Hemp Growing

It is important that consumers receive accurate information on whether or not a product is organic. The European Union prohibits the use of “organic” on any product label where less than 95% by weight of ingredients of agricultural origin are not organic, or any product produced with or containing genetically-modified organisms. Similar provisions are included in US product labeling law. Due to federal prohibition of marijuana in the United States, however, marijuana companies are not allowed to market marijuana products as ‘organic’. If federal prohibition is lifted, companies may use the term ‘organic’ in marijuana packaging and marketing to increase product appeal. More research is needed to understand how organic labeling on marijuana packages impacts risk perceptions and use, and what public health messages could counteract misperceptions of risk. Young adults may be receptive to health-related content on tobacco warnings and this could be translated to warning labels for hookah, e-cigarettes, and marijuana. While these findings should be validated with a larger sample, for many participants chemicals, toxins, and additives were associated with greater harm. Warnings for hookah, e-cigarettes, and marijuana could address chemicals and toxins found in the organic matter, as well as chemicals used to produce marijuana concentrates and e-liquids. Warning labels could address the misperception that a product is safer because it contains, or was extracted with, water. Warning labels reflecting the novel themes identified in this study might be more effective if they follow the current state of the art for tobacco warning labels, including use of images in addition to text,ebb flow tray and if warning label messages are reinforced by mass media educational campaigns. The opioid epidemic is a major public health concern in the United States . The number of opioids prescribed in 2015 was approximately three times as high as in 1999 . At least 11.8 million adolescents and adults misused opioids, and 2.1 million had an opioid use disorder , in 2016 . The opioid-related hospitalizations increased by 64%, and emergency department visits doubled, in 2005-2014 .

Over the past decade, concerted policy efforts have been made to restrict the prescribing of opioids . Expanding access to effective treatments for OUD is essential to reduce its burden . Historically, medications for treating OUD, such as methadone and buprenorphine, were provided only in opioid treatment programs, and, therefore, only a fraction of patients were willing and able to access these medications . To expand the clinical ability to treat OUD, the US Drug Addiction Treatment Act of 2000 waived the requirement of obtaining a Drug Enforcement Administration registration as an opioid treatment program for physicians providing buprenorphine treatment in their offices. Physicians can acquire DATA-2000 waivers if they had a board certification in addiction medicine or psychiatry or completed required training . Since 2010, there has been a dramatic increase in the number of DATA-2000 waivered providers . These providers might be more likely to begin prescribing buprenorphine in areas with higher opioid-related mortality rates . It was hoped that expanding the capacity of buprenorphine treatment could improve access to OUD treatment. The expansion of buprenorphine treatment affected opioid-related outcomes at the population level has remained unexplored. Parallel with the opioid epidemic, marijuana legalization has expanded throughout the US. As of November 2018, in addition to the District of Columbia, 33 states have legalized marijuana use for medical purposes, 10 of which further legalized marijuana use for recreational purposes. First, marijuana use may exacerbate opioid use. Second, marijuana use may substitute for opioid use . The rationale for the first hypothesis was that marijuana may precede use of opioids, and individuals who used marijuana may share risk factors with individuals who used opioids . As demonstrated by a cohort study, recreational marijuana use was associated with increased likelihoods of opioid misuse and OUD . But the data of this study were collected before any states have legalized recreational marijuana use.

The evidence on the impact of state recreational marijuana laws on opioid-related outcomes remained scarce, and no positive associations have been documented . The rationale for the second hypothesis was the potential therapeutic effects of cannabinoids and smoked marijuana on pain symptoms, which were supported bysystematic reviews of randomized controlled trials . Chronic or severe pain was, therefore, the most commonly approved condition in the states that legalized medical marijuana. Several ecological studies consistently suggested that state-wide medical marijuana laws were associated with considerable reductions in opioid prescriptions, misuse, overdose deaths, and related hospitalizations at state level . However, these ecological studies above were not supported by a recent individual-level prospective cohort study in Australia which found no evidence that marijuana use was associated with reduced opioid use among pain patients . But in this study, the majority of participants used illicitly obtained marijuana. It is still unknown to what extent the findings can be generalized to the current legal environment in the US. The availability of marijuana dispensaries and DATA-2000 waivered providers varied substantially across neighborhoods within a state, but its associations with opioid-related outcomes in a neighborhood was unknown . To fill the knowledge gap, we examined the associations of neighborhood availability of marijuana dispensaries and DATA-2000 waivered providers with hospital stays related to opioids, using hospital records from January through June in 2016 in Washington. We hypothesized that the availability of recreational and medical marijuana dispensaries was associated with a higher and lower risk of hospital stays related to opioids, respectively. According to availability theory, increased access to marijuana may lead to increased marijuana use among the local population .

Thus, increased availability of recreational marijuana dispensaries may result in increased marijuana use for recreational purposes which may lead to increased opioid or OUD-related health outcomes, while increased availability of medical marijuana dispensaries may results in elevated marijuana use for medical purposes which may lead to alleviated opioid or OUD-related health outcomes. We also hypothesized that the availability of DATA-2000 waivered providers was associated with a lower risk of hospital stays related to opioids. According to the Andersen’s behavioral model of health services use, individuals living in areas with more available health care resources were more likely to visit a provider . One study reported that living in neighborhoods with more DATA-2000 waivered providers was associated with an increased likelihood of being treated with buprenorphine for OUD . Thus, increased availability of DATA-2000 waivered providers may lead to improved opioid- or OUD-related health comes through more accessible OUD treatment. To analyze the potential differential associations with recreational and medical marijuana dispensaries,flood and drain tray we took advantage of the unique policy context in Washington in early 2016, a time when recreational marijuana and medical marijuana dispensaries coexisted. Washington passed the laws to legalize medical marijuana in 1998 and recreational marijuana in 2012. Before recreational marijuana was legalized, medical marijuana dispensaries in Washington largely operated without regulations. Unlike other states such as Colorado that built its recreational marijuana industry and regulations on top of the existing medical marijuana system, Washington chose to abandon its medical marijuana system and start recreational marijuana regulations from scratch. In 2015, Washington passed the Cannabis Patient Protection Act requiring that all marijuana dispensaries operate as licensed recreational marijuana dispensaries and obtain a medical marijuana endorsement if they opt to specialize in medical marijuana . As a result, between July 2014 when the first recreational marijuana dispensary opened and July 2016 when SB 5052 took effect, the old medical marijuana dispensaries that exclusively served medical marijuana patients and the newly licensed recreational marijuana dispensaries that might serve both patients and recreational users operated at the same time in Washington. This is a cross-sectional ecological study using secondary de-identified data, and the ethics approval and consent were not needed.

