Although our baseline results showed that medical use had an adverse impact on functional impairment, these effects did not persist over the follow up period. Given the changing political landscape around marijuana, further studies focused on the potential adverse clinical effects and differences between recreational and medical marijuana users in psychiatry treatment samples will be needed to shape prevention and treatment strategies.Limitations should be noted. Data were collected from an outpatient psychiatry setting of insured patients in the San Francisco Bay Area, limiting generalizability. A PHQ-9 score of 10 indicates a positive screen for major depression, after which diagnostic assessments are required before a diagnosis of major depressive disorder can be made based on DSM criteria . Since inclusion was based on a PHQ-9 score ≥ 5, indicating at least mild depression, many participants would not have met the DSM criteria for major depressive disorder; results should be interpreted accordingly. Our marijuana status measure required medical users endorse exclusive medical use, and allowed for non-medical users to endorse non-medical use alone or in addition to medical use. As such, the data derived from this measure may underestimate medical marijuana use and overestimate non-medical marijuana use. Regarding medical marijuana use,drying racks data were not available on medical reasons for use, and future work would benefit from incorporating objective and subjective measures into the assessment.
Although adjusted multivariable analyses were used, clinical differences could present between the marijuana-use/no-use groups on unobserved factors, such as medical comorbidities and marijuana use frequency, and the results should be interpreted accordingly. Data were not available on primary marijuana compounds, Δ9 – tetrahydrocannabinol and cannabidiol , and given the potential for marijuana use to have either anxiolytic or anxiogenic effects based on the primary cannabinoid , it will be important for future work to examine the contribution of these factors to clinical outcomes in psychiatry samples. Given that several statistical tests were computed without adjustment for multiple inference testing, and all measures were based on self-report, future work would benefit from use of more robust methods and analytic procedures.Despite consistent declines in rates of cigarette use among adolescents in the last five years, rates of marijuana use have remained constant, with marijuana being the most widely used illicit drug among adolescents . Nationally representative data from Monitoring the Future show rates of conventional cigarette use among 10th graders declining significantly from 9.1% in 2013 to 7.2% in 2014; and among 12th graders from 16.3% in 2013 to 13.6% in 2014 . Rates of marijuana use have remained stable, with 16.6% of 10th graders and 21.2% of 12th graders reporting past 30-day use in 2014 . Blunts have become a common form of marijuana among adolescents, with more than half of 30-day marijuana users also reporting blunt use . Adolescents’ perceptions related to marijuana use have also changed, with the number of youth who perceive significant risk from using marijuana once or twice a week decreasing from 54.6% in 2007 to 39.5% in 2013 .
Moreover, 73.3% of 10th graders reported disapproval of occasional marijuana use in 2007, yet 62.9% reported disapproval in 2014 . Social media is a key venue for sharing marijuana-related information and attitudes, particularly among adolescents. For example, between 2012 and 2013, more adolescents than adults tweeted about marijuana, with the majority of these tweets reflecting positive attitudes about marijuana . Social acceptability and perceptions of risks and benefits, including the active sharing of these beliefs on social media, are important predictors of health behavior decision-making . Perceptions of risks generally vary by sex and age, with females and minorities tending to rate perceived risks higher than white males . Additionally, perceptions of risk related to marijuana use are known to be higher among females, non-whites, older adults, and individuals who have a family income between $20,000-49,999 . However, few studies have examined adolescents’ beliefs about specific risks and benefits related to marijuana and blunts, and studies have not examined relationships among adolescents’ perceptions, social acceptability, awareness of social media and actual marijuana use . Understanding these relationships is critical, especially since smoking marijuana places one at risk for a number of the same negative health outcomes and secondhand smoke effects as smoking conventional tobacco cigarettes . Long-term use of marijuana can lead to addiction, with initiation in adolescence associated with higher rates of addiction, negative impacts on brain development, and lower levels of school and lifetime achievement . There is also concern that using both marijuana and tobacco at the same time can reinforce the rewarding effects of both substances . Using a sample of 9th and 12th grade students recruited from California schools, this study addresses important gaps in the literature by first reporting adolescents’ rates and patterns of use of and access to marijuana, blunts, and cigarettes.
Second, this study examines and compares adolescents’ perceived prevalence, social acceptability, and risks and benefits of marijuana, blunts, and cigarettes. Lastly, this paper assesses to what extent these factors are associated with actual use of marijuana. Such information is important in order to inform the creation of better education and warning messages, especially as marijuana and blunt use increases in popularity and moves from an illicit drug to a legal drug for recreational use .This study utilized a convenience sample, in which we recruited participants from 10 large high schools throughout California. These schools were diverse with respect to geographic location , race/ethnicity, and socioeconomic status ; and were schools that were willing to participate in the study. Researchers introduced the study and invited all ninth and 12th graders to participate, during which time they provided students with consent forms for parents and students 18 and over, assent forms for students under age 18, and project information to take home and discuss with their parents/guardians. Approximately 4,000 students learned about the study,cannabis drying of whom 1,299 returned signed consent/assent forms; 405 of the consented students were disqualified from the study because of incorrect contact information, being in the wrong grade, or non-response to subsequent contact. Overall, 786 of eligible consented students completed the survey. There were some small but non-meaningful racial/ethnic differences between those who did and did not complete the survey; however, there were no differences by mother’s education. The sample size was designed to allow sufficient power to detect the contrasts of interest. The sample included 484 females and 281 males; mean age = 16.1 . Participants were ethnically diverse, with 207 White, 171 Asian/Pacific Islander, 232 Hispanic, and 168 other. Demographics of the students who participated in the study reflected the demographic make-up of their respective schools. The survey included 125 questions addressing a number of research questions; and took participants between 30 and 60 minutes to complete. Participants were allowed as much time as they wanted to complete the survey, although they were encouraged to complete the survey at one time to increase confidentiality of their responses. Only those measures related to the current study are reported here. Comprehensive results regarding the cigarette use data can be found in Roditis et al. . Many measures were derived from past surveys on adolescents’ attitudes towards substances, including those that have tested the validity of the assessments . All measures were pilot tested with adolescents of the same age and demographics of our sample. Participants indicated items that were not clear, and then we revised the survey and pilot tested it again until all measures were clear. Most items were continuously scored; the few that were dichotomized are noted below.Differences in perceptions of risks and benefits and social norms across products were assessed using a generalized linear model with the generalized estimating equation method and an exchangeable correlation matrix to adjust the variance estimates for nonindependence within school as implemented in Proc Genmod of SAS, v94. Post hoc testing utilized Tukey-Kramer tests. The relationship among marijuana use, perceptions of social norms, risks and benefits, and viewing of ads on social media was assessed using logistic regression.
The outcome variable, marijuana use, was coded into 2 categories of never used and ever used. Predictor variables included: perceived prevalence variables, perceived risk and benefit variables factor analyzed into the following categories: health and social risks, benefits, and risk of addiction, and awareness of social media attitudes and beliefs related to marijuana. Age, sex, and race/ethnicity were also included in the model; however, interactions with sex and race/ethnicity were not significant and therefore were removed in the final model. Missing data, which was negligible and varied item to item, were left missing. SPSS version 23 was used for the descriptive analyses. There were significant differences in participants’ reports of mother, father, sibling, and friend use of these products. Participants reported lower rates of marijuana and blunt use and higher rates of cigarettes use among adult figures in their lives. Conversely, participants reported much higher rates of marijuana than cigarette use among friends . They perceived significant differences in rates of use among peers, reporting that 50.92% of their peers had ever used marijuana, 42.63% had ever used blunts and 34.43% had ever used cigarettes. Participants viewed marijuana and blunts as more socially acceptable than cigarettes . Participants rated cigarettes as being overall more harmful to their health, more harmful to their friends’ health, more harmful to the environment, and more addictive than marijuana or blunts . Post-hoc analyses showed that participants perceived marijuana as more harmful to the environment than blunts, and perceived blunts as more likely to lead to addiction than marijuana. Participants viewed marijuana and blunts as similarly risky when it comes to their and their friends’ health . Generally, participants rated marijuana and blunt use as less likely to result in short-term health risks than cigarettes, with post-hoc analyses showing that they viewed marijuana and blunts as similarly risky. Participants also rated marijuana and blunt use as less likely than cigarettes to result in the short-term social risks of friends getting upset and bad breath. Participants reported no difference in the likelihood of getting in trouble from using marijuana, blunts, or cigarettes. Adolescents rated marijuana and blunts as more likely to confer social benefits of looking cool and fitting in than cigarettes, though they rated all products as equally likely to make them look mature. Participants rated marijuana and blunts as less likely to make them feel jittery or nervous, more likely to reduce stress, and more likely to make them feel high or buzzed than cigarettes. They rated all three products as equally likely to help with concentration. Use rates in this study were highest for marijuana, followed by blunts and cigarettes. Most adolescents who use these products get them from friends, use them in friends’ houses, and when they feel stressed. Adolescents perceived lower marijuana and blunt use but higher cigarette use among parents. Conversely, adolescents perceived higher use of marijuana and blunts and lower use of cigarettes among their siblings and peers. These differences in perceived use may reflect current trends in adolescent marijuana and cigarette use nationwide, in which rates of cigarette use is much lower than marijuana use, with cigarette use continuing to decline, marijuana use remaining higher , and rates of marijuana use being higher among adolescents and young adults compared to adults . While approximately a quarter of participants report having used marijuana, they thought that more than half of their friends have used marijuana. Importantly, participants who reported that their friends used marijuana had a 27% greater odds of using marijuana themselves. Previous studies also show relationships between friend drug use and adolescent drug use, and friend use is a powerful influence on adolescents’ social norms and acceptability of particular behaviors . The fact that participants report friend use rates of marijuana as double that of self-reported use may be reflective of changing social norms in which marijuana use is seen as an acceptable and common behavior, which, in turn, may be influencing decisions to use . Marijuana and blunts were generally perceived as more socially acceptable, less risky, and more beneficial than cigarettes. Despite the fact that blunts contain nicotine yet marijuana doesn’t, adolescents didn’t perceive differences in the likelihood of becoming addicted or being able to quit marijuana or blunts, although adolescents rated marijuana as more addictive than blunts. This is of particular importance, as it is possible that using both tobacco and marijuana together may actually increase the addictive potential of these products .