2014 vol. 38 no. 1 Australian and New Zealand Journal of Public Health 89© 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia

conditions, including schizophrenia. There is a six times greater risk of schizophrenia in vulnerable young people if they use cannabis more than three times per week prior to the age of 15.1

Since the 2011 report by Howard, Ali and Roberts2 on alcohol, cannabis and amphetamine use among young people in the Western Pacific Region (WPR), more recent data has become available, allowing a clearer picture of cannabis use in the region’s Pacific Island Countries and Territories (PICTs). Surveys in the WPR have primarily used three standardised instruments: the youth risk behaviour survey (YRBS);3 WHO’s global school-based student health survey (GSHS);4 and the second generation behaviour surveillance survey (BSS)5. Data on cannabis use was extracted from these three surveys from the PICTs. Data from Australia and New Zealand – where secondary school surveys (SSS) are used6,7 – and the United States was also extracted for comparison.

Available data on ‘ever use’ and ‘current use’ of cannabis in PICTs, and Australia, New Zealand, Malaysia and the US for comparison, are presented in Table 1. The rates of both ‘ever use’ and ‘current use’ vary greatly between

Table 1: Ever and current use of cannabis in young people in the Pacific Island Countries and Territories and Australia, New Zealand and the United States, 2000-2012.Country Year Survey Sample Male Female

Ever % Current % Ever % Current %American Samoa 2011

2007

YRBS

YRBS

2,927

3,381

23.0

25.3

15.6

15.2

7.2

10.6

3.9

5.6

Cook Islands 2011 GSHS 1,274 11.2 - 6.9 -

Federated States of Micronesia–Pohnpei 2007 SGS 280 14.5 - 14.5 -

Guam 2011

2007

YRBS

YRBS

1,542

1,542

56.0

49.9

38.1

25.6

41.1

40.6

25.6

20.5

Kiribati 2011 GSHS 1,582 6.8 - 1.6 -

Mayaysia 2012 YRBS 25,507 1.5 - 0.4

Marshall Islands 2007

2003

YRBS

YRBS

1,323

824

22.4

31.0

14.1

21.5

5.5

8.9

3.2

6.1

Northern Mariana Islands 2005

2003

YRBS

YRBS

2,188

2,073

63.9

72.3

29.8

49.2

52.2

63.8

23.5

33.1

Palau 2011

2007

YRBS

YRBS

425

671

65.8

64.3

42.8

35.9

62.6

55.6

29.8

33.0

Samoa 2011 GSHS 2,418 43.2 - 24.7 -

Solomon Islands 2011 GSHS 1,421 16.1 - 11.1 -

Tokelau 2007 SGS 207 37.0 - 13.0 -

Tonga 2010 GSHS 2,211 4.8 - 8.0 -

Vanuatu 2011 GSHS 1,119 5.0 - 1.9 -

Wallis and Futuna 2006 SGS 199 15.3 - 12.6 -

Australia 2011

2008

SSS

SSS

24,854

24,408

16.2

14.4

4.5

6.9

13.4

12.7

2.7

5.4

New Zealand 2007 SSS 9,107 27.2 16.5 26.8 14.8

United States 2011

2007

YRBS

YRBS

14,925

13,632

42.5

41.6

25.9

22.4

32.7

34.5

20.1

17.0

YRBS = youth risk behaviour survey; GSHS = global school-based student health survey; SGS = behaviour surveillance survey; SSS = Secondary school survey

doi: 10.1111/1753-6405.12136

Cannabis use among young people in Pacific Island Countries and TerritoriesJohn Howard,1 Hammad Ali2

1. National Cannabis Prevention and Information Centre, University of New South Wales

2. The Kirby Institute, University of New South Wales

While cannabis is the most common illicit drug in the Western world,1 its impacts on mental and physical health and psycho-social functioning of young people are often under-recognised. There are numerous missed opportunities for health promotion and early interventions for those who experience difficulties related to cannabis use.1

