Economic and cultural correlates of cannabis use among mid-adolescents in 31 countries

Aims: To examine cannabis use among mid-adolescents in 31 countries and associations with per-capita personal consumer expenditure (PCE), unemployment, peer factors and national rates of cannabis use in 1999. Design, participants and measurement: Nationally representative, self-report, classroom survey with 22 223 male and 24 900 female 15-year-olds. Country characteristics were derived from publicly available economic databases and previously conducted cross-national surveys on substance use. Findings: Cannabis use appears to be normative among mid-adolescents in North America and several countries in Europe. The life-time prevalence of cannabis use was 26% among males and 15% among females and was lowest for males and females in the former Yugoslav Republic (TFYR) of Macedonia: 2.5% and to 2.5%, respectively; and highest for males in Switzerland (49.1%) and in Greenland for females (47.0%). The highest prevalence of frequent cannabis use (more than 40 times in life-time) was seen in Canada for males (14.2%) and in the United States for females (5.5%). Overall, life-time prevalence and frequent use are associated with PCE, perceived availability of cannabis (peer culture) and the presence of communities of older cannabis users (drug climate). Conclusions: As PCE increases, cannabis use may be expected to increase and gender differences decease. Cross-national comparable policy measures should be developed and evaluated to examine which harm reduction strategies are most effective. (Review' s abstract)