1
|
Watkins SL, Thompson J, Feld AL, Ling PM, Lee YO. Flavored Cannabis Use and Cannabis-Tobacco Co-use: Patterns In U.S. States With Legalized Nonmedical Adult Use. Am J Prev Med 2023; 65:551-559. [PMID: 37169316 PMCID: PMC10527725 DOI: 10.1016/j.amepre.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Little is known about inhaled flavored cannabis use. This study aimed to investigate the prevalence and patterns of flavored cannabis use and cannabis-tobacco co-use. METHODS This study surveyed adult past 30-day cannabis users in U.S. states and districts that have legalized cannabis for nonmedical/adult use (n=9) (November 2018; n=2,978). By product/behavior (any cannabis, cannabis extract vaporizers, mixed cannabis-nicotine vaporizers, blunts, chasing), the association between flavored (versus non-flavored) use and sociodemographic characteristics, cannabis use disorder symptoms, and tobacco use was estimated using weighted multivariable logistic regression in January 2022. RESULTS Almost half of adult cannabis users reported using at least one flavored cannabis product (46.5%). Flavored cannabis use was more likely among respondents who were female (AOR=1.2, CI=1.0, 1.4), were Black (ref: White; AOR=2.2, CI=1.5, 3.1), were Hispanic/Latino/a/x (ref: White; AOR=1.6, CI=1.2, 1.9), had cannabis use disorder symptoms (AOR=2.0, CI=1.6, 2.4), or were currently using tobacco (AOR=2.4, CI=2.1, 2.9). Use was less likely among middle-aged/older adults (ref: ages 21-34 vs 35-49 years; AOR=0.6, CI=0.5, 0.7). CONCLUSIONS Observed differences in flavored cannabis use are concerning if flavors raise appeal or dependence. Integrating flavored cannabis and tobacco research and practice is warranted.
Collapse
Affiliation(s)
- Shannon Lea Watkins
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa.
| | - Jesse Thompson
- RTI International, Research Triangle Park, North Carolina
| | - Ashley L Feld
- RTI International, Research Triangle Park, North Carolina
| | - Pamela M Ling
- Center for Tobacco Control Research and Education and Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Youn Ok Lee
- RTI International, Research Triangle Park, North Carolina
| |
Collapse
|
2
|
Ali MM, McClellan C, Mutter R, Rees DI. Recreational marijuana laws and the misuse of prescription opioids: Evidence from National Survey on Drug Use and Health microdata. Health Econ 2023; 32:277-301. [PMID: 36335085 DOI: 10.1002/hec.4620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 08/30/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Several studies have concluded that legalizing medical marijuana can reduce deaths from opioid overdoses. Drawing on micro data from the National Survey on Drug Use and Health, a survey uniquely suited to assessing patterns of substance use, we examine the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. Using a standard difference-in-differences (DD) regression model, we find that RML adoption reduces the likelihood of frequently misusing prescription opioids such as OxyContin, Percocet, and Vicodin. However, using a two-stage procedure designed to account for staggered treatment and dynamic effects, the DD estimate of relationship between RML adoption and the likelihood of frequently misusing prescription opioids becomes positive. Although event study estimates suggest that RML adoption leads to a decrease in the frequency of prescription opioid abuse, this effect appears to dissipate after only 2 or 3 years.
