Adolescent Marijuana Use, Marijuana-Related Perceptions, and Use of Other Substances Before and After Initiation of Retail Marijuana Sales in Colorado (2013–2015)

  • Ashley Brooks-Russell
  • Ming Ma
  • Arnold H. Levinson
  • Leo Kattari
  • Tom Kirchner
  • Erin M. Anderson Goodell
  • Renee M. Johnson


Due to the recentness of changes to marijuana policies in a number of states, the effect on adolescent use and perceptions is not yet well understood. This study examines change in adolescent marijuana use and related perceptions in Colorado, before and after the implementation of legal commercial sale of recreational marijuana for adults starting on January 1, 2014. The data are from a repeated cross-sectional survey of a representative sample of Colorado high school students, with separately drawn samples surveyed in fall 2013 (prior to implementation) and fall 2015 (18 months after implementation). We examined change in the prevalence of adolescent marijuana use, measured by lifetime use, past 30-day use, frequent use, and use on school property. To consider the possibility of heterogeneity in the change in marijuana use, we examined change in past 30-day marijuana use by demographic characteristics (sex, grade, race/ethnicity), school characteristics (poverty, percent minority), urbanicity of the school district, and whether the city or county permitted retail marijuana stores. There was an absence of significant effects for change in lifetime or past 30-day marijuana use. Among those reporting past 30-day use, frequent use and use on school property declined. There was a significant decline in the perceived harm associated with marijuana use, but we did not find a significant effect for perceived wrongfulness, perceived ease of access, or perceived parental disapproval. We did not find significant variability in past 30-day use by demographic characteristics or by school and community factors from 2013 to 2015. We did not find a significant effect associated with the introduction of legal sales of recreational marijuana to adults in Colorado on adolescent (illegal) use, but ongoing monitoring is warranted, including consideration of heterogeneity in the effects of marijuana policies.


Adolescent Substance use Marijuana/cannabis Policy evaluation Risk behaviors Surveillance 



Data used for this study were collected under contracts with the Colorado Department of Public Health and Environment (CDPHE; Arnold H. Levinson and Ashley Brooks-Russell, principal investigators). This work was supported by several National Institutes of Health grants (K01DA031738l, Johnson; T32DA007292, Goodell).

Compliance with Ethical Standards


The content is solely the responsibility of the authors and does not necessarily reflect the official views of the NIH.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Colorado Multiple Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Colorado Multiple Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The data collection for this study was approved as exempt, which included a waiver of written parental consent and student assent. Student participation in data collection was voluntary and no personal identifiers were collected. Parents were notified in writing at least 2 weeks in advance of data collection and could opt out their child from data collection. Students were instructed that they could skip questions or chose not to complete the survey.


