In other words, workforce participation at age 23 is associated with lower marijuana-use rate over subsequent years for both males and females. This finding supports key concepts from the life-course theory which emphasizes salient life events such as employment or marriage to explain both continuity in childhood deviant behavior and changes during the life-course, and highlights the need for integrated drug programs that provide substance abuse treatment in conjunction with occupational trainings. Third, marijuana-use during the initial observation period was negatively correlated with slope of employment trajectory for males, indicating that marijuana-use is associated with decreased levels of workforce participation and has an adverse consequence on subsequent career growth. Clearly, the implication is that the harm of marijuana-use on users’ socioeconomic aspects of life is long term and chronic. One possible explanation for why this is uniquely found for males may lie in the dissimilarity of level of workforce participation and level of marijuana consumption. As illustrated in Figure 1, on average, females appear to be employed less time than males and tend to engage in marijuana-use to a lesser degree. Kaestner calls to attention the importance of including demographic contexts such as educational achievement, marital status and number of dependent children in examining the association of marijuana-use and employment. These demographic factors have been reported as important determinants of work participation and also show influences on level of marijuana consumption . Therefore, indoor grow rack further studies that simultaneously examine the association of employment with drug use as well as the demographic contexts are recommended.
Finally, slope of employment trajectory is not significantly correlated with slope of marijuana-use trajectory for either gender, indicating that the association between changes in marijuana-use and work participation over age are not systematic. The lack of consistency in the association between the two longitudinal trajectories suggests that the magnitude and direction of relationship between employment and drug use are not consistent over age, and that the direction of causality is complicated and uncertain. Again, this is consistent with other longitudinal studies , and it highlights the need for sophisticated causal inference approaches in future studies, especially given the limitations of empirical analyses on providing credible evidence for causal relationships. Despite significant findings, the present study has several limitations. The sample used for the analysis was a subset of the National Longitudinal Survey of Youth 1979 cohort who completed the 2004 follow-up survey. While utmost care was taken in examining participants’ demographic characteristics for any possible systematic missing patterns of subjects, the generalizability of the findings from this study sample to the entire NLSY79 cohort may be limited. Furthermore, the measures used in NLSY to record substance use are relatively coarse. A dichotomous measure of marijuana-use are relative crude and may differ drastically from person to person when identifying patterns of marijuana-use that affect employment. The current approach to estimating a BRISM is also limited in its ability to incorporate time varying covariates , as these would need to be treated as additional longitudinal trajectories within a multivariate random intercept and slope model. In addition, inclusion of quadratic, or higher order terms, within the bivariate longitudinal model resulted in a lack of model convergence. Work is currently ongoing to develop methods that allows for the incorporation of time-varying covariates.
One possible solution to be explored in future studies include taking a Bayesian approach to fitting the model with informative prior distributions that are derived from empirical studies . In sum, our results highlight the cross-correlational longitudinal effects of substance use and employment outcomes for young adults, while properly accounting for dynamic interdependencies between two concurrent repeated-measures outcomes. Additional research is encouraged to determine whether the findings endure with other data sets, different types of drugs and different employment variables. In particular, future research should closely examine how these two concurrent longitudinal outcomes may differ by race/ ethnicity groups through assessment of their interaction effect with the inter-dependent trajectories. Marijuana continues to be legalized in many states, generally with limited public health input. Although valid medicinal applications exist, the National Academies of Science, Engineering, and Medicine concluded that substantial evidence suggests that marijuana use is also associated with significant harms, including psychosis, schizophrenia, problem marijuana use, motor vehicle collisions, low birth weight, and respiratory symptoms.Evidence is emerging regarding the association of marijuana use with youths’ cognition and cardiovascular disease,as well as other areas, and the 2019 vaping epidemic demonstrated the hazards of rapid product innovation without due evaluation of safety.With widespread lifetime and adolescent use of marijuana, reaching 43.6% of 12th-grade students nationally, and 51.5% of 18- to 25-year-olds in 2018, even modest increases in risk may have a significant effect on population health.
Vaping of marijuana in the past 30 days, which typically involves high-potency concentrates, increased from 5% of 12th-grade students in 2017 to 14% in 2019, with 3.5% vaping near daily in 2019.10 The potential magnitude of mental health effects associated with the growing market of high-potency marijuana products is evidenced by estimates of the population-attributable fraction of first-episode psychosis due to use of high potency marijuana at 12% in 11 primarily European cities studied, and by elevated risk for first-episode psychosis found in individuals using these products daily. Treatment data also suggest reason for concern. In 2014, marijuana was the leading drug used by clients entering drug treatment in a study of 22 European countries, representing 46% of all new clients, up from 29% in 2003.Both marijuana-related new clients and daily users in treatment more than doubled between 2003 and 2014. Prior to legalization of adult use of marijuana in California, as legalization advanced nationally, identification of key policy concerns and calls for caution emerged. Barry and Glantz recommended that “to protect public health, marijuana should be treated like tobacco, legal but subject to a robust demand reduction program modeled on evidence-based tobacco control programs before a large industry develops and takes control of the market and regulatory environment.”Authors noted that the transition from small-scale marijuana growers and retailers to large-scale industrial consolidation and marketing would bring risks, including aggressive lobbying, campaign contributions, and efforts to create favorable regulation. Richter and Levy noted the parallels between modern trends in marijuana product diversification and past transformations of tobacco to a deadly industrialized product designed to boost nicotine delivery and enhance addictive potential and palatability. Volkow et al at the National Institutes of Health raised concerns over the potential effects of rising product potency and of use on the developing brain.Subsequently, in 2019, Ayers et al called attention to emerging patterns of marijuana branding, marketing health claims,indoor farming equipment lack of health warnings, and appeals to youths and called for federal regulation. California’s tobacco control oversight experts called for broad application of lessons learned from tobacco control to commercial marijuana.Others called for legalization processes to intentionally advance social equity through criminal justice policy, offering economic opportunity to communities hard hit by the war on drugs, and reinvesting revenues in those communities.In November 2016, a California ballot initiative, Proposition 64, successfully legalized production and sale of marijuana for adult use, 20 years after legalization of medicinal use of marijuana in the state. An important part of that initiative was the assurance that local control would be preserved and cities and counties would have broad discretion to allow legal marijuana commerce, or not, and to regulate its practice.