We obtained inpatient and observation stay discharge records in all the community hospitals between January 1, 2016 and June 30, 2016 from Washington Comprehensive Hospital Abstract Reporting System administered by the State Department of Health. The records included detailed information on patient demographics, zip code of patient’s home address, as well as up to 25 International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis and procedure codes. Patients younger than 12 years of age or living outside of Washington were excluded from the analyses. The final study sample included 264,013 inpatient stay records and 12,621 observation stay records. Directories and point locations of marijuana dispensaries with physical storefronts in Washington were obtained between March and June in 2016 from a crowd sourced website . Weedmaps provides detailed and up-to-date dispensary information contributed by dispensary owners and users. Its data have been validated and used in previous research . Notably, each dispensary on weedmaps self reports whether it is a medical or recreational marijuana dispensary. This is the only source to differentiate recreational and medical marijuana dispensaries during our study period, as official records for medical marijuana dispensaries were not available until they were regulated in July 2016. Directories and point locations of DATA-2000 waivered providers in Washington were obtained in August 2016 from the Substance Abuse and Mental Health Services Administration. Tobacco and alcohol outlet locations were obtained from business list provider reference USA and other contextual factors were obtained from the US Census and the American Community Survey.The patient-level outcome variables were opioid related hospital stays, including inpatient stays and observation stays. Inpatient stays were hospital stays after patients were formally admitted to a hospital. Observation stays were short-term hospital stays for patients who were not well enough to go home but not sick enough to be admitted right away. Observation stays usually lasted for less than 24 hours and rarely exceeded 48 hours. Patients were either discharged or admitted as inpatients after observation stays. In CHARS, if a patient was transferred to inpatient care after an observation stay, this patient would only be recorded as an inpatient. In other words, observation stay discharge records in CHARS captured patients who were discharged after observation stays. To construct opioid-related hospital stays, we first used ICD-10-CM diagnosis codes to identify OUD and opioid overdose . A hospital stay with OUD or opioid overdose in all-listed diagnoses, including principal diagnoses as well as secondary diagnoses, was defined as an opioid-related hospital stay. Accordingly, three dichotomized indicators were created to represent inpatient stays involved with OUD, inpatient stays involved with opioid overdose, and observation stays involved with OUD. Observation stays involved with opioid overdose were not analyzed because of insufficient sample size. The primary explanatory variables of interest were the availability of marijuana dispensaries and DATA-2000 waivered providers in a neighborhood defined by zip code tabulation area . Measures for recreational and medical marijuana dispensaries were constructed separately. All the point locations were geocoded using ArcGIS and aggregated to zip code level. Availability was measured by the density of marijuana dispensaries or DATA-2000 waivered providers per square mile. In sensitivity analyses, we altered the operationalization of primary explanatory variables to test the robustness of our results. First, we used the total density of recreational and medical marijuana dispensaries. Second, we used three dichotomous variables indicating the presence of any recreational marijuana dispensaries, medical marijuana dispensaries, or DATA-2000 waivered providers because the majority of zip codes did not have any of them. Third, we used three categorical variables to represent 0, 1, and 2+ recreational marijuana dispensaries, medical marijuana dispensaries, or DATA-2000 waivered providers in a zip code, as few zip codes had more than two of them. Patient-level covariates included age , sex , primary payer , and race/ethnicity . Zip code level covariates included proportion of population under age 21 , whether the population were predominantly racial and ethnic minority , median household income in thousand dollars of 2016, number of tobacco and alcohol outlets per square mile, and population density . The descriptive and regression analyses were conducted in STATA 14 . We conducted multilevel logistic regressions with random intercepts at the zip code level to examine the associations of the availability of DATA-2000 waivered providers and marijuana dispensaries with opioid-related inpatient or observation stays, controlling for other patient and neighborhood covariates. Multilevel models were used to account for within-neighborhood correlations, as patients nested within zip codes shared the same zip code level explanatory variables of interest and covariates.

The George Washington University Committee on Human Research, Institutional Review Board determined that this study did not meet the definition of human subjects research. Table 3 presents the predicted probabilities of past-month marijuana use at each level of risk and by reasons for use. We also present marginal effects, which represent the change in the probability of each outcome as the risk factors change, while holding all other characteristics constant. Adjusted relative risk ratios from the multinomial logistic regression model are presented in supplemental Table S3 in the online version of this article. Overall, the average predicted probabilities of marijuana use for medical, recreational, and both reasons were 28.6%, 38.2%, and 33.1%, respectively. Several covariates were associated with marijuana users’ reported reasons for use including, but not limited to, gender, age, race, education status and employment. Associations between both health status and frequency of use and reasons for use were large in magnitude and statistically significant. For example, respondents who reported 14+ versus no days of poor mental health had significantly increased chances of reporting marijuana use for medical reasons or both reasons and a significantly decreased probability of reporting recreational reasons . This same pattern—that is, greater probabilities of reporting medical reasons or both reasons among those in poor health—was also evident for physical health. Marijuana users who reported daily use had a 6.3% increased probability of reporting medical reasons and a 15.6% increased probability of reporting both reasons. Daily users had a significantly reduced likelihood of reporting recreational reasons for use . Estimates from the logistic regression model showed similar patterns. See Supplemental Table S4 in the online version of this article.Among respondents in fully legal states, the chance of reporting recreational reasons was 5.5% lower than in illegal states ,grow table hydroponic but the chance of reporting both reasons was 7.0% higher . While the predicted probability of reporting medical reasons was lower with states’ liberalization of marijuana, differences were not statistically significant. Our user profiles confirmed these patterns .

We deliberately modeled illustrative profiles possessing characteristics associated with medical and recreational reasons for use based on our results: an older woman in poor mental and physical health who is a daily marijuana user and a young adult male who is an infrequent marijuana user and a binge drinker. In the first case, we found that the average predicted probabilities of reporting medical, recreational, and both reasons did not significantly vary by states’ legal environments. For the second user profile, we found that the predicted probability of reporting recreational reasons was 5.3% lower in a fully legal state than in a fully illegal state. Conversely, the predicted probability of reporting both reasons was 5.0% higher in a fully legal than in an illegal state. The difference in the probabilities of reporting medical reasons in legal versus illegal states was not statistically significant.Our study makes two, unique contributions. First, we estimated the change in probability associated with incremental changes in risk factors on each reason for use and created user profiles to illustrate these relationships. Second, we used three years of BRFSS data to examine marijuana users’ reasons for use, data which we do not believe has been previously used for this purpose. We found that the prevalence of past-month marijuana use in our sample was 11.2%, which was similar to, but not the same as, rates reported from other U.S. sample surveys. For example, two studies based on BRFSS data from 2016 and 2016-2017, respectively, found prevalence rates of 9.1% and 13.6% . The National Survey on Drug Use and Health reported rates of past-month marijuana use among persons aged 12 or older from 11.2% in 2017 to 13.0% in 2019 , 2018, 2019, 2020. Findings from a study that used 2005-2018 National Health and Nutrition Examination Survey data reported a 14.4% past-month marijuana prevalence rate . Differences in these estimates could be attributable to time trends, study inclusion criteria, and/or differences in each survey’s design and data collection procedures.

Like other studies , we found that adults were most likely to report recreational reasons for use followed by both reasons and medical reasons . The characteristics we identified as being associated with marijuana users’ reasons for use—gender, age, race, education, health status, and frequency of use—also comport with prior research . Consistent with prior studies , we found that medical marijuana users were less likely to report smoking marijuana and more likely to eat/drink, vape, and use other routes of administration. This pattern is consistent with evidence, which has found that vaporization is a commonly used mode of delivery among medical marijuana users because of its relative health advantages over smoking and the flexibility, portability, efficiency, and ease of use that accompanies vaporization devices . It is possible that eating/drinking offers similar benefits. Additional studies are needed to explore this phenomenon. We found that being a woman increased the odds of reporting medical reasons for past month marijuana use . While prior studies have found that women were more likely to report using marijuana for medical reasons compared to recreational ones , in only one of these studies was the difference statistically significant . Our findings complement a recent study , which explored gender differences in medical marijuana use and found that women were more likely than men to use medical marijuana for a variety of symptoms including pain, anxiety, and nausea—conditions which commonly qualify patients for medical use . Finally, we found that past-month marijuana users who reported medical reasons for use were more likely to be older and in poorer health, and they were more likely to be daily users. Prior studies have produced similar findings . Notably, we also found that marijuana users who reported using for both medical and recreational reasons were the most likely to be daily users. Because the frequency and quantity of marijuana consumed have been associated with marijuana dependence and other adverse effects , persons who report using for medical and/or both reasons could bear greater risks. Studies that compare daily and intermittent marijuana users’ reasons for use and adverse outcomes, and which draw on diverse populations, are needed to better understand these relationships and optimize generalizability .

