Elsevier

Drug and Alcohol Dependence

Volume 156, 1 November 2015, Pages 150-156
Drug and Alcohol Dependence

Who receives cannabis use offers: A general population study of adolescents

https://doi.org/10.1016/j.drugalcdep.2015.09.009Get rights and content

Highlights

  • Adolescents who received cannabis offers differ from their peers in many respects.

  • Delinquency and peer cannabis use independently predicted being offered cannabis.

  • Peer cannabis use increased the risk of offers primarily for low-delinquent youth.

Abstract

Background

Drug use is predicated on a combination of “willingness” and “opportunity”. That is, independent of any desire to use drugs, a drug use opportunity is required; be it indirect (i.e., being in a drug-use setting) or direct (i.e., receiving a direct drug offer). However, whether some youth are more likely to encounter such direct drug use opportunities is not fully known.

Aims

We examined whether certain characteristics placed adolescents at greater risk for being offered cannabis, after accounting for a number of demographic-, contextual-, interpersonal-, and personal-level risk factors.

Methods

We utilized data from a Norwegian school survey (n = 19,309) where the likelihood of receiving cannabis offer in the past year was estimated using logistic regression models. Substantive focus was on the individual and combined effects of personal (i.e., delinquency) and interpersonal (i.e., cannabis-using close friend) risk factors. Separate models were fit for middle- and high-school students.

Results

Delinquency was a significant risk factor for receiving cannabis offers, as was a cannabis-using best friend. In addition, peer cannabis use increased the risk of cannabis offers mostly for adolescents on the lower delinquency spectrum, but less so for highly delinquent adolescents. These interaction effects were primarily driven by the middle-school cohort.

Conclusions

Cannabis offers were more likely to be extended to youth of certain high-risk profiles. Targeted prevention strategies can therefore be extended to a general profile of younger adolescents with externalizing problems and cannabis-using peers.

Introduction

Illicit drug use, like a number of other risky behaviors, is predicated on a combination of ‘willingness’ and ‘opportunity’. That is, irrespective of any individual desire to engage in drug use, opportunity – be it indirect (i.e., being present in a situation where drugs are readily available) or direct (i.e., being directly offered drugs for purchase or sharing) – to do so is necessary as well. However, although ‘drug exposure opportunity’ has been recognized as the initial stage in the natural history of drug use (Van Etten et al., 1997, Van Etten and Anthony, 1999, Wagner and Anthony, 2002), it is still relatively unknown if some youth are at greater risk than others for encountering such opportunities. This was the main question explored in this report.

Indeed, entry into drug use is only possible given the chance, and studies of young people in the USA (Kosterman et al., 2000, Pinchevsky et al., 2012, Van Etten et al., 1997) and in other countries (Caris et al., 2009, Delva et al., 1999, Wells et al., 2011) show that the likelihood of initiating drug use once the opportunity has occurred may be substantial. In fact, cannabis availability accounted for the majority of shared environmental risk for cannabis initiation (Gillespie et al., 2009), and the rate of transition from opportunity exposure to actual use tends to be higher for cannabis than for substances such as cocaine and amphetamines (Manning, 2001). Moreover, cannabis use is associated with an increased risk of progression to harder drugs (Fergusson et al., 2006, Wagner and Anthony, 2002), and some studies suggest that this in part may reflect a causal effect (Bretteville-Jensen et al., 2008, Bretteville-Jensen and Jacobi, 2011).

Exposure to cannabis use opportunities increases by age during adolescence, but the risk of progressing to cannabis use given the chance seems to be inversely related to age (Van Etten et al., 1997). There is also evidence that an early onset of cannabis use may be particularly detrimental, as it is linked to a range of adverse health and psychosocial outcomes (Fergusson and Horwood, 1997, Hall, 2015). Hence, from a preventive perspective, it is imperative to identify potential risk factors for encountering cannabis use opportunities at an early age. However, previous research has focused mainly on the transition from drug use opportunity to actual drug use, and not on the opportunity itself and the associated risk factors.

Drug use opportunity has typically been operationalized as any situation in which individuals perceived that they had the chance to use drugs if they wished to (Van Etten et al., 1997, Wagner and Anthony, 2002), including receiving explicit drug offers or being present when others were using (Parker et al., 1998, Storr et al., 2011, Wells et al., 2011). Focusing specifically on cannabis, Storr et al. (2011) identified aggressiveness as a risk factor for early opportunity to try the drug. Underage use of alcohol and tobacco were also noted as risk factors (Caris et al., 2009, Ellickson and Hays, 1992, Neumark et al., 2012, Wagner and Anthony, 2002), as were problem behaviors and exposure to drug-using peers (Neumark et al., 2012, Pinchevsky et al., 2012). Moreover, delinquent youth were more likely to receive offers to purchase illegal drugs (Rosenberg and Anthony, 2001). Overall, similar risk factors seem to operate for adolescent cannabis use opportunities as for the actual cannabis use (Brook et al., 2001, Coffey et al., 2000, Hawkins et al., 1992).

