Knowledge of medical cannabis use, cannabis in food, and health literacy among late-adolescent students in a Thai province

Authors

  • Prasittichai Poonphol Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University,Ubon Ratchathani, Thailand.
  • Charuwan Thanawiroon Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmaceutical Sciences, Ubon Ratchathani Universityi, Thailand.
  • Chaisit Soontara 3Department of Pharmacy, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
  • Supaphit Thammakittiphan Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand.
  • Soraya Kulbunya Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand.
  • Chanathip Dalas Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand.
  • Janjaree Kunnamas Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand.
  • Tawanchai Phohom Department of Industrial Engineering, Faculty of Engineering, Ubon Ratchathani University, Ubon Ratchathani, Thailand.
  • Narongchai Chaksupa Division of Biopharmacy, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University,Ubon Ratchathani, Thailand.
  • Jeerisuda Khumsikiew Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University,Ubon Ratchathani, Thailand.
  • Teeraporn Sadira Supapaan Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University,Ubon Ratchathani, Thailand.

DOI:

https://doi.org/10.31351/vol35iss1pp229-242

Keywords:

Cannabis, Knowledge, Health Literacy, Adolescence, Students

Abstract

Cannabis is the most widely used illicit drug globally, with an increasing use for both medicinal and non-medical purposes. Despite evolving policies and regulations, knowledge gaps persist among the youth, particularly regarding cannabis use, its integration into food products, and associated health risks. Many adolescents rely on unverified sources such as social media and peer networks for cannabis-related information, thereby increasing the risk of misinformation and unsafe consumption. This cross-sectional descriptive study assessed knowledge levels with respect to medical cannabis use, cannabis in food, and health literacy among late adolescent students in educational institutions. Additionally, it examined factors influencing knowledge, experience, and willingness to try cannabis while exploring opinions on medical cannabis use and cannabis in food. Data were collected from 252 students aged 15 - 18 years, using self-administered questionnaires. Descriptive statistics were used to analyze participant characteristics, while the chi-square test was applied to assess relationships between demographic factors, knowledge, and health literacy. The Decision Tree method (CART Algorithm) identified key determinants, classified participants based on significant factors, and predicted cannabis use and abstinence. The findings revealed that 49.2% of the participants had low cannabis-related knowledge, whereas 62.3% demonstrated moderate health literacy. Gender and field of study significantly influenced knowledge and health literacy. Most of the participants acknowledged the benefits and risks of cannabis use. These results highlight the need for targeted educational interventions to enhance cannabis-related knowledge and health literacy among late adolescents, considering their unique contexts and experiences.

How to Cite

1.
Poonphol P, Thanawiroon C, Soontara C, Thammakittiphan S, Kulbunya S, Dalas C, et al. Knowledge of medical cannabis use, cannabis in food, and health literacy among late-adolescent students in a Thai province. Iraqi Journal of Pharmaceutical Sciences [Internet]. 2026 Mar. 28 [cited 2026 Apr. 1];35(1):229-42. Available from: https://bijps.uobaghdad.edu.iq/index.php/bijps/article/view/4445

Publication Dates

Received

2025-03-03

Revised

2025-04-06

Accepted

2025-07-15

Published Online First

2026-03-29

References

Hurst T. World Drug Report. The Encyclopedia of Women and Crime. Hoboken, NJ: John Wiley & Sons, Inc., 2019, pp.1-2.

Barata PC, Ferreira F, Oliveira C. Non-medical cannabis use: international policies and outcomes overview. An outline for Portugal. Trends Psychiatry Psychother, 2022; 44: e20210239. 2021/12/14. DOI: 10.47626/2237-6089-2021-0239.

United Nations Office on Drugs and Crime (UNODC). UNODC World Drug Report 2022 highlights trends on cannabis post-legalization, environmental impacts of illicit drugs, and drug use among women and youth, https://www.unodc.org/unodc/press/releases/2022/June/unodc-world-drug-report-2022-highlights-trends-on-cannabis-post-legalization environmental-impacts-of-illicit-drugs--and-drug-use-among-women-and-youth .html, 2022, accessed 15 Feb 2025.

Pacula RL, Smart R. Medical marijuana and marijuana legalization. Annu Rev Clin Psychol, 2017; 13: 397-419. 2017/05/10. DOI: 10.1146 /annurev - clinpsy - 032816-045128.

