Risk factors for adolescent cannabis use following partial cannabis legalization in Germany: a cross-sectional study in secondary schools.

Trümpelmann M.; Lüthgen M.; Burgard A.; Axt P.; Faesser H.; Jagomast T.; Weckmann M.; Drömann D.; Brinkmann F.; Penner L. et al. · Substance abuse treatment, prevention, and policy · 2026

**Background & Methods** This cross-sectional survey examined risk factors for adolescent cannabis use in Germany following partial legalization in April 2024. A total of 829 students aged 11-19 years from three secondary schools in northern Germany completed questionnaires between April-July 2024, with associations analyzed using ordinal cumulative link models and binary logistic regression adjusted for age, gender, and school type. **Key Findings** - Cannabis lifetime use prevalence increased significantly with age, from 1.0% at age 13 to 39.1% at age 18, with 3.8% prevalence in younger grades (5-7) and 20.3% in older grades (8-12). - Social media use emerged as a strong risk factor, particularly Instagram (OR = 4.3, 95% CI: 1.79-12.74, p = 0.003), and exposure to nicotine advertising on digital platforms nearly doubled cannabis use odds (OR = 2.02, 95% CI: 1.27-3.20, p = 0.003). - Risk perception was the strongest predictor identified (Nagelkerke R² = 0.20); adolescents perceiving cannabis as "much healthier" than cigarettes had substantially elevated odds of use (OR = 22.5, 95% CI: 10.39-49.98, p < 0.001). Additional risk factors included parental smoking in the adolescent's presence (OR = 2.22-2.78, p = 0.001) and higher pocket money (>50 €/month; OR = 3.0, p < 0.001). **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This study provides Level III evidence with significant limitations. The cross-sectional design precludes causal inference and temporality assessment. The sample, while reasonable in size (n = 829), was geographically restricted to three schools in northern Germany, limiting generalizability. School-based prevention showed no significant association (p = 0.70), suggesting potential measurement or implementation issues. The study was conducted immediately following legalization, capturing an important policy transition point but potentially affecting risk perception patterns. The absence of validated substance use instruments and reliance on self-reported data represent additional limitations. Notably, school-based prevention findings contradict existing literature, warranting further investigation.

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