Early drug use opportunities may evidently comprise diverse phenomena, which might be differently related to individual characteristics and other potential risk factors. However, the existing research on these topics is scarce and somewhat unfocused. For instance, indirect opportunities (i.e., being in a situation where drugs are readily available) are often examined together with direct opportunities (i.e., being offered drugs for purchase or sharing). Also, although cannabis is the most commonly used illicit drug, and is a potential gateway drug to harder drugs (Bretteville-Jensen and Jacobi, 2011), past research tended to lump ‘illicit drug use’ into a single category and failed to fully identify specific factors that increase the risk of early cannabis involvement. By analyzing data from a large population survey of Norwegian adolescents, the present study aimed to add to the limited body of research focusing specifically on direct opportunities (i.e., offers) for cannabis use.

Compared to both the USA and to other European countries, the prevalence of adolescent cannabis use in Norway is low (Hibell et al., 2012, Romelsjo et al., 2014). The 2011 European School Survey Project on Alcohol and Other Drug (ESPAD) among 15- to 16-year-old students showed that 5% of the Norwegian students reported any cannabis use. The prevalence was more than twice as high in 25 of the 36 participating countries (Hibell et al., 2012). The 2011 ESPAD study also showed that the proportion of Norwegian students that perceived cannabis to be easily obtained (25%) was close to the European average (29%; Hibell et al., 2012). Finally, it may be noted that Norway prohibits any cannabis use and that the attitudes toward the drug are largely unfavorable: in a national survey from 2008, more than 90% 15 to 20-year olds opposed legalization of cannabis, and almost as many reported that they would not use the drug even if there was no risk of arrest (Vedøy and Skretting, 2009).

Are some youth more likely to be offered cannabis than others? We explored this question in a large adolescent sample, by examining individual and combined contribution of risk factors potentially associated with cannabis offers. We hypothesized that there may be both visible individual characteristics signaling potential interest in drugs, as well as environmental factors increasing the chance of cannabis exposure: such personal and interpersonal characteristics may differentiate certain youth as likely targets for cannabis offers. Specifically, we focused on the previously identified unique roles of delinquency (Pedersen et al., 2001, Rosenberg and Anthony, 2001) and substance-using close friends (Neumark et al., 2012, Pinchevsky et al., 2012), while accounting for a range of demographic-, contextual, interpersonal-, and personal-level covariates.

In addition, we were interested in the combined effects of these risk factors, and consequently examined whether (and if so, how) having cannabis-using peers interacted with delinquency to influence the risk of being offered cannabis. Given the limited research on this topic, this question was largely exploratory. To the best of our knowledge, no previous reports examined combined effects of these risk factors in relation to direct cannabis offers among youth. Finally, we examined the same questions across the middle-school and high-school cohorts.

Section snippets

Study sample

In 2004–2006, the Norwegian Institute for Alcohol and Drug Research conducted annual cross-sectional school surveys in 16 municipalities across Norway. The initial purpose was to evaluate a community-based prevention project targeting adolescent substance use (Rossow et al., 2011). Nine municipalities participated in the project and seven were included as controls. The latter were selected in order to match the intervention municipalities with respect to factors such as population size and

Sample characteristics

Sample characteristics are shown in Table 1. Shown are also unadjusted likelihoods (odd ratio, OR) of receiving cannabis offer during the previous year for all predictors. A total of 3280 participants (or 17%) reported receiving cannabis offer(s) during the past year, while 1455 (or 7.5%) reported ever using cannabis. All hypothesized risk factors were associated with cannabis offers in the expected direction (Table 1, all p < 0.001). In addition, high-school students were 4 times more likely to

Discussion

Direct opportunity for cannabis use (i.e., being offered a drug for purchase and/or sharing) is often the first step in the chain of drug use (Benjet et al., 2007, Caris et al., 2009, Pinchevsky et al., 2012, Siegel et al., 2014, Storr et al., 2011). Nevertheless, this common precursor of actual drug use remains relatively poorly understood. Despite some limited research on cannabis use opportunities (Neumark et al., 2012, Pinchevsky et al., 2012, Siegel et al., 2014), little is known about

Conflict of interest

None.

Author contributions

JBA was responsible for conceptualization of research questions and primary data analysis, while HP directed the original study and performed majority of literature review. Both authors contributed to writing.

Author disclosures

JBA was responsible for conceptualization of research questions and primary data analysis, while HP directed the original study and performed majority of literature review. Both authors contributed to writing.

This report utilized data from the survey conducted by the Norwegian Institute for Alcohol and Drug Research, 2004–2006, which was approved by the Norwegian Social Service Data Services (NSD)/Data Protection Official for Research. Neither of the authors has any conflict of interest.

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