Nicotine and Alcohol Use as Predictors of Recreational Cannabis Use in Adolescence: A Systematic Review and Narrative Synthesis

Abstract

Background: The prevalence of recreational cannabis use among adolescents is a growing public health concern due to its link to short- and long-term adverse effects on adolescents’ wellbeing, physical health, mental health, and interpersonal behaviors. Method: Five databases were searched from inception to March 17, 2023, for exposure (nicotine product, alcohol) and outcome (recreational cannabis) in adolescents (persons aged 10–19 years). The studies were screened independently by two reviewers, and the quality of the studies was assessed with Newcastle Ottawa and AXIS tool. PRISMA guidelines were employed in this review. Result: Twenty-one (21) studies involving 2,778,406 adolescents were included in the appraisal and heterogeneity was found among these studies. Ascertainment bias was commonly detected in thirteen (13) of the included studies. Among the substances examined as potential exposures, nicotine-product use emerged as a significant factor associated with future cannabis use among adolescents, particularly in mid-adolescence and in places where recreational cannabis use has been legalized. Conclusion: Current evidence suggests an association between nicotine-product use and subsequent recreational cannabis use among adolescents. However, further research is needed to establish causality between exposure to nicotine substances and the use of recreational cannabis within this age demographic. Additionally, there is a need for the development of prevention programs and targeted policies that continuously inform and update this vulnerable sub-population about the risks associated with cannabis use for leisure.

Keywords:

• Adolescents
• recreational cannabis
• alcohol
• nicotine
• cohort
• systematic review

Acknowledgments

We extend our sincere thanks to the University of Arizona Health Sciences Librarian-Jean McClelland for her invaluable assistance in shaping our search strategy for the systematic review process. Her expertise in database research was crucial in ensuring the success and rigor of this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

We have included Supplementary Material with this publication, which contains the datasets, and additional materials used in our study. This Supplementary Material is provided to enhance the transparency and reproducibility of our research. For any data or materials not found in the Supplementary Material, we encourage interested researchers to reach out to the corresponding author to provide further information or share any additional resources upon request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.