Skip to main content

Development of scales to measure Lebanese university students’ perceived knowledge about and attitudes about cannabis use: initial psychometric properties

Abstract

Background

For a long period, cannabis in Lebanon was categorized as an illegal psychoactive substance criminalized by law, despite being the 3rd largest producer of cannabis resin after Morocco and Afghanistan. The current available literature on the topic in Lebanon is scarce, as perceived knowledge towards cannabis use in the general population is not well established, and public health policies are absent. In the context of future legalization of cannabis for both medical and recreational purposes, what is the public’s perception of cannabis perceived knowledge about and attitude against cannabis use? The objectives of this study were to create two scales to assess perceived knowledge towards cannabis use and attitude against cannabis use and check their psychometric properties in a sample of Lebanese university students.

Methods

The study was designed as a cross-sectional study involving 415 Lebanese university students aged between 18 and 30 years. Students were only recruited from one university and were sent an email with a brief description of the study and a link to the questionnaire. The questionnaire items covered perceived knowledge and attitude about cannabis use, recovered and adapted from available literature.

Results

Perceived knowledge items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 64% of the variance (factor 1 = perceived knowledge about cannabis quality of life improvement; factor 2 = perceived knowledge about cannabis psychiatric use; factor 3 = perceived knowledge about cannabis risks; factor 4 = perceived knowledge about cannabis neurological use). Attitude items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 58.2% of the variance (factor 1 = negative attitude about cannabis use; factor 2 = positive attitude about cannabis use). Good Cronbach’s alpha values were found for the perceived knowledge and attitude scales (α = 0.78 and α = 0.73 respectively). Greater perceived knowledge was found in male participants and in those who have tried cannabis for recreational purposes. Greater perceived knowledge was also associated with stronger attitude about cannabis use and older age. Furthermore, greater mean attitude about cannabis use scores were significantly found in male participants and in those who have tried cannabis for recreational or medicinal purposes.

Conclusion

Primary results showed acceptable psychometric properties for the perceived knowledge towards and attitudes about cannabis use scale. Further studies are needed in order to validate them among the general population and assess more psychometric properties of these scales.

Background

The United Nations Office on Drugs and Crime (UNODC) ranked Lebanon as the world’s third largest producer and supplier of cannabis resin in 2019 after Morocco and Afghanistan (World Drug Report 2018). Cannabis history and social background in Arabic-speaking countries date back to the ninth century when it was used to treat ear diseases (Fakhry et al. 2021). Cannabis was later employed by Arabic physicians for a variety of purposes such as anti-parasitic characteristics, dermatologic problems, and rheumatological/ophthalmological conditions (Lozano 2001). Cannabis was banned in Lebanon; nevertheless, it was widely grown, covering an estimated 400,000 hectares and centered mostly in the Beqaa valley, due to its unique geographic location and Mediterranean weather. Furthermore, its proximity to the borders, as well as the ease of access to trafficking routes, resulted in high-quality cultivation (Fakhry et al. 2021).

A draft law to legalize cannabis was released for parliament voting on October 17, 2019. Aside from the financial benefits of taxing and regulation, the goal of this law was to lessen the strain on the justice system by controlling product quality and safety and raising awareness about the negative health effects of cannabis usage (El-Khoury et al. 2020). Prior to the voting assembly, the Lebanese Psychiatric Society, which is accredited by the Lebanese Order of Physicians, issued a statement urging all involved parties to reconsider the proposed legalization of cannabis cultivation for medical purposes, as it does not guarantee that the local prevalence of cannabis use disorders will not rise. Similarly, the Lebanese National Ethics Committee advised that medical cannabis should be limited to situations where benefit has previously been shown, such as chemotherapy-induced nausea, HIV-related appetite loss, and multiple sclerosis spasticity (El-Khoury et al. 2020).

