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The Substance Use and Norms (SUN) project

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Developing a comprehensive understanding of marijuana use among youth is a public health priority, and prevention science offers a unique framework for generating research that can be used to develop preventive interventions to address marijuana use. This special issue includes 10 empirical studies and 2 commentaries on the topic of marijuana use among adolescents and emerging adults in association with and in the context of changing medical and recreational marijuana laws, marijuana-specific risk and protective factors from multiple ecological domains, and the use of existing and the need for new cross-sectional and longitudinal data to advance our understanding of youth marijuana use in the rapidly changing social, normative, and policy context.
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Innovative analysis of existing social science and behavioral data has the potential to advance our understanding of the epidemiology and etiology of marijuana and other substance use among adolescents and emerging adults, so as to inform future policy, prevention, and intervention efforts. In this commentary, we highlight two commonly used and publicly available datasets, the National Survey on Drug Use and Health (NSDUH) and the Youth Risk Behavioral Survey (YRBS), in order to describe their usefulness for evaluation of the effects of changes in marijuana policy on adolescent and emerging adult substance use and marijuana-specific risk factors. We use recent examples of trend and quasi-experimental studies to highlight the unique strengths of each dataset. We also describe their limitations, identify gaps in existing knowledge, and offer recommendations for future research to answer emergent questions about the changing legal, social, and normative context related to marijuana and contribute to prevention efforts aimed at reducing substance use and related health risk behaviors among youth.
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Marijuana use has been linked to a wide variety of negative consequences, especially for those who initiate use in early adolescence and become daily or regular users as a teenager. If these negative consequences are to be avoided, prevention efforts must focus upstream on childhood and adolescent developmental periods before marijuana use is initiated or has become frequent. Upstream prevention targets factors that predict initiation and escalation of marijuana use, which are often called risk and protective factors. This chapter provides a review of current knowledge about risk and protective factors, with an emphasis on psychosocial variables specific to marijuana, differentiating predictors of marijuana use from predictors of other legal and illegal drugs when possible. The chapter also provides suggestions for future research in light of the rapidly changing legal and community conditions related to access, availability, and norms of marijuana use.
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Accurate estimates of substance use in the teenage years by race/ethnicity may help identify when to intervene to prevent long-term substance use disparities. We examined trends in past 30-day use of marijuana, cigarette, and alcohol among 8th, 10th, and 12th graders in Washington State, which passed a recreational marijuana law in 2012 and initiated retail marijuana sales in 2014. Data are from the 2004–2016 Washington Healthy Youth Surveys (n = 161,992). We used time series regression models to assess linear and quadratic trends in substance use for the full sample and stratified on race/ethnicity and grade level and examined relative differences in prevalence of use by race/ethnicity. In Washington, across all racial/ethnic groups, marijuana use peaked in 2012. Although there was not a significant overall change in marijuana use for the full sample across the study period, there was a statistically significant increase in use among 12th graders and a statistically significant decrease among 8th graders. Relative to Whites, Asians had a lower prevalence of marijuana use, whereas all other race/ethnicity groups had a higher prevalence of use. Prevalence of marijuana use is particularly high among American Indian/Alaska Native and Black youth and has increased most rapidly among 12th grade Hispanic/Latinx youth. There were large and statistically significant decreases in alcohol and cigarette use across the study period for the full sample, as well as for each race/ethnicity group. These findings highlight the need for continued monitoring of trends in use among these groups and potentially warrant consideration of selective interventions that specifically focus on students of color and that include developmentally-appropriate strategies relevant to each grade.
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Background: Marijuana policies are rapidly evolving. In the United States, recreational use of marijuana is now legal in 4 states and medical marijuana is legal in 23 states. Research evaluating such policies has focused primarily on how policies affect issues of price, access to, use, and consequences of marijuana. Due to potential spillover effects, researchers also need to examine how marijuana policies may impact use and consequences of alcohol. Methods: The current paper is a critical review of articles evaluating alcohol outcomes associated with marijuana decriminalization, medical marijuana legalization, and nonmedical or recreational marijuana legalization. We identified articles and reports through (1) online searches of EBSCO host database including Academic Search Premier, Econlit, Legal Collection, Medline, PsycARTICLES, and PsycINFO, as well as PubMed and Google Scholar databases; (2) review of additional articles cited in papers identified through electronic searches; and (3) targeted searches of state and local government records regarding marijuana law implementation. We reviewed studies with respect to their data sources and sample characteristics, methodology, and the margin of alcohol and marijuana use, timing of policy change, and the aspects of laws examined. Results: The extant literature provides some evidence for both substitution (i.e., more liberal marijuana policies related to less alcohol use as marijuana becomes a substitute) and complementary (i.e., more liberal marijuana policies related to increases in both marijuana and alcohol use) relationships in the context of liberalization of marijuana policies in the United States. Conclusions: Impact of more liberal marijuana policies on alcohol use is complex, and likely depends on specific aspects of policy implementation, including how long the policy has been in place. Furthermore, evaluation of marijuana policy effects on alcohol use may be sensitive to the age group studied and the margin of alcohol use examined. Design of policy evaluation research requires careful consideration of these issues.
Purpose: As marijuana laws have become more permissive, survey data on adolescents in the United States have shown an increase in marijuana-specific risk factors, particularly in the proportion of youth who do not perceive marijuana use as harmful. Prevalence of marijuana use among youth, however, has changed little. Using representative data from Washington State, which has legalized medical and nonmedical marijuana for adults, we examined two competing hypotheses to account for this divergence in population trends. Methods: Data were from 2000 to 2014 biennial Washington State surveys of 10th-grade students. First, we assessed whether associations between marijuana use and marijuana-specific risk factors have weakened over time. Second, we examined whether decreases in alcohol and cigarette use can account for the lack of expected increase in marijuana use prevalence. Results: Despite stability in marijuana use prevalence, there were increases in marijuana-specific risk factors of low perceived harm, youth favorable attitudes about use, and perceived community attitudes favorable to use. Associations between marijuana use and marijuana use predictors varied little across time; if anything, the positive association between low perceived harm and marijuana use grew stronger. Decreases in prevalence of alcohol and cigarette use largely accounted for stability in marijuana use during a period when marijuana risk factors increased. Conclusions: Decreases in other types of substance use or in the underlying, common risk for substance use may have mitigated effects of increases in marijuana-specific risk factors.
As of January 2016, 23 U.S. states and the District of Columbia have legalized medical or nonmedical cannabis, with more likely to follow. This dynamic policy context represents a substantial challenge for policy evaluation. Part I of this article provides a summary of state-level cannabis policy components across states and federal action regarding state-level policies. Part II presents a detailed history of cannabis policies in Washington State from 1998 to 2015 and analyzes the potential impacts of the policy changes on cannabis supply and demand. As an early adopter of both medical and nonmedical cannabis policies, Washington State provides an excellent example of the key elements to be considered in evaluating the relationship between policy changes and cannabis use. We highlight the importance of the interplay of federal enforcement priorities and previously adopted state-level cannabis regimes in interpreting the potential impacts of new cannabis policies.