The Department of Public Health licenses and oversees manufacturing and testing or marijuana products, and the State Board of Equalization collects taxes from marijuana businesses. Staffing and development in the state agencies that will carry out these aims is incomplete and ongoing to date. Approaches to limiting youth exposure to marijuana products have changed dramatically as marijuana has become a legal product offered in retail settings. With the expansion of medical marijuana into the retail domain, preventing youth access to marijuana took on a new dimension, where in addition to preventing access to marijuana through illicit markets and social networks it became necessary to prevent youth from accessing it from storefronts located in communities.Explicit regulations on business practices can be applied to legal retail environments while law enforcement agencies are often the only agencies with the authority to deal with illicit markets. Within legal markets, however, prevention advocates face new and different challenges and that may require different approaches. Policy-based prevention approaches have proven to be effective at reducing adolescent substance use, despite targeting the general population and have been particularly useful to address legal substances available in retail settings . With the movement of marijuana into the legal market, regulatory controls on business practices have become necessary tools for prevention of adolescent marijuana use. Practices currently required by California law to restrict youth access include requiring employee assistance to handle products, keeping all products in their original child-resistant packaging,cannabis cultivation technology checking ID electronically or manually, and prohibiting products designed to be attractive to youth . Other recommended approaches to prevent youth marijuana use include requiring increased retailer liability and enacting stiff penalties for providing marijuana to youth .
City policies intended to prevent underage marijuana use include limiting the density of marijuana outlets in a community, preventing them from being located near sensitive areas such as schools and parks, limiting billboard advertising, and limiting the extent of exterior signage on dispensaries. Key informant interviews with LA County residents recently conducted by the LA County Dept. of Public Health indicate that keeping dispensaries a safe distance from schools and residential areas and limiting the density of outlets in the city were the top concerns stated by residents, followed by concerns about the effects of allowing dispensaries on social acceptability, particularly among youth . Perhaps intimidated by the challenge of regulating dispensaries, 75 of the 88 cities in LA County have passed local ordinances prohibiting dispensaries from locating within city limits . In Los Angeles County, the ten cities that have passed ordinances that allow and regulate dispensaries have set forth detailed rules for how dispensaries can operate. Conditions that these cities have specified to minimize the impact of dispensaries on public health include requiring them to be located a minimum distance from schools, parks, libraries and other places frequented by youth, limiting the hours of operation, and controlling their density and location . However, research indicates that preventing unlicensed dispensaries and restricting them from sensitive areas has been a problem in cities that allow dispensaries as well as in cities that ban them . Enforcement of city regulations intended to prevent adolescent substance use is an important determinant of their effectiveness in preventing substance use behaviors . A key concern for this study is the degree to which adolescents are exposed to dispensaries in the city where they attend school and likely live. Exposure to dispensaries is therefore a factor that depends not only on the city ordinances regulating dispensaries but on how effectively those ordinances are enforced.
It not yet known whether banning outlets altogether or allowing and regulating them is more effective at keeping outlets a safe distance from schools and other sensitive areas, as unlicensed dispensaries have been found in sensitive areas in cities that ban dispensaries as well as in cities that allow them. Cities that allow dispensaries are faced with enforcing limits on density and keeping outlets a defined distance away from sensitive areas such as parks and schools and some cities are more successful than others in accomplishing this. For example, unlicensed marijuana outlets were found to greatly outnumber licensed outlets within the City of Los Angeles . Among cities that have banned dispensaries the enforcement challenge has been to shut down unlicensed outlets and prevent new ones from opening in a different area of the city. This has been a problem in the unincorporated areas of LA County as well. For example, the LA County Office of Marijuana Management recently reported that it had identified 75 unlicensed outlets operating in the unincorporated areas of LA County in 2017. Seven months later, 29 of those shops had been shut down, but 31 new ones had opened in their place . Differentiating between licensed and unlicensed medical marijuana dispensaries is important because each type of dispensary may comply with regulations intended to prevent marijuana related harm and youth use to different degrees. By already existing in defiance of local law by operating in a location where they are not permitted, unlicensed dispensaries may have little incentive to comply with medical marijuana regulations. Recent observational research on compliance with regulations among dispensaries in LA County indicates that unlicensed outlets were more likely to have violated several practices designed to restrict youth access, such as displaying products designed to be attractive to youth, displaying products outside of their original child resistant packaging, or allowing onsite consumption .
