Marijuana Use and Depressive Symptoms; Gender Differences in African American Adolescents

Introduction: This study aimed to examine gender differences in the bidirectional associations between marijuana use and depressive symptoms among African American adolescents. The study also tested gender differences in the effects of socioeconomic status, maternal support, and friends' drug use on adolescents' depressive symptoms and marijuana use. Methods: This is a secondary analysis of the Flint Adolescent Study (FAS). Six hundred and eighty one African American adolescents (335 males and 346 females) were followed for 3 years, from 1995 (mean age 16) to 1997 (mean age 19). Depressive symptoms (Brief Symptom Inventory) and marijuana use were measured annually during the follow up. We used multi-group latent growth curve modeling to explore the reciprocal associations between depressive symptoms and marijuana use over time based on gender. Results: Baseline marijuana use was predictive of an increase in depressive symptoms over time among male but not female African American adolescents. Baseline depressive symptoms were not predictive of an increase in marijuana use among male or female adolescents. Conclusion: Study findings suggest that male African American adolescents who use marijuana are at an increased risk of subsequent depressive symptoms. Interventions that combine screening and treatment for marijuana use and depression may be indicated for African American male adolescents.

Personal Income and Substance Use among Emerging Adults in the United States

BACKGROUND

Taxation and other policy measures have been implemented across the United States to curb the accessibility of substance use, especially among youth. While the inverse relationship between price and youth consumption is well known, available research on youth earned income and substance use is sparser, particularly among emerging adults.

OBJECTIVES

We examined the association between emerging adult past-year personal income and 30-day substance use.

METHODS

We analyzed data from Wave 5 (n = 2,202) of the NEXT Generation Health Study, an annual survey study administered to a nationally representative sample of emerging adults in the U.S. Wave 5 (mean age = 20.28 years, SE = 0.02 years) was administered during the 2013-2014 academic year. After grouping participants into five levels of self-reported, pre-tax personal income, we used binomial logistic regression to examine the association between personal income and cigarette smoking, marijuana use, alcohol use, and heavy episodic drinking (HED).

RESULTS

In unadjusted models, those at certain levels of higher past-year income were more likely to smoke cigarettes, consume alcohol, or engage in HED at least once in the past 30 days. Several associations remained significant after controlling for covariates. Most associations were no longer significant after including perceived peer norms as additional covariates. Personal income was not associated with 30-day marijuana use in unadjusted or adjusted models. Conclusions/Importance: Higher earned income may provide emerging adults greater economic access to cigarettes and alcohol, but the association might be partly attenuated by social factors, particularly perceived peer norms.

Examination of Market Segmentation among Medical Marijuana Dispensaries

BACKGROUND

As medical marijuana legislation becomes more common, concerns arise about the overconcentration of dispensaries, raising questions about the number of medicinal marijuana dispensaries (MMD) needed to serve medicinal users.

OBJECTIVES

This paper applies niche-marketing theory-which suggests dispensaries market to specific types of people-to examine if MMDs might be targeting recreational users. Observed differences between dispensary populations and between dispensary clients and local residents may indicate that dispensaries are drawing in patients based on factors other than medical need.

METHODS

Data were collected via exit surveys with patients at four dispensaries in Long Beach, CA. A total of 132 patients were surveyed regarding demographic data, purchase information, medical condition, and nearest cross street for their home address. Census tract information was collected for every dispensary.

RESULTS

Chi-squared tests show significant associations between dispensary visited and race (χ² = 31.219, p < 0.001) and significant associations between medical condition and dispensary visited (χ² = 22.123, p < 0.05). Lastly, we found that all four of the dispensaries had patients who were different from community residents in some characteristics.

CONCLUSIONS

There were significant differences relating to race, medical condition, and distance traveled across dispensaries. Results suggest dispensary users do not necessarily reside in the same area in which dispensaries are located and do not necessarily reflect the local population. Taken together these results provide some support for market segmentation.

Prevalence of Substance Use among Lesbian, Gay, Bisexual, and Transgender Youth in Military Families: Findings from the California Healthy Kids Survey

BACKGROUND

In addition to the challenges associated with military life, lesbian, gay, bisexual, and transgender (LGBT) youth in military families may face stressors associated with having a stigmatized sexual orientation and/or gender identity or expression, placing them at risk of substance use. To the authors' knowledge, this is the first study exploring substance use outcomes among LGBT youth in military families.

OBJECTIVES

This study assessed the role of military connection, LGB identity, and transgender identity on lifetime and past 30-day substance use.

METHODS

This study is a secondary data analysis of the 2013-2015 California Healthy Kids Survey (CHKS). The study's participants (n = 634,978) were students attending middle and high schools in nearly all school districts in California. The study outcomes were lifetime and past 30-day cigarette, alcohol, tobacco, and marijuana use. Chi-square tests of associations (including cross-tabulations) and multivariate logistic regressions were conducted to address the study aims.

RESULTS

Multivariate logistic regression results indicated that military connection, LGB identity, and transgender identity were significantly associated with an increased odd of lifetime and past 30-day substance use. Compared to military non-transgender youth, military transgender youth had an increased likelihood of past 30-day cigarette use and past 30-day alcohol use. In addition, military LGB youth were 3.62 times as likely as military non-LGB youth to report past 30-day cigarette use. Conclusions/Importance: This study provides researchers with knowledge about the behavioral health of LGBT youth in military families, a vulnerable subgroup within the military-connected youth population, thus informing substance use prevention programs.

Gender Differences in the Relationships among Young Adults' Religiosity, Risk Perception, and Marijuana Use: A Moderated Mediation Model

BACKGROUND

Studies show that religiosity is a protective factor against marijuana use. Given many religions' teachings to promote risk perception of substance use, risk perception possibly mediates the relationship between religiosity and marijuana use. Moreover, since males and females differ in religiosity, risk perception, and marijuana use, gender may moderate religiosity's indirect effect on marijuana use through risk perception and religiosity's direct effect on marijuana use. Despite substantial research on religiosity and adolescent marijuana use, little research has targeted the young adult population.

OBJECTIVES

This study is the first to investigate the conditional nature of religiosity's influence on marijuana use through risk perception among young adults in the U.S.

METHODS

Using a nationally representative sample from the 2014 National Survey on Drug Use and Health (N = 12,646), conditional process analysis was examined through significant test of the index of moderated mediation. Additionally, mediation analysis was conducted in male (n = 6042) and female (n = 6604) groups separately to further characterize the nature of the relationships.

RESULTS

Religiosity's indirect effect on marijuana use through risk perception was found to be significantly different between males and females, while there were no gender differences in religiosity's direct effect on marijuana use. The indirect effect of religiosity on marijuana use via risk perception was significant among both males and females and was larger for females than males.

CONCLUSION

Prevention interventions for young adults' marijuana use that incorporate religiosity should emphasize factors related to risk perception and have a gender informed perspective. Direction for future research is provided.

Substance Use among Sexual Minorities: Has it Actually Gotten Better?

BACKGROUND

Despite efforts to decrease substance use, rates among sexual minority youth (SMY) remain higher than among heterosexuals. Substance use is a leading contributor to morbidity and mortality in adulthood, and SMY's use of substances is related to poorer mental and emotional health.

OBJECTIVES

We sought to document the trends in substance use for a large sample of youth over 14 years with special attention to SMY. In addition, we tested whether there were disparities in substance use behaviors between SMY and heterosexual youth. Last, we examined changes in disparities over time in substance use among SMY.

METHODS

We analyzed data from 8 waves of the Massachusetts YRBS (N = 26,002, M_age = 16), from 1999 to 2013, to investigate trends and disparities in current tobacco, alcohol, and cannabis use for heterosexual youth and SMY. We used logistic regression interaction models to test whether these disparities have widened or narrowed for SMY, as compared to heterosexuals, over the span of 14 years.

RESULTS

In absolute terms, substance use rates decreased for nearly all youth between 1999 and 2013. There were striking disparities in substance use between heterosexual youth and all sexual minority subgroups. These disparities in substance use narrowed among males but remained unchanged or worsened among females. Conclusions/Importance: Trends in substance use are changing over time, but not in the same ways for all sexual minority subgroups. Patterns are worsening for females. These findings suggest that we need to address the needs of LGB populations in novel ways.

Factors that Differentiate Prescription Stimulant Misusers from those At-Risk for Misuse: Expectancies, Perceived Safety, and Diversion

BACKGROUND

The nonmedical use of prescription stimulants (NMUPS) is one of the most prevalent illicit behaviors on college campuses. While numerous risk factors for NMUPS have been identified, it is unknown how nonusing students who meet several risk factors for NMUPS differ from those who have used, which may inform intervention efforts. We expected that users would evidence greater cognitive enhancement and anxiety/arousal expectancies and intentions to use, and lower guilt/dependence expectancies, perceptions of NMUPS-related harm, and academic self-efficacy.

METHODS

Between 2014 and 2016, students (N = 121; 65% female) at two demographically dissimilar colleges in the Northeastern and Midwestern United States who reported lifetime NMUPS or endorsed two or more NMUPS risk factors (i.e., recent marijuana use, recent binge drinking, grade point average <3.5, Greek-life involvement, male gender) reported on their prescription stimulant expectancies; academic self-efficacy; perceived harm of NMUPS; lifetime NMUPS; and intentions for NMUPS in the next six months.

RESULTS

A MANCOVA showed that at-risk nonusers had lower cognitive expectancies, higher guilt/dependence expectancies, and higher anxiety/arousal expectancies compared to users. ANCOVAs and Chi-square tests showed that nonusers also perceived NMUPS to be more harmful and were less likely to divert their medication if prescribed. The groups did not differ on academic self-efficacy or total number of risk factors endorsed. However, recent marijuana use was more prevalent in users.

CONCLUSIONS

Targeted preventive interventions for NMUPS should focus on students who are using marijuana and should aim to maintain lower positive and higher negative stimulant expectancies and reaffirm potential NMUPS-related harms.

Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008-2015

Although research has established a link between cannabis legalization and use, and cannabis use and mental health, the relationship between medical cannabis legalization and mental health remains uncharacterized. This analysis investigated the relationship between state medical cannabis laws (restrictive, i.e. covering a narrow set of medical conditions; or liberal, i.e. covering a broad range of medical conditions), whether the law permits patients to petition their physician to approve medical cannabis use for specific medical conditions, and state prevalence of serious mental illness (SMI) in the National Survey of Drug Use and Health 2008-2015. In a covariate-adjusted meta-regression, liberal laws were significantly associated with higher prevalence of SMI (Coeff = 0.003, SE = 0.001, p < .001). Restrictive laws (Coeff = 0.001, SE = 0.001, p = .285) and the ability to petition physician approval (Coeff = -0.001, SE = 0.001, p = .140) were non-significant. When added to the model, state past-year cannabis use was significantly associated with higher prevalence of SMI (Coeff = 0.037, SE = 0.015, p = .018), liberal laws remained significant (Coeff = 0.002, SE = 0.001, p = .015), and restrictive laws (Coeff = -0.0001, SE = 0.001, p = .945) and the ability to petition a physician (Coeff = 0.001, SE = 0.001, p = .290) remained non-significant. Medical cannabis laws are likely related to state mental health, and a higher prevalence of cannabis use partially explains this relationship.

Trends in and correlates of medical marijuana use among adults in the United States

BACKGROUND

Trends in and correlates of medical marijuana use are important to inform ongoing clinical, research, policy, and programmatic efforts. This study assessed trends in and correlates of medical marijuana use among U.S. adults.

METHODS

We analyzed data from approximately 147,200 U.S. civilians aged 18 or older who participated in the 2013-2015 National Surveys on Drug Use and Health. Descriptive analyses, multivariable logistic regressions, and zero-truncated native binomial regressions were applied.

RESULTS

Among U.S. adults, the prevalence of medical marijuana use increased from 1.2% in 2013 to 1.6% in 2015 (p = 0.0007). After adjusting for covariates, adults residing in medical marijuana states (states with legalized medical marijuana use) were 1.3 times more likely to use marijuana medically in 2015 than in 2013 (adjusted odds ratio (AOR) = 1.3, 95% confidence interval (CI) = 1.03-1.61), and adults in nonmedical marijuana states were 1.4 times more likely to report medical marijuana use in 2015 than in 2013 (AOR = 1.4, 95% CI = 1.05-1.90). Among adults who used marijuana exclusively for medical purposes in the past 12 months, trends in 12-month cannabis use disorders, daily or near daily use, and the number of days of marijuana use remained unchanged during 2013-2015. We identified how correlates of medical marijuana use among adults in medical marijuana states differed from their counterparts in nonmedical marijuana states.

CONCLUSIONS

Adults were more likely to use marijuana medically in 2015 than in 2013 in both medical and nonmedical marijuana states. Clinicians need to learn about and address evolving patterns of medical marijuana use in patients.

A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students

OBJECTIVE

This study investigated associations between adverse childhood experiences (ACE) prior to age 18 years and multiple health behaviors (eg, cigarette and other substance use) and outcomes (eg, obesity, depression) for a large college sample.

PARTICIPANTS

2,969 college students from seven universities in the state of Georgia were included in the analysis.

METHODS

Web-based surveys were completed by students (45-60 minutes) during the spring semester, 2015.

RESULTS

Findings indicate that more ACEs are associated with higher levels of depressive symptoms, ADHD symptoms, cigarette use, alcohol use, marijuana use, and BMI, in addition to lower levels of fruit and vegetable intake, and sleep.

CONCLUSION

ACEs may carry forward in the lifespan to influence a range of unhealthy outcomes among college students. College intervention programs may benefit by recognizing the pervasiveness of ACEs and their associations with health behaviors and outcomes, and include interventions across more than one health behavior.

Marijuana Use among Young Adults: Who Quits and Why?

Objective

In this study, we examined: (1) differences among never, current, and former young adult marijuana users; and (2) reasons for use and cessation.

Methods

We conducted interviews with 57 young adults (including 46 marijuana users) enrolled in a longitudinal study of 3418 young adults and a survey in this cohort (N = 2866). Participants reporting former but not current use on the survey (N = 607) completed the Reasons for Marijuana Cessation section.

Results

Interview data indicated reasons for initiating (or not initiating) use, continued use, and quitting. The Reasons for Marijuana Cessation scale included 2 factors: (1) Instrumentality and 2) Social/Legal reasons.

Conclusions

These findings might inform theoretical frameworks upon which marijuana cessation occurs and direct future intervention studies.

Self-reported marijuana use over 25 years and abdominal adiposity: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

AIMS

We investigated the association between cumulative lifetime and current marijuana use with total abdominal adipose tissue (AT), visceral AT, subcutaneous AT, intermuscular AT, and mean liver attenuation (LA) at mid-life.

DESIGN

Longitudinal and cross-sectional secondary data analysis of participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

SETTING

CARDIA field centers in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA, USA.

PARTICIPANTS

CARDIA participants, aged 18-30 years in 1985-1986, who were present at the clinic examination in 2010-2011 (n = 2902).

MEASUREMENTS

Marijuana use was assessed from responses to self-administered questionnaires at 8 CARDIA examinations over 25 years, determined as cumulative marijuana-years and current use status. Non-contrast computed tomography imaging of the abdomen was obtained in 2010-2011.

FINDINGS

In 2010-2011, 84% of participants reported a history of marijuana use with 11% reporting use within the past 30 days. Before adjustment, we observed greater cumulative marijuana use was associated with lower total abdominal and subcutaneous AT volume and lower LA and current marijuana use was associated with lower subcutaneous AT. However, after adjustment for age, sex, race, field center, cigarette pack-years and current use, regular alcohol consumption, cumulative drink-years, and physical activity, neither cumulative marijuana use nor current use showed an association with any abdominal adipose depot. Our estimates did not differ by age, sex, or race nor after accounting for cohort attrition.

CONCLUSION

Neither cumulative marijuana use nor current marijuana use is associated with total abdominal, visceral, subcutaneous, or intermuscular adipose tissue, or liver attenuation in mid-life.

Adolescents: Evidence From Michigan Youth Risk Behavior Surveillance Data

Research findings are inconsistent regarding a positive association between the passage of state medical marijuana laws (MML) and adolescent access and use marijuana. We utilized a novel analytical approach to examine this issue with multi-year data from the 1997–2013 Youth Risk Behavior Surveillance System (YRBSS) of the State of Michigan. After controlling for the historically declining trend in marijuana use prior to the passages of MML in Michigan, we found that marijuana use among adolescents had increased subsequent to the passage of state MML. Study findings suggest the need for considering the increased risk of marijuana use among adolescents as the number of states with laws permitting marijuana use is increasing.

Sex and age differences in risk factors of marijuana involvement during adolescence

Objectives

We aimed to examine whether there are sex and age differences in psychosocial risk factors of marijuana use during adolescence.

Methods

Data were drawn from 57,767 adolescents (8^th and 10^th graders) from the 2012-2013 Monitoring the Future study. We examined the association between socio-demographic and behavioral correlates with different frequencies of past-year marijuana use (non-use, occasional use: <10 time, frequent use: 10-39 times, and regular use: 40+ times). We further investigated whether these associations were similar for boys and girls of different ages.

Results

Overall, 20.6% of the adolescents reported past-year marijuana use: 12.1% occasional use, 4.3% frequent use, and 3.8% regular use. Girls were less likely to be frequent and regular marijuana users (frequent use: OR=0.83 [0.75, 0.93]; regular use: OR=0.41 [0.36, 0.48]) while no sex difference was noted for occasional use. Also, the odds of deviant behaviors were higher as the frequencies of marijuana use were higher. Compared to younger girls, older boys and girls had higher association between all levels of marijuana use and low self-esteem, low perceived harm, peer influence and perceived easy access. Besides, younger boys were more likely than younger girls to report an association between regular marijuana use with low self-esteem, peer influence, and perceived easy access but not with perceived low harm.

Conclusions/Importance

Findings suggest the relationship between these psychosocial correlates and frequency of marijuana involvement varies across sex and age groups. These variations ask for a nuanced approach to prevention of marijuana involvement in different groups of youth.

Reasons for Marijuana and Tobacco Co-use Among Young Adults: A Mixed Methods Scale Development Study

BACKGROUND

Marijuana-tobacco co-use has increased recently, particularly in young adults.

OBJECTIVES

We conducted a mixed-methods study to: (1) examine reasons for co-use; and (2) develop a scale assessing reasons for co-use among participants in a longitudinal cohort study of 3,418 students aged 18-25 from 7 Georgia colleges and universities.

METHODS

Phone-based semi-structured interviews were conducted in Summer 2015 among 46 current (past 30-day, n = 26) or lifetime (n = 20) marijuana users. Subsequently, scale items were developed and included at Wave 3. Participants reporting past 4-month tobacco and marijuana use (n = 328) completed the Reasons for Marijuana-Tobacco Co-use section.

RESULTS

Per qualitative data, reasons for marijuana-tobacco co-use included synergistic effects, one triggering or preceding the other's use, using one to reduce the other's use, co-administration, social context, and experimentation. The survey subsample included 37.1% who used cigarettes, 30.4% LCCs, 9.4% smokeless, 23.7% e-cigarettes, and 30.4% hookah. Four subscale factors emerged: (1) Instrumentality, indicating synergistic effects; (2) Displacement, indicating using one product to reduce/quit the other; (3) Social context, indicating use in different settings/social situations; and (4) Experimentation, indicating experimentation with both but no specific reasons for co-use. These subscales demonstrated distinct associations with tobacco type used; nicotine dependence; marijuana and alcohol use frequency; tobacco and marijuana use motives, respectively; perceptions of tobacco and marijuana; and parental and friend use. Including these subscales in regressions predicting nicotine dependence and days of marijuana use significantly contributed to each model.

CONCLUSIONS

These findings might inform theoretical frameworks upon which marijuana-tobacco co-use occurs and direct future intervention studies.

Neighborhood Contexts and Marijuana Use Among Urban Dwelling Emerging Adult Men

Neighborhoods are key socio-environmental contexts for marijuana use during emerging adulthood. This study examined the relationships between neighborhood context, traditional masculine norms (status, toughness, and anti-femininity), and marijuana use among 119 majority African American emerging adult men in a small urban community. Poisson regression models were used to determine the associations between neighborhood problems, social cohesion, and marijuana use. Moderator effects were examined to determine if masculinities modified these associations. Neighborhood problems and social cohesion were positively associated with marijuana use. Men who had a lower endorsement of some traditional masculine norms had greater marijuana use compared to men with a higher endorsement of these norms. These findings have implications for intervention strategies and policies.

The association of therapeutic versus recreational marijuana use and antiretroviral adherence among adults living with HIV in Florida

PURPOSE

Marijuana use is common among people living with HIV (PLWH), but its association with antiretroviral therapy (ART) adherence is unclear. This study examined the association between reason for marijuana use and ART adherence in a sample of adults living with HIV.

PATIENTS AND METHODS

Participants (N=703) recruited from seven community health centers in Florida completed a 45-minute questionnaire assessing demographics, symptoms of anxiety and depression, ART adherence, and substance use, including reasons for marijuana use. ART adherence was defined as the proportion of days in the last 30 days participants did not miss any medication and dichotomized as optimal (≥95%) and suboptimal (<95%). Multivariate logistic regression analysis assessed the association between therapeutic marijuana use to manage HIV symptoms (ie, improve appetite/gain weight, induce sleep, relieve nausea/vomiting, relieve pain, relieve anxiety/depression/stress) versus recreational marijuana use and ART adherence.

