Cannabis use is becoming more popular among teenagers compared to other drugs, such as cigarettes. The change policies surrounding the legalization of cannabis emphasize the importance of understanding the connection between early-life cannabis exposure and mental health and development. Cannabis contains psychoactive compounds, including "9-tetrahydrocannabinol" (THC), which, when inhaled or ingested, affected the functioning of the brain. In particular, THC tends to interact with the brain's endogenous endocannabinoid system, a part of the brain that is very crucial for pre-and post-natal neurodevelopment. Therefore, THC and other psychoactive compounds contained in cannabis have the ability to override normal adolescent neurodevelopment. This means that these compounds can affect the development of the users' brain's and force it into a disease-prone condition. As a result, adolescent smokers become predisposed to affective and psychotic disorders. Early cannabis use has been linked to anxiety and depression. There is also a positive correlation between the development of schizophrenia and cannabis use, particularly when genetic factors interfere with this type of environmental exposure. Given the delicate nature of adolescent neurodevelopment and the long-term effects of early cannabis exposure, this study seeks to examine the impact of cannabis smoking among adolescent on mental health and development. The findings of this study will help policymakers change or implement policies to minimize cannabis use among adolescents in order to fully resolve the increasing problem of mental disorders and to ensure a healthier future.
Problem Statement
Despite the fact that researchers have been examining the effect of cannabis use, there is a gap in research investigating the effect of adolescent cannabis use on mental health and development. Most of the studies do not estimate the specific risk of cannabis use during adolescence. Since the adolescent brain is still developing, the use of cannabis during adolescence can affect physiological neurodevelopment. In particular, adolescent cannabis use can have a profound effect on the frontal cortex and limbic system. Despite this growing evidence, most studies involve both youth and adults, failing to pinpoint the specific risk among adolescents. In other words, the majority of the studies mostly looked at usage in the general population (adolescents and adults), so they couldn't look into the adolescent risk window. This study seeks to close this existing research gap by examining the impact of cannabis smoking among adolescent on mental health and development.
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Research Questions and Objectives
Research Objectives:
The primary objective:
To examine the impact of cannabis smoking among adolescent on mental health and development.
Sub-objectives:
Does cannabis have a negative impact on human health?
What specific mental or physical issues are related to cannabis smoking among adolescents?
Are the mental or physical health impacts as a result of cannabis smoking among adolescents reversible?
Research Question:
Does cannabis smoking among adolescents have a significant impact on their mental health and development?
Literature Review
Search Strategy
A comprehensive literature review was developed. The following databases were used to conduct the search: PubMed and Google Scholar. The search was limited to studies published between 2010 and 2021. Any literature preceding 2010 was excluded. Boolean and limiters were applied to narrow the search area. Keywords were carefully selected to narrow the search area. "Cannabis," "Marijuana," "Mental Health," and "Mental Development" are some of the keywords that were used. Some keywords, such as "Cannabis," "Cannabis Sativa," "Marijuana," and "Bhang", were used interchangeably so as not to miss out on any literature.
Literature Review
Marijuana Legislation and Prevalence in the U.S.
The word "marijuana" refers to a crude substance made up of dried, shredded parts of several Cannabis plant varieties. There are many varieties of Cannabis plant, but the most common ones are Cannabis indica and Cannabis sativa (Johnson 129). The use of marijuana in the U.S. has undergone multiple phases of legality, though this drug was illegalized by the federal government since the enactment of the 1970 Federal Controlled Substance Act (Johnson 129). Under this Act, marijuana was classified as an illegal drug. Despite the fact that marijuana is illegal at the federal level, a number of states have enacted permissive marijuana law to legalize the use of marijuana for medical and recreational marijuana laws.
As of 2018, over 30 states in the U.S. had legalized the use of marijuana for medical purposes, which provide a diverse set of provisions that essentially enable individuals or patients with certain health conditions to buy, possess, grow, and use the herb for medicinal purposes. Recreational marijuana laws, on the other hand, have been enacted across different states, including the District of Columbia, to effectively enable adults to use marijuana for recreational purposes. Over the past few decades, the legalization of marijuana at the state level have been hotly debated, with concerns that any more permissive approach to marijuana legalization could impact the prevalence of use among teenagers.
