Social media interventions addressing physical activity among emerging adults who use cannabis: A pilot trial of feasibility and acceptability

Emerging adulthood (typically ages 18–25 years) is a developmental period where substance use reaches peak prevalence (Arnett, 2000, Arnett, 2005). For example, 23.1% of emerging adults used cannabis in the past month (Substance Abuse and Mental Health Services Administration, 2021). Cannabis use in emerging adulthood portends negative consequences, including worse physical and mental health and potential development of cannabis use disorder (CUD) (Behrendt et al., 2009, Chan et al., 2021, Volkow et al., 2014). Cannabis is increasingly available legally (e.g., state-level recreational or medical access) and cannabis disapproval is at an all-time low (Carliner et al., 2017) while the variety of cannabis products and their potency rises (ElSohly et al., 2021). Behavioral interventions that reduce cannabis consumption among emerging adults are needed because ∼30% will develop CUD (Hasin et al., 2016), but few seek treatment (Standeven et al., 2020) given barriers like problem recognition, stigma, and availability (Kerridge et al., 2017). Also, the newer concept of “pre-addiction” refers to the period before full CUD onset, which presents a critical intervention point to disrupt progression to disorder (McLellan et al., 2022). This paper describes a pilot randomized controlled trial (RCT) of novel social media-delivered cannabis behavioral interventions involving physical activity (PA) as an intervention target among emerging adults.

Recent reviews report that early interventions specifically targeting emerging adults’ cannabis use are rare, and existing approaches have had modest impacts (O'Connor et al., 2020). Behavioral approaches that have shown promise for cannabis prevention/early intervention or CUD treatment typically involve motivational interviewing (MI) or motivational enhancement therapy (MET) and/or cognitive behavioral therapy (CBT) (Connor et al., 2021), although the MI literature is mixed. For example, one review found that 1–2 sessions of MI-based counseling reduced cannabis use over a short-term follow-up (Halladay et al., 2019) and another study found that a web-based cannabis personalized feedback intervention reduced cannabis consequences (Palfai et al., 2014). Others [e.g., brief MI intervention+booster for multiple substances, MI-based personalized feedback intervention] had no significant intervention effects (Gmel et al., 2013, Lee et al., 2010).

Social media is heralded for its potential role in preventive care (Merchant, 2020), harnessed as a health intervention-delivery platform [e.g., sexual health, tobacco cessation, weight loss/diet, exercise; (Bull et al., 2012, Pagoto et al., 2016, Pumper et al., 2015, Ruotsalainen et al., 2015, Struik and Baskerville, 2014)]. We previously piloted an 8-week social media-delivered MI+CBT-based cannabis intervention with 149 emerging adults (Bonar et al., 2022b). We chose social media delivery because emerging adults frequently use social media (Auxier and Anderson, 2021), providing a scalable means of intervening during daily life over time. This intervention targeted upstream factors associated with cannabis consumption (e.g., stress, coping) as well as harm reduction and protective strategies, delivered in a secret Facebook group. This cannabis intervention had promising effects on vaping at 6-months (d =0.40) as well as other cannabis outcomes and was acceptable and feasible with good fidelity and engagement. Herein, we examine an expansion of this intervention model with a unique intervention target: physical activity (PA).

Targeting PA in cannabis-focused interventions is supported by research showing associations with improvements in substance use disorders and mental health (Linke and Ussher, 2015, Lynch et al., 2013, Wang et al., 2014). Promoting PA in teens reduces substance use (Simonton et al., 2018) and youth who stopped cannabis use were more likely to meet PA guidelines than those continuing use (Zuckermann et al., 2019). In sequential cohorts, greater PA was associated with less frequent cannabis use at age 18 and increasing PA coincided with decreasing cannabis use in emerging adulthood (Terry-McElrath and O'Malley, 2011). In a lab setting, when cannabis-using emerging adults exercised after exposure to cannabis cues, those with heavier baseline cannabis use experienced slower craving return (Wilson et al., 2018). Thus, potential mechanisms for PA to reduce cannabis consumption could involve impacts on reducing craving and altering the endocannabinoid system, stress reduction, or behavioral replacement (Brellenthin and Koltyn, 2016). Additionally, PA has impacts on mental health symptoms such as depression and anxiety (Smith and Merwin, 2021). Given that such mental health problems often co-occur with cannabis use and that affect regulation is a common motive for cannabis use, there is also a potential mechanistic pathway for PA to alter cannabis use via impacts on mental health symptoms.

Regarding interventions, a small pilot (N = 37) compared two intervention conditions: in-person 4-session MET+CBT or the same intervention plus access to common PA mobile apps along with encouragement to use PA as an alternative to cannabis consumption (Prince et al., 2020). Emerging adults receiving MET+CBT+PA reduced cannabis use more over follow-up than the non-PA group. In a single-arm study among adults with CUD, cannabis use quantity was significantly reduced during a 2-week supervised PA intervention and a 2-week follow-up period, which also showed reduced cannabis craving (Buchowski et al., 2011). Thus, PA may be a useful, acceptable, and parsimonious target for reducing cannabis consumption.

Given prior research, we developed and evaluated PA-focused social-media delivered cannabis interventions for emerging adults. Our pilot RCT used content from our prior cannabis-focused social media intervention (Bonar et al., 2022b), with updates to include greater PA content (PA+Cannabis), a PA-content-only intervention, and an attention-placebo control condition. This paper describes the approach, feasibility, acceptability, and preliminary outcomes.

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