Hemp Growing

Furthermore, only students who attended school participated in the survey, so the study findings may not be generalizable to students not attending school; of note, data regarding the percentage of students in attendance during the period of data collection are not available. There is also a potential for attribution bias as youth were asked about perceived harassment due to various aspects of their identity—race, gender, and sexuality—as well as the potential for reporting and recall bias due to social desirability. Strengths of the study include utilization of a large probability sample that is representative of the California high school student population, which allowed comparisons among peer groups. Moreover, this survey was administered in the school setting, an important environment for youth. School is also a potential setting for culturally informed interventions to support trans BLY and reduce their risk of substance use. The presence of student clubs, such as Gay-Straight Alliances, is associated with reduced risk of substance use and attenuating other health risks among gender-diverse and sexual minority students. The Gay, Lesbian, and Straight Education Network advocates intersectional approaches to foster support for Black and Latinx gender-diverse and sexual minority youth, specifically to reduce school-based victimization and harassment, which our study shows is associated with substance use. Finally, our study demonstrates the relative vulnerability for substance use among trans BLY, reinforcing the need for schools, community-based organizations, cannabis drying system and clinicians to work together to prevent substance use by addressing factors that increase risk of substance use with culturally informed interventions.

The term stress is generally used to refer to heightened psychological distress resulting from physical, verbal, or sexual abuse, in addition to discrimination from family, peers, and adverse experiences with schools, churches, and other institutions . Studies have indicated that sexual minorities, including MSM, consistently report higher rates of psychological stress compared with the general population . According to the minority stress theory, sexual orientation victimization is a result of the transactions between gays, lesbians, bisexuals, and other sexual minorities with hostile social environments, which leads to adverse mental health consequences . Some researchers have examined sexual orientation victimization as a single construct that includes both personal and institutional sexual orientation victimization . However, theory and research has indicated that sexual orientation victimization can be reliably subtyped into three categories: childhood, personal, and institutional sexual orientation victimization . Childhood sexual orientation victimization refers to childhood experiences of physical or emotional abuse based on an individual’s sexual orientation, sexual identity, or gender nonconformity. Much of the literature on stress and HIV sexual risk behavior among MSM has focused on the link between childhood sexual abuse and adult vulnerability . Studies on the effects of childhood sexual-orientation victimization on HIV sexual risk behavior among MSM are rare. Research on childhood sexual-orientation victimization has examined the consequences that childhood gender nonconformity has on the mental health of adolescent and young adult sexual minorities. Results from these studies found that adolescents and young adults who report being bullied or victimized based on their gender nonconformity exhibit elevated risks of depression and suicidal thoughts and behaviors .

Based on a sample of gay and bisexual men in New York City, Pachankis et al. found boyhood gender role nonconformity to be associated with sexual compulsivity among adult MSM. Using the minority stress framework, studies have also found childhood peer-rejection, internalized homophobia, discrimination experiences, and expectations of rejection to be associated with HIV risk behavior among MSM . Personal sexual orientation victimization can result from individual or personal conditions such as losing a job, being beaten, being raped by another male, or being verbally abused . For example, a descriptive study of the effects of rape on men in Britain observed victims experiencing long-term adverse psychological symptoms of anxiety, depression, increased feelings of anger and vulnerability, and loss of self-image .Institutional sexual orientation victimization involves systematic forms of action or inaction based on sexual orientation, sexual identity, or gender nonconformity that contribute to physical mistreatment and emotional stress . This includes discriminatory institutional policies , being denied a job, being fired from a job, and being denied housing based on an individual’s sexual orientation, sexual identity, or gender nonconformity. Studies examining the effects of institutional factors found that gays and lesbians who experience institutional sexual orientation victimization report significantly more mental health disorders than heterosexual respondents. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions , researchers examining states that enacted constitutional amendments against same-sex-marriage found significant increases in mental disorders among lesbian, gay, and bisexual respondents compared to heterosexual respondents in these states .

Another study found that sexual minority youth who were in non-supportive or discriminatory social environments toward sexual minority youth were at a significantly higher risk of suicide compared to heterosexual youth .Alcohol is the most commonly abused substance, followed by marijuana , in South Africa . Approximately 46% of South Africans over age 18 report problem or binge drinking in comparison to the global average of 11.5% . A population-based study conducted in South Africa in 2012 revealed that among households reporting consumers of alcohol, 31% were male and 10% were female . Studies have shown that sexual minorities are more vulnerable to alcohol and substance abuse than the general population . A study by Irwin, Morgenstern, Parsons, Wainberg, and Labouvie showed a positive correlation between drinking alcohol and HIV risk behavior among HIV-negative MSM. Studies have also evidenced a positive relation between marijuana use and HIV risk behavior among MSM . Lane et al. observed in a sample of MSM in South Africa that men who reported smoking marijuana in the past 6 months were more likely to report being infected with HIV. The impact that problem drinking and marijuana use have in mediating the effects that sexual orientation victimization has on HIV sexual risk behavior is unknown. Plausibly alcohol abuse and marijuana use may function as buffers in reducing the stress from sexual victimization, thus lessening the probability for engaging in condomless sex. Alternately, sexual orientation victimization may foster alcohol abuse and substance use, which could lead to condomless sex among MSM. This is an area requiring investigation. The primary aim of this study is to advance understanding of the psychosocial correlates of the three sexual orientation victimizations and HIV sexual risk behavior among Black South African MSM, taking into consideration relevant factors including social support, outness,gender identity, and perceived masculinity. Secondarily, this study examines whether marijuana use and problem drinking mediate the relationship between the three types of sexual orientation victimization and HIV risk behavior among this high-risk population.The institutional review board at Temple University reviewed and approved this study. Study participants comprised 125 Black men residing in Port Elizabeth and the adjoining townships of Kwazakhele and New Brighton who self-reported having sex with men. Participants were recruited using snowball sampling by two Black South African recruiters who were members of the target population and who lived in the targeted communities. Eligible participants had to be 18 years or older, reported having had sex with another man within the past year, and could speak and read English. Participants received R20 and light refreshments for completing a 90-minute survey. Surveys were administered in small groups and were read aloud in English and IsiXhosa by two research assistants who were Black MSM fluent in IsiXhosa and English. Each participant completed a written survey administered in small groups.Descriptive staThistics, including percentages, means, and standard deviations, were used to describe the sociodemographic characteristics of the sample. Three multiple regressions were conducted to analyze psychosocial correlates of the three types of victimization: childhood, personal, and institutional. Each regression model included age, education, social support, outness, gender identification, drying rack for weed and other’s perception on masculinity. Mean differences and corresponding 95% confidence intervals are reported for the regression analyses. The p = 0.05, two-tailed staThistical significance criterion was employed. Multiple regressions were conducted to analyze the relations between the three types of sexual orientation victimization and having condomless anal sex with casual partners. Mediation path analyses with multiple parallel mediators were conducted to test direct effects of sexual orientation victimizations on condomless anal sex, and potential mediators including problem drinking and marijuana use that mediated the relations between sexual orientation victimizations and having condomless anal sex with casual partners. We analyzed three mediation models for the three different victimizations.

We used PROCESS, a computational tool for path analysis-based mediation analysis, to conduct the analyses. This method generates direct and indirect effects in mediation models with multiple mediators functioning in parallel. It constructs heteroscedasticity-consistent standard errors and percentile-based bootstrap confidence intervals and is recommended as superior to a normal theory approach. All analyses were conducted using SPSS with the PROCESS macro for Windows. The significance criterion was p < .05 two-tailed, and the number of bootstrap samples for bias-corrected bootstrap confidence interval was set at 5000.This study addresses the question of what are the relationships between the three forms of sexual orientation victimization stressors and HIV sexual risk behavior among South African MSM. Second, this study tests whether problem drinking and marijuana use mediate the relationships between the three forms of victimization and HIV sexual risk behavior. The finding that personal and institutional sexual orientation victimizations were directly associated with condomless anal sex is consistent with studies exploring the relationships between adverse health behavior and experiences of personal victimization among sexual minorities . The finding that others’ perceptions of participants’ masculinity was associated with personal sexual orientation victimization is notable. This finding may reflect the concerns that these men have about negative cultural and societal attitudes on gender nonconformity. As posited by the minority stress theory , personal victimization may heighten the concern that these men have of being perceived by others as deviant if they do not comply with cultural masculine gender norms. The finding that older participants tended to report experiencing institutional sexual orientation victimization stress more than younger participants may reflect a heightened sensibility and awareness of systemic discrimination among older men. Surprising and not consistent with other studies with MSM is the finding that neither problem drinking or marijuana use was associated with condomless anal sex. However, caution is suggested in making inferences from this finding. Alcohol abuse is a major health problem in South Africa. Problem drinking was measured using the CAGE questionnaire, which focuses on attitudes. Plausibly, social and cultural attitudes on drinking alcohol may be less inhibitory in South Africa. Therefore, measures on the frequency and amount of consumption may be more culturally appropriate. The finding that childhood sexual orientation victimization was positively associated with problem drinking is consistent with other studies exploring the relationship between childhood sexual abuse and the health and mental health of MSM . Strengths of this study include examining the effects of three types of sexual orientation victimization on HIV sexual risk behavior among Black South African MSM in a middle income country with a high HIV prevalence. Early studies examined the effects of sexual orientation victimization as a construct that combined personal and institutional stressors . More recent studies have either examined the consequences of one type of sexual orientation victimization, e.g., personal victimization , or institutional sexual orientation victimization on the health and mental health of MSM. To our knowledge the current study is the first to concurrently examine the consequences of both types of sexual orientation victimization. The emphasis on exploring experiences of childhood sexual orientation victimization among adult MSM is also notable. This is one of the few studies to examine the effects of childhood sexual orientation victimization on health behavior among MSM. Although childhood sexual orientation victimization was not associated with HIV risk behavior, the association with problem drinking is important, indicating the need for further research in this area. The reliance on self-reports of behavior is a limitation. Additionally, while the nature of the sample afforded a unique opportunity to learn about the effects of problem drinking and marijuana use among South African MSM with histories of experiences of sexual-based stressors in the Eastern Cape, it may limit the generalizability of the study. Globally, MSM are disproportionately infected with HIV.

A crucial function of sustained inhabitance is to perform counter-surveillance efforts. Cultivators are trained by cartel employees, often veterans of the Mexican army, and equipped with weapons ranging from shotguns to assault rifles. A station is setup at a vantage point above the grow site so a watchman can detect and alert his colleagues to approaching scouts or the presence of pedestrians. While entering sites, laborers sweep trails of any prints so they can patrol for signs of entry by others. One positive development is that the use of booby-traps has drastically declined. However, the protective behavior of inhabiting guards has become increasingly aggressive year to year as a result of escalating grower competition, law enforcement pressure, high crop value, and DTOs’ demand for harvest delivery. Men on patrol have been known to threaten anybody they encounter, and even harass law enforcement and forest service employees at their homes. Their engagement in armed standoffs with law enforcement scouts has increased in conjunction with the occurrence of gunfire. By shooting at site detection scouts, cultivators create a two to three day window during which they harvest all of the buds they can carry out, and flee the area before a larger task force can return. The rate of violence and harassment towards pedestrians has also increased. In June 2006, two individuals in a remote area north of Covelo, California, came near a marijuana plantation and were shot and killed.” Two months later, in October 2006, “a man hunting in a remote location within the Mendocino National Forest was fired upon by four individuals after he inadvertently approached the edge of a grow site.” Both instances lead to the discovery of the plantations that the gunmen were trying to protect.Due to the illegal status and consequently hazardous state of marijuana plantations, racking system law enforcement agencies are the primary organizations responsible for site reclamation on public lands. “In the past, site reclamation has not been considered much, if any, by the law enforcement community.” 

Environmental cleanup and remediation are crucial to mitigating the effects of remote cultivation. Since the objectives of law enforcement agencies have changed, leaders have recognized the significance of clean up in counter-cultivation efforts, and have emphasized site reclamation in their large scale marijuana control plan. Even so, environmental cleanup and remediation remain the most neglected tasks associated with post-raid site processing. Enforcement agencies, land managers and volunteer groups are increasing post-eradication cleanups, but reclamation efforts remain inadequate when compared to the damage that cultivators create.The remoteness of Cannabis grow sites makes clean up both time consuming and arduous. Clean up crews remove marijuana plants, disassemble water diversion and drip irrigation systems, and clean up camp sites and surrounding areas. As forest technician Madison Thomson states, “[cultivators] pack everything in and nothing out. We [the conservation fund] don’t have enough money or enough manpower to go into these places and clean them up. It’s a big eye sore.” Depending on the number of people, available funding and equipment involved, the site cleanup process can take anywhere from a number of days to several months. More often than not, cleanup is not completed at all. From the perspective of law enforcement agencies, it is crucial for grow sites to be cleaned up. Undoing the work cultivators put in and removing grow infrastructure minimizes the incentive for cultivators to come back. Otherwise, cultivators readily return to a location to save countless hours preparing the grow site. Equipment and trash that is dispersed across cultivated landscapes provides visual evidence of marijuana cultivation activities. Sites that are not cleaned up are indistinguishable from active cultivation plots, and provide evidence that may result in raids on unoccupied areas.