Marijuana is one of the most commonly used illegal drugs by teenagers in the U.S. Besides, marijuana is among the leading cause of substance use/abuse treatment. A wide range of studies documents that the use of marijuana mostly begins during adolescence and peak in adulthood (Volkow et al. 2219). The adolescent period is the stage where an individual's neural development takes place. Therefore, the use of marijuana during this crucial period can disrupt mutational processes. Evidence suggests that the magnitude of effects on cognitive development is dependent on a wide range of factors, including the age of initiation (Jacobus et al., 561). Other evidence suggests that marijuana users are highly likely to engage in other risky behaviours or activities, including risky illicit or risky sex, use of other drugs, such as alcohol and cocaine usage, lower performance in school, and a wide range of mental health issues (Johnstone et al. 35).
With regard to the prevalence of marijuana use among youths in the U.S., a 2017 survey conducted by Monitoring in the Future revealed that in 2017, 10.1, 25.5%, and 37.1% of 8 th , 10 th , and 12 th graders reported using marijuana in 2016, respectively (Johnstone et al. 69). The use of this drug among this population increased dramatically in 2017. This rise contrasts with overall secular decreases in adolescent alcohol and tobacco use, as well as declines in other traditional risk-taking behaviours.
A wide range of existing research has used nationally available or state representative samples of U.S. adolescents to determine trends in adolescent marijuana usage following the enactment of medical marijuana laws. None of the recent studies on medical marijuana laws and trends in adolescent marijuana usage found substantial estimates of pre-and post-medical marijuana law changes in adolescent marijuana use prevalence relative to their counterparts who have not implemented medical marijuana laws yet (Sarvet et al. 1009). However, scholars have started to shift their focus and are starting to assess the heterogeneity inherent in medical marijuana law design to see whether more permissive provisions have an impact on teenage marijuana usage (Chapman et al. 1176; Pacula et al. 9).
Research evaluating recreational marijuana law is still in its nascent stage. Only a few studies have documented marijuana usage in states with recreational marijuana laws. One study found higher nonsignificant marijuana usage prevalence rates among adolescents (Mason et al. 331). Another study, which looked at the prevalence and effects of teenage marijuana usage, found that the pre-and-post-RML groups used marijuana at about the same rate. However, there was a strong positive association between marijuana-related effects and perceived risk following the enactment of recreational marijuana laws (Estoup et a. 1883).
More permissive drug legislation may have a number of negative consequences, one of which being a rise in marijuana use. The use of marijuana has negative health consequences. Marijuana usage can lead to the following: marijuana use disorders (MUDs), mental health disorders and suicidality, among many other effects or behaviours. Additionally, marijuana legalization has resulted in the development of new forms of consumption, such as the development of edibles and vaporizing. These new forms of consumption are more appealing to adolescents. Besides, it has led to advances in production that have, in turn, resulted in marijuana products with alarming levels of tetrahydrocannabinol (THC).
Elucidating the Impact of Adolescent Marijuana Use
Impact on the Brain
The incidence of cannabis use among adolescents has increased significantly in recent years. Tonkin (73) performed a study to assess adolescent health status and risk behaviours among students between grade seven and twelve in British Columbia. The chief variables considered in the study were frequency of cannabis use and related educational and risk behaviours. The study revealed an increased frequency of marijuana use. Moreover, Tonkin (73) reported an early onset age of marijuana use among British Columbia adolescents. Marijuana users face a higher risk for risky behaviour than non-users.
Evidence shows that chronic marijuana use has adverse effects on adolescent brain development, especially the hippocampus. Ashtari et al. (1055) performed a study that compared hippocampal morphology in fourteen adolescents aged between eighteen and twenty. The selected population had a prior history of chronic marijuana use, smoking an average of 5.8 joints daily. An MRI and cognitive testing were used. Chronic marijuana users exhibited significantly smaller volumes of the hippocampus compared to controls. Larger hippocampus volumes in the control group indicated enhanced verbal learning and memory scores (Ashatri et al. 1057). After supervised abstinence for 6.7 months, no difference was noted between users and normal controls.
Neuroimaging studies show that chronic marijuana use leads to alterations in brain morphology. Ballat et al. (722) performed a study to measure the influence of the COMT gene polymorphism on brain volume in chronic early-onset marijuana users. Twenty-nine chronic marijuana users who begun using before sixteen years were matched to 28 healthy volunteers. A structured psychiatric interview was used to assess the study participants and COMT genotyping and structural MRI data. COMT polymorphism was found to influence brain volume (Ballat et al. 727). Therefore, the COMT genotype causes neuroanatomical changes due to cannabis use.
