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Student Perceptions of Cannabis Use

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Title: Student Perceptions of Cannabis Use
Language: English
Authors: MacDougall, Christiana (ORCID 0000-0001-5678-5570), Maston, Matthew (ORCID 0000-0002-4883-0711)
Source: Journal of American College Health. 2023 71(4):1003-1017.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 15
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Tests/Questionnaires
Education Level: Higher Education
Postsecondary Education
Descriptors: Foreign Countries, Undergraduate Students, Marijuana, Drug Use, Social Life, Academic Achievement, Laws, Student Attitudes, Risk Management, Social Influences, Drug Therapy, Safety, Physical Health, Mental Health, Performance, Ability, Burnout, Stress Management
Geographic Terms: Canada
DOI: 10.1080/07448481.2021.1910272
ISSN: 0744-8481
1940-3208
Abstract: Objective: This qualitative study explored post-secondary students' perceptions of cannabis use on students' health, academic pursuits, and social lives, and investigated how these issues have been impacted by the legalization of recreational cannabis. Participants: 20 undergraduate students at a small liberal arts university in Atlantic Canada participated in this study. Methods: Semi-structured interviews were used to learn more about student perceptions of cannabis. Interview transcripts were analyzed using general thematic analysis. Results: Students in this study report using cannabis in thoughtful ways, balancing various considerations in terms of health, social connections, and academics. They were aware that cannabis is not a risk-free drug and took some steps to manage risks. Conclusion: Knowing why young adults believe they use cannabis is information for university professionals who want to develop effective harm reduction campaigns. Conclusion
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1389328
Database: ERIC
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  Value: <anid>AN0164010996;acl01may.23;2023Jun02.06:31;v2.2.500</anid> <title id="AN0164010996-1">Student perceptions of cannabis use </title> <p>This qualitative study explored post-secondary students' perceptions of cannabis use on students' health, academic pursuits, and social lives, and investigated how these issues have been impacted by the legalization of recreational cannabis. Participants: 20 undergraduate students at a small liberal arts university in Atlantic Canada participated in this study. Methods: Semi-structured interviews were used to learn more about student perceptions of cannabis. Interview transcripts were analyzed using general thematic analysis. Results: Students in this study report using cannabis in thoughtful ways, balancing various considerations in terms of health, social connections, and academics. They were aware that cannabis is not a risk-free drug and took some steps to manage risks. Conclusion: Knowing why young adults believe they use cannabis is information for university professionals who want to develop effective harm reduction campaigns.</p> <p>Keywords: Cannabis; legalization; qualitative; post-secondary</p> <hd id="AN0164010996-2">Introduction</hd> <p>Cannabis use among undergraduate students, and the potential for increased consumption rates post legalization of recreational cannabis, are concerns for student services professionals.[<reflink idref="bib1" id="ref1">1</reflink>] This study was conducted to gain insight into cannabis use among post-secondary students. We were interested in learning about participants' motivation for consuming cannabis, as well as their perceived effects of this consumption on their health, academic pursuits, and social lives. We also wanted to learn about how the students at one university made sense of cannabis use on their campus. Because this study was conducted shortly after the legalization of recreational cannabis use in Canada we also explored how legalization impacted students' perceptions of cannabis use among themselves and their peers.</p> <p>We believe every individual perceives the world uniquely[<reflink idref="bib2" id="ref2">2</reflink>] and so we hoped to gain an understanding of the subjective interpretations participants had regarding their cannabis use and its effects. Having students speak about their cannabis use can be useful for several stakeholders. University administrators and student affairs professionals may learn about usage patterns and beliefs, allowing them to better educate students on the risks/benefits of cannabis use. Such studies may help to inform academia, and governmental and non-governmental organizations, as they respond to students' needs in a post-legalization society. Findings may also be of use to researchers wanting to conduct similar studies.</p> <hd id="AN0164010996-3">Review of the literature</hd> <p>According to the National Cannabis Survey,[<reflink idref="bib3" id="ref3">3</reflink>] in the three months prior to legalization, cannabis was consumed by about 15% of Canadians aged 15 or older. In the final months of 2018 (which included the date of legalization), nearly 19% of New Brunswickers (the site of this study) reported using cannabis in the previous 3 months, and the highest usage rates in the country were in the Atlantic region.[<reflink idref="bib4" id="ref4">4</reflink>] After the legalization of recreational cannabis in Canada, provincial and territorial governments were responsible for the sale and distribution of cannabis while the federal government-maintained responsibility for laws related to criminal charges, safety, and advertising.[<reflink idref="bib5" id="ref5">5</reflink>],[<reflink idref="bib6" id="ref6">6</reflink>] The provincial government in New Brunswick took an aggressive approach to cannabis sales opening 20 brick and mortar stores in 17 communities, for a provincial population of 780k.[<reflink idref="bib7" id="ref7">7</reflink>] For comparison, at the time of writing, Ontario (Canada's most populous province) has 44 stores[<reflink idref="bib8" id="ref8">8</reflink>] serving a population of 14.6 million.[<reflink idref="bib7" id="ref9">7</reflink>]</p> <p>The health risks and benefits of cannabis have been, and continue to be, widely researched. It has been found that young users of cannabis are less likely to reach higher status levels in regard to employment and education[<reflink idref="bib9" id="ref10">9</reflink>] and are more likely to have health complications and use illegal drugs.[<reflink idref="bib9" id="ref11">9</reflink>],[<reflink idref="bib10" id="ref12">10</reflink>] Conversely, some participants of studies have indicated that cannabis use has had a beneficial impact on their health.[[<reflink idref="bib11" id="ref13">11</reflink>], [<reflink idref="bib13" id="ref14">13</reflink>]] Although a thorough review of the medical uses and risks of cannabis is beyond the scope of this article, we know that youth are looking for accurate and practical information on potential risks and benefits associated with cannabis use.[<reflink idref="bib14" id="ref15">14</reflink>]</p> <hd id="AN0164010996-4">Self-medicating</hd> <p>Little is known about how post-secondary students use cannabis for self-medicating. Research conducted by Sarvet et al,[<reflink idref="bib15" id="ref16">15</reflink>] found individuals in states with medical marijuana laws were significantly more likely to self-medicate for mood and anxiety disorders with cannabis than those living in states without legal medical cannabis. A qualitative study completed by Ogborne et al[<reflink idref="bib12" id="ref17">12</reflink>] investigated self-medicating behaviors in individuals with various illnesses in Toronto. This study found participants generally reported their cannabis use was associated with greater health benefit than health risk. However, data were collected prior to legalization with a different participant subset and context than this study.</p> <hd id="AN0164010996-5">Perceptions of health risks and benefits</hd> <p>In a survey study conducted by Webb and Webb[<reflink idref="bib13" id="ref18">13</reflink>] medical cannabis users reported significant benefits using cannabis for ailments such as chronic pain, nausea, appetite, depression, anxiety, and sleep difficulties. Research conducted by Brooks-Russell et al[<reflink idref="bib16" id="ref19">16</reflink>] and Cerdá et al[<reflink idref="bib17" id="ref20">17</reflink>] investigated if rates of perceived harmfulness of cannabis use decreased after recreational legalization in Colorado, and in Colorado and Washington respectively. Both studies were conducted with high-school students, and results were mixed. Brooks-Russell et al[<reflink idref="bib16" id="ref21">16</reflink>] studied surveys completed by students of grades 9 through 12 in Colorado and found that perceptions of harm associated with cannabis use decreased after legalization (52.9% to 47.7%). Cerdá et al[<reflink idref="bib17" id="ref22">17</reflink>] studied surveys of 8th, 10th, and 12th grade students and found participants in Colorado perceived no significant change regarding harm and cannabis use before and after recreational legalization. Cerdá et al[<reflink idref="bib17" id="ref23">17</reflink>] did find, however, that 8th and 10th grade students in Washington perceived a decrease in harm associated with cannabis use post-legalization.</p> <p>A Canadian study conducted by Spackman et al[<reflink idref="bib18" id="ref24">18</reflink>] investigated perceived harms of cannabis use among both users and non-users and found the greatest number of respondents associated cannabis use with physical and mental harm. A study conducted by Carhart-Harris and Nutt[<reflink idref="bib11" id="ref25">11</reflink>] involved survey data from 93 drug users in the United Kingdom in an effort to understand how participants assessed the harms and benefits of 11 illicit drugs. Participants ranked cannabis as the second least harmful substance (after psilocybin) and second most beneficial substance (after MDMA) and noted benefits in terms of stress relief, pain management, and insomnia.</p> <p>Asbridge et al's[<reflink idref="bib19" id="ref26">19</reflink>] Canadian mixed methods study of 202 cannabis and tobacco users in Halifax, Montreal, Toronto, and Vancouver explored perceptions of risk associated with the two substances. Participants in their study endorsed the view of tobacco as a carrying significant health risks but viewed cannabis as a relatively low-risk drug.