The law was finally passed by the Lebanese Parliament on April 21, 2020 (Cannabis law and legislation in Lebanon [https:, , cms.law, en, int, expert-guides, cms-expert-guide-to-a-legal-roadmap-to-cannabis, lebanon]. n.d.). However, little was done to address local cannabis consumption because the law only permitted exportation under official authorization, leaving local medicinal consumption illegal and penalized. Indeed, under Lebanese law, items containing more than 1% tetrahydrocannabinol (THC) will remain illegal. More local information on the cannabis timeline can be found here in Fig. 1 (Cannabis law and legislation in Lebanon [https:, , cms.law, en, int, expert-guides, cms-expert-guide-to-a-legal-roadmap-to-cannabis, lebanon]. n.d.).

Fig. 1
figure 1

Cannabis historical timeline in Lebanon

Under these circumstances, perceived knowledge toward and attitude about cannabis use became a great concern. Various studies underlined the moderating effect of perceived knowledge and risk perceptions on substance use, whereas a substance being considered as risky/dangerous is less likely to be used/abused (Salloum et al. 2018). This risk perception could be influenced by accumulated personal perceived knowledge and attitude on cannabis, hence affecting the decision of cannabis use in the general population (Park et al. 2020). Indeed, cannabis education has been shown to have a significant impact on using cannabis in the future (Okaneku et al. 2015), as seen in the National Survey on Drug use and health, whereas the states with its highest cannabis risk education presented a lower percentage of cannabis use among individuals (Hughes et al. 2016).

According to the Theory of Reasoned Action, attitude will be used to assess an individual’s beliefs and cognitive rational behaviors on cannabis use. The desired goal is to measure the overall attitude (positive vs. negative), which will drive an individual’s behavioral intentions and, in this case, the individual’s own behavior in relation to cannabis (Prochaska et al. 2002). In case of perceived knowledge, its intended use could be a deciding element in an individual’s personal decision to use cannabis, thereby contributing to the rational action pathway. Perceived knowledge will examine the reasoning elements and traits that form the foundations of each person’s decision-making process (Prochaska et al. 2002).

In Lebanon, a recent study in community pharmacists found that only 51% were found to have good perceived knowledge of cannabis uses and adverse effects as well as 44.7% were with legalization of cannabis in the country (Jaffal et al. 2020). In addition, among medical students, only 32.6% knew the adverse events of cannabis use (Assaf et al. 2017).

Studies assessing cannabis in any setting in the Arab and Lebanese region are relatively scarce, with few taking cannabis as the core substance in their study. Previous findings indicated that cannabis was the most used substance among high school and university students (Karam et al. 2010). Other ones indicated a 12.5% consumption rate of cannabis among university students, with 1 in 5 students likely to report a lifetime use of cannabis (Salameh et al. 2015; Ghandour and Donna S: El Sayed, and Silvia S. Martins. 2012).

To the best of our knowledge, previous studies have used various questionnaires to assess those variables but there are no validated scales for assessing perceived knowledge about and attitude about cannabis use. However, assessing such elements is critical since greater perceived knowledge and negative attitude entail better protection against cannabis abuse/misuse (Zvonarev et al. 2019). While this increase could be due to multiple reasons such as abolished legal penalty, decrease in prices and increased availability (various forms of cannabis products), and increased presence in daily life (social media, advertisement etc.), the health impact of legalization should be monitored extensively (Zvonarev et al. 2019). The current available literature on the topic in Lebanon is poor, as perceived knowledge about cannabis use in the general population is not well established, and public health policies are practically absent. In face of future legalization of cannabis use for both medical and recreational use, where does the public stand on the matter in terms of perceived knowledge and attitude? Going down the legalization road should be prepared by studies of the population mostly at risk: the young adult population, as a decriminalized and easier access will possibly lead to a surge in users and an increased exposure to cannabis products. The objectives of this study were to create and validate two scales to assess perceived knowledge towards cannabis use and attitude about cannabis use and check their psychometric properties in a sample of Lebanese university students.