Cannabis is regarded by many as a ‘soft drug’ with minimal negative impact. Such views ignore significant changes in the patterns of cannabis use among young people over the past 40 years, including a decline in the age of initiation of use, an increase in potency and availability of the drug, and use with peers and when alone. Early onset, and frequent and heavy use of cannabis, can affect cognitive functioning and respiratory function and can exacerbate mental health

different countries of the region. More than 50% of young males were reported to have ever used cannabis in Guam (2007, 2011); Northern Mariana Islands (2003); and Palau (2007, 2011); more than 50% of young females in Northern Mariana Islands (2003); and Palau (2007, 2011) reported ever use of cannabis. These rates are far higher than those for Australia for both ever and recent use, for ever use in Malaysia, and from other surveys conducted in the PICTs (e.g. Samoa).8

Routine data collection can be costly; however, routine surveillance of youth risk behaviours – especially of vulnerable young people, or those in vulnerable settings such as working away from home, living in dormitories or engaged in sex work – is essential. Routine surveillance plays a vital role for effective prevention and treatment interventions to be developed to address cannabis use-related issues, such as: risk-taking behaviours; violence; mental health problems; crime; lack of participation in education, training and employment; and the spread of blood-borne viruses and sexually transmitted infections (via unprotected sexual activity while intoxicated). This review shows that YRBS, GSHS and second generation BSS are yielding results that cannot be compared easily, as questions can vary between the survey instruments and also over time. Hence, using and comparing findings from these surveys raises questions of validity. There remains a need to identify ‘best questions – best survey’. If it becomes clear that there are cannabis use-related difficulties among young people in the PICTs, evidence informed, adolescent-specific brief interventions exist that could be adapted and trialled.2,10

Acknowledgements Funding for the initial review was provided by the WHO’s Western Pacific Regional Office.

References1. Copeland J, Howard J. Cannabis use disorders. In:

Rosner R, editor. Handbook of Adolescent Addiction. New York (NY): Wiley-Blackwell; 2013.

2. Howard J, Ali H, Robins L. Alcohol, cannabis and amphetamine-type stimulants use among young Pacific Islanders. Drug Alcohol Rev. 2011;30:104-10.

3. Centers for Disease Control and Prevention. Youth Risk Behavior Surveys Data [Internet]. Atlanta (GA): CDC; 2013 [cited 2013 Jun 1]. Available from: http://apps.nccd.cdc.gov/youthonline/App/Default.aspx?SID=HS

4. World Health Organisation. Global School-based Secondary Health Survey (GSHS) Fact Sheets [Internet]. Geneva (CHE): WHO; 2013 [cited 2013 Jun 1]. Available from: http://www.who.int/chp/gshs/factsheets/en/index.html

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90 Australian and New Zealand Journal of Public Health 2014 vol. 38 no. 1© 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia

5. Secretariat of the Pacific Community. Second Generation Surveillance Studies (Federated States of Micronesia, Tokelau, Wallis and Futuna) [Internet]. Noumea (NCL): SPC Public Health Division; 2013 [cited 2013 Jun 1]. Available from: http://www.spc.int/hiv/index.php?option=com_docman&task=cat_view&gid=76&Itemid=148

6. White V, Bariola, E. Australian Secondary School Students’ Use of Tobacco, Alcohol, and Over-the-counter and Illicit Substances in 2011. Melbourne (AUST): Cancer Council Victoria; 2012.

7. White V, Smith G. Australian Secondary School Student’s Use of Tobacco, Alcohol, and Over-the-counter and Illicit Substances in 2008. Melbourne (AUST): Cancer Council Victoria; 2009.

8. Adolescent Health Research Group. Youth’07: The Health and Wellbeing of Secondary School Students in New Zealand. Technical Report. Auckland (NZ): University of Auckland; 2008.

9. Odden H. Alcohol, tobacco, marijuana and hallucinogen among Samoan adolescents. Drug Alcohol Rev. 2012;31:47-55.

10. Martin G, Copeland J, Swift W. The Adolescent Cannabis Check-Up: randomised trial of a brief intervention for young cannabis users. J Subst Abuse Treat. 2008;34:407-414.

Correspondence to: Dr John Howard, National Cannabis Prevention and Information Centre, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052; e-mail: john.howard@unsw.edu.au

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