Abstract
Laws regarding cannabis are rapidly changing in the USA as more states legalize nonmedical cannabis for adults aged 21 and older. Previous research has examined whether legalization has led to an increase in cannabis use as well as the use of other substances. The current study examined changes in cannabis- and alcohol-specific risk factors following legalization of nonmedical cannabis. We used 6 years of annual cross-sectional data (2014–2019) from 12,951 young adults age 18 to 25 who resided in Washington state. Risk factors examined include perceiving that use was common among same-age peers, believing use was acceptable, having easy access, and low perceived physical and psychological harm from use. Logistic regression models estimated annual rate of increase in these risk factors. All cannabis-specific risk factors increased among those aged 21+ (range of ORs for annual rate of change: 1.07–1.31) while significant increase in cannabis-related risk factors among those under age 21 was limited to perceptions of cannabis use being common (medical use: OR=1.08, 95% CI: 1.03, 1.12; nonmedical use: OR=1.13, 95% CI: 1.08, 1.18) and low perceived physical harm of occasional use (OR=1.08, 95% CI: 1.03, 1.13). Although descriptive norms for past-year use of alcohol among those aged 21+ increased (OR = 1.09, 95% CI: 1.02, 1.17), other risk factors for alcohol did not change significantly or, in the case of low perceived physical and psychological harm, decreased among both those under age 21 and those aged 21+ (range of ORs = 0.90–0.94). Given these findings show an increase in cannabis-specific risk factors since legalization was implemented, particularly among those young adults aged 21+, preventive interventions correcting risk misperceptions and related risk factors among young adults aged 21+ may prove efficacious in reducing use and resultant negative consequences.
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References
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl, & J. Beckmann (Eds.), Action control. SSSP Springer series in social psychology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-69746-3_2
Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (1998). Explaining recent increases in students’ marijuana use: Impacts of perceived risks and disapproval, 1976 through 1996. American Journal of Public Health, 88, 887–892. https://doi.org/10.2105/AJPH.88.6.887
Bertholet, N., Faouzi, M., Studer, J., Daeppen, J. B., & Gmel, G. (2013). Perception of tobacco, cannabis, and alcohol use of others is associated with one’s own use. Addiction science & clinical practice, 8, 1–9. https://doi.org/10.1186/1940-0640-8-15
Borsari, B., & Carey, K. B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13, 391–424. https://doi.org/10.1016/S0899-3289(01)00098-0
Buckner, J. D. (2013). College cannabis use: The unique roles of social norms, motives, and expectancies. Journal of studies on alcohol and drugs, 74(5), 720-726. https://doi.org/10.15288/jsad.2013.74.720
Carlini, B., Firth, C., & Garrett, S. (Eds.) (2020). Cannabis concentration and health risks: A report for the Washington state prevention research subcommittee (PRSC). Available at: https://adai.uw.edu/wordpress/wp-content/uploads/2020/11/Cannabis-Concentration-and-Health-Risks-2020.pdf
Cash, M. C., Cunnane, K., Fan, C., & Romero-Sandoval, E. A. (2020). Mapping cannabis potency in medical and recreational programs in the United States. PLoS ONE, 15, e0230167. https://doi.org/10.1371/journal.pone.0230167
Catalano, R. F., Fagan, A. A., Gavin, L. E., Greenberg, M. T., Irwin, C. E., Jr., Ross, D. A., & Shek, D. T. (2012). Worldwide application of prevention science in adolescent health. Lancet (London, England), 379, 1653–1664. https://doi.org/10.1016/S0140-6736(12)60238-4
Catalano, R. F., Haggerty, K. P., Hawkins, J. D., & Elgin, J. (2011). Prevention of substance use and substance use disorders: The role of risk and protective factors. In Y. Kaminer & K. C. Winters (Eds.), Clinical manual of adolescent substance abuse treatment (pp. 25–63). American Psychiatric Publishing.
Catalano, R. F., Speaker, E. C., Skinner, M. L., Bailey, J. A., Hong, G., Haggerty, K. P., et al. (2018). Risk and protective factors for adolescent marijuana use. In K. C. Winters & K. A. Sabet (Eds.), Contemporary health issues on marijuana (pp. 219–235). Oxford University Press.