RESULTS

Approximately one third (33.2%) of the participants reported using marijuana in the past 3 months. Of marijuana users, 21.8% reported using marijuana only for therapeutic purposes to manage HIV-associated medical symptoms, while 78.2% reported recreational use. After controlling for covariates, therapeutic use of marijuana was not associated with ART adherence (AOR =1.19, 95% CI =0.60-2.38, p=0.602) while recreational marijuana users showed significantly greater odds of suboptimal ART adherence compared to nonusers (AOR =1.80, 95% CI =1.18-2.72, p=0.005).

CONCLUSION

Our results suggest differences in ART adherence between individuals who report recreational versus therapeutic marijuana use. Continued research examining the health implications of marijuana use among adults living with HIV is important as legalization of recreational and medical marijuana proliferates in the United States.

Motivation Precedes Goal Setting in Prediction of Cannabis Treatment Outcomes in Adolescents

Studies have shown that motivation to change is related to better substance use outcomes among treatment-seeking adolescents. Goal setting, which may be related to motivation, also has been shown to be associated with positive treatment outcomes. However, relationships between motivation and goal setting as mediators of change in cannabis use over time among treated youth have not been investigated. This study tested direct and indirect associations of motivation and goal setting with cannabis use frequency over 12 month follow-up among treated adolescents. A longitudinal study of 163 adolescents enrolled in intensive outpatient substance use treatment (mean age = 16.69, 34% female, 87% Caucasian) provided repeated assessment of motivation, goal setting, and cannabis use. Path analysis tested direct and indirect effects of motivation and goal setting on cannabis use. A comparison of two path models that tested motivation and goal setting independently showed that goal setting had better model fit and accounted for more of the variance in 6-month (R² = .35) and 12-month (R² = .46) cannabis use frequency than motivation (R² = .28, .44, respectively). When both mediators were included in the same model, better model fit was found for motivation preceding goal setting in the context of double mediation. Overall, results suggest that goal setting, or the combination of motivation preceding goal setting in a double mediation model, predicted lower cannabis use in treated adolescents.

Associations between anhedonia and marijuana use escalation across mid-adolescence

BACKGROUND AND AIMS

Anhedonia-a transdiagnostic psychopathological trait indicative of inability to experience pleasure-could lead to and result from adolescent marijuana use, yet this notion has not been tested. This study aimed to estimate the association of: (1) anhedonia at age 14 with rate of change in marijuana use over an 18-month follow-up, and (2) marijuana use at age 14 with rate of change in anhedonia over follow-up. Secondary aims were to test whether gender, baseline marijuana use history and peer marijuana use moderated these associations.

DESIGN

Observational longitudinal cohort repeated-measures design, with baseline (age 14 years), 6-month, 12-month and 18-month follow-up assessments.

SETTINGS

Ten public high schools in Los Angeles, CA, USA, 2013-15.

PARTICIPANTS

Students [n = 3394; 53.5% female, mean (standard deviation) age at baseline = 14.1 (0.42)].

MEASUREMENTS

Self-report level of anhedonia on the Snaith-Hamilton Pleasure Scale and frequency of marijuana use in the past 30 days.

FINDINGS

Parallel process latent growth curve models adjusting for confounders showed that baseline anhedonia level was associated positively with the rate of increase in marijuana use frequency across follow-ups [β, 95% confidence interval (CI) = 0.115 (0.022, 0.252), P = 0.03]. Baseline marijuana use frequency was not related significantly to the rate of change in anhedonia across follow-ups [β, 95% CI = -0.015 (-0.350, 0.321), P = 0.93]. The association of baseline anhedonia with faster marijuana use escalation was amplified among adolescents with (versus without) friends who used marijuana at baseline [β, 95% CI = 0.179 (0.043, 0.334) versus 0.064 (-0.071, 0.187), interaction P = 0.04], but did not differ by gender or baseline ever marijuana use.

CONCLUSIONS

In mid-adolescence, anhedonia is associated with subsequent marijuana use escalation, but marijuana use escalation does not appear to be associated with subsequent anhedonia.

A reinforcement sensitivity model of affective and behavioral dysregulation in marijuana use and associated problems

This study tested a model linking sensitivity to punishment (SP) and reward (SR) to marijuana use and problems via affect lability and poor control. A 6-month prospective design was used in a sample of 2,270 young-adults (64% female). The hypothesized SP × SR interaction did not predict affect lability or poor control, but did predict use likelihood at baseline. At low levels of SR, SP was associated with an increased likelihood of abstaining, which was attenuated as SR increased. SP and SR displayed positive main effects on both affect lability and poor control. Affect lability and poor control, in turn, mediated effects on the marijuana outcomes. Poor control predicted both increased marijuana use and, controlling for use level, greater intensity of problems. Affect lability predicted greater intensity of problems, but was not associated with use level. There were few prospective effects. SR consistently predicted greater marijuana use and problems. SP however, exhibited both risk and protective pathways. Results indicate that SP is associated with a decreased likelihood of marijuana use. However, once use is initiated SP is associated with increased risk of problems, in part, due to its effects on both affect and behavioral dysregulation. (PsycINFO Database Record

Trajectories of marijuana use from late childhood to late adolescence: Can Temperament × Experience interactions discriminate different trajectories of marijuana use?

Informed by developmental ecological and epigenetic theory, the current study examined three aims concerning adolescent marijuana use with a large community sample (N = 755; gender = 53% female) and six annual assessments that spanned 11-18 years of age. First, the natural history of adolescent marijuana use was modeled using a two-part latent growth curve analysis. Second, the validity of the mixtures was examined with a broad array of known correlates of adolescent marijuana use. Third, temperament (e.g., surgency, effortful control, and negative affect) was tested as individual differences that would enter into statistical interactions with peer substance use and prior alcohol and cigarette use to distinguish trajectories of marijuana use. The results suggested that escalations in marijuana use were observed for some youth who initiated marijuana use early in adolescence. Youth whose marijuana use did escalate substantially (10%) were distinguished on temperament, conduct disorder, peer delinquency, and pubertal development at baseline. Furthermore, hypothesized interactions between surgency and both peer substance use and prior substance use discriminated different patterns of marijuana use. The findings are discussed with respect to strategies for timing and content of preventive interventions.

Head Injury and Substance Use in Young Adults

BACKGROUND

Prior studies suggest a link between head injuries and substance use but do not routinely capture mechanisms connecting the two.

OBJECTIVES

The goal of the study was to explore whether past head injuries predicted current substance use among young adults, taking factors such as stress, self-esteem, temper, and risk-taking into consideration.

METHODS

Data were drawn from a web-based survey conducted in 2014 and 2015 at a public university in the United States (n = 897). Questions were asked about history of head injuries as well as past 12-month binge drinking, marijuana use, and prescription drug misuse. To evaluate the association between head injury and substance use, two logistic regression models were performed for each substance. Head injury was first regressed on the outcome, then related risk factors were entered into the models to determine whether they explained any association between injury and outcome.

RESULTS

A history of multiple head injuries was associated with increased odds of bingeing, marijuana, and prescription drug use. Prior delinquency and risk-taking accounted for the associations with bingeing and marijuana use. Taking all variables into consideration, multiple head injuries were associated with greater odds for prescription drug misuse.

CONCLUSIONS

Results suggest the need to give consideration to a range of concomitant variables when considering behavioral outcomes associated with head injury. Head injuries may be a marker of a constellation of risk-taking behaviors that contributes to substance use. For those with multiple injuries, misuse of prescription drugs may be an attempt to cope with lingering side effects.

Emotion regulation deficits in regular marijuana users

Effective regulation of negative affective states has been associated with mental health. Impaired regulation of negative affect represents a risk factor for dysfunctional coping mechanisms such as drug use and thus could contribute to the initiation and development of problematic substance use. This study investigated behavioral and neural indices of emotion regulation in regular marijuana users (n = 23) and demographically matched nonusing controls (n = 20) by means of an fMRI cognitive emotion regulation (reappraisal) paradigm. Relative to nonusing controls, marijuana users demonstrated increased neural activity in a bilateral frontal network comprising precentral, middle cingulate, and supplementary motor regions during reappraisal of negative affect (P < 0.05, FWE) and impaired emotion regulation success on the behavioral level (P < 0.05). Amygdala-focused analyses further revealed impaired amygdala downregulation in the context of decreased amygdala-dorsolateral prefrontal cortex functional connectivity (P < 0.05, FWE) during reappraisal in marijuana users relative to controls. Together, the present findings could reflect an unsuccessful attempt of compensatory recruitment of additional neural resources in the context of disrupted amygdala-prefrontal interaction during volitional emotion regulation in marijuana users. As such, impaired volitional regulation of negative affect might represent a consequence of, or risk factor for, regular marijuana use. Hum Brain Mapp 38:4270-4279, 2017. © 2017 Wiley Periodicals, Inc.

A Multigroup, Longitudinal Study of Truant Youths, Marijuana Use, Depression, and STD-Associated Sexual Risk Behavior

Truant youth are likely to engage in a number of problem behaviors, including sexual risky behaviors. Previous research involving non-truant youth has found sexual risk behaviors to be related to marijuana use and depression, with differential effects for male and female youth. Using data collected in a NIDA funded, prospective intervention project, results are reported of a male-female, multi-group, longitudinal analysis of the relationships among truant youth baseline sexual risk behavior, marijuana use, and depression, and their sexual risk behavior over four follow-up time points. Results indicated support for the longitudinal model, with female truants having higher depression scores, and showing stronger relationships between baseline depression and future engagement in sexual risk behavior, than male truants. Findings suggest that incorporating strategies to reduce depression and marijuana use may decrease youth sexual risk behavior.

Is the Legalization of Marijuana Associated With Its Use by Adolescents?

BACKGROUND

Growing moves in the U.S. toward relaxed laws surrounding adult use of marijuana raise concerns about concurrent increases in adolescent use of marijuana.

OBJECTIVES

This study collected and analyzed primary data on the relationship between marijuana legalization status in U.S. states and adolescents' marijuana use.

METHODS

Recruited through social networking sites and youth-services community agencies, a sample of 1,310 adolescents from 48 U.S. states and the District of Columbia reported their use of marijuana. Youths' use rates were compared with the marijuana legalization status of youths' states of residence.

RESULTS

Study findings failed to show a relationship between adolescents' use of marijuana and state laws regarding marijuana use. Relationships were found for increased marijuana use by older youths, females, and non-Hispanic youths. Youths whose parents completed 2 or more years of college were less likely to report marijuana use than those whose parents completed fewer than 2 years of college.

CONCLUSIONS

Albeit study findings do not support predictions of growing marijuana use by adolescents in states with liberalized adult use laws, further monitoring of adolescents' use with larger and more representative samples is needed.

Effects of the "Circle of Life" HIV-prevention program on marijuana use among American Indian middle school youths: a group randomized trial in a Northern Plains tribe

BACKGROUND

Early substance use threatens many American Indian/Alaska Native (AI/AN) communities, as it is a risk factor for maladaptive use and adverse health outcomes. Marijuana is among the first substances used by AI/AN youth, and its use becomes widespread during adolescence. Interventions that delay or reduce marijuana use hold the promise of curbing substance disorders and other health risk disparities in AI/AN populations.

OBJECTIVES

We evaluated the effectiveness of the Circle of Life (COL) program in reducing marijuana use among young AI adolescents. COL is a culturally tailored, theory-based human immunodeficiency virus (HIV) and sexually transmitted disease (STD) intervention shown to delay sexual initiation among AI youths.

METHODS

We conducted secondary analyses of data from a school-based group randomized trial conducted between 2006 and 2007 in all 13 middle schools on a rural, Northern Plains reservation (N = 635, 47% female). We used discrete-time survival analysis (DTSA) to assess COL effectiveness on risk of marijuana initiation among AI youths and latent growth curve modeling (LGCM) to evaluate effects on frequency of marijuana use over time.

RESULTS

DTSA models showed that the overall risk of marijuana initiation was 17.3% lower in the COL group compared to the control group. No intervention effect on frequency of marijuana use emerged in LGCM analyses.

CONCLUSION

COL is a multifaceted, culturally tailored, skills-based program effective in preventing marijuana uptake among AI youth.

Maltreated and comparison adolescents' recollections of lifetime residences: Relationship to delinquency and marijuana use

Both childhood maltreatment and frequent childhood residence changes are associated with poor behavioral outcomes including drug use and delinquency. It is not clear whether a higher number of residences results in poorer outcomes for maltreated adolescents compared to adolescents living in the same community but without child welfare-documented maltreatment. Our study of child welfare-affiliated maltreated youth (n=216) and comparison youth (n=128) from the same community (age M = 18.21, SD = 1.42) examined: 1. whether child/caregiver characteristics and maltreatment status were associated with lifetime number of residences and 2. whether child/caregiver characteristics, residences, and maltreatment status were associated with delinquency and marijuana use. The outcomes of this study, number of residences, delinquency, and marijuana use, were all skewed, and consequently negative binomial regressions were used. Maltreatment status, ever living with a non-parent caregiver, and being older are associated with more residence changes during childhood. More residences and male sex are associated with person offense delinquency and marijuana use. In lower income neighborhoods, such as where the adolescents in this study lived, residence changes are not unusual, but in this study maltreated youth moved more often than youth from the same community. It is important to help caregivers who live in disadvantaged neighborhoods, especially families with child welfare involvement, understand the behavioral consequences of residence changes and provide support for stable long-term housing.

Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database

The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. A total of 387,608 current marijuana users were identified based on ICD‐9 codes for marijuana use among hospitalized patients in the Nationwide Inpatient Sample database between 2007 and 2011. Logistic regression analysis was performed to determine the association between marijuana use and heart failure, cardiac disease, stroke, and in‐hospital mortality. All models were adjusted for age, gender, race, residential income, insurance, residential region, pain, and number of comorbidities. Among hospitalized patients, marijuana use was associated with a 60% increased odds of stroke (OR: 1.60, 95% CI: 1.44–1.77) compared with non‐users, but significantly reduced odds of heart failure (OR: 0.78, 95% CI: 0.75–0.82), cardiac disease (OR: 0.86, 95% CI: 0.82–0.91), or in‐hospital mortality (OR: 0.41, 95% CI: 0.38–0.44). Among cancer patients, odds of in‐hospital mortality was significantly reduced among marijuana users compared with non‐users (OR: 0.44, 95% CI: 0.35–0.55). Hospitalized marijuana users were more likely to experience a stroke compared with non‐users, but less likely to experience in‐hospital mortality. Prospective studies will be needed to better characterize the health effects of marijuana use, especially among older, sicker, and/or hospitalized patients. In the meantime, conversations regarding marijuana use/misuse may be warranted in the clinical setting in order for patients and healthcare providers to adequately weigh the anticipated benefits of marijuana use with potentially significant health risks.

