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Having friends who use cannabis is a strong risk factor for initiation, but the mechanisms underlying this relationship are unclear. This study examined the role of perceived ease of access to cannabis in the association between close friends' cannabis use and cannabis initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational longitudinal investigation using data from the COMPASS study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A convenience sample of 11 high schools in Qu\u00e9bec, Canada, from 2017 to 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1768 students who had not initiated cannabis use before 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Having \u22651 close friend who uses cannabis and perceived ease of access to cannabis were measured in 2018, while cannabis initiation in the past 12\u2009months was assessed in 2019. Covariates measured in 2017 included sociodemographic factors, substance use history, lifestyle behaviors and school\u2010related variables. We compared the risk of cannabis initiation across groups defined jointly by friends' cannabis use and perceived access. Generalised estimating equations with bootstrap resampling, inverse probability weighting for attrition and multiple imputation for missing data were used to estimate these associations. Natural effect models were then applied to estimate total, direct and indirect effects with initiation as the outcome and perceived access as the mediator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Within the COMPASS cohort, 14% of cannabis\u2010naive adolescents in 2018 initiated use in 2019. Using students with no close friends who use cannabis and who perceive access as difficult as the reference group, the risk difference (RD) for having at least one friend who uses cannabis while still perceiving access as difficult was 3.2 [95% confidence interval (CI) = \u22123.8 to 10.2]. Perceiving access as easy but having no friends who use cannabis yielded an RD of 8.4 (95% CI = 3.0\u201313.7). Friends' cannabis use combined with easy access acted synergistically, producing an RD of 21.6 (95% CI = 15.5\u201327.7). According to the natural effect models, perceived ease of access mediated about 39% of the association between having \u22651 close friend who uses cannabis and subsequent initiation, suggesting a possible explanatory pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Canada, cannabis initiation risk appears to be highest among adolescents with both exposure to close friends who use cannabis and perceived easy access. Perceived access may help explain part of this association. Preventive strategies should address the influence of friends and accessibility through school policies, public education and stricter enforcement of access restrictions to delay adolescent cannabis use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70490","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:01:15Z","timestamp":1781150475000},"page":"2757-2767","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of perceived access to cannabis in the association between friends who use cannabis and adolescent initiation: A longitudinal analysis from the Canadian COMPASS study"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5803-4615","authenticated-orcid":false,"given":"Marie\u2010Pierre","family":"Sylvestre","sequence":"first","affiliation":[{"name":"Department of Social and Preventive Medicine Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Centre de recherche du centre hospitalier de l'Universit\u00e9 de Montr\u00e9al (CRCHUM)  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Boulanger","sequence":"additional","affiliation":[{"name":"Centre de recherche du centre hospitalier de l'Universit\u00e9 de Montr\u00e9al (CRCHUM)  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4118-9412","authenticated-orcid":false,"given":"Annie","family":"Pelekanakis","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Centre de recherche du centre hospitalier de l'Universit\u00e9 de Montr\u00e9al (CRCHUM)  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mounia","family":"Naja","sequence":"additional","affiliation":[{"name":"Centre de recherche du centre hospitalier de l'Universit\u00e9 de Montr\u00e9al (CRCHUM)  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9033-7368","authenticated-orcid":false,"given":"Guillaume","family":"Dub\u00e9","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Dor\u00e9","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Centre de recherche du centre hospitalier de l'Universit\u00e9 de Montr\u00e9al (CRCHUM)  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"School of Kinesiology and Physical Activity Sciences, Faculty of Medicine Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E.","family":"B\u00e9langer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Pediatrics Universit\u00e9 Laval  Qu\u00e9bec City Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slim","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine Universit\u00e9 Laval  Qu\u00e9bec City Qu\u00e9bec Canada"},{"name":"VITAM\u2014Centre de recherche en sant\u00e9 durable  Qu\u00e9bec City Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott T.","family":"Leatherdale","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences, Faculty of Health University of Waterloo  Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Government of Canada.Canadian Cannabis survey 2022: Summary. 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