The most important piece of equipment used for optimizing the cleanup process is a helicopter. Helicopters enable cultivation equipment and trash to be removed quickly and in large quantities. Clean up crews fill up hauling nets with marijuana plants, irrigation tubing and trash bags. The nets are connected to an extended line and flown to a designated area for transport to a disposal location. A clear area is critical for helicopters to drop lines with nets into sites for equipment removal. Heavy tree canopy and forest fires hinder the use of helicopters, and greatly reduce the efficiency of cleanup efforts. What cannot be flown out due to inaccessible site conditions, limited time allocated for helicopter use, or limited funding to pay for helicopter costs, must be hiked out on peoples backs or left to rot. Marijuana removal and destruction is a historical focus of law enforcement agencies that subsists today, despite the reality that plant removal after raids actually accomplishes little to remedy the environmental damages. Plant eradication provides a measure of operational success, prevents cultivators and civilians from attaining marijuana from already raided areas, and enables land alterations including terracing and mounds to be rectified.However, the effort put into plant eradication is needless in sites that will not be cleaned up because abandoned sinsemilla Cannabis will rot and will not reproduce to grow in subsequent years. During eradication, officers, land management employees and volunteer laborers use machetes and loppers to cut down Cannabis plants at the stems. On large plots, the work is both physically demanding and time consuming. Depending on the location of the site, different strategies are used to remove eradicated plants. Traditionally, a common method was to leave the cut plants on the ground to decompose. Today, this generally occurs only in the most remote locations to prevent plant acquisition by outside parties.

Another historically prevalent practice was to burn the marijuana plants on-site. However, this process releases carbon into the atmosphere and poses a potential risk of fire spreading to surrounding vegetation. To prevent forest fires, this option requires constant monitoring and can only be done during certain times of the year. The final option is to airlift or hike plants out to a landfill or a location suitable for burning. The most important structure to remove is the water diversion system. Removing miles of irrigation tubing is one of the most intensive aspects of cleanup in terms of time, effort, and money. It is the most important infrastructure to remove because DTOs invest large quantities of money and labor into its installation. When irrigation systems remain intact, DTOs retain a major incentive to return to eradicated sites in subsequent years, which perpetually prevents ecological recovery. Irrigation lines alone can fill multiple helicopter removal bundles, each weighing about five hundred pounds when full.76 The most environmentally harmful element of irrigation systems is the dam or cistern that is used to create a catchment from which cultivators extract water. Removal of catchments requires great care to restore original flow patterns, while minimizing sedimentation and alterations to primary and ephemeral flows. Additional clean up aims to remove equipment, supplies, piles of cleared vegetation and remains from human inhabitance: this includes bags of fertilizer, chemical containers, propane tanks, camp dwellings, food preparation areas, latrine sites, scattered trash and more. The scattered trash includes composed of plastic wrapping, notebooks, clothing, tin cans, hiking packs, beer cans, pruning saws, rope, and more. It is important to gather and remove these scattered remains so that eradicated sites can be distinguished from active ones. The latrine, however, cannot be simply picked up and taken away. Cultivators generally dig at least one hole deep into the ground to be used throughout the duration of their stay. Nothing is currently done to remove the excrement aside from covering up the hole, rack system marking the location, and allowing the contents to filter through the soil.Holistic remediation efforts attempt to restore landscapes to pre-alteration conditions, which entails watershed maintenance, surface restoration, vegetation management, and wildlife promotion. While there are astounding regularities from one DTO site to another, remediation efforts still must be suited to specific landscapes and management goals because the individual problems of each site influence reclamation solutions.

Watershed maintenance centers on restoring water courses by removing cisterns and dams. Dams must be removed in a way that will not wash the dam components downstream. This requires careful consideration about how to release collected water in a controlled manner to its original path. However, the process of diversion may permanently alter the direction of ephemeral water flow and the way in which it accumulates in pools. Equally important in preserving watershed function is preserving landscape drainage. Restoring the integrity of watershed drainage goes hand in hand with rectifying land alterations such as reservoirs, terracing and displaced vegetation that alters surface and subsurface water flow. Remediation teams attempt to fill reservoirs, holes and sumps, re-contour slopes, and disperse vegetation. It is important to fill any holes dug by cultivators because they can trap and kill small mammals. Remediators use rakes and shovels to re-grade slopes and flatten mounds to smooth soil surfaces. While re-contouring can be significant, soil replacement is inevitably an imperfect process. The removal of logs providing terrace support can cause rapid erosion, which makes terrace remediation complicated and difficult. The original grade is never reproduced perfectly, but over time, the decomposition of organic matter and normal physical processes replace soil losses. In addition, crews perform restoration tasks such as “filling in planting holes and covering the hillsides with small branches and duff to help prevent [further] erosion.” Clean up crews use the slash piles created by cultivators to control erosion in areas with bare soil. It is important to disperse cleared vegetation, to remove large berms that obstruct site accessibility, and to redistribute piles from streams and creeks. Remote landscapes generally recover very well with time through “natural or unassisted regeneration.” The dark and rich organic soils provide abundant nutrients to new sprouts, and the more inhospitable landscapes are well suited for native plants. For example, large trees that are topped off will take tens to hundreds of years to recover if at all; but successive plants will thrive in the newly sunlit areas. When remediators do restore vegetation, they spread seeds of native plant species or plant seedlings. This can provide habitat, prevent further establishment of invasive plants and mitigate erosion. Habitat maintenance and restoration is a major concern for cultivated areas containing threatened or endangered species. In certain cases, plant restoration requires regular monitoring to gauge effectiveness. The success of plant recovery depends on each site, but the most vital factors in site recovery are the prevention of cultivator return and the passing of time. Little can be done to remove the presence of chemicals from the biomass. The high nitrogen and phosphorous fertilizers are both moveable and soluble, thus they are absorbed mostly in and around the site. Fungicides such as sulfur generally have a short half-life, so they remain in the area for only a short period of time before they decompose or dissolve into the atmosphere. Insecticides cannot be prevented from dissolving into the air and soil, or from accumulating in the food chain. However, a commonly used pesticide, Malathion, is rapidly broken down in soil and by sunlight and causes the most harm only through directexposure. Rat poison pellets and similar rodenticides cause the most adverse and irreparable effects because they dissolve into soils and water tables and their direct consumption causes death in animals.According to Patrick Heil, the Director of Public Affairs for the US Forest Service, the average cost of cleanup per site is $5,000. This is the real cost of cleanup on average for a ten acre site using helicopter assistance. When environmental remediation is included, the cost of site processing doubles, bringing the average to approximately $10,000. These expenses include helicopter fees, fuel consumption, wages, food, gear , trash disposal fees, and other variable costs not including the cost of raids, eradication, or investigations. Land management agencies have had to divert funding from other areas of operation to finance cleanup efforts due to the high costs. In 2007, the US Forest Service eradicated 346 sites, but allocated only $300,000 to site cleanup and remediation. This means that the organization is over 3 million dollars short of what the cost would be to clean up and remediate every site eradicated, not including plantations on land managed by other agencies. Land managers often create partnerships to allocate the resources necessary to clean up cultivated landscapes.

Law enforcement and US Forest Service reports indicate that Drug Trafficking Organizations control a significant portion of Cannabis cultivation in the United States and are establishing an increasing number of both indoor and outdoor growing sites. The primary DTOs operating in California are of Mexican origin and consist of the most powerful cartels in Mexico. The outdoor cultivation sites developed by DTOs are of special concern because they mainly occur on public lands. Remote areas used by cultivators include land holdings managed by the US Forest Service, the Bureau of Land Management, the National Park Service, the Fish and Wildlife Service, the Bureau of Indian Affairs, and the Bureau of Reclamation. However, DTOs also cultivate marijuana plots on private lands including conservation reserves, game lands, and large private land holdings. Marijuana cultivation on public lands is entrenched in California structurally, institutionally, economically, and culturally. The issues that surround marijuana cultivation and prevention efforts are both complex and large in scale. The systems and processes employed by both cultivators and law enforcement agencies are long established and the product of a dynamic progression. However, the scale of marijuana production and the adverse effects of cultivation have reached unprecedented proportions. Black market revenues have increased with the demand for marijuana, giving rise to criminal enterprises that go to any lengths necessary to maximize profits. The result is an oligopolistic market control, continued natural resource damage and sustained infringement on public safety.Marijuana is California’s largest cash crop, weed dryer estimated to be worth between 10 and 14 billion dollars annually. 

This immense profit incentive is the main cause for continual marijuana cultivation on public lands, and is based on high demand and inflated market prices. In the most highly concentrated cultivation counties in California, the economies of which are based on the marijuana industry, only a handful of cultivators are arrested each year. Marijuana has a great cultural significance which is apparent in clothing, artwork, music, and many other forms. People of all ages and backgrounds consume marijuana for a variety of reasons. It is a constant and accessible commodity, even more so than alcohol to some, and has become deeply ingrained in California culture. Its accessibility makes it easy for people to use regularly and to create substance based relationships where marijuana becomes routine in certain activities or social situations. These habitual relationships are significant in social participation and the creation of psychological reliance. Marijuana’s unique psychoactive function distinguishes it from any other drug. Marijuana can alter one’s perception in a way to provide relief from stress, or to simply to produce a pleasurable sensory perception. The most common mechanism of ingestion, inhalation, allows the psychoactive chemicals to take effect within thirty seconds. Marijuana is dose dependent so people can control the intensity of their high to some extent. It is a versatile natural medicine and provides viable relief from a myriad of symptoms and diseases. While individuals have their own motivation for smoking marijuana, the cannabis plant is a deeply rooted product in American culture.Marijuana cultivation by Drug Trafficking Organizations is a relatively recent development in California history.

The foremost organizations that produce commercial marijuana plantations are of Mexican descent. Other major cultivators include outfits of Canadian and South American origin as well as comparably small scale independent growers. These groups began cultivating Cannabis on public lands in order to evade border security, capitalize on lucrative domestic markets, and take advantage of the optimal growing conditions provided by California lands. Remote Cannabis cultivation requires large scale capital investments as well as a high degree of risk; however, DTOs have had a great measure of success.Traditionally, major organizations conducted drug traffic across international borders. Illegal substances were produced in foreign areas and transported across United States borders. Trafficking organizations utilized a variety of methods and a large quantity of smugglers to transport a steady flow of drugs beyond US border security with minimal losses to seizure. Mexican cartels were notorious for supplying large amounts of low quality marijuana to the southern regions of the United States. This commercial grade marijuana was often referred to as ‘Mexican Brick Weed’; a reference to the tightly condensed ‘bricks’ of dried marijuana buds packaged for international transfer. The process of drying and condensing buds distorted bud shape, reduced THC content, and decreased overall marketability, however, high volume smuggling created a surplus of marijuana that could be sold cheaply and in large quantities to compensate for the low quality of the substance. Mexican Brick Weed contained approximately 2-3 percent THC, whereas domestically produced strains of sinsemilla, marijuana without seeds, could reach levels upwards of 10 percent THC. In most areas of California, Mexican marijuana could not compete with domestically produced strains in terms of quality; only in competitive price.