In 2017 and 2018, the state created a regulatory framework for legal cultivation, manufacturing, and retailing of marijuana, which generally prioritized facilitating the shift from the illegal market to the legal market rather than demand reduction strategies. The first legal marijuana dispensaries for adult use in California opened January 2018. Three marijuana industry behaviors—extensive increases in potency , manufacturing of products to attract youths, and aggressive marketing—that were directly adopted from tobacco industry practices became immediately evident across the state. Despite the threat to public health, state regulations failed to constrain these practices, even though California has led tobacco control efforts in the United States and pioneered tobacco control policies such as public smoking bans, flavored product bans, and electronic cigarette bans. Cities and counties are often “laboratories” of innovation in public policy, and, notably, in tobacco control. Because California law allowed significant local control, we therefore asked: To what extent have recommendations from the public health community and potential lessons from tobacco control and other legal, but harmful, products been adopted in the marijuana legalization process?In a cross-sectional study with data collection and analysis from February 1 to November 30, 2019, we studied laws and regulations in California to understand the extent to which public health recommendations and tobacco control best practices, and in some cases, alcohol control best practices with evidence of effectiveness and potential relevance, had been incorporated into marijuana legislation by January 31, 2019. We followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline. The jurisdiction law review reported here was determined not to be human participant research by the Public Health Institute Institutional Review Board.Selected practices were identified during an earlier literature review and national consultation with 62 stakeholders during key informant interviews conducted from 2017 to 2019 with experts in marijuana, tobacco, and alcohol regulation, the First Amendment, tobacco and alcohol law, local government, community organizing, criminal justice, and substance abuse and marijuana research, as well as marijuana industry participants. Collectively, the results of these interviews informed production of 2017 model ordinances for marijuana retailing, marketing, and taxation for California local government.Potential best practices identified included restrictions on retail outlets, buffer zones, certain product types, delivery, marketing, and conflicts of interest, as well as requiring preservation of smoke-free air, health warnings, pricing and taxation measures, and equity policies in licensing, hiring, and revenue capture.Although only practices considered legally defensible were recommended, descriptions of local measures were collected regardless of whether they went beyond recommendations .Of 147 jurisdictions allowing medical or adult use storefront commerce, 93 limited the number of dispensaries, with a mean of 1 store for every 19 058 residents . The state imposed no limits on the number of dispensaries or delivery businesses that could be licensed. Forty-two jurisdictions imposed a buffer between retailers and schools greater than the stater equired 600 feet, yet 6 jurisdictions allowed retailers to locate closer to schools than the state’s requirement, at a mean of 258 feet. More than 100 jurisdictions added establishments to the state’s list of “sensitive use” sites from which storefront dispensaries must be distanced, which consisted of kindergarten through grade 12 schools, day care centers, or youth centers. Locally adopted examples included colleges, public beaches, libraries, tutoring centers, and recreation centers. More than one-third of jurisdictions imposed buffers between retail locations, with a median of 600 feet.Provisions to promote economic equity and diversity in marijuana licensing were limited to 5 of the largest cities. Oakland, Long Beach, and the city of Los Angeles gave a defined class of “equity” applicants priority in licensing and a reduction in certain costs, and required that certain percentages of employees be low-income, local, or transitional workers. Sacramento also had equity licensing priority and reduced costs, and San Francisco had equity licensing priority and employee requirements. The state did not establish an equity licensing system. Proposition 64 established the right to expunge certain past marijuana convictions, and state legislation subsequently approved a process for automatic expungement, reducing barriers for eligible individuals to benefit.Among jurisdictions allowing retail sale, only 8 imposed restrictions on types of marijuana products for sale, beyond state regulations. One jurisdiction, Contra Costa County, pioneered the prohibition of sale of flavored products for combustion or inhalation, 3 jurisdictions prohibited the sale of marijuana-infused beverages resembling “alcopops” , 5 jurisdictions restricted products appealing to youths, and 5jurisdictions imposed restrictions on edible marijuana products beyond state regulations. No jurisdictions limited the potency of products sold, although 1 jurisdiction established a potency linked tax. The state did not limit or tax potency, except for establishing a maximum 10-mg THC dose for edible marijuana products , nor did they limit manufacturing or sale of flavored products, such as flavored vaping liquids or prerolled cigarettes, although state regulations did create restrictions on products resembling existing foods or with characteristics that were particularly attractive to children.