With regard to cannabis, however, an increase in use has been observed among young people in Norway.
However, an understudied possible risk factor for cannabis use in adolescents is common physical health problems, such as physical pain and nausea.
The data analysed in this study come from Ungdata, a cross-sectional survey conducted by the social research institute NOVA at Oslo Metropolitan University .
The 3 years of lower secondary school were represented by around a third each, but in upper secondary school the first year was overrepresented, having about half of respondents.
Cannabis use was investigated with the question “How many times have you used hash/marijuana/cannabis in the past year ?” Possible responses were “not at all”, “once”, “2–5 times”, “6–10 times” and “11 or more times”.
This variable had the following five response options: “well off all the time”, “mostly well off”, “neither well off nor badly off”, “mostly badly off” and “badly off all the time”.
In Ungdata, the Depressive Mood Inventory was used as a measure of mental health problems, with internal consistency with Cronbach’s α of 0.88.
Physical health problems were measured by six variables as responses to the question “Have you had any of these problems in the past month?”: 1.
Initially, a robustness test was conducted for cannabis use, dichotomizing the variable into “not at all/once” versus “more than one time”, which resulted in the same results of the logistic regression analysis.
Permission to access and use the data were given by NOVA at Oslo Metropolitan University on the 24.11.2020.
There is a fairly even distribution of respondents between the years of lower secondary and year 1 of upper secondary, but the numbers decline in year 2 of upper secondary and again in year 3.
A total of 19,500 respondents, corresponding to 8.2% of the study population, had used cannabis once or more in the previous 12 months.
Among boys, 89.7% reported not having used cannabis in the previous year, while for girls the figure is 93.9%.
When comparing cannabis users and non-users, we see greater differences in mental than in physical health problems. A high degree of mental health problems was reported by 16.5% of non-users but 31.6% of users.
Further, there is a statistically significant association between physical health problems and cannabis use among Norwegian adolescents, even after adjusting for gender, age, self-reported family finances and mental health.
When comparing this with figures from the European School Survey Project on Alcohol and Other Drugs , we see that Norwegian adolescents use less cannabis than those in several other countries.
The difference may be because Ung-HUNT used different response categories; their figures would probably have been lower if they had only included respondents reporting daily pain .
The results from this study show that adolescents who had used cannabis in the previous 12 months had more physical health problems than those who had not used cannabis, in terms of both nausea and pain.
The results also show that the cannabis users reported more pain in the form of headaches, abdominal pain and musculoskeletal pain.
We found a clear association between cannabis use and physical health problems in the bivariate analysis, and in regression analysis when controlling for gender, year of secondary school and socioeconomic status in addition to mental health problems. This suggests a real connection between cannabis use and physical health problems. What is more, young adults may use cannabis as self-medication to reduce physical and mental distress .
There exist different models for the relationship between substance use and mental health problems; these may be transferable to the relationship between substance use and physical health problems. The first theory is the self-medication hypothesis.
The cannabis variable was dichotomized to either “have not used cannabis in the past 12 months” or “have used cannabis once or more in the past 12 months”.
It may well be difficult for some respondents to remember details about what took place so far back in time, which can lead to information bias if, for example, cannabis users do not remember as well as non-users.
If health professionals working with adolescents become more aware of the connection between physical health problems and cannabis use, they may find it more natural to ask adolescents whether they use cannabis when they come to be treated for physical health problems. It will also place healthcare workers in a better position to inform young people about the acute and chronic harmful effects of cannabis use to enable them to make informed choices about whether they want to take the risks involved.
This makes it important for healthcare workers to pay particular attention to the physical health of cannabis users and to inform adolescents to a greater extent about the possible harmful effects of cannabis.
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