Collapse
Affiliation(s)
- Mir M Ali
- Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia, USA
| | - Chandler McClellan
- Agency for Healthcare Research and Quality, North Bethesda, Maryland, USA
| | - Ryan Mutter
- Congressional Budget Office, Washington, District of Columbia, USA
| | | |
Collapse
|
3
|
Donnelly J, Young M, Marshall B, Hecht ML, Saldutti E. Public Health Implications of Cannabis Legalization: An Exploration of Adolescent Use and Evidence-Based Interventions. Int J Environ Res Public Health 2022; 19:ijerph19063336. [PMID: 35329023 PMCID: PMC8950733 DOI: 10.3390/ijerph19063336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
This article examines the relaxation of state marijuana laws, changes in adolescent use of marijuana, and implications for drug education. Under federal law, use of marijuana remains illegal. In spite of this federal legislation, as of 1 June 2021, 36 states, four territories and the District of Columbia have enacted medical marijuana laws. There are 17 states, two territories and the District of Columbia that have also passed recreational marijuana laws. One of the concerns regarding the enactment of legislation that has increased access to marijuana is the possibility of increased adolescent use of marijuana. While there are documented benefits of marijuana use for certain medical conditions, we know that marijuana use by young people can interfere with brain development, so increased marijuana use by adolescents raises legitimate health concerns. A review of results from national survey data, including CDC’s YRBS, Monitoring the Future, and the National Household Survey on Drug Use, allows us to document changes in marijuana use over time. Increased legal access to marijuana also has implications for educational programming. A “Reefer Madness” type educational approach no longer works (if it ever did). We explore various strategies, including prevention programs for education about marijuana, and make recommendations for health educators.
Collapse
Affiliation(s)
- Joseph Donnelly
- Department of Public Health, Montclair State University, Upper Montclair, NJ 07043, USA;
- Correspondence:
| | - Michael Young
- Center for Evidence-Based Programming, South Padre Island, TX 78597, USA;
| | - Brenda Marshall
- Department of Nursing, William Paterson University, Wayne, NJ 07470, USA;
| | | | - Elena Saldutti
- Department of Public Health, Montclair State University, Upper Montclair, NJ 07043, USA;
| |
Collapse
|
4
|
Abstract
We investigate whether adult marijuana use in Washington responds to increased local access as measured by drive time to the nearest legal marijuana retailer as well as measures of retail density. Using survey data from the Behavioral Risk Factor Surveillance System, we find that as retailers open closer to where they live, more individuals use marijuana and more frequently. These effects are concentrated among young adults (ages 18-26), women, and rural residents. Controlling for distance to the nearest retailer, we find that whether retail density affects marijuana use depends on how it is measured.
Collapse
Affiliation(s)
| | - Benjamin W. Cowan
- School of Economic Sciences, Washington State University and NBER, Pullman, WA, 99164-6210
| | - Robert E. Rosenman
- School of Economic Sciences, Washington State University, Pullman, WA, 99164-6210
| |
Collapse
|
5
|
Abstract
Alaska and Hawaii, the only two noncontiguous states in the United States, have different marijuana policy environments. Alaska enacted recreational marijuana legalization (RML) in 2014, whereas recreational marijuana is still illegal in Hawaii. This study analyzed how RML affects adolescents' marijuana use (MU) by comparing two states. We used data from 2 states (Alaska and Hawaii) from the Youth Risk Behavior Survey, 2009 to 2019 years (N = 35 467). The trends of lifetime MU and current MU were examined. Using difference-in-differences analysis models, this study investigated whether RML increased lifetime and current MU in Alaska compared with Hawaii after adjusting for socioeconomic characteristics. Both lifetime and current MU prevalence among adolescents in Alaska increased after RML, while both rates in Hawaii gradually decreased. The rate of lifetime MU in Alaska was significantly increased after RML (odds ratio [OR] = 1.29) compared with Hawaii. Similarly, the current MU among adolescents in Alaska was significantly increased compared with that in Hawaii (OR = 1.34). Both lifetime and current MU were increased following RML in Alaska, suggesting that RML may affect the increase of MU among adolescents.