Hall W, Lynskey M. Assessing the public health impacts of legalizing recreational cannabis use: the US experience. World Psychiatry, 2020; 19: 179-186. 2020/05/13. DOI: 10.1002/wps.20735.

Ladegard K, Bhatia D. Impact of cannabis legalization on adolescent cannabis use. Child Adolesc Psychiatr Clin N Am, 2023; 32: 1-12. 2022/11/22. DOI: 10.1016/j.chc.2022.07.001.

Yimsaard P, Lancaster KE, Sohn AH. Potential impact of Thailand's cannabis policy on the health of young adults: current status and future landscape. Lancet Reg Health Southeast Asia, 2023; 10. DOI: 10.1016/j.lansea.2023.100145.

Kongjareon Y, Samoh N, Peerawaranun P, Guadamuz TE. Pride-based violence, intoxicated sex and poly-drug use: a vocational school-based study of heterosexual and LGBT students in Bangkok. BMC Psychiatry, 2022; 22: 148. 2022/02/26. DOI: 10.1186/s12888-022-03777-7.

Meebankreng K, Suancharoen P, Jootar T, Chuaichip S, Mungkalarungsi S. Knowledge, attitude, and cannabis use behavior among adolescents aged 15-22 in Bangkok. UBRU J Public Health Research, 2024; 13: 87-94.

Scheyer AF, Laviolette SR, Pelissier AL, Manzoni OJJ. Cannabis in adolescence: Lasting cognitive alterations and underlying mechanisms. Cannabis Cannabinoid Res, 2023; 8: 12-23. 2022/10/28. DOI: 10. 1089 / can .2022.0183.

Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med, 2014; 370: 2219-2227. 2014/06/05. DOI: 10.1056/NEJMra1402309.

Jacobus J, Tapert SF. Effects of cannabis on the adolescent brain. Curr Pharm Des, 2014; 20: 2186-2193. 2013/07/09. DOI: 10.2174/13816128113199990426.

Hernandez Mejia M, Wade NE, Baca R, Diaz VG, Jacobus J. The influence of cannabis and nicotine co-use on neuromaturation: A systematic review of adolescent and young adult studies. Biol Psychiatry, 2021; 89: 162-171. 2020/12/19. DOI: 10. 1016 /j. biopsych .2020 .09.021.

Schlienz NJ, Spindle TR, Cone EJ, Herrmann ES, Bigelow GE, Mitchell JM, et al. Pharmacodynamic dose effects of oral cannabis ingestion in healthy adults who infrequently use cannabis. Drug Alcohol Depend, 2020; 211: 107969. 2020/04/17. DOI: 10.1016/j.drugalcdep.2020.107969.

Godin SL, Shehata S. Adolescent cannabis use and later development of schizophrenia: An updated systematic review of longitudinal studies. J Clin Psychol, 2022; 78: 1331-1340. 2022/01/13. DOI: 10.1002/jclp.23312.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). European Drug Report 2024: Trends and Developments, https://www.euda.europa.eu/publications/european-drug-report/2024_en, 2024, accessed 29 June 2025.

Freeman TP, Groshkova T, Cunningham A, Sedefov R, Griffiths P, Lynskey MT. Increasing potency and price of cannabis in Europe, 2006-16. Addiction, 2019; 114: 1015-1023. 2019/01/01. DOI: 10.1111/add.14525.

Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int, 2000; 15: 259-267. DOI: 10.1093/heapro/15.3.259.

Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 2012; 12: 80. 2012/01/27. DOI: 10.1186/1471-2458-12-80.

Kinnunen JM, Paakkari L, Rimpelä AH, Kulmala M, Richter M, Kuipers MAG, et al. The role of health literacy in the association between academic performance and substance use. Eur J Public Health, 2022; 32: 182-187. 2022/01/06. DOI: 10.1093/eurpub/ckab213.

Kim Y, Vera L, Huang J, Emery S. Marijuana content on digital media and marijuana use among young people in the United States. Cannabis, 2022; 5: 74-84. 2022/11/05. DOI: 10.26828/cannabis/2022.02.007.

Fleary SA, Joseph P. Adolescents' health literacy and decision-making: A qualitative study. Am J Health Behav, 2020; 44: 392-408. 2020/06/20. DOI: 10.5993/ajhb.44.4.3.

Fleary SA, Joseph P, Pappagianopoulos JE. Adolescent health literacy and health behaviors: A systematic review. J Adolesc, 2018; 62: 116-127. 2017/11/28. DOI: 10.1016/j.adolescence.2017.11.010.

Fleary SA, Rastogi S, Fenton T, Ali Z. Health literacy and adolescents' substance use behaviors and correlates: a scoping review. Health Promot Int, 2024; 39 2024/06/29 23:42. DOI: 10.1093/heapro/daae074.

Harrison ME, Kanbur N, Canton K, Desai TS, Lim-Reinders S, Groulx C, et al. Adolescents' cannabis knowledge and risk perception: A systematic review. J Adolesc Health, 2024; 74: 402-440. DOI: 10.1016/j.jadohealth.2023.09.014.

Kannan K, Nattala P, Mahadevan J, Meena KS. Knowledge, attitude, and expectancies related to cannabis use: A cross-sectional community study among college students from Bangalore, Karnataka. Indian J Psychol Med, 2024; 46: 221-227. 2024/05/03. DOI: 10.1177/02537176231210681.

Park SY, Constantino N, Yun GW, Moser L, Cortes-Arriola D. U.S. college students' marijuana information sources, confidence in knowledge, and objective knowledge. J Health Commun, 2020; 25: 859-869. 2020/11/06. DOI: 10.1080/10810730.2020.1840677.

Bishop LD, Drakes DH, Donnan JR, Rowe EC, Najafizada M. Exploring youths' cannabis health literacy post legalization: A qualitative study. J Adolesc Res, 2025; 40: 130-160. 2024/12/16. DOI: 10.1177/07435584221118380.

Friese B, Slater MD, Annechino R, Battle RS. Teen use of marijuana edibles: A focus group study of an emerging issue. J Prim Prev, 2016; 37: 303-309. 2016/04/09. DOI: 10.1007/s10935-016-0432-9.

Reboussin BA, Wagoner KG, Sutfin EL, Suerken C, Ross JC, Egan KL, et al. Trends in marijuana edible consumption and perceptions of harm in a cohort of young adults. Drug Alcohol Depend, 2019; 205: 107660. 2019/11/11. DOI: 10.1016/j.drugalcdep.2019.107660.

Goodman S, Hammond D. THC labeling on cannabis products: an experimental study of approaches for labeling THC servings on cannabis edibles. J Cannabis Res, 2022; 4: 17. DOI: 10.1186/s42238-022-00124-1.

Cooper M, Shi Y. Packaging of cannabis edibles, health warning recall, and perceptions among young adults. JAMA Netw Open, 2025; 8: e253117. 2025/04/03. DOI: 10.1001/jamanetworkopen.2025.3117.

Spindle TR, Bonn-Miller MO, Vandrey R. Changing landscape of cannabis: novel products, formulations, and methods of administration. Curr Opin Psychol, 2019; 30: 98-102. 2019/05/10. DOI: 10.1016/j.copsyc.2019.04.002.

Moreno MA, Jenkins M, Binger K, Kelly L, Trangenstein PJ, Whitehill JM, et al. A content analysis of cannabis company adherence to marketing requirements in four states. J Stud Alcohol Drugs, 2022; 83: 27-36. 2022/01/19. DOI: 10.15288/jsad.2022.83.27.

Torrejón-Guirado MC, Baena-Jiménez M, Lima-Serrano M, de Vries H, Mercken L. The influence of peer's social networks on adolescent's cannabis use: a systematic review of longitudinal studies. Front Psychiatry, 2023; 14: 1306439. 2024/01/08. DOI: 10.3389/fpsyt.2023.1306439.

Assanangkornchai S, Pattanasattayawong U, Samangsri N, Mukthong A. Substance use among high-school students in Southern Thailand: trends over 3 years (2002-2004). Drug Alcohol Depend, 2007; 86: 167-174. 2006/07/14. DOI: 10.1016/j.drugalcdep.2006.06.001.

Ministry of Education of Thailand. Upper secondary and vocational education Ccurriculum structure B.E. 2566 Bangkok: Office of the Basic Education Commission / Office of Vocational Education Commission. [In Thai], 2023.

