Cannabis Grow

In fact, the modeling approaches used in previous studies of alcohol consumption trajectories are specific instances of finite mixture models . This study has some limitations. First, we relied on self-reported alcohol consumption which is known to have some measurement error. Nonetheless, our use of a validated instrument , delivered by a computer assisted interview, has been shown to be a valid and reliable method to measure alcohol consumption, and a recent analysis of trajectories using AUDIT-C has shown that they are correlated with alcohol consumption biomarkers. Second, the time period for this study is prior to the widespread use of direct acting agents for HCV infection, and it is unknown how HCV cure may affect drinking over time. Third, this is a clinic-based study of PWH, which means our data collection is dependent on the health care process. While this may affect the quality of our measurements, this may increase the generalization of our results to the population of diagnosed and linked to care PWH. Also, we do not know what the drinking patterns of participants were prior to study start. It is possible that some of the people that did not drink at their first CASI who subsequently transitioned to moderate or alcohol misuse had prior misuse, which is an important predictor of subsequent alcohol use. In a recent study in this same cohort, vertical growing systems greater than 1/3 of current individuals reporting non-use had a prior alcohol use disorder. Fourth, we only considered predictors measured at baseline .

Previous research has shown the importance of considering longitudinal changes in some clinical factors such as depression or anxiety, which may be cause and consequence of specific alcohol consumption patterns. However, our study was descriptive in nature and we did not aim at making inferences about the causal direction of this association. Furthermore, our main analysis only presents the age-, race-, and site-adjusted associations. We believe this represents the clinical reality better than a multivariate model that adjusts for every other factor available, where associations may be harder to interpret. However, we include the fully adjusted multivariate model in the appendix for transparency. Finally, our study classifies all individuals with AUDIT-C scores between 3 or 4 to 12 in the same group . Recent studies have shown that people with AUDIT-C scores equal or above 8 have increased risk for mortality. Future studies with adequate sample size to examine trajectories among individuals in this group would provide greater insights about those with heavier alcohol misuse. Our study has important implications for the management of alcohol use in HIV clinical settings. First, given that trajectories of alcohol use do change, it is important to routinely screen all individuals for alcohol use, including those who report no or moderate use. Second, it is also important to ensure that individuals with alcohol use are screened for comorbid mental health and substance use disorders.

With the relatively high frequency of comorbid mental health and substance use among those with alcohol misuse, it may be important to develop bundled interventions for these comorbid conditions. Finally, with significant alcohol related morbidity and mortality among PWH, integration of evidence based alcohol interventions into HIV clinical settings is an important aspect of the primary care of PWH. Future studies must work to identify how best to implement these interventions at both the provider and the system-level.Substance use initiation greatly increases across adolescence . Youth with greater internalizing and externalizing problems tend to show high risk for substanceuse, and differences in the activation of to two key stress response systems—hypothalamic pituitary adrenal axis and emotion—have been related to both . However, limited research has examined whether differences in the biological and psychological responses to stress, with respect to changes in corThisol secretion and emotions following stressor onset and across a recovery period, relate to substance use among adolescents, especially those at heightened risk for substance use. The present study examined how differences in the stress response related to substance use in a sample of Mexican-origin youth growing up in a low-income region with high levels of adversity . Using a longitudinal study design, we tested whether differences in HPA axis reactivity and emotion and recovery to stress at age 14 were associated with use of alcohol, marijuana, and cigarette use by age 14 ; use of alcohol, marijuana, cigarettes, and vaping of nicotine by age 16; and onset of alcohol, marijuana, and cigarette use between ages 14 and 16. Finally, we tested whether associations between stress reactivity, stress, recovery, and substance use varied by poverty status and sex.

Substance use greatly increases during adolescence, as the percentage of students who have used an illicit drug doubles from 8th to 10th grade, and nearly half of students report using at least one substance by 12th grade . Although experimentation is common in adolescence, youth who use alcohol, tobacco, and marijuana earlier in adolescence are at higher risk for psychopathology and substance use disorders in adulthood . Previous research has also consistently found that use of alcohol and marijuana by ages 14 and 16 specifically are related to poorer adjustment and higher use later in adolescence and adulthood . Risk is particularly high for Latinx adolescents, who show higher lifetime use of varied substances by 8th grade and by 12th grade compared to White and Black youth, and tend to begin using cigarettes, alcohol, and other drugs at earlier ages than other ethnic minorities . Furthermore, prior research suggests that Mexican American adolescents, specifically, are more likely to have initiated substance use by the eighth grade than non-Latinx and other Latinx youth .People generally respond to stress by showing increased negative emotion, decreased positive emotion, and activation of the HPA axis, a biological system especially sensitive to social-evaluative stressors . Exaggerated emotion reactivity to stress has been related to poorer health . However, inability to mount a response or showing blunted reactivity to stress may suggest disengagement and has also been related to poorer well-being . Dampened reactivity and recovery following stress have also been related to poorer health including depression and externalizing problems . Individuals can show blunted rather than exaggerated stress reactivity and recovery for many reasons . Individuals who experience chronic or repeated stress may initially show heightened emotional and biological stress reactivity and recovery, and these responses may habituate and show a blunted profile over time . Therefore, whereas unpredictable, acute stressful life events may promote a profile of exaggerated reactivity to stress, living in adversity can serve as a chronic stressor and consequently can promote inflexibility of psychobiological systems over time, such that individuals are incapable of responding to acute stressors . Indeed, youth and adults who experience more adversity generally show blunted rather than enhanced corThisol and heart rate reactivity to acute stress , grow rack as well as reduced activation of neural regions involved in threat such as the amygdala . It has been posited that individuals who experience high levels of adversity may be inclined to disengage from stressors, which can attenuate psychobiological reactivity and recovery . Lastly, low reactivity may result from socialization from peers and parents .

For instance, youth who experience adversity may interact with deviant peers or bullies who prompt them to be less responsive to stress and may be socialized by parents to be less affected by daily stressors . Just as heavy substance use can dysregulate HPA axis function , dysregulation of the HPA axis may also contribute to substance use risk. Youth with blunted HPA axis reactivity to stress may lack physiological inhibitory control, such that they may be less inhibited by the social consequences of risk-taking compared to adolescents who show greater corThisol reactivity to stress . Alternatively, adolescents with chronic under arousal may be generally more inclined to pursue risky behaviors to promote physiological arousal . Youth may not show corThisol reactivity to a stressor because they are not sensitive to that stressor, or because they have already become elevated in anticipation of a stressor . That is, certain youth may be more responsive to the threat such that they already show elevated levels of corThisol prior to stress onset and consequently show no further elevation in corThisol thereafter. Both blunted corThisol reactivity and anticipatory corThisol have been associated with more frequent substance use later in adolescence, especially among youth with difficulties in emotion regulation . Dysregulation of HPA axis function may similarly promote risk for lifetime substance use during adolescence. Adolescents with higher basal corThisol had earlier onset of substance use, although corThisol was not assessed following stress , and blunted corThisol secretion in anticipation of a laboratory task has been linked to greater substance use in pre-pubertal boys . Given the potential for bidirectional associations between HPA axis function and substance use, longitudinal studies are needed to disentangle whether HPA axis reactivity to and recovery from stress relate to risk for substance use onset during adolescence. Specifically, it is well-established that heavy substance use—as opposed to substance use initiation or less frequent substance use—can dysregulate physiology , so researchers may be best positioned to examine the role of physiology on substance use risk during adolescence when youth are initiating substance use but have not yet engaged in heavy substance use. In addition to corThisol reactivity, emotion reactivity to stress may relate to substance use. There are several emotion-related risk factors for substance use and substance use disorders in both adults and adolescents, including greater negative emotions, emotional lability, and emotional dysregulation . Although it is well-established that emotions influence frequency of substance use among users, it remains unclear whether emotion reactivity to stress relate to adolescents’ risk for substance use initiation. Emotion reactivity to stress often includes increases in negative emotions of both high arousal and low arousal and decreases in positive emotion, and each form of emotional change can have unique implications for health . Youth with exaggerated and dampened stress reactivity and recovery with respect to emotion may be particularly at risk for earlier onset of substance use, especially for Mexican-heritage adolescents, who experience culturally-specific stressors . Therefore, research is needed to determine whether emotion reactivity to stress and recovery from stress is related to substance use and the emergence of substance use among these youth.The impact of stress reactivity and recovery on substance use during adolescence may vary by sex. Adolescents’ motivations for substance use differ by sex . Male youth tend to be more motivated to use substances for social enhancement whereas female adolescents are more motivated to use substances to cope with negative emotion and stress . Further, female adolescents show higher comorbidity between substance use and depression relative to male adolescents, suggesting that emotion and stress may be particularly tied to female adolescents’ substance use . Therefore, although male adolescents tend to show earlier and more frequent substance use relative to female adolescents , substance use may be particularly related to the stress response among female adolescents. Indeed, prior research regarding youth who have used substances by age 16 in this cohort of Mexican-origin adolescents has found that greater corThisol reactivity relates to earlier age of initiation of alcohol use for girls, whereas blunted corThisol reactivity was related to earlier initiation of marijuana use only for boys with less advanced pubertal status . It is critical to disentangle whether differences in stress reactivity and recovery precede substance use across the sexes. Poverty status may also moderate associations between responses to stress and substance for two reasons. First, early life adversity including poverty status has been found to influence psychobiology such that youth who experience early life adversity, including youth belowthe poverty line, tend to show profiles of blunted corThisol responses to stress . Because these youth are already at heightened risk for blunted corThisol responses, the association between these responses and substance use may be stronger among these youth. Second, poverty status may influence adolescents’ propensity for substance use. Youth below the poverty line may experience earlier exposure to substance use and substance related crime, more targeted marketing of substances, and lower parental involvement . They may also be more motivated to use substances for reasons beyond stress, such as due to boredom, sensation seeking, and pursuit of enhancing effects in order to compensate for a lack of pleasurable substance-free daily activities .

Hookah is one of the most commonly used combustible tobacco products by young adults in the United States. Hookah smokers often perceive it as safer than cigarettes, but a growing literature points to deleterious health effects, including toxicant exposure, nicotine addiction and cardiorespiratory consequences. Existing evidence on the health effects of hookah shows it more than doubles the risk of lung cancer and respiratory illness, and case cardiovascular diseases. Moreover, multiple tobacco and nicotine product use with hookah is becoming more common. Emerging adulthood is a critical period for risk taking behavior, and use of tobacco and other nicotine containing products has been associated with increased risk of polysubstance use, particularly alcohol and marijuana. Among college students in the United States, the high rates of ever using hookah meet or exceed the lifetime prevalence of cigarette use. Initiation of hookah increases during the transition from high school to college, suggesting that the first few months of college is a particularly risky time for initiation. Similar to drinking, the risk of rapid transition to hookah use in college may be exacerbated by the trend of social influence, cannabis drying rack as hookah is most commonly used in groups in social settings.

Social Learning Theory and The Theory of Reasoned action emphasize the impact of socialization through peer influence and approval on substance use risk among young adults. Previous studies have identified risk factors for hookah use similar to those for cigarettes and associated risk behaviors such as marijuana and binge drinking. However, most studies have not included racial and ethnic minorities limiting our understanding of use among these growing populations, this is essential in understanding patterns in risk behaviors, as the US and its college populations become increasingly diverse. Nationally, less than one third of young adult past-30 day hookah users were exclusive hookah users. Thus, it is important to understand the risk of hookah use as a function of its use pattern . To help fill this gap, we conducted a study with a racially/ethnically diverse sample of urban college students to describe the patterns of hookah use , assessed the association between hookah use patterns and perceived social acceptance and peer influence, and explored the associations between hookah use patterns and other substance use risk behavior including binge drinking and marijuana use. Our main hypothesis was that hookah-specific social influence factors assessed by perceived social disapproval of hookah smoking and number of friends who smoke hookah are associated with patterns of hookah smoking.

Among a racially/ethnically diverse sample of young adults in one of the largest public urban university systems in the US, in contrast to prior studies, use of other tobacco and nicotine products along with hookah was less prevalent than exclusive hookah use among our young adult sample. Patterns of hookah use were significantly associated with past year alcohol binge drinking and marijuana use, where dual/poly hookah users were more likely to report binge drinking and marijuana use more than exclusive hookah use with never hookah users as the reference group. Historically, young adult males have had higher estimates of hookah use compared to females; however, trends have started changing with recent reports indicating that male and female prevalence is comparable. In contrast to the overall national US prevalence estimates, current hookah smoking was not significantly different between males and females, even when analyzed by hookah use pattern. However, there is a growing appeal for hookah smoking among urban female college students, including use of multiple tobacco and nicotine products in addition to hookah. Hookah is thought to be emerging during young adults’ transition to college, especially among females, which could be perceived a sign of independence among college age students. Hookah bars are usually located around college campuses, and where there is potentially high density of college students, particularly around the campuses included in our study. Around 121 out of 137 of the hookah bars in New York State are present in the 5 boroughs where the campuses included in our study are located. Given that females are reportedly more likely to smoke hookah in cafes/hookah bars compared to males, this high density of hookah bars might be a contributing risk factor for the higher hookah smoking prevalence among young adult females in our study compared to the national US estimates.

Race/ethnicity and social influences were independently associated with patterns of current hookah use.One significant difference by race/ethnicity was that Caribbean/West Indian origin students were less likely to be dual/poly users of hookah. We did not find higher hookah use rates among young adult White and Hispanic populations reported in other studies. This may be due to the unique pattern of smoking behavior within New York City, which limits hookah use disparities among college students. Future studies should assess in depth the racial and ethnic differences within patterns of hookah use while accounting for a more comprehensive set of hookah use predictors. These findings are consistent with the prior literature of substance use, as well as hookah use, which reflects a strong context for hookah use as a social activity. However, this finding can be interpreted in two ways; social influence could be impacting hookah use in general and whether an individual uses hookah exclusively or in combination with other products; a novel finding in the hookah literature. Moreover, having a greater number of friends who use hookah was more strongly associated with exclusive hookah smoking in contrast to dual/poly hookah smoking. On the other hand, indviduals who elect to use hookah may be prone to seek friends with similar behaviors ; especially since smoking hookah usually occurs in groups. Thus, future interventions could benefit from addressing groups rather than individuals; for example, by promoting and facilitating other group social activities and interactions to replace hookah-smoking gatherings. As hypothesized and consistent with prior studies, we found an incremental risk of past year binge drinking and marijuana use associated with current exclusive and dual/poly hookah user. Dual/poly hookah users had significantly higher odds of past year binge drinking and marijuana use, in contrast to never hookah users and exclusive hookah users. However, these associations may have been inflated due to limiting the comparisons between the least risky group of never users of hookah to the current dual/poly hookah users. Consistent with Problem Behavior Theory, risk behaviors assessed in our study clustered together. These findings suggest that current dual/poly hookah use relates to higher risk of binge drinking and marijuana use and reflects an emerging constellation of risky behaviors that might benefit from a brief intervention. Second, these results imply that many hookah users do not only need assistance with abstaining from hookah, but may need assistance abstaining from other forms of tobacco, as well as binge drinking and marijuana. Interventions and policies designed for prevention and cessation of hookah use may have an impact on other substances such as alcohol and marijuana use. Nevertheless, this also suggests that there is a need for cessation interventions that are designed to address multiple substances.

Hookah use continues to spread among young adults. To help reduce tobacco initiation among young adults, there has been growing advocacy and support for raising the tobacco purchasing age to 21 years old in the US. New York City was one of the first cities to implement this ban; this provision does not yet apply to hookah use and access to hookah bars. Given that the average age of initiation for hookah in the US is 18 years old, current regulations that raised the minimum purchasing age of other tobacco products to 21 should include clear provisions on types of tobacco covered to include hookah as well, mobile rolling shelving and also to include hookah tobacco and bars and cafes where hookah is served. Enforcing such regulations might also be particularly more impactful among young adult females transitioning to college, as they are more likely to be using hookah in cafes compared to young adult males.This is the one of the first studies we are aware of, which assesses patterns of hookah use among a racially/ethnically diverse college population including a large racial/ethnic minority group and its association with binge drinking and marijuana use. Limitations include a relatively low survey response rate. It did not account for other predictors of tobacco and substance use, such as religiosity or sensation seeking, that might interfere with some substance use assessed in our study. The analyses were based on self-reported data; recall and social desirability biases may have affected the results. We did not include former hookah users in the final analyses, this group may have had different patterns of use and risk behavior that our current analyses did not address. The survey utilizes cross-sectional data; therefore, it was not possible to assess the causality of relationships. There are potentially other important unexplored variables in this assessment of hookah use patterns. In addition, patterns of hookah or other tobacco use may be different in university systems with substantial suburban or rural populations, limiting the generalizability of these findings to other college populations.Despite the decline in adolescent use of substances such as cigarettes and alcohol in the last two decades, substance use continues to be a prevalent public health problem affecting adolescents in the United States. The rapid expansion of recreational marijuana legalization across the United States and vaping device use are recent factors that may affect newer trends in adolescent substance use. The potential negative effects of substance use on adolescent neurocognitive function have been well-documented. For example, marijuana use and alcohol use have been associated with decreased visual-spatial functioning, attention, memory, and psychomotor speed in adolescents. Furthermore, substance use during adolescence is associated with increased risk of substance abuse in adulthood. Studies have suggested that minoritized youth have higher prevalence of substance use when compared to peers. Specifically, transgender and gender-diverse youth—youth whose gender identity does not align with societal expectations ascribed to their sex designated at birth— have higher rates of substance use compared to their cisgender counterparts. Similarly, while frequent marijuana use is decreasing among White youth, frequent marijuana use has increased among both Black and Latinx youth. Divergent rates and patterns in substance use point to the need to compare youth subgroups by race, ethnicity, and gender identity to examine substance use disparities among minoritized youth populations. Moreover, specifically examining substance use among Black and Latinx transgender youth , who have minoritized experiences based on race, ethnicity, and gender, is critical to determine their specific risk for substance use. School is one of the most important socioecological domains for youth; thus, exploring factors that influence substance use among trans BLY in this setting is particularly salient. School is a key environment for engagement with peers, and peer influence is strongly associated with adolescent substance use. Negative peer experiences within schools are associated with increased substance use for youth among minoritized students. For example, among gender-diverse youth, school-based victimization is a risk factor for substance use. One study found that gender nonconformity increased risk of substance use, particularly among students who were assigned male at birth, and experiences of school-based victimization mediated this increased risk. Similarly, among racial and ethnic minoritized youth, school-based racial discrimination increases risk of substance use. Understanding school-based factors that impact risk of substance use among trans BLYis particularly relevant for developing culturally informed approaches to support them in reducing substance use. The minority stress theory posits that minoritized individuals experience social stressors unique to their minoritization. When these stressors are internalized, they increase the vulnerability of minoritized individuals to poor health outcomes and behaviors that may increase their risk for such outcomes. This theory initially focused on sexual minority individuals but later was expanded to apply to experiences of gender-diverse individuals with the gender minority stress framework. This framework helps to conceptualize how trans BLY may be vulnerable to substance use due to social stressors related to minoritized experiences of being both gender diverse and racial and ethnic minorities. There is a dearth of data focused specifically on substance use among trans BLY. Prior studies of substance use among gender-diverse youth populations have not explored differences between White transgender youth and trans BLY. To our knowledge, there have been no studies that have compared differences between trans BLY and Black and Latinx cisgender youth .

Previously, useful evidence would have remained untouched at the site, or on rare occasions, kept in police storage. The potentially useful information left at sites was lost to neglect. Now, a significant portion of the evidence left behind is subjected to intelligence analysis. Increased utilization of intelligence analysis centers has made this process much more efficient and effective, which enables preventative tactics and helps governmental agencies learn about and infiltrate tight drug trafficking institutions. Governmental agencies have also changed investigation and detection strategies. While some authorities claim that there is nothing better than a helicopter and a well-trained eye, enforcement agencies are developing the use of more sophisticated techniques. These include, but are not limited to, ultraviolet, infrared, and electronic detection systems. Other techniques include night time patrols in high risk areas when cultivators may be less attentive, year-round patrols, and new detection methods such as monitoring for irrigation and cultivation supplies, comparing watershed precipitation with surveys of water flow quantities, and testing for chemical nutrient imbalances in bodies of water. The more time that is dedicated to research and detect sites early, the less time is required to raid and eradicate each site. Raids are carefully planned efforts, designed to reach set goals while minimizing the risk to agents. First, team leaders develop a raid plan and develop logistics such as funding sources, cannabis drying racks equipment requirements and invasion methods. Agents in charge then gather a team that they brief, supply and prepare.

New agents and officers are required to complete a thorough training program to learn remote raid techniques. Teams sometimes hike into sites for covert operations, but more often, they rappel down from a helicopter into the nearby area. Officers face major disadvantages when raiding sites because cultivators have been living at the location for months. Covert operations involve the most risk because hiking conditions and landscape characteristics can subject officers to ambush and provide cultivators with vantage points for armed engagement. While no officers have been fatally wounded during remote operations, there have been various cases involving gunshot wounds. During helicopter raids, cultivators generally flee from the scene while law enforcement officers are lowered into the area. While living on-site for months, cultivators develop elaborate escape routes and hiding spots. Hiding places can be as close as one hundred feet from a grow site, and are rarely found without K-9 assistance. The cultivators that are obtained are generally low-level employees with minimal knowledge about the larger organization that employs them. To complement tactical operations, government agencies have developed another significant long-term goal to develop an understanding of commercial scale, remote marijuana cultivation, within the broader public. Regional leadership conducts public education programs by presenting PowerPoint demonstrations about DTOs at meetings, forums, and presentations for politicians, government employees, and the general public. Law enforcement organizations facilitate information sharing with the media and local contacts, and have developed “bi-lingual material to be distributed in high risk areas seeking information and offering rewards.” These programs aim to increase the awareness in an effort to increase reports of suspicious activities.

When marijuana related activities are reported early, enforcement agencies gain a strategic advantage in combating individual sites. In addition, early detection allows more sites to be discovered and raided throughout the year because enforcement efforts are spread over a longer period of time. Public education creates an understanding of the consequences of marijuana production on various scales. This can provide political support for the prevention of DTO related activities in California, as well as alter patterns of marijuana acquisition and consumption within the general public.The production of potent marijuana requires intensive resource inputs to achieve high yield. This means that carefully planned and executed cultivation systems are crucial to developing quality marijuana harvests, and that cultivators manipulate the environment to optimize conditions for Cannabis plants. The widespread influence of Mexican cartels on outdoor cultivation in California causes similar processes to be performed at separate sites dispersed across large geographic distances. DTO operated grow sites have developed systematic patterns of behavior that occur with regularity and make their efforts distinct. Cultivators inhabit remote sites over long periods of time to develop plantations, and create a multitude of adverse effects in the process.Site selection is a crucial aspect of the cultivation process. DTOs often choose prospective locations long before they enter into a site. Some key elements that they look for on maps and aerial photographs are isolated water sources, slight canopy cover and adequate sunlight exposure. Sites are created in areas such as logged landscapes, conservation reserves, remote areas of national parks, and other places with difficult access and visually indistinct features from a birds-eye view. These are often areas where people rarely go because entry is made difficult by physical barriers such as cliff faces, steep talus slopes, dense clusters of vegetation such as poison oak, and even man-made berms. Due to the rugged and highly vegetated condition of most prospective sites, preparing land for marijuana planting is both labor intensive and time-consuming. Laborers work long hours to provide Cannabis plants a monopolistic domination of the landscape. The dynamics of landscape alteration depend on site-specific characteristics, but many similar practices occur throughout DTO operations. During the site supply process, cultivators cut or wear trails into the landscape that weave back and forth making site access for material transport easier. In order to avoid detection, laborers try to avoid leaving evidence of their presence up to a certain point, such as a major physical barrier, after which distinct paths are worn into the ground. The sheer weight of laborers’ equipment loads combined with regular use of the trails is enough to trample and kill small vegetation.

Dense stands of brush and trees are removed with saws and machetes. The paths connect site entry routes to the food preparation area, sleeping area, latrine, and various marijuana plantations. One site may contain 30,000 plants, but within that site the plants are often divided up between multiple smaller plots. Laborers’ movement along the paths is responsible for the introduction and distribution of non-native plant species to new areas. Laborers accumulate and transport seeds or spores on their bodies, clothing, shoes and equipment. In the California central coast region, cultivator movement along self-created paths is cited for the spread of Sudden Oak Death syndrome in Tan Oak, Black Oak, and Coastal Live Oak trees. Studies conducted by the Santa Lucia Conservancy show that the occurrence of SOD is facilitated by remote inhabitance through transmission of the plant pathogen responsible for SOD, Phytophora ramorum. Marijuana cultivators contribute to the spread of Phytophora ramorum to uninfected oak trees and exacerbate the effects of Sudden Oak Death syndrome by moving throughout affected landscapes that are part of their widespread system of sites. Movement by any person or animal can effectively transmit this pathogen to uninfected oak trees, but cultivators navigate through these areas more frequently than other people who may pass through. Their movements are also responsible for the spread of a variety of harmful invasive species including thistles, Vinca, Periwinkle, English Ivy Yard, and others. Invasive organisms often out-compete native species because they possess adaptive characteristics and lack natural competitors when introduced in new areas, which results in widespread alterations to the food-web, nutrient cycling, fire regimes, and hydrology of otherwise well preserved ecosystems. Many attributes of remote ecosystems are not ideal for agriculture, weed dry rack so laborers invest much time and energy in altering land to make it suitable for Cannabis cultivation. Workers clear understory vegetation to eliminate potential competition and prepare the soil for Cannabis plantations. The cleared vegetation, referred to as “slash piles,” are discarded in stream beds, causing impediments to hydrologic flows, or used to create berms up to 8 feet tall in order to bar site access. Throughout the growing season, cultivators use chemical techniques to maximize THC content and bud production. These intensive methods change soil dynamics, nutrient levels and chemical makeup, thus creating the opportunity for a new composition of vegetation to emerge. Landscape alteration may awaken seedbanks in the soil that have sat dormant for up to hundreds of years, alter the ability for some plants to re-grow because of changes in soil chemistry, destroy habitat for a variety of organisms, and have many other adverse affects on otherwise preserved ecosystems. In short, remote Cannabis cultivation forever changes the ecosystems in which it takes place. In highly mountainous areas, growers dig out terraces on hill slopes to create planting beds. In the process, soil is displaced leading to accelerated rates of hill-slope erosion. Some terrace beds are stabilized by falling trees, trimming them into logs, and inserting the logs into the terrace walls to hold the dirt in place. This is an important step to provide somewhat stable access to individual plants on steep slopes, and to prevent landslides that could destroy entire plantations. However, when these are removed, the stock of topsoil is greatly diminished. On slight grades or flat surfaces, cultivators mound soil around Cannabis stems to optimize nutrient uptake. For plantations with high percentages of gravel or sand, growers will bring in loamy soil to provide proper soil composition and nutrients. The affects of these changes on the natural environment can vary. For instance, fallen trees naturally promote the growth of under story species; however, the cutting of trees can disturb soil and impact the ecosystem services that they once provided such as habitat, nutrient cycling and moisture retention. Many land alterations remove perennial root structures that stabilize sediment causing the hillsides to lose stability and become more susceptible to small landslides and sedimentation of water sources during precipitation. Sedimentation alters water flow, reduces the capacity of water stocks, degrades the habitats of various species, and makes waters turbid – reducing the capacity for organisms to photosynthesize. Further, chemical toxins and metals bind to clay particles in fluvial sediment, are consumed by bottom feeding organisms, and bio-accumulate in higher order predators throughout the food chain. Cultivators approach land alterations with utter disregard; falling old growth trees, discarding of brush in stream beds, and littering the ground indiscriminately with waste. In sites intended for continued cultivation, laborers dig deep holes that are used to dispose of trash at the end of the harvest season in order to reduce the chances of detection between one season and the next. While their grow operations are usually restricted to between 5 and 10 acres, according to the National Park service, “for every acre of forest planted with marijuana, 10 acres are damaged.” In other words, the adverse effects of remote Cannabis cultivation reach far beyond the borders of the plots in which the plants are grown. An isolated water source is essential for the success of the marijuana plant to produce market grade buds. Mendocino County Sheriff, Tom Allman, claims that “one marijuana plant requires approximately one gallon of water per large plant per day,” meaning that a typical remote grow site can consume approximately 7,000 gallons of water each day over a period of three to four months. This makes water diversion no simple task. Finding a reliable water source that is available year round is especially crucial because the growing season occurs during the summer months. Ideal water sources include springs, creeks, and small bodies of water that do not dry up even during the hot California summers. Cultivators enact a variety of methods to exploit water sources high in the watershed, some of which include makeshift dams, cisterns, storage tanks, on-site reservoirs, and gravity based PVC pipe flow systems. These systems are built to utilize gravity-based pressure to extract water from natural or man-made pools. The water is then transported through PVC pipes to cultivation sites. The resources that cultivators possess to build these extensive systems include shovels, pumps, sheets of plastic, tarps, string and large quantities of PVC piping. Other necessities are extracted from the nearby environment and include logs, rocks, clay, brush, and moss. One site in Carmel contained a makeshift cistern that was dug out, lined with black plastic, and held in place with rocks.

ED utilization that KPNC did not pay for is not captured, although we capture external, paid-for ED utilization through claims. Consequently, ED use may be higher than we report. Low base rates of SUDs other than alcohol, marijuana, and opioid use disorders precluded our ability to examine the effect of these conditions on ED visits.Marijuana is one of the most commonly used drugs worldwide. In the U.S., 47% of adults report lifetime marijuana use and 13% endorse past-year use. It is estimated that 30% of those who use marijuana may have some degree of marijuana use disorder. The acquired preparedness model 4 has been theorized to explain substance use behaviors, wherein individuals who are high on risky personality traits are predisposed to learn certain beliefs and expectations regarding substance use, which in turn influence their substance use behavior. Therefore, the APM proposes a mediational model in which high-risk traits influence specific patterns of psychosocial learning and ultimately increase risk for problematic substance use outcomes. Most of the literature supporting the APM comes from studies on alcohol behavior among college students , although a few studies have begun to apply this model to other substances, including marijuana . Two of the previous studies focused on marijuana found evidence for a mediating role of negative expectancies between personality traits and marijuana outcomes. The direction of the effect differed in these studies. Hayaki and colleagues found that individuals with high impulsivity had more negative expectancies, which in turn, led to reduced frequency of use, drying cannabis while Vangness and colleagues found that individuals with high impulsivity had fewer negative expectancies and used marijuana more frequently.

Furthermore, the former study found a direct mediational role of negative expectancies in the associations between impulsivity and marijuana problems, as well as between impulsivity and marijuana dependence. Two of the three prior studies found a mediating role of positive expectancies in the association between impulsivity and marijuana use among samples of adult marijuana users from the community. Due to the inconsistent findings in the few studies that have evaluated the APM for marijuana outcomes, additional research is needed to parse out the role of positive and negative expectancies. Although the three studies discussed above have tested the APM for marijuana outcomes, all used non-clinical samples. It is important to evaluate these associations in more severe populations as findings from such studies can be particularly helpful in informing prevention and intervention efforts for individuals at-risk. Prior research demonstrates greater impulsivity in individuals with substance use disorders than healthy controls , as well as a link between impulsivity and later cannabis use and abuse . In addition, research shows greater impulsivity among adolescents in treatment for serious substance and conduct problems than community controls. The present study expands on the APM literature by evaluating two marijuana outcomes, i.e. frequency of use and marijuana use disorder symptom count, in an at-risk sample of young adults with a history of both substance use and conduct disorder symptoms and their siblings. The siblings are considered lower risk than the probands, but higher risk than community counterparts. We hypothesized that marijuana expectancies would mediate the relationship between impulsivity and marijuana outcomes among this at risk sample.

However, given the discrepancy in the past literature, we had no a priori hypotheses regarding whether positive and/or negative expectancies would be significant mediators. Probands were originally identified via treatment programs and schools in San Diego County, CA and had to have one or more lifetime substance use disorder symptom and at least one conduct disorder symptom. Siblings of probands also were recruited, but did not need to meet the previously mentioned criteria. Overall, the siblings have been shown to be at higher risk for substance use and antisocial behavior than community samples, but symptom counts were not as high as those of the probands. At the time of original recruitment, probands were between 14 and 19 years old, and their siblings were between 14 and 27 years old. A follow-up assessment, which included self-reported measures of impulsivity and marijuana expectancies, was conducted approximately six years after the original assessment. As the impulsivity measure was not administered at baseline, the present study only used data collected on probands and siblings at the follow-up assessment. Participants older than 30 years of age were excluded from the study to maintain the focus of the study on a sample of young adults. The final study sample consisted of 48% probands, was 54% male, 36% white, 42% Hispanic, and had an average age of 23.5 years .The nested structure of these data presents a potential analytic challenge because related individuals share common family influences with a potential for interdependence among observations. Researchers traditionally measure the degree of interdependence by the intraclass correlations among the observed variables .