</p> <p>In a notable Canadian qualitative study, Duff and Erickson[<reflink idref="bib20" id="ref27">20</reflink>] interviewed long-term cannabis users in Canada, exploring participants' perceived effects of cannabis use and their insight on risks. They found participants perceived cannabis use as a normalized activity with little risk associated when it is consumed in a controlled fashion. Our study shares similarities with Duff and Erickson's[<reflink idref="bib20" id="ref28">20</reflink>] work with the notable difference that our study has been conducted post-legalization. Further, our study included only students attending university in Atlantic Canada as participants, and investigated perceptions beyond health and into other realms of student experience.</p> <hd id="AN0164010996-6">Social influences on perceptions of risk</hd> <p>Brochu et al[<reflink idref="bib21" id="ref29">21</reflink>] also focused on the Canadian context (Vancouver, Toronto, Montreal, and Halifax). The qualitative study explored the relationship between informal and formal regulation of cannabis and participants' perspectives on their cannabis use. The authors reported informal control (work, social norms, relationships with others) had more impact on use than formal/legal control, where young people were more likely to have their cannabis use influenced by peers than by legal sanctions. Similarly, Dirisu et al[<reflink idref="bib22" id="ref30">22</reflink>] explored young people's cannabis use with respect to legalization and other social forces in a Nigerian context. This qualitative study found criminal identity/legal risk was not a deterrent to cannabis use, but personal meaning, social networks and dependence were factors in the choice to use cannabis even in a context where penalties for cannabis use and possession are quite severe.</p> <p>There have been notable studies conducted in Canada which have investigated cannabis use and perceived effects. However, there is a need for further research on this topic after the legalization of cannabis use in Canada. Further, most of the studies cited in this literature review have not investigated user motivations and perceptions in great detail and none have been conducted exclusively among post-secondary students in this region. We argue that an investigation of motivations for and perceptions on cannabis use amongst post-secondary students will add to the literature on cannabis use. It is also of note that there is a lack of research on cannabis use that has focused on Atlantic Canada specifically, especially in regard to perceptions of use and risk among university students. Canada is a geographically extensive country, and each region has distinctive characteristics. This is the case with cannabis usage patterns and in way of life. Because of this, we believe a study focusing on university in the Atlantic Canadian region is important and will add to the literature on cannabis use in this country. This will be explored in greater detail in the forthcoming section.</p> <hd id="AN0164010996-7">Methods</hd> <p>Research ethics board approval was granted from the university involved in the study. The study was conducted at a small university in Atlantic Canada from January to March 2019, shortly after the legalization of recreational cannabis in Canada. Participants were university students who self-identified as cannabis users. Data analysis was carried out using general thematic analysis.[<reflink idref="bib23" id="ref31">23</reflink>]</p> <hd id="AN0164010996-8">Recruitment</hd> <p>Student participants were recruited from the university community. Posters with a brief description of the study and contact information were put up across the campus. Twenty-two potential participants contacted the researchers directly. A follow up email was sent to these students and a time to meet for an interview was scheduled. Of the 22 students who were offered a time to meet, 20 followed through and were interviewed. Informed consent was reviewed with participants, any questions were answered, and all participants provided signed informed consent. Pseudonyms were used in the interviews, transcripts, and data sharing.</p> <hd id="AN0164010996-9">Participants</hd> <p>Twenty students participated in this study from the interview phase onward. The participants reflected a fairly even distribution across academic standing (5 first year students, 4 second year students, 6 third year students, and 5 fourth year students) and degree program (BA and BSc). Instead of collecting other demographic information, we specifically asked participants to talk about if/how their identity influenced their experiences with cannabis. As only a small subset of participants mentioned identity factors (such as gender and LGBTQ identity) we cannot report demographic information more generally as we do not know how all participants identify (for example in terms of race and gender) and we risk misgendering and making other faulty assumptions.</p> <p>Most of the students interviewed for this study came from Nova Scotia (<reflink idref="bib7" id="ref32">7</reflink>) or New Brunswick (<reflink idref="bib6" id="ref33">6</reflink>). Students interviewed also came from Ontario (<reflink idref="bib5" id="ref34">5</reflink>), and Western Canada (<reflink idref="bib2" id="ref35">2</reflink>). Sixteen students interviewed for the study were aged 19-23 with 4 participants being 24 or older (See Table 1).</p> <p>Table 1. Demographic information.</p> <p> <ephtml> <table><thead><tr><td /><td>Number of participants</td></tr></thead><tbody valign="top"><tr><td>Home province</td><td char="." /></tr><tr><td> New Brunswick</td><td char=".">6</td></tr><tr><td> Nova Scotia</td><td char=".">7</td></tr><tr><td> Ontario</td><td char=".">5</td></tr><tr><td> Western Canada</td><td char=".">2</td></tr><tr><td>Year of study</td><td /></tr><tr><td> 1st</td><td char=".">5</td></tr><tr><td> 2nd</td><td char=".">4</td></tr><tr><td> 3rd</td><td char=".">6</td></tr><tr><td> 4th</td><td char=".">5</td></tr><tr><td>Age</td><td /></tr><tr><td> 19</td><td char=".">4</td></tr><tr><td> 20</td><td char=".">5</td></tr><tr><td> 21</td><td char=".">2</td></tr><tr><td> 22</td><td char=".">2</td></tr><tr><td> 23</td><td char=".">3</td></tr><tr><td> 24+</td><td char=".">4</td></tr></tbody></table> </ephtml> </p> <p>The authors also gathered information on participants' cannabis use (Table 2). Students were asked about their early cannabis consumption, and responses indicated that most participants started to use cannabis in grades 10-12 (<reflink idref="bib13" id="ref36">13</reflink>). Other participants started using cannabis in university (<reflink idref="bib3" id="ref37">3</reflink>) or during grade 9 or earlier (<reflink idref="bib4" id="ref38">4</reflink>). All participants have consumed cannabis, at some time, by smoking it. At the time of interview, 18 students mentioned smoking as a current method of use. Other current usage methods included vaporizing (<reflink idref="bib5" id="ref39">5</reflink>), edibles and oils (<reflink idref="bib5" id="ref40">5</reflink>), and concentrates (<reflink idref="bib4" id="ref41">4</reflink>). Students also spoke to how often they used cannabis, with participants indicating that they used cannabis on a daily (<reflink idref="bib8" id="ref42">8</reflink>), weekly (<reflink idref="bib6" id="ref43">6</reflink>), or monthly (<reflink idref="bib5" id="ref44">5</reflink>) basis. One student indicated that they were not currently using cannabis.</p> <p>Table 2. Information on cannabis use.</p> <p> <ephtml> <table><thead><tr><td>Use</td><td>Number of participants</td></tr><tr><td>School level at first use</td><td /></tr></thead><tbody valign="top"><tr><td> Grade 10–12</td><td char=".">4</td></tr><tr><td> High School</td><td char=".">13</td></tr><tr><td> University</td><td char=".">3</td></tr><tr><td>Current use (frequency)</td><td /></tr><tr><td> Daily</td><td char=".">8</td></tr><tr><td> 1–5x a week</td><td char=".">6</td></tr><tr><td> 1–3x a month</td><td char=".">5</td></tr><tr><td>Not currently using</td><td char=".">1</td></tr><tr><td> Current methods of use</td><td /></tr><tr><td> Smoking</td><td char=".">18</td></tr><tr><td> Concentrates</td><td char=".">4</td></tr><tr><td> Vaporizer</td><td char=".">5</td></tr><tr><td> Edibles and oils</td><td char=".">5</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164010996-10">Site</hd> <p>This study was conducted at a small university located in Atlantic Canada. As noted previously, the provinces that make up Atlantic Canada have some of the highest rates of cannabis use in the country and provinces such as New Brunswick and Nova Scotia have a relatively high number of legal cannabis stores compared to other parts of Canada, often within walking distance of campuses. It is also of note that the Atlantic region is heavily rural with each province in the region having a population of less than 1 million.[<reflink idref="bib7" id="ref45">7</reflink>] Halifax, the region's largest city has a population of about 440,000. St. John's, Newfoundland, Atlantic Canada's next most populous city, has a population of just over 200,000.[<reflink idref="bib28" id="ref46">28</reflink>] Despite the relatively small population, Atlantic Canada has 17 universities and four colleges.[<reflink idref="bib29" id="ref47">29</reflink>] Communities in the Atlantic region tend to be close-knit, and access to larger centers can be challenging, especially for students without access to personal transportation. Many post-secondary institutions in the area are located within these smaller communities and make a significant impact on the population numbers and economy of these communities. Further, within these college towns, socialization tends to occur in situ with individuals being well known in the community. The university that this study reports on is in one of these smaller communities.</p> <hd id="AN0164010996-11">Data collection and preparation</hd> <p>The two researchers completed the first two interviews together to ensure we had similar approaches to interviewing. The remaining 18 interviews were carried out by either one of the researchers. All interviews occurred on campus in a private, unmarked meeting room. Each participant was interviewed one time using a semi-structured guide lasting between 45 and 90 minutes and all interviews were recorded (Appendix). Recordings were given to student research assistants who transcribed the interviews into word processing documents, including verbal and paraverbal content. All participants were offered the opportunity to review the transcripts and 13 participants asked to have the transcripts sent to them for review. One participant provided feedback requesting a piece of the interview not be used due to confidentiality concerns. We did not use this information in our findings.