Chye et al. (823) confined the alterations to hippocampal shape and volume to cannabis dependence. The study aimed to elucidate the impact of marijuana use and dependence on the hippocampus. Chye et al. (824) compared hippocampal volume and shape variations between non-users and cannabis users. Study participants were matched on cannabis use pattern, including the age of onset and dosage. The right and left hippocampal volumes in cannabis-dependent users were significantly smaller than non-dependent users (Chye et al. 825). Therefore, there are dependent-specific neuroadaptations in cannabis-dependent users.
Prolonged use of cannabis impairs memory and verbal learning. Blest-Hopley et al. performed a study to investigate impaired verbal learning in cannabis users. Early-onset chronic marijuana users were compared to non-users. An fMRI was used at least twelve hours after marijuana use while performing a verbal learning task. The task allowed the examination of trial-by-trial learning among cannabis users. While performing the task, brain activation was encoded using an fMRI signal. Though learning occurred in both groups, learning was poorer in marijuana users than in non-users. Non-users exhibited a progressive surge in recruitment of the midbrain and thalamus. On the other hand, marijuana users displayed a more enhanced but disrupted activation pattern in the same regions (Blest-Hopley et al.). Consequently, the study showed that disrupted midbrain functions impair learning in marijuana users.
Marijuana use during adolescence causes poor neurocognitive outcome. Jackson et al. (E500) performed a study to investigate the association between marijuana use and alterations in intellectual quotient (IQ). Standardized intelligence measures were administered to adolescents between nine and twelve years before the onset of marijuana use. These measures were then administered at seventeen to twenty years. Marijuana users exhibited the lowest test scores compared to non-users. Moreover, they exhibited a significant decline in crystallized intelligence during adolescence (Jackson et al. 16). Therefore, marijuana use adversely affects intelligence in adolescence-onset users.
Impact on Mental Health
Cannabis is the most commonly consumed illegal substance in the world. In 2019, 3.8 percent of the world's population reported using marijuana (Gobbi et al. 427). Over the past few decades, the prevalence of marijuana use has remained constant (Gobbi et al. 427). However, trends in individual nations are shifting, with the youth reporting higher use of marijuana. Cannabis usage is common among U.S. adolescents and high school seniors (Johnston et al. 16). Given the legalizations of marijuana in some states for medical and recreational use, marijuana usage is projected to increase among the youth in the future.
The key psychoactive and mood-related effects of cannabis are mediated by THC, which also has addictive properties. Normal cannabis usage in adolescence is of great concern, as it is linked to a higher risk of negative effects, such as lower academic performance, addiction risk, early initiation of psychosis, and neuropsychological deterioration (Volkov et al. 2226). In addition, a wide range of studies suggests that there is a link between cannabis use and increased risk of the development of psychoses and other mental health disorders (Volkov et al. 2226).
Putative associations between cannabis use and mental illness have been one of the most influential issues. Significant doses of cannabis appear to be capable of triggering acute psychotic episodes and can exacerbate the symptoms of existing psychosis. Non-psychotic disorders have had less coverage than psychotic disorders. Despite this, evidence of a connection between marijuana usage and mental health disorders, such as depression and anxiety, is growing (6). According to a study conducted by Volkov et al., cannabis users are highly likely to develop the following mental issues: high levels of anxiety and depression (2221). In the study, adolescents reported anxiety symptoms following the use of marijuana, with the symptoms more prevalent in women than men. Overall, the use of marijuana is associated with mental health disorders.
Chronic cannabis use has adverse effects on mental health. Gage et al. (971) used Mendelian randomization (MR) to ascertain causation between cannabis use and schizophrenia. The study revealed that marijuana initiation is casually related to the odds of developing schizophrenia (Gage et al. 977). Therefore, a causal association exists between marijuana use and schizophrenia.
Cannabis use positively influences mental health due to its desired effects on mental illnesses, such as anxiety and depression. Turna et al. (134) investigated the prevalence of medicinal use of marijuana for anxiety symptoms. Eight hundred eighty-eight participants completed all psychometric screening instruments. The participants had various anxiety and depressive disorders, such as including social anxiety disorder and agoraphobia. These participants reported improved symptoms after cannabis use. Many of these participants replaced psychiatric medication with CMP (Turna et al. 137). Therefore, cannabis use improves anxiety and depressive symptoms.
Despite the growing evidence that there is a link between marijuana usage and mental health, there is gap in research on the connection between cannabis use and mental health among adolescents, as well as the mechanism that underpins it. Pre-existing symptoms can increase the probability of cannabis use as a self-medicating mechanism. This research study seeks to close this existing research gap by examining the impact of cannabis smoking among adolescent on mental health and development.