However, it has been argued that the “design effect,” which takes into account the average cluster size, is more important in determining the extent of interdependence in the data. In the current sample , 94% of the 180 families had only one proband with no sibling or a proband and one sibling ; there were 10 families with a proband and two siblings. The average cluster size, therefore, was small . This resulted in small design effects for marijuana use and MUD symptoms , suggesting that clustering did not pose a problem for a single-level analysis . As such, the use of multilevel modeling was not warranted, and instead within-family correlation on the outcomes was controlled for using a standard error correction . Indirect effects from sensation seeking to MUD symptoms via positive and negative marijuana expectancies were evaluated using a product-of-coefficients test known as the distribution of the product. The values at the 2.5th and 97.5th percentile reflect the lower and upper limits of the 95% confidence interval; mediation can be said to occur if this confidence interval does not contain zero. Age, gender, and proband status were correlated with marijuana use and therefore included as covariates in the models, which were run separately for marijuana use and MUD symptoms. Descriptive analyses were conducted using SPSS . All indirect analyses were conducted in MPlus version 7.31 using the MLR estimator .This study evaluated the ability of the APM to account for marijuana outcomes in an at-risk sample of young adults. Preliminary analyses showed that sensation seeking was directly associated with higher marijuana use in the past 180 days and more symptoms of MUD. Other impulsivity facets, such as lack of perseverance, negative urgency, and positive urgency, were directly associated with MUD symptoms, but not with marijuana use in the past 180 days. Given that we wanted to evaluate both marijuana outcomes, the following discussion of the APM only refers to sensation seeking as the independent variable. We hypothesized that we would find a significant mediating relationship of marijuana expectancies on the relationship between impulsivity and marijuana outcomes. However, given the discrepancy in the prior APM literature regarding marijuana outcomes as well as the use of different measures of impulsivity , drying weed we had no a priori hypotheses on which facets of impulsivity and which type of marijuana expectancies would be significant in mediational models. Results indicated that only positive marijuana expectancies mediated the associations between sensation seeking and marijuana outcomes in this at-risk sample. Our findings suggest that higher sensation seeking is related to increased positive beliefs about marijuana outcomes, which is related to higher marijuana use and more MUD symptoms. In this way, our findings are consistent with the APM, which theorizes that certain “risky” traits predispose individuals to acquire certain beliefs, such as positive expectancies, which, in turn, lead to risky behaviors and negative consequences. This finding is particularly relevant for the sample used in this study, as individuals with a childhood history of antisocial behaviors and substance use tend to show increased levels of impulsivity. This study adds to the existing literature, which has been inconsistent regarding the role of positive and negative marijuana expectancies as mediators. The current study replicates the findings of two prior studies that demonstrated a mediating role of positive expectancies in the association between impulsivity and marijuana use among samples of adult marijuana users from the community. On the other hand, the current study did not find a mediating role of negative expectancies in the association between sensation seeking and marijuana use, which was previously demonstrated. In the present study, only positive marijuana expectancies mediated the association between sensation seeking and MUD symptoms.

It is possible that this inconsistency relates to the atrisk nature of our sample and that in our sample, 90% of the participants reported lifetime use of marijuana. For example, a study using an at-risk young adult sample found that negative expectancies in adolescence prevented marijuana use in young adulthood; however, 82% of the young adults reported never using marijuana. On the other hand, a research study using a clinical sample found that positive cannabis outcome expectancies, but not negative outcome expectancies, were a direct predictor of marijuana use. This is consistent with other research with individuals endorsing substance misuse, which shows that positive expectancies seem to play a more salient role in substance use behavior than negative expectancies. The literature has shown negative expectancies primarily play a role in preventing tobacco use, as well as influencing positive changes in alcohol treatment. It also is possible that we used a more nuanced measure of impulsivity than used in prior studies. That is, our study used the UPPS-P framework , which identifies five separate, though related, impulsivity facets. A recent meta-analysis of various UPPS-P impulsivity facets and marijuana-related outcomes found that marijuana use was associated with all impulsivity-related facets except lack of perseverance and that negative marijuana consequences were only significantly related to sensation seeking, lack of planning, and positive urgency. This meta-analysis also found small effects for marijuana use and medium effects for marijuana consequences . Because our analyses tested a mediational model that included marijuana expectancies, it is noteworthy that only the facet of sensation seeking, the tendency to seek sensory pleasure and excitement, was a significant impulsivity facet in the mediational model which also included positive expectancies and marijuana outcomes. The current study has several limitations. First, as neither the impulsivity nor the expectancy measures were administered at baseline, we utilized cross-sectional data collected at the follow-up assessment. Impulsivity is a more distal, stable, trait-like construct, whereas expectancies are more proximal and fluid, and therefore, a mediational model is acceptable, but not ideal. Future research would benefit from longitudinal designs, capturing changes in expectancies, marijuana use, and negative consequences. Second, marijuana use was measured using a single item, which is prone to self-report and recall biases. Although using single items to capture specific substance use behaviors is a common practice ,utilizing a method such as the timeline followback may provide a more nuanced and accurate assessment of substance use. Despite these limitations, the findings suggest that positive expectancies are a potentially important risk factor for marijuana use and misuse, particularly for at-risk individuals with elevated rates of sensation seeking. There is extensive empirical support for interventions that challenge expectancies of alcohol use . As such, challenging expectancies about marijuana’s positive effects may be an effective intervention for reducing marijuana related problems among at-risk individuals.Already the most commonly used illicit drug in the United States, marijuana is becoming more widely used and more potent with expanded legalization. Legalization has also popularized “edible” forms of marijuana, including teas and food products. Although often portrayed as a harmless drug with potential therapeutic uses, marijuana has detrimental effects on brain development, psychiatric health , lungs and heart . Public perception of these risks decreases with legalization, and no guidelines exist to help patients gauge the personal safety of use. As emergency providers treat more patients with cannabis use disorders, they must educate patients about these chronic health risks and also manage the acute medical and psychiatric complications of marijuana intoxication. To illustrate the management of acute complex marijuana intoxication and psychosis, we present a case of a woman requiring prolonged emergency department management after ingestion of edible tetrahydrocannabinol , the active ingredient in marijuana.A 34-year-old woman with no significant psychiatric history presented to the emergency department with erratic and disruptive behavior. She broke into a neighbor’s home, requesting to “go to heaven.” She feared people were stealing from her and that “something bad” was going to happen. She reported insomnia, racing thoughts, and euphoria for the past week.

In an era that is often characterized as one of a growing isomorphism of the laws and procedures governing criminal activities in different countries, the issue area of cannabis policy undergoes processes of fragmentation and polarization. Some countries continue to criminalize all forms of medical and recreational uses of cannabis. Others have sought to “separate the market” for cannabis from that of other drugs by decriminalizing the possession of small amounts of marijuana,authorizing its use for medical purposes, and establishing administrative measures for taxing and regulating the commercial sale of the drug. These reforms have gained international momentum despite resistance from key actors in the international drug control system, including the International Narcotic Control Board and the US federal government. The proliferation of cannabis liberalization reform is frequently depicted as a historical step toward the collapse not only of this TLO but of the entire edifice of the international narcotic control system of which it forms a part. How deep is the current crisis of the cannabis prohibition TLO? What are its causes and consequences? What does this case study reveal about the conditions under which criminal justice TLOs rise and fall? In this Article, I explore these questions to demonstrate the complex ways in which the cannabis prohibition TLO has served as a battleground between competing conceptions of the role of criminal law in addressing social and medical harms. Drawing on TLO theory, the Article shows that the capacity of the cannabis prohibition TLO to regulate the practices of legal actors at the international, national, bud drying system and local levels has been eroded as a result of effective contestations of the input and output legitimacy of its governance endeavors.

The rapid and widespread diffusion of new models of decriminalization, depenalization, and legalization has relied on the operation of mechanisms of recursive transnational lawmaking. These mechanisms originate from the indeterminacy of drug prohibition norms, the ideological contradictions between competing interpretations of their meaning, the impact of diagnostic struggles over the social issues that the international drug control system should address, and the mismatch between the actors shaping formal prohibition norms at the international level and those implementing these norms in national and local contexts. However, our analysis also shows that the cannabis prohibition TLO creates path-dependent trajectories that constrain the development of non-punitive strategies for regulating cannabis markets. In this context, the Article explains why it is too early to sound the death knell for the prohibitionist agenda of cannabis control. The dense array of UN treaties, transnational and regional monitoring schemes, national laws, and local enforcement arrangements put in place throughout the institutionalization of the cannabis prohibition TLO impede efforts to initiate more progressive regulatory innovations in this field. The Article is organized as follows: Section I briefly introduces the historical formation of the international legal framework governing cannabis regulations. Italso identifies the inherent ambiguities giving rise to interpretive disagreements regarding the scope of application of cannabis prohibition norms. Section II examines the debates that evolved during the 1960s–70s regarding the criminological logic of drug prohibition policies and the cannabis liberalization reforms shaped by these debates.

It then considers the processes leading to the reversal of these liberalizing trends and the extensive institutionalization of new measures reinforcing strict interpretations of the prohibition norms enshrined in the international treaties. Section III discusses the causes and consequences of the legitimation crisis that the cannabis prohibition TLO has experienced since the mid- 1990s as well as the global wave of depenalization, decriminalization, and legalization reforms precipitated by this crisis. Section IV considers the extent to which this wave of cannabis liberalization reform lessens the impact of the prohibitionist approach on the development of cannabis regulations at the international, national, and local levels.Cannabis prohibition laws were initially established in the late nineteenth and early twentieth centuries through disparate national drug control initiatives. Over the course of the nineteenth century, cannabis medical uses were regulated in a patchwork manner as part of wider legal frameworks governing the production and sale of pharmaceuticals. In the US, cannabis use began to be perceived as a social problem that should be a subject of criminal regulation during the Progressive Era. This criminalization campaign was inspired by the legislative inroads made by the temperance movement during that period and by awakening nativist sentiments toward incoming Mexican migrants, whose habits of marijuana smoking became major objects of media attention and public anxiety.15In 1915, California introduced the nation’s first anti-marijuana criminal prohibition.

Three decades later, such prohibitions appeared in the statute books of forty-six states and a series of marijuana-related federal offenses were included in the Marijuana Tax Act of 1937. An earlier international drug convention, signed at The Hague in 1912, focused on regulating opium, morphine, and cocaine and did not include implementation mechanisms. Under the League’s auspices, new requirements concerning the regulation of medical and non-medical uses of cannabis were introduced at the 1925 International Opium Convention. However,the pre-UN frameworks of international drug control did not place emphasis on the use of punitive measures to regulate cannabis or other psychoactive substances. Although the US had strongly advocated the introduction of a strict prohibitionist approach, this position was met with resistance from European colonial powers that had significant financial interests in the production of opium and coca and the manufacturing of their derivatives. In the absence of an international consensus regarding the need to strengthen the criminal regulation of illicit drug use, the preUN drug control framework focused on the development of administrative measures to govern cross-border commodity flows and to encourage a more effective domestic regulation of local drug markets. Following WWII, the growing capacity of the US to shape the rules and institutions of the international drug control system facilitated the move of the prohibitionist approach from the periphery to the center of the policy agenda. To a considerable extent, the institutionalization of the cannabis prohibition TLO provides a paradigmatic example of what has been usefully conceptualized as “globalized localism”—a process by which policy models that originated in the distinctive cultural and institutional contexts of a powerful country come to be perceived as global standards due to their inclusion in treaties, diagnostic indicators, interpretive guidelines, and other instruments of transnational legal diffusion. The introduction of the Single Convention on Narcotic Drugs in 1961 served as an important milestone in this process. The Convention frames the issue of drug use as a moral problem, stating in its preamble that “addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind.” In line with this moralizing framing, commercial grow room the Convention requires signatory countries to criminalize a wide range of drug-related activities.The two subsequent UN drug conventions adopted in 1971 and 1988 sought to extend the application of the prohibitionist approach to new contexts of drugregulation. Responding to the increasing production and use of synthetic drugs as part of the rise of the counter-cultural movements of the late 1960s, the 1971 Psychotropic Drug Treaty applied these policy principles to synthetic psychoactive drugs, such as opioids and amphetamine-type stimulants. The 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances further expanded the array of criminal justice enforcement measures states are required to adopt. Importantly, however, the mandatory criminalization norms established by the UN drug conventions are defined in a manner that leaves two major sources of textual ambiguity regarding their scope of application. First, the conventions deliberately refrain from providing a definition of what constitutes medical and scientific uses of drugs. Second, they clarify that countries should implement the duty to criminalize drug-related activities in accordance with their domestic constitutional principles. As is often the case, these two provisions are products of efforts to paper over divergent policy preferences.

During the negotiations of the Single Convention, several countries objected to banning certain drugs that have traditional and quasi-medical uses among indigenous populations. India, for example, expressed concerns regarding the implied need to criminalize traditional uses of bhang, which is made from cannabis leaves with a low Tetrahydrocannabinol content. Other countries emphasized the need to retain interpretive flexibility in light of the possibility that future research would reveal new medical benefits. The resulting compromise encouraged countries that would not have otherwise supported the prohibitionist principles set by the treaties to come on board. However, this compromise also sowed the seeds of later controversies regarding the ways in which cannabis prohibition norms should be applied. As the following discussion shows, these controversies will set recursive processes of transnational legal change in motion, leading to the settling and unsettling of specific interpretations of the scope and meaning of these norms. It is an irony of history that the first decade following the entry into force of the Single Convention experienced a marked increase in the prevalence of cannabis use in Western countries. When the Single Convention was signed in 1961, cannabis use was particularly prevalent in developing countries where the plant was traditionally cultivated, while it had little impact on mainstream culture in North America and Europe. By the end of the decade, the drug acquired unprecedented political salience not only in light of objective increases in the prevalence of its use but also due to its symbolic association with emerging countercultures and the perceived threat they putatively posed to public morality. These dramatic changes intensified the enforcement of cannabis offenses, but they also attracted heightened public attention to the negative consequences of such enforcement efforts. In the late 1960s, there was an historical increase in the rates of arrests, prosecutions, and convictions of cannabis users in various Western countries. The magnitude of this change was most remarkable in the US. In California, for example, the number of people arrested for marijuana offenses increased from about 5,000 in 1960 to 37,514 in 1967. Arrests for cannabis possession became increasingly common in countries such as Germany, the Netherlands, and Canada as well. The civil rights implications of these increased levels of drug law enforcement generated vigorous public debate on the justifications of treating cannabis on par with other psychoactive substances that are widely perceived to be more dangerous and harmful. Disagreements regarding whether cannabis should be classified under the strictest schedules of the UN drug control treaties were already evident during the Plenipotentiary Conference, which drafted the Single Convention However, it was only as a result of the increased enforcement of cannabis prohibitions that such disagreements precipitated domestic forms of political and legal resistance. Due to increasing public criticism, national governments in several countries appointed public committees to consider the effectiveness of the existing laws. These committees directed strong criticism towards the criminological and medical underpinnings of the prohibitionist approach and sided with proponents of the decriminalization of mild forms of cannabis use.Broadly similar conclusions were reached by other committees operating in the Netherlands , Canada , and Australia . In the US, the public debate that followed President Nixon’s famous identification of drug abuse as “America’s public enemy number one” led to the nomination of the National Commission on Marihuana and Drug Abuse . To the surprise of many, the Commission’s 1972 Report, entitled Marihuana: A Signal of Misunderstanding, concurred with the liberal approach endorsed by other national investigation committees. While the Commission emphasized that cannabis was not a harmless substance, it stressed that its dangers had often been overstated. It advocated repealing the criminal prohibitions on the possession of small amounts of marijuana and establishing alternative measures to address the public health concerns associated with cannabis use. Such reforms, the Commission stated, are needed to relieve “the law enforcement community of the responsibility for enforcing a law of questionable utility, and one which they cannot fully enforce.” These recommendations were repudiated by the Nixon administration, but they inspired grassroots activists to mobilize cannabis liberalization reforms at the state and local levels. In 1973, Oregon became the first state that decriminalized the possession of small amounts of marijuana. Eleven states followed suit during the next half of the decade. The failure of the US national administration to secure the compliance of state governments with the prohibitionist norms it sought to propagate internationally provided a clear indication of the decline of the cannabis prohibition TLO.

To over-sample SMW who identified as African American or Latinx, each wave of recruitment targeted a random sample that was one-third African American/Black, one-third Latinx, and one-third unrestricted by race/ethnicity. Participants were compensated through the panel companies following their standard payment protocols. The participation rate for the general panel sample was 45 % and the participation rate for the LGBT sample was 28.7 %. Heterosexual participants were recruited from a pool of former participants in the National Alcohol Survey , a national probability survey. The NAS is a cross-sectional probability survey of adults ages 18 or older in the U.S., conducted approximately every-five years that used computer-assisted interviewer with a random sample of both landlines and cell phones with oversampling in low-population states and oversampling in Black- and Latinx-dense areas. Participants from the probability survey were eligible for random selection in the present study if they selected “female” as their gender and “only heterosexual or straight” in response to a question asking them to choose the category that best described their sexual orientation. A random sample of 1,961 heterosexual women who participated in the 2015 NAS were invited to participate in the current study. Computer assisted telephone interviews were completed with 623 respondents .

The general panel sample and the national probability survey sample included only binary “male/female” response options and did not assess whether respondents were assigned female at birth. The LGBT-specific panel allowed participants to select multiple sex and gender identities; however, pipp drying racks to be consistent with categorizations in the general panel and probability samples, only participants from this panel were included in the current study if they selected “female” as their gender . Although we refer to participants as“women” in this paper, we acknowledge that study participants may have endorsed other gender categories had they been provided such options. The SMW samples were initially screened based on endorsing sexual minority identity and the heterosexual comparison sample was selected based on prior endorsement of heterosexual identity; the few participants who selected “mostly heterosexual” in the current study were combined with those endorsing heterosexual or straight identity. As shown in Table 1, 44.6 % of the study sample was from the national population-based survey, one-quarter was from the LGBT panel sample, and close to one-third was from the general panel sample. Approximately 46 % of the sample identified as heterosexual; 23 % identified as bisexual and 31 % as lesbian. The majority of the sample was<50 years old , college-educated , currently employed , and currently partnered ; just under one-half identified their race as White. Although the majority also reported being Protestant, Catholic, Jewish, or some other religion, a quarter of the sample reported not having a religious affiliation.

Table 1 displays characteristics by sexual identity. Differences by sexual identity were found with respect to age, race/ethnicity, educational attainment, current employment, partner status, current religion, current religious environment, and study sample.In the current study we examined differences in the associations of religiosity and importance of spirituality with AUD and marijuana use by sexual identity in a large sample of adult sexual minority and heterosexual women. Consistent with prior research, importance of spirituality, importance of religion, and participation in religious services were independently associated with lower odds of substance use. However, this protective effect varied by sexual identity, particularly in regard to AUD. In analyses of the interaction between spirituality and the study outcomes, we found that greater importance of spirituality was associated with greater odds of AUD among both lesbian and bisexual women, but was protective for heterosexual women. Among study participants who reported the highest levels religious importance odds of AUD were also greater among lesbian women than heterosexual women. These findings are consistent with minority stress theory, which suggests that religiosity and spirituality are less protective for SMW than heterosexual women and, in some cases, may contribute to greater risk of substance use. Findings are also consistent with research results indicating that religiosity is not protective against, and is sometimes associated with, increased heavy episodic drinking among adolescent and young adult SMW . Although our study did not explore participants’ subjective experiences and meanings of religiosity and spirituality, findings from qualitative research suggests that although religion or spirituality may provide support for some sexual minorities, it can also be associated with unique stressors which may contribute to adverse psychological and health outcomes .

It may also be possible that some SMW are turning to accessible coping outlets to deal with minority stress—including both spirituality and substance use. Findings from tests of interaction between religious attendance and sexual identity approached but did not reach statistical significance in relation to past year AUD or any marijuana use in the past year. Lack of significant differences may be related to the markedly lower levels of religious service attendance reported by SMW relative to heterosexual women, which may have reduced our ability to detect differential risk by sexual identity. These findings underscore the importance of future research considering religious behavior, such as attending religious services, in addition to religiosity or spirituality, given the potential of each to contribute to disparately negative behavioral health outcomes for SMW. We also explored potential differences in outcomes among participants based on religious environment—specifically, whether the study outcomes differed for participants involved in religious environments that were unwelcoming to LGBT people. Differences by sexual identity in interaction models were attenuated and no longer significant when we added this variable. Our ability to explore this question in greater depth was limited by the relatively small number of SMW participants who reported that they attended services in unwelcoming religious environments . Although the percentage of participants reporting attendance at LGBT welcoming environments was similar across sexual identity groups , over 80 % of SMW, compared with 48.5 % of heterosexual women, described themselves as not affiliated with or attending services. These demographic differences are consistent with literature suggesting that sexual minorities are more likely than heterosexuals to dissociate from religious institutions entirely or seek alternatives to disaffirming religions . Studies with larger samples of SMW who attend religious services that are both welcoming and unwelcoming of LGBT people are needed to explore the potential impact of the immediate religious environment on substance use outcomes.Findings should be interpreted in the context of study limitations. Although the SMW participants were drawn from two large national panel samples of SMW, they were not recruited using probability sampling methods, which may limit generalizability. As noted above, the great majority of SMW did not participate in religious services, which limited our ability to explore the impact of religious environment on substance use outcomes. There were also some limitations related to measurement. We assessed importance of religion, religious attendance, and importance of spirituality each with a single item. Although the use of single items are common in survey research, there are other measures that capture different dimensions of religiosity not captured in the current study, such as organizational, nonorganizational, vertical grow room and subjective religiosity ; daily spiritual experiences such as awe, inner peace, gratitude, transcendent experiences ; or facets of religiosity that may be particularly salient to health such as religious coping and religious social support .