Methods

Study design and participants

This is a cross-sectional study involving a sample of Lebanese university students aged between 18 and 30 years. The data collection was carried out during the month of January 2021. Excluded from this study were adults outside this age interval and those not currently enrolled in any major. The choice of sample is based on cannabis consumption being prevalent mostly in this age interval (Academies and of Sciences E, Medicine: The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research 2017; Keethakumar et al. 2021) and on cannabis being the second most used substance in Lebanese youth after alcohol (Salameh et al. 2015).

Procedure

The coronavirus pandemic challenged the proper execution of the study due to nationwide lockdown, curfews, required social distancing, universities shutting down, and moving their presence to social media and online platforms. In response to this new situation, a Google Forms link was created. Prior to proceeding with the data collection, a pilot study consisting of 20 participants was conducted to assess the duration and technical feasibility and rephrase misunderstood questions. The data related to the pilot study was not included in the final database. Students were exclusively part of one university, recruited via an email containing a brief description of the study with the link of the questionnaire. The university in question requires its students to have an acceptable university level of English (reading/writing/speaking) prior to enrollment.

Minimal sample size calculation

According to Comrey and Lee, a minimum of 10 observations is needed for each item of a scale intended to be validated. Since there were 29 items included in the perceived knowledge scale, a minimum number of 290 participants was deemed necessary. At the end of the data collection, 415 individuals responded to the questionnaire.

Questionnaire

The questionnaire was available in English and was divided into 4 sections:

The first section contained a brief introduction of the study design, objectives, statement of privacy, and consent request from each participant before proceeding to the questions in the next section. The student had the choice to accept or refuse participation in this study.

The second section contained socio-demographic questions (such as age, gender, marital status), self-reported evaluation of physical activity index, and mental health (where the participant is simply asked to self-evaluate his/her current mental health status with responses varying from poor to excellent).

The third section included a yes/no type of questions related to cannabis use for recreational purposes: “Have you ever tried cannabis for recreational uses? and “Have you ever tried cannabis during the ongoing COVID-19 pandemic?”.

Moreover, participants were asked 16 different statements assessing their attitude about recreational use of cannabis in daily life, with responses varying from 1 = strongly agree to 5 = strongly disagree. These questions were adapted from other studies (Swift et al. 2005; Philpot et al. 2019) and relate mostly to driving under influence of cannabis, the frequency of cannabis use in the participant’s surrounding environment, access, and legal status of cannabis in the participant opinion. The total score varied between 16 and 80. Greater scores indicated stronger attitude about cannabis use.

The fourth section evaluated the participant’s perceived knowledge regarding cannabis utilization for medical purposes. This section first assessed the participant’s previous experience regarding medicinal cannabis using a yes/no type of question. Furthermore, a total of 29 questions evaluated cannabis effect on quality of life, utilizations in neurological and psychological scenarios, and assessment of the risks associated with its consumption. All questions were graded on a 5-point system with statements varying from strongly disagree to strongly agree. Scores varied between 29 and 145, with greater scores indicating greater perceived knowledge of medical cannabis applications and risks. The statements and questions forming this questionnaire were assembled from various studies assessing cannabis consumption in different populations (Swift et al. 2005; Philpot et al. 2019) and were tailored to the current population. Throughout the questionnaire, the authors referred to a reverse scoring system for some items in both scales.

Statistical analysis

No missing data was found since all questions were required in the Google form. The FACTOR software was used to conduct the exploratory factor analysis of the perceived knowledge and attitude scales, using the Pearson correlation matrix and using the parallel analysis as a procedure for determining the number of factors/components. The promax rotation was used to extract items since the latter were highly correlated. The Kaiser–Meyer–Olkin (KMO) and the Bartlett’s test of sphericity p-value were calculated to ensure model’s adequacy. Factors with an Eigenvalue over 1 were retained; according to Kaiser (1960), there are as many reliable factors as there are eigenvalues greater than one. The reasoning is that an eigenvalue less than one implies that the scores on the component would have negative reliability (Cliff 1988; Kaiser 1960). Cronbach’s alpha values were recorded for reliability of the perceived knowledge and attitude scales and subscales.