Darnell, A. J. (2020). Review of scientific evidence on effects of medical and non-medical marijuana legalization on public health in the United States. French Monitoring Center for Drugs and Drug Addiction.
Darnell, A. J., Hirsch, M., & Wanner, P. (2019). Suppressing illicit cannabis markets after state marijuana legalization. (Document Number 19- 08-3201). Olympia: Washington State Institute for Public Policy.
Dotson, K. B., Dunn, M. E., & Bowers, C. A. (2015). Stand-alone personalized normative feedback for college student drinkers: A meta-analytic review, 2004 to 2014. PloS one, 10, e0139518. https://doi.org/10.1371/journal.pone.0139518
Fischer, B., Robinson, T., Bullen, C., Curran, V., Jutras-Aswad, D., Medina-Mora, M. E., Pacula, R. L., Rehm, J., van den Room, R., Brink, W., & Hall, W. (2021). Lower-risk cannabis use guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. International Journal of Drug Policy. https://doi.org/10.1016/j.drugpo.2021.103381
Fleming, C. B., Guttmannova, K., Cambron, C., Rhew, I. C., & Oesterle, S. (2016). Examination of the divergence in trends for adolescent marijuana use and marijuana-specific risk factors in Washington State. Journal of Adolescent Health, 59, 269–275. https://doi.org/10.1016/j.jadohealth.2016.05.008
Fleming, C. B., Ramirez, J. J., Rhew, I. C., Hultgren, B. A., Hanson, K. G., Larimer, M. E., & Guttmannova, K. (2022). Trends in alcohol, cigarette, e-cigarette, and nonprescribed pain reliever use among young adults in Washington State after legalization of nonmedical cannabis. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2022.03.006
Guttmannova, K., Jones, A. A., Johnson, J. K., Oesterle, S., Johnson, R. M., & Martins, S. S. (2019). Using existing data to advance knowledge about adolescent and emerging adult marijuana use in the context of changes in marijuana policies. Prevention Science, 20, 291–299. https://doi.org/10.1007/s11121-019-00991-w
Guttmannova, K., Lee, C. M., Kilmer, J. R., Fleming, C. B., Rhew, I. C., Kosterman, R., & Larimer, M. E. (2016). Impacts of changing marijuana policies on alcohol use in the United States. Alcoholism: Clinical and Experimental Research, 40, 33–46. https://doi.org/10.1111/acer.12942
Guttmannova, K., Skinner, M. L., Oesterle, S., White, H. R., Catalano, R. F., & Hawkins, J. D. (2019). The interplay between marijuana-specific risk factors and marijuana use over the course of adolescence. Prevention Science, 20, 235–245. https://doi.org/10.1007/s11121-018-0882-9
Hall, W., & Lynskey, M. (2016). Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction, 111, 1764–1773. https://doi.org/10.1111/add.13428
Hammond, D., Goodman, S., Wadsworth, E., Rynard, V., Boudreau, C., & Hall, W. (2020). Evaluating the impacts of cannabis legalization: The international cannabis policy study. International Journal of Drug Policy, 77, 102698. https://doi.org/10.1016/j.drugpo.2020.102698
Hanson, D. J. (1982). The effectiveness of alcohol and drug education. Journal of Alcohol and Drug Education, 27, 1–13.
Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64–105. https://doi.org/10.1037/0033-2909.112.1.64
Johnson, R. M., & Guttmannova, K. (2019). Marijuana use among adolescents and emerging adults in the midst of policy change: Introduction to the special issue. Prevention Science, 20(2), 179–184. https://doi.org/10.1007/s11121-019-0989-7
Kilmer, J. R., Rhew, I. C., Guttmannova, K., Fleming, C. B., Hultgren, B., Gilson, M. S., Cooper, R. L., Dilley, J., & Larimer, M. E. (2022). Cannabis use among young adults in Washington state after legalization of nonmedical cannabis. American Journal of Public Health, 112, 638–645.
