Perceptions of Harm from Marijuana Use and Other Marijuana-Specific Risk Factors Among Young Adults in Diverse Legal Contexts

Introduction: Marijuana use in young adulthood is of particular concern because it can derail the successful transition into adult roles and responsibilities. Low perception of harm from use is one of the strongest risk factors for use, and national data over the past 20 years indicate decreasing perception of harm from marijuana use. Over the same time period, most US states have loosened their policies regarding restrictions on marijuana use for medical purposes and, more recently, 9 states have also legalized use for non-medical/“recreational” purposes. While not an evaluation of the effects of state-level marijuana policies, this study examined differences in the perception of harm from use (self and others) and other marijuana-specific risk factors among young adults (YA) living in diverse marijuana policy contexts. Main objective was to inform the direction of future preventive interventions.

Methods: Data came from the CYDS sample and were collected in 2016 when participants were about 23 years old. Marijuana policy context was based on the state-level policy of participants’ place of residence at the time of the survey (i.e., legalized medical and nonmedical use [34.5%, n=586], legalized medical use only [7.1%, n=121], and not legalized [58.4%, n=993]). Analyses adjusted for variation in demographic characteristics of participants (gender, age, race, Latino ethnicity) and for clustering within their communities of origin by including 11 dummy variables indicating the communities in which they grew up. Logistic regression models examined associations between marijuana policy context, marijuana-specific risk factors, and marijuana use.

Results: YA living in states with more permissive marijuana policies (i.e., with legalized marijuana for medical and “recreational” use) perceived lower risk of harm from regular use (OR=.54, p<.01), greater ease of access to marijuana, more favorable injunctive norms (e.g., how wrong would it be to use; OR=2.02, p<.05) and less harm to children from seeing adult use in public (OR=.49, p<.01). They were also more likely to use marijuana in the past year (OR=1.72, p<.01) and had a higher likelihood of marijuana misuse (OR=1.67, p<.05) than YA who lived where marijuana use was illegal. The finding of lower risk perceptions, greater availability, and more favorable norms in more permissive legal context persisted even after accounting for the differences in the prevalence of marijuana use.

Conclusions: Future preventive interventions for YA who live in states with legalized marijuana should be universal, focusing on those who use as well as those who do not, go beyond teaching about harm of marijuana to users, and provide accurate information about additional risks and harms of use, particularly to children.