Collapse
Affiliation(s)
- Meen Hye Lee
- University of North Carolina, Wilmington, NC, USA
| | | | - Hyungjo Hur
- Dankook University, Yongin-si, Gyeonggi-do, South Korea
| |
Collapse
|
6
|
Kerr DCR, Bae H, Alley ZM. Enhancing gender and ethnic representativeness of NCHA-II data with survey weights: The examples of substance use prevalence and state marijuana legalization. J Am Coll Health 2021; 69:370-377. [PMID: 31662043 DOI: 10.1080/07448481.2019.1679151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/23/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
We evaluated how applying post-stratification sampling weights to National College Health Assessment II (NCHA-II) data affects estimates of substance use prevalence and tests of medical and recreational marijuana legalization (MML and RML) effects. Participants/Methods: We constructed weights for Fall 2015 and Spring 2016 surveys (n = 90,503) using population information on U.S. undergraduates' gender and race/ethnicity and three institutional characteristics (region, city population, public/private). We estimated substance use prevalence (e.g., e-cigarettes, prescription opioid misuse) and compared 30-day marijuana use rates in states with RML, MML, or neither policy. Results: When unweighted versus weighted data were used, prevalence estimates did not differ appreciably; conclusions from logistic regressions were similar (weighted 30-day marijuana use rates among undergraduates in RML, MML, and non-ML states were 30.0%, 20.3%, and 16.3%, respectively) but effect sizes differed. Conclusions: The value of using weighted NCHA-II data depends on the analysis and the precision required for the research questions.
Collapse
Affiliation(s)
- David C R Kerr
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Harold Bae
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Zoe M Alley
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| |
Collapse
|
7
|
Cerdá M. Commentary on Bae & Kerr (2020): Recreational marijuana legalization-we need to think about heterogeneity of policy effects. Addiction 2020; 115:1125-1126. [PMID: 32090386 PMCID: PMC7556737 DOI: 10.1111/add.14985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Magdalena Cerdá
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| |
Collapse
|
8
|
Bae H, Kerr DCR. Marijuana use trends among college students in states with and without legalization of recreational use: initial and longer-term changes from 2008 to 2018. Addiction 2020; 115:1115-1124. [PMID: 31833119 DOI: 10.1111/add.14939] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/14/2019] [Accepted: 12/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Young adult college students in the United States are likely to be affected by marijuana liberalization trends. However, changes in students' marijuana use following recreational marijuana legalization (RML) have not been examined in more than one RML state at a time, or beyond 1-2 years post-legalization. DESIGN Cross-sectional National College Health Assessment survey administered twice yearly from 2008 to 2018. SETTING A total of 587 4-year colleges and universities in 48 US states. PARTICIPANTS Undergraduates aged 18-26 years attending college in US states that did (n = 234 669 in seven states) or did not (n = 599 605 in 41 states) enact RML between 2008 and 2018. MEASUREMENTS Self-reported marijuana use (past 30 days) and individual and contextual covariates, institution-provided institutional and community covariates and publicly available dates when states enacted RML. FINDINGS Adjusting for covariates, state differences and state-specific linear time trends (accounting for pre-RML trends), prevalence of 30-day marijuana use increased more among students exposed to RML [odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.19-1.28, P < 0.001] than among non-RML state students throughout the same time-period; the results were similar for frequent use (≥ 20 days) (OR = 1.18, 95% CI = 1.10-1.27, P < 0.001). Interaction models supported stronger RML effects among students who were female, residing off-campus and aged 21 years and older; sexual orientation did not moderate RML effects. In the earliest states to enact RML (2012) there were increases in use prevalence in the second through the sixth year post-RML compared to pre-RML. In the second legalization group (2015) there were increases in the first and second year post-RML, and greater increases in the third year. In the later states (2016-17), increases were observed in both years after RML. CONCLUSIONS In US states that enacted recreational marijuana legislation from 2012 to 2017 there was evidence for a general trend towards greater increases in marijuana use by college students and differential impact by gender, legal using age and campus residence.