Kilmer, J.R., Walker, D.D., Lee, C.M., Palmer, R.S., Mallett, K.A., Fabiano, P., & Larimer, M.E. (2006). Misperceptions of college student marijuana use: Implications for prevention. Journal of Studies on Alcohol, 67, 277–281. https://doi.org/10.15288/jsa.2006.67.277
Koval, A. L., Kerr, D. C. R., & Bae, H. (2019). Perceived prevalence of peer marijuana use: Changes among college students before and after Oregon recreational marijuana legalization. The American Journal of Drug and Alcohol Abuse, 45, 392–399. https://doi.org/10.1080/00952990.2019.1599381
National Conference of State Legislatures [NCSL]. (2022). State medical marijuana laws. Retrieved October 18, 2018, From https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed 26 January 2022.
Neighbors, C., Geisner, I. M., & Lee, C. M. (2008). Perceived marijuana norms and social expectancies among entering college student marijuana users. Psychology of Addictive Behaviors, 22, 433. https://doi.org/10.1037/0893-164X.22.3.433
Office of Financial Management. (2015). Washington State privatization of liquor: The impact of Initiative 1183. Office of Financial Management. https://www.ofm.wa.gov/sites/default/files/public/legacy/fiscal/pdf/liquor_privatization_initiative1183.pdf
Perkins, H. W., Meilman, P. W., Leichliter, J. S., Cashin, J. R., & Presley, C. A. (1999). Misperceptions of the norms for the frequency of alcohol and other drug use on college campuses. Journal of American College Health, 47, 253–258. https://doi.org/10.1080/07448489909595656
Schulenberg, J. E., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Miech, R. A. & Patrick, M. E. (2020). Monitoring the Future national survey results on drug use, 1975–2019: Volume II, College students and adults ages 19–60. Ann Arbor: Institute for Social Research, The University of Michigan. Available at https://www.monitoringthefuture.org/pubs.html#monographs
Schulenberg, J. E., Patrick, M. E., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Miech, R. A. (2021). Monitoring the Future national survey results on drug use, 1975–2020: Volume II, College students and adults ages 19–60. Ann Arbor: Institute for Social Research, The University of Michigan. Available at https://www.monitoringthefuture.org/pubs.html#monographs
Scribner, R.A., Theall, K.P., Mason, K., Simonsen, N., Schneider, S.K., Towvim, L.G., & DeJong, W. (2011). Alcohol prevention on college campuses: The moderating effect of the alcohol environment on the effectiveness of social norms marketing campaigns. Journal of Studies on Alcohol and Drugs, 72, 232-239. https://doi.org/10.15288/jsad.2011.72.232
Smart, R., & Pacula, R. L. (2019). Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations. The American journal of drug and alcohol abuse, 45, 644–663. https://doi.org/10.1080/00952990.2019.1669626
Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved January 31, 2021, from https://www.samhsa.gov/data/.
Turel, O. (2020). Perceived ease of access and age attenuate the association between marijuana ad exposure and marijuana use in adolescents. Health Education & Behavior, 47(2), 311–320. https://doi.org/10.1177/1090198119894707
Wu, L. T., Swartz, M. S., Brady, K. T., Hoyle, R. H., & Workgroup, N. A. (2015). Perceived cannabis use norms and cannabis use among adolescents in the United States. Journal of psychiatric research, 64, 79–87. https://doi.org/10.1016/j.jpsychires.2015.02.022
Acknowledgements
This research was supported by the National Institute on Drug Abuse grant R01DA047996-01 awarded to Katarina Guttmannova and T32AA007455. Partial support for this research also came from a Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure grant, P2C HD042828, to the Center for Studies in Demography and Ecology at the University of Washington. Data used in these analyses were from the Washington state Young Adult Health Survey, funded by a contract awarded to Jason Kilmer from Washington’s Division of Behavioral Health and Recovery (DBHR) within the Health Care Authority (HCA). The content of this research is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
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Gilson, M.S., Kilmer, J.R., Fleming, C.B. et al. Substance-Specific Risk Factors for Cannabis and Alcohol Use Among Young Adults Following Implementation of Nonmedical Cannabis Legalization. Prev Sci 24, 1047–1057 (2023). https://doi.org/10.1007/s11121-022-01435-8
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DOI: https://doi.org/10.1007/s11121-022-01435-8