  1. Cantrell, J., Anesetti-Rothermel, A., Pearson, J., Haijun Xiao, M. S., & Kirchner, T. R. (2014). The impact of tobacco retail outlet concentration on adult cessation attitudes and behaviors and differences by neighborhood socioeconomic status. Addiction, 110, 152–161.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Cantrell, J., Pearson, J., Anesetti-Rothermel, A., Haijun Xiao, M., Vallone, D., & Kirchner, T. R. (2015). Tobacco retail outlet density and young adult tobacco initiation. Nicotine and Tobacco Research, 18, 130–137.CrossRefPubMedGoogle Scholar
  3. Carliner, H., Brown, Q. L., Sarvet, A. L., & Hasin, D. S. (2017). Cannabis use, attitudes, and legal status in the U.S.: A review. Preventive Medicine, 104, 13–23.Google Scholar
  4. Cerda, M., Wall, M., Feng, T., Keyes, K. M., Sarvet, A., Schulenberg, J., & Hasin, D. S. (2016). Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatrics, 171(2), 142–149.Google Scholar
  5. Choo, E. K., Benz, M., Zaller, N., Warren, O., Rising, K. L., & McConnell, K. J. (2014). The impact of state medical marijuana legislation on adolescent marijuana use. Journal of Adolescent Health, 55, 160–166.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. Freisthler, B., & Gruenewald, P. J. (2014). Examining the relationship between the physical availability of medical marijuana and marijuana use across fifty California cities. Drug and Alcohol Dependence, 143, 244–250.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Grucza, R. A., Agrawal, A., Krauss, M. J., Bongu, J., Plunk, A. D., Cavazos-Rehg, P. A., & Bierut, L. J. (2016). Declining prevalence of marijuana use disorders among adolescents in the United States, 2002 to 2013. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 487–494.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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.Google Scholar
  10. Hasin, D. S., Wall, M., Keyes, K. M., Cerdá, M., Schulenberg, J., O’Malley, P. M., et al. (2015). Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: Results from annual, repeated cross-sectional surveys. The Lancet Psychiatry, 2, 601–608.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Joffe, A. (2017). Understanding the full effect of the changing legal status of marijuana on youth: Getting it right. JAMA Pediatrics, 171, 115–116.CrossRefPubMedGoogle Scholar
  12. Johnson, J. K., Johnson, R. M., Hodgkin, D., Jones, A. A., Matteucci, A. M., & Harris, S. K. (2017). Heterogeneity of state medical marijuana laws and adolescent recent use of alcohol and marijuana: Analysis of 45 states, 1991–2011. Substance Abuse, 1–8.
  13. Johnson, R. M., Brooks-Russell, A., Ma, M., Fairman, B. J., Tolliver Jr, R. L., & Levinson, A. H. (2016). Usual modes of marijuana consumption among high school students in Colorado. Journal of Studies on Alcohol and Drugs, 77, 580–588.Google Scholar
  14. Johnson, R. M., Fairman, B., Gilreath, T., Xuan, Z., Rothman, E. F., Parnham, T., & Furr-Holden, C. D. M. (2015). Past 15-year trends in adolescent marijuana use: Differences by race/ethnicity and sex. Drug and Alcohol Dependence, 155, 8–15.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Johnson, R. M., Fleming, C. B., Cambron, C., Dean, L. T., Brighthaupt, S., & Guttmannova, K. (2018). Race/ethnicity differences in trends of marijuana, cigarette, and alcohol use among 8th, 10th, and 12th graders in Washington State, 2004–2016. Prevention Science.
  16. Johnston, L. D., Bachman, J. G., O’Malley, P. M., & Schulenberg, J. E. (2016). Monitoring the Future: A continuing study of american youth (12th-Grade Survey), 2016. Retrieved from
  17. Kann, L., McManus, T., Harris, W. A., Shanklin, S., Flint, K. H., Hawkins, J., et al. (2016). Youth risk behavior surveillance—United States, 2015. MMWR CDC Surveill Summary, 65, 1–174.Google Scholar
  18. Keyes, K. M., Wall, M., Cerdá, M., Schulenberg, J., O’Malley, P. M., Galea, S., et al. (2016). How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991–2014. Addiction, 111, 2187–2195.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Kirchner, T. R., Anesetti-Rothermel, A., Gao, H., Bennett, M., Carlos, H., Scheuermann, S. S., et al. (2016). Tobacco outlet density and converted versus native nondaily tobacco use in a national US sample. Tobacco Control, 26(1), 85–91.Google Scholar
  20. Kirchner, T. R., Villanti, A., Cantrell, J., Anesetti-Rothermel, A., Ganz, O., Conway, K., ... Abrams, D. (2014). Tobacco retail outlet advertising practices and proximity to schools, parks and public housing affect Synar underage sales violations in Washington, D.C. Tobacco Control.Google Scholar