Black-White Disparities in Criminal Justice Referrals to Drug Treatment: Addressing Treatment Need or Expanding the Diagnostic Net?

Slightly more than half of admissions to U.S. publicly-funded treatment for marijuana use are referred by the criminal justice system; this pattern has remained for at least 20 years. Nationally, Blacks comprise nearly a third of treatment admissions for marijuana use. This article explores the interplay between race and criminal justice referrals to treatment for marijuana use. Using data from the (U.S.) 2011 Treatment Episode Data Set, we examine the relationship between race and diagnosis of cannabis use disorder (dependence versus abuse) among referrals to community-based treatment in North Carolina. We compare Black/White differences in cannabis diagnoses across four referral sources: the criminal justice system, healthcare providers, self, and other sources. Race was significantly related to type of diagnosis across all four referral sources, however, the nature of the relationship was distinctly different among criminal justice referrals with Whites being more likely than Blacks to be diagnosed with cannabis dependence. Moreover, the marijuana use profiles of criminal justice referrals differed substantially from individuals referred by other sources. The findings suggest that diagnoses of cannabis abuse (rather than dependence) may have worked to widen the diagnostic net by “capturing” individuals under control of the criminal justice system who manifested few problems with marijuana use, other than their involvement in the criminal justice system. The potential for a net-widening effect appeared to be most pronounced for Blacks.

The Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) and Substance Use Among College Students

Transition-to-adulthood themes, or thoughts and feelings about emerging adulthood, have been measured by the Inventory of the Dimensions of Emerging Adulthood (IDEA) and found to be associated with substance use among emerging adults. It has been suggested, however, that the IDEA is lengthy and may not include the most unique and theoretically relevant constructs of emerging adulthood. The Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) was developed as an alternative instrument, but research has yet to determine the relationship between the IDEA-R and substance use among emerging adults (ages 18-25 years). College students completed surveys indicating their identification with transition-to-adulthood themes and substance use. Logistic regression models examined the associations between transition-to-adulthood themes and marijuana use and binge drinking, respectively. Participants who felt emerging adulthood was a time of identity exploration were less likely to report marijuana use, while feelings of experimentation/possibility were positively associated with marijuana use and binge drinking. The IDEA-R may be useful for identifying correlates of substance use among emerging adults. Future research should evaluate the IDEA-R among representative samples of emerging adults to confirm the findings of this study. Health professionals working in substance use prevention may consider targeting the themes of identity exploration and experimentation/possibility in programs intended for emerging adults.

Local spatial clustering in youths' use of tobacco, alcohol, and marijuana in Boston

BACKGROUND

Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods.

OBJECTIVES

The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana.

METHODS

Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13-19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included "none," "1-2," "3-9," and "10 or more." The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan™ software package.

RESULTS

Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with a p-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models.

CONCLUSION

Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use.

A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States

Increases in Hispanic youth admissions to substance abuse treatment programs for marijuana use are a growing public health concern. In this study, we investigated trends in Hispanic youth from 1995 to 2012 utilizing the Treatment Episode Data Set-Admissions of the Substance Abuse Mental Health Services Administration. Hispanic youth marijuana admissions are associated with youth 15-17 years old, in high school, and living in a dependent situation. Notably, female admissions increased at greater rates than males. Results also point to decreasing tolerance of minor marijuana use by schools and community agencies. Findings highlight the need for targeted, culturally specific, and cost-effective treatment and prevention efforts.

Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies

Marijuana is one of the most commonly used drugs in the United States, and use during adolescence--when the brain is still developing--has been proposed as a cause of poorer neurocognitive outcome. Nonetheless, research on this topic is scarce and often shows conflicting results, with some studies showing detrimental effects of marijuana use on cognitive functioning and others showing no significant long-term effects. The purpose of the present study was to examine the associations of marijuana use with changes in intellectual performance in two longitudinal studies of adolescent twins (n = 789 and n = 2,277). We used a quasiexperimental approach to adjust for participants' family background characteristics and genetic propensities, helping us to assess the causal nature of any potential associations. Standardized measures of intelligence were administered at ages 9-12 y, before marijuana involvement, and again at ages 17-20 y. Marijuana use was self-reported at the time of each cognitive assessment as well as during the intervening period. Marijuana users had lower test scores relative to nonusers and showed a significant decline in crystallized intelligence between preadolescence and late adolescence. However, there was no evidence of a dose-response relationship between frequency of use and intelligence quotient (IQ) change. Furthermore, marijuana-using twins failed to show significantly greater IQ decline relative to their abstinent siblings. Evidence from these two samples suggests that observed declines in measured IQ may not be a direct result of marijuana exposure but rather attributable to familial factors that underlie both marijuana initiation and low intellectual attainment.

Separating the Association Between Inhibitory Control and Substance Use Prevalence Versus Quantity During Adolescence: A Hurdle Mixed-Effects Model Approach

BACKGROUND

Inhibitory control is a critical component to the self-regulation of affect and behavior. Research consistently demonstrates negative associations between inhibitory control and several problem behaviors including substance misuse during early adolescence. However, analytic approaches previously used have often applied ordinary least squares (OLS) regression to non-normal count data with an excessive number of zeros (i.e., never users), violating several model assumptions. Further, OLS regression fails to model effects of the independent variable, separately, for both prevalence and quantity of use.

OBJECTIVE

The study objective was to simultaneously model associations between inhibitory control and both past 30-day prevalence and amount of cigarette and marijuana use. It was hypothesized that when doing so, inhibitory control would be significantly associated with prevalence, but not quantity of use.

METHOD

Hurdle Mixed-effects Models (HMM) were used for hypothesis testing on data collected from 3,383, 9th grade adolescents (M(age) = 14.08 years).

RESULTS

Results confirmed hypotheses, demonstrating that although significant bivariate associations between inhibitory control and quantity of cigarette and marijuana use existed, HMM analyses established that the associations were more precisely specific to past 30-day prevalence, and not quantity of use.

CONCLUSION

Results from a HMM approach contribute to a more comprehensive and nuanced understanding of which characteristics of cigarette and marijuana use are associated with inhibitory control during early adolescence.

Marijuana Use and Psychiatric Disorders in Perinatally HIV-Exposed Youth: Does HIV Matter?

OBJECTIVE

 To examine longitudinal reciprocal relationships between marijuana use and psychiatric disorders, and identify the role of HIV in a sample (N = 340) of youth perinatally infected with HIV (PHIV+) and youth perinatally exposed but uninfected with HIV (PHIV-) (60.6% PHIV+; 9-16 years at baseline; 51% female). 

METHODS

 Cross-lagged structural equation modeling was used to examine longitudinal associations between changes in marijuana use and changes in any behavioral, mood, and anxiety disorders at three time points across adolescence. 