Lwanga SK, Lemeshow S, Organization WH. Sample size determination in health studies: a practical manual/SK Lwanga and S. Lemeshow. Sample size determination in health studies: a practical manual/SK Lwanga and S Lemeshow. 1991.

Marcano Belisario JS, Jamsek J, Huckvale K, O'Donoghue J, Morrison CP, Car J. Comparison of self-administered survey questionnaire responses collected using mobile apps versus other methods. Cochrane Database Syst Rev, 2015; 2015: Mr000042. 2015/07/28. DOI: 10.1002/14651858.MR000042.pub2.

Wright KB. Researching internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J Comput-Mediat Commun, 2005; 10. DOI: https://doi.org/10.1111/j.1083-6101.2005.tb00259.x.

Dillman D, Smyth J, Christian L. Internet, phone, mail, and mixed-mode surveys: The tailored design method (4th ed). New Jersey: John Wiley & Sons, Inc., 2014.

Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR. Taxonomy of educational objectives. Longmans, Green New York, 1964.

Intarakamhang U, Khammungkul J, Boocha P. General health literacy scale for Thais and comparison between age groups. Heliyon, 2022; 8: e09462. 2022/05/28. DOI: 10.1016/j.heliyon.2022.e09462.

Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health, 2006; 29: 489-497. 2006/09/16. DOI: 10.1002/nur.20147.

Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health, 2007; 30: 459-467. 2007/07/27. DOI: 10.1002/nur.20199.

Grant JS, Davis LL. Selection and use of content experts for instrument development. Res Nurs Health, 1997; 20: 269-274. 1997/06/01. DOI: 10.1002/(sici)1098-240x(199706)20:3<269::aid-nur9>3.0.co;2-g.

Bathula PP, Maciver MB. Cannabinoids in treating chemotherapy-induced nausea and vomiting, cancer-associated pain, and tumor growth. Int J Mol Sci, 2023; 25 2024/01/11. DOI: 10.3390/ijms25010074.

Kamkaen N, Treesak C. Medicinal cannabis for cancer. J Chulabhorn Royal Acad, 2019; 1: 16-29.

Ward SJ, Lichtman AH, Piomelli D, Parker LA. Cannabinoids and cancer chemotherapy-associated adverse effects. J Natl Cancer Inst Monogr, 2021; 2021: 78-85. 2021/12/02. DOI: 10.1093/jncimonographs/lgab007.

West M, Rice S, Vella-Brodrick D. Mid-adolescents’ social media use: Supporting and suppressing autonomy. J Adolesc Res, 2023; 40: 448-482. DOI: 10.1177/07435584231168402.

González-Cano-Caballero M, Torrejón-Guirado M-C, Cano-Caballero MD, Mac Fadden I, Barrera-Villalba M-D-C, Lima-Serrano M. Adolescents and youths’ opinions about the factors associated with cannabis use: a qualitative study based on the I-Change model. BMC Nursing, 2023; 22: 114. DOI: 10.1186/s12912-023-01283-z.

Fordjour E, Manful CF, Khalsamehta TSK, Armah A, Cheema M, Thomas R. Cannabis-infused foods: Phytonutrients, health, and safe product innovations. Compr Rev Food Sci Food Saf, 2024; 23: e70021. 2024/09/13. DOI: 10.1111/1541-4337.70021.

Chayasirisobhon S. Mechanisms of action and pharmacokinetics of cannabis. Perm J, 2020; 25: 1-3. 2021/02/27. DOI: 10.7812/tpp/19.200.

Barrus DG, Capogrossi KL, Cates SC, Gourdet CK, Peiper NC, Novak SP, et al. Tasty THC: Promises and challenges of cannabis edibles. Methods Rep RTI Press, 2016; 2016 2017/01/28. DOI: 10.3768/rtipress.2016.op.0035.1611.

Matheson J, Le Foll B. Cannabis legalization and acute harm from high potency cannabis products: A narrative review and recommendations for public health. Frontiers in Psychiatry, 2020; 11. Review. DOI: 10.3389/fpsyt.2020.591979.

Tan ASL, Weinreich E, Padon A, Sanchez M, Snyder KM, Vasilyeva A, et al. Presence of content appealing to youth on cannabis-infused edibles packaging. Subst Use Misuse, 2022; 57: 1215-1219. 2022/05/03. DOI: 10.1080/10826084.2022.2069268.