Statistical analysis was performed using the SPSS software, version 23. The normality of distribution of the perceived knowledge and attitude scores was confirmed via a calculation of the skewness and kurtosis; values for asymmetry and kurtosis between − 2 and + 2 are considered acceptable in order to prove normal univariate distribution (George 2011). These conditions consolidate the assumptions of normality in samples larger than 300 (Mishra et al. 2019). Accordingly, the Student t-test was used to check for an association between perceived knowledge and attitude scores and dichotomous variables (i.e., gender). Pearson correlation test was used to correlate two continuous variables. Significance was set at p < 0.05.

Results

Sociodemographic and other characteristics

The characteristics of the participants are displayed in Table 1. The mean age was 20.96 ± 2.67 years, with 58.8% females. The mean perceived knowledge score was 71.49 ± 8.44 (median = 73) and that of the attitude score 49.42 ± 3.87 (median = 50).

Table 1 Sociodemographic and cannabis use characteristics of 415 Lebanese university students

Exploratory factor analysis (EFA) of the perceived knowledge about cannabis use scale items

The factor analysis was run over the total sample. All items concerning perceived knowledge about cannabis use could be extracted from the list except for item “How helpful do you think medical cannabis is for Memory problems” that showed a low communality (< 0.3). Items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 64% of the variance (factor 1 = perceived knowledge about cannabis quality of life improvement; factor 2 = perceived knowledge about cannabis psychiatric use; factor 3 = perceived knowledge about cannabis risks; factor 4 = perceived knowledge about cannabis neurological use). The KMO value was 0.915, with a significant Bartlett’s test of sphericity (p < 0.001). A good Cronbach’s alpha value was found for the total scale (α = 0.78) (Table 2).

Table 2 Factor analysis of the perceived knowledge of cannabis use items using a promax rotation: loading of each item on its corresponding factor

Exploratory factor analysis (EFA) of the attitude about cannabis use scale’s items

The factor analysis was run over the total sample. All items concerning attitude about cannabis use could be extracted from the list except for items (people under 18 years old should not be using cannabis) and (driving a car while under the influence of cannabis should be a criminal offense) that showed a low communality (< 0.3). Items converged over a solution of two factors, explaining a total of 58.2% of the variance (factor 1 = negative attitudes about cannabis use; factor 2 = positive attitude for cannabis use). The KMO value was 0.915, with a significant Bartlett’s test of sphericity (p < 0.001). A good Cronbach’s alpha value was found for the total scale (α = 0.73) (Table 3).

Table 3 Factor analysis of the attitude about cannabis use items using a promax rotation

Bivariate analysis

The bivariate analysis of categorical and continuous variables associated with the perceived knowledge and attitude about cannabis use scores are summarized in Tables 4 and 5. The results showed that greater perceived knowledge was found in male participants and in those who have tried cannabis for recreational purposes. Greater perceived knowledge was also associated with stronger attitude about cannabis use and older age. Furthermore, a greater mean attitude about cannabis use was significantly found in male participants and in those who have tried cannabis for recreational or medicinal purposes.

Table 4 Bivariate analysis of categorical factors associated with the perceived knowledge and attitude scores
Table 5 Bivariate analysis of continuous factors associated with the perceived knowledge and attitude against cannabis use scores

Discussion

Scales’ factorial validity

The factor analysis of the perceived knowledge about cannabis use items resulted in 4 factors (Table 2), and the analysis of the attitude about cannabis use items resulted in 2 factors (Table 3). These two scales, on another hand, showed good Cronbach’s alpha values. The internal consistency is considered acceptable above the commonly suggested threshold of 0.70 (Furr 2021; Hair et al. 2011). These scales may be completed in 5–7 min; the questions are simple to comprehend, making them useful tools for future research.