  21. Martins, S. S., Mauro, C. M., Santaella-Tenorio, J., Kim, J. H., Cerda, M., Keyes, K. M., & Wall, M. (2016). State-level medical marijuana laws, marijuana use and perceived availability of marijuana among the general US population. Drug and Alcohol Dependence, 169, 26–32.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Mauro, C. M., Newswanger, P., Santaella-Tenorio, J., Mauro, P. M., Carliner, H., & Martins, S. S. (2017). Impact of medical marijuana laws on state-level marijuana use by age and gender, 2004–2013. Prevention Science.Google Scholar
  23. McGinty, E. E., Niederdeppe, J., Heley, K., & Barry, C. L. (2017). Public perceptions of arguments supporting and opposing recreational marijuana legalization. Preventive Medicine, 99, 80–86.CrossRefPubMedGoogle Scholar
  24. McGinty, E. E., Samples, H., Bandara, S. N., Saloner, B., Bachhuber, M. A., & Barry, C. L. (2016). The emerging public discourse on state legalization of marijuana for recreational use in the US: Analysis of news media coverage, 2010–2011. Preventive Medicine, 90, 114–120.CrossRefPubMedGoogle Scholar
  25. Miech, R. A., Johnston, L., O’Malley, P. M., Bachman, J. G., Schulenberg, J., & Patrick, M. E. (2015). Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: The case of California 2007–2013. International Journal of Drug Policy, 26, 336–344.CrossRefPubMedGoogle Scholar
  26. National Center for Education Statistics. (2017). Common core of data. Retrieved from
  27. National Conference of State Legislatures. (2017). Marijuana laws. Retrieved from Accessed 17 July 2018
  28. National Student Clearinghouse Research Center. (2015). High School Benchmarks 2015: National College Progression Rates. Retrieved from Herndon: National Student Clearinghouse.
  29. Rao, J. N. K., & Scott, A. J. (1987). On simple adjustments to chi-square tests with sample survey data. Annals of Statistics, 15, 385–397.CrossRefGoogle Scholar
  30. Rusby, J. C., Westling, E., Crowley, R., & Light, J. M. (2017). Legalization of recreational marijuana and community sales policy in Oregon: Impact on adolescent willingness and intent to use, parent use, and adolescent use. Psychology of Addictive Behaviors. Google Scholar
  31. Salas-Wright, C. P., Oh, S., Goings, T. C., & Vaughn, M. G. (2017). Trends in perceived access to marijuana among adolescents in the United States: 2002–2015. Journal of Studies on Alcohol and Drugs, 78, 771–780.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Salas-Wright, C. P., Vaughn, M. G., Todic, J., Córdova, D., & Perron, B. E. (2015). Trends in the disapproval and use of marijuana among adolescents and young adults in the United States: 2002–2013. The American Journal of Drug and Alcohol Abuse, 41, 392–404.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Schuermeyer, J., Salomonsen-Sautel, S., Price, R. K., Balan, S., Thurstone, C., Min, S. J., & Sakai, J. T. (2014). Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003–11. Drug and Alcohol Dependence, 140, 145–155.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Shi, Y. (2016). The availability of medical marijuana dispensary and adolescent marijuana use. Preventive Medicine, 91, 1–7.CrossRefPubMedGoogle Scholar
  35. Shi, Y., Meseck, K., & Jankowska, M. M. (2016). Availability of medical and recreational marijuana stores and neighborhood characteristics in Colorado. Journal of Addiction.
  36. Snyder, T., & Musu-Gillette, L. (2015). Free or reduced price lunch: A proxy for poverty? Retrieved from
  37. Terry-McElrath, Y. M., O’Malley, P. M., Patrick, M. E., & Miech, R. A. (2017). Risk is still relevant: Time-varying associations between perceived risk and marijuana use among US 12th grade students from 1991 to 2016. Addictive Behaviors, 74, 13–19.CrossRefPubMedGoogle Scholar
  38. Thrul, J., Pabst, A., & Kraus, L. (2016). The impact of school nonresponse on substance use prevalence estimates—Germany as a case study. International Journal of Drug Policy, 27, 164–172.CrossRefPubMedGoogle Scholar
  39. Wu, L. T., Swartz, M. S., Brady, K. T., & Hoyle, R. H. (2015). Perceived cannabis use norms and cannabis use among adolescents in the United States. Journal of Psychiatric Research, 64, 79–87.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Department of Community and Behavioral Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Colorado Department of Public Health and EnvironmentDenverUSA
  3. 3.College of Global HealthNew York UniversityNew YorkUSA
  4. 4.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations