Chan Olsen, Daudi Ahad, Ji David, Wang Mathias, Steen Jeremy P, Parnian Parsia, Li Crystal, Xiong Annie, Zhang Wei, Lopes Luciane C, MacKillop James, Busse Jason W, Wang Li
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
JAMA Pediatr. 2024 Dec 1;178(12):1280-1289. doi: 10.1001/jamapediatrics.2024.3674.
Cannabis use during adolescence and young adulthood may affect academic achievement; however, the magnitude of association remains unclear.
To conduct a systematic review evaluating the association between cannabis use and academic performance.
CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, Scopus, and Web of Science from inception to November 10, 2023.
Observational studies examining the association of cannabis use with academic outcomes were selected. The literature search identified 17 622 unique citations.
Pairs of reviewers independently assessed risk of bias and extracted data. Both random-effects models and fixed-effects models were used for meta-analyses, and the Grading of Recommendations Assessment, Development, and Evaluation approach was applied to evaluate the certainty of evidence for each outcome. Data were analyzed from April 6 to May 25, 2024.
School grades, school dropout, school absenteeism, grade retention, high school completion, university enrollment, postsecondary degree attainment, and unemployment.
Sixty-three studies including 438 329 individuals proved eligible for analysis. Moderate-certainty evidence showed cannabis use during adolescence and young adulthood was probably associated with lower school grades (odds ratio [OR], 0.61 [95% CI, 0.52-0.71] for grade B and above); less likelihood of high school completion (OR, 0.50 [95% CI, 0.33-0.76]), university enrollment (OR, 0.72 [95% CI, 0.60-0.87]), and postsecondary degree attainment (OR, 0.69 [95% CI, 0.62-0.77]); and increased school dropout rate (OR, 2.19 [95% CI, 1.73-2.78]) and school absenteeism (OR, 2.31 [95% CI, 1.76-3.03]). Absolute risk effects ranged from 7% to 14%. Low-certainty evidence suggested that cannabis use may be associated with increased unemployment (OR, 1.50 [95% CI, 1.15-1.96]), with an absolute risk increase of 9%. Subgroup analyses with moderate credibility showed worse academic outcomes for frequent cannabis users and for students who began cannabis use earlier.
Cannabis use during adolescence and young adulthood was probably associated with increases in school absenteeism and dropout; reduced likelihood of obtaining high academic grades, graduating high school, enrolling in university, and postsecondary degree attainment; and perhaps increased unemployment. Further research is needed to identify interventions and policies that mitigate upstream and downstream factors associated with early cannabis exposure.
青少年和青年时期使用大麻可能会影响学业成绩；然而，两者之间关联的程度仍不明确。
进行一项系统综述，评估大麻使用与学业表现之间的关联。
自数据库建立至2023年11月10日的CINAHL、EMBASE、MEDLINE、PsycInfo、PubMed、Scopus和Web of Science数据库。
选取了考察大麻使用与学业成果之间关联的观察性研究。文献检索共识别出17622条独特的引文。
由两位评审员独立评估偏倚风险并提取数据。采用随机效应模型和固定效应模型进行荟萃分析，并运用推荐分级评估、制定与评价方法来评估每个结果的证据确定性。数据于2024年4月6日至5月25日进行分析。
学校成绩、辍学、缺课、留级、高中完成情况、大学入学、高等学位获得情况以及失业情况。
63项研究（涉及438329名个体）被证明符合分析条件。中等确定性证据表明，青少年和青年时期使用大麻可能与较低的学校成绩相关（B级及以上成绩的优势比[OR]为0.61[95%置信区间，0.52 - 0.71]）；高中完成的可能性降低（OR为0.50[95%置信区间，0.33 - 0.76]）、大学入学的可能性降低（OR为0.72[95%置信区间，0.60 - 0.87]）以及高等学位获得的可能性降低（OR为0.69[95%置信区间，0.62 - 0.77]）；辍学率增加（OR为2.19[95%置信区间，1.73 - 2.78]）和缺课情况增加（OR为2.31[95%置信区间，1.76 - 3.03]）。绝对风险效应范围为7%至14%。低确定性证据表明，大麻使用可能与失业增加相关（OR为1.50[95%置信区间，1.15 - 1.96]），绝对风险增加9%。具有中等可信度的亚组分析显示，频繁使用大麻的人群以及较早开始使用大麻的学生学业成果更差。
青少年和青年时期使用大麻可能与缺课和辍学增加、获得高学业成绩、高中毕业、大学入学以及高等学位获得的可能性降低相关，并且可能与失业增加有关。需要进一步研究以确定减轻与早期大麻暴露相关的上游和下游因素的干预措施和政策。
