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Weeding out the information: an ethnographic approach to exploring how young people make sense of the… Moffat, Barbara M; Jenkins, Emily K; Johnson, Joy L Nov 27, 2013

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RESEARCH Open AccessWeeding out the information: an ethnographicapproach to exploring how young people makesense of the evidence on cannabisBarbara M Moffat*, Emily K Jenkins and Joy L JohnsonAbstractBackground: Contradictory evidence on cannabis adds to the climate of confusion regarding the health harmsrelated to use. This is particularly true for young people as they encounter and make sense of opposing informationon cannabis. Knowledge translation (KT) is in part focused on ensuring that knowledge users have access to andunderstand best evidence; yet, little attention has focused on the processes youth use to weigh scientific evidence.There is growing interest in how KT efforts can involve knowledge users in shaping the delivery of youth-focusedpublic health messages. To date, the youth voice has been largely absent from the creation of public healthmessages on cannabis.Methods: This ethnographic study describes a knowledge translation project that focused on engaging youngpeople in a review of evidence on cannabis that concluded with the creation of public health messages generatedby youth participants. We facilitated two groups with a total of 18 youth participants. Data included transcribedsegments of weekly sessions, researcher field notes, participant research logs, and transcribed follow-up interviews.Qualitative, thematic analysis was conducted.Results: Group dynamics were influential in terms of how participants made sense of the evidence. The processesby which participants came to understand the current evidence on cannabis are described, followed by themanner in which they engaged with the literature for the purpose of creating an individual public health messageto share with the group. At project end, youth created collaborative public health messages based on theirunderstanding of the evidence illustrating their capacity to “weed out” the information. The content of thesemessages reflect a youth-informed harm reduction approach to cannabis use.Conclusions: This study demonstrates the feasibility of involving young people in knowledge translation initiativesthat target peers. Youth participants demonstrated that they were capable of reading scientific literature and hadthe capacity to engage in the creation of evidence-informed public health messages on cannabis that resonate withyoung people. Rather than simply being the target of KT messages, they embraced the opportunity to engage indialogue focused on cannabis.Keywords: Cannabis, Youth, Scientific evidence, Public health recommendations, Knowledge translation* Correspondence: barb.moffat@nursing.ubc.caSchool of Nursing, University of British Columbia, 302-6190 Agronomy Road,Vancouver, BC V6T 1Z3, Canada© 2013 Moffat et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.Moffat et al. Harm Reduction Journal 2013, 10:34http://www.harmreductionjournal.com/content/10/1/34BackgroundApproaches to addressing cannabis use are fragmentedin Canada, which contributes to a climate of confusionregarding its potential harms. On the one hand, advo-cates of the substance promote its beneficial properties,while those in opposition focus on the harms associatedwith the drug. Indeed cannabis is a complex substancewith blurred boundaries between its medicinal proper-ties and recreational appeal [1]. Although recreationalcannabis use is illegal in Canada, it remains the mostwidely used illicit drug particularly among young people.Health Canada data indicate that young people areexperimenting with cannabis at a younger age than inthe past, with the average age of first use currently at13.7 years [2].In Canada, there is growing support among lawmakers and health professionals [3], as well as the gen-eral public [4] for changes that will permit the regulationof cannabis in a climate where current approaches tocriminalizing the substance are considered counterpro-ductive to overall public health. The support toregulate cannabis in neighboring American States ofWashington and Colorado in the 2012 United Stateselection has added fuel to this issue in Canada. Withinthis environment of polarized views on the substance,little attention has focused on how young people cometo understand the potential harms and benefits relatedto cannabis use.Navigating the abundant research on cannabis is acontinuous exercise in weighing the best evidence. Al-though the adverse health effects of cannabis use havebeen studied extensively [5-7], some evidence remainsinconclusive which adds to the challenge of addressingthe harms related to this drug [8]. Cannabis is a complexsubstance with differing ratios and effects of its psycho-active components, tetrahydrocannabinol (THC) andcannabidiol (CBD) [9]; to date, however, the psycho-pharmacology of this substance has been largely underresearched. Furthermore, scientific literature supportscontradictory evidence. For example, the anxiolyticproperties of CBD are well documented [10] and re-cently have been noted to benefit individuals withschizophrenia [11,12]. In contrast, other findings linkcannabis use and psychosis [5,13-15]. Translating similarconflicting evidence to make it accessible is no easy task[16]. In the popular media, cannabis is often depicted ina way which distills and distorts scientific evidence tohighlight findings that promote its salutary aspects. As aresult, some young people have come to view cannabisas therapeutic [17,18]. An in-depth understanding ofhow young people make sense of the contrary scientificevidence on cannabis is lacking in an era and socialcontext where they are exposed to diverse sources ofinformation.An absence of consistent messages and harm reduc-tion strategies related to cannabis has particular implica-tions for young people as they encounter opposinginformation and make choices regarding its use. Withinthe Canadian context, young people receive adult-drivenpublic health messages emphasizing the harms of canna-bis, yet frequently hear about permissible medicinal useand are exposed to an environment where recreationaluse among peers and adults is common. Adolescencerepresents a critical developmental period for targetingsubstance use prevention and harm reduction strategiesgiven that experimentation with substance use coincideswith this stage of development. If our intention is thatyoung people minimize the harms related to cannabisuse, an understanding of how they engage in weighingthe evidence and making decisions regarding use isindicated.Approaches to addressing the topic of cannabis are in-consistent in school settings in Canada. A dominantabstinence discourse prevails in some high school com-munities with well-intended anti-drug messages to re-frain from cannabis use altogether. Relying solely onsuch messages, however, may be ineffective as manyyoung people have started to routinely use cannabis bytheir early teenage years. Other high school communitiesconvey messages emphasizing that cannabis use will notbe tolerated during the school day, which some youthinterpret as an attempt to avoid addressing the topicdirectly [19]. In short, open dialogue and balanced dis-cussion about cannabis with young people is lacking,resulting in minimal engagement to explore their under-standings of the risks associated with cannabis.Reducing the potential harms related to cannabis userequires a planned process of disseminating informationand engaging in dialogue regarding the reasons for useand the associated risks based on the best evidence avail-able. The growing field of knowledge translation (KT),which is aimed at promoting the utilization of best evi-dence to improve health outcomes, provides a usefullens for informing efforts to reduce the risks associatedwith cannabis use among young people. While KT is abroad field encompassing a range of approaches, there isheightened interest placed on the importance of utilizingcollaborative methods, engaging end-users of knowledgethroughout the KT process [20,21]. Referred to as inter-active or integrated KT, this type of approach is seen toenhance the relevance and meaning of research evidenceamong knowledge users [22]. Although the decision touse an integrated KT strategy should be based on thepurpose of the research and desired outcomes, it mayprovide a particularly useful approach for enhancing theutilization of evidence among young people given that“children do indeed interpret their worlds differentlyfrom adults; they have distinctly different perspectives,Moffat et al. Harm Reduction Journal 2013, 10:34 Page 2 of 9http://www.harmreductionjournal.com/content/10/1/34values and understandings about all sorts of things…”[23] p. 318. However, while KT provides a mechanismfor enhancing youth awareness of best evidence on theharms associated with cannabis use, to date, there hasbeen a reticence to share such evidence with youngpeople within the school context. As a result, there is alack of understanding regarding young people’s ability toactively engage in the KT process — to critically weighor appraise scientific evidence, or to be involved in thedevelopment of public health messages targeting youth;a gap we seek to address in our research.It is clear that youth require evidence-based, culturallyappropriate strategies that can effectively convey therisks associated with cannabis use. In this KT study, weengaged with young people in a supportive academic en-vironment to foster the development of basic researchand critical thinking skills with the goal of enhancingyouth capacity to navigate the scientific and lay literaturepertaining to cannabis. The purpose of this project wastwofold: 1) to understand the processes by which youngpeople work collaboratively to make sense of evidenceon cannabis and, 2) to understand how youth engagewith the literature for the purpose of contributing to thepublic health dialogue on cannabis.MethodsAn ethnographic approach was used in this study to ob-serve how young people worked with cannabis-relatedmaterials, synthesized information, and interacted withpeers during group activities. An ethnographic approachfocuses on complex and multilayered practices and themeanings attached to processes and practices utilized[24]. Ethnographic methods are well suited for providinga holistic approach to explore a phenomenon, in ourcase, how participants made sense of scientific evidenceon cannabis and created public health messages, andpresenting this information from participants’ perspec-tives [25].Ethical approval was obtained from the ResearchEthics Board at the University of British Columbia.Information about participating in this study was circu-lated widely within high school communities. Our sam-ple consisted of two groups and included a total of 18young people (10 females and 8 males), aged 15 to 18,who were hired to participate in weekly study sessions.Most participants had never tried cannabis (n = 12), afew had tried on several occasions (n = 3) while othersused it regularly (n = 3). The first group took place overa six-week period (n = 10), and the second group metover the course of eight weeks (n = 8). Group 1 was fa-cilitated by two adult researchers, whereas Group 2 wasfacilitated by one adult researcher and one youth whohad been a participant in Group 1. The sessions wereheld after school at the University of British Columbia ina conference room transformed into an informal learn-ing environment. The group sessions began with anintroduction to the basic topics of research, such asconfidentiality and informed consent, and participantssigned a consent form which outlined the expectationsof the research project (e.g., completing homework,attending all sessions). Weekly activities includedreviewing select literature and other sources of canna-bis-related messaging as well as preparing an individualevidence-informed public health message.To facilitate the participants’ skills in evidence ap-praisal, we engaged them in group learning activities thatinvolved a discussion of materials (i.e., research articles,reviews, lay commentaries) selected by the team ontopics such as distinguishing evidence from opinion andbalanced from biased content. Participants also attendeda library orientation that focused on conducting litera-ture searches. In addition, the research team providedongoing support for accessing and interpreting articlesrelated to their personal projects.Data were collected from a number of sources. Partici-pants maintained reflective logs and presented theirevidence-informed public health message at the end ofthe project. Sessions were audio-recorded and relevantsegments were transcribed. Throughout the project, par-ticipant observation occurred and extensive field noteswere made; the youth facilitator in Group 2 also main-tained field notes. A member check was integrated intothe analysis that involved sharing excerpts from groupdiscussion, and emerging findings to ensure that theresearch team was on track with early analysis and tomaximize participants’ understanding of the researchprocess. Individual follow-up interviews were conductedwith all participants to further explore their reflectionson making sense of the evidence on cannabis. Althoughwe draw on different sources of data in this paper, wefocus on the observational component of this ethno-graphic study, thereby supporting the research teams’ in-terpretations of how participants worked collaborativelyto make sense of the evidence and how they engagedwith the scientific literature.Analysis involved a team of three researchers who fo-cused on reviewing and interpreting sections of the datathat focused on how youth made sense of the evidence oncannabis. The software program, NVIVO, was used forthe purpose of storing and organizing the data. One mem-ber of the research team (BMM) was responsible for man-aging and coding relevant data. Emergent themes andrelevant excerpts from the data were discussed with theresearch team to ensure accuracy of interpretations.ResultsReviewing the evidence on cannabis was an unchartedand challenging task for the participants. From theMoffat et al. Harm Reduction Journal 2013, 10:34 Page 3 of 9http://www.harmreductionjournal.com/content/10/1/34outset, they were enthusiastic vis-à-vis the prospect oflearning more about cannabis and the opportunity toparticipate in ongoing discussion focused specifically onthe substance. We begin by turning our gaze to the over-arching group dynamics that unfolded within the con-fines of this research project. Next, we describe theprocesses by which participants made sense of thecurrent evidence on cannabis, and finally we depict themanner in which they engaged with the literature for thepurpose of creating a public health message to sharewith the group. At project end, youth in Group 2 createdcollaborative public health recommendations based ontheir understanding of the evidence. One participantfrom Group 2 assisted with the development of a bro-chure showcasing these messages.Group dynamics at playParticipants came to the project with different perspec-tives and experiences. This clearly influenced the dy-namics within the group and shaped the process ofcollaboratively engaging with the evidence. Some of theyoung people revealed that they knew very little aboutthe substance, while others possessed strong opinionsand claimed knowledge based on their personal cannabisuse. This made for animated discussions, inspired curi-osity for learning, and accommodated diverse perspec-tives and dialogue focused on the evidence.Comfort levels and participation during discussionwere distinct between both groups. Personal experiencewith marijuana was a powerful force that was particu-larly palpable in Group 1. Those who were regular can-nabis users were vocal, revealing their use to others earlyin the process; they also spoke with authority. Thosewithout personal cannabis experience listened intently tothe confident and persuasive voice of “knowledge” basedlargely on personal experience. Subtle silencing tran-spired suggesting that some participants were unpre-pared to challenge this self-assured voice. In contrast,the participants in Group 2 were immediately relaxedwith one another. This group included several youthwho had used cannabis occasionally, but no regular can-nabis users.In both groups, certain participants (including thosewithout personal cannabis experience) spoke with con-siderable ease. During discussion, these youth made fre-quent contributions about their understandings of theevidence and were influential players as demonstratedwhen select content was later picked up and repeated byothers. One participant, who had smoked marijuanaonce, was described by his peers as having “a way of cap-turing the audience” when sharing his understanding ofthe evidence. On occasion, articulate and effusive youthshared misinformation unknowingly whereby it was ne-cessary for the research team to provide clarification.Other participants’ contributions regarding the evidencewere measured, suggesting a preference for reflectionwhile quietly making sense of the evidence. These youthsurprised the team with their sophisticated understand-ing of cannabis at project end. Despite the serious focusof the sessions, the dynamics also included laughter andplayful elements that were most often initiated by themale participants. Humor appeared to be a way to punc-ture potential awkwardness within this context of differ-ent perspectives and experiences.Expecting simple answersMany participants entered into an examination of thescientific literature with the notion that there would beclear, straight forward answers in the research on canna-bis. This was based on the assumption that this body ofscience was firmly established. As a result, many lookedfor single causes in research findings and pursuedconsistent and concrete results. Within little time, how-ever, they encountered unanticipated and contradictoryevidence. Many expressed their frustration with theseperceived shortcomings in the evidence that was particu-larly apparent when researchers acknowledged that find-ings remained “inconclusive.” Proposed “theories” ofbenefit and harm undermined any sense of certaintyand, for some youth, they were difficult to grasp. In re-sponse, many participants became guarded when makingsense of the evidence; some reacted with skepticism. Forexample, with regard to the association between canna-bis and schizophrenia, one participant remarked, “itcould be this [or] it could be this… and it might not bemarijuana that’s causing this, [pause] or it could be.” An-other young person was particularly dissatisfied when re-searchers concluded with the phrase “we don’t know”which was interpreted as “an easy out”.It’s a classic answer for a complicated question in sci-ence …it’s better than saying an answer that could befalse or that you don’t really have sufficient evidence toback up. So it’s not necessarily like not a bad answer,well, I want more. (Female, 17, occ. MJ use).It was also somewhat unsettling for some participantsto realize that the evidence was neither as solid norstraight forward as had been suggested when exposed toabstinence styled public health messaging. At the sametime, it was as if a light switch had been turned on; mostwere beginning to appreciate the complexity surround-ing the substance and were intent on unraveling thepuzzle so as to gain more certainty. After reading oneacademic article, one young woman noted in her log,“the claim that I found interesting was the negativeeffect on memory may depend solely on the strain[of cannabis].” These youth embarked on the challengeof unpacking the evidence on cannabis to gain moreclarity.Moffat et al. Harm Reduction Journal 2013, 10:34 Page 4 of 9http://www.harmreductionjournal.com/content/10/1/34Wrestling with uncertaintyParticipants engaged with and “puzzled” over contradict-ory and inconclusive findings. In addition, unexpectedevidence challenged what young people had previouslyheld to be true, which was an obvious source of confu-sion. Certain findings were simply labeled “bizarre,”pointing to the level of surprise for some participants.For one young man, firm beliefs about the health harmsof cannabis were exposed and needed to be re-examinedwhen confronted with evidence suggesting that smokingtobacco was more harmful than cannabis. A femaleparticipant commented on the evidence related to can-nabis use and driving noting how it was “kind of hard towrap your head around” some of the evidence adding,“Marijuana impairs your psychomotor performance, sowhy would some drivers actually improve their perform-ance?” Findings could not be taken at face value. Partici-pants’ efforts and abilities to absorb new informationrequired inquisitiveness and diligence.Use of conditional language added to existing uncer-tainty. Specifically, the terms “could” and “may” that fre-quently appeared in scientific materials were deemedunsatisfactory and vague. In addition, the concept of“risk” was elusive and hard to comprehend. Weighingbalanced evidence that explored risk was particularlychallenging for those who had previously aligned them-selves with strong beliefs that cannabis was either safe orharmful. As such, one young person, a fervent advocatefor the use of vaporizers, initially had difficulty acceptingthat there were risks associated with “vaporizing” canna-bis. In contrast, those who had always seen it as a harm-ful substance struggled to acknowledge the value ofpurported medicinal benefits.Some participants came to understand that there weredegrees of evidence when sorting through “information.”One young person noted the importance of being ableto distinguish between “facts, kind of facts, and some-what factual.” Communicating their confusion, emergingunderstandings and insights of the evidence with oneanother appeared to be a helpful outlet as participantsrecognized a shared uneasiness with the uncertainty inthe literature.Relaxing with ambiguityOver time, we observed that most participants developedthe ability to consider opposing findings when makingsense of the evidence by applying varying degrees of crit-ical thinking. Most were gaining skills in recognizingbias and valued balanced reporting in the literature thatthey were encountering.Participants settled into a position where they pro-posed that cannabis “affects everybody differently”,making it a substance that was “not black and white”.This indisputable stance appeared to bring some relief.Having reviewed select evidence, they had gained a levelof confidence and reflected on how they understood thestatus of the evidence. The limitations were underscoredwith claims that “everyone said there needs to be moreresearch”. One youth concluded that “confounding fac-tors can contribute to the results”. They readily acknowl-edged that the topic of cannabis was “so controversial”.Having explored the literature and weighed the evidence,they felt justified with their position in this middle zonewhere cannabis was perceived as neither good nor bad.I thought doing the research would kind of help usfind the ‘yes’ and the ‘no’s, but it actually didn’t, it madeus more confused. But we did learn more of the why itcould be ‘yes’ or it could be a ‘no’. So, I think those arereally valuable towards finding the conclusions. (Female,16, non-user).Despite this lack of certainty in the midst of inconclu-sive and conflicting evidence, the exercise of inquiry wasdeemed to be worthwhile.Most youth who came into the project thinking thatcannabis was “all bad”, no longer believed that was thecase at project end, an unanticipated finding for the re-search team. Furthermore, those who initially held ex-treme beliefs about cannabis as either a good or badsubstance appeared at ease with their uncertainty. Par-ticipants had gained an appreciation for the complexitysurrounding the evidence on cannabis. Most had devel-oped basic critical thinking skills and were better able toidentify bias and unreliable sources of information. As aresult, participants were able to relax within the scope ofuncertainty that was present in the literature.Approaches to reading the literatureReading the scientific literature involved encounteringnew terminology and interpreting a “different” style ofwriting initially described as “hard to read/understanddue to the vocabulary and complex sentence structures”.Participants soon developed strategies for “weeding outthe information”. The degree to which participantsremained engaged in the activity of careful readingvaried over the course of the project. Two distinct stylesbecame apparent within several weeks: effortful engage-ment and intermittent engagement. Although some par-ticipants drew on both approaches depending on thematerial at hand, most relied primarily on one style. Ofnote, there was no association between personal canna-bis use and style of engaging with the literature.Effortful engagementWith the first approach, participants became immersedin a methodical sorting through the evidence on canna-bis because they were curious about the topic andwanted to learn. They demonstrated perseverance whengrappling with challenging and unfamiliar materials,Moffat et al. Harm Reduction Journal 2013, 10:34 Page 5 of 9http://www.harmreductionjournal.com/content/10/1/34highlighting articles, making notes, and developing sys-tems for organizing the new information. One youthroutinely read articles twice and was purposeful in herapproach.The first time was sort of to get a feel of it and thesecond time was to pick out key ideas, to pick out wordsthat I didn’t know, to pick out any questions I mighthave about the article … to focus more on bias. (Female,17, non-user).This approach was characterized by enthusiasm forfocused learning about the evidence on cannabis, andcuriosity about the topic selected for their final researchproject.At times, this type of engagement was ephemeral. Forone young man, it occurred in spurts based entirely onhis interest in specific materials. One research article ad-dressed the debate on measurement issues and cannabiswhich had sparked his curiosity. After reading it thor-oughly, he was articulate in sharing his understanding ofthe different points of view represented in the articleand accompanying commentaries. However, his level ofengagement was not sustained when it came to his finalpresentation, reflective of the second style, intermittentengagement, highlighting the ebb and flow of effort ob-served with some participants when tasked with en-gaging with the literature.Intermittent engagementA second style involved a ‘cherry picking’ approach toreading materials on cannabis. Some young peopleclaimed to already have the answer, whereas others ap-peared generally capable but uninterested in investingthe necessary time. This expedient approach was charac-terized by “skimming” the literature, all the while ex-pressing confidence in “knowing what to look for” inorder to “skip through to the important parts”. One par-ticipant elaborated on selecting what to read.I pick out the parts that I find interesting. And I readthose and then I also look through the graphs first be-cause they’re well organized and interesting and I findthe relevant sections of text that actually elaborate onthose graphs…. I can form my own thought process be-cause I’m reading through it in my own way. (Male, 17,occ. MJ use).Based on a superficial and partial read, conclusionswere drawn quickly. Some entered into the literature,determined to find evidence to support what theyalready believed and not pursue that which challengedit. On occasion, errors were made as a result of relyingon this approach.Group outcomesDespite the challenges that all participants experiencedwhen making sense of the scientific evidence oncannabis, collaborative public health messages were cre-ated by participants in Group 2, reflecting language thatwas concrete and direct. There was a palpable sense ofaccomplishment that the group had made sense of someevidence on cannabis.1. It is better to stay abstinent than to suffer thepotential consequences.2. It’s best not to resort to marijuana when life isn’tgoing well. There is always help available.3. Initiating cannabis use before adulthood is a lotmore dangerous than beginning at a later age.4. Marijuana affects everyone differently, bothphysically and mentally. Know what you’re gamblingwith when using marijuana.5. If you do choose to use it, make sure it only impactsyour life and not the lives of others.6. Know your source. There may be more in the dosethan just marijuana.7. The higher the dosage, the more severe theimpairment.8. Know the risks, make informed decisions, useresponsibly.As one young person acknowledged, “Public healthmessaging is focused more and more around knowledgeand making your own decision from this knowledge, andless around scare tactics”. Accordingly, these participantshad created balanced public health messages based ontheir shared knowledge on the topic of cannabis follow-ing a review of the evidence. It is worth noting that theabove public health messages were produced by a groupof young people with a low rate of cannabis use. Nodoubt comparable messages by youth counterparts whouse cannabis regularly would encompass a more permis-sive tone.How participation in this study would informdecision-making about whether or not to use cannabisin the future was not the goal of this study. That said, atthe end of the project, most participants who had notused cannabis conveyed a resolve to “avoid marijuana atall costs”. Participating in this project also influencedself-reflection for several participants who did use can-nabis regularly. As one young man noted, “I now feelmore cautious in my approach to pot”.In keeping with a KT approach, the collaborative,youth-driven public health messages were assembledinto an information brochure, a process which involvedsubstantial input from a Group 2 participant; these re-sources were later made available to youth preventionworkers based in Vancouver high schools. Responses tothese brochures have been positive and, consistent withother KT research projects, demonstrate the enhancedapplicability of findings that result from involving theMoffat et al. Harm Reduction Journal 2013, 10:34 Page 6 of 9http://www.harmreductionjournal.com/content/10/1/34end-users of evidence throughout the entire KT process[26]. One youth worker shared, “I really like the messa-ging” adding “the layout would work really well for thetype of work we do. It gives 8 solid points - great youthvoice quotes, and reminds us what is most important toyouth.... how the message is communicated”. Anotheryouth worker identified how the brochure supports initi-ating critical dialogue on cannabis use, which to date,has been largely absent in schools , adding “it helps thatit's through youth voice and not the usual adult orhealth authority”. Requests for additional brochuresfrom several local high schools have resulted in needingto print additional copies. It also points to the dearth ofculturally relevant materials available on cannabis tosupport balanced dialogue on the topic within schoolsettings. Although no formal evaluation of brochure hasyet occurred, it is clear that the brochure has been a wel-come resource.By project end, participants conveyed continuing en-thusiasm to learn more about cannabis, demonstratingthat their interest in the evidence was alive and well.One young man suggested, “Besides making our ownmessages for teens, I feel that we can use our researchto try and reach out to programs such as D.A.R.E. tohelp them improve their courses”. They expressedappreciation for the opportunity to have engaged inresearch focused on cannabis that had “broadenedknowledge” and “opened their eyes” to the challenges indrawing “definite conclusions”. Attitudinal shifts towardsthe substance were expressed from a position of “strictlyopposed and ignorant” to “more educated” and able to“consider both sides”. And one young man who usedcannabis on a regular basis noted, from here on, hewould be “more careful checking the credibility of facts”.Most were visibly eager to deliver their personal healthmessage and to participate in discussion about a topicthat was perceived as “controversial, misunderstood,demonized” and rarely talked about in a non-judgmentalforum. One young woman proposed, “Just keep the con-versation open… teens love to express themselves giventhe chance”.ConclusionsThere are clear benefits to understanding how youngpeople make sense of the literature on cannabis. Mostyouth in this project were capable of reading scientificliterature, making sense of content and weighing poten-tial risks related to cannabis use. Given the status of thecurrent evidence on cannabis as well as the abundanceand accessibility of information, can we expect youth toreach an unwavering understanding of the associatedrisks? While it is not possible to monitor how youth ac-cess information on cannabis, it is possible to supportthem in the review of credible sources, and in so doing,foster capacity for the critical examination of evidence.Importantly, our study findings point to untapped op-portunities to challenge beliefs on cannabis and encour-age reflection upon possible misunderstandings.The group setting provided an important context thatfacilitated some participants’ understandings of the evi-dence of cannabis, albeit with prominent group dynam-ics at play. There was clearly much value from thediscussion component of the project, a time to reflect onand share understandings of the evidence within thegroup setting. Creating and supporting this environmentwhere youth were able to participate in facilitatedcannabis-related discussion with peers and not be judgedfor held views or personal cannabis practices was wellreceived. Participants were eager to discuss opposing re-search findings, highlighting the pros and cons of canna-bis use, an opportunity that did not exist within theschool setting. Building similar opportunities for in-depth discussion on cannabis to encourage young peopleto think critically about the evidence would foster mean-ingful dialogue.The different approaches applied to making sense ofthe evidence are hardly a surprise given the range inpersonal learning styles and abilities to take in new in-formation. In our study, we intentionally focused onyouth aged 15 and older, recognizing that youngerpeople (i.e. those in Grades 8 and 9) need structure andwould likely have encountered additional challenges withthe demands of the project. Participants were motivatedto make sense of the evidence when they were passion-ate about a specific topic. However, Gasser [27] notesthe double edge sword of knowledge and expertise read-ily available on the internet, specifically “how the ab-sence of traditional gatekeepers engenders a complicatedinformation landscape, capable of facilitating honestexchange and empowerment as well as danger andharm” (p. 40), hence the urgency of taking into consider-ation what information young people are now able touncover. Indeed, this highlights the need to encourageaccess to and support the uptake of credible informationon cannabis.Admittedly language use remains a challenge in publichealth [28]; conveying precise and accurate “risk” infor-mation to youth and adult populations regarding canna-bis is no easy task when much remains unclear [29].Our study findings point to the importance of usingclear and precise terminology. Ambiguity can be off put-ting for young people with the use of terms such as“could” and “may”, perceived to be indicative of a failureto take a stand by some youth in our study. Not surpris-ingly, participants carefully selected simple and directlanguage for their collaborative public health recommen-dations. How the evidence on cannabis translates intopublic health messages, including potential risk deservesMoffat et al. Harm Reduction Journal 2013, 10:34 Page 7 of 9http://www.harmreductionjournal.com/content/10/1/34ongoing attention. Given that proposed “theories” re-garding risk were perceived to undermine certainty, theymay be beyond the comprehension of some youth.Nonetheless, engaging in meaningful discussion aboutand reflecting upon possible risks and theories appearsto contribute to more sophisticated understandings aswas the case for some participants in this study.With regard to researchers engaged in KT activities,our findings reveal that young people are indeed capableand appreciative of the opportunity to engage in KT ac-tivities. Furthermore, given that involving knowledgeusers in the KT process is seen as an important step to-wards enhancing the outcomes of this work, youth mustbe acknowledged and engaged as a central stakeholdergroup, particularly when it concerns evidence for use byyouth populations; young people respond differently toinformation than do adults [23].Finally, project findings revealed how young peoplecan contribute to the public health dialogue on cannabis.Creating accurate and credible public health recommen-dations is undeniably a challenge, yet the youth in ourstudy were able to do so. Currently in Canada, there islittle consensus on appropriate public health messagesfor this illicit yet widely used substance. Recommenda-tions or “Lower risk guidelines” for cannabis use werecreated for adult populations [30] and implicitly foryouth and young adult populations in a “Taking Carewith Cannabis”, brochure [31]; both were written byadults without input from young people. Including youthvoices and perspectives on culturally relevant publichealth recommendations has the potential for reachingthe youth population in a credible fashion. For mostyouth who are recreational cannabis users, cannabis isharmless, a rite of passage that ends as young people set-tle into adults lives and careers [6]. Balanced publichealth dialogue regarding potential risks of cannabisbased on the best evidence must be part of health educa-tion for it to be deemed believable.This study is not without limitations. Most partici-pants were clearly motivated as demonstrated by theirwillingness to participate in an after school activity thatrequired additional reading and project work; most werehigh achievers academically. Given this small sample,our findings are not representative of all youth. Inmany ways, participants reflected the demographics ofVancouver; for some, English was not their first languagewhich may have added a layer of difficulty with compre-hension of some materials. One participant from Group1, who encountered challenges finalizing his researchproject, did not attend the final session and was lost tofollow-up. Gordon [32] notes that in ethnography, datais generated by researchers rather than collected. Obvi-ously, the team could only make observations whenyouth were physically present. Although some researchlogs contained rich data that shed light on makingmeaning of the evidence on cannabis, it was not possibleto observe what transpired when youth were engaged inmaking sense at home.As adults, it is a challenge to understand the perspec-tives of young people. The aim of this study was to at-tempt to understand how young people make sense ofthe evidence on cannabis. Our study findings reveal theabilities of some young people to critically review theevidence and to contribute to public health and harm re-duction messaging. As Reist proposes, health literacy inthe domain of drug education is a resource or asset, anda precursor for healthy action [33]. Adults involved inthe field of public health must not underestimate thecapabilities of young people.AbbreviationsDARE: Drug abuse resistance education; KT: Knowledge translation;B.C.: British Columbia.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsBMM led the conceptualization, design, project coordination, analysis andwriting of this manuscript. EJ participated in coordination of the study,contributed to analysis and interpretation of the data and writing of themanuscript. JJ is the principal study investigator, contributed to theconceptualization, design, analysis and interpretation of the data, and writingof the manuscript. All authors read and approved the final manuscript.AcknowledgementsThis research was supported by funds from Canadian Institute of HealthResearch (CIHR). 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Reist D: Mental health literacy. What does it mean for substance use andwhy does it matter? Visions 2013, 8(2):11–12.doi:10.1186/1477-7517-10-34Cite this article as: Moffat et al.: Weeding out the information: anethnographic approach to exploring how young people make sense ofthe evidence on cannabis. Harm Reduction Journal 2013 10:34.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitMoffat et al. Harm Reduction Journal 2013, 10:34 Page 9 of 9http://www.harmreductionjournal.com/content/10/1/34


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