</p> <hd id="AN0164010996-12">Interpretation</hd> <p>We used inductive and deductive coding in this study. We were specifically interested in students' perceptions of their cannabis use in regards to health, academic performance, and social life and how this may (and may not) have been impacted by the recent legalization of recreational cannabis in Canada. While we entered the transcripts looking specifically for content regarding these topics, we were interested in how students made meaning of and interpreted their own and other's use. We were also interested in what else might emerge in the students' interviews regarding their cannabis use, and so we also coded other content not directly related to these topics.</p> <p>We coded the interview transcripts in three stages. First, each author coded individually. As we read through transcripts we each identified codes we felt were relevant to the study. These reflected the main ideas presented in the interview guide and were descriptive codes. We discussed and reached agreement on these first pass codes. For our second pass coding, we used the codes agreed on in the first stage (for example health, social, academic) and recoded all the transcripts to make sure we had coded all relevant data according to the new codes. Codes were captured in quote tables in word documents, with one document for each descriptive category, with supporting quotes. In the third pass of coding we took each descriptive category and we looked for nuanced meanings within these while reviewing the transcripts and original quotes in the quote table together. For example, students spoke directly about health risks, and in our third pass analysis we developed the analytical sub-theme of distancing. We also decided on new sub-themes that crossed descriptive categories. The authors agreed upon final analytical themes together. These themes were then collated into a quote table using spreadsheet software. We looked for areas of commonalities as well as areas of contradiction. We continued the coding process until all relevant statements were coded and fit within our agreed upon thematic framework. Our coding and thematic development occurred over several meetings, and by mutual editing of the word documents. All codes were not necessarily present in all interviews, and so we chose specific quotations to share here, that we believe illustrate how students in this study understood various aspects of their cannabis use</p> <hd id="AN0164010996-13">Trustworthiness</hd> <p>For this research to be helpful to the student services professionals, you, the reader must have some faith in its trustworthiness[<reflink idref="bib30" id="ref48">30</reflink>] therefore we outline here how we have evaluated the trustworthiness of this study. To address credibility, we engaged in member checking with participants, presented our early findings at academic and professional conferences, and sought feedback on our analysis from students and student services professionals. The two researchers who led the study also participated in ongoing discussion and debriefing with each other to ensure we remained "on track" with our analysis. As a research team, where one of us currently works as a student services professional and one of us currently an academic, we were also fortunate to have two perspectives looking at the data, adding to our ability to triangulate our findings. We also believe our findings and analysis link to existing and emerging data in this field. Transferability refers to how well our findings transfer to other sites[<reflink idref="bib30" id="ref49">30</reflink>] and while we may not know how well this study speaks to other researchers, we have endeavored to provide the details necessary to help the reader determine if they can apply our findings to their own experiences. Similarly, we have achieved dependability by documenting our process throughout the study and sharing the relevant details of our process in this article.[<reflink idref="bib30" id="ref50">30</reflink>] We encourage any readers who would like to discuss our research process to contact the lead author directly. Confirmability requires that our interpretations are based on the data and not the researchers' overreaching or biased interpretation.[<reflink idref="bib30" id="ref51">30</reflink>] We believe the descriptions and interview excerpts we have chosen contribute to the confirmability of this study. The inclusion of contradictory examples also contributes to the confirmability of this study. We encourage additional research exploring undergraduate student's perceptions of cannabis use which will add to the confirmability of this study.</p> <hd id="AN0164010996-14">Results</hd> <p>The findings shared below focus on how students in this study understand their motivations for using cannabis, and the effects of cannabis use on their health, academics, and social life. Research of this nature does not lend itself to grand statements about typical student use. Instead, the excerpts we share here illustrate themes on student perceptions and explore how students make what they feel are informed decisions about cannabis use.</p> <hd id="AN0164010996-15">Health considerations</hd> <p>Findings from this study suggest participants perceive positive health effects associated with their cannabis use. Student participants discussed using cannabis for both physical and mental health reasons, including efforts to diminish side effects and other risks associated with prescription medication. While participants seemed to share an understanding that there are health risks associated with cannabis use in general, students did not tend to perceive significant risks on their health personally.</p> <hd id="AN0164010996-16">Positive health effects</hd> <p>A number of participants in this study spoke to the perceived positive health effects of their cannabis use (Table 3). Of the twenty participants interviewed for this study, fourteen indicated medical benefits were at least part of the reason for their use.</p> <p>Table 3. Reported positive mental and physical health effects of cannabis use.</p> <p> <ephtml> <table><thead><tr><td>Effect</td><td>Participant</td><td>Quote</td></tr></thead><tbody valign="top"><tr><td>Cannabis for treating physical complaints</td><td>Ashley</td><td>I don't know if only because you're stoned, but I feel like when I do smoke weed my vision does become better. For those 3 hours, it becomes much more clear.</td></tr><tr><td /><td>Lisa</td><td>I have really bad headaches, so it's like sometimes if I'm up and I can't sleep for the life of me, my head is just pounding I will [use cannabis] to go to sleep.</td></tr><tr><td /><td>Ed</td><td>Getting a good night's sleep really affects how my back pain is the next day, so I think that's the biggest improvement when it comes to the pain relief.</td></tr><tr><td /><td>Terrance</td><td>I mean my lung capacity is better than before I used it,</td></tr><tr><td>Cannabis as beneficial for mental health</td><td>John</td><td>Well, my mental illness is bipolar, and I get really bad depressions, and when I get overwhelmed that's when it really magnifies. And I find if I smoke it and I just relax for that night the next day my symptoms feel nowhere near as bad and I kind of get better.</td></tr><tr><td /><td>Emily</td><td>I think it can definitely help with like anxiety related things. Like it's definitely helped me with that and with like sleep.</td></tr><tr><td /><td>Alex</td><td>I find that it's, it almost makes me chemically incapable of being anxious...</td></tr><tr><td /><td>Theo</td><td>Sometimes I have trouble sleeping if I'm really stressed or sore, so it usually gives me a really good time to catch up on my sleep, and I'll wake up feeling refreshed</td></tr><tr><td /><td>George</td><td>When you smoke weed, I feel just more relaxed and the energy around everyone is more, how can I say this, well, relaxed and de-stressed.</td></tr><tr><td>Safer than prescriptions</td><td>Jimmy</td><td>It's either that you're on this hardcore drug that you take every single day or when you're having an attack versus, you know, smoking weed once a week. If this does the trick, it's definitely better than me getting these amounts of chemicals put into my body.</td></tr><tr><td /><td>John</td><td>I feel like there is less negative consequences of marijuana compared to prescription drugs.</td></tr><tr><td /><td>Noah</td><td>I've tried Aleve, Naproxen, turmeric, I've had 2 years of pain so I've tried a lot of things prior to cannabis being legal. And I've almost got stomach ulcers, it hasn't worked, I've tried so many different things, so many different types of therapies, nothing seemed to work. Then I tried smoking weed for a couple times I'm like, 'Hey, I feel less pain' so I'm, like, this seems to work.</td></tr><tr><td /><td>Jacob</td><td>I have worked with my doctor to sort of work out proper dosage, when to take it, that kind of stuff. </td></tr><tr><td /><td>Ed</td><td>I take certain amounts every day depending on my pain level. Usually about 10 mg of THC a day. With varying amounts of CBD depending on what oils I order, but most days I'll take that early on in the day and then maybe an hour or two later I'll start noticing an effect.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164010996-17">Cannabis for treating physical and mental health conditions</hd> <p>Students spoke of using cannabis for physical ailments such as chronic pain, headaches, vision problems, sleep issues, and lung health. This study's findings also suggest some participants perceived cannabis as being beneficial for their mental health. Participants with diagnosed mental illnesses spoke of using cannabis to positive effect for issues including diagnosed bipolar disorder and anxiety disorders. Participants used cannabis for stress reduction and other non-clinical mental health issues as well including for help with sleep and stress reduction.</p> <hd id="AN0164010996-18">Safer than prescriptions</hd> <p>Students in this study spoke about using cannabis in conjunction with or as an alternative to other medications for mental and physical health issues. Our findings suggest participants view cannabis as a less harmful alternative to prescription medications. While many participants spoke to the health risks they associate with conventional medical treatments, and their view of cannabis as less risky for their health, some students noted they are using cannabis much like they would use any prescribed medication. Findings from this study suggest some students may experience their cannabis use as medically helpful. For many participants, cannabis is seen as a safer and less medically risky approach to managing physical health and emotional complaints. It was, however, also suggested that students understand that cannabis use does involve some potential risk to health.</p> <hd id="AN0164010996-19">Risks of cannabis use</hd> <p>Participants in this study discussed the various sorts of health risks they associated with cannabis use (Table 4).</p> <p>Table 4. Reported mental and physical risks of cannabis use.</p> <p> <ephtml> <table><thead><tr><td>Effect</td><td>Participant</td><td>Quote</td></tr><tr><td>Physical</td><td>Jacob</td><td>It's just bad for your lungs and you can smell it and you can feel the effects, and coughing up ash and stuff like that, it's not good.</td></tr></thead><tbody valign="top"><tr><td /><td>Josh</td><td>... the amount of brown stuff and tar and I don't need to be putting that in my body.</td></tr><tr><td>Distancing from risk (physical health)</td><td>Jimmy</td><td>Physically, smoking one joint a week is probably not that bad. Seeing how people smoke a pack a day of cigarettes and live till they're 80.</td></tr><tr><td /><td>Charlie</td><td>I guess part of me is thinking that, you know, I would have noticed something by now. If something was going to happen</td></tr><tr><td>Psychosis and mental health</td><td>Ellen</td><td>I remember having like heard that you were at a greater risk for developing schizophrenia or for schizophrenia to be activated if you're smoking at that age.</td></tr><tr><td /><td>Terrence</td><td>I know that some studies have shown an association with psychosis, like schizophrenia. Especially in young users.</td></tr><tr><td /><td>Josh</td><td>I do remember being a bit concerned about, yeah, definitely schizophrenia and the mental health aspect.</td></tr><tr><td /><td>Antonio</td><td>(Regarding frequency of use) It's again only, you know, very occasional because I do know about the health risks kind of more.</td></tr><tr><td /><td>Jacob</td><td>I wish I had never started, because obviously it does affect brain development.</td></tr><tr><td>Distancing from risk (mental health)</td><td>Ellen</td><td>I was aware of that and I think it made me nervous for a little while and I probably cut back on how much weed I was smoking at that point but it was never really at the front of my mind.</td></tr><tr><td /><td>Charlie</td><td>I was aware that it could be catalyst for schizophrenia, but I don't know. I wasn't really too concerned about health risks that were associated with it.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164010996-20">Physical health risks</hd> <p>Students noted the potential physical health risks of cannabis with most concerns centered on lung health. Most of these concerns were related to smoking cannabis, and participants some expressed plans or actions already underway to switch to vaping as a perceived harm reduction strategy.</p> <hd id="AN0164010996-21">Distancing from risk (physical health)</hd> <p>While many participants voiced their awareness of and concerns about potential health risks of cannabis use, other participants also showed little personal concern regarding physical health. As discussed previously, some participants felt that cannabis use has improved their physical health. Other participants in this study seemed to be cognitively distancing themselves from the risks associated with consuming cannabis. This may illustrate that while participants understand there are known and suspected health risks of cannabis use, they vary in how they consider themselves in relation to these risks.</p> <hd id="AN0164010996-22">Psychosis and mental health</hd> <p>Several participants had knowledge of a potential link between cannabis use and schizophrenia or other mental health disorders, especially in young people. A few participants noted such risk had an effect on their personal usage patterns and expressed regret regarding the potential harm that using cannabis may have done to their health.</p> <hd id="AN0164010996-23">Distancing from risk (mental health)</hd> <p>Like physical health risks, a number of participants did not view the mental health risks of cannabis consumption as applying to their own lives and while the students interviewed for this study did show an understanding of the mental health risks associated with cannabis use, few participants showed significant concern over this risk.</p> <p>Overall, participants identified both positive and negative health effects of cannabis use. Benefits included pain relief, sleep assistance, stress reduction, and relief around mental illness symptoms. Risks identified focused mostly around lung health and mental health. Participants spoke of these risks in general with few identifying personal concerns regarding their own health. Findings further suggest students perceive of cannabis as less harmful than other substances, especially prescription drugs.</p> <hd id="AN0164010996-24">Academic considerations</hd> <p>Our findings suggest there may be academic impacts associated with cannabis use (Table 5). Students in this study identified risks and benefits and spoke to managing cannabis use in consideration of their academic pursuits. Notable risks students identified centered around motivation, focus and attention to detail, and poor academic output. Participants also noted academic benefits including finding cannabis helpful for increasing creativity and understanding of deeper academic topics, reducing academic stress, and better sleep for improved academic performance.</p> <p>Table 5. Academic considerations of cannabis use.</p> <p> <ephtml> <table><thead><tr><td>Consideration</td><td>Participant</td><td>Quote</td></tr></thead><tbody valign="top"><tr><td>Motivation</td><td>Ron</td><td>Well I've had days where I just get high first thing in the morning and don't touch my schoolwork and let it pile up and I just keep smoking the entire day.</td></tr><tr><td /><td>Josh</td><td>I don't like smoking during the day. It definitely takes your motivation away I'd say, to, like, want to do things.</td></tr><tr><td /><td>Hailey</td><td>First semester it took me out for like 2 days. If I got very high, I would be out for a long time and I wouldn't be able to do any work, you'd just sleep all day.</td></tr><tr><td>Focus</td><td>George</td><td>things just might not grab your attention as [they] might should</td></tr><tr><td /><td>Antonio</td><td>You can't depend on it to develop a real, you know, structured understanding or anything</td></tr><tr><td /><td>Jacob</td><td>When it comes to more technical aspects, like math... absolutely not. Because it makes it worse, it makes it harder... It's like trying to do gymnastics when you're drunk.</td></tr><tr><td /><td /><td>I don't know if other people have said this, but, to me, it keeps me focused; it keeps me focused on the task at hand...</td></tr><tr><td>Quality of work</td><td>John</td><td>If I tried to do schoolwork, I know that it would just not be good compared to me being sober, like the quality of my work.</td></tr><tr><td /><td>Ellen</td><td>I feel like the thing that I make after I've smoked weed is never, in retrospect, is never as good as I kind of thought it was while doing it, so I don't see that as a benefit for me personally.</td></tr><tr><td /><td>Felicity</td><td>I try to express my thoughts, I'm like wow this is perfect this makes so much sense and [the professor] reads my essay that I wrote high and they're like' 'like you have the ideas here, but yeah.</td></tr><tr><td /><td>Antonio</td><td>High ideas aren't always the best ideas.</td></tr><tr><td>Creativity and insight</td><td>Felicity</td><td>(It) helped me a lot and uh, influencing my thought process and helping me to think differently to be more creative</td></tr><tr><td /><td>Terrance</td><td>...if I'm going to read, it might help to have a little bit of cannabis in me. Just like I said, when you watch a movie or have a discussion with somebody, it does open you up a little bit to some new ideas.</td></tr><tr><td /><td>Josh</td><td>It makes things more interesting. Like I'll be reading a book about something I couldn't care very much about but if I smoke and then do it, it at least makes it a little more tolerable to do certain tasks.</td></tr><tr><td /><td>John</td><td>I grew up pretty low-class working person, working my whole life really hard jobs... and when I smoked weed with my buddy, we always discussed astronomy was the first academic field, and we used to love talking about that and metaphysics and yeah. So, I would go as far to say that marijuana might have introduced me to the world of academia.</td></tr><tr><td>Academic stress</td><td>Jimmy</td><td>...relaxing is super important, and I typically forget to relax, and so this forces me to do that so I can't see how that's a bad thing for my academics</td></tr><tr><td /><td>Ellen</td><td>It's like I have been working really hard for a while, and I really feel like I need to relax and take a night off.</td></tr><tr><td /><td>Emily</td><td>When my mental health is improved, I'm a better student. So, you know, if I'm sleeping better and feeling less stressed then I can perform better.</td></tr><tr><td /><td>Josh</td><td>Say I was stressed out about a test or something. Before I'd go to bed I'd smoke and wouldn't worry all night.</td></tr><tr><td>Managing use</td><td>George</td><td>I wouldn't smoke during the day because I used to do my stuff during the day, so smoking at night more like a reward to relax and just enjoy your own alone time if you want.</td></tr><tr><td /><td>Lisa</td><td>I would never smoke during the day, because, like, I just could never focus like that, that's just not for me. Yeah, I've never smoked instead of studying or instead of going to class. </td></tr><tr><td /><td>Noah</td><td>Yeah, in my leisure time that's when I ever do it. Often Friday afternoons. Because we call them fried-days.</td></tr><tr><td /><td>Ed</td><td>Without any pain relief it is useless for me to go to class because I can't sit still; I can't focus at all... I'm not able to do it. So there's some tradeoff, which is I'd rather have, you know, slightly lower mental ability than you know a full inability</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164010996-25">Motivation and focus</hd> <p>Our participants suggested academic motivation may be negatively affected by cannabis use. Participants spoke of cannabis use as distracting from schoolwork, and many felt that consuming cannabis reduced their motivation for school work. Another risk noted by participants related to academic focus, where students interviewed for this study spoke about cannabis use impacting their ability to focus on academic work, especially work requiring great attention to detail.</p> <hd id="AN0164010996-26">Quality of work</hd> <p>Students in this study also discussed how the quality of their academic output can be negatively affected by cannabis use. Some students felt more confident doing their work while using cannabis only to be disappointed in the quality of the work when they reviewed it while sober. Antonio may have summed it up best when he stated, "High ideas aren't always the best ideas".</p> <hd id="AN0164010996-27">Creativity and insight</hd> <p>In contrast, a number of students who participated in this study reported finding cannabis helpful for formulating creative ideas, opening their minds to new ways of thinking, or in working on less detail-oriented subjects. One participant (John) credits cannabis use with his entry into the academy as a result of deep thinking and meaningful conversations he had regarding metaphysics while using cannabis.</p> <hd id="AN0164010996-28">Academic burnout and stress</hd> <p>Many students who participated in this study perceive of cannabis as a potentially helpful substance for reducing academic burnout and stress. Some participants use cannabis regularly and regimentally for this very reason. Participants viewed the relaxation that can come with cannabis as a sort of self-care activity that contributes to their success as students, including improved ability to manage their academic workloads.</p> <hd id="AN0164010996-29">Managing use</hd> <p>While participants identified risk associated with cannabis use, they were clear that cannabis use may prove beneficial in some areas of academics. This risk/benefit understanding led to a further finding that was identified through student interviews: cannabis-use management in relation to academics. Participants for this study noted the importance of managing cannabis-use while being a student. Many spoke of using cannabis only at night or on weekends to avoid negative academic impacts. Another student (Ed) spoke about using cannabis for physical pain in order to be able to concentrate on his academics. These statements made by participants suggest students who use cannabis may need to manage their use carefully in regard to their academic pursuits.</p> <p>Through this study, we found that students perceive there to be both positive and negative effects on academics with cannabis use. Cannabis use can be a risk as it may inhibit academic motivation, negatively affect focus, and impact academic output. On the other hand, cannabis use may help with creativity or in the understanding of broader topics and may help students in coping with academic burnout and stress. The identification of both risks and benefits is also noted in relation to how students manage their cannabis use. Findings suggest students interviewed for this study are managing their cannabis use in an effort to pursue academics according to their objectives.</p> <hd id="AN0164010996-30">Social effects</hd> <p>Findings from this study suggest there has been, and continues to be, a significant link between social life and cannabis use (Table 6). Many of the students interviewed for this study indicated there was social influence on their early use and that cannabis use continues to affect their social life, with both positive and negative effects noted.</p> <p>Table 6. Social effects of cannabis use.</p> <p> <ephtml> <table><thead><tr><td>Social effect</td><td>Participant</td><td>Quote</td></tr></thead><tbody valign="top"><tr><td>Facilitating social engagement</td><td>Ron</td><td>Yeah it's just nice. Everyone is in the same head and you can have a bit of a different kind of fun.</td></tr><tr><td /><td>Jimmy</td><td>Otherwise I wouldn't socialize as much. It kind of just puts me in a situation where I socialize.</td></tr><tr><td /><td>Ashley</td><td>I just like to have something that we can all share at a BBQ or a family get together or whatever.</td></tr><tr><td /><td>John</td><td>Some of the best times of my life has been sitting around on beanie bag chairs; the whole typical stoner atmosphere.</td></tr><tr><td /><td>Charlie</td><td>I'm trying to think how often any of us invite someone over for reasons other than to drink or smoke</td></tr><tr><td /><td>Antonio</td><td>I think it's [a] pretty small aspect of the social life.</td></tr><tr><td /><td>Ron</td><td>Cool people smoke pot. You know, it was ridiculous how it connected the friends you had and the drugs you did were.</td></tr><tr><td /><td>George</td><td>Well since day one I came here, first thing I made my buddies was by smoking a joint all together, so that was the first social thing that we did together you know. And instead of going to orientation, which the whole house does, we were doing something separate. All the common interest was consuming cannabis.</td></tr><tr><td /><td>Josh</td><td>You hang out with people more just because they're nice people or based on like, the content of their character, not just because they like to use cannabis.</td></tr><tr><td /><td>Ellen</td><td>The atmosphere has kind of been one of like 'oh would you like any? If not, that's fine.' And then everybody kind of makes their own choice of whether or not to smoke it.</td></tr><tr><td /><td>Jimmy</td><td>But that's not like a prerequisite for friendship, but it's a primer for friendship.</td></tr><tr><td /><td /><td /></tr><tr><td>Cannabis as safer than alcohol</td><td>Terrance</td><td>You know, it's not a party. We're not hooting and hollering and falling into each other. It's, yeah, it's just a way to get some discussion going and maybe listen to some music.</td></tr><tr><td /><td>Jacob</td><td>Most of the people that have some sort of you know, they don't show up to class or they have trouble with school, um, it's alcohol, 100% alcohol that contributes to that. Sure, they smoke cannabis as well, but no it's the party culture surrounding alcohol that's contributing to that kind of stuff for sure</td></tr><tr><td>Stigma and social risks</td><td>Ashley</td><td>Marijuana still has this stigma around it where, like, if you smoke, you're a drug addict.</td></tr><tr><td /><td>Emily</td><td>There's, like, there is a bit of stigma with it, like, some people are very against it even though it's legal now.</td></tr><tr><td /><td>Felicity</td><td>I don't like that people associate stoners with idiots.</td></tr><tr><td /><td>Alex</td><td>I think that some people, because they do want to be part of the social group, that they will do things that they're not necessarily comfortable with.</td></tr><tr><td /><td>Charlie</td><td>It's kind of like the rest of my peers are going to do it; I kind of don't want to be missing out.</td></tr><tr><td /><td>Hailey</td><td>I don't want to go out and smoke with everybody but then everybody else is gone out smoking and I'm here by myself in my room.</td></tr><tr><td /><td>Felicity</td><td>It's kind of like so you have the drug and you're already isolated and the drug makes you isolate yourself more unless you're with your other stoner friends who are also isolated.</td></tr><tr><td /><td>Jacob</td><td>The way I got into opioids was through smoking cannabis...It was the people. Right? So, the guy who was selling me cannabis had moxies, and that's where I got introduced into that kind of stuff.</td></tr><tr><td /><td>Felicity</td><td>We bonded over weed...and then you know that's not enough, so then Xanax comes in and yeah.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164010996-31">Facilitating social engagement</hd> <p>Participants spoke to the social benefits of cannabis use, and our findings suggest these students perceive cannabis as a social drug that makes it easier to socialize with others. Students also spoke about the drug bringing people together and creating social cohesion, drawing a link between social gatherings and substance use. However, some disagreed with the general view that cannabis has a significant social impact, instead seeing cannabis as a "pretty small aspect of the social life" (Antonio). This study's findings suggest the social benefit students perceive with cannabis use is twofold: cannabis use makes one more sociable, while also creating a more social atmosphere.</p> <p>These positive social effects of cannabis use have allowed for more enduring social dynamics. Participants spoke of their close-knit social connections in relation to cannabis use, and while participants spoke to cannabis as having a great impact on close social relationships, it was also noted by many that choosing to consume cannabis did not serve as a requisite for social grouping. These findings suggest students use cannabis as a social drug and this social use has helped to create long-lasting connections. However, it was also clear in our findings that social groupings may include both users and non-users.</p> <hd id="AN0164010996-32">Cannabis as safer than alcohol</hd> <p>Although participants of this study suggested cannabis is a social drug, many were clear to differentiate between the social uses of cannabis and alcohol. Although cannabis was viewed as a drug that brings people together, it was not described as a "party drug", like alcohol. Cannabis use was perceived by participants as a low-risk behavior especially in relation to alcohol use.</p> <hd id="AN0164010996-33">Stigma and social risks</hd> <p>Participants identified not only benefits, but social risks in regard to cannabis use. Some participants noted the social stigma around cannabis use and many participants noted that the negative stereotype of people who use cannabis as "stoners" continue.</p> <p>Another social risk identified by participants was peer pressure. Although, as noted earlier, social groupings might include both users and non-users, pressure exists for students to use cannabis to fit in, resulting in people choosing to use cannabis when perhaps they might not have otherwise. Similarly, some of our findings suggest cannabis use on campus may create social isolation. Hailey and Felicity both spoke to this, reflecting on how choosing not to consume cannabis when their friends are can result in being excluded from certain social events. One participant (Felicity) also made note of the risks around addiction and use of harder drugs, linking their early social cannabis use to their eventual use of harder drugs.</p> <p>Participants of this study identified both social benefits and risks with cannabis use. Social benefits included cannabis use positively affecting students' sociability, helping to create a social atmosphere, and having an impact on close social ties. Risks were noted as well, with social stigma, peer pressure and social isolation identified among participants. Furthermore, participants differentiated the social effects of cannabis of alcohol, with alcohol being identified as more of a party drug than cannabis.</p> <hd id="AN0164010996-34">Effects of legalization</hd> <p>Recreational cannabis was legalized in Canada on Oct. 17, 2018 (Table 7). Students who participated in this study spoke about their perceptions regarding the effect legalization had on their own use and on cannabis use more generally. A number of participants noted little change in their own use patterns, although some participants noted that they had begun purchasing cannabis through legal channels. Most participants in this study have a negative perception of the legal market, with both cost and quality being criticized. There was also an indication that participants believed there to be an increase in cannabis use in general, and a reduction in stigma post-legalization.</p> <p>Table 7. Effects of legalization.</p> <p> <ephtml> <table><thead><tr><td>Effect</td><td>Participant</td><td>Quote</td></tr></thead><tbody valign="top"><tr><td>Participants' use</td><td>Noah</td><td>(Regarding use pre-legalization) Like, very rarely would I, because of that, because I didn't want any repercussions.</td></tr><tr><td /><td>Ashley</td><td>(Regarding changes in personal use post-legalization) It didn't change</td></tr><tr><td /><td>George</td><td>(Regarding changes in personal use post-legalization) Me personally? Not really.</td></tr><tr><td /><td>Theo</td><td>For me, it hasn't really made much of a difference.</td></tr><tr><td /><td>Alex</td><td>I think it's business as usual really... building up to legalization, people still treated it the same, at least people who were already using it.</td></tr><tr><td>Privilege</td><td>Ellen</td><td>I'm just like a cute young white woman. I can't really see, the police aren't out to get me, you know what I mean?</td></tr><tr><td /><td>Felicity</td><td>Weed has always been legalized to me... I'm very privileged, I could afford, you know, walking downtown Toronto smoking a joint, no one would stop me.</td></tr><tr><td>Influence on other's use</td><td>Lisa</td><td>This is what I would infer, is that more people are smoking like I said, more people are experimenting.</td></tr><tr><td /><td>Jimmy</td><td>Now it's legal too, a lot, like, one of my friends that never smoked weed before smokes with me...</td></tr><tr><td /><td>Noah</td><td>I think just more people are using it, but also more people are informed about it... It's definitely de-stigmatized marijuana</td></tr><tr><td /><td>Sandra</td><td>...I'm a lot more comfortable with it now, and definitely with students it's become like a more comfortable topic</td></tr><tr><td /><td>Terrance</td><td>I found so many people in my life that I had no idea touched cannabis have now come out and said yeah I've been using it for 10 years.</td></tr><tr><td>Perceptions of the legal market</td><td>Hailey</td><td>I've never bought anything from there just because it's more expensive.</td></tr><tr><td /><td>Ashley</td><td>I mean I go to my friend and I can get it for a 100, you're selling it for 200? I'm not going to buy it from [provincial retailer].</td></tr><tr><td /><td>Ron</td><td>I don't think I know anyone that goes to the store regularly, and if they do, I think they're getting ripped off.</td></tr><tr><td /><td>Ashley</td><td>We are 6 months in now, and every time I go, you are out of this and you're out of this and you're out of this.</td></tr><tr><td /><td>Alex</td><td>I think that there's still people around here who will rely on the people that they used to buy from, simply because they don't like the product that [retailer] offers.</td></tr><tr><td /><td>Charlie</td><td>(Regarding reasons for purchasing from the provincial retailer) I don't know, partially convenience I guess.</td></tr><tr><td /><td>Lisa</td><td>(Regarding reasons for purchasing from the provincial retailer) ...I have a lot of control...there's so many risks involved with, like, cutting and lacing and that kind of thing.</td></tr><tr><td /><td>Emily</td><td>(Regarding reasons for purchasing from the provincial retailer ... they say it's one thing, but you really have no idea...</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164010996-35">Effects of legalization on participants' use</hd> <p>With few exceptions, participants did not indicate that there was a significant difference in their own cannabis use pre and post-legalization. Noah, was a participant that noted some change in his use due to previous concerns over occupational ramifications stating that he rarely used cannabis prior to legalization. Students also spoke of the acceptance of cannabis use even pre-legalization feeling that people who were going to use cannabis were already doing so pre-legalization.</p> <hd id="AN0164010996-36">Privilege</hd> <p>Some participants reflected on the relationship between social location, privilege, and cannabis legalization. Some students reflected on how their various positions of social privilege was protective against criminalization pre-legalization.</p> <hd id="AN0164010996-37">Effects of legalization on other's use</hd> <p>Participants spoke about shifts in cannabis use post-legalization when asked about use in general. While the majority of our participants felt their own use had not increased since legalization, many felt it likely that more people are using cannabis. Students also spoke to there being more acceptance around cannabis post-legalization in terms of use and also openness about use. Findings of this study suggest that students perceive an increase in use and a reduction in stigma post-legalization. Students also, however, spoke to some failures regarding recreational cannabis legalization.</p> <hd id="AN0164010996-38">Perceptions of the legal market</hd> <p>Participants in this study suggested that students have a negative view of the legal sales of cannabis. Participants noted that the provincially sanctioned cannabis retailers' prices were too high, which has turned many away from purchasing through this avenue. In addition to being turned off by the cost of legally purchased recreational cannabis, many participants also noted that the low quality of the product. However, a few students did speak to the convenience and trustworthiness of purchasing through a legal retailer and some participants mentrioned the assurance of a safe and legal supply.</p> <hd id="AN0164010996-39">Discussion</hd> <p>This qualitative study, based in a small Atlantic Canadian undergraduate university, used semi-structured interviews to gain insight into students' perceptions of their cannabis use. Data was collected shortly after the legalization of recreational cannabis in Canada and was motivated by interest in understanding how students make decisions about their cannabis use so that harm reduction campaigns can be directly targeted to meet the needs of students who use cannabis. The concepts of normalization, informal controls, and risk denial help frame our interpretation of our findings.</p> <p>The participants in this study did not believe that legalization had much impact on their cannabis use. As the participant Felicity said "weed has always been legalized for me". It may be that some young people are moving to the legal market to procure their product out of convenience (however, the participants in our study did not feel positively about the legal market in terms of both quality and price) but their experiences of cannabis have never been associated with illicit activity or criminalization. This finding is in line with the work of Brochu[<reflink idref="bib21" id="ref52">21</reflink>] and Dirisu[<reflink idref="bib22" id="ref53">22</reflink>] who report that cannabis users prioritize their own agentic decisions regarding their use over legal and regulatory controls. They found that prior to legalization, people who use cannabis are more likely to mitigate legal risk behaviorally rather than give up using cannabis. Their findings also suggest that for many cannabis users, the legal risks associate with use were considered negligible. Our findings are also in line with the research that argues the normalization of youth drug use is a typical adolescent experience[<reflink idref="bib19" id="ref54">19</reflink>] as well as research demonstrating that cannabis use is undergoing a process of normalization more generally.[<reflink idref="bib21" id="ref55">21</reflink>]</p> <p>Normalization refers to the ways in which certain practices and ideas (which may have been stigmatized) become embedded and integrated into everyday life.[<reflink idref="bib19" id="ref56">19</reflink>],[[<reflink idref="bib31" id="ref57">31</reflink>], [<reflink idref="bib33" id="ref58">33</reflink>]] The students in this study saw cannabis as becoming normalized within their social milieu. The relationship between legalization and normalization of cannabis is co-constitutive where legalization may be more likely to occur in areas where cannabis use is normalized, while legalization may also contribute to normalization.[<reflink idref="bib34" id="ref59">34</reflink>]Our findings suggest that legalization and normalization of cannabis use have reduced the legal and social risks of cannabis use among our participants, and as a result students in this study made use of other mechanisms for managing their cannabis use. With the reduction of the formal control of cannabis use through laws and punishment, informal controls become more important for understanding how young adults make sense of their cannabis use, especially in a post legalization context. Brochu et al[<reflink idref="bib21" id="ref60">21</reflink>] explored the role of informal control to understand how people make decision about their cannabis use. As they explain: "Informal control is broader and more subtle to detect than formal control. It manifests itself in different ways, by any social actor, always in relation to a situation or context, and is absorbed directly or internalized."[<reflink idref="bib21" id="ref61">21</reflink>]<sups>(p.1661)</sups> Given the setting of our study was a small university campus, the context student participants experience is focused primarily on academics and social life. In making decision about cannabis use in a social context, informal controls may include making rules for oneself about when and where to use cannabis in order to manage the potential social impacts of cannabis use.[<reflink idref="bib21" id="ref62">21</reflink>] Our findings in terms of social considerations are in line with those of Brochu et al[<reflink idref="bib21" id="ref63">21</reflink>] who report that participants in their study considered the social context when making decisions about cannabis use – avoiding it in certain contexts where cannabis use might be frowned upon (for example around grandparents, children, and professors) while using it in others (around friends who also use cannabis). Brocu et al[<reflink idref="bib21" id="ref64">21</reflink>] reported a relationship between informal and academic goals, wherein cannabis was seen by their participants as a hinderance to academic performance. Students in this study were less negative about cannabis in relation to academics, mentioning both negative (fatigue, attention and concentration difficulties) and positive (creativity, opening the mind to new ideas) aspects of cannabis use and academic performance.</p> <p>Students in this study might not go to class under the influence of cannabis if they felt it could hurt their reputation or performance, but might use cannabis prior to class to manage health issues that would interfere with learning. And while they might not go to class impaired, the context of hanging out with friends talking about topics of importance that they have discussed in class might lend itself to cannabis use, showing that students in this study are influenced by both the context and their own goals for themselves. While student participants in this study held a relatively positive view of cannabis, they were also aware that cannabis is not a risk-free drug and took some steps to manage risks. For example, participants managed their cannabis use in relation to their academic goals and performance and considered how cannabis might help or hinder academic processes. This decision-making process also reflects the idea on informal control at work in their cannabis use.</p> <p>While one might assume some similarity between social dynamics with respect to alcohol and other legal and regulated substance, students in this study reported a different experience of peer pressure and peer influence with cannabis than they experience with alcohol. Participants reported feeling some pressure to engage in cannabis use in order to fit into their social milieu. However, the quality of the pressure was different than they experienced with alcohol. Whereas alcohol was seen as a party drug, where people lose inhibitions and control, cannabis was seen as a recreational drug bringing people together and into deeper relationships with each other. However, the stigma associated with cannabis and its history as an illegal drug continues to influence how students believe others see them. Our findings, that young people in this study desired to fit in with their peer group, and looked to peers to influence behavior with regard to cannabis use, is in line with other's findings regarding peer influence on decisions about cannabis use.[<reflink idref="bib21" id="ref65">21</reflink>],[<reflink idref="bib22" id="ref66">22</reflink>]</p> <p>While students in this study applied a risk/benefit analysis in relation to their cannabis use and their academic and social lives, they appeared to be less likely to apply this same analysis to both short and long term health effects. Risk denial involves the cognitive moves people make to neutralize their perceptions of the potential harm a behavior can cause.[<reflink idref="bib35" id="ref67">35</reflink>] Risk denial can include many strategies such as believing a risk applies to other people but not oneself (self-confidence) and using a comparison with another behavior that is already considered risky to minimize the sense of risk with the behavior in question (comparisons between risks).[<reflink idref="bib36" id="ref68">36</reflink>]<sups>(p.374)</sups> Both of these strategies of risk denial are evident in this study. Many students in the study spoke about the positive effects cannabis has had on their health and wellbeing, while admitting to not paying much concern to issues such as the risk for psychosis and negative effects on lung health. It may be that health risks feel longer term, despite this age group being the time when first onset of psychosis is most likely,[<reflink idref="bib37" id="ref69">37</reflink>],[<reflink idref="bib38" id="ref70">38</reflink>] and students are more focused on their immediate reality. That is, students in this study were aware of the known and suspected mental and physical health risks of cannabis use, but they did not see these as applying to them. This is aligns with what is known about perceptions of risks associated with smoking tobacco.[<reflink idref="bib28" id="ref71">28</reflink>],[<reflink idref="bib29" id="ref72">29</reflink>] They see cannabis as a safer alternative to alcohol for socialization and as a relatively safe recreational drug that also has health benefits. Other studies report similar findings, where using cannabis is seen as a safer alternative to other drug use. Brochu et al[<reflink idref="bib21" id="ref73">21</reflink>] found respondents in their study believed cannabis to be a safer alternative to tobacco without the problems associated with alcohol. Both Wilkinson et al[<reflink idref="bib39" id="ref74">39</reflink>] and Lau et al[<reflink idref="bib40" id="ref75">40</reflink>] studied perceptions about cannabis among people in treatment for problematic drug use, and found cannabis was often viewed as a rather safe and innocuous drug. Other studies have similarly shown young people perceive cannabis as a low-risk drug, and observed this change in perception has occurred along with more permissive cannabis laws.[<reflink idref="bib16" id="ref76">16</reflink>],[<reflink idref="bib41" id="ref77">41</reflink>],[<reflink idref="bib42" id="ref78">42</reflink>]</p> <p>The findings of this study support the research indicating normalization of drug use does not result in a free for all with rampant drug use, instead, findings suggest the normalization of cannabis among youth means that youth engage informal mechanisms of control to make decisions about their drug use that align with their academic, social, and health goals. And while informal controls show up in terms of academic, social goals, and (for some participants) health goals, there remains a level of risk denial especially with respect to the potential health risks of cannabis use.</p> <hd id="AN0164010996-40">Limitations and directions for future research</hd> <p>This study allows a greater understanding of the how students within the institution where the study took place are understanding their choices about cannabis use. As with all qualitative research of this nature, it is likely that these results could be different if this study were to be carried out at another institution with different demographics, geographic location, and age cohort. We believe these findings should be of particular interest to those working with undergraduate students in rural communities. This study also relies on self-report and so while some students may see their cannabis use as not harmful, or even as helpful, others may have different opinions about the impact of these particular participants' cannabis use on their health, academics, and social lives. However, the goal of this research was to learn how students understand their choices so as to target harm reduction campaigns effectively. Thus, subjective interpretations are more important in this regard. It is perhaps a limitation of this study that further information on student demographics and usage methods were not gathered. The authors anticipate that usage method may be tied to motivations for cannabis use but are unable to support this based on the data used for this study. Future studies might attempt to gain insight into the perceptions and motivations of cannabis use within specific groups of students (e.g. racial identity, gender, program of study, etc.) or among types of cannabis users (e.g. daily users, students using edibles, etc.).</p> <hd id="AN0164010996-41">Recommendations</hd> <p>Given that students may see cannabis as a safe or safer drug for recreation, medical, and academic use, and work to balance the risks or cannabis use with its potential benefits, it is important for campus health and mental health services to take a holistic approach to cannabis education. Focusing solely on risks, and especially on health and mental health risks, perhaps may not be as effective as creating campaigns that balance physical and mental health information with social and academic information as well.</p> <p>Students in this study wanted to use cannabis in a way that did not interfere with their social, health and academic goals, and may be interested in learning more about how cannabis could help them achieve their goals. While it may be beyond the scope of, and indeed may be misguided for, student affairs professionals to provide advice on how to use cannabis to achieve goals, student affairs professionals should consider that students are looking for this information and will make decisions about how cannabis fits into their lives despite risks. Balancing these messages is difficult, and it is important. Knowing why young adults believe they use cannabis, how their use fits within their social milieu, and what benefits students gain from their cannabis use, are important pieces of information for university professionals who want to develop effective harm reduction campaigns. The extensive behavioral science theory literature for health promotion and harm reduction should be considered when developing cannabis education and harm-reduction campaigns on campuses (see eg Glanz & Bishop[<reflink idref="bib43" id="ref79">43</reflink>] and Kelly & Barker[<reflink idref="bib44" id="ref80">44</reflink>]) Specifically, we believe harm reduction campaigns that create a path of connection for students between the abstract idea of risk and their own personal risk factors will be especially important.</p> <hd id="AN0164010996-42">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of Canada and received approval from the Institutional Review Board of Mount Allison University.</p> <hd id="AN0164010996-43">Funding</hd> <p>This project received funding through the Mount Allison Cannabis Education Fund.</p> <hd id="AN0164010996-44">Appendix – interview guide</hd> <p>Cannabis Use Among [Atlantic Canadian University] Students</p> <p>Demographics and Interview Guide</p> <p>Identifier:</p> <p>University year:</p> <p>Program:</p> <p>Home Province:</p> <p>Age:</p> <p>The interview will be semi-structured. The following questions and prompts will be used as needed to elicit information relevant to the participant's situation and story.