The risk involved with Cannabis cultivation enabled local growers and distributors to charge high prices, while the methods of pollination prevention, crossbreeding, and nutrient additives created highly psychoactive buds that maintained a widespread demand in California and across the nation. Domestic marijuana cultivation traditionally occurred on a small scale by California residents. Small gardens were tended by a few people on private property, or a nearby location where plots of up to one hundred plants were grown. While marijuana cultivation remained illegal, this method provided a form of income and sustenance for people living in rural areas. Grow sites were generally outdoors near an accessible water source, and growers lived in local proximity to their sites. These small scale plantations were the primary producers of the marijuana sold in California up until early 1980s, when large scale organizations entered into marijuana production inside the US.These policies initiated a transition in immigration practices that allowed more Mexican laborers to legally enter the United States while deterring illegal methods of entry by tightening border security. The increased border security led to higher rates of drug seizure. These shifts in immigration were reinforced by the Immigration Act of 1990, which increased the limits on legal immigration, changed the status of aliens, and further increased border security by deploying a regular presence of National Guard troops to assist with Border Patrol. As the presence of law enforcement troops increased, the funding for extended patrols, searches and seizures increased as well. These measures threatened the flow of non-documented laborers and restricted the ability for Mexican organizations to regularly transport drugs across the border. As more traffickers were intercepted, DTOs responded by developing products within US borders.18 During the early 1990s the Mexican cartels began to participate in the trend that originated in California in the early 1980s. In response to increased marijuana related property seizures, California citizens began to grow marijuana on public lands because it made “ownership of marijuana… difficult to prove.”19 Growing Cannabis outside of personal property enabled local cultivators to limit investments on land and greatly reduced both the probability of getting caught and the liability of losing their property to the state. Commercial growers were able to diversify and decentralize their cultivation sites in order to make them less vulnerable. This cultivation model was ideal for cartels because they did not need to acquire land and could operate undetected by discreetly encroaching on remote landscapes. Meanwhile, the dynamics of the marijuana market in California began to change as a result of state level policy changes. In 1996, the Compassionate Use Act, Proposition 215, passed 55.6 percent to 44.4 percent to allow medical marijuana to be legally grown and consumed in California, soon followed by thirteen other states. Minimal regulation of doctor prescribed medical marijuana cards allowed cultivators to easily enter into the medical marijuana market.

The new legal standing of marijuana decreased the consequences for cultivation on the whole, and often enabled traditional commercial cultivation to occur under the umbrella of the Compassionate Use Act. This proposition reduced the scale of some grow sites by setting limitations on legally cultivated amounts, cannabis drying racks but it also significantly increased the number of growers. Proposition 215 created a political climate conducive to innovative cultivator practices. Access to important infrastructure and Cannabis enhancing inputs increased because cultivation efforts no longer needed to be kept completely secret. Commercial outlets and plant nurseries could supply high technology indoor and outdoor grow systems along with all of the associated inputs. As a result, more specialized systems were designed and sold commercially. As time passed, individuals increasingly experimented with techniques incrossbreeding, transgenesis, and high-tech indoor cultivation environments. Meticulous grower experimentation and utilization of extensive inputs increased the quality of high grade marijuana by increasing THC and Cannabinoid contents. Whereas the THC content of marijuana previously peaked around 12%, new strains could reach levels upward of 20%. The change in California state marijuana policy decreased the demand for lower quality imported marijuana. California’s Mediterranean climate, abundant water, and loamy organic soils provide ideal growing conditions. By increasing cultivation operations on US lands, DTOs were able to exploit the abundant resources, and domestic research and development necessary to produce high quality psychoactive Cannabis.The transition from traditional marijuana cultivation to DTO operated cultivation has transformed the scale, methods, economic scope, and environmental impact of marijuana growing. Land encroachment practices have likely increased cartel expenditures compared to traditional trafficking methods, but they have also increased market accessibility, demand and price. The marijuana market has become big business, and is estimated to be the most profitable industry in California. However, the primary profiteers are safeguarded outside of the US. Modern DTOs are international organizations governed by tight hierarchical structures, the upper ranks of which are controlled by familial ties. The logistics of their operations are meticulously planned and highly organized. DTOs are sophisticated in their methods, technologically advanced in their systems, and resourceful in their practices. Cultivators select sites in rugged and remote wilderness locations that push the limits of human accessibility. They choose unusual locations to evade detection, even planting in sites not considered conducive for Cannabis cultivation. Grower methods for entering sites are both inventive and evasive. Suppliers drop off materials at inconspicuous locations during night hours in order to remain undetected. Laborers use irregular entry points and carry the supplies on their backs, hiking long distances off established paths through the darkness. These men sometimes carry more than their body weight in supplies over extremely rough terrain, and are careful to remove evidence of their presence. While some individuals use night vision goggles to navigate in the darkness, they still cross terrain that is dangerous in full daylight without added weight. DTO-established sites are setup and operated by two to fifteen people, several of which live on location. A select number of workers with specialized technical expertise rotate between sites and aid in preparation according to their skill set . The men who live on site throughout the season are usually Mexican nationals recruited out of economic desperation or to settle a debt to a Cartel. Their payment depends on the delivery of a complete harvest of marijuana buds without detection. Sometimes their lives and the lives of their families are used as collateral. DTOs invest tens of thousands of dollars for each site, depending on the number of plants and necessary infrastructure. Expensive infrastructure components include weapons, drip irritation, camp gear and mechanical equipment. Cultivators spray-paint subtle tree markings to identify campsites for re-utilization. Supplies that must be replenished annually include seed, or cloned starters, chemical inputs, food, ammunition and more. In addition, Cartels pay for travel and logistics, labor, and other variable costs. While these systems may seem both expensive and risky to establish, each harvest produces millions of dollars in profit. The wholesale value of one pound of high quality marijuana buds ranges from $1,800 to $2,000, and the market value ranges from $2,000 to $6,000. At these prices, marijuana is more valuable pound for pound than gold. The average number of plants for all discovered sites in 2006 was about 7,000, with each site producing between 7,000 -14,000 pounds ofbuds. This means that the average harvest is valued between $12.6 million and $28 million. Some outdoor plantations have contained upwards of 50,000 marijuana plants. In 2006, 346 sites were eradicated by the Forest Service in California estimated to represent only 30% to 40% of the marijuana produced within the state that year. 

The Netherlands pioneered the experimentation with depenalization strategies in 1976 when it formalized the use of the expediency principle to guide the enforcement of drug prohibitions. Based on this principle, Dutch prosecutors are instructed not to bring charges when cannabis use offenses take place within the user’s home or within the so-called coffee shops, where cannabis can be openly consumed and purchased. From the 1990s onward, many national and subnational jurisdictions introduced cautioning and diversion schemes to deal with drug use offenses. Cautioning schemes authorize police officers to avoid arresting suspected drug offenders under certain circumstances. Instead, the cautioning schemes require them to issue a written warning of the possible consequences of the illegal behavior. Diversion schemes, which may operate at the pre-trial, pre-sentence, or post-conviction stages of the legal process, are intended to shift offenders from the criminal justice system and its carceral institutions to other channels of legal intervention. When applied before the sentencing stage, such measures may require the offender to participate in certain treatment and education programs as part of the bail conditions. After the sentencing stage, diversion measures may subject a convicted offender to community-based or rehabilitative measures . The widespread transnational diffusion of depenalization regimes is enabled by the structural mismatch between the actors shaping the formal rules of the international drug control system and those implementing these rules in national and local contexts. Rather, it has evolved through uncoordinated processes of institutional isomorphism, grow room reflecting converging professional concerns regarding the complexities of implementing criminal prohibitions that are extensively violated by ordinary citizens and that do not reflect widespread social disapprobation of the targeted activity.

From the perspectives of ground-level enforcement officials and more senior bureaucratic elites, the implementation of cannabis prohibitions raised pragmatic concerns regarding the limited effectiveness of conventional penal measures and the immense costs that such efforts entailed. In democratic systems committed to the principle of legalism, it seems natural to expect that schemes of depenalization would translate into de jure changes in the statutory definitions governing processes of criminalization. The international drug conventions place constraints on the ability of national legislatures to introduce such reforms. However, the treaties also contain textual ambiguities that provide leeway for negotiating the scope and ambit of such prohibitions. The rise of the medical cannabis movement illustrates the unfolding of such processes of normative contestation. The movement began to gain ground in the early 1990s, focusing its efforts on promoting ballot initiatives at the municipal and state levels in the US. Within the next two decades, it effectively initiated the enactment of laws decriminalizing the medical use of marijuana in thirty-one states across the US and inspired norm entrepreneurs in dozens of other countries to campaign for the adoption of similar models. Countries adopting medical cannabis laws utilize the latitude allowed by the UN drug conventions regarding the definition of the term “medical and scientific purposes.” Importantly, they challenge the powerful view that marijuana has no demonstrated medical use. In this regard, the medical cannabis movement has demonstrated the effectiveness of bottom-up legal mobilization strategies operating at the subnational level to contest authoritative interpretations of transnational prohibition norms produced by powerful global actors.

Building on the successes of the medical marijuana reform movement, advocacy networks in various countries have campaigned for the enactment of more radical models of decriminalizing and even legalizing the recreational use of cannabis. The seeds of this development were sown in the 1990s when European countries increased the thresholds of the amounts of cannabis possession exempted from criminal responsibility. Portugal, for example, adopted threshold parameters based on “the quantity required for an average individual consumption during a period of ten days.” Whereas Portugal adopted this policy as part of a comprehensive redesign of its drug laws on the basis of harm reduction principles, in other countries, these steps toward legalizing cannabis use were stimulated by court rulings reviewing the constitutionality of cannabis prohibitions. For example, in Argentina, a 2009 ruling by the Supreme Court struck down Article 14 of the country’s drug control legislation, which punished the possession of small amounts of cannabis with prison sentences ranging from one month to two years. The Court stated that the possession of cannabis is protected by Article 19 of Argentina’s Constitution, which states that “private actions that in no way offend public order or morality, nor are detrimental to a third party, are reserved for God and are beyond the authority of legislators.” Recent developments in Canada and nine US states signify the growing momentum of the trend toward the legalization of recreational uses of cannabis and the development of more complex regulatory models to govern legal cannabis markets. In different ways, these jurisdictions grant licenses to professional farmers and pharmacies to produce and to sell cannabis commercially and exempt individuals from criminal responsibility for noncommercial uses.

The trend toward liberalizing cannabis prohibitions illustrates the recursive nature of transnational processes of legal change. The networks of actors participating in these processes—comprised of grassroots activists, legislatures, bureaucratic elites, criminal justice actors, scientists, journalists, and public health officials—created new regulatory models that gradually transformed the application of cannabis prohibition norms in various jurisdictions. These actors invoked the indeterminacy of treaty provisions, contested the framing of cannabis use as indicative of a moral malaise, and highlighted the diverse ways in which the enforcement of cannabis prohibitions produces social harms that are severer than those generated by cannabis use. They also utilized the space for norm-making provided by the mismatch between the institutions and actors that formulate globalnorms and those assigned with the actual implementation of these norms in national and sub-national settings. The success of these campaigns warrants a reflection on the conditions under which local and national acts of contesting TLOs can reshape the agenda of global actors invested in preserving the current normative settlements. The following section focuses on this question.The rapid and widespread transnational diffusion of new models of decriminalizing, depenalizing or legalizing the use of marijuana serves as a product and a catalyst of the declining capacity of the cannabis prohibition TLO to shape the policy choices of criminal lawmakers and the routine practices of enforcement officials. However, to what extent do these reforms change the agendas of the global actors that play key roles in shaping and maintaining the normative and institutional structures of this TLO? Faced with the global spread of cannabis liberalization reforms, the INCB has positioned itself as the most steadfast defender of the normative expectancies of the cannabis prohibition TLO. In its annual reports, the Board contested the legitimacy of the legal interpretations underpinning states’ engagement with decriminalization, depenalization, curing cannabis and legalization initiatives. The Board repeatedly expressed its concern that the introduction of civil sanctions for possession offenses was sending the wrong signal, downplaying the health risks of marijuana use. It criticized medical cannabis reforms and questioned the scientific basis on which they are premised. Most recently, the Board condemned Uruguay and Canada for adopting legalization schemes, stating that such reforms constituted clear breaches of the international conventions. The literature examining the roles of naming and shaming mechanisms in international politics observes that most countries are inclined to bring their laws into formal compliance with international standards to avoid being stigmatized as “deviant states.” The efforts of the INCB to achieve such influence by condemning countries deviating from the prohibitionist expectancies of the international drug conventions failed to generate such adaptive responses. Some countries have practically ignored the Board’s proposed interpretation of the international obligations set by the conventions. Others have argued that the Board’s interpretive approach was too narrow and relied on selective use of the available evidence-base concerning the medical uses of cannabis. Still others contended that the Board was exceeding its mandate when it adopted a hostile stance toward legitimate policy choices of sovereign states. The limited impact of the Board’s attempts to delegitimize the adoption of non-punitive models of cannabis regulation provides important insights into the conditions under which naming and shaming strategies can succeed. One reason for this limited impact is that some of the central countries pioneering the experimentation with decriminalization and legalization schemes are not particularly vulnerable to economic and reputational pressures. 

Supporters of cannabis liberalization reforms across Europe and North America justify these policies on the grounds that they are needed to reconcile drug policies with fundamental human rights values as well as with human development concerns. In this polemical context, it is unsurprising that the INCB, which has long failed to restrain the human rights abuses inflicted in the name of the war on drugs, has not succeeded in harnessing transnational civil society actors to support its line of attack on the perceived departures from the settled interpretations of the international drug conventions. Whereas the INCB has remained unambiguously committed to the task of defending the normative settlements of the cannabis prohibition TLO, the approach taken by the US has been marked by ambivalence. President Barack Obama’s administration adopted the ambiguous position of respecting the decisions of US states legalizing the medical and recreational use of marijuana while continuing to condemn steps toward legalization in Latin American and Caribbean countries. Responding to shifts in national public opinion, the administration set out lenient guidelines for the federal prosecution of marijuana users in states that had legalized its medical and recreational uses. It thereby allowed legalized drug markets to take roots in Colorado and Washington, and subsequently in other states. Like other national governments, the US federal government invoked its domestic constitutional principles to argue that its policies are in compliance with the international standards. However, during the same period, the US continued to apply its strict punitive approach to evaluating the compliance of other countries with the UN drug conventions. The annual certification process continues to include assessments of the extent to which the seventeen countries currently identified as “drug majors” are willing to eradicate the cultivation of cannabis and to penalize its growers and sellers. With a majority of Americans supporting the legalization of marijuana 73 and a majority of US states already implementing decriminalization schemes for medical marijuana, lawmakers in the House and Senate are facing increasing pressure to end the federal ban on cannabis. Despite efforts by Attorney General Jeff Sessions to revive the zero-tolerance approach of the federal government, President Donald J. Trump has recently expressed his intention to support such reforms. It is too early to predict whether and when such a change will take place or how it will impact the federal government’s foreign policy stance on the issue of cannabis legalization. However, as long as the US adheres to this “do as I say, not as I do” message, its ambivalent posture enables further steps toward the unsettling of cannabis prohibition norms. Nevertheless, it is important to note that despite its declining regulatory effectiveness, the cannabis prohibition TLO continues to exert considerable influence on the development of drug policies at the international, regional, national, and local levels. In this context, it is notable that countries that have liberalized their cannabis laws emphasize their commitment to remain bound by the confines of the current treaty regimes of the international drug control system. Remarkably, the extensive recognition of the severe failures and counterproductive effects of the cannabis prohibition TLO has not generated viable political efforts to amend the international treaties underpinning its operation. To a considerable extent, the reluctance to renegotiate the treaty norms governing cannabis policies stems from the notion that the cannabis prohibition TLO is embedded within the mega-TLO of the international narcotic control system. This serves as a powerful mechanism of issue linkage, leading countries that support cannabis liberalization reforms to avoid initiating formal treaty amendments out of concern that such actions might destabilize the settled norms prevailing in other issue-areas of narcotic control . The fact that the UN drug conventions regulate the global trade of both the illicit and licit uses of drugs, including substances on the World Health Organization’s list of essential medicines, further escalates the stakes in renegotiating the terms of these treaties. In addition, the reputational costs of defecting from UN crime suppression treaties might be higher than those suffered by persistent objectors in other areas of public international law.

Using electronic health record data, we aimed to: Determine the risk of ED and inpatient visits each year from 2010 to 2014 for MUD patients relative to controls; Examine differences in the rates of emergency department and inpatient utilization between MUD patients and controls over 5- years; and Identify predictors of emergency department and inpatient utilization over time within the MUD sample.Marijuana increasingly takes center stage in public policy and debate as legislation to legalize marijuana spreads and use for medical purposes is already established in many states . Attitudes towards liberalization are normalizing, particularly among youth , with regular users at high risk of addiction and developing MUD in adulthood . Consequently, patterns of marijuana use and MUD are rapidly changing and have considerable implications for health systems. This study examined how adult patients with MUD use ED and inpatient resources over time, services that suggest poor health and/or inappropriate use of health care. Findings suggest MUD patients remained at higher risk for having ED and inpatient hospital visits than controls, even though their use of these services declined at a faster rate over the study follow-up period. Further, for MUD patients with cooccurring conditions, utilization of ED and inpatient services continued to increase throughout the follow-up, suggesting these patients may need identification and intervention to address health problems before they become acute. Similar to other studies with different designs and populations , we found that MUD patients had high levels of concurrent medical, psychiatric and substance use disorders. Because these conditions worsen prognosis, lead to high morbidity, commercial weed and contribute to inappropriate service use , it is not surprising we found that MUD patients had consistently greater likelihood of hospital and ED use relative to controls.

In contrast, one recent study reported no association between any marijuana use and patients’ hospital or ED admission status, but this sample consisted of adults who did not have significant medical comorbidity and the study identified frequent use, but not MUD . This difference may reflect the higher severity of patients in our sample, who likely have greater impact on health system resources. Although not specific to MUD, the broader evidence base suggests high ED and hospital utilization among those with substance use disorders is associated with poor health, accidents, and concurrent use of multiple substances , signaling unmet service needs in specialty care, such as addiction treatment and psychiatric care. Further, as legalization evolves and the availability of marijuana increases, there is heightened concern that MUD prevalence and associated health problems will increase . Consequently, building on initial work in this area, it will be critical for future studies to explore the efficacy and feasibility of enhanced screening and intervention for marijuana use and MUD in ED and inpatient settings. Over time all patients had fewer visits, but patients with MUDs experienced a more rapid decrease of visits compared to controls, though MUD patients still maintained higher use at each time point. National data have showed increasing ED visits involving marijuana use . This national increase could be due to the combined effects of increasing marijuana potency, liberalizing views of the drug, and increasing trends toward its legalization . However, our finding of a decrease in ED or inpatient utilization over time may suggest that some patients’ health may improve , and/or may be specific to patients receiving services within integrated health systems where specialty services are provided internally. While we cannot measure this with the current data, it is possible that MUD patients may be more likely to be linked with addiction treatment and other specialty services, as well as primary care services, following an inpatient or ED encounter, potentially reducing the need for subsequent acute care. There are condition- and specialty specific clinical decision support tools embedded in the EHR to assist hospitalists and ED care teams in linking patients back to both primary and secondary care.

For example, during an ED encounter patients can be booked into a follow-up primary care appointment. Prior studies in KPNC have shown patients who have ongoing primary care and addiction treatment are less likely to have subsequent ED visits and inpatient admissions, and this may be related to improved substance use and health outcomes . Despite decreasing utilization rates, it is critical to note that MUD patients were at higher risk of using these services over the follow-up compared to controls, with twice the risk even at the last time point. Thus, MUD patients remain at high risk for ED and inpatient visits despite a more rapid decrease in utilization over time. The health impacts of marijuana use remain controversial as policies evolve, yet our findings indicate that patients with MUD do have more severe health conditions. Co-occurring psychiatric and other substance use disorders and medical conditions were associated with higher odds of ED and inpatient utilization. Each of these comorbidities is over represented among patients who have frequent and inappropriate use of health care services . Most of the related research has focused on patients with alcohol or opioid use disorder, and our findings extend the literature to those with MUD. Patients with MUD are likely to have frequent ED and inpatient visits requiring a range of medical treatments, psychiatric symptom stabilization or detoxification from other drugs or alcohol. This suggests that MUD patients’ presenting problem may not be their only or most severe problem, and clinicians should routinely assess and address multiple cooccurring conditions in these individuals. Several limitations should be noted. We relied on provider-assigned clinical diagnoses, which limited the sample to patients who had a MUD disorder diagnosis and a health care visit, which may represent the lower bound of identified MUD, though we did include current and preexisting diagnoses. We did not have data on rate or frequency of marijuana use; it is important to examine outcomes related to the extent and severity of marijuana related problems in future prospective studies. We did not have data on the reason for ED or hospital admission or length of stay, which are important areas of further investigation.

ED utilization that Kaiser did not pay for is not captured. Patients were insured members of an integrated health system, and the results may not be generalizable to uninsured populations or to other types of health plans. As noted previously, patients were required to have a health plan visit in 2010 for cohort selection, but were not required to have a health plan visit in subsequent years, which may partially explain the steep decline in ED and inpatient hospitalization visits between 2010 and 2011 and the subsequent leveling off of ED use from 2011 to 2014. However, patients were required to have membership four of the five years, and visits continued to decline over the study period; utilization for MUD patients were consistently higher than non-MUD patients. This study found that MUD patients remained at high risk for having ED and inpatient visits, even though utilization of these services significantly declined over 5-years. Utilization of ED and inpatient services was higher for MUD patients with co-occurring conditions throughout the follow-up, suggesting that targeting these patients for outreach and intervention may be a useful strategy for improving outcomes.Over the past decade, there has been a notable change in the consumption patterns of inhaled and ingested substances, driven in part by the increased legalization of cannabis and the growing popularity of electronic cigarettes . While cigarette use is on the decline, the use of e-cigarettes and marijuana has witnessed an upward trend, which is expected to continue with the ongoing progress of cannabis legalization across states and diminishing societal stigma. Despite these changes, there remains limited research on the frequency of use, effectiveness, and safety of these substances for various medical conditions, particularly among individuals with underlying lung disease. Cystic fibrosis , formerly considered a fatal condition, has experienced a remarkable transformation, drying rack for cannabis largely attributed to advances in precision medicine and the introduction of modulator therapy. As the CF population continues to age, attention is shifting towards addressing unique challenges teenagers and adults face, including mental health and substance use. People with CF may seek complementary and alternative treatments to address common issues associated with their chronic illness, including treatment burden, anxiety, depression, decreased appetite, pain, and sleep disturbances. 

Additionally, as health outcomes improve in the era of effective modulator therapy and respiratory symptoms become less prominent, pwCF may resort to inhalation of substances that could have significant impact on their lung health. Limited data currently exists on the prevalence, modalities, perceptions, demographic, and health factors associated with using marijuana, cannabidiol , e-cigarettes, and cigarettes in pwCF, particularly in the era of effective modulator therapy. In the past decade, there were only two studies on substance abuse in CF ; both were conducted before the legalization of marijuana and before the majority of pwCF qualifying for effective modulator therapy. Given these evolving circumstances, it is essential to reexamine substance use and its perception among pwCF. Gaining a deeper understanding of substance usage patterns can enhance the quality of clinical care and provide valuable insights into the underlying reasons, empowering healthcare teams to provide informed guidance and support. In this study, we investigated the rate of use of marijuana, CBD, e-cigarette, and cigarettes within the CF community and the characteristics of users. We sought to determine if pwCFusing these substances were on cystic fibrosis transmembrane receptor modulators as well. Lastly, we investigated reasons for and attitudes regarding substance usage and self-reported clinical outcomes with substance use. Recent users were compared to nonusers of each substance for all analyses. To assess differences in socioeconomic characteristics, demographics, and illness severity markers, Fishers exact test was used. Univariate and multivariate logistic regressions were performed to evaluate the unadjusted and adjusted association between usage of CFTR modulators and recent usage of each substance. Potential confounders included in the multivariate models were chosen a priori based on prior literature and a directed acyclic graph of the framework of potential relationships of use of CFTR modulators and substance use. Potential confounders were gender , age , race and ethnicity , FEV1 percent predicted , PHQ-4 . Subjects with missing data were excluded from the regression analyses. A p value of less than .05 was considered statistically significant. All statistical analyses were conducted using R version 4.2.1 . The study procedures were reviewed and approved by the Institutional Review Board at the University of California, San Francisco .Overall, we found that recent users of each of the four substances were more likely to be college-educated, between the ages of 26 and 39 years old, and Black when compared to nonusers. Demographic and socioeconomic characteristics between recent users and nonusers differ depending on the substance used . Compared to nonusers, recent users of CBD, e-cigarettes, and cigarettes were more likely to be male, which contrasts with recent marijuana users, who were slightly more likely to identify as female and other gender identities. Black subjects were more likely to be recent users of all substances than other races. Non-Hispanic white subjects were more likely to be recent users of marijuana and cigarettes. Asian, Native American, other races, or multirace subjects were more likely to be recent users of e-cigarettes. It is worth noting that while we did appreciate significance when comparing race/ethnicity to recent substance use, representation of non-White participants was limited, potentially limiting the generalizability of the findings. Specific to marijuana, there was no significant association between recent users and nonusers and state of residence in terms of legality based on cannabis laws during the study period. However among recent users, there was a higher percentage of use in states where marijuana was legalized , compared to those in medically legal and illegal states . Significant patterns also emerged with respect to markers of CF disease severity and PHQ-4 scores between recent users and nonusers . Recent marijuana users were more likely to be on pancreatic enzymes, while recent cigarette users were less likely to be on pancreatic enzymes. Subjects with self-reported FEV1 percent predicted of 60%–80% were more likely to be recent users of e-cigarettes and cigarettes as compared to nonusers who were more likely to have a self-reported FEV1 less than 60% and greater than 80%.