It is possible that a measure of religious coping or a multi-dimensional measure of spirituality would have yielded different results. Furthermore, it was not possible to assess the degree to which participants conflated religiosity and spirituality; multidimensional measures may have allowed for a more nuanced exploration of the impact of spirituality independent of religiosity. Measures of religious environment also differed between the SMW and heterosexual women, which may have contributed to the different distributions of “non-affirming” attendance by sexual identity. Given research suggesting differences in perceived importance of religion and religious affiliation by race and ethnicity among SMW , future studies might examine possible subgroup differences in the associations of religiosity and spirituality to substance use outcomes. Finally, differences between the two panel samples may have influenced the findings in the current study. Although research suggests that substance use is typically greater among SMW relative to heterosexual women regardless of the sample or measures used , LGBT specific panels may reach individuals whose characteristics differ than LGBT peers recruited from general samples .Findings from this study contribute to previous research suggesting that religiosity and spirituality are less protective against alcohol and marijuana use among SMW than among heterosexual women, and, in fact may be a risk factor for some SMW. Furthermore, risk and protection may differ for lesbian and bisexual women. Findings underscore the importance of research on risk factors for substance use among SMW that include distinct measures of religion and spirituality, and that disaggregate bisexual and lesbian subgroups in analyses.The prevalence of type 2 diabetes mellitus is increasing, and it is projected that in the USA alone, type 2 DM will increase to 48.3 million by 2050. In addition to defects in pancreatic b-cell function and insulin sensitivity, systemic inflammation is thought to be involved in its pathogenesis.1 2 Marijuana is the most commonly used illicit drug in the USA and is currently used by 14.4 million Americans.The major psychoactive CB is delta 9-tetrahydrocannabinol whose effect is mediated through the CB1 and the CB2 subtypes of CB receptors found in the brain and lymphoid tissues. The endocannabinoids, a group of neuromodulatory lipids also bind to these receptors. Cannabis, THC and other CBs have been shown to have both beneficial6 and detrimental effects. Marijuana users have higher caloric intake while eating less nutrient-rich foods, yet have similar or slightly lower body mass index than non users. We hypothesised that the prevalence of DM would be reduced in marijuana users due to the presence of one or more CBs because of their immunomodulatory and anti-inflammatory properties. We assessed the association between DM and marijuana use among adults aged 20e59 years in a national sample of the general population.Data on marijuana use were collected by self-report. Non-marijuana users included never users and those who reported ever having used marijuana, but who had not used marijuana in the past month . We classified participants who reported using marijuana in the past month by frequency of use as either light current users or heavy current users as previously described. The definition of marijuana for purposes of this survey includes ‘hash,’ ‘pot’ or ‘grass’ or any other references to the Cannabis plant. The phrase ‘used marijuana’ refers to either smoking or ingesting marijuana. Subjects were defined as having DM if they answer ‘yes’ to the question ‘Have you ever been told you have sugar/diabetes?’ or had a fasting blood glucose level $126 mg/dl . Of the 719 patients with DM, 418 answered the question about whether they take insulin and 116 reported that they do take insulin. Of those, nine reported that they began using insulin at age #20 years, the majority being likely to have type 1 DM, although a few may have had type 2 DM. Thus, we estimate that 1.5% of patients with DM had type 1 DM, and because of this low number, we analysed all subjects with DM together. There was no difference in any of our analyses if the nine patients of age #20 years were excluded. The study included 151 pregnant women . Of them, eight women had diabetes. There was no difference in the use of marijuana by DM. Because of the low number in the diabetes category, we included them in the analysis. A series of sensitivity analyses excluding the pregnant women showed no difference. Plasma glucose and whole blood haemoglobin A1c were measured at the University of MissouriColumbia School of Medicine Department of Child Health, Diabetes Reference Laboratory, Columbia, Missouri, by David Goldstein, MD, director. Subjects were classified as obese/non-obese according to the BMI level using a cut-off of 30 kg/m2 . We analysed data related to DM, age, gender, race/ ethnicity, education level, family history of DM, physical activity, BMI, cigarette smoking, cocaine use, alcohol use, total serum cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, serum 25-hydroxy vitamin D , HbA1c, fasting plasma glucose level, C reactive protein level and the serum levels of less robust inflammatory markers count and uric acid that have been previously used in NHANES III analysis.

Past research examining cultural variables has primarily focused on racial/ethnic minority individuals in relation to the dominant culture, or mainstream U.S. culture, , however an individual can also experience stress emanating from tensions within their own racial/ethnic group.This phenomenon, known as intragroup marginalization,refers to the perceived interpersonal distancing by members of one’s racial/ethnicgroup when the individual diverges from racial/ethnicnorms . Deviating from racial/ethnicnorms can create a backlash whereby group members reject or distance themselves from the individual. The interpersonal distancing occurring from intragroup marginalization can be viewed as a social sanction placed on the individual and can take the form of teasing and criticism. Intragroup marginalization is based on social identity theory suggesting that group members marginalize in-group members when they do not conform to group standards in order to maintain the uniqueness and stability of the group .Group members displaying behaviors or attitudes that conflict with group norms can be perceived as threatening the distinctiveness of the group and can then be marginalized in order to preserve the group’s distinctiveness. Intragroup marginalization may be experienced by any racial/ethnic group. Additionally, family, friends, harvest drying rack and other racial/ethnic members in the community can all impose group norms and engage in the process of intragroup marginalization.

Limited research suggests intragroup marginalization may lead to higher levels of acculturative stress, or stress associated with adapting to a new culture, and increased alcohol use among young adults .Past research, while not directly investigating intragroup marginalization, has made potential links between familial and peer stress with tobacco and marijuana use . Foster and Spencer suggest that marijuana and other drug use may underlie a deeper need for connection in the absence of close familial connections for marginalized young adults, or young adults that have been rejected by their families. These young adults may be seeking opportunities to connect and create a sense of belonging,and marijuana use can play a common and significant social role in building supportive and caring relationships . Researchers further contend that investigation is needed to better understand how culture impacts these young adults’ drug use . Currently, intragroup marginalization is measured using the Intragroup Marginalization Inventory , which is comprised of three separate scales measuring perceived intragroup marginalization from the heritage culture family , friends , and other members of the individual’s ethnic group . The inventory is comprised of 42-items rated on a 7-point Likert scale . While the scale is comprehensive, the length of the survey can make it difficult for researchers to distribute the entire inventory, with many opting to use only one scale in their research . In practice this has limited studies of intragroup marginalization to focus either on family members or friends, rather than examining both.

Due to the length of the survey, the feasibility of using the measure in large scale studies or with large sample sizes has been limited. Most studies using the inventory have limited sample sizes focused on one racial/ethnic group . Greater sample sizes allow for segmentation of the data across demographic characteristics , reduce the margin of error, and provide the statistical power to conduct more advanced analyses.In addition, some items may have less applicability for certain groups, such as items related to linguistic expectations .Lastly, the inventory was developed and validated with a college population and hasnot been validated with non-college populations . Tobacco and marijuana use are problematic for all young adults and intragroup marginalization may be an important factor in understanding tobacco and marijuana disparities in this population as a whole.Yet,without an efficient means to assess intragroup marginalization, this important construct will continue to remain absent within health disparities research.Limited research addresses whether shared cultural values or feelings of marginalization may help explain high rates of tobacco and marijuana use among young adults . The purpose of this study is to provide a psychometrically sound abbreviated measure of intragroup marginalization. Such a measure would have great utility when survey length is of concern and the survey needs to be distributed across diverse racial/ethnic groups. This study tests and validates an abbreviated measure of the Intragroup Marginalization Inventory, which we refer to as the IMI-6. The IMI-6 consists of six items that measure perceived intragroup marginalization from the heritage culture family and friends.

The items of the IMI-6 are hypothesized to have content validity, as items were taken directly from the existing scale, which has already been found to have content validity and were selected in consultation with the survey developer and by the primary author whose research focuses on racial/ethnic minority issues and intragroup marginalization in specific. We hypothesize that the IMI-6 also has construct validity, which we establish in this study through exploratory factor analyses. In addition to testing the feasibility of using this abbreviated measure, a primary aim of this study was to apply the IMI-6and examine relationships between intragroup marginalization and tobacco and marijuana use. We hypothesize that participants reporting more experiences of intragroup marginalization would be more likely to use cigarettes, e-cigarettes, cigars, blunts, hookahs, and marijuana.The original Intragroup Marginalization Inventory consists of three scales: Family, Friend, and Ethnic Group. The scales have a common factor structure, and while there are slight differences in items and factor names, they fall into five general factors: Homeostatic Pressure , Linguistic Expectations , and Accusations of Assimilation , Accusations of Differentiation , and Discrepant Values . The IMI-6 consists of six items that measure perceived intragroup marginalization from the heritage culture family and friends. The original scale developer provided consultation during item selection, ultimately reviewing and approving the final six items. Items were selected based on the researchers’ and developer’s experience with the survey as well as those items that had the greatest applicability to a diverse pool of respondents and were broad enough to remain appropriate for different racial/ethnic groups. Items from the Accusations of Assimilation and Linguistic Expectations factors were not included as they contained items that were tailored to specific racial/ethnic groups . Items from the Homeostatic Pressure were similar to items from the Accusations of Differentiation factor, however items from the Homeostatic Pressure focused solely on the individual’s behavior, while items from the Accusations of Differentiation included items assessing both behavior and appearance. The selected items were taken from the Discrepant Values factor and the Accusation of Differentiation factor of the full inventory .Two items were taken from the Discrepant Values factor assessing whether family and friends have the same hopes and dreams as the respondent. Four items were taken from the Accusation Differentiation factor assessing whether family and friends accuse the respondent of not really being a member of one’s ethnic group because s/he does not look like and act like members of the group. Responses were rated on a 7-point Likert scale, ranging from ‘never/does not apply’ to ‘extremely often .’ Items 3 and 6 were reverse coded, so that higher numbers represent greater experiences of intragroup marginalization. Items were piloted with 45 young adults from the San Francisco Bay Area. Participants were recruited from local bars on a Thursday, Friday and Saturday evening to be interviewed that same weekend and received a $75 incentive if they participated in a one-hour focus group, pipp rack completed the pilot questionnaire, and engaged in an interview with project staff to share feedback about the questionnaire Individuals reviewed the item clarity and representation of their experiences. No items were altered and participant feedback suggested that the selected items accurately captured participant experiences.

Sample—This study used data we collected in 2014 as part of the San Francisco Bay Area Young Adult Health Survey, a probabilistic multi-mode household survey of 18–26 year old young adults, stratified by race/ethnicity. The study was conducted in Alameda and San Francisco Counties in California. We identified potential respondent households using address lists from Marketing Systems Group in which there was an approximately 30–40% chance that an eligible young adult resided at a selected address . We used 2009–2013 American Community Survey and 2010 decennial census data in a multistage sampling design to identify Census Block Groups and then Census Blocks in which at least 15% of residents were Latino or nonHispanic Black adults in the eligible age range. Ultimately, we randomly selected 61 blocks, then households within these blocks then young adults within eligible households . We oversampled these blocks because young nonwhite urban adults are among the most difficult populations to survey, and we wished to ensure appropriate population representation. We surveyed in three stages and utilized four modes of contact . In the first stage we conducted a series of three mailings with sample 1 households; respondents returned paper questionnaires or completed surveys online using Qualtrics. In the second stage we telephoned those who did not respond to mail, and lastly we performed face-to-face interviews with a random selection of the remaining non-responders from sample 1 as well as all of the households identified in sample 2. Potential sample 2 respondents did not participate in the mail or telephone phases of the survey; each of these households was visited in person. The final sample consisted of 1,363 young adult participants, for a response rate of approximately 30%, with race, sex and age distributions closely reflecting those of the young adult population overall in the two counties surveyed. Ethnicity/race was measured using items from the Census Bureau’s American Community Survey instrument, with participants first asked to identify if there were Hispanic, Latino, or Spanish origin and then to select their race from 14 categories. Race/ethnicity was then collapsed into mutually exclusive categories including Hispanic, non-Hispanic White, nonHispanic black, non-Hispanic Asian/Pacific Islander and Mixed Race. Those who selected more than one race/ethnic category were categorized as Mixed Race.We constructed individual sample and post-stratification adjustment weights during data reduction .Results support the use of an abbreviated measure of intragroup marginalization. The IMI-6 was found to be psychometrically sound and representative of the full construct of intragroup marginalization as theorized by Castillo and colleagues . Two factors emerged from the abbreviated scale. The first factor encompassed items related to belonging and membership, capturing whether individuals felt marginalized due to deviations in their physical appearance or behaviors . The second factor encompassed whether the individual shared similar hopes and dreams as their families and friends. These factors reflected similarly identified factors from the validation study of the full inventory scales, suggesting good agreement between the original measure and the abbreviated version. Examining racial/ethnic differences in mean scores across factors demonstrated significant differences in Factor 1. Latinos and Mixed Race young adults experienced greater intragroup marginalization related to not looking or acting like members of their racial/ethnic group compared to non-Hispanic Blacks and Asian Americans/ Pacific Islanders. The full Intragroup Marginalization Inventory was developed with a diverse sample and past research has explored intragroup marginalization with African Americans , Asian Americans and Latinos ; however, specific racial/ethnic differences have not been examined. Latinos may be particularly susceptible to intragroup marginalization given the heterogeneity among Latinos in terms of national origin, physical appearance, political ideology, immigration status, and class status . In particular, Latinos can encompass different racial groups , which can contribute to differences in appearance one of the concepts captured in Factor 1. Physical appearance can limit the extent to which people are accepted as belonging to a certain racial/ethnic group, which is also especially relevant for multiracial individuals, whose physical appearance may not align with any specific ethnic/racial group. Additionally, multiracial individuals describe feeling marginalized from peers rooted in having different appearance, culture, and/or beliefs than their peers , explaining the higher rates of intragroup marginalization observed in this study. Research examining young adult tobacco and marijuana use often relies on college samples, thereby neglecting individuals in this age group that may be at greater risk of substance use . The Intragroup Marginalization Inventory, which may have particular utility with young adults who are negotiating the stresses of transitioning to adulthood, was also developed and tested with a college-only sample . This study validates an abbreviated version of the IMI, the IMI-6, which was developed to capture tensions experienced within racial/ethnic groups.We tested the IMI-6in a large representative household sample of racially/ethnically diverse young adults in the San Francisco Bay Area in order to better understand the impact of cultural stressors on tobacco and marijuana use among young adults in general. When controlling for demographic characteristics, Factor 1 was associated with greater marijuana use.

Though unhealthy eating and marijuana use are health-risk behaviors, they are inherently different. Research has indicated that eating behaviors in children are shaped by observing the eating behaviors and food preferences of their parents , while marijuana use is modeled more by one’s peers . Parents may exhibit greater motivation to discuss unhealthy eating as this behavior has an impact on their child’s direct survival from infancy to adulthood. The discussion tool of marijuana use may be missing important elements that motivate a protective response in parents. A revised tool may be needed to promote discussions about more controversial topics such as marijuana use. Such a tool is needed particularly given that recent changes in legalization and availability of marijuana use in the United States may lead to parents viewing marijuana use by youth as less risky or troubling, leading to fewer discussions of the behavior with their child. These trends are in line with recent declines in perceived risks of marijuana use among youth . The study further tested the moderating effects of parenting styles on tool conditions and perceived effectiveness, perceived interpretability, motivations to address the behavior, self efficacy, coherence, intentions, willingness, tool download, discussion behavior, tool use, and willingness to pay for the tool relative to the control condition . With the inclusion of the authoritative parenting-framed message in the unhealthy eating and marijuana use discussion tools, vertical weed grow it was predicted that parenting styles would moderate the relationships between tool effects and the dependent measures.

In particular, it was predicted that the improvement relative to the control condition would be greater for low authoritative parents than for high authoritative parents, greater for high authoritarian parents than for low authoritarian parents, and greater for high permissive parents than for low permissive parents. This is because it is believed that authoritarian and permissive parents will benefit more from authoritative tools compared to authoritative parents, as they are in the greatest need for assistance. The effects of the discussion tools on perceived interpretability, motivations to address the behavior, marijuana use discussion intentions, and willingness to pay for the tool were moderated by authoritative parenting styles. In fact, for parents with high authoritative parenting styles, the marijuana use discussion tool led to lower perceived interpretability and lower motivations to address the behavior. Whereas, for parents with low authoritative parenting styles, the marijuana use discussion tool led to higher marijuana use discussion intentions and higher willingness to pay for the tool relative to the sedentary behavior tool. In line with hypotheses, the findings on dependent measures show that the marijuana use discussion tool had greater effects for low authoritative parents compared to high authoritative parents. This extends research on the positive effects of authoritative parenting in encouraging parent communication about health related behaviors leading to better health outcomes for children as the tools were authoritatively-framed. The effects of the discussion tools on motivations to address the behavior, self efficacy of unhealthy eating discussions, coherence of unhealthy eating discussions, and self-efficacy of marijuana use discussions were moderated by authoritarian parenting styles.

In fact, for parents with high authoritarian styles, the marijuana use discussion tool led to higher coherence of unhealthy eating discussions and higher self-efficacy of marijuana use discussions relative to the sedentary behavior tool. Whereas, for parents with low authoritarian styles, the marijuana use discussion tool led to lower motivations to address the behavior, lower self efficacy of unhealthy eating discussions, lower coherence of unhealthy eating discussions, and lower self-efficacy of marijuana use discussions relative to the sedentary behavior tool. In line with hypotheses, the findings on dependent measures show that the marijuana use discussion tool had greater effects for high authoritarian parents compared to low authoritarian parents. These findings provide support for the efficacy of authoritative parenting-framed messages in motivating parental discussions of risky behaviors in parents with high authoritarian parenting styles.The effects of the discussion tools on perceived effectiveness, motivations to address the behavior, self-efficacy of unhealthy eating discussions, coherence of unhealthy eating discussions, unhealthy eating discussion intentions, coherence of marijuana use discussions, and sedentary behavior discussion intentions were moderated by permissive parenting styles. In fact, for parents with high permissive styles, the unhealthy eating discussion tool led to higher coherence of unhealthy eating discussions, lower unhealthy eating discussion intentions, and higher coherence of marijuana use discussions relative to the sedentary behavior tool. Whereas, for parents with low permissive styles, the unhealthy eating discussion tool led to higher perceived effectiveness, higher motivations to address the behavior, lower self-efficacy of unhealthy eating discussions, higher unhealthy eating discussion intentions, and higher sedentary behavior discussion intentions relative to the sedentary behavior tool. In line with hypotheses, the findings on coherence of unhealthy eating and marijuana use show that the unhealthy eating discussion tool had greater effects for high permissive parents compared to low permissive parents.

Contrary to hypotheses, the effects of the unhealthy eating discussion tool on unhealthy eating discussion intentions showed negative effects for high permissive parents, and negative effects for perceived effectiveness, motivations to address the behavior, intentions of unhealthy eating and sedentary behavior for low permissive parents. Overall, the findings for the moderation analyses mostly supported hypotheses by suggesting that low authoritative parents, high authoritarian parents, and high permissive parents find the tools more useful. For authoritative parents and authoritarian parents, the marijuana use discussion tool was more effective in motivating discussions compared to the unhealthy eating discussion tool for permissive parents. Specifically, for low authoritative parents the marijuana use discussion tool led to increased levels of perceived interpretability and motivations to address the behavior, and for high authoritarian parents the marijuana use discussion tool led to an increase in coherence of unhealthy eating discussions and self-efficacy of marijuana use discussions. For permissive parents the unhealthy eating discussion tool led to higher coherence of unhealthy eating and marijuana use. An interesting discovery is that authoritative and authoritarian parenting served as moderators for marijuana use conditions, whereas permissive parenting served as a moderator for the unhealthy eating conditions. It could be that authoritative and authoritarian parents are more likely to have marijuana use discussions because they feel more confident compared with permissive parents. Whereas, permissive parents identify better with unhealthy eating because it is an easier topic to discuss as compared with marijuana use. According to Baumrind Classification of parenting styles authoritative and authoritarian parents tend to be higher in discipline and structure, and expectation compared to permissive parents that have lower discipline and structure, and expectation. In fact, authoritarian parents are known for establishing strict rules which could be more common for marijuana use, while permissive parents allow for freedom of choice which could be more common for children when picking which foods to eat . This knowledge should be applied to revise the discussion tools that were developed for parents to have discussions about unhealthy eating and marijuana use with their children. A priority should be on the development of the discussion tools based on the behavior by taking into account aspects of the parenting styles and how they might affect the specific discussions. Being exploratory in nature, this study has several important study implications. First, the difference in unhealthy eating and marijuana use offers opportunity to refine and validate the discussion tools in future studies for these behaviors. These differences can be assessed by taking into account the behavior and framing the messages with not only parenting styles but behavior as well. For instance, rolling benches for growing implementing tools for unhealthy eating that utilizes friendlier language compared with more structure for marijuana use. Second, we generated two new discussion tools that were effective in motivating discussions. These discussion tools can be applied to other risky behaviors and possibly distributed to parents in different settings in order to test the adaptability and acceptability of each tool with larger parent populations. Future studies could look to examine these dynamics more clearly in a larger sample of parents of children ages 10 to 17 years old. It is important to note that there were several moderating relationships of various dependent measures that were not significant. Since these discussions tools are newly developed, more research is needed to explore the moderating effects of parenting styles in motivating discussion behaviors of unhealthy eating and marijuana use.

Additional studies could add more dimensions of authoritative parenting styles in the discussion tool , instead of just including a script. Strengths of the present study include its focus on a largely unexplored area of parent motivations to discuss unhealthy eating and marijuana use, its contributions to further development of discussion tools utilizing authoritative parenting-framed message, and the use of a longitudinal design, in a sample of parents in the United States. This study added partial evidence of the moderating effects of parenting styles in some of the relationships between unhealthy eating and marijuana use discussion tools and the PWM factors. A second strength of the study is that it could be replicated, and tested, with other conditions in order to test the moderating impact of authoritatively-framed discussion tools on more behaviors. Though, if replicated alterative strategies should be implemented for motivating parents to have these discussions by revising the tools or testing with a no-treatment control condition. A third strength is that the study provided valuable information on whether these newly developed discussion tools would be effective in promoting discussion behaviors in a sample of parents. These tools could possibly be disseminated to school settings in order to further test their effectiveness in motivating discussions of unhealthy eating and marijuana use. Lastly, these findings provided important data on the differences in discussion behaviors for unhealthy eating and marijuana use, in which the unhealthy eating discussion tool was more likely to motivate discussion behavior. Limitations of this study require consideration when interpreting the results and point to directions for future research. Initially, the results may not be representative of all parents across the nation or in other countries, as it consisted predominantly of NonHispanic White and well-educated participants. Although, MTurk has become a popular method used for recruiting large heterogeneous samples such as parents of adolescents from across the nation and has been demonstrated in several published psychological studies . Second, the findings may not be generalizable to all parents, particularly as we focused on parents of children ages 10 to 17 years old. More research is needed to determine if results would vary for different ages , ethnicities, number of children, gender of parent, and if the results would extend to other behaviors as well. There is a definite need to extend the study to test for differences in mothers and fathers and to assess if their possibly differing parenting styles could influence discussion motivations of unhealthy eating and marijuana use with their children. This could provide vital information on whether the discussion tools could be more generalizable to a more representative population of parents and children across the United States.The parent-child relationship has a major influence on child development and behavior. Parents can play a critical role in preventing their children from engaging in behaviors that could harm their health and well-being. Identifying whether or not discussion tools of unhealthy eating and marijuana use are effective for parent and child conversations centered on risky health behaviors is of particular importance. Another component to consider in promoting parent-child discussions about unhealthy eating and marijuana use is the associations of parenting styles. In particular, the present research project examined parenting styles in three ways. Initially, guided by an adapted PWM framework the study tested the associations of parenting styles, attachment styles, parent child communication; specific risks and prototypes of unhealthy eating and marijuana use by one’s child; levels of self-efficacy, coherence, worry; discussion intentions and willingness on parental past discussions of unhealthy eating and marijuana use . Second, it revealed the authoritative parenting-framed message on talking with one’s parent about unhealthy eating and marijuana use was perceived by young adults as most effective in motivating discussions about these behaviors . Finally, it provided partial support of the moderating effects of parenting styles on discussion tools and cognitive factors . The findings supported most of the hypothesized relationships delineated by an adapted PWM framework , suggesting the potential utility of the parenting styles and cognitive factors in promoting discussions about unhealthy eating and marijuana use.