Our findings regarding the association between legalization and marijuana users’ reported reasons for use were unexpected. We found that in fully legal states , the predicted probability of reporting recreational use was significantly lower while the probability of reporting both reasons was significantly higher. While these findings are counter intuitive, restrictive recreational marijuana laws and higher tax rates incentivize medical use . These forces could drive recreational users, especially those who use marijuana to self-medicate , 2020c, towards using and reporting medical reasons or both reasons for use, which might explain our findings. Alternatively, states that have legalized marijuana for recreational use tend to hold liberal positions on other issues and attract residents who share those values. It is entirely possible that persons who hold such liberal values are more likely to view marijuana favorably, recognize its therapeutic benefits,grow table and attribute at least some of their use to a medical need. Our findings should be placed within the context of data and study limitations. BRFSS data are self-reported, which could introduce reporting bias. While we combined the three most recent years of BRFSS data, we effectively limited our sample to 20 states and 18,925 marijuana users. This diminishes the generalizability of our results. We know that marijuana prevalence varies by state , 2020c, at least in part, because of states’ policies regarding marijuana use, possession, and sales . If the subset of states that opted to include the BRFSS marijuana module also had different use rates or reasons for marijuana use, confounding could have been introduced. Further, we excluded 294,751 respondents from our sample . These respondents differed from those retained on many characteristics. For example, respondents in our study sample were more likely to be male, older, report using tobacco and binge drinking and less likely to be married. If this same pattern existed for the variables of greatest interest, our estimates could be biased.Additionally, the BRFSS’ asks respondents about their reasons with three responses: medical, recreational, or both. In reality, marijuana users’ reasons for use may be more nuanced; users might not fit “neatly” into these three categories. For example, some may view marijuana as having general health benefits—helping with relaxation or enhancing wellness. This is supported by studies, which have found users describing marijuana as a “natural” alternative to or substitute for other prescription medications and the marijuana industry’s marketing of it as a lifestyle product . In these cases, it is unclear how a user might answer the BRFSS question. Further, the BRFSS does not ask respondents about several potentially important predictors of marijuana users’ reasons for use, including quantity, duration of use or dose. Our coding of states’ policy environments as a categorical variable could be an imprecise reflection of how states’ policy environments influence consumption patterns . Given that local government entities have enacted additional policies that further regulate marijuana markets, studies that also account for local policies and other factors such as retail availability of marijuana are needed. Finally, our analysis offers insight into the correlates of reasons for marijuana use, but because of the BRFSS’ cross-sectional nature, causal inferences cannot be made.

Recent national data showed that 27.1% of high school students reported past 30-day use of any tobacco1 and 19.8% reported past 30-day use of any marijuana.Furthermore, several studies indicated that past 30-day co-use of two substances was higher than use of either tobacco or marijuana only among adolescents,and higher than use of marijuana only among young adults.The use of these substances during neurodevelopmental stages exposes AYA to numerous adverse health consequences and societal impacts .Understanding tobacco and marijuana co-use among AYA has become more important given the proliferation of new products. The tobacco landscape has shifted from conventional cigarettes to cigars/cigarillos, hookah, smokeless tobacco, and more recently, e-cigarettes.Marijuana is also available in a variety of combustible , vaporized , and edible products .Co-use can refer to use of both substances separately across the aforementioned products during the past 30 days, or at the same time or in the same product, such as with blunts .Recent studies have demonstrated a transformation of tobacco use patterns with the use of non-cigarette products now surpassing conventional cigarette use among adolescents.In contrast, despite the appeal of newer marijuana products, combustible marijuana remains the most common form used across all age groups.Therefore, it is critical to characterize tobacco and marijuana co-use in light of specific products. Past research on tobacco and marijuana co-use among AYA has predominantly focused on examining the overall relationship between tobacco and marijuana using “blanket terms” , or only co-use of combustible forms and blunts.Newer co-use research among AYA has taken into account specific products.However, these studies have examined only the co-use of individual tobacco products with “any marijuana,” which limits our understanding on specific marijuana products co-used with tobacco. Only two recent studies have assessed couse of specific products for both substances. One study among 1,420 high school students compared past 30-day use of cigarettes, cigars, hookah, and e-cigarettes between current blunt and combustible marijuana users.This study, however, focused on only combustible forms of marijuana; thus, it did not fill an important gap in the literature on alternative forms of marijuana .The other study among 2,668 adolescents assessed the relationship between previous use of tobacco products and subsequent use of marijuana products .Although this study provided more insights by including noncombustible marijuana products, it did not directly provide data on past 30-day co-use of tobacco and marijuana products, and more importantly, did not include a sample of young adults, a group with the highest risk of co-use relative to other age groups.National data indicated co-use prevalence among young adults in 2014–2015 was 21.3%,4 and nearly half of adult co-users were between 18–25 years old.To our knowledge, there has been no research among young adults considering specific products for both tobacco and marijuana. Given the current era of marijuana legislative reform nationwide as well as the proliferation of proposed national and state tobacco regulations, more research on co-use of tobacco and marijuana is needed to inform these actions.

To continue, when participants were asked about whether or not they have noted marijuana recovery programs within their counties or the state, they responded that they have not heard of marijuana recovery programs nor have they seen visual representations/advocacy associated with these programs. Because the respondents conveyed that they were unaware of marijuana recovery programs within South Central LA, this finding suggests that the existence marijuana use recovery programs have been obfuscated not only due to the acceptance of marijuana legalization, but also due to ineffective community educational programming tailored to the promotion of marijuana recovery programs in South Central LA. It was implied that more visual flyers and media promotion must be available to shed light onto current highly regulated community educational programming directed towards marijuana mis-use prevention/recovery strategies. In alignment with Goldstick’s argument, education in the form of disseminating “health outcomes” is crucial in informing decision making/intervention strategies. Dissemination of health outcomes through increased production of visual aids may establish presence of these interventions, while reinforcing their benefits in lowering marijuana dependency. It can also be inferred that ineffective community educational programming may not only hinder the development of these intervention strategies, but also may create nebulousness around substance mis-use recovery program compilation as well as subsequent dissemination. For adults, the implementation and uncovering of medical marijuana education programs, assisted in the reduction of adult marijuana mis-use instances, in comparison to loosely regulated marijuana prevention programs. Consequently, the presence of tight marijuana educational programming, whether its medical marijuana education or marijuana mis-use prevention,mobile vertical grow tables can be beneficial in lowering youth ingestion of marijuana alongside decreasing their inclination to access marijuana within outlets.

With this study finding bolstered by Goldstick’s and Lemstra’s argument as well as supported by Williams, it further coalesces with the research question: “can effective educational programming spur awareness on marijuana mis-use rates amongst adolescents of color, while emphasizing the presence of marijuana mis-use recovery initiatives amidst the indoctrinating marketing behind marijuana outlet formation and decreasing youth consumption of marijuana?”Towards the end of the focus group discussion, respondents provided their opinions on types of community educational programs which could be beneficial towards educating youth communities of color on the dangers of marijuana mis-use as well as challenge the effects of social disorganization factors such as lacking educational programming materials which could prompt increases in marijuana mis-use rates. Specifically, respondents proposed that increased community intervention programming, related to long-term deleterious effects of marijuana as well as marijuana outlet development prevention, that are implemented in middle schools and high schools may steer youth from mis-using marijuana. These programs that were suggested by respondents were also said to be effective in encouraging middle/high schoolers to turn to marijuana recovery programs if addiction behaviors prevail. This finding suggests that effective educational programming in the form of informative presentations with subtopics such as short/long-term effects of marijuana, perceptions behind marijuana use, as well as statistics that show target groups mostly affected by marijuana use, can not only educate youth on marijuana mis-use prevention, but also it can prevent marijuana outlet construction and sensationalized marketing towards youth. Continuing this, according to a systematic review conducted by Lemstra, researchers unraveled that school-based marijuana prevention programs helped adolescents reduce marijuana usage per month by 7 days.

This result is validated by Lemstra’s argument and further implicates that effective educational curricula development tailored to youth attunement on marijuana mis-use can potentially attenuate the likelihood of youth accessing marijuana outlet concentrations within South Central LA. When I attended Drug Take Back Day in South Central LA, SCPC volunteers and I encouraged event attendees to fill out a survey that asked them to strongly agree or disagree with statements related to the effectiveness of these events as a means to shed light on increased substance mis-use practices. Ninety percent of survey respondents who participated in active prescription drug disposal and who filled out the survey agreed that safe drug disposal events are beneficial for the community. This result suggests that the creation of events, similar to the engaging Drug Take Back Day event, can be developed to not only incorporate marijuana mis-use education/safe substance prevention practices in South Central LA, but also empower attendees to resist adverse drug marketing/outlet construction community indicators. Ultimately, this ties into the research inquiry presented above in that this finding provides support for whether the effectiveness of educational programming in a community event format can dismantle substance mis-use behaviors spurred by social disorganization indicators. Within the study data collection tools and methodology, study limitations were identified. During the focus group interview, eight individuals participated in this interview and received a monetary award for their participation. To strengthen evidence for the research question as well as effectively seal the gaps presented in the literature review, the focus group interview could have included a total of 12-15 individuals and more focus group interviews could have been conducted if time permitted. Additionally, the decreased quantity of focus group interviews tailored toward the exploration of increased marjiuana mis-use as well as contributing causes to marijuana mis-use amongst adolescents, posed as a limitation to this community engaged research.