Research Methodology and Design
Null Hypothesis:
H 01 : Chronic cannabis users with an early onset age do not exhibit lower intelligence quotient (IQ) levels, indicated by memory function and verbal learning, than non-users.
H 02 : Chronic cannabis use is not a causative factor of psychosis or schizophrenia.
Alternative Hypothesis:
Hypotheses
H1: Chronic cannabis users with an early onset age exhibit lower intelligence quotient (IQ) levels, indicated by memory function and verbal learning, than non-users.
H2: Chronic cannabis use is a causative factor of psychosis or schizophrenia.
Research Approach and Design
This research study will use both a qualitative and quantitative research approach as the research methodology. This means that qualitative data will be collected in this study. A qualitative approach gives researchers the ability to conduct a critical analysis of the research topic under investigation. The role of telehealth in nursing is an extensive topic with multiple variables. Therefore, this research approach is the most effective option. A qualitative approach will ensure that participants' experiences and opinions can be quantified and understood through contextual analysis. In this study, an exploratory research design will be employed as the research design. This research design dictates the techniques that will be used to collect and analyze data. Since this research design was adopted, interviews and questionnaires will be used as the primary data collection methods.
Participants
In this study, twenty current cannabis users will be conveniently recruited using local and targeted online advertising. Twenty non-users will also be randomly selected for the control group, where the inclusion criteria included lifetime use of cannabis not exceeding ten times. The inclusion criteria for cannabis users include consumption of marijuana for at least four days a week. The surveys will be administered online. The table below gives a summary of the population that will be used in this study.
Table 1: Study Population
| Target Population | Source Population | Sample Population |
| Educational institutions. | Primary schools, secondary schools, colleges, and universities. | 20 current cannabis users will be conveniently recruited. |
Dependent and Independent Variables
The independent variables that will be considered in the study are age on the onset of marijuana use, frequency of use, and cannabis dependence. Dependent variables to be measured in the study include mental health issues (psychosis), memory function, and verbal learning.
|
Dependent Variables (DVs) |
Independent Variables (IVs) |
| Age of onset of marijuana use. | 1. Mental health issues (psychosis). |
| Frequency of use. | 2. Memory function. |
| Cannabis dependence. | 3. Verbal learning. |
Data Collection, Instrumentation, and Measurement
Data Collection
The study will use interviews and questionnaires as the primary data collection techniques. Basically, these two methods are employed when collecting qualitative data. In addition to the questionnaires and interviews, audiovisual files will be recorded during the interviews. Other instruments will be used to collect and/or record data, including pens, recorders, and cameras.
Instrumentation and Measurement
The onset age and frequency of marijuana use will be measured using the Cannabis Use Problems Identification Test (CUPIT). The test includes the following question.
How many times do you use marijuana on a usual day and week? (Bashford et al. 615).
Marijuana dependence will be measured using the Severity of Dependence Scale (SDS) (van der Pol et al. 138). The tool has five items. For the first four items, the dependence scores range from 0 to 3, where 0, 1, 2, and 3 indicate never or almost never, sometimes, often, and always/nearly always, respectively. For the fifth item 0, 1, 2, and 3 indicate not difficult, quite difficult, very difficult, and impossible, respectively. The maximum total score is 15, indicating psychological dependence (van der Pol et al. 139). The five items in the self-report instrument are indicated in the table below.
| Item | Description | Item Scores (0-3) |
| 1 | Do you feel your marijuana use is excessive? | |
| 2 | Does the prospect of missing a dose of marijuana cause anxiety or worry? | |
| 3 | Do you worry about your marijuana use? | |
| 4 | Do you desire to stop marijuana use? | |
| 5 | How difficult is it to stop or go without marijuana? |
Table 1. SDS (van der Pol et al. 139).
Acute psychotic symptoms will be measured using the Psychotomimetic State Inventory (PSI) and Brief Psychiatric Rating Scale (BPRS). The change score on both scales will be calculated by subtracting the score on the non-intoxicated day from the score on an intoxicated day (Curran et al. 1574). The mean increase in psychotic-like symptoms in cannabis users will be compared to the score in non-users.
IQ will be assessed using the California Verbal Learning Test (CVLT). The memory function will be determined by asking participants to recall as many words from a sixteen-nouns list. The scores will be compared to those in non-users. Participants will also be asked to indicate whether words in a 44-word list are target words or distractors. These scores will also be compared to those of non-users (Radoman et al. 1047).
