Beyond Mere Substance Use: Association between Perceived Risk of Cannabis Use, Current Substance Use, and Mental Health Problems Among High School Seniors in the United States

Background/Purpose

Cannabis stands as the most prevalent federally illicit substance among adolescents in the US (Miech et al., 2023). The consumption of cannabis during adolescence is linked to heightened risks of mental health disorders (Bechtold et al., 2015) and subsequent substance use (Keyes et al., 2022). Despite these significant risks, there is a paucity of research examining how perceptions of risk regarding substance use and mental health issues influence current cannabis consumption. In addition, studies on impact of substance use and mental health on cannabis have been focused on adult population or young adolescents (Compton et al., 2019). Therefore, to address this critical gap, the present study aims to investigate the prevalence of current cannabis use among high school seniors, while exploring potential correlates including demographic factors, substance use histories, perceived risks associated with cannabis, and problematic mental health symptoms.

Methods

Data were derived from the nationally representative 2020 Monitoring the Future survey (N=617; 12^th graders). Participants self-reported their gender, race/ethnicity, urban status, high school program type, and parental education levels. The surveys assessed perceived risks related to cannabis use, problematic mental health symptoms, and substance use behaviors in relation to current cannabis consumption. Ordered logistic regression and structural equation modeling (SEM) were employed in Mplus with FIML estimation to identify factors associated with current cannabis use among high school seniors.

Results

24.3% of adolescents reported current cannabis use. SEM analysis indicated that those with problematic mental health symptoms had a higher likelihood of alcohol intoxication (β=0.309, p=.007) and smoking cigarettes (β=0.170, p=.001), an increased likelihood of current cannabis use (β=0.115, p<.001; β=0.182, p<.001; respectively). Smoking cigarettes had a lower likelihood of perceived risk of cannabis use (β=-0.072, p=.021), which led to a higher likelihood of current cannabis use (β=-0.246, p<.001). Those who engaged in binge drinking also had a higher likelihood of current cannabis use (β=0.107, p=.003).

Conclusions/Implications

These findings underscore the urgent need for targeted interventions among adolescents exhibiting low perceived risks, problematic mental health symptoms, and substance use, particularly within marginalized populations. Given that students’ characteristics, background, cultural upbringings, and family support are all connected to adolescents substance abuse (Tangenstein et al., 2021), it is imperative to implement culturally adapted evidence-based interventions to mitigate substance use and its associated consequences among adolescents. Specifically, late adolescence is key developmental stages where individuals begin to solidify their identities and take responsibility for their mental and physical well-being (Arnett et al., 2014; Creamer, 2017), making it an especially critical time for effective interventions and the development of resilience. Furthermore, clinical mental health treatment is vital to address problematic symptoms and diminish the likelihood of subsequent substance use. Attention must also be directed toward family dynamics, as older siblings and parents who openly consume and advocate for cannabis can significantly influence adolescents’ perceptions. Prevention and treatment strategies must confront misconceptions regarding the safety and medicinal applications of cannabis. Additionally, prioritizing preventive measures aimed at reducing polysubstance use is essential to promote the overall well-being of adolescents across various life domains.