Parents completed a survey with measures of the adapted PWM factors, parenting factors , and personal characteristics . The study aims were to: evaluate the descriptive characteristics of parent past discussions of unhealthy eating and marijuana use with their child; test the associations of attachment styles, parenting styles, parent-child communication, perceived risks of unhealthy eating and marijuana use, prototypes of unhealthy eating and marijuana use, self-efficacy of unhealthy eating and marijuana use, coherence of unhealthy eating and marijuana use, worry of unhealthy eating and marijuana use, intentions of unhealthy eating and marijuana use, willingness of unhealthy eating and marijuana use, and past discussion behavior of unhealthy eating and marijuana use; and to test for child age-group differences in parent discussions of unhealthy eating and marijuana use. Given the exploratory nature of the model-testing aims, this cross sectional survey assessed PWM predictors of past discussion behavior which, in light of high consistency in health behaviors over time , is expected to be a reasonably valid proxy for future discussion behavior for the purposes of model development.For Aim 1, we tested the hypothesis that parents were less likely to report past discussions of unhealthy eating and marijuana use with their child. For Aim 2, we tested hypotheses that: lower attachment anxiety and lower attachment avoidance will be associated with higher authoritative parenting style, whereas higher attachment anxiety and higher attachment avoidance will be associated with higher authoritarian parenting style and higher permissive parenting style; higher authoritative parenting style will be associated with higher parent-child communication compared to lower attachment anxiety, lower attachment avoidance, lower authoritarian parenting style, and lower permissive parenting style; higher authoritative parenting style and higher parent-child communication will be associated with higher self-efficacy of unhealthy eating and marijuana use compared to lower authoritarian parenting style and lower permissive parenting style; higher parental perceived risks of harms of unhealthy eating and marijuana use, and negative prototypes of unhealthy eating and marijuana use will be associated with higher coherence and higher worry about their child eating unhealthy and using marijuana; higher self-efficacy, drying rack cannabis higher coherence, and higher worry will be associated with higher intentions and higher willingness of unhealthy eating and marijuana use discussions with one’s child; and higher intentions and higher willingness will be associated with higher levels of past discussions about unhealthy eating and marijuana use with child.

Lastly for Aim 3, we tested the hypothesis that parents would be more likely to discuss unhealthy eating with younger children as compared with discussing marijuana use with older children.Table 1e presents the zero-order correlations for the measures of parent-child communication, perceived risks of unhealthy eating, negative prototypes of unhealthy eating, self-efficacy of unhealthy eating, coherence of unhealthy eating, worry of unhealthy eating, intentions of unhealthy eating, willingness of unhealthy eating, and past discussion of unhealthy eating with child. For unhealthy eating, parent-child communication exhibited positive correlations with negative prototypes, worry, intentions, willingness, and past discussion behavior. Perceived risks of unhealthy eating was positively correlated with self-efficacy, coherence, worry, intentions, willingness, and past discussion. Negative prototypes of unhealthy eating were positively correlated with worry, willingness, and past discussion. Self-efficacy of unhealthy eating was positively correlated with coherence, worry, intentions, and past discussion. Worry of unhealthy eating correlated positively with intentions, willingness, and past discussion. Intentions and willingness of unhealthy eating were positively associated with one another and both were positively correlated with past discussion behavior. Table 1f presents the zero-order correlations for the measures of parent-child communication, perceived risks of marijuana use, negative prototypes of marijuana use, self-efficacy of marijuana use, coherence of marijuana use, worry of marijuana use, intentions of marijuana use, willingness of marijuana use, and past discussion of marijuana use with child.

For marijuana use, parent-child communication exhibited positive correlations with negative prototypes, self-efficacy, worry, intentions, and past discussion behavior. Perceived risks of marijuana use was positively correlated with negative prototypes, self-efficacy, coherence, worry, intentions, willingness, and past discussion. Negative prototypes of marijuana use were positively correlated with self efficacy, coherence, worry, intentions, willingness, and past discussion. Self-efficacy of marijuana use was positively correlated with coherence, worry, intentions, willingness, and past discussion. Coherence of marijuana use was positively correlated with worry and willingness. Worry of marijuana use correlated positively with intentions, willingness, and past discussion. Lastly, intentions and willingness of marijuana use were positively associated with one another and both were positively correlated with past discussion behavior.Next, regression analyses were conducted on the model paths for the variables of parent-child communication, self-efficacy of unhealthy eating, coherence of unhealthy eating, worry of unhealthy eating, intentions of unhealthy eating, willingness of unhealthy eating, and past discussion behavior of unhealthy eating with child. Each analysis included all proximal and distal variables in the model that were predicted to have direct or indirect paths with the dependent measure. The analysis was repeated, taking out the non-significant variable with the lowest beta coefficient, until the model included only significant predictor variables. Table 1g presents the results of the regression analyses for unhealthy eating measures. Higher authoritative parenting style and lower authoritarian parenting style were associated with higher self-efficacy of unhealthy eating. Higher perceived risks of harms of unhealthy eating was associated with higher coherence of unhealthy eating and higher worry of unhealthy eating. While, more negative prototypes of unhealthy eating were associated with higher worry of unhealthy eating. Higher authoritative parenting style and higher worry about unhealthy eating were associated with higher intentions to discuss unhealthy eating with child. Higher parent-communication, higher perceived risks of harms of unhealthy eating, more negative prototypes of unhealthy eating, and higher worry of unhealthy eating were associated with higher willingness to discuss unhealthy eating with child. Lastly, higher authoritative parenting style, higher authoritarian parenting style, higher parent-child communication, more negative prototypes of unhealthy eating, higher self-efficacy of unhealthy eating, and higher intentions of unhealthy eating were associated with higher levels of past discussion of unhealthy eating with child.Similarly, regression analyses were conducted on the model paths for the variables of parent-child communication, self-efficacy of marijuana use, coherence of marijuana use, worry of marijuana use, intentions of marijuana use, willingness of marijuana use, and past discussion behavior of marijuana use with child. Each analysis included all proximal and distal variables in the model that were predicted to have direct or indirect paths with the dependent measure. The analysis was repeated, taking out the non-significant variable with the lowest beta coefficient, until the model included only significant predictor variables. Table 1h presents the results of the regression analyses for the marijuana use measures. Higher authoritative parenting style was associated with higher self-efficacy of marijuana use. Higher perceived risks of harms of marijuana use and more negative prototypes of marijuana users were associated with higher coherence of marijuana use. Higher perceived risks of harms of marijuana use was associated with higher worry of marijuana use. Higher parent-child communication, higher perceived risks of harms of marijuana use, higher coherence of marijuana use, and higher worry about marijuana use were associated with higher intentions to discuss marijuana use with child. Higher self efficacy of marijuana use was associated with higher willingness to discuss marijuana use with child. In addition, higher parent-child communication, higher perceived risks of harms of marijuana use, how to cure cannabis fast higher self-efficacy of marijuana use, higher coherence of marijuana use, and higher intentions of marijuana use were associated with higher levels of past discussion of marijuana use with child.The two sets of analyses testing the adapted PWM for parental discussions of unhealthy eating and marijuana use with one’s child yielded somewhat consistent patterns across the two behaviors and that provides support for the proposed model.

Figures 1c and 1d illustrate the patterns of significant relationships yielded by these analyses for unhealthy eating and marijuana use. The figures include significant paths, non-significant paths, and unpredicted significant paths. Lastly, Figures 1e and 1f illustrate the final model for all significant paths for unhealthy eating and marijuana use. The common significant paths for both unhealthy eating and marijuana use included: higher authoritative parenting style was associated with higher self-efficacy; higher perceived risks of harms was associated with higher coherence and higher worry; higher worry was associated with higher intentions; and higher parent-child communication, higher self-efficacy, and higher intentions were associated with higher levels of past discussion of behavior. The significant paths for unhealthy eating included : lower authoritarian parenting style was associated with higher self efficacy of unhealthy eating; more negative prototypes of unhealthy eating were associated with higher worry of unhealthy eating; higher authoritative parenting style was associated with higher intentions to discuss unhealthy eating with child; higher parent-communication, higher perceived risks of harms of unhealthy eating, more negative prototypes of unhealthy eating, and higher worry of unhealthy eating were associated with higher willingness to discuss unhealthy eating with child; and higher authoritative parenting style, higher authoritarian parenting style, and more negative prototypes of unhealthy eating were associated with greater past discussion of unhealthy eating with child. The significant paths for marijuana use included : more negative prototypes of marijuana users was associated with higher coherence of marijuana use; higher parent-child communication, higher perceived risks of marijuana use, and higher coherence of marijuana use were associated with higher intentions to discuss marijuana use with child; higher self-efficacy of marijuana use was associated with higher willingness to discuss marijuana use with child; and higher perceived risks of harms of marijuana use and higher coherence of marijuana use were associated with greater past discussion of marijuana use with child.This study initially gathers information on the extent of parental discussions of unhealthy eating and marijuana use with their children . Descriptive analyses revealed that, of the past discussions about unhealthy eating and marijuana use, parents’ reported greater ratings of encouraging child to eat healthy or not use marijuana; telling child to eat healthy or not use marijuana; and discussing the negative consequences of unhealthy eating and marijuana use. Of importance is that more than half of parents did not discuss the behaviors of unhealthy eating or marijuana use in the past 6 months. By supporting our hypothesis that parents were less likely to report past discussions of unhealthy eating and marijuana use with their child, this extends the possible benefits of developing discussion tools that would provide parents with guidance on how to have these discussions with their children. Next, this study provides new evidence about the proposed relationships of the extended PWM framework on parental discussions of unhealthy eating and marijuana use . The study focused on the associations of attachment styles, parenting styles, parent-child communication, perceived risks, prototypes, self-efficacy, coherence, worry, intentions, willingness, and past discussions of unhealthy eating and marijuana use with one’s child. The findings, which yielded patterns of relationships that were mostly in line with the adapted PWM predictions, further replicate and extend prior research in several ways. First, the association of attachment styles and parenting styles adds an interesting adaptation to the model. For instance, lower levels of attachment anxiety and attachment avoidance were associated with higher authoritative parenting, while higher levels of attachment anxiety were associated with more authoritarian and permissive parenting. This parallels previous literature on the relationship of higher levels of secure attachment and authoritative parenting style , and between higher levels of attachment anxiety and authoritarian and permissive parenting styles . There was not a significant relationship between greater attachment avoidance and authoritarian and permissive parenting styles. Authoritative parenting was a significant predictor of parent child communication, whereas attachment anxiety, attachment avoidance, and permissive parenting were not. Several studies have found a positive association between authoritative parenting and increased open parent-child communication about problems .On the contrary, higher levels of authoritarian parenting were also associated with more parent-child communication. It could be that authoritarian parents are also inclined to talk to their kids about risky behaviors, but perhaps they are doing so in potentially harmful or ineffective ways, and may benefit from tools on how to effectively engage in these discussions. Consistent with hypotheses, higher authoritative parenting was associated with higher self-efficacy of unhealthy eating and marijuana use. Other studies have also found a parallel association with authoritative parents often times displaying more confidence in dealing with challenges their child faces as compared with authoritarian and permissive parents .