Data Analysis
Microsoft Excel and other statistical tools will be used to analyze the qualitative and quantitative data that will be collected in this study. Different statistical tools will be used to transcribe the recordings obtained from the interviews. Using Microsoft Excel and other statistical tools, the data will then be organized into themes and then be coded. After coding the data, quantitative and qualitative analysis of the data will be conducted. Through the analysis, thematic correlations and patterns relevant to the study will be determined. The thematic correlations derived will then be used to address the study's research question, objectives, and hypotheses.
Plan of Sharing Results
To disseminate the result of the research findings back to the study participants and other stakeholders, I will send a copy of the research findings to each participants or stakeholder. In the copy, I will begin by thanking and acknowledging the research participants. I will provide an explanation of the main research question addressed in the study, the importance of the study, the historical context and what problem the research addresses, including the target audience. Next, I will provide a brief explanation of what I did, what transpired in the study, as well as who was involved. Afterwards, I will describe the findings of the study and how they related to public health. Lastly, it will provide a description of what the study's findings mean for the research participants and the impact the research findings will have on policy formulation.
Budget
| Item | Cost |
| Personnel |
$22,500 |
| Non-Personnel |
$10,550 |
| Other Direct Costs |
$2,000 |
| Indirect Costs |
$13,475 |
| Total |
$48,525 |
Personnel Expenses
The research will be comprised of a principal investigator and 5 interviewers. The principal researcher will receive $10,000 to oversee the project. The main roles and responsibilities of the investigator will be to supervise the staff and coordinate with other experts. The fiver interviewers will primarily be responsible for administering interviews and questionnaires. Each interviewer will receive $2,500.
Non-personnel Expenses
Non-personal expenses include travel expenses. The data collection process involves a lot of travels and, sometimes, spending nights in lodgings.
Airfare ticket: $250*5 = $ $750
Night lodging: 5*$100*5= $ 2,500
Per diem days: 5*10*$ 50= $2,500
Trips to schools: $2,000
Total travel expenses: $7,750
The research will also require the acquisition of supplies, including office supplies and others. Besides, funds will be required to publish. Extra expenses will be incurred in the form of communication and the acquisition of communication devices.
Office supplies: $ 500
Publication: $ 1,000
Communication: $300
Communication devices: $1000
Total: $2,800
Non-personal expenses=$7,750+$2,800 = $10,550
Other Direct Costs and Indirect Costs
Additional expenses will be incurred in the form of computer services, postage expenses, and stationeries. These costs are projected to be $2,000—the indirect calculated based on personnel expenses.
Indirect cost: 0.51 × 22,500 = $13,475
The projected budget for the study is $48,525.
Conclusion
This study seeks to examine the impact of cannabis smoking among adolescent on mental health and development. This study will employ a qualitative and quantitative research approach. Interviews and questionnaires will be used to collect data. Data will then be analyzed using Microsoft Excel and other statistical tools. It is hypothesized that chronic cannabis users with an early onset age will exhibit lower IQ levels, indicated by memory function and verbal learning, than non-users. The findings of this will help policymakers change or implement policies to minimize cannabis use among adolescents in order to fully resolve the increasing problem of mental disorders and to ensure a healthier future.
References
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Estoup, Ashley C., et al. "The impact of marijuana legalization on adolescent use, consequences, and perceived risk." Substance Use & Misuse 51.14 (2016): 1881-1887.
Gobbi, Gabriella, et al. "Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systematic review and meta-analysis." JAMA psychiatry 76.4 (2019): 426-434.
Johnson, Julie K. "Elucidating the impact of adolescent marijuana use." Journal of Adolescent Health 63.2 (2018): 129-130.
Johnston, Lloyd D., et al. "Monitoring the Future National Survey Results on Drug Use, 1975-2018: Overview, Key Findings on Adolescent Drug Use." Institute for Social Research (2019).
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., ... & Zaza, S. (2016). Youth risk behavior surveillance—United States, 2015. Morbidity and Mortality Weekly Report: Surveillance Summaries , 65 (6), 1-174.
Mason, W. Alex, et al. "Prevalence of marijuana and other substance use before and after Washington State's change from legal medical marijuana to legal medical and nonmedical marijuana: Cohort comparisons in a sample of adolescents." Substance abuse 37.2 (2016): 330-335.
Pacula, Rosalie L., et al. "Assessing the effects of medical marijuana laws on marijuana use: the devil is in the details." Journal of Policy Analysis and Management 34.1 (2015): 7-31.
Sarvet, Aaron L., et al. "Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta‐analysis." Addiction 113.6 (2018): 1003-1016.
Volkow, Nora D., et al. "Adverse health effects of marijuana use." New England Journal of Medicine 370.23 (2014): 2219-2227.
