Objectives

This project aims to:

1. Identify factors associated with problematic Internet use among cannabis users, such as habits surrounding their cannabis consumption and Internet use, use of other psychoactive substances, factors related to mental health, etc.
2. Understand the experience and background of cannabis users with problematic Internet use.

Phase 1: Cross-sectional correlational study

The first phase will constitute a self-reported online questionnaire (n = 1500) via a web panel, which will identify factors associated with problematic Internet use among cannabis users.

Ethics statement

This research project has been ethically and scientifically approved by the Research Ethics Committee and Scientific Evaluation Committee of the Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie—Centre hospitalier universitaire de Sherbrooke (CHUS) on July 19, 2023 (reference number: 2024-5139-CyberD-Cannabis; see S1 and S2 Files). Written consent will be obtained from all participants in this study prior to their participation and participants will be informed of their right to withdraw at any time.

Recruitment and sampling

To be eligible in the study, participants must have used cannabis at least once a week in the past 12 months, be 18 years of age or older, and reside in Quebec. Recruitment will employ probability sampling (i.e., stratified simple random) and will be done by email through a firm specializing in surveys and web panels. The target sample size is 1500 people. Recruitment through the web panels firm, which reaches over 200,000 members in Quebec, will be carried out to ensure that the Quebec population is representative in terms of age, sex and gender, language, and geographic region. This will be done by generating a sample representative of the general Quebec population (according to Statistics Canada) and asking filter questions based on the aforementioned variables to the firm’s participant pool, ultimately identifying our target population. As compensation for their time, participants will receive credits redeemable for cash through the surveys and web panels firm’s website.

Sample size calculation

Sample size (n = 1500) was determined according to the number of participating individuals needed for the development of a regression model composed of 10 variables, i.e., 10 participants per variable [23], with enough statistical power (0.8) and able to detect a relatively small effect size (0.11) in the relationship between cannabis use and Internet use [24]. This sample size will also allow us to obtain a congruent sample size for phase 2 of the study (n = 45) based on participant measurements of Internet addiction and the estimated prevalence of problematic Internet use (6 to 15%) [14,25].

Data collection

Data will be collected through a bilingual (French and English) online questionnaire. The questionnaire, composed of validated tools in English and French, will be divided into 5 sections: 1) Sociodemographic profile; 2) Cannabis and other psychoactive substance use profile; 3) Internet use profile; 4) Link between cannabis use and Internet use and impacts; 5) Mental health profile. A pre-test will be conducted with 30 people during the month preceding the launch of the questionnaire. At the end of the questionnaire, people will be asked to indicate their interest in participating in phase 2 of the study.

Variables and measurement instruments

Data analysis

Descriptive analyses will be used to depict the characteristics of the individuals participating in the study and to create a profile of their cannabis and Internet use. In order to meet objective 1, multivariate logistic regression models will be used to identify variables that predispose to problematic Internet use (independent variables: e.g., age, sex, gender, marital status, employment, substance use (alcohol, drugs, etc.), characteristics associated with cannabis use (frequency, method of use, type of product, age of initiation, quantity consumed, etc.), characteristics of Internet use (type of use, time of use, frequency of use, etc.), PHQ-9 score (depressive symptoms), GAD-7 score (anxiety symptoms), etc.) as a function of IAT score (dependent variable—continuous type) [40,41]. Odds ratios will also be reported. Descriptive analyses and regression models will be performed with SPSS ® software.

Phase 2: Descriptive qualitative study

In phase 2, semi-structured interviews will be used (n = 45) to better understand the experience and background of cannabis users with probable problematic Internet use [42,43].

Recruitment and sampling

Inclusion criteria to participate in the semi-structured interviews are 1) have participated in Phase 1 of the study, 2) have agreed to be contacted for Phase 2, and 3) present a problematic use of the Internet, according to IAT score during Phase 1, i.e., a score greater than 50 [25]. Sampling will be targeted and with maximum variation [44] using the following criteria: age, sex, gender, and region of residence. This will allow for the study and understanding of the experience and background of cannabis users with problematic Internet use according to different profiles. Three groups of 15 individuals will be recruited (n = 45): 1) individuals with probable cannabis use disorder (CAST Score > 8); 2) individuals who use cannabis regularly (i.e., 1–6 days per week); 3) individuals who use cannabis daily (i.e., every day) without probable cannabis use disorder [27].