Correlates of perceived knowledge about and attitude about cannabis use

In this study, greater perceived knowledge and stronger attitudes about cannabis were found in male participants compared to women. A previous study showed that male reported greater cannabis use over time (Hemsing and Greaves 2020). To the best of our knowledge, no previous research has looked at the relationship between gender and cannabis perceived knowledge about and attitudes about cannabis. Many possibilities can explain this finding. This can be explained by the fact that men use cannabis more frequently than women (Carliner et al. 2017), and they have greater perceived knowledge about this substance. Furthermore, when males use the substance more frequently, they are more likely to be subject to withdrawal symptoms, commonly seen among users of the substance (Bahji et al. 2020). As a result, their attitude towards cannabis use might become more negative. In addition, men are more likely to initiate cannabis use at younger age than women (Pope et al. 2003). Another possible explanation for the existing sex differences in cannabis use may reflect women’s increased perceptions of risks associated with regular use (Cuttler et al. 2016). However, future research on biological and psychosocial mechanisms underlying cannabis-related sex differences are needed to better understand this association.

Greater perceived knowledge was also associated with a stronger attitude about cannabis use. Our results are consistent with previous findings correlating greater knowledge to better attitude about cannabis in athletes (Zeiger et al. 2020a). We also found that having tried cannabis for recreational or medicinal purposes was significantly associated with greater perceived knowledge. This can be explained by the Knowledge-Attitude-Behavior model, which postulates the temporal ordering, as follows: “As knowledge accumulates in a health behavior domain, changes in attitude are initiated. Over some period of time, changes in attitude accumulate, resulting in behavioral change” (Baranowski et al. 2003). In terms of cannabis use, the triad of knowledge, attitudes, and behavior has not been widely explored, although past studies examining cannabis use in adolescents have followed a harms-avoidance approach (Asbridge et al. 2014). Adolescent drug knowledge, pro-drug attitudes, and adolescent drug use were all assessed in research on parenting methods. Both drug knowledge and drug use were predicted by pro-drug attitudes (Zeiger et al. 2020b). Another study among adolescents found that drug use education influenced substance use attitudes, resulting in lower cigarette and cannabis use. However, the growing acceptance of cannabis use among the general public in the USA is leading to increased use, suggesting a review of the knowledge-attitudes-behavior paradigm (Zeiger et al. 2020b). It is noteworthy to draw the attention to one important issue: we cannot separate/differentiate attitude against cannabis use from attitude towards cannabis use since some people might be against cannabis use for recreational purposes, but they lean towards cannabis use for medicinal purposes. Future studies are needed to differentiate both types of attitudes.

On another hand, we found that a greater mean attitude about cannabis use in those who have tried cannabis for medicinal purpose. This result aligns with the fact that medical cannabis has gotten a lot of attention due to its possible beneficial effects on chronic pain, nausea, fibromyalgia, inflammatory bowel disease, and other difficult-to-treat conditions (Zeiger et al. 2020c). Participants in a previous study overestimated the medicinal efficacy of cannabis, while underestimating the risks (Kruger et al. 2020). Although there is a lack of evidence on its therapeutic benefits, there is also lack of perceived knowledge about its negative health consequences. There is substantial evidence that cannabis has negative effects in many contexts such as on the respiratory (Tetrault et al. 2007; Moore et al. 2005; Pletcher et al. 2012) (especially inhaled cannabis (Loflin and Earleywine MJCjortCRcdltrR, 2015)), as well as the reproductive (Kolodny et al. 1974; Maccarrone et al. 2021; Hsiao 2018), gastrointestinal (Sullivan 2010; Naftali et al. 2014; Gotfried et al. 2020), and immunologic (Svrakic et al. 2012; Friedman et al. 2003) systems.

Limitations

The data’s cross-sectional nature limits the ability to make causal conclusions and the use of a self-administered questionnaire containing some unfamiliar terms poses a risk for information bias. Besides, an under/over-estimation and the misunderstanding of a question could be experienced by a participant, leading to an information bias. There is also a risk for selection bias, given the sample was recruited from a single university, with a female predominance. A residual confounding bias might be present since not all factors known to influence perceived knowledge and attitude about cannabis use were considered in this paper. Further studies are needed in order to validate it among the general population and assess more psychometric properties of these scales.