This study utilized one focus group interview session that spanned 2 hours, however, if more focus group interviews were conducted with different sets of 12 participants each, then the credibility of the results as well as the application of the results to the research goals could have been improved. By including a few more participants and focus group interview sessions, more responses to the questions asked could have been analyzed and validated the use of the data tools in corroborating research goals as well as the overarching research question. Lastly, during the Drug Take Back day event, program evaluation surveys were devised and administered to participating individuals within South Central LA. With only nine participants filling out the Drug Take Back Day survey pertaining to the disadvantages and advantages in holding the Drug Take Back Day structured event,mobile vertical farm this small sample size overall alongside limited outreach about the event to community members may present another limitation to this community engaged research project. Therefore, increasing the sample size from 9 to around 50 participants may authenticate participants responses to questions pertaining to whether the Drug Take Back day event goals/practices or events similar to this were beneficial as well as may substantiate whether general perceptions suggest that more events similar to Drug Take Back day construction will sideline the historically based propulsion of substance outlet development. Future research that could be undertaken would be creating surveys before and after marijuana mis-use presentation materials to further record whether participants agreed with statements regarding marijuana mis-use before/after the presentation as well as evaluate whether they were/are aware of the information presented. Additionally, the responses from these surveys can be used to substantiate community programming/marijuana prevention programming development within South Central LA. Further research can also investigate strategy based proposals in regards to reducing the prevalence of marijuana outlet presence/development in South Central LA. Data collection tools that may be used for this would be focus group interviews, participant observation, and literature tables which can be coined to highlight current perceptions on marijuana outlet presence in middle school/high school areas as well as review policy rhetoric that underscores marijuana outlet development permissibility. Lastly, as the open-coding process was completed and yielded substantial themes for discussion, a few themes were omitted from the study as they weren’t affiliated with the research topic nor did they directly contribute to the address al of the gap. Themes from this study that could be further explored through outlet density mapping and interviewing are: pop culture promotion and commercialization of marijuana. Next steps include further collaborating with my community partner to contest potential data limitations by setting up more focus group interviews with disparate respondent choice, creating program evaluation surveys for Drug Take Back day which consists of multiple questions regarding program structure areas of strengths/weaknesses instead of just 1-2 questions for a larger audience, and generating eclectic substance mis-use education materials which address substance use misconceptions/community social disorganization causes.

Ultimately, these steps can be enacted to ascertain which programming materials have the potency to combat historically known causes that propel substance mis-use and whether these materials can effectively implore individuals to abstain from substance use/refer individuals to substance prevention programming. TOBACCO USE, INCLUDING CIGARETTE smoking, remains the single most preventable cause of morbidity and mortality in the United States, accounting for approximately one in five deaths, or 440,000 deaths per year . In the United States, the prevalence of cigarette smoking has declined among adults since 1983. However, the cigarette smoking prevalence among young adults ages 18–25 years has remained stable, with 34% reporting having smoked in the past month in 2010 . More than 90% of cigarette smokers become regular users before age 18 . Tobacco industry documents reveal that young adults ages 18–24 years constitute the largest segment of targeted tobacco-marketing efforts , which are associated with smoking initiation . Compared with other age groups, young adults are less likely to use behavioral or pharmacotherapy interventions for smoking cessation . Marijuana is the most commonly used illicit substance among young adults, with approximately 19% of those ages 18–25 reporting marijuana use in the past month . Rates of marijuana use among young adults have increased since 2008 and are highest among those ages 18–25, compared with any other age group. Young adulthood is an important developmental stage for understanding use patterns of cigarettes and marijuana .In 2009, 35% of cigarette smokers ages 18–25 had used marijuana in the past month, almost three times the rate of the general adult population . Tobacco use has been implicated as a gateway drug to the use of marijuana and other illicit drugs . Cigarette smoking is associated with the initiation and the extent of marijuana use in young adulthood. One study demonstrated that young adults ages 18–25 are 10 times more likely to have ever used marijuana if they also have a history of smoking cigarettes . Research also documents a reverse gateway effect, whereby those who smoke marijuana in early young adulthood are more likely to initiate tobacco use and to have a greater likelihood of developing nicotine dependence than their nonsmoking peers . Those who go on to have problems with the use of illicit drugs, including but not limited to marijuana, are more likely to be heavy smokers, to be nicotine dependent, and to experience greater difficulty with quitting smoking . The mechanisms by which tobacco and marijuana use are related include shared genetic factors, a similar route of administration , and co-administration . Possible manifestations of such commonalities in use are a substitution effect, whereby using marijuana causes smokers to smoke fewer cigarettes than they otherwise would have, or a facilitation effect, whereby smoking marijuana increases the intensity of use and is associated with reduced motivation, reduced abstinence goals, and increased barriers to quitting tobacco. For example, in one study among college students who reported smoking both marijuana and tobacco, 65% had smoked tobacco and marijuana in the same hour, and 31% reported that tobacco prolonged and sustained the effects of marijuana . Additionally, a qualitative study reported that youth were most likely to relapse to tobacco use while smoking marijuana . A recent review of clinical outcomes of tobacco and marijuana co-use found that, relative to tobacco use only, co-occurring use was not associated with a greater likelihood of tobacco use disorder, psychosocial problems, or poorer tobacco-cessation outcomes . However, many of the studies reviewed included marijuana use as a dichotomous variable , limiting the ability to detect a relationship between heavier marijuana use and tobacco use outcomes. As others have noted, most substance use interventions target risk behaviors individually . However, interventions that have targeted tobacco use in the context of treatment for other substance dependence have demonstrated significant post treatment effects on tobacco use and even improved long-term sobriety . Given the high rate of tobacco and marijuana co-use among young people, information is needed on patterns and processes of tobacco and marijuana use to determine the best way to tailor interventions to this population.

As marijuana use was considered illegal for most yearly examinations in CARDIA, use may have been under reported. However, at each examination, marijuana use was self-reported , collected at a research site , and participants’ responses were confidential. The route of administration of marijuana can also affect the onset, intensity, and duration of the psychoactive effects, as well as organ systems. Investigations into marijuana use via other routes of administration may provide novel additional insights, including the latter, which was not present during the time points in the current study but is becoming more widely used. Additionally, this study examined acute exposure to marijuana , compared to hyperacute exposure and investigations into DNA methylation changes due to hyperacute exposure may provide further insight into the acuity of exposure on epigenetic factors. And lastly, although CARDIA is a diverse cohort, Black and White participants were sampled from four centers across the US. As such, additional studies from more diverse populations across different geographical locations will enable for better generalizability of the findings presented here.Legalization for medical purposes has been accompanied with increased daily use and marijuana use disorders among US adults . Approximately 15% of the US adult population used marijuana in some form in 2017 . Between 2016 and 2017, past-month use of marijuana increased nearly 2% among adults aged 18 to 25 years and 1.2% among adults 26 years and older . Additionally, national surveys suggest the perception of ‘‘great risk’’ from weekly marijuana use dropped from 50.4% in 2002 to 33.3% in 2014 and has dropped further since . Recent national surveys also demonstrate that the public attributes benefits to marijuana that are not supported by existing scientific evidence,indoor weed growing accessories such as relief from anxiety, stress, and depression, improved appetite, and improved sleep .

It is unknown whether adult residents of states where marijuana has been commercialized for recreational use are more likely to attribute benefits to marijuana use. Given the growing body of evidence that adverse consequences are associated with regular marijuana use , determining whether residents of recreational states perceive marijuana use differently than residents of states without commercial legalization is an important consideration and may inform the needs for more investment in communications of potential risks to the public. In this study, we examine the differences in beliefs about marijuana use and rates of use across states defined by their marijuana legalization status .Survey questions were developed by identifying gaps in existing federally funded national surveys, including the National Survey on Drug Use and Health and Monitoring the Future , and drafting questions to address those gaps. Questions were refined through interviews with marijuana industry professionals, dispensary staff, marijuana distributors, and mental health and substance use disorder experts. Survey items developed included individual opinions on the risks and benefits of marijuana use, comparisons of risks and benefits of marijuana to other psychoactive substances, and the form, amount, and frequency with which individuals use marijuana. In total, the survey included 29 questions assessing beliefs about the risks and benefits of marijuana and 54 questions assessing marijuana use. Answer options for all opinion questions used Likert scales to allow participants to respond with the answer most closely aligned with their beliefs. All questions were written at an 8th-grade reading level and were tested on a convenience sample of 40 adults to ensure readability and construct validity. Full details on survey development have been previously published . The survey tool is available in the supplementary material .We conducted a survey of a nationally representative sample of 16,280 US adults on risks and benefits of marijuana use. The survey was conducted using KnowledgePanel —a nationally representative panel of civilian, non-institutionalized US adults aged 18 years and older that has been used to survey public opinion since 1999 .

GfK created a representative sample of US adults by random sampling of addresses . The address-based sampling covers 97% of the country and encompasses a statistical representation of the US population. Households without internet access are provided with an Internet connection and a tablet to ensure participation. All participants in the panel are sampled with a known probability of selection. No one can volunteer to participate. Participants are provided with no more than 6 surveys a month and are expected to complete an average of four surveys a month . Sampling was stratified by legalization status of marijuana in the state of residence . California residents and young adults aged 18 to 26 years old were over sampled to facilitate a future investigation into the role of recreational legalization on use patterns among young adults in California. Sampling weights were provided by GfK.The response rate, determined using methods outlined by the American Association for Public Opinion Research, was the ratio of respondents to all potential participants . Characteristics of the survey respondents were weighted using weights provided by GfK to approximate the US population based on age, sex, race, ethnicity, education, household income, home ownership, and metropolitan area. All analyses used weighting commands using the weight variable provided by GfK to generate national estimates. We first compared the sociodemographic characteristics of our respondents to that of the NSDUH—an annual, federally funded epidemiologic survey . We then compared views and forms of marijuana use of residents across recreational, medical, and nonlegal states using chi-square statistics. Finally, we reported the prevalence of different forms of use stratified by legalization status of states and the associated 95% confidence interval . In supplementary analyses, using logistic regression, we examined views of residents of recreational states compared with other states after adjusting for baseline demographic characteristics including age, sex, race, employment status, and household size. All analyses were performed with R statistical software .

The response rate of the survey was 56.3% and did not vary by status of legalization in state of residence . The rate of missing or refused questions ranged from 0% to 3.9%. The sample was 52% female, 64% white, 12% black, 16% Hispanic, and 8% other race with a mean age of 48 years. Residents of the 3 state types did not differ by age. The residents of recreational states were predominantly white and less diverse than other state types . The residents of recreational states had higher rates of education and higher income levels compared with other state types. Sociodemographic characteristics of the respondents were largely similar to those of NSDUH,cannabis trimming though our sample had a slightly higher average income .Overall, residents of states where marijuana was legalized for recreational purposes were more likely to endorse the belief that marijuana had benefits compared with residents of other states . Specifically, residents in recreationally legal states were more likely to believe marijuana could be beneficial for pain management ; provide relief from stress, anxiety, or depression ; and improve appetite . Pain management was endorsed as the most important benefit regardless of state of residence . Residents of nonlegal states were more likely to endorse the belief that marijuana had no benefits compared with those in recreationally legal states . Multivariate analyses confirmed that residents of recreational states were less likely to believe marijuana had ‘‘no benefits’’ and more likely to believe that marijuana use had benefits in pain management, helped with reducing or stopping other medications, provided relief from stress, anxiety, and depression, improved sleep and appetite, and improved creativity compared with residents of medical and nonlegal states after adjusting for baseline characteristics .The belief that marijuana use was associated with the development of addiction was similar across states . Residents of recreational, medical, and nonlegal states all endorsed addiction as the most important risk associated with use . Multivariate analyses revealed that residents of recreational states were more likely to believe that marijuana use impaired memory, and also caused a decrease in intelligence and energy compared with residents of other medically legal and nonlegal states after adjusting for baseline characteristics .Residents in recreational states were significantly more likely to believe that smoking one marijuana joint a day is somewhat or much safer than smoking 1 cigarette a day . Residents of recreationally and medically legal states were more likely to believe second-hand marijuana smoke was somewhat or much safer than second-hand tobacco smoke .

Opinions regarding other relevant public health concerns were largely similar across states: most residents, regardless of legal status in state of residence, agreed that it is unsafe for children and adults to be exposed to second-hand marijuana smoke, and that marijuana use was unsafe for pregnant women. Multivariate analyses confirmed that residents of recreational states were more likely to believe that smoking 1 marijuana joint a day was safer than smoking 1 cigarette a day compared with residents of other medically legal and nonlegal states after adjusting for baseline characteristics . Residents of recreational states were also more likely to believe second-hand smoke from marijuana was safer than second-hand smoke from tobacco compared with residents of other medical and nonlegal states after adjusting for baseline characteristics .In this national study, we found that residents of states that had legalized recreational marijuana use more commonly attributed some benefit to marijuana than residents of medically legal or nonlegal states. We also found that the perception of risks from marijuana use was similar across states. In addition, we found that residents of states where marijuana was legalized were more likely to believe that marijuana smoke was less harmful than tobacco smoke. Finally, use of all forms and multiple forms of marijuana was more common among residents of recreationally legal states. Several national surveys, including the NSDUH and MTF, assess individual risk perception of marijuana use among national samples, and recent research suggests that risk perception has decreased nationwide . Previous research demonstrates that marijuana legalization is associated with decreases in risk perception, as evident from studies examining California pre and post medical legalization in 1999 . More recent research supports this assertion , and while research into the role of recreational legalization specifically is limited, initial data in adolescents suggest recreational legalization has been associated with a considerable decrease in risk perception . While such surveys have adequately examined the decrease in risk perception associated with marijuana, there exists no detail on the types of risks individuals associate with marijuana use or potential benefits individuals assign to marijuana use. Our results show that residents of states where marijuana has been legalized for recreational use have an overall more favorable view towards potential benefits of marijuana use and were more likely to attribute benefits to marijuana use that are not supported by evidence. For example, a majority of respondents endorsed pain relief as a benefit of marijuana use, despite only limited evidence supporting its effect in managing chronic neuropathic pain and no evidence in treating other types of chronic pain . There is no evidence currently available that suggests second-hand marijuana smoke is safer than tobacco smoke and some evidence suggesting it is toxic . When taken in context with previous research demonstrating the decrease in risk perception associated with marijuana use, our findings are significant as they illustrate the need for targeted public health campaigns to combat misinformation specifically in states with recreational marijuana legalization. We found that residents of recreationally legal states expressed less concern regarding second-hand marijuana smoke compared with second-hand tobacco smoke, and were more likely to believe that smoking marijuana is somewhat or much safer than smoking tobacco. These differences in perception are concerning, given the evidence that inhalation of particulate matter in any form is associated with increased cardiovascular risk . The perception that marijuana smoke is relatively safe compared with tobacco smoke has been perpetuated by the spread of inaccurate information on the internet . Some highly frequented internet sites suggest that smoking marijuana has many health benefits, such as improvement of lung health or the slowing of Alzheimer symptoms . There is currently no data to suggest that smoking marijuana improves lung health. On the contrary, recent evidence demonstrates smoking marijuana is associated with coughing, wheezing, and sputum production .