Collapse
Affiliation(s)
- Harold Bae
- Biostatistics Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - David C R Kerr
- School of Psychological Science, College of Liberal Arts, Oregon State University, Corvallis, OR, USA
| |
Collapse
|
9
|
Lane TJ, Hall W. Traffic fatalities within US states that have legalized recreational cannabis sales and their neighbours. Addiction 2019; 114:847-856. [PMID: 30719794 DOI: 10.1111/add.14536] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/26/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS A growing body of evidence suggests that cannabis impairs driving ability. We used mortality data to investigate whether the commercial sale of cannabis for recreational use affected traffic fatality rates both in states that legalized it and in neighbouring jurisdictions. DESIGN Interrupted time-series of traffic fatality rates adjusted for seasonality and autocorrelation. Changes are reported as step and trend effects against a comparator of states that had not implemented medicinal or recreational cannabis during the study period (2009-16). Sensitivity analyses added a 6-month 'phase-in' to account for lags in production. Meta-analyses were used to derive pooled results. SETTING Three states that legalized recreational cannabis sales [Colorado (January 2014), Washington State (June 2014) and Oregon (October 2015] and nine neighbouring jurisdictions [Kansas, Nebraska, New Mexico, Oklahoma and Utah (Colorado neighbours); British Columbia and Oregon (Washington neighbours); and California and Nevada (Oregon neighbours)]. MEASUREMENTS Monthly traffic fatalities rates per million residents using mortality data from CDC WONDER and RoadSafetyBC and census data. FINDINGS There was a pooled step increase of 1.08 traffic fatalities per million residents followed by a trend reduction of -0.06 per month (both P < 0.001), although with significant heterogeneity between sites (step: I2 = 73.7%, P < 0.001; trend: I2 = 68.4%; P = 0.001). Effects were similar in both legalizing (step: 0.90, P < 0.001; trend: -0.05, P = 0.007) and neighbouring sites (step: 1.15, P = 0.005; trend: -0.06, P = 0.001). The 6-month phase-in produced similar if larger effects (step: 1.36, P = 0.006; trend: -0.07, P < 0.001). CONCLUSIONS The combination of step increases and trend reductions suggests that in the year following implementation of recreational cannabis sales, traffic fatalities temporarily increased by an average of one additional traffic fatality per million residents in both legalizing US states of Colorado, Washington and Oregon and in their neighbouring jurisdictions.
Collapse
Affiliation(s)
- Tyler J Lane
- Insurance, Work and Health Group, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia.,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
10
|
Kerr DCR, Bae H, Phibbs S, Kern AC. Changes in undergraduates' marijuana, heavy alcohol and cigarette use following legalization of recreational marijuana use in Oregon. Addiction 2017; 112:1992-2001. [PMID: 28613454 DOI: 10.1111/add.13906] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/23/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Recreational marijuana legalization (RML) went into effect in Oregon in July 2015. RML is expected to influence marijuana use by adolescents and young adults in particular, and by those with a propensity for substance use. We sought to quantify changes in rates of marijuana use among college students in Oregon from pre- to post-RML relative to college students in other states across the same time period. DESIGN Repeated cross-sectional survey data from the 2012-16 administrations of the Healthy Minds Study. SETTING Seven 4-year universities in the United States. PARTICIPANTS There were 10 924 undergraduate participants. One large public Oregon university participated in 2014 and 2016 (n = 588 and 1115, respectively); six universities in US states where recreational marijuana use was illegal participated both in 2016 and at least once between 2012 and 2015. MEASUREMENTS Self-reported marijuana use in the past 30 days (yes/no) was regressed on time (pre/post 2015), exposure to RML (i.e. Oregon students in 2016) and covariates using mixed-effects logistic regression. Moderation of RML effects by recent heavy alcohol use was examined. FINDINGS Rates of marijuana use increased from pre- to post-2015 at six of the seven universities, a trend that was significant overall. Increases in rates of marijuana use were significantly greater in Oregon than in comparison institutions, but only among students reporting recent heavy alcohol use. CONCLUSIONS Rates of Oregon college students' marijuana use increased (relative to that of students in other states) following recreational marijuana legislation in 2015, but only for those who reported recent heavy use of alcohol. Such alcohol misuse may be a proxy for vulnerabilities to substance use or lack of prohibitions (e.g. cultural) against it.
Collapse
Affiliation(s)
| | - Harold Bae
- Oregon State University, Corvallis, OR, USA
| | | | | |
Collapse
|