Household cannabis cessation and adolescent mental health outcomes in a prospective cohort study

Household cannabis use is a risk factor for adolescents' mental health problems. However, little is known about the association of the cessation and psychological impairments in affected adolescents. This study examined the associations of household cannabis cessation and adolescents' mental health outcomes and potential pathways.

This cohort study used data from the Adolescent Brain Cognitive Development study and included adolescents aged 10-13 years with household cannabis use within 12 months at wave 2. Household cannabis cessation was defined as the absence of cannabis use by household members (excluding the adolescent participant) at wave 3 among households that reported use at wave 2. Internalizing and externalizing problems were assessed using the Child Behavior Checklist, and psychotic-like experiences (PLEs) were evaluated using the Prodromal Questionnaire-Brief Child Version. Family conflict and sleep problems were assessed using the Family Environment subscale and the Sleep Disturbance Scale for Children, respectively. Demographic and psychometric confounders were balanced with propensity score matching (PSM). Linear regression was applied to investigate the associations between cessation and mental health outcomes. Mediation analyses of family conflict and adolescent sleep problems were performed. We further considered the influence of genetic predisposition to cannabis use disorder (CUD) and examined whether brain connectivity patterns, measured by resting-state fMRI, modified the relationships.

Of the 1426 adolescents exposed to household cannabis within 12 months, 438 (30.7%) were no longer exposed by wave 3. After PSM, cessation was associated with lower levels of internalizing and externalizing problems, and PLEs (mean ratios, 0.84-0.86, all P < 0.02), adjusting for baseline scores. The associations persisted after additionally adjusting for the adolescents' polygenic risk for CUD among White participants. Family conflict and sleep problems mediated the associations of cessation with internalizing (proportion mediated, 6.8% and 25.8%, respectively) and externalizing symptoms (14.3% and 24.8%, respectively). Adolescents with weaker connections between cingulo-parietal and dorsal attention networks showed stronger associations between cessation and PLEs.

Household cannabis cessation was linked to a lower level of adolescent mental health problems at follow-up. These findings suggest that interventions aimed at reducing or eliminating household cannabis exposure may be beneficial for youth well-being.