Conclusion

This study was able to create and validate two scales to assess perceived knowledge about and attitude about cannabis use in Lebanese university students. The primary results showed acceptable psychometric properties. We hope these scales will be useful in future epidemiological studies.

Availability of data and materials

All data generated or analyzed during this study are not publicly available to maintain the privacy of the individuals’ identities. The dataset supporting the conclusions is available upon request to the corresponding author.

Abbreviations

THC:

Delta-9-tetrahydrocannabinol

HIV:

Human immunodeficiency virus

References

  • National Academies of Sciences E, Medicine: The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. 2017.

  • Asbridge M, Duff C, Marsh DC, Erickson PG. Problems with the identification of ‘problematic’ cannabis use: examining the issues of frequency, quantity, and drug use environment. Eur Addict Res. 2014;20(5):254–67.

    Article  Google Scholar 

  • Assaf G, Noureddine S, Kouyoumdjian SP, El Khoury J: Medical students’ knowledge, attitudes and behaviours related to substance use in Lebanon: a cross-sectional survey. Eastern Mediterranean Health J. 2017;23(11).

  • Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DPJJno: Prevalence of cannabis withdrawal symptoms among people with regular or dependent use of cannabinoids: a systematic review and meta-analysis. 2020;3(4):e202370-e202370

  • Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obes Res. 2003;11(Suppl):23S-43S.

    Article  Google Scholar 

  • Cannabis law and legislation in Lebanon [https://cms.law/en/int/expert-guides/cms-expert-guide-to-a-legal-roadmap-to-cannabis/lebanon]

  • Carliner H, Mauro PM, Brown QL, Shmulewitz D, Rahim-Juwel R, Sarvet AL, Wall MM, Martins SS, Carliner G, Hasin DS. The widening gender gap in marijuana use prevalence in the U.S. during a period of economic change, 2002–2014. Drug Alcohol Depend. 2017;170:51–8.

    Article  Google Scholar 

  • Cliff N. The eigenvalues-greater-than-one rule and the reliability of components. Psychol Bull. 1988;103(2):276.

    Article  Google Scholar 

  • Cuttler C, Mischley LK, Sexton M. Sex differences in cannabis use and effects: a cross-sectional survey of cannabis users. Cannabis Cannabinoid Res. 2016;1(1):166–75.

    Article  Google Scholar 

  • El-Khoury J, Bou Khalil R, Nemer A, Richa S: Legalizing medical cannabis in Lebanon: the complex interface between medicine, law, ethics, and economics. Cannabis Cannabinoid Res 2020.

  • Fakhry B, Abdulrahim M, Chahine MN. Medical cannabis in Lebanon: history & therapeutic, ethical, and social challenges: a narrative review. Arch Clin Biomed Res. 2021;5:137–57.

    Article  Google Scholar 

  • Friedman H, Newton C, Klein TW. Microbial infections, immunomodulation, and drugs of abuse. Clin Microbiol Rev. 2003;16(2):209–19.

    CAS  Article  Google Scholar 

  • Furr RM: Psychometrics: an introduction: SAGE publications; 2021.

  • George D: SPSS for windows step by step: a simple study guide and reference, 17.0 update, 10/e: Pearson Education India; 2011.

  • Ghandour LA, El Sayed DS, Martins SS. Prevalence and patterns of commonly abused psychoactive prescription drugs in a sample of university students from Lebanon: an opportunity for cross-cultural comparisons. Drug Alcohol Dependence. 2012;121(1–2):110–7.

    Article  Google Scholar 

  • Gotfried J, Naftali T, Schey RJG: Role of cannabis and its derivatives in gastrointestinal and hepatic disease. 2020, 159(1):62-80.