RESULTS

 Marijuana use predicted behavioral and mood disorders in youth, regardless of HIV status. Behavioral and mood disorders predicted marijuana use for PHIV- youth; behavioral disorders predicted marijuana use for PHIV+ youth. Anxiety disorders and marijuana use were not associated for either group. 

CONCLUSIONS

 For PHIV+ and PHIV- youth, interventions that target early marijuana use may reduce later psychiatric disorders. Similarly, treatment for early behavioral disorders may prevent subsequent marijuana use.

Sexual Risk Behavior among Male and Female Truant Youths: Exploratory, Multi-Group Latent Class Analysis

Little is known of sexual risk behaviors among truant youths across gender. This study utilized latent class analysis to examined heterogeneity of sexual risk behaviors across gender among a sample of 300 truant adolescents. Results revealed two latent subgroups within gender: low vs. high sexual risk behaviors. There were gender differences in baseline covariates of sexual risk behaviors, with male truants in higher risk group experiencing ADHD (attention deficit hyperactivity disorder) problems, and female truants in higher risk group experienced marijuana use and depression symptoms. African-American race was a significant covariate for high sexual risk behaviors for both genders. Service and practice implications of sexual risk issues of truant youth are discussed.

Are Dimensions of Parenting Differentially Linked to Substance Use Across Caucasian and Asian American College Students?

BACKGROUND

Parental warmth and autonomy granting are commonly thought of as protective factors against substance use among Caucasians. However, limited research has examined whether associations between parenting dimensions and substance use outcomes are the same or different among Asian Americans.

METHOD

A final analytic sample of 839 college students was used to test whether race (Caucasian vs. Asian American) moderated the relations between parenting dimensions and substance use outcomes across Caucasians and Asian Americans. We utilized the Parental Bonding Instrument (Parker, Tupling, & Brown, 1979) to measure maternal and paternal warmth, encouragement of behavioral freedom, and denial of psychological autonomy.

RESULTS

Multivariate regression models controlling for covariates including age, gender, and paternal education indicated four significant parenting by race interactions on alcohol problems and/or marijuana use. Specifically, maternal warmth was inversely associated with both alcohol problems and marijuana use among Caucasians but not among Asian Americans. Both maternal and paternal denial of psychological autonomy were positively associated with alcohol problems among Caucasians but not among Asian Americans.

CONCLUSIONS

Consistent with emerging cross-cultural research, the associations between parenting dimensions and substance use behaviors observed in Caucasian populations may not be readily generalized to Asian Americans. These findings highlight the importance of considering different parenting dimensions in understanding substance use etiology among Asian Americans. Future research should use longitudinal data to replicate these findings across development and seek to identify other parenting dimensions that may be more relevant for Asian American youth.

Befriending Risky Peers: Factors Driving Adolescents' Selection of Friends with Similar Marijuana Use

Adolescents often befriend peers who are similar to themselves on a range of demographic, behavioral, and social characteristics, including substance use. Similarities in lifetime history of marijuana use have even been found to predict adolescent friendships, and we examine whether this finding is explained by youth's selection of friends who are similar on a range of more proximate, observable characteristics that are risk factors for marijuana use. Using two waves of individual and social network data from two high schools that participated in Add Health (N = 1,612; 52.7% male), we apply longitudinal models for social networks to test whether or not several observable risky attributes (psychological, behavioral, and social) predict adolescent friendship choices, and if these preferences explain friend's similarities on lifetime marijuana use. Findings show that similarities on several risk factors predict friendship choices, however controlling for this, the preference to befriend peers with a similar history of marijuana use largely persists. The results highlight the range of social selection processes that lead to similarities in marijuana use among friends and larger peer groups, and that also give rise to friendship groups whose members share similar risk factors for substance use. Friends with high "collective risk" are likely to be important targets for preventing the onset and social diffusion of substance use in adolescents.

Parental involvement in brief interventions for adolescent marijuana use

Adolescents (aged 12-18 years) identified in a school setting as abusing marijuana and other drugs were randomly assigned to complete 1 of 2 brief interventions (BIs). Adolescents and their parent (N = 259) were randomly assigned to receive either a 2-session adolescent only (BI-A) or a 2-session adolescent and additional parent session (BI-AP). Interventions were manualized and delivered in a school setting by trained counselors. Adolescents were assessed at intake and at 6 months following the completion of the intervention. Using a latent construct representing 6-month marijuana use outcomes, current findings supported previous research that BI-AP resulted in superior outcomes when compared to BI-A. The presence of a marijuana dependence diagnosis at baseline predicted poorer outcomes when compared to youth without a diagnosis. Both baseline diagnostic status and co-occurring conduct problems interacted with intervention condition in predicting marijuana use outcomes. A marijuana dependence diagnosis resulted in poorer marijuana use outcomes within the BI-A condition when compared to BI-AP. Co-occurring conduct problems were associated with poorer marijuana use outcomes within the BI-AP intervention when compared to BI-A. Implications for implementing BIs given diagnostic status, parent involvement, and co-occurring conduct problems are discussed.

Prevalence of marijuana and other substance use before and after Washington State's change from legal medical marijuana to legal medical and nonmedical marijuana: Cohort comparisons in a sample of adolescents

BACKGROUND

A growing number of states have new legislation extending prior legalization of medical marijuana by allowing nonmedical marijuana use for adults. The potential influence of this change in legislation on adolescent marijuana and other substance use (e.g., spillover or substitution effects) is uncertain. We capitalize on an ongoing study to explore the prevalence of marijuana and other substance use in 2 cohorts of adolescents who experienced the nonmedical marijuana law change in Washington State at different ages.

METHODS

Participants were 8th graders enrolled in targeted Tacoma, Washington public schools and recruited in 2 consecutive annual cohorts. The analysis sample was 238 students who completed a baseline survey in the 8th grade and a follow-up survey after the 9th grade. Between the 2 assessments, the second cohort experienced the Washington State nonmedical marijuana law change, whereas the first cohort did not. Self-report survey data on lifetime and past-month marijuana, cigarette, and alcohol use were collected.

RESULTS

Multivariate multilevel modeling showed that cohort differences in the likelihood of marijuana use were significantly different from those for cigarette and alcohol use at follow-up (adjusting for baseline substance initiation). Marijuana use was higher for the second cohort than the first cohort, but this difference was not statistically significant. Rates of cigarette and alcohol use were slightly lower in the second cohort than in the first cohort.

CONCLUSIONS

This exploratory study found that marijuana use was more prevalent among teens shortly after the transition from medical marijuana legalization only to medical and nonmedical marijuana legalization, although the difference between cohorts was not statistically significant. The findings also provided some evidence of substitution effects. The analytic technique used here may be useful for examining potential long-term effects of nonmedical marijuana laws on adolescent marijuana use and substitution or spillover effects in future studies.

Sex differences in self-report and behavioral measures of disinhibition predicting marijuana use across adolescence

Disinhibition has been consistently linked to substance use across development. Recent research suggests, however, that these relations may be influenced by both sex and measurement approach. The current study examined the moderating effect of sex on the association between behavioral and self-report measures of disinhibition and marijuana use across adolescence. Participants were 115 boys and 89 girls initially evaluated at Grade 8 using a laboratory behavioral assessment and self-report questionnaires of disinhibitory variables. Marijuana use was measured annually from Grades 9 through 12. Results suggest that boys and girls did not differ on either self-reported or behaviorally assessed levels of disinhibition, and that disinhibition measured using both approaches was associated with increases in marijuana use over time. There was a significant interaction between sex and disinhibition, suggesting that boys (but not girls) who self-reported elevations in disinhibition evidenced greater increases in marijuana use. The current findings add to a growing literature supporting the importance of using multiple methods to assess disinhibition and highlight the critical role of biological sex in understanding these relations.

The Validity of Truant Youths' Marijuana Use and Its Impact on Alcohol Use and Sexual Risk Taking

Few studies investigating the validity of marijuana use have used samples of truant youth. In the current study, self-reports of marijuana use are compared with urine test results for marijuana to identify marijuana underreporting among adolescents participating in a longitudinal Brief Intervention for drug-involved truant youth. It was hypothesized that marijuana underreporting would be associated with alcohol underreporting and engaging in sexual risk behaviors. The results indicated marijuana underreporting was significantly associated with self-denial of alcohol use, but not associated with sexual risk behavior. Also, there was an age effect in marijuana use underreporting such that younger truant youth were more likely to underreport marijuana use, compared to older truant youth. Implications for policy and future research are discussed.

Washington State recreational marijuana legalization: parent and adolescent perceptions, knowledge, and discussions in a sample of low-income families

BACKGROUND

In November 2012, Washington State and Colorado became the first states in the United States to legalize recreational marijuana use for adults, and Uruguay became the first country to allow the cultivation, distribution, possession, and use of marijuana. One possible consequence of these changes is increased adolescent marijuana use. Parents may mitigate this adverse consequence; however, whether parents and adolescents have accurate knowledge about the laws and are discussing marijuana use in light of the law changes is unknown.

OBJECTIVE

We examine perceptions, knowledge, and parent-child discussions about Washington State's recreational marijuana law in a sample of low-income families.

METHODS

Participants were a subset of families (n = 115) in an ongoing study that originally recruited parents and adolescents from middle schools in Tacoma, Washington. In summer 2013, when students were entering the 11(th) grade, students and their parents were asked questions about the recreational marijuana law.

RESULTS

Participants perceived that their marijuana-related attitudes and behaviors changed little as a result of the law, and displayed uncertainty about what is legal and illegal. Most parents reported discussing the new law with their children but only occasionally, and conversations emphasized household rules, particularly among parent lifetime marijuana users compared to non-users. Conclusions/Importance: Results suggest that there should be a public health campaign focused on families that provides clear information about the recreational marijuana laws.

Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win

BACKGROUND

There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years.

OBJECTIVES

This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions.

METHODS

In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products.

RESULTS

Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance: Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.

Disruptive Behavior Disorders and Marijuana Use: The Role of Depressive Symptoms

OBJECTIVE

The present study sought to examine the relations among disruptive behavior disorders (DBDs; ie, attention-deficit/hyperactivity disorder [ADHD], conduct disorder [CD], oppositional defiant disorder [ODD]), depressive symptoms, and marijuana use among a sample of late adolescents and emerging adults.

METHOD

A total of 900 students (75.8% female, 80.3% Caucasian, M_age = 20) from a large public university completed an online survey.

RESULTS

Findings indicated that depressive symptoms mediated the relation between the marijuana use and past symptoms of ADHD, past diagnosis of ADHD, CD symptoms, CD diagnosis, and ODD diagnosis.

CONCLUSION

Depressive symptoms represent a link between DBDs and marijuana use that is suggested, but not well documented in the existing literature. The current findings add to this evidence and suggest a need to assess individuals presenting with symptoms of DBDs for depressive symptoms, as this symptom pattern may result in a greater likelihood of marijuana use.

At-school substance use as a marker for serious health risks

OBJECTIVE

At-school substance use is associated with increased rates of violence and delinquency. However, whether at-school substance use is a useful marker for other serious health risks and whether this association varies by gender or substance is still unclear.

METHODS

We analyzed data from the national 2011 Youth Risk Behaviors Survey of 15,698 ninth to 12th grade students. We used multivariate regressions controlling for age and race and evaluated whether at-school marijuana and alcohol users were more likely than out-of-school users to exhibit 9 serious health risks (exposure to intoxicated driving, fighting, carrying a weapon at school, substance use with intercourse, experiencing intimate partner violence, being forced to have intercourse, experiencing depression, suicidal ideation, and attempting suicide). We included interaction terms to determine whether this association varied by gender or substance.

RESULTS

At-school alcohol and marijuana use were both associated with increased odds of all 9 serious health risks. The association between at-school substance use and fighting and being forced to have sex was greater for boys than for girls. Associations did not vary significantly by substance. Specificity of at-school substance use for serious health risks ranged from 0.93 to 0.96, and positive predictive values ranged from 0.23 to 0.69, well above the ranges for out-of-school use and nonuse.

CONCLUSIONS

Students found using alcohol or marijuana at school should be immediately and carefully screened for other serious health risks that pose significant present dangers; this might represent a critical opportunity to identify troubled youth.

Discrepant Patterns of Heavy Drinking, Marijuana Use, and Smoking and Intimate Partner Violence: Results From the California Community Health Study of Couples

This study analyzed whether discrepant (husband or wife use only) or concordant (both partners use) patterns of heavy drinking, marijuana use, and smoking are associated with increased risk for male-to-female partner violence and female-to-male partner violence among adult couples. Based on a geographic sample of married or cohabiting couples residing in 50 California cities, logistic regression analyses were conducted using dyadic data on past-year partner violence, binge drinking and frequency of intoxication, marijuana use, and smoking. When all substance use patterns were included simultaneously, wife-only heavy drinking couples were at elevated risk for male-to-female partner violence, as were concordant marijuana-using couples. Husband-only marijuana discrepant couples were at increased risk for female-to-male partner violence. Further research is needed to explore the processes by which discrepant and concordant substance use patterns may contribute to partner aggression.

Sibling popularity: A moderator of sibling influence for adolescent substance use

Sibling substance use is a known correlate of adolescent substance use. Yet, not all siblings are equally influential. Sibling influence has been found to vary by age gap, sex, and birth order. Little research, however, has investigated whether siblings' peer context is also a source of variation. The present study tested whether more popular siblings were more influential for adolescent use of cigarettes, alcohol, and marijuana. Data were obtained from sibling pairs in the National Longitudinal Study of Adolescent Health. Findings indicate that older siblings have more influence on younger sibling marijuana use when they have more friends. These findings contribute to prior work examining which siblings are more influential and highlight the need to consider siblings as part of a greater peer context.

Changes in substance use-related health risk behaviors on the timeline follow-back interview as a function of length of recall period

The timeline follow-back (TLFB) interview was adopted to collect retrospective data on daily substance use and violence from 598 youth seeking care in an urban Emergency Department in Flint, Michigan during 2009-2011. Generalized linear mixed models with flexible smooth functions of time were employed to characterize the change in risk behaviors as a function of the length of recall period. Our results suggest that the 1-week recall period may be more effective for capturing atypical or variable patterns of risk behaviors, whereas a recall period longer than 2 weeks may result in a more stable estimation of a typical pattern.