Accordingly, it was asserted at the start of this dissertation that, because of the ongoing changes in the public’s knowledge about and attitudes toward marijuana use, the informational assumptions that individuals maintain at the time judgment are important for understanding their reasoning and ultimate evaluations of the issue. To gain insight into their informational assumptions about marijuana use, respondents were asked to evaluate the act if it was determined to be safe or determined to be harmful. Results provided support for the proposition that the types informational assumptions maintained and the way these assumptions are understood are integral to individuals’ ultimate judgments. The introduction of the ‘lack-of-harm condition’ to respondents who had initially stated a belief in harmfulness resulted in a significant positive shift. The reverse was also true : Respondents who had stated a belief in the safety of marijuana use were somewhat less likely to provide positive evaluations of use after being introduced to the proposition that use was harmful. These findings suggest that informational assumptions about the harm had considerable effects on respondents’ judgments about marijuana use. Importantly, not all the respondents who were asked to consider marijuana use under the proposition that use was harmful were swayed toward negative evaluations of marijuana use. Nearly half of these respondents provided positive or mixed/uncertain evaluations of marijuana use even under the condition of definite harm. This may have resulted for various reasons, such as respondents’ weighing of the harm factor against other relevant considerations. For example,vertical growing system justification results suggest that respondents’ support for the medical use of marijuana and/or for an individual’s right to choose was a prominent consideration in their reasoning .

Such considerations may have ultimately outweighed concerns about the harm involved in use. Thus, findings indicating shifts in marijuana act evaluations under the condition of harm or lack thereof, as well as findings suggesting that the certainty of harm wasn’t necessarily sufficient for all respondents to evaluate the act negatively demonstrate the important role informational assumptions play in judgments of ambiguous social issues. Moreover, these findings imply that the uncertainties about the facts regarding the safety of marijuana use, as well as general shifts in the public’s perceptions of and attitudes toward the issue , may play a significant role in how adolescents evaluate this issue.Because the data for this study were gathered through a convenience sampling of students from multiple periods of the same course in a northern Bay Area school, the generalizability of these findings to the larger adolescent population is limited. It is possible that factors such as respondents’ city of residence, particularly their location in the Bay Area of California , may have been critically influential to respondents’ response patterns . A similar study conducted with adolescents of the same age in a more politically conservative area of the United States may have yielded a different pattern of findings. Moreover, because respondents were all enrolled in the same course, factors like the academic material previously covered in the course or the group’s shared perspectives or experiences may have also contributed to their response patterns. Future studies that include samples of students from various schools or courses in multiple regions of the country would be valuable for improving the generalizability of this study and serving as comparisons for the current findings. Relatedly, it is important to consider the impact of cohort effects on this study’s results. Changes in public perceptions of marijuana, the media’s presentation of the safety, commonality, and general acceptability of marijuana, as well as many other considerations have been impactful to adolescents’ judgments about this issue.

The present study attempted to account for such unknowns by avoiding forced-choice methodologies and instead using a short-answer approach to data collection. However, taking this approach was not necessarily a sufficient means for accounting for the depth and breadth of factors that may have influenced this sample’s judgments, including factors that respondents may not have been conscious of or able to articulate. Future research may benefit from using an interview approach for data collection to gain a degree of clarity about the roles of these variables in adolescents’ judgments. Also because of the ongoing changes in societal perceptions and attitudes toward marijuana use, it may be that these respondents’ judgments about the marijuana use issue would be unstable over time. It is possible that as the research, public perception, and legal status of marijuana change over time, so will judgments about the issue. As an example, the data for this study were gathered before a pivotal election determining the legality of recreational use of marijuana for individuals 21 years of age or older in the state where the data for this study were gathered . Although a significant number of the respondents in this study already indicated positive views toward marijuana use under the condition of a legal age , this kind of significant actual change in legal status has an unknowable impact on judgments; it is likely that such a change would have an impact on respondents’ judgments about marijuana use. These types of societal shifts, as well as other contextual caveats, make conclusive determinations about judgments of marijuana use challenging. Accordingly, the present study can be considered a snapshot of a specific population’s judgments about this issue at a specific time. Ongoing research investigating changes in judgments about marijuana use over time could help elucidate any changes in the controversial nature of various other ambiguous social issues like marijuana use .

The stealing and purchasing music issues were selected as prototypically moral and personal issues to serve as points of comparison to the marijuana issue . The expected pattern of results emerged from the data, showing that stealing was consistently evaluated negatively and justified with moral domain justifications, music purchasing was consistently evaluated positively and primarily justified with personal domain responses, and evaluations of marijuana use were more mixed and showed justification variability. It can be argued that the consequences related to a prototypically moral issue like stealing are more consequential than any potential morally-related consequences of marijuana use. For example, the stealing issue calls to mind concerns about the welfare of others and moral obligations in general. Though these considerations seem at first to stand in contrast to considerations regarding marijuana use, a review of respondents’ justifications provides evidence suggesting that the marijuana use issue also has features of such prototypically moral issues. Results from the present study indicated that, though they were not prompted to consider the medical use of marijuana, respondents frequently referred to this consideration. Respondents who provided Medical Purposes justifications often stated that marijuana could be beneficial for the well being of individuals who benefit from its use for medical reasons and that it therefore would be unfair or unjust to disallow its use. In fact,marijuana drying as previously explained, justifications referring to medical uses would be classified under the Welfare justification category of the moral domain . Thus, this consideration suggests that not only is marijuana use relevant to the moral domain, but is perceived to have critical ramifications on the lives of others in similar ways to other more typically moral issues such as stealing. In addition to considerations of the medical benefits of marijuana use, respondents also made frequent references to personal choice justifications when explaining their reasoning. Though these responses were coded as personal domain justifications, respondents’ arguments when stating this justification frequently referred to the importance of the individual’s right to choose what he/she does with his/her mind and body. Arguably, this line of reasoning may have been represented in the Justice/Rights category of the moral domain as many respondents asserted that taking away one’s right to choose to use marijuana was akin to taking away any other personal freedoms. These examples are provided to demonstrate that, in some ways, individuals have come to view marijuana in terms of morally-relevant consideration like welfare, justice, and rights. Accordingly, comparing a multi-faceted issue like marijuana use to a prototypical one like stealing helped provide insight into the salience and importance of different informational assumptions adolescents draw upon and coordinate in the process of forming judgments about social issues. Interestingly, whereas some respondents primarily referred to the importance of having the right to choose whether to use marijuana , others found this justification less weighty in their evaluative process. For example, results suggested that respondents were in fact more likely to reference prudential as well as conventional considerations when justifying their responses to the marijuana use items. This stood in contrast to their primarily personal domain justifications for the music item set. Their justifications to the music items, as well as their consistently positive evaluations of the act of purchasing music , provided a point of contrast to their more variable evaluations and justifications of marijuana use.

Comparisons of the prototypically moral and personal issues selected for this study thus provided greater clarity about the differences between adolescents’ conceptualizations of this multi-faceted/ambiguous social issue and their understanding of other more unequivocal social issues. Accordingly, future research in this field may likewise benefit from the inclusion of such prototypical issues to allow for comparisons and deeper insights into the topic issue.Additional noteworthy considerations for future research emerged from this study’s results. Because of the relative prevalence of this consideration among the respondents in this sample, as well as its the moral relevance , study-design that distinguishes the medical use of marijuana from use for recreational reasons may prove to be worthwhile in future research on this issue. The absence a of distinction between these two different uses of marijuana seemed to cause uncertainty regarding the basis for some of the positive evaluations of marijuana in the present study. For example, it was unclear when and to what extent respondents’ positive evaluations of marijuana use were based on considerations of medical use, recreational use, or both. Making this distinction would therefore provide more constructive information about judgments and further elucidate their reasoning about the issue. Additional questions teasing apart adolescents’ judgments about the harm involved in marijuana use and about the age at which they are more or less likely to consider use acceptable would likewise provide valuable data on their perspectives on the issue. The present study asked respondents whether they thought that frequent marijuana use causes physical or psychological harm to the user . Future research may consider the inclusion of additional questions about whether respondents think any use causes harm and/or questions about how much use is thought to be associated with what degree of harm. Moreover, additional open-ended questions about the age at which respondents think marijuana use is acceptable would add valuable information regarding their reasoning about marijuana use . Respondents at times reported that setting the legal age for marijuana at 21 would be appropriate because development is generally complete by this age, because adults of this age are mature and responsible enough to make their own choices about use, and because the effects of marijuana use are comparable to that of alcohol use so these substances should be treated similarly. Such considerations entice further questions about how adolescents would evaluate and reason about marijuana use at different ages . Thus, questions asking respondents to distinguish between the specific purpose of use, frequency of use, and the user’s age would provide further clarity into results and allow for greater insights into adolescents’ reasoning about this issue. As the field of education and psychology has grown and research on child development has advanced, so has our understanding of adolescent cognition. In many ways, adolescents are still children who are developing their understanding of their social worlds by assimilating new information with old and by reconciling the inconsistencies that arise. With new experiences and with new knowledge, thinking becomes more complex and judgments more nuanced . Transitions in adolescents’ social world, including advances in research, shifts in public policy and perception, and various other contextual changes in which adolescents function have important effects on how they conceptualize and reason about social issues. In the present study, adolescents’ judgments and justifications about one social issue in particular, marijuana use, was investigated using the social domain theory framework. Results supported the hypothesized ambiguity of this issue and demonstrated the complexity in adolescent reasoning about the act.

Table 6 presents results of general act evaluations and age contingency act evaluations for the stealing and music issues. The results for the marijuana use items that are counterparts to these questions are also presented in this table as point of comparison. Results indicate considerable differences between respondents’ evaluations of stealing and purchasing music in general, as well as under the age contingency and common practice conditions. Judgments about the legality of these issues also show a contrast . Moreover, respondents’ more homogenous judgments about stealing and purchasing music show considerable differences with their judgments about marijuana use. Similarly, results indicate differences between respondents’ judgments about the legality of marijuana use as opposed to stealing or purchasing music – these results are presented in Table 7. As mentioned above , statistical contrast comparisons were not possible for the stealing and music issues due to the lack of response variance. Descriptive statistics are presented and discussed instead.The third research question asked how respondents conceptualize marijuana with regard to the criterion judgments found to be associated with the social domains. Criterion judgments were evaluated using the hypothetical conditions proposed in the second part of item 2 and item 4 1 . Criterion judgments were assessed through an evaluation of response patterns to contingency questions about the legality of the issue or the commonality of the issue. It would be expected that, based on the characterization of moral issues as obligatory, non-alterable, and generalizable, judgments about these acts should be consistent despite any conditions or contingencies placed on the act. This is in contrast to conventional domain issues that are by definition rule-, authority-, or context-dependent.

Moral and conventional issues stand in contrast to personal domain issues,cannabis drying which are non-moral and not part of the conventionally regulated system. Comparisons between results of items 2a/b and 4a and results of the corresponding prototypical moral and personal issue items provided further evidence for the ambiguous nature the marijuana use as compared to these prototypical issues. Table 8 provides a summary of the criterion judgment results.Results from item 2a and 2b asking respondents about the acceptability of the act in the case that it is legal or illegal are presented first. When presented with these conditions, the differences in the evaluations of marijuana use became non-significant. Respondents who had initially agreed that there should be a law prohibiting marijuana use were directed to consider whether marijuana use would be all right if there was no law prohibiting use . Among this group , a plurality said use would be all right in this case, 27% of respondents continued to maintain that use would still not be all right, and 13% provided mixed responses. However, these differences were not significant = 5.85, p = .055. Respondents who agreed that there should not be a law prohibiting marijuana use, on the other hand, were directed to consider whether marijuana use would be all right in the presence of a law prohibiting use . There were no significant differences in evaluation response patterns under this condition = 0.36, p = .849. This suggests that the added condition of a law against use was not sufficient to significantly sway these respondents to a negative evaluation of marijuana use . Instead, respondents in this group were evenly split in their evaluations of marijuana use; 35% said marijuana use would be all right even if there was a law prohibiting the act, 32% said that use would not be all right if there was a law against it, and 30% provided mixed responses . Pairwise contrasts between responses to item 2 compared to item 2a and responses to item 2 compared to item 2b could not be calculated because of the lack of variance in responses . Due to the lack of variance, cross-tabulations were also not possible.

Criterion judgments regarding marijuana use were further assessed by item 4a asking respondents about the acceptability of the act in the case that it is not commonly practiced. Respondents who had previously agreed that marijuana use would be all right if it was common practice for people to use marijuana were directed to consider whether marijuana use would be all right if use was not common practice. Results showed significant differences in response patterns, with most respondents reporting that use would be all right under even under the condition that it was not commonly practiced = 6.18, p = .041. Among this group , 47% of the respondents said use would be all right even if this was case while 24% of respondents indicated that use would not be all right and 29% provided mixed responses . A pairwise contrast between item 4 and 4a was not statistically significant = 4.39, p = .112. This suggests that there were no significant shifts in respondents’ evaluations of marijuana use. That is, when comparing responses to item 4 and item 4a, there was not a significant change in the number of respondents who provided positive, negative, or uncertain evaluations of marijuana use .The criterion judgments questions for the stealing and music issues were evaluated using the items that asked respondents to judge the act of stealing and the act of purchasing music under the condition that the act was legal/illegal or commonly practiced. Like act evaluation results above, the criterion judgments results for the stealing and music items also followed expected patterns and further demonstrated the difference between judgments regarding the marijuana use issue and these more prototypical issues. Table 8 presents the findings from the criterion judgment items by act/issue. Response patterns provided support for the proposition that responses to contingencies placed on the stealing and music purchasing acts would be less subject to change than marijuana use because of the moral and personal characteristics of these acts. Specifically, responses were expected to remain generally negative for the stealing items and generally positive for the music items whether or not that the acts are legal or common.

The significant majority of respondents maintained that stealing would be unacceptable even in the absence of a law prohibiting the act; 82% maintained that the act is not all right, even under this condition = 152.49, p < .0001. Likewise, a significant majority of respondents indicated that stealing would not be all right even if it was a commonly practiced act = 81.18, p < .0001. In contrast, the significant majority of respondents maintained that purchasing music would be acceptable even in the presence of a law prohibiting the act = 92.165, p < .0001. Notably, some respondents did state that purchasing music would not be all right if there was a law prohibiting the act – these respondents often stated that though such a law would be unfair or unwarranted,indoor grow methods individuals should nevertheless abide by the laws. Not surprisingly, most respondents indicated that purchasing music would be all right if it was commonly practiced = 86.17, p < .0001.Respondents’ general evaluations of marijuana use and their informational assumptions about marijuana use were compared. A pairwise contrast between items shows a statistically significant difference = 19.4, p = .001 with a medium effect size . There was a moderate negative correlation between items , suggesting that respondents who reported that marijuana use was not all right were more likely to report that use causes harm . Respondents who chose depends to the general marijuana use question were also more likely to report that use causes harm . On the other hand, respondents who reported that marijuana use was all right were least likely to report that use causes harm . Results thus suggest that evaluations of the acceptability of marijuana use was inversely correlated with informational assumptions about the presence of harm; those who said marijuana use was all right were more likely to think marijuana use doesn’t cause harm to the user while those who said marijuana use was not all right were more likely to report that marijuana does cause to the user. Additional cross-tabulation analyses of these items provided additional details regarding response patterns. These results are presented in Table 10. Results indicated that, of the respondents who generally evaluated marijuana use as acceptable , 39% also reported that frequent marijuana use causes harm to the user while 40% of this group provided mixed or uncertain responses about the harm involved with marijuana use. Most respondents who initially provided positive evaluations to marijuana use went on to agree or partially agree that frequent marijuana use causes harm to user. Only 21% of the respondents who had initially evaluated marijuana use as acceptable went on to report that marijuana use does not cause harm. Not surprisingly, of the respondents who had generally negative evaluations of marijuana use , 100% indicated that frequent marijuana use causes harm to the user. Of the respondents who had mixed evaluations of marijuana , 74% stated that frequent marijuana use causes harm to the user and 23% provided uncertain evaluations regarding the harm involved with use.