Recruitment will be conducted by members of the research team via email from the list of participating individuals who have agreed to be contacted for Phase 2 and meet the inclusion criteria. Individuals who do not respond to the invitation will be contacted again after 7 days by telephone. A gift card (e.g., grocery store, pharmacy) worth $50 will be given to each participant as compensation for their time.

Data collection

Semi-structured interviews (60 to 90 minutes) will be conducted in French or English. They will be conducted in person or virtually, depending on the participant’s preference, and the research team’s availability. The interviews will be conducted by two team members with expertise in qualitative methods and experience in semi-structured interviews.

As expected in a sequential explanatory design, the results of phase 1 will help guide the sampling and the development of the semi-structured interview guide for phase 2 and identify areas requiring further investigation (e.g., links between cannabis use and Internet use and its impacts) [45]. The interview guide, which will be pre-tested on a sample of five individuals, will be structured to better understand the experience and background of cannabis users with probable problematic Internet use [44,46]. Open-ended questions will be used to explore the dynamics of use and to understand how cannabis use relates to their daily lives (interpersonal relationships, work, study, etc.) as well as to their overall mental health. The interviews will be recorded in digital audio format and then transcribed verbatim and anonymized.

Data analysis

An inductive and deductive thematic analysis based on the "agent-host-environment" theoretical framework [19] will be carried out [44]. The transcription of the interviews will first be independently coded and classified by themes by two members of the research team. These themes will then be grouped into similar groups to create a thematic tree structure. The team will carry out iterative analysis phases to ensure a thorough understanding of the analysis content and coding process, as well as to establish a shared comprehension of the context and data being studied [21]. This iterative process will allow for the triangulation of team members’ expertise (medical, psychological, etc.) and knowledge. Recruitment will be done following a data saturation grid and will be carried out until the data are saturated [47]. Once the iterative coding is complete, the team will present their findings and proposals, supported by qualitative data and emerging themes, to address the second objective of the project. NVivo ® software will be used for all qualitative data analysis.

Integration phase

An integration phase will be conducted after both phases of the project. Matrices, diagrams, graphs, and tables will be created to integrate quantitative and qualitative data [45,51].

A co-construction workshop will be carried out to formulate courses of action using the Technique de Recherche d’Informations par Animation d’un Groupe Expert (Technique of Information Retrieval by Animation of a Group of Experts, TRIAGE Method) [52,53]. This workshop, conducted with members of the project’s steering committee, will provide valuable insights for the development of effective strategies to mitigate the negative impacts of cannabis and problematic Internet use. The TRIAGE method includes four stages: 1) preparation; 2) individual production; 3) compilation; and 4) collective production. The preparation phase will be carried out by members of the research team [53]. To support the deliberation of the participating individuals, the matrices, diagrams, graphs, and tables produced during the integration phase will be distributed in order to present the quantitative and qualitative data of the study in an integrated manner during the individual production phase [45]. During this phase, participants will be invited to formulate and reflect on priority courses of action aimed at preventing and reducing the harms associated with cannabis use and problematic Internet use, considering the results of the study. This information will then be transmitted to the members of the research team who will compile the responses in preparation for the collective production phase. This next phase will make it possible to select, by consensus, the courses of action to be prioritized according to the sex and gender of people who use cannabis and have problematic Internet use [53]. At the end of this workshop, key messages for all groups that will benefit from the project (people who use cannabis and the Internet, partners in the call for proposals, decision-makers, practice settings, the general public, scientists, etc.) will also be developed in collaboration with the steering committee.

Anticipated benefits

This study has many strengths. To our knowledge, this is the first mixed-methods study of cannabis use and problematic Internet use in Quebec and internationally. It will identify factors associated with problematic Internet use among cannabis users and better understand the experience and background of cannabis users with problematic Internet use. The data collected will be essential for the development of effective public policies in line with the needs of the population studied and the stakeholders in the field. This study is also distinguished by its strong partnership component. It includes a steering committee made up of stakeholders in the field who will be involved in all phases of the study to ensure that the project is in line with the needs of the stakeholders and to achieve an integrated mobilization of knowledge throughout the project (see Knowledge Mobilization). Ultimately, this study will have considerable concrete benefits at different levels.

This will be one of the first studies at the international level to specifically address the risks associated with cannabis use and problematic Internet use in the general adult population. The mixed-methods design will make it possible to identify the factors associated with problematic Internet use among cannabis users and to better understand the experience of people affected by this problem, which is fundamental to the development of interventions for this population.

In line with the guiding principles of the PAID, this study will support the development of public policies by formulating courses of action to contribute to the prevention and reduction of harm associated with cannabis use and problematic Internet use by informing, raising awareness, and supporting decision-makers and managers. Call for proposal meetings with partners, including the Quebec Ministry of Health and Social Services (MSSS) will ensure that the needs of the parties involved are met and that measures are identified to facilitate the implementation of measures resulting from the project.

This study will contribute to training the next generation of research students (at the undergraduate, master’s, and doctorate levels). We will offer various possibilities (summer internships, part-time employment, thesis, etc.) to involve them in all phases of the project and familiarize them with this type of research project including a strong partnership component. Furthermore, the results of this project will educate the public about the harms associated with cannabis use and problematic Internet use (see Knowledge Mobilization section) and contribute to prevention and harm reduction in this area.

Ultimately, the project will have various effects. A few examples of how the results could be applied by the various stakeholders at the end of the project include awareness campaigns (traditional and social media) on the harms associated with cannabis use and Internet use in collaboration with the MSSS, implementation of online visual messages aimed at raising awareness among cannabis users (e.g., social networks, Société Québécoise du cannabis (SQDC) website, etc.), the adaptation of interventions measures based on sex and gender for people who use cannabis and have a problematic Internet use, etc. The net goal is for this study to be a first step towards the implementation of concrete measures aimed at preventing and reducing harms associated with problematic Internet use among cannabis users.

Knowledge mobilization

Knowledge mobilization for this project will be achieved through an integrated co-construction action plan via the involvement of stakeholders sitting on the project steering committee. This plan will be oriented towards large-scale dissemination in Quebec, in Canada, and internationally, in collaboration with our partners. The knowledge mobilization plan will include different activities and aims to highlight and disseminate the results of the project to five (5) target populations: decision-makers, managers, and partners of the call for proposals; practitioners and practice settings; the general public (including people who use cannabis and the Internet as well as their relatives); the scientific community; and the student community. Knowledge mobilization activities include reports at the end of each phase of the study for stakeholders, an online training session centered around the themes of the study open to all students and workers of the labor market, dissemination of educational material adapted to the general public, participation in national and international research conferences and publication of results in scientific journals.

Limitations

Conducting a study of this type involves certain challenges. The main challenge is the number of participants to be recruited. In aims to facilitate recruitment, a firm specializing in surveys and web panels will allow us to recruit a random sample of participants (N = 1500). Given that our study is interested in people who use cannabis and use the Internet, recruitment via a web panel (including only people with access to the Internet), is appropriate in this context and poses fewer challenges in terms of representativeness. Participants invited to participate in Phase 2 of the study will be recruited from this pool. The second challenge is the collection of self-reported data during the cross-sectional portion of the study. By answering the questionnaire, participants could, for example, minimize certain habits or symptoms, i.e., a social desirability bias. To minimize this bias, we will mainly use validated scales during the quantitative phase of the study. A third challenge will be to carry out the qualitative phase. This phase will generate a significant amount of data. To do so, we will use various tools including NVivo software and benefit, as in phase 1 where SPSS software will be used, from the combined expertise of the team members. Finally, in aims to foster a caring environment for the project, all team members and members of the steering committee will attend a workshop on unconscious bias in research as well as equity, diversity, and inclusion.