Longitudinal research with diverse groups of youth is needed, including multi-ethnic youth, so we can examine how use in middle school and high school may affect functioning in high school. Fourth, most studies that examine how trajectories affect outcomes tend to focus on one outcome, such as mental health or academic achievement. It is important to assess several different domains, such as academics, physical and mental health, social functioning, and behavior as findings could shed light on what domains may be most affected during this important developmental period, which could help inform prevention efforts. Most importantly, these studies do not typically address potential disparities in functioning that may occur given the same rates of use during this time period. One cross sectional study found that Latino high school aged youth who reported drinking also reported a higher likelihood of getting into trouble with the police compared to White and Asian youth who drank alcohol . The current study moves the field forward significantly in this area by a) testing slope and intercept differences for AM use by race/ethnicity to determine whether differences exist in probability of use and rate of change in probability of use, b) testing whether the intercept and slope of probability of AM use from age 11 to 16 predict outcomes across several key domains of functioning at age 17, and c) adjusting for level of AM use and comparing outcomes for White, Black, Hispanic, Asian and multi-ethnic youth to understand whether functioning in high school differs for these groups after controlling for AM use.The current study moves the field forward in the area of trajectory research by examining how AM use among a diverse sample of youth across this developmental period affects functioning for a variety of domains, pipp grow racks including physical and mental health, academics, social functioning, and behavior.

In addition, we assessed whether there were racial/ethnic differences in functioning for White, Black, Hispanic, Asian and multi-ethnic youth after controlling for level of AM use. Similar to previous work in this area , Asian youth reported less alcohol and marijuana use than White youth, and Black and multi-ethnic youth reported less alcohol than White youth. Furthermore, the rate of increase in the probability of drinking and marijuana use for Whites during adolescence was greater than the rate of increase in the probability for Hispanics, which corresponds with recent research on the Add Health data set . Thus, White youth continue to be at higher risk for substance use during middle school and high school. Marijuana and alcohol use both affected functioning in high school; however, marijuana use was associated with poorer functioning across more domains. Specifically, youth who had a higher probability of marijuana use also reported lower academic functioning, were less prepared for school, engaged in more delinquent behavior and had poorer mental health. In addition, delinquent behavior in high school was more likely among youth who showed a greater increase in their probability of marijuana use from middle school to high school. These findings are important because teen marijuana use is rising across the United States . In addition, many youth tend to think that alcohol use has more consequences than marijuana use and therefore view marijuana use as “safer” than drinking , which may be due, in part, to changing views of marijuana use that have occurred due to changing marijuana policies . Prevention efforts must begin to address these changing views by educating youth about marijuana’s effects and how although marijuana may help with certain ailments, larger clinical trials with more varied groups of patients are needed .

In addition, youth need to understand the potential harms of this drug such as its potential effect on their developing brain and how it can affect performance in both adolescence and adulthood . Similar to marijuana use, delinquent behavior and academic unpreparedness in high school were more likely among youth who showed a greater increase in their probability of alcohol use from middle school to high school. These youth also reported higher social functioning in high school. Of note, some items on the social functioning measure focused on acceptance and popularity . Alcohol use is often driven by social motives , and youth who view themselves as more popular tend to report heavier drinking . This is in contrast to youth who report use of other drugs, such as prescription drug use; these youth view themselves as less popular and therefore report lower social functioning . Thus, it may be that during this time period drinking is associated with being more social, and feeling more accepted and popular. Tucker and colleagues suggest that more work is needed in this area to gain a clearer understanding of why adolescents with a larger number of school-based friendship ties are more likely to drink . When we examined functioning in high school by race/ethnicity while controlling for level of AM use, we found differences in academic functioning and physical health. Specifically,Asian youth and multi-ethnic youth reported more problems with physical health than White youth when using at the same level; Asian, Black and Hispanic youth reported being less prepared academically, and Hispanic and multi-ethnic youth reported lower academic performance compared to White youth. The difference that showed up most frequently was in regards to academic performance, which is developmentally applicable given that most youth are still in school and this may be one of the first domains to show problems due to AM use. However, Asian and multi-ethnic youth also reported poorer physical health even when controlling for level of AM use, which is something that has been shown in adult populations.

Thus, it is crucial to address AM use early on for non-White youth, especially in light of findings, perhaps by increasing protective factors such as parental support , enhancing culture , or improving resistance skills . The current study is limited by the nature of the survey data being self-report; however, AM data from these youth have matched AM self-reported data from national surveys . We had larger samples of White, Asian, Hispanic and youth of mixed ethnicity compared to Black youth, yet we still found statistically significant differences for Black youth compared to White youth. Finally, we were unable to recontact many youth as they transitioned from middle school to high school; however, youth that completed the survey at wave 6 in high school did not differ demographically or on their AM use compared to those who did not complete the survey. In addition, we retained most of the sample once in high school, from wave 6 to wave 7, which occurred one year later. In sum, findings suggest that during adolescence, non-White youth who report similar likelihood of AM use as White youth also report worse outcomes across several domains. One explanation for our findings is that similar levels of AM use affect diverse groups differently, and may be more problematic for non-white groups of youth. Thus, intervention programs that target AM use during this developmental period among those at-risk for negative outcomes might be one viable approach to ameliorating disparities in functioning. However, there are other preexisting factors that we did not include in the current study that could have potentially contributed to either AM use or lower functioning during this time period, such as discrimination, parental involvement, or neighborhood quality. In addition, pipp drying racks although we did not find differences on demographics or AM use between those youth who dropped out of the study and those who continued to complete surveys, they could have differed on characteristics that we were unable to measure. Future work must continue to survey diverse groups of youth longitudinally and measure a variety of factors so that we can obtain a clearer understanding of how functioning may be affected by AM use during adolescence and emerging young adulthood and whether disparities in functioning may differ across different developmental milestones.Marijuana has been criminalized since the late 1920’s due to a plan orchestrated by the Bureau of Narcotics , which aimed to restrict its importation, consumption, and sale. This focused effort resulted in the plant fading from the spotlight until the early 1960’s, when its popularity began to soar. Today, four states and the District of Columbia have legalized recreational marijuana use and nineteen additional states have passed laws that permit the use of medical marijuana. Although permitted in some form in these twenty three states, it is still a violation of Federal law to possess marijuana, due to its classification as a Schedule I drug under the Controlled Substances Act. Despite its classification, marijuana’s increasing popularity, combined with an increasing demand for legalization, calls for an examination of why the plant is illegal in the first place. The purpose of this paper is to examine the validity of these arguments, as well as provide possible solutions to the complex issue of legalization.

Many anti-marijuana groups, such as American Society of Addiction Medicine , National Association of Drug Court Professionals , Citizens Against Legalizing Marijuana , Smart Approaches to Marijuana , Parents Opposed to Pot , and National Families in Action , and many more, argue that the legalization of recreational marijuana will lead to easier access and increased use among minors. A study published in October 2014 in the Journal of Adolescent health found that marijuana use does not increase. The study was conducted by Choo, Benz, Zaller, Warren, Rising, and McConnel who looked at a population sample of 11,703,100 students between 1991 and 2011; the students were varying ages, but they all resided in states that had medical marijuana legalization laws. They found past-month marijuana consumption was common , but there was no significant statistical differences in use before and after marijuana policy changes for any state. Choo et. al. also did not find any overall increased probability of marijuana consumption related to the policy change in the regression analysis. Even though this study examines medical marijuana, the concern of minors having access to the plant is very limited. In a state where getting a medical marijuana card is fairly easy for anyone twenty-one and older, minors will turn to previous connections for the drug instead of asking from older siblings, relatives, etc. The real concern comes from the mentality among youth that marijuana is a safe drug to consume, which is not the case for developing minds . A study conducted by Loyola Medicine says that early use can lead to lifelong addiction and damaging developmental changes such as impaired thinking, increased likelihood of dropping out of school, and poor educational outcomes . Whether it is medical or recreational marijuana, there is a solution to youth consumption. Educational talks about the impactof marijuana on developing brains need to be implemented as a result of legalizing recreational marijuana. Like sex education and domestic violence, teaching minors about the consequences of marijuana can have a profound effect. Relating sex education in schools and marijuana prohibition, a study conducted by Kathrin F. StangerHall and David W. Hall found states with abstinence- only programs in public schools have drastically more teenage pregnancy and birth rates than schools with more comprehensive sex education programs. Like marijuana prohibition, minors are more likely to engage in risky behavior the less they are educated about said behavior. The power of education can show middle and high-schoolers the repercussions of marijuana consumption at an early age which can deter the behavior. This a very reasonable concern, especially with the Mexican drug cartels committing horrible acts as a result of the drug war. However, a recent study conducted by Morris, TenEyck, Barnes, and Kovandzic found crime was not exacerbated by the passing of medical marijuana laws in Part I offenses such as rape, homicide, robbery, burglary, assault, auto theft, and larceny. Morris et. al. did find the laws may be correlated with reductions in assault and homicide rates. Additionally, Smith, Homish, Collins, Giovino, White, and Leonard at University of Buffalo sampled 634 couples in their first nine years of marriage who consumed marijuana. They found of the 634 couples tested, the more the couple smoked marijuana, the less likely they were to commit domestic violence acts . The researchers also found the study supports the notion that marijuana does not increase aggressive conflict and it may actually decrease the instances .

Moreover, models incorporating age, frequency and years of tobacco smoking with marijuana accounted for 25-44% of variance in adolescent nicotine dependence. Interestingly, CPD was only minimally associated with the frequency of marijuana use and made minimal contribution to the model since associations with the mFTQ were similar after removing the question about CPD.The finding that with the exception of drive and priority, the other subscales of the NDSS were not significantly associated with marijuana frequency was not surprising since most of these adolescent smokers were light and intermittent tobacco users and dimensions of dependence such as stereotypy and tolerance become more prominent as teens develop more regular and established patterns of smoking . However, despite relatively light tobacco use, the drive subscale, which measures the compulsion to smoke, and the priority subscale, which measures the preference of smoking over other reinforcers, were associated with marijuana use. It is possible that since both marijuana and tobacco share common pathways of use, smoking cues for one substance may trigger craving for the other, and thus reinforce patterns of use. As such, tobacco and marijuana may serve as reciprocal reinforcers. Some limitations of this brief include the relatively small sample size and the lack of detailed information on the timing of the initiation of marijuana use with regard to cigarette smoking. Future studies will need to examine how the proximity of marijuana use to cigarette smoking affects the degree of nicotine addiction. For example, pipp horticulture racks cost examining whether concomitant use impacts the level of nicotine addiction more than smoking marijuana separately from tobacco. The sample largely consisted of light smokers, which reflects adolescent smoking in the US.

That we found such a strong association between marijuana use and nicotine addiction in this group of relatively light tobacco smokers is notable, and reinforces the relevance of the association.Data for this study came from the Tobacco Perceptions Study, an 8-wave prospective cohort study designed to measure tobacco and marijuana perceptions, intentions, actual use, social norms, and marketing among California high school students. The 10 high schools were chosen using convenience sampling; the original sampling frame included all students in the 9th and 12th grades from these schools. Ninth graders were chosen since the average age of first trying a cigarette in the U.S. was 14.5 years, thus providing for a prospective examination of the impact of perceptions on tobacco use. Twelfth graders were chosen as following them into young adulthood would afford a broader sample of young adults then obtained by simply sampling college students or those who joined the workforce. Our cohort study was designed to examine changes in use and perceptions of tobacco products over time instead of making population-level estimates, which was suitable to test the validity, reliability, and predictive strength of the measurement items used. Independent variables came from Wave 1 through Wave 3 and dependent variables from Waves 5–7. Details of the study design and procedures are provided elsewhere . Variables tested are described in detail below.We initially examined 26 Short-Term Risks, Benefits, and Long-Term Risks perceptions items and then discarded those with limited variation or too few participant responses. We formed candidate scales from the earliest of Waves 1 and 3 for which all measurement items for a given product were available. Measurements were taken from distinct samples, as indicated in tables; all significance tests were two-sided.