These findings suggest that while most respondents agree that frequent marijuana use causes harm to the user, this factor does not seem to be sufficient to lead respondents to evaluate marijuana use negatively. This suggests that other considerations aside from harmfulness are impacting their judgments about marijuana use. Justification results presented in the next section provide further information about respondents’ reasoning and help elucidate their evaluations.Results of the hypothetical follow-up questions to item 5 are presented in Table 11. Respondents who said that frequent marijuana use does cause harm to the user were directed to consider whether marijuana use would be all right if scientists conclusively determined that use is not harmful . Results indicated a significant interaction; respondents were more likely to report that marijuana is all right under the condition that marijuana was determined not to be harmful = 68.08, p = < .0001. Among this group , most said use would be all right under this condition, while 11% of respondents maintained that use was not all right, and 10% provided mixed/uncertain responses. By contrast, respondents who reported thinking that frequent marijuana use does not cause harm to the user were directed to consider whether marijuana use would be all right or not if scientists were to conclusively determine that use is harmful. Results showed significant interaction; respondents were more likely to report that marijuana would not be all right under this condition = 6.08, p = .04.Among this group , more individuals stated that it was not all right in this case than those who said it was all right: 48% said that marijuana use would not be all right if it was conclusively determined that use was harmful , 33% said that marijuana use would still be all right even if it was determined to be harmful, and 11% provided mixed responses. A pairwise comparison between item 5 asking whether respondents think frequent marijuana use is harmful and item 5a asking whether use would be acceptable if marijuana was determined to be harmless indicated a statistically significant contrast between these items = 6.32, p = .043 with a medium effect size . This suggests that respondents who reported that marijuana harms the user were also more likely to evaluate use as all right in the case that it was conclusively determined to be harmless to the user. On the other hand, a pairwise contrast between item 5 asking whether respondents think frequent marijuana use is harmful and item 5b asking whether use would be acceptable if marijuana was determined conclusively to be harmful was not statistically significant = 5.48, p = .241. Therefore, it is not possible to determine whether there is a significant relationship between respondents’ informational assumptions about the harm involved with marijuana use and their evaluations of marijuana under the condition that it is conclusively harmful.Respondents’ justifications were elicited through questions asking them to state their reasons for each of their evaluations. These justifications were coded according to the categories summarized in Table 2.When subjects provided more than one justification for anitem, all justifications were coded and represented.

Briefly, issues in the moral domains are defined as obligatory, non-alterable, and generalizable. This stands in contrast to evaluations in the conventional domain; the criterion characteristic of acts in the conventional domain include judgments of wrongfulness that are 1) contingent on rules, authority, and existing social practice, and 2) tied to aspects of the social context . In contrast to moral and conventional domains, the personal domain encompasses non-moral issues that are “not part of the conventionally regulated system” , but are instead considered to primarily apply to the individual and therefore to be within the realm of an individual’s personal prerogative. Although some social issues clearly fall under one domain or another, other more intricate social issues are not always as clear-cut and therefore not consistently judged to be within one domain. In fact, there seem to be developmental trends in the ways in which children and adolescents reason about complex social issues. Nucci and Turiel explain the complexity of the reasoning process during moral development: Development moves from early childhood set of judgments about unprovoked harm to notions of fairness as regulated by just reciprocity. Along with this understanding of fairness, however, comes an expanded capacity for incorporating facets of moral situations that render the application of morality more ambiguous and divergent. Thus, rather than presenting a straightforward picture of moral development as linear moral ‘progress’ toward shared answers to moral situations, moral development includes periods of transition in which the expanded capacity to consider aspects of moral situations leads to variations in the application of moral criteria . Because adolescence is a time in which individuals are beginning to broaden their repertoire of social knowledge and gain exposure to the various elements involved in social issues,curing cannabis the ability to effectively reason about and understand social matters is still expanding and transforming.

With development, adolescents’ capacity for recognizing and incorporating multiple aspects of an issue increases the potential for complexity and variation in judgments . The capacity to incorporate the various features of a single issue is a part of reasoning about multi-faceted or more ambiguous social issues, or issues involving numerous components. Ambiguous issues can be differentiated from “prototypical” moral and personal issues through the application of the criteria commonly used to define and study social domain issues . A large body of research has provided ample evidence that certain criterion judgments are applied to issues that are unambiguously moral, conventional, or personal . With regard to marijuana use, specifically, each of the social domains can be seen to be pertinent to the issue. For example, issues within the moral domain are those that include evaluations that an act is wrong regardless of the convention/context and therefore not based on the existence of rules or command of an authority figure . Marijuana use may have facets related to the moral domain, as individuals may reason that using marijuana is physically harmful or harms others because it hurts society at large when people engage in illegal acts. On the other hand, other judgments about an individual’s personal rights and freedoms to do as he/she wishes with his/her own body may become salient but stand in contrast to the ‘other-focused’ moral considerations just described. In the sections that follow, I consider why marijuana use is an “ambiguous” social issue involving several, at times contradictory, considerations that make judgments less consistent among individuals. Several factors have contributed to the complexity of the marijuana use issue, and relatedly, the evolution and continued ambivalence of public thinking about marijuana. A brief overview of the trajectory of public information, opinions, and behaviors regarding marijuana over the past few decades may assist in further elucidating the basis for the increasingly controversial and ambiguous nature of marijuana use.

The public’s understanding, perspectives, and attitudes toward marijuana use have undergone substantial changes in the past few decades. These changes are in large part due to the advances in scientific research on marijuana, as well as shifts in the commonality and illegality of marijuana use. Earlier in the 20th century, the effects of marijuana use were in many ways unknown and merely speculated about. Public opinions and fears about marijuana are partly illustrated by the 1930’s movie, Reefer Madness, which through a dramatization of the devastating effects of marijuana use , fostered public fear and alarm about its use. However, by the 1960’s and 70’s, previous anxieties and frightful speculations about the detrimental consequences of marijuana use soon transformed into more lax attitudes about what had become a commonplace drug. Furthermore, as extensive research made marijuana and its effects far less elusive than it had been in previous generations, public opinion about the drug seemed to move in the direction of greater acceptance and less restrictiveness. Interestingly, however, as further research has provided clearer data on the positive and negative effects of marijuana use, and as use of the drug has become more unremarkable, the issue has become more contentious. This is partly due to mixed findings about the benefits and harm associated with marijuana use. For example, besides clarifying that the impact of the drug on the brain and body is less consequential than previously assumed, research has suggested that marijuana may be beneficial for use by patients with certain diagnoses, such as cancer, glaucoma, and various chronic pain conditions. Accordingly, debates about the true harmfulness of the drug have led to questions and concerns about the legitimacy of its illegality and the reaches of individuals’ personal freedom to choose to engage in use or not. On the other hand, because the use of marijuana remains illegal in most states, trafficking of marijuana continues to be a lucrative business, one related to gangs and cartel crime as well as many drug-dealing related deaths each year.

So, whereas much of the American public has come to understand the immediate harm of marijuana use to be more marginal, concerns over the indirect harm caused by the purchase and sales of illegal substances, in addition to considerations of the general harm caused by any form of drug use, are some of the factors making marijuana a moral issue for many individuals. Given that various considerations make marijuana use a complex issue even for many adults in American society, it is not surprising that research on adolescents’ evaluations of marijuana use have likewise suggested the ambiguity of the matter through inconsistent and/or multilayered findings . Besides the ambivalence over the morality of marijuana use, conventional considerations are also indeterminate. Marijuana has become so easily accessed and commonly used in the general populace, public perception and reaction to the use of marijuana has become more relaxed and tolerated in many cities across the United States. In fact, in the recent 2012 and 2016 elections, the states of Colorado, Washington, Oregon, California, Massachusetts, Maine, Nevada, and Alaska voted to make the recreational use of marijuana legal. Moreover, a total of 26 states have legalized the use of marijuana for medical purposes since the 1970’s. Indeed, debates regarding the effectiveness and purpose of the illegality of marijuana use have been taking place for several years, making marijuana illegality a controversial issue. Practical considerations such as the benefits of legalizing, controlling, and taxing the sales of marijuana have also become compelling arguments for legalization. The politically-charