 students from secondary schools primarily located in disadvantaged areas of Quebec (Canada) who were assessed annually from the age 12 to 16 years. Trajectories were identified using growth mixture modeling. The course of behavioral (delinquency, substance use) and academic adjustment (school liking, academic achievement) in trajectories was examined by deriving latent growth curves for each covariate conditional on trajectory membership. RESULTS We identified five trajectories of stable-low (68.1%), increasing (12.1%), decreasing (8.7%), transient (8.7%), and stable-high (2.4%) depressive symptoms. Examination of conditional latent growth curves revealed that the course of behavioral and academic problems closely mirrored the course of depressive symptoms in each trajectory. CONCLUSIONS This pattern of results suggests that the course of depressive symptoms and other adjustment problems over time is likely to involve an important contribution of shared underlying developmental process(es).

Latent classes of substance use in adolescent cannabis users: Predictors and subsequent substance-related harm

Cannabis use is highly prevalent in late adolescence, but not all users experience significant negative consequences. Little information is available to identify the substance use patterns and risk factors of users who are at greater risk of experiencing negative consequences. In this prospective study, we aimed to empirically identify latent classes of substance use in adolescent cannabis users and to examine how these classes relate to antecedent psychosocial predictors and subsequent substance-related outcomes. The sample was recruited from 68 high schools in Quebec and consisted of 1618 participants who reported using cannabis in grade 10. We used latent class analysis to empirically identify classes of users based on the age of onset, frequency, and typical quantity of cannabis and other substance use, as well as substance mixing behaviors. We then compared classes in terms of (a) sociodemographic and psychosocial predictors in grades 7–8 and (b) substance-related consequences in grade 11. Four distinct classes were identified: Late-Light Users (28%); Late-Heavy + Polydrug Users (14%); Early-Moderate Users (33%); Early-Heavy + Polydrug Users (26%). Late-Light Users reported the lowest levels of substance use, while Early-Heavy + Polydrug Users reported the highest levels. Intermediate levels of substance use were found in the other two classes. Sex, age, delinquency, peer delinquency, school bonding, parental monitoring, and parental conflict all helped to differentiate classes. Class membership predicted substance-related harm, with greater consequences in early- and late-onset heavy using classes. In light of results, in addition to age and sex, screening and intervention for risky cannabis use among adolescents should focus on school bonding in order to target the most risky late-onset adolescents and on peer delinquency in order to target the most risky early-onset ones.

The Influence of Close Friends on Adolescent Substance Use: Does Popularity Matter?

The goal of this study was to determine whether adolescents’ relative popularity plays a protective role against peer influences towards substance abuse as suggested by a Social Discrepancy model (Bukowski et al., 2008), or whether, conversely, adolescents’ relative popularity represents a vulnerability factor as suggested by the Socialization-Popularity model (Allen et al., 2005). To achieve this goal, we used a sample of 531 adolescents followed from ages 10-11 through ages 14-15. Participants and their friends provided self-reports of their substance use. Peers rated participants and their friends in terms of popularity. Results suggest that having friends that consume more at ages 12-13 predicts an increase in substance use from ages 10-11 to ages 14-15. In line with the Socialization-Popularity model, but opposite to the Social Discrepancy model, adolescents who were more popular were at greater risk of adopting the drug- related behaviors of their friends, particularly if these friends were also popular. Theoretical and practical implications of these results are discussed.

Adolescent illicit drug use and subsequent academic and psychosocial adjustment: An examination of socially-mediated pathways

BACKGROUND Questions remain regarding the consequences of illicit drug use on adolescent adjustment and the nature of mechanisms that may explain these consequences. In this study, we examined whether early-onset illicit drug use predicts subsequent academic and psychosocial adjustment and whether associations are socially-mediated by decreased school engagement and increased peer deviancy. METHOD 4885 adolescents were followed throughout secondary school. We used regressions to determine whether illicit drug use in grade 7 predicted academic achievement, school dropout, depressive symptoms, and conduct problems in grades 10-11, adjusting for potential confounders. We used path analysis to test whether significant associations were mediated by school engagement and peer deviancy in grade 8. RESULTS Illicit drug use predicted conduct problems and school dropout, but not academic achievement and depressive symptoms. The association between illicit drug use and conduct problems was fully mediated by increased peer deviancy. The association between illicit drug use and school dropout was partially mediated by increased peer deviancy, but remained mostly direct. No indirect association via decreased school engagement was found. Examination of reverse pathways revealed that conduct problems and academic achievement in grade 7 predicted drug use in grades 10-11. These associations were mediated by peer deviancy and school engagement (conduct problems only). CONCLUSION Adolescent illicit drug use influences the risk of school dropout and conduct problems in part by contributing to deviant peer affiliation. Reciprocal social mediation characterizes the association between drug use and conduct problems. A reverse mechanism best explains the association with academic achievement.

