Digital interventions for recreational cannabis use among young adults: a systematic review, meta-analysis, and behavior change technique analysis of randomized controlled studies (Preprint)

Abstract

High prevalence of cannabis use among young adults pose substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile applications, have emerged as promising tools to enhance accessibility and availability of evidence-based interventions for young adults with cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with many other substances in their meta-analytical results, and do not target interventions for cannabis use solely.

We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community.

We performed a systematic review and meta-analysis in seven databases without language restrictions for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use and cannabis-related negative consequences. Reference lists of included studies were consulted and forward citation searching was also performed. We included randomized studies assessing web- or mobile-based interventions that included a comparator or a control group. Studies were excluded if they target other substance use (e.g., alcohol), did not report cannabis use separately as an outcome, did not enrolled young adults (16-35 years old), had unpublished data, were delivered via teleconference of mobile phones and computers or in a hospital-based setting, or involved people with mental-health disorders, substance-use disorders or dependence. Data were independently extracted by two reviewers with a pilot-tested extraction form. Authors were contacted to clarify study details and to obtain additional data. Characteristics of included studies, study participants, digital interventions and their comparators were summarized. Meta-analysis results were combined using a random effect model and pooled as standardized mean differences.

Of 6606 unique records, 19 were included (n = 6710 participants). Half of these studies reported an intervention effect on CU frequency (n = 9/19). The digital interventions included in the review were mostly web-based interventions. A total of 184 behavioral change techniques were identified across interventions (range 519) and Feedback on behavior was the most frequently used (n = 17/19). Digital interventions for young adult reduced cannabis use frequency at three-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the past month (95% CI [-9.59, -4.00], p < 0.05).

Our results indicate the potential of digital interventions to reduce cannabis use in young adults, but raise important questions about optimal exposure dose that could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults.

International Prospective Register of Systematic Reviews (PROSPERO; no. CRD42020196959); Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/XNV73).