  • Hair JF, Ringle CM, Sarstedt M. PLS-SEM: indeed a silver bullet. J Market Theory Pract. 2011;19(2):139–52.

    Article  Google Scholar 

  • Hemsing N, Greaves L. Gender norms, roles and relations and cannabis-use patterns: a scoping review. Int J Environ Res Public Health. 2020;17(3):947.

    Article  Google Scholar 

  • Hsiao P, ClavijoRIJEuf: Adverse effects of cannabis on male reproduction. 2018, 4(3):324-328.

  • Hughes A, Lipari RN, Williams MR: Marijuana use and perceived risk of harm from marijuana use varies within and across states. The CBHSQ Report 2016.

  • Jaffal LH LN, Zein S, Awada S, Khachman D. : Lebanese pharmacists’ knowledge and attitude toward cannabis medical use legality. 2020;2(3):106. doi:https://doi.org/10.2991/dsahmj.k.200507. Dr Sulaiman Al Habib Med J 2020, 2(3):106–114.

  • Kaiser HF. The application of electronic computers to factor analysis. Educ Psychol Measur. 1960;20(1):141–51.

    Article  Google Scholar 

  • Karam EG, Ghandour LA, Maalouf WE, Yamout K, Salamoun MM. A rapid situation assessment (RSA) study of alcohol and drug use in Lebanon. Le J Med Libanais Lebanese Med J. 2010;58(2):76–85.

    Google Scholar 

  • Keethakumar A, Mehra VM, Khanlou N, Tamim H. Cannabis use and patterns among middle and older aged Canadians prior to legalization: a sex-specific analysis of the Canadian Tobacco, Alcohol and Drugs Survey. BMC Public Health. 2021;21(1):1–14.

    Article  Google Scholar 

  • Kolodny RC, Masters WH, Kolodner RM, Toro GJNEJoM: Depression of plasma testosterone levels after chronic intensive marihuana use. 1974, 290(16):872-874.

  • Kruger DJ, Kruger JS, Collins RL. Cannabis enthusiasts’ knowledge of medical treatment effectiveness and increased risks from cannabis use. Am J Health Promot. 2020;34(4):436–9.

    Article  Google Scholar 

  • Loflin M, Earleywine MJCjortCRcdltrR: No smoke, no fire: what the initial literature suggests regarding vapourized cannabis and respiratory risk. 2015;51(1):7.

  • Lozano I. The therapeutic use of Cannabis sativa (L.) in Arabic medicine. J Cannabis Therapeut. 2001;1(1):63–70.

    Article  Google Scholar 

  • Maccarrone M, Rapino C, Francavilla F, Barbonetti AJNRU: Cannabinoid signalling and effects of cannabis on the male reproductive system. 2021, 18(1):19-32.

  • Mishra P, Pandey CM, Singh U, Gupta A, Sahu C, Keshri A. Descriptive statistics and normality tests for statistical data. Ann Card Anaesth. 2019;22(1):67.

    Article  Google Scholar 

  • Moore BA, Augustson EM, Moser RP, Budney AJ. Respiratory effects of marijuana and tobacco use in a US sample. J Gen Inter Med. 2005;20(1):33–7.

    Article  Google Scholar 

  • Naftali T, Mechulam R, Lev LB, Konikoff FMJDD: Cannabis for inflammatory bowel disease. 2014, 32(4):468-474.

  • Okaneku J, Vearrier D, McKeever RG, LaSala GS, Greenberg MI. Change in perceived risk associated with marijuana use in the United States from 2002 to 2012. Clin Toxicol. 2015;53(3):151–5.

    Article  Google Scholar 

  • Park SY, Ryu SY, Constantino N, Yun GW, Jennings E, Fred D: Marijuana knowledge, confidence in knowledge, and information efficacy as the protective and risk factors of marijuana use among college students. Journal of American college health : J ACH 2020:1–8.

  • Philpot LM, Ebbert JO, Hurt RT. A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers. BMC Fam Pract. 2019;20(1):1–7.

    Article  Google Scholar 

  • Pletcher MJ, Vittinghoff E, Kalhan R, Richman J, Safford M, Sidney S, Lin F, Kertesz S. Association between marijuana exposure and pulmonary function over 20 years. JAMA. 2012;307(2):173–81.

    CAS  Article  Google Scholar 

  • Pope HG Jr, Gruber AJ, Hudson JI, Cohane G, Huestis MA, Yurgelun-Todd D. Early-onset cannabis use and cognitive deficits: what is the nature of the association? Drug Alcohol Depend. 2003;69(3):303–10.

    Article  Google Scholar 

  • Prochaska JO, Redding CA, Evers KE, Glanz K, Rimer B, Viswanath K: Health behavior and health education: theory, research, and practice. The transtheoretical model and stages of change. 2002:60–84.

  • Salameh P, Rachidi S, Al-Hajje A, Awada S, Chouaib K, Saleh N, Bawab W. Substance use among Lebanese university students: prevalence and associated factors/Consommation de substances psychoactives des etudiants universitaires libanais: prevalence et facteurs associes. East Mediterr Health J. 2015;21(5):332–42.

    CAS  Article  Google Scholar 

  • Salloum NC, Krauss MJ, Agrawal A, Bierut LJ, Grucza RA. A reciprocal effects analysis of cannabis use and perceptions of risk. Addiction. 2018;113(6):1077–85.

    Article  Google Scholar 

  • Sullivan S: Cannabinoid hyperemesis. Canadian journal of gastroenterology = Journal canadien de gastroenterologie 2010, 24(5):284–285.

  • Svrakic DM, Lustman PJ, Mallya A, Lynn TA, Finney R, Svrakic NM. Legalization, decriminalization & medicinal use of cannabis: a scientific and public health perspective. Mo Med. 2012;109(2):90–8.

    PubMed  PubMed Central  Google Scholar 

  • Swift W, Gates P, Dillon P. Survey of Australians using cannabis for medical purposes. Harm Reduct J. 2005;2(1):1–10.

    Article  Google Scholar 

  • Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med. 2007;167(3):221–8.

    Article  Google Scholar 

  • World Drug Report 2018 [https://www.unodc.org/wdr2018/]

  • Zeiger JS, Silvers WS, Fleegler EM, Zeiger RS. Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes. J Cannabis Res. 2020a;2(1):18.

    Article  Google Scholar 

  • Zeiger JS, Silvers WS, Fleegler EM, Zeiger RS. Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes. J Cannabis Res. 2020c;2:1–13.

    Article  Google Scholar 

  • Zeiger JS, Silvers WS, Fleegler EM, Zeiger RSJJocr: Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes. 2020b, 2(1):1-13

  • Zvonarev V, Fatuki TA, Tregubenko P: The public health concerns of marijuana legalization: an overview of current trends. Cureus. 2019;11(9).

Download references

Acknowledgements

We would like to thank all students who participated in this study.

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

AM and CR wrote the paper; AM and MS designed the study; SH carried out the analysis and interpreted the results; all authors read and approved the final manuscript; MS and SH were the project supervisors.

Corresponding authors

Correspondence to Souheil Hallit or Michel Soufia.

Ethics declarations

Ethics approval and consent to participate

The “Psychiatric Hospital of the Cross” ethics committee approved the study protocol (HPC-008–2021). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). The objectives of the study were explained to each participant; submitting the form online was considered equivalent to signing a written informed consent. No financial compensation was provided within completion of the questionnaire.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mina, A., Rahme, C., Hallit, S. et al. Development of scales to measure Lebanese university students’ perceived knowledge about and attitudes about cannabis use: initial psychometric properties. J Cannabis Res 4, 34 (2022). https://doi.org/10.1186/s42238-022-00144-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s42238-022-00144-x

Keywords

  • Cannabis
  • Perceived knowledge
  • Attitude
  • University students
  • Lebanon