Can fantasizing while listening to music play a protective role against the influences of sensation seeking and peers on adolescents' substance use?

“The combination of music and drugs proved to be potent, and scientific research has yet to explain it” (Levitin, 2008, p. 74; The World in Six Songs).This study examined if fantasizing while listening to music could represent a potential protective factor against adolescent substance use (cigarette, alcohol, and cannabis). The first hypothesis was that fantasizing while listening to music would moderate (buffer) the link between sensation-seeking and substance use. The second hypothesis was that fantasizing while listening to music would also moderate (buffer) the link between peer substance use and individual substance use. The sample comprised 429 adolescent boys and girls who answered a self-report questionnaire in 2003. They were regular students attending a public high school in Montreal, Canada. The results revealed that fantasizing while listening to music came short of buffering the link between sensation-seeking and substance use among highly musically involved adolescents. Still, fantasizing while listening to music significantly attenuated the relationship between peer substance use and individual substance use (thereby, showing a protective effect) among highly musically involved adolescents. Fantasizing while listening to music did not buffer the relation between either risk factor (sensation-seeking or peer substance use) and substance use among moderately musically involved adolescents.

Le marché légal du cannabis suite à sa légalisation au Canada : pistes de réflexion pour un encadrement efficace

RésuméLa légalisation prochaine du cannabis au Canada pose plusieurs défis auxquels les provinces devront répondre à l’aide de mesures efficaces d’encadrement. Les études le montrent, en soit, les politiques ont peu d’impacts sur les taux d’usage, alors que les approches et modalités de régulation semblent importantes pour réduire les possibles conséquences négatives pouvant découler de la légalisation. Bien qu’aucun système d’encadrement n’offre de solution parfaite aux enjeux entourant l’usage et le commerce du cannabis, il nous apparaît essentiel de mettre en place un modèle de légalisation qui s’appuie sur une perspective de santé publique et sur des mesures qui proposent un compromis entre un accès restreint au cannabis et le maintien d’une offre suffisante pour contrer le marché illégal. Nous recommandons notamment un contrôle du marché légal du cannabis par le biais d’un monopole d’État, un prix concurrentiel au marché illicite et une taxe de vente modélisée selon la teneur en THC, l’implantation d’un nombre contrôlé de points de vente de petites superficie et densité, un âge légal d’achat à partir de la majorité, l’interdiction complète de la promotion et la publicité des produits du cannabis, ainsi qu’un financement massif en prévention et en recherche.AbstractThe upcoming legalization of cannabis in Canada poses several challenges in which each province will have to respond with effective regulation. Studies show that policies alone have little impact on use rates. However, regulatory approaches and modalities seem important to reduce the possible negative consequences that may result from legalization. Although no framework system offers a perfect solution to the issues surrounding the use and sale of cannabis, it seems essential to implement a legalization model based on a public health perspective. The modalities of this model will have to ensure a compromise between restricted access to cannabis and the maintenance of a sufficient supply to counter the illegal market. We recommend controlling the legal cannabis market through the following: a state monopoly, competitive pricing in relation to the illicit market, a sales tax modeled on the THC content, the implementation of a controlled number of points of sale of small surface area and density, a legal age of purchase from the age of majority, and a complete ban on the promotion and advertising of cannabis products, as well as massive funding for prevention and research.

L’étude d’évaluabilité : Utilité et pertinence pour l’évaluation de programme

Résumé : L’étude d’évaluabilité (ÉÉ) a été conceptualisée vers la fi n des années 1970 à la suite du constat de la mauvaise qualité d’implantation des programmes et de l’incapacité des évaluations à répondre aux besoins des parties prenantes. L’ÉÉ est une démarche qui pourrait permettre d’apporter des améliorations à la fois au programme et à l’évaluation qui sera conduite ultérieurement. En eff et, l’ÉÉ permet, d’une part, de favoriser la clarifi cation de la théorie du programme qui sous-tend la mise en œuvre des activités et, d’autre part, de faciliter l’élaboration du modèle logique qui aide à l’implantation. Lorsqu’elle est conduite par un évaluateur ou une équipe d’évaluateurs qui possède les compétences requises, elle permet également de disposer d’informations utiles à l’évaluation formative ou sommative qui sera entreprise. L’ÉÉ fait partie des évaluations de type exploratoire que l’on peut réaliser en quelques semaines ou sur une période de plusieurs mois en fonction de la complexité du programme et de son ampleur.