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• Low-risk perceptions of cannabis use, cigarette smoking, and alcohol consumption were identified as pathways between poor mental health and current cannabis use among high school seniors. • Prevention and treatment approaches are needed to address perceptions of the safety of cannabis for both recreational and medicinal use among high school seniors. • Culturally adapted evidence-based interventions should be implemented to prevent substance use and the consequences of cannabis use among high school seniors. • Clinical mental health treatment efforts are needed to improve mental health symptoms and provide a buffer for potential substance use. Cannabis use among adolescents is prevalent in the U.S. Few studies have investigated the ties between adolescents' perceived risk of cannabis use, other substance use, and mental health. The current study fills this gap by identifying a pathway of factors associated with cannabis use among high school seniors. Data were extracted from a nationally representative survey, Monitoring the Future (N = 617). Ordered logistic regression was used to examine the association between demographic characteristics, perceived risk of cannabis use, substance use behaviors, and mental health with current cannabis use. SEM analysis was conducted to identify the pathways of problematic mental health, substance use, and perceived risk to current cannabis use. This study identified low-risk perceptions of cannabis use, cigarette smoking, and alcohol consumption as pathways between poor mental health and current cannabis use among high school seniors. Factors associated with current cannabis use were being an African American/Black, metropolitan residence, more drinking to intoxication, more smoking cigarettes, and lower perceived risk of cannabis use as addictive and criminal. These findings highlight the need for prevention and intervention efforts among adolescents with low perceived cannabis use risk, mental health symptoms, and substance use histories, especially among marginalized populations. Preventative strategies should be considered to reduce polysubstance use including cannabis use and to promote well-being among adolescents. [ABSTRACT FROM AUTHOR]

Background: Health disparities associated with e-cigarette use are increasingly apparent among US adolescents. Perceptions of e-cigarette harm and addiction play an important role in understanding adolescents' e-cigarette use behavior. The objective of this systematic review is to examine racial/ethnic and socio-economic disparities in e-cigarette harm and addiction perceptions among US adolescents., Methods: We searched five databases to identify cross-sectional or longitudinal studies that focused on adolescents (≤ 18 years of age) who were ever, current, or never e-cigarettes users; we then examined how race/ethnicity and/or socio-economic status (SES) impacted e-cigarette harm and/or addiction perceptions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias., Results: Adhering to PRISMA guidelines, eight of 226 identified studies met the inclusion criteria. These eight studies examined either perceptions regarding absolute e-cigarette harm and/or addiction (i.e., assessing perception of only e-cigarette) or relative e-cigarette harm and/or addiction (i.e., comparative perceptions to traditional cigarettes) by race and ethnicity. Two of the eight studies assessed absolute harm and/or addiction perceptions of e-cigarettes by SES. Our results indicate that, compared to all other racial/ethnic groups, relative e-cigarette harm and addiction perceptions were lower among Non-Hispanic White adolescents; however, absolute e-cigarette harm perception was higher among these groups. No clear patterns of racial/ethnic differences in absolute e-cigarette addiction perceptions and SES differences in absolute e-cigarette harm perceptions were reported., Conclusion: More research is needed to explicitly assess perceptions of e-cigarette harm and addiction among US adolescents by race/ethnicity and SES to develop subgroup appropriate public health messaging., (© 2023. W. Montague Cobb-NMA Health Institute.)