</p> <p></p> <ulist> <item> Please tell us about your background and any early associations you had with cannabis.</item> <p></p> <item> Possible follow-up prompts</item> <p></p> <item> Why did you first choose to use cannabis? What were your motivations and influences?</item> <p></p> <item> At what age did you begin to use cannabis? How did you consume?</item> <p></p> <item> What do you remember about this? What was it like?</item> <p></p> <item> How was cannabis use viewed within your family context?</item> <p></p> <item> What was the social context like in regard to cannabis use?</item> <p></p> <item> Were you ever concerned about health risks or other risks (police, financial, etc.)?</item> <p></p> <item> Tell us about your current cannabis use.</item> <p></p> <item> Possible follow-up prompts</item> <p></p> <item> How do you consume cannabis? How often? Where? When?</item> <p></p> <item> Why do you consume cannabis? Motivations and Influences?</item> <p></p> <item> What is it like?</item> <p></p> <item> What are the effects on your health?</item> <p></p> <item> What is the social context like in regard to cannabis use here? How do other students consume cannabis? How many would you say?</item> <p></p> <item> What do you know about the mental and physical health risks of cannabis use?</item> <p></p> <item> Are you concerned about health risks or other risks due to your consumption?</item> <p></p> <item> Do you ever think about stopping cannabis use or reducing it? Explain.</item> <p></p> <item> Please speak to your perception of any affects legalization has had on cannabis use.</item> <p></p> <item> Possible follow-up prompts</item> <p></p> <item> Have you changed anything about your cannabis use since legalization? Explain</item> <p></p> <item> In general, has cannabis use at this university changed since legalization?</item> <p></p> <item> What other substances have you and/or do you consume?</item> <p></p> <item> Possible follow-up prompts</item> <p></p> <item> Tell us about your consumption of alcohol</item> <p></p> <item> What is your relationship between alcohol and cannabis use?</item> <p></p> <item> What do you think the relationship of alcohol and cannabis use is on campus in general?</item> <p></p> <item> Do you use other drugs? How often? What kind?</item> <p></p> <item> What is your relationship between other drugs and cannabis use?</item> <p></p> <item> Approximately how much do you spend on Cannabis per week? Alcohol?</item> <p></p> <item> What do you think the relationship of other drugs and cannabis use is on campus in general?</item> <p></p> <item> Have you ever used cannabis for medical reasons?</item> <p></p> <item> Possible follow-up prompts</item> <p></p> <item> Was it prescribed or not?</item> <p></p> <item> How often?</item> <p></p> <item> Explain why you chose to use cannabis instead of other strategies or medications</item> <p></p> <item> Explain the effects</item> <p></p> <item> Please explain the relationship between your cannabis use and your academic pursuits</item> <p></p> <item> Possible follow-up prompts</item> <p></p> <item> How has cannabis use affected your academics (positive/negative/no change)?</item> <p></p> <item> What do you think about the general relationship between cannabis use and academics at this university?</item> <p></p> <item> Please explain the relationship between your cannabis use and your social life</item> <p></p> <item> Possible follow-up prompts</item> <p></p> <item> How has it affected your social life (positive/negative/no change)?</item> <p></p> <item> What do you think about the general relationship between cannabis use and social relationships at this university?</item> <p></p> <item> Are there differing types of cannabis users? 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Public Health. 2016; 136 : 109 – 116. doi: 10.1016/j.puhe.2016.03.030.</bibtext> </blist> </ref> <aug> <p>By Christiana MacDougall and Matthew Maston</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref12"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref13"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref14"></nolink> <nolink nlid="nl4" bibid="bib14" firstref="ref15"></nolink> <nolink nlid="nl5" bibid="bib15" firstref="ref16"></nolink> <nolink nlid="nl6" bibid="bib12" firstref="ref17"></nolink> <nolink nlid="nl7" bibid="bib16" firstref="ref19"></nolink> <nolink nlid="nl8" bibid="bib17" firstref="ref20"></nolink> <nolink nlid="nl9" bibid="bib18" firstref="ref24"></nolink> <nolink nlid="nl10" bibid="bib19" firstref="ref26"></nolink> <nolink nlid="nl11" bibid="bib20" firstref="ref27"></nolink> <nolink nlid="nl12" bibid="bib21" firstref="ref29"></nolink> <nolink nlid="nl13" bibid="bib22" firstref="ref30"></nolink> <nolink nlid="nl14" bibid="bib23" firstref="ref31"></nolink> <nolink nlid="nl15" bibid="bib28" firstref="ref46"></nolink> <nolink nlid="nl16" bibid="bib29" firstref="ref47"></nolink> <nolink nlid="nl17" bibid="bib30" firstref="ref48"></nolink> <nolink nlid="nl18" bibid="bib31" firstref="ref57"></nolink> <nolink nlid="nl19" bibid="bib33" firstref="ref58"></nolink> <nolink nlid="nl20" bibid="bib34" firstref="ref59"></nolink> <nolink nlid="nl21" bibid="bib35" firstref="ref67"></nolink> <nolink nlid="nl22" bibid="bib36" firstref="ref68"></nolink> <nolink nlid="nl23" bibid="bib37" firstref="ref69"></nolink> <nolink nlid="nl24" bibid="bib38" firstref="ref70"></nolink> <nolink nlid="nl25" bibid="bib39" firstref="ref74"></nolink> <nolink nlid="nl26" bibid="bib40" firstref="ref75"></nolink> <nolink nlid="nl27" bibid="bib41" firstref="ref77"></nolink> <nolink nlid="nl28" bibid="bib42" firstref="ref78"></nolink> <nolink nlid="nl29" bibid="bib43" firstref="ref79"></nolink> <nolink nlid="nl30" bibid="bib44" firstref="ref80"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Student Perceptions of Cannabis Use
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22MacDougall%2C+Christiana%22">MacDougall, Christiana</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-5678-5570">0000-0001-5678-5570</externalLink>)<br /><searchLink fieldCode="AR" term="%22Maston%2C+Matthew%22">Maston, Matthew</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-4883-0711">0000-0002-4883-0711</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2023 71(4):1003-1017.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Tests/Questionnaires
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Marijuana%22">Marijuana</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Use%22">Drug Use</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Life%22">Social Life</searchLink><br /><searchLink fieldCode="DE" term="%22Academic+Achievement%22">Academic Achievement</searchLink><br /><searchLink fieldCode="DE" term="%22Laws%22">Laws</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+Management%22">Risk Management</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Influences%22">Social Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Therapy%22">Drug Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Safety%22">Safety</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Health%22">Physical Health</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Performance%22">Performance</searchLink><br /><searchLink fieldCode="DE" term="%22Ability%22">Ability</searchLink><br /><searchLink fieldCode="DE" term="%22Burnout%22">Burnout</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Management%22">Stress Management</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Canada%22">Canada</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2021.1910272
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: This qualitative study explored post-secondary students' perceptions of cannabis use on students' health, academic pursuits, and social lives, and investigated how these issues have been impacted by the legalization of recreational cannabis. Participants: 20 undergraduate students at a small liberal arts university in Atlantic Canada participated in this study. Methods: Semi-structured interviews were used to learn more about student perceptions of cannabis. Interview transcripts were analyzed using general thematic analysis. Results: Students in this study report using cannabis in thoughtful ways, balancing various considerations in terms of health, social connections, and academics. They were aware that cannabis is not a risk-free drug and took some steps to manage risks. Conclusion: Knowing why young adults believe they use cannabis is information for university professionals who want to develop effective harm reduction campaigns. Conclusion
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1389328
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1389328
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2021.1910272
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 1003
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Marijuana
        Type: general
      – SubjectFull: Drug Use
        Type: general
      – SubjectFull: Social Life
        Type: general
      – SubjectFull: Academic Achievement
        Type: general
      – SubjectFull: Laws
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Risk Management
        Type: general
      – SubjectFull: Social Influences
        Type: general
      – SubjectFull: Drug Therapy
        Type: general
      – SubjectFull: Safety
        Type: general
      – SubjectFull: Physical Health
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Performance
        Type: general
      – SubjectFull: Ability
        Type: general
      – SubjectFull: Burnout
        Type: general
      – SubjectFull: Stress Management
        Type: general
      – SubjectFull: Canada
        Type: general
    Titles:
      – TitleFull: Student Perceptions of Cannabis Use
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            NameFull: MacDougall, Christiana
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            NameFull: Maston, Matthew
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              Type: published
              Y: 2023
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            – Type: issn-print
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              Value: 1940-3208
          Numbering:
            – Type: volume
              Value: 71
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              Value: 4
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            – TitleFull: Journal of American College Health
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