Analyses were adjusted for clustering by school. Scales were correlated with measures from the same wave for convergent and discriminant validity analysis. When correlating scales with future behavior, comparable independent variables from the same wave were used where possible . Analysis was then carried out in three stages for each product using the final 19 Short-Term Risks and Benefits items. First, to determine how many factors to extract for rotation, minimum average partials was used for three reasons: accuracy , tendency to under-factor when inaccurate , and factors with too small loadings were not retained . As some data were missing, the expectation-maximization algorithm was used to estimate the variance/covariance matrix for each product and then that matrix was factor analyzed. This approach used all available data rather than excluding cases with a missing item. For ease of interpretation, rotated factor loading cutoffs of >0.40 were examined . The possible influence of missing data was examined by repeating the process using only records without missing data. The final factor loadings were virtually identical. Items with weak or virtually no loadings were investigated as follows: first, descriptive statistics were computed, then correlation matrices including the problematic item and other items thought to be measuring the same construct were analyzed. Based on the strength of correlation and face validity of the item, a decision was made to either retain or remove the item. The seven Long-Term Risk items were not factored because they were highly correlated and with only seven items, we examined the correlation matrix manually and created a single scale by combining the items. Second, once candidate scales were identified in the first step, Cronbach’s α was used to check internal consistency of the newly-created scales and to identify items that could be removed either because removal improved α or did not degrade α .

Cronbach’s α was recomputed for any changed scales. Thereafter, we checked the face validity of the scales and formed the final scales for all products. Scales were then correlated with each other and related independent variables to check for convergent and discriminant validity. Third, we constructed correlation matrices to explore whether the newly-developed scales correlated with future behavior and compared their predictive ability with related measures and theoretical constructs shown to be predictive of behavior . All measures above were used as independent variables in bivariate correlation analysis and as comparators in predictive testing of initiation and escalation of tobacco and marijuana use. Age, a known correlate of perceptions and behavior, was adjusted for . We estimated Kendall’s tau-b correlation coefficients which are robust to non-linearity and extreme observations .Correlation analysis among the factors indicated that scales representing risks were highly interrelated and were not related to benefits. The long-term risks scale correlated positively with general harm for all products and with perceived prevalence for cigarettes, hookah, vaped marijuana, and blunts; long-term risks correlated negatively with behavioral intention for all products except cigars and e-cigarettes, with ever-use for all except hookah and smokeless, and with age for hookah, smoked marijuana and vaped marijuana, and blunts. The short-term risks scale correlated positively with general harm for all products and with perceived prevalence for cigarettes, vaped marijuana, blunts, and smokeless tobacco. The short-term risks scale correlated negatively with ever-use for all products except smokeless, with age for all except cigarettes, and with behavioral intention for all except cigars and e-cigarettes. The benefits scale correlated positively with perceived prevalence for all products, with ever-use for all products except smokeless, and with behavioral intention for all except cigars. Benefits correlated negatively with general harm for e-cigarettes, hookah, blunts, and smoked marijuana, it positively correlated); no correlation with age was found. The social risks scale correlated positively with general harm and negatively with age; the addiction risks scale correlated positively with general harm and perceived prevalence .The variable or construct that most strongly predicted initiation for all products was willingness, followed by behavioral intention . The long-term risks scale and benefits scale were found to be third-most strongly predictive of initiation for different products. The long-term-risks scale was third for smokeless, e-cigarettes, blunts, and vaped marijuana and smoked marijuana and benefit came in third as predictors of initiation for all products except for e-cigarettes and smokeless. Fourth was the short-term risks scale . General harm predicted initiation for just three products , although the strength of the correlation was strong for both marijuana products. Perceived prevalence proved weakly predictive and only for initiation of blunts and smoked marijuana . Escalation of use for all products correlated strongly with willingness to use; other than the social risks scale that weakly predicted against escalation, willingness was the sole strong predictor for escalation of smokeless tobacco use. For hookah, blunts, and smoked marijuana and vaped marijuana, though, commercial grow racks behavioral intention outperformed willingness as the strongest predictor of escalation.

Our short-term risks scale was the third-best performer against escalation of hookah use, general harm was third for predicting against escalation of smoked marijuana. General harm was the next best performer against escalation of vaped-marijuana, followed by short-term risks . Perceived prevalence weakly predicted escalation of hookah, blunts, and smoked marijuana and vaped marijuana use, whereas general harm strongly predicted against escalation although only for smoked marijuana and vaped marijuana .In this study, we created and validated new scales that measure perceptions of specific risks and benefits associated with AYA use of cigarettes, cigars, smokeless tobacco, hookah, blunts, smoked marijuana, and vaped marijuana, and compared their predictive ability with measures of perceptions of general harm, social norms , willingness, and behavioral intentions. We report the following three key findings in answer to our research questions. First, measures of perceptions of specific social and health risks and benefits were less strongly associated than measures of perceptions of global outcomes with willingness, social norms, and intentions to use tobacco and marijuana; these differences varied by product. Scales measuring perceptions of specific risks were highly interrelated and not related to the benefits scales, which could indicate that AYA’s perceived risks and benefits are isolated or unrelated concepts. Second, although we demonstrated the reliability and validity of using the specific risk and benefit perceptions measurement scales to identify factors underlying motivation for initiation and escalation of tobacco and marijuana use, measures of perceived general harm outperformed specific measures in predicting uptake and continued use. Third, there were clear differences between the strength of correlation between specific measures of short-term and long-term risks and measures of willingness, social norms, and behavioral intentions, which likely indicates differences in utility and saliency of the scales for predicting behavior. Study implications include support for the use of brief measures of perceived general harm when seeking to determine initiation and escalation of tobacco and marijuana use among AYA, resulting in shorter surveys. Shorter surveys reduce the risk and deleterious effects of participant fatigue from lengthy surveys containing a range of products and that enumerate specific risks and benefits, thereby garnering more accurate and useful data. In addition, the extent to which our scales of perceived health and social risks and benefits correlated differently across products suggests that these measures may capture motivational determinants that are product-focused. Further, such motivations may lie earlier in the causal chain and mediate actual use, which suggests that targeting these motivations may bring about behavior change . For example, the perceived harmfulness of cigarettes appears to have permeated our sample, which could be due to tobacco control messaging, resulting in decreased reporting of use and of intentions to use. However, perceived short-term and long-term risks of using e-cigarettes, blunts, and smoked and vaped marijuana were not correlated with behavior or behavioral intentions, suggesting a need to address specific health and social outcomes perceptions. Some of our findings relate to particular under-studied products and are therefore worth mentioning. For example, there are few longitudinal studies examining smokeless tobacco and AYA initiation and escalation in rural areas where such use is most widespread, and there is limited evidence of how perceptions of long-term risk influence smokeless tobacco use over time . It is plausible that the correlation we identified in this study between initiation of smokeless tobacco and the long-term risk scale could be due to long-standing social stigma related to smokeless tobacco, in addition to the scale’s specific delineated risks . Stigma is a likely factor in AYA decisions to use smokeless tobacco, especially when one considers that long-term health consequences of smokeless tobacco use are similar to long-term health consequences of using other tobacco products. Additionally, our finding that initiation of blunts most strongly correlated with the measure of perceived prevalence among peers comports with other studies reporting that initiation of blunts is most likely due to a perception that many peers are using them . Ethnographic studies among adolescents and young adults also suggest that blunt use is more often perceived to have social benefits . These findings can guide development of future, in-depth studies that focus on the often-overlooked use of smokeless tobacco and burgeoning use of blunts among AYA.

Data were collected in November 2017. 3. Parenting-Framed Messages These parenting-framed messages were developed with guidelines from previous research focusing on parenting styles and attitudes and perceptions of adolescent risky behaviors . The messages were framed with respect to either of the parent’s or caregiver whom the participant identified with. Before viewing the messages, each participant was asked to identify which parent or caregiver they will be thinking of when answering the questions. Each message differed with respect to the parenting style measured . The messages began with the following guidelines: “We are interested in understanding the observations that instantly enter your mind if your parent or caregiver was to have this conversation with you about certain behaviors. When answering these questions, please consider one of your parents or caregiver. Remember that it is your immediate impressions that we are interested in when you read the message.” Below we include the three parenting-framed messages of unhealthy eating and marijuana use. 3.1. Unhealthy Eating Messages Authoritative Parenting Style: “I wanted to have a conversation with you about unhealthy eating because I care about you. I want to make sure that we both have an equal opportunity to express our feelings to each other about unhealthy eating in a respectful matter. So, I am curious to know if you think eating unhealthy is harmful to you. Is there anything you have heard or seen in school, movies, growing racks or music about unhealthy eating? I want you to feel safe to communicate any feelings you may have towards unhealthy eating with me, I am here for you. Please know that you are in a safe place to communicate your feelings.”

Authoritarian Parenting Style: “We are having a conversation about unhealthy eating because it is harmful to you and your health. You will listen to me and do as I say, because I am your parent and my opinion about this is what matters most. So, I want you to know that eating unhealthy is very harmful to you and I do not want you to ever try it. Is there anything you have heard or seen in school, movies, or music about unhealthy eating? You need to tell me this because if you don’t you could get in a lot of trouble in school and at home.” Permissive Parenting Style: “I was wondering if it would be possible to have a conversation with you about unhealthy eating? I am not sure if you want to talk about this, do you think it would be okay? But, then again, we should have this conversation. So, I am curious to know what you think about eating unhealthy and if it is harmful to you. Is there anything you have heard or seen in school, movies, or music about unhealthy eating? If you don’t want to talk to me about this, I guess it is okay. But if you do talk to me about this I will make sure to make your favorite dinner and take you to the movies.”This measure derived from Buri and is a reliable measurement for assessing perception of parenting styles of authoritative, authoritarian, and permissive. Previous research has focused on the importance of investigating both parent and child reports of the parents’ parenting styles in order to accurately assess the typology of parenting styles across parent and child samples. The measure includes 60 items, 30 items referring to the mother, and 30 items referring to the father.

We used an adapted version of the questionnaire that measured only 30 items by changing the wording of the items to refer to “parent.” Prior to answering the questions for the PAQ, participants received an open-ended question that stated, “Please let us know which parent or caregiver you are thinking of” Then, the participant responded to the items included in the measure. Some examples of items include: “Whenever my parent told me to do something as I was growing up, he/she expected me to do it immediately without asking questions”, “My parent has always felt that what I need is to be free to make up my own mind and to do what I want to do, even if this does not agree with what he/she might want”, “As I was growing up, my parent did not allow me to question any decision he/she made”, and “As the children in my family were growing up, my parent consistently gave us direction and guidance in rational and objective ways.” Items ratings ranged from 1 to 5 .Table 2d presents the unhealthy eating zero-order correlations for the measures of attachment anxiety, attachment avoidance, authoritative parenting style, authoritarian parenting style, permissive parenting style, perceived effectiveness, perceived interpretability, motivations to discuss behavior, and discussion similarity. For attachment anxiety, there was a positive correlation with perceived effectiveness of authoritarian message, perceived interpretability of authoritarian message, and motivations to discuss unhealthy eating for authoritative, authoritarian, and permissive messages, and discussion similarity of authoritarian message. In contrast, it was negatively correlated with perceived effectiveness of authoritative message.

For attachment avoidance, there was a positive correlation with discussion similarity of authoritarian message, and negative correlations with perceived effectiveness of authoritative message, motivations to discuss unhealthy eating for authoritative message, and discussion similarity of authoritative message. For perceived authoritative style of the parent, there was a positive correlation with perceived effectiveness of authoritative message and discussion similarity of authoritative and permissive message; in contrast it was negatively correlated with perceived interpretability of authoritative message and discussion similarity of authoritarian message. For the perceived authoritarian style of the parent, there was a positive correlation with discussion similarity of authoritarian message. Perceived permissive style of the parent was positively associated with perceived effectiveness of the authoritarian message, motivations to discuss authoritative message and permissive message, and discussion similarity of authoritative and permissive messages. In contrast, it was negatively correlated with perceived effectiveness of authoritative message and discussion similarity of authoritarian message.Table 2e presents the marijuana use zero-order correlations for the measures of attachment anxiety, attachment avoidance, authoritative parenting style, authoritarian parenting style, permissive parenting style, perceived effectiveness, perceived interpretability, motivations to discuss behavior, and discussion similarity. For attachment anxiety, there was a positive correlation with perceived effectiveness of authoritarian message, perceived interpretability of authoritative and authoritarian messages, and motivations to discuss marijuana use for permissive message, and discussion similarity of authoritarian message. In contrast, it was negatively correlated with discussion similarity of authoritative message. For attachment avoidance, there was a positive correlation with discussion similarity of authoritarian message and negative correlations with perceived effectiveness of authoritative message, and discussion similarity of authoritative message. For perceived authoritative style of the parent, there was a positive correlation with perceived effectiveness of authoritative message and discussions similarity of authoritative and permissive messages; in contrast it was negatively correlated with perceived interpretability of permissive message and discussion similarity of authoritarian message. For the perceived authoritarian style of the parent, there was a positive correlation with discussion similarity of authoritarian message and negative correlations with discussion similarity of authoritative and permissive messages. Perceived permissive style of the parent was positively correlated with motivations to discuss marijuana use for authoritative message, and discussion similarity of authoritative and permissive messages. In contrast, it was negatively correlated with discussion similarity of authoritarian message.Overall, participants were more likely to rate the authoritative parenting-framed messages of unhealthy eating and marijuana use as higher in effectiveness, interpretability, motivations to discuss the behavior, and discussion similarity compared to the authoritarian and permissive parenting-framed messages. Initially, this study explored the associations of attachment styles and parenting styles as perceived about one’s parent . It was found that lower attachment anxiety and lower attachment avoidance were associated with higher authoritative parenting styles. Several studies have found an association between secure attachment and authoritative parenting styles, where parents who display secure attachment are likely to practice an authoritative parenting style . Whereas, lower secure attachment was associated with stronger preferences for the authoritarian-framed messages of unhealthy eating and marijuana use.