The same premise survey also found that unlicensed dispensaries are more likely to be found located near sensitive areas where dispensary regulations prohibit them than licensed dispensaries . Although a robust body of literature supports the efficacy of city ordinances in preventing alcohol and tobacco use among adolescents , there exists a gap in empirical literature evaluating the effectiveness of these approaches in preventing marijuana use among adolescents . While a handful of studies have examined the impacts of the local marijuana policy environment on adult marijuana use the ability to quantify the impacts of city dispensary policies on youth marijuana use and outcomes has thus far been severely hampered by a lack of available data on youth marijuana use at the local level. Population-based national surveys like the Youth Risk Behavior Survey, the National Survey on Drug Use and Health, and state-level surveys like the California Health Interview Survey do not sample with enough density to allow for comparison of teen marijuana use between the cities within Los Angeles County . Even the Los Angeles County Health Survey, a population-based survey of health behaviors among adults and children in LA County, does not sample enough youth under 18 to provide estimates of adolescent marijuana use for geographic units smaller than the County’s health districts,indoor grow cannabis most of which span several cities . It is important to know whether the hundreds of ordinances that have been enacted to ban dispensaries in local jurisdictions across California have any impact on young people or whether the many other ways people can obtain marijuana render them primarily symbolic. Even if city ordinances do not influence the supply of marijuana available to youth or ultimately impact their marijuana use behaviors, what effect do they have on their perceptions of risk and on youth social norms surrounding marijuana use? The primary aims of this dissertation will be to answer these research questions, i.e., to learn whether local policies governing dispensaries are linked to rates of use as well as risk perceptions among Los Angeles County adolescents. Effective prevention of adolescent substance use requires an understanding of the complex etiology behind this very common behavior. Explanatory theories of adolescent substance use must elucidate relationships within the wide variety of factors that have been shown to influence substance use behavior while accounting for the unique context of adolescence. Consequently, comprehensive theoretical models that incorporate factors from multiple domains of influence have gained prominence as the field of substance abuse prevention has developed . Key themes in the etiology of adolescent substance use are that there are both distal and proximal influences at work and that a young person’s developmental stage interacts with almost every other influence . This chapter will give more emphasis to theories that apply to community and societal-level domains of influence on adolescent substance use behaviors. These theories directly address important constructs for this study, such as how and why young people’s substance use attitudes and behaviors are responsive to community contexts.
Developmental theories encompassing a wide range of biological, psychological, and experiential factors are prominent among individual-level theories and provide an explanatory framework for the most proximal influences on adolescent substance use behavior . However, even developmental theorists are increasingly looking to community contexts to explain inconsistencies and conditional relationships that have been identified in individual and relationship influences, such as the ways neighborhood effects mediate peer and family relationships . Simultaneously, an increased interest in the social determinants of health has led to more examination of how cultural and economic community characteristics and local policy may act on adolescent substance abuse . Individual-level factors represent the most proximal motivations for substance use and therefore tend to be important predictors of substance use behaviors. Generally, life experiences and psychological factors that present challenges to mental and emotional health also present risk factors for substance use and SUD . Decades of research have found that sub-groups of adolescents who experience social isolation, abuse, trauma, and mood disorders are at very high risk for SUDs and resulting health harms . The most vulnerable adolescent populations include youth who are in the child welfare system , drop out of high school , are involved with the criminal justice system , or have a minority sexual identity . Peer-reviewed empirical research of the influence of parental marijuana use on individual-level risk factors for adolescent substance use is still relatively sparse to date. Freisthler and colleagues found that parents who reported that they were current marijuana users were more likely to be physically abusive and used corporal punishment more frequently, but current marijuana use was associated with neither supervisory neglect or physical neglect. This led the authors to theorize that marijuana might be used by highly impulsive and agitated parents to relax but that their marijuana use did not appear to impair parents’ ability to care for their children’s basic needs. Intra-personal correlates of adolescent marijuana use include social and friend networks, the quality of family interactions, and the influence of school peers . Social networks are important influences on adolescents’ behavior and often mediate more distal influences like community and societal-level factors . Peer and family values, attitudes, and beliefs about substance use help shape adolescents’ values, attitudes, and beliefs about acceptable levels substance use . More accepting attitudes toward substance use among adults are correlated with a greater likelihood of substance use among adolescents and several studies have replicated these findings for marijuana use specifically . For example, in the state of Montana, Friese and Grube found that adolescents who lived in counties with a higher percentage of adult voters reporting approval for legalization of medical cannabis were more likely to have used cannabis with the last 30 days, whereas the number of medical cannabis cards that had been issued by county was not associated with higher rates of recent or lifetime cannabis use among the adolescent residents. This finding suggests that adults’ favorable attitudes toward cannabis drove the association between state policy and adolescent marijuana use rather than an increase in the availability of cannabis in the community. A marijuana-using parent could present a predisposing factor for an adolescent to use marijuana from the standpoint that they are communicating social norms accepting of marijuana use and may possibly contribute to adolescents’ perceptions that marijuana use represents little risk for health harms. To date, very little research has been dedicated to examining the relationship of parental marijuana use with adolescent marijuana use. However, a national survey of young adults ages 18 to 25 found that children of parents who smoke marijuana were more than three times more likely to use it themselves. Among young adults whose parents had used marijuana, 72% had used it, while only 20% of those whose parents had never used marijuana reported having used it themselves .