Muhajarine, Nazeem2023-04-2820232023-042023-04-28April 2023https://hdl.handle.net/10388/14635Background: Cannabis legalization and emerging e-cigarette legislation and policies have created an evolving regulatory landscape for these products. Given this, the consequences of direct use, prevalence, practices and associated effects of cannabis and e-cigarette among the vulnerable youth populace are inconclusive, necessitating further research and greater insights. Objectives: This thesis addressed three objectives through three manuscripts to: (1) Evaluate the body of evidence through the completion of a systematic review to answer the question: compared to pre-legalization, what are the rates of (i) cannabis-related health care utilization, such as hospitalizations, use of services for toxicity, and changes in (ii) cannabis-related perceived risks, educational outcomes, use of other psychoactive substances and justice-involved incidents among adolescent and youth (10–26 years) post-legalization? (2) Examine the frequency and determinants of use of cannabis, e-cigarette and tobacco cigarettes. More specifically to: (a) Describe the national prevalence of cannabis, e-cigarette and tobacco cigarette use among Canadian youth before legalization of cannabis (in 2014–2015) and immediately after (in 2018–2019). (b) Identify the factors associated with youth cannabis, e-cigarette and tobacco cigarette use before cannabis legalization (2014–2015) and compare it with factors associated with substance use immediately after legalization (2018–2019) among Canadian youth. (3) Identify the perceptions regarding the risks and benefits associated with cannabis and e-cigarettes use (in a post-legalization environment) among Saskatchewan youth. Methods: The study used quantitative and qualitative methods including systematic review, survey and focus group discussions to gather information about youth diverse behavior and perspectives. Thematic, descriptive and multinomial logistic regression analyses were conducted to identify prevalence, associations and differences among correlates and outcome across smoking and vaping behavior. Results: The literature identified in the systematic review suggests that recreational cannabis legalization has negatively influenced youth perceptions of risk associated with cannabis use, use of other psychoactive substances and cannabis-related health care utilization such as Intensive Care Unit admissions, unintentional ingestion cases and intoxication visits. Based on the evidence from the studies, legalization of cannabis for medicinal purposes impacted emergency and health care utilization due to cannabis-related exposure, perceptions and attitudes towards cannabis use and youth educational attainment, such as completing high school, earning a high school diploma, enrolling in college, or completing a college degree. The prevalence of use among Canadian youth of cannabis has been unchanged, e-cigarette use has been increasing, and tobacco cigarette use has been declining post-legalization. Smoking preferences, namely cannabis exclusive, e-cigarette exclusive, tobacco cigarette exclusive and multiple product use, were mainly associated with alcohol drinking, energy drink consumption and being a passenger of a driver under the influence of cannabis. Focus group discussions with the youth revealed that though they were aware of some of the negative consequences of cannabis and e-cigarette use, they perceived their use to be safer than smoking tobacco cigarette. They described various benefits from the use of cannabis and e-cigarettes. Youth had mixed views about the effect of cannabis legalization on their perception of risks associated with its use, as some felt safer to use it while others were unaffected. Conclusion: Cannabis legalization for either recreational or medicinal purposes may be associated with negative consequences on the youth populace. The results from this thesis suggest there is cause for concern and a need for strategies that target multiple risky behaviors simultaneously as well as an ongoing assessment of the consequences of cannabis legislation for youth substance use and related health and behavioral repercussions. Also, further research is warranted in various settings to inform policies, programs and practices to safeguard youth from the harmful effects of using smoking products.application/pdfenAdolescentCannabisConsequenceE-cigaretteLegalizationPerceptionYouthThesis2023-04-28