These findings converge with previous evidence of a negative relationship between secure attachment and authoritarian parenting styles . In contrast, commercial weed grow lower secure attachment did not predict evaluations of permissive parenting-framed messages of unhealthy eating and marijuana use. These seem to be consistent with associations of attachment styles and parenting styles in Study 1. The study mostly revealed a coherent pattern of significant associations of lower levels of attachment anxiety and attachment avoidance, and higher authoritative parents exhibiting greater acceptability of authoritative parenting framed messages of unhealthy eating and marijuana use compared to higher levels of attachment anxiety and attachment avoidance, and higher authoritarian and permissive parents exhibiting greater acceptability of the authoritarian and permissive parenting framed messages . The parenting styles were as or more strongly associated with positive responses to the the parenting-framed messages compared to the attachment styles. These findings highlight the potential utility of framing the messages in accordance with parenting styles and how each of the styles had parallel comparisons to their own parenting-framed message . Subsequently, this study explored the relationship of parenting-framed messages of unhealthy eating and marijuana in terms of their perceived effectiveness, perceived interpretability, motivations to discuss behavior, and discussion similarity . Importantly, participants were more likely to rate the authoritative parenting-framed messages of unhealthy eating and marijuana use as higher in effectiveness, interpretability, motivation to discuss the behavior, and discussion similarity. These effects were likely to hold for authoritative parenting-framed messages for both unhealthy eating and marijuana use, suggesting the significance of developing tools with inclusion of authoritative parenting characteristics to motivate parents to have discussions with their children about unhealthy eating and marijuana use. This directly supports the development of authoritatively-framed discussion tools implemented in Study 3, which directly incorporates the authoritative parenting-framed message used in Study 2. It further extends previous literature on the positive relationship of authoritative parenting style in motivating open communication about risky behaviors between parent and child . Strengths of the present study include its focus on a largely unexplored area of youth acceptability of newly developed parenting-framed messages to motivate discussions of unhealthy eating and marijuana use with parents. A second strength is that previous literature has not focused on the development of theory-driven discussion tools and reactions to them by youth. As a result, analyses were conducted to test for ethnic differences for message conditions, however there was no statistical significance. Limitations of this study require consideration when interpreting the results. First, the results may not be representative of all the nation or other countries, as it consisted primarily of individuals ages 18 to 20 years old attending a university in Central California. Further research is needed to assess these discussion message effects with a broader age group range, geographic location, etc. Second, the utilization of self-report on personal questions of unhealthy eating behavior and marijuana use behaviors may lead to social desirability bias in participant responses. Finally, the study focused on participant responses to hypothetical scenarios; more research can further this line of inquiry by testing whether participants would have similar responses to actual communications with parents.This chapter begins with a description of Study 3 including aims and hypotheses; discussion of Pilot Study; methods ; discussion of manipulations ; detailed list of measures; overview of statistical analyses; results, discussion, and conclusion of study. Results from Study 2 provided evidence that the authoritative parenting-framed message on talking with one’s parent about unhealthy eating and marijuana use was perceived by youth as the most effective in motivating discussions about these behaviors as compared with authoritarian and permissive parenting-framed messages. In particular, authoritative parenting style was associated with higher ratings of perceived effectiveness, perceived interpretability, motivations to discuss the behavior, and discussion similarity. These findings provided empirical justification to utilize the authoritative parenting-framed message within the context of the fuller tools that were developed in this study and administered to parents. The discussion similarity items were not tested in Study 3, as those questions were specific to youth in Study 2 with questions, such as, “If your parent were to ask you to have a discussion about unhealthy eating , how much of it would be similar to this message?”

Instead our results converge with past reports that show continued linear declines in extraversion in late adolescence in male youth , and stable levels of extraversion in late adolescence for female youth . As described in a recent review, findings on mean-level change in extraversion continue to be inconsistent ; however, our findings seem to link together several previous reports, and suggest that flexible modeling are necessary to capture sex-specific effects in the development of reported extraversion. For emotional stability, our findings continue to fit well with past literature. Like others , we find steady increases in emotional stability in male participants across the entire developmental age range, while female participants demonstrate a dip in emotional stability during mid-adolescence, followed by a slight rise, before largely leveling off in late adolescence and early adulthood. Again, we note an important difference here between our GAMM findings and quadratically- and cubically-fit linear models. Our LME model results suggest that in male participants, emotional stability rises slightly during early- and mid-adolescence before declining in late-adolescence and early adulthood . While this effect in male youth has been demonstrated previously , we found that after controlling for substance use, and using more flexible non-linear modeling strategies, a linear fit was better in male youth. Therefore, like with extraversion, vertical farming racks our findings replicate several previous results, and suggest that disparate findings may be due to different modeling strategies.

In general, the sex differences noted in our sample are highly convergent with past literature. That is, female youth typically report greater extraversion, openness, agreeableness, and conscientiousness, and less emotional stability, and these effects for openness, agreeableness and conscientiousness are persistent throughout adolescence and young adulthood , while past findings regarding the developmental timing of sex differences in extraversion and emotional stability have been less clear. Our findings provide added support for the existing notion that the largest differences in emotional stability and extraversion between male and female youth emerge by mid-to-late adolescence and persist into young adulthood . These findings, particularly in regards to emotional stability, may have relevance for sex differences in rates of internalizing mental health disorders, with women showing much higher rates of depression than men, beginning during adolescence . Regarding the association between substance use and personality, our results fit with past literature. Like others , we see that alcohol use is associated with lower conscientiousness and higher extraversion, though our findings suggest the association between alcohol use and conscientiousness may be limited to adolescence, dissipating in young adulthood. Further, we replicate past reports of greater marijuana use being associated with less agreeableness, conscientiousness and emotional stability ; however, our results suggest these associations between marijuana use and conscientiousness are limited to early adolescence and later in young adulthood.Importantly, we replicate previous reports of alcohol and marijuana use being differentially related to extraversion , particularly in young adulthood , highlighting the importance of examining their effects concurrently.

Additionally, while past reports found the association between marijuana use and emotional stability was stronger in female youth than male youth , we found that greater marijuana use was associated with lower emotional stability throughout adolescence and young adulthood for female youth, but only in young adulthood for male youth. Lastly, in contradiction to past literature, we found alcohol use was associated with higher openness. However, as noted in regards to the developmental increase in openness we found, it is possible that the 10-item measure of personality may not have reliably captured this trait. Thus, these results should be interpreted with caution. In young adults, lower emotional stability has been associated with using marijuana as a coping mechanism, an effect mediated by anxiety sensitivity ; however, young adults with lower conscientiousness are also more likely to experience negative consequences related to their marijuana use . This suggests that adolescents and young adults with lower conscientiousness and emotional stability may be more prone to using marijuana as a method for managing stress and anxiety, but may also be more likely to experience negative consequences of their drug use, and that female youth may be more susceptible to these effects. Meanwhile, previous studies demonstrated that extraversion is associated with positive alcohol expectancies and that alcohol expectancies mediate the relationship between extraversion and alcohol use , suggesting that those reporting higher extraversion may be more inclined to drink alcohol for its prosocial effects. Finally, strengths and weaknesses regarding our modeling techniques should be noted. First, our GAMMs produced subtle but important differences compared to LME models in the development of extraversion in females and emotional stability in males. While our LME results, using lower-order polynomial effects, may align with singular past studies, our GAMM results help bring convergence to several past studies, some of which had more narrow age ranges.

However, GAMMs do not provide parametric coefficients for growth parameters, even in the case of linear growth, making it difficult to assess of effect sizes for both change across age and age-dependent sex-specific effects. Here, simultaneously fitting traditional polynomial effects , where appropriate, may be of added benefit. Future studies should consider using GAMMs as an exploratory analytic first step in identifying subtle changes in personality over time, before following up with traditional linear models. Several additional limitations should also be noted. First, while our goal was to evaluate the development of personality in association between past-year substance use, it is difficult to determine from our models whether substance use is predictive of changes in personality. In fact, it is most likely that personality and substance use have bidirectional effects over the course of development. With this question in mind, a different set of modeling techniques would be necessary to test such effects. Given the broad range of timing of substance use initiation and our desire to focus on the non-linear shape of personality development, such analyses fall beyond the scope of the current report, and may be better answered by more robust single cohort longitudinal studies . Further, our measure of substance use is rather course, and does not capture the vast array of patterns and quantity of use often occurring during this developmental period. However, as is the case in most studies to date, marijuana use has proven to be difficult to properly quantify . As such, we have chosen to prioritize selection of use variables that could be equated across the two substances, so that our findings may be compared in a meaningful way. It is also the case that, for this study, we are using sex at birth as the variable of interest, in the absence of other potentially meaningful and related variables of individual difference, such as gender identity or other psychosocial or cultural factors that may influence personality. Therefore, interpretation of sex-specific findings is limited. Finally, as noted before, personality effects may be most generalizable when measured in a multimethod, multiscale, and even multinational capacity . While our findings replicate many previous results and highlight the ability of even brief measures of gaining insight into personality, their generalizability may be questioned. Future studies with similar methodological techniques, but different samples, or measures, could provide further confirmation of our results. In conclusion, we used a large, multi-site longitudinal dataset to replicate and extend several past findings on personality development in adolescence. We confirm findings of steady linear increases in agreeableness and conscientiousness across adolescence and young adulthood, and provide additional clarity regarding discrepant reporting on the development of extraversion and emotional stability. We also replicate the preponderance of literature that finds female youth report higher agreeableness, openness, conscientiousness and extraversion and lower emotional stability, compared to male youth, and provide added clarity on the developmental timing of such effects. Finally, we provide novel information regarding the timing of the association between substance use and personality, vertical grow rack and we replicate past reporting of differential associations between alcohol and marijuana use on extraversion and sex-dependent effects of marijuana use on emotional stability. Taken together, these findings highlight the importance of modeling sex differences in personality development, using flexible non-linear modeling strategies, and accounting for sex- and age-specific effects of alcohol and marijuana use.Adolescence, the transition from childhood to adulthood, is often characterized as a particularly difficult time for children . Adolescents undergo bodily and hormonal changes, which further influences their mental and physical health .