Borodovsky JT, Lee DC, Crosier BS, Gabrielli JL, Sargent JD, Budney AJ. U.S. cannabis legalization and use of vaping and edible products among youth. Drug Alcohol Depend, 2017; 177: 299-306. 2017/07/01. DOI: 10.1016/j.drugalcdep.2017.02.017.

Khamluang P. Enhancing health literacy on cannabis: Preventing issues and health impact on the population. Journal of Nursing and Health Research, 2023; 24: 153-167.

Sikaow O, Trakulsithichoke S. Health literacy and health behaviors of student age 10-18 year. Nursing J of The Ministry of Public Health, 2024; 34: 72-85.

George T, Vaccarino F. Substance abuse in Canada: The effects of Cannabis use during adolescence, https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Effects-of-Cannabis-Use-during-Adolescence-Report-2015-en.pdf, 2015, accessed 17 Feb 2025.

Rolova G, Gavurova B, Petruzelka B. Exploring health literacy in individuals with alcohol addiction: A mixed methods clinical study. Int J Environ Res Public Health, 2020; 17: 6728.

Ritchwood TD, Ford H, DeCoster J, Sutton M, Lochman JE. Risky sexual behavior and substance use among adolescents: A meta-analysis. Child Youth Serv Rev, 2015; 52: 74-88. 2015/04/01. DOI: 10.1016/j.childyouth.2015.03.005.

Loyalka P, Huang X, Zhang L, Wei J, Yi H, Song Y, et al. The impact of vocational schooling on human capital development in developing countries: Evidence from China. World Bank Econ Rev, 2016; 30: 143-170.

Phiphithkul P, Samawattana R, Wattanaburanont A. Development of health education program based on constructionism concept and health belief model for enhancing health literacy on health quotient of vocational education students. J Royal Thai Army Nurses, 2024; 25: 151-159.

Klinker CD, Aaby A, Ringgaard LW, Hjort AV, Hawkins M, Maindal HT. Health literacy is associated with health behaviors in students from vocational education and training schools: A Danish population-based survey. Int J Environ Res Public Health, 2020; 17 2020/01/24. DOI: 10.3390/ijerph17020671.

Pulimeno M, Piscitelli P, Colazzo S, Colao A, Miani A. School as ideal setting to promote health and wellbeing among young people. Health Promot Perspect, 2020; 10: 316-324. 2020/12/15. DOI: 10.34172/hpp.2020.50.

CICC Research CGI. Establishing equitable and efficient systems for education and healthcare. Building an olive-shaped society : Economic growth, income distribution and public policies in China. Singapore: Springer Nature Singapore, 2024, pp.107-139.

Svendsen MT, Bak CK, Sørensen K, Pelikan J, Riddersholm SJ, Skals RK, et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population-based survey among Danish adults. BMC Public Health, 2020; 20: 565. 2020/04/30. DOI: 10.1186/s12889-020-08498-8.

Karlsgodt KH. Cannabis use in adolescence: Vulnerability to cognitive and psychological effects. Biol Psychiatry Glob Open Sci, 2023; 3: 167-168. 2023/05/01. DOI: 10.1016/j.bpsgos.2022.09.004.

Connor JP, Stjepanović D, Le Foll B, Hoch E, Budney AJ, Hall WD. Cannabis use and cannabis use disorder. Nat Rev Dis Primers, 2021; 7: 16. 2021/02/26. DOI: 10.1038/s41572-021-00247-4.

Khairinisa MA, Alfaqeeh M, Rafif SN, Muljono FO, Colin MN. Cannabis and other substance misuse: Implications and regulations. Toxics, 2023; 11: 756.

Substance Abuse and Mental Health Services Administration (SAMHSA). Preventing marijuana use among youth. SAMHSA Publication No. PEP21-06-01-001. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2021.

Meeprom S, Sathatip P, Leruksa C, Manosuthi N, Fakfare P. Cannabis-infused food: Uncovering effective conditions for achieving well-being perception and choice behavior among young adult consumers. Food Quality and Preference, 2023; 109: 104915. DOI: https://doi.org/10.1016/j.foodqual.2023.104915.

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2026-03-28