ArticleJournal of cannabis research2026
Operationalizing ASSIST-based indicators to estimate the prevalence and correlates of problematic cannabis involvement among U.S. college students.
Article in Journal of cannabis research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCannabis use and cannabis-related harms remain important public health concerns among college-age adults. However, nationally representative estimates that characterize the severity of problematic cannabis use in U.S. college students are limited. Using pooled American College Health Association-National College Health Assessment (ACHA-NCHA) III data, we developed a screening-based index of cannabis involvement severity and examined mental health and other correlates.
methodsThis cross-sectional study used pooled ACHA-NCHA III data from Fall 2019 to Spring 2024. Cannabis involvement severity was operationalized using cannabis-specific items from the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) module embedded in the ACHA-NCHA III (e.g., use frequency, craving/urge, difficulty controlling use, role impairment, and cannabis-related problems). Indicator responses were summed and categorized as no/low involvement (0-1), mild (2-3), moderate (4-5), or severe/high involvement (≥ 6). We estimated prevalence overall and among students with lifetime cannabis use. Ordinal logistic regression identified correlates of greater involvement severity among those with lifetime cannabis use. Modified Poisson and log-linear models assessed associations between involvement severity and mental health indicators among students with cannabis use history.
resultsThe prevalence of elevated problematic cannabis involvement (score ≥ 2) was 8.66% among all students and 20.77% among those with lifetime cannabis use; among students with cannabis use history, 7.32% had mild involvement, 6.88% moderate involvement, and 6.56% severe/high involvement. Greater involvement severity was more common among males, American Indian/Alaskan Native/Non-Hispanic (NH) Black/NH Other/NH multiracial students (compared with NH White), undergraduates (compared with Master's/PhD students), and those not living on campus, and was associated with greater co-occurring tobacco/other substance use and greater counts of chronic mental health conditions. Compared to students with no/low cannabis involvement, those with mild/moderate/severe involvement had higher prevalence of anxiety, depression, other mental health conditions, and mental health service receipt, as well as higher non-specific serious mental illness, loneliness, and suicide behavior scores.
conclusionsProblematic cannabis involvement is common among U.S. college students and shows a graded association with adverse mental health indicators. These findings support targeted screening and integrated behavioral health services for students reporting more severe patterns of cannabis involvement.
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