Adolescents feel misunderstood and struggle to fit in with the pressures they may feel from their peers, family, and society . Often times, this may lead to the practice of risky and harmful behaviors such as poor diet, substance use, unprotected sex, and reckless driving . These health risk behaviors can further shape adolescent health during this critical time and may even affect their decisions in adulthood, and thus it is critical to address these behaviors early on . The Centers for Disease Control and Prevention identified unhealthy eating and substance use as health risk behaviors that are particularly likely to negatively impact adolescent health . The focus on unhealthy eating is important given the increase in obesity during adolescence throughout the last decade . With the rise in obesity rates among children and adolescents in the United States, it has become vital for parents to learn effective communication strategies that may influence their children to make healthier food choices in their daily lives. Marijuana is the most commonly used illicit substance among adolescents, with the prevalence of marijuana use increasing every year in the United States . Among these adolescents, there is a decrease in adolescents perceived harm and disapproval towards marijuana use . Changes in marijuana policies have tracked with greater acceptance of marijuana use in adults and adolescents across the United States . These trends suggest that marijuana use will continue to rise with increases in legalization of marijuana for medicinal and recreational use across the United States. Though adolescents begin to desire independence from their parents, parents still play an integral role in the prevention of health risk behaviors in their children . It has been found that parent-child discussions centered on preventing risky behaviors serve as a protective influence . Weekly parent-child discussions have also been identified as one of the strongest factors in influencing healthier food choices in adolescents . Parent decisions to discuss health risk behaviors with their children are likely to be influenced by their general parenting dynamics such as their attachment styles, their parenting styles, and their communication tendencies . These parental decisions are also likely to be shaped by more proximal and behavior-specific psychological factors such as their risk perceptions of unhealthy eating and marijuana use, their social prototypes or stereotypes of children who engage in these behaviors, and their worry about the potential harms of these behaviors . In the present research project, we propose an extended adaptation of the PWM framework in which we integrate general parenting dynamics with both established PWM factors and new cognitive factors as predictors of parental discussions of unhealthy eating and marijuana use with their children . After testing this adapted PWM in Study 1, we used the model to guide the development and evaluation of discussion tools designed to provide parents with guidance on how to communicate about unhealthy eating and marijuana use with their children . There is a need for evidence-based discussion tools that will provide parents with tips on how to talk with their child about these health risk behaviors, particularly given evidence that parenting practice interventions about substance use with a communication component have been effective in increasing discussions with their child about substance use, as well as alleviating or decreasing substance use in the child . This dissertation is organized as follows. The general introduction provides an overview of the PWM including measures of perceived risks, prototypes, worry, intentions and willingness; evidence supporting the adapted PWM for predicting parental discussions of marijuana use with child; overview of attachment styles, parenting styles, parent-child communication, coherence, and self-efficacy; and lastly a summary and research overview. Then, Chapter Two will focus on Study 1, Chapter Three will focus on Study 2, Chapter Four will focus on Study 3, and Chapter Five will focus on the general discussion, limitations, and concluding remarks and recommendations.According to the PWM, two sets of psychological processes motivate risk-related behavior .

Some methodological limitations should be considered. First, preexisting differences in neurocognition, which may increase risk for substance use , cannot be ruled out in this cross-sectional study. Second, given the studies suggesting decreased motivation associated with marijuana use , the observed cognitive differences may be due to amotivational influences on test performance. Third, we used composite scores for data reduction purposes, and although common practice, they may not reproduce in other samples. Fourth, results may not generalize to other samples with different lengths of abstinence, patterns of substance use , gender or ethnic distribution, or SES0parental income. In conclusion, the general pattern of results suggested that even after a month of abstinence, adolescent marijuana users demonstrate subtle deficits in psychomotor speed, complex attention, planning and sequencing, and verbal story memory compared with non-marijuana using teens. Increased frequency of lifetime marijuana use was also associated with decreased performance in these areas. Implications include the need for psychoeducation aimed at informing adolescents and parents of the potential long-term cognitive consequences of heavy marijuana use. Longitudinal studies are critical to help rule out premorbid influences on cognitive function and to assess the developmental trajectory of neuropsychological functioning among adolescent marijuana users over time.College-going individuals in the United States may have unique attitudes toward substance use behavior and tobacco use, grow vertical including shifts in attitudes and behaviors that are associated with the constantly changing product landscape of alternative tobacco products , such as electronic-cigarettes .

Psychosocial behaviors and campus culture, including class attendance, peer socializing, campus policies, and residential environments, may also facilitate these unique attitudes toward favorability of smoking among college subgroups, while also introducing a unique risk environments for tobacco initiation, uptake, transition, and use . In addition, part of the variation explaining these health behaviors may be influenced by the specific demographic and socioeconomic characteristics of a college campus population and community. Data from social media platforms are often used to self-report and publicly communicate health-related attitudes and behaviors . Young adults [ages 18–25 ] in the United States are much more likely than older populations to actively use social media, including popular platforms Twitter, Snapchat, and Instagram . Infoveillance research, which uses online information sources to detect trends about the distribution and determinants of disease, including health knowledge and behaviors, has been used to develop insights on numerous public health issues including infectious diseases, vaccination sentiment, opioid use disorder, mental health issues, and, relevant to the exploratory aims of this study, tobacco and alternative tobacco use attitudes and behavior . However, smoking-related discussions on social media tied to specific colleges with geographic specificity has not been widely investigated. Existing studies using social media to examine tobacco-related attitudes and behaviors in college aged populations have primarily focused on evaluating the impact of social media health promotion anti-tobacco campaigns, recruiting hard-to-reach college populations using social media platforms, and examining the influence of exposure to tobacco-related social media content and marketing on current and future behavior and use .

Other research on college-aged populations has focused on assessing tobacco initiation and transition of use patterns, particularly as new alternative and emerging tobacco products become available . Accelerating research using social media to assess tobacco-related attitudes/influences among youth has also been supported by U.S. Federal initiatives, including projects funded by the National Cancer Institute and U.S. Food and Drug Administration Tobacco Centers of Regulatory Science, which for have identified and characterized e-cigarette advertisements on image-focused social media sites and tobacco user experiences with little cigars and e-cigarettes as discussed on Twitter . Changes in local, state, and national health policy related to tobacco and other products smoked or used concurrently with tobacco and electronic cigarettes can also have an impact on attitudes and behaviors of these populations. For example, recent debate in the United States regarding the legalization of marijuana/cannabis may positively influence marijuana-related attitudes for college populations, who tend to skew toward more liberal policies regarding decriminalization, legalization, and increased access . Similarly, the 2019 outbreak of e-cigarette and vaping-related lung injury associated with products containing tetrahydrocannabinol may dissuade tobacco or THC use in certain young adult populations, particularly since they were most heavily impacted by the disease . Examining the changing public attitudes and behaviors of college-aged smokers is particularly salient for the State of California, USA. As of January 2014, all campuses in the statewide University of California system became tobacco free , and the California State University system followed suit in 2017 . In addition, voters in California approved Proposition 56 in late 2016, which added a $2.00 increase to the cigarette tax effective April 2017, with an equivalent increase on other tobacco products and electronic cigarettes . Voters in 2016 also approved Proposition 64, which legalized the use of recreational cannabis in November 2016 .

During this time, the popularity of e-cigarettes in the United States was increasing . These changes in policy and preferences underscore the interconnected nature of the Triangulum of tobacco products , including potential for dual-use, transition between products, and challenges associated with conducting surveillance and implementing cessation programs . This changing policy landscape supporting tobacco control measures, as reflected in the shift of California’s public university systems to become smoke-free, is a key impetus for this study. The ability of these colleges to eliminate on-campus smoking relies in large part on understanding past and existing knowledge and attitudes held by the campus smoking populations, along with their perceptions and behaviors that may be associated with compliance or non-compliance to smoke free campus policies. In response, this study conducted exploratory research on the popular microblogging platform Twitter. Specifically, we used big data, data mining, and geospatial approaches to identify and characterize tweets originating from Twitter users specifically geolocated at California 4-year university campuses. Our primary objective was to assess types of tobacco and ATP products mentioned by users, the distribution of user sentiment toward tobacco and smoking behavior, and to assess the feasibility of detecting self-reported smoking behavior that may represent a violation of campus smoke free policies. Secondarily, we also sought to conduct a cross-campus assessment to determine how these factors vary across different university and college communities and over time.The objective of the study’s data collection approach was to obtain a highly refined subset of tweets, which were both posted from college campus’ geolocated coordinates in California and also included user discussions about smoking, in preparation for manual review to more purposefully identify tweets that specifically discussed different types of tobacco and smoking products, sentiment of users toward smoking behavior, and selfreported smoking behavior on campus. Data were collected from the Twitter public streaming Application Programming Interface using the cloud-computing service Amazon Web Services . The public streaming API was set with filters to collect all tweets that included metadata containing latitude and longitude coordinates, initially with no filter for keywords. Tweets were collected continuously from 2015 to 2019. All tweets collected included the text of the tweet and associated metadata, including the date and time of tweets. The use of the public Twitter streaming API to collect data pre-filtered only for tweets including latitude and longitude coordinates represent a subset of all tweets posted during the time frame of the study.

There exists the potential for sampling bias associated with different Twitter APIs that are not representative of all Twitter data , grow racks and data filtered only for geocoded data may omit many conversations from college aged populations about topics, such as smoking, which may be linked to college-related user groups . Though resulting in a much smaller volume of data, our approach nevertheless allows for detection of tweets in specific geospatial bounds at the high resolution of latitude and longitude coordinates in the state of California. Therefore, by using this data collection approach, we were able to isolate tweets originating from geospatial coordinates within the formal spatial boundaries of all 4-year universities in California. To enable this geolocation, a basemap of California 4-year universities from the Stanford Prevention Research Center was obtained and cross-referenced. The SPRC’s basemap included a relational geodata base which classified polygons by college name. College areas were comprised of multiple polygons for different campuses and associated properties, though aggregation was conducted at the overall college level to enable comparison across different colleges. Tweets were then filtered for 37 keywords which were broadly related to tobacco-related topics, including the names and brands of different tobacco and ATPs and descriptive terms associated with smoking and vaping as expanded upon from those used in prior studies . Specifically, the following keywords were used: bidis, cigarette, cigarettes, cigarillos, cigars, cigie, class, dip, e-cig, hookah, huqqa, joint, JUUl, kereteks, Marlboro, Newport, njoy, pipe, roll-up, shag, smoke, smoking, snuff, snus, tobacco, vape, vaped, vapejuice, vaper, vapes, vaping, vapor, waterpipe, waxpen, and weed. The purpose of this keyword filtering was to better isolate smoking-related conversations from all other Twitter discussions occurring on college campuses. After tweets were manually reviewed to positively identify smoking-related conversations originating in these college campuses, a snowball sampling design was employed which compared the frequency of all non-keyword terms in “signal” tweets with the frequency of these words in “noise” tweets . This methodology resulted in the identification and querying for ten additional keywords: 420, 818, blunt, bong, cigs, kush, marijuana, roll, smell, and stoge.After isolating a corpus filtered for tobacco-related keywords in areas geolocated for California 4-year universities, four researchers trained in social media content analysis used an inductive coding approach to identify study characteristics of interest by manually annotating all tweets , following an approach also described in prior studies . Annotators had backgrounds in public health and had experience manually annotating social media posts for tobacco behaviors in prior published research projects . Manual annotation included: identifying the type of smoking product discussed ; assessing positive, negative, or neutral sentiment related to smoking behavior ; and identification of whether the tweet included first-person use or second-hand observation of smoking behavior. Table A1 contains further details about topics that were coded as valid and invalid for positive identification as a “signal” tweet. Tweets that did not express sentiment related to smoking were excluded from analysis of signal tweets. The primary objective of this approach was to conduct exploratory research into what tobacco and smoking products were being discussed by Twitter users at California universities, assess the overall sentiment toward tobacco and smoking by these users, and explore whether it was possible to identify self-reporting of tobacco use-related behavior . Four authors coded posts independently and achieved a high inter rater reliability for overall coding categories and equally high inter rater reliability for specific subcoding for tobacco , vape , and marijuana specific tweet categories. For inconsistent results and any discrepancies related to coding, all authors convened to discuss, confer, and reach consensus on the correct classification informed by the inductive coding approach outlined in Table A1. Analyses of variation across college campuses were limited to the top twenty colleges by tweet volume, as estimates collected from samples of tweets from other colleges may have been biased due to insufficient volume of tweets collected. A p < 0.10 was considered statistically significant for correlational analyses due to sample size limitation. Point density algorithms were used to visualize and detect geospatial trends. Analysis was conducted in R version 4.0.1 and geospatial visualization of data was done in ArcGIS Desktop version 10.7. This project was part of a broader study to examine college campus smoke-free policies using qualitative focus groups and examining social media data with the qualitative analysis approved by the Institutional Review Board at California State University, Fullerton .Data collection resulted in 83,723,435 geo-identifiable tweets located in the state of California in the 5-year period from 2015 to 2019. From these tweets, 1,381,019 originated from 88 CA 4-year colleges, with the five schools contributing the most tweets including UC Los Angeles , Stanford University , UC Riverside , University of Southern California , and UC Berkeley . Thirty-eight schools contributed over 10,000 tweets each, overall representing 89% of the entire corpus of CA 4- year college geocoded tweets. Of these tweets, 7,342 contained smoking-related keywords with approximately one third occurring after 2015. In total, smoking-related topics originating from all geocoded tweets in the state made up an extremely small proportion of all topics and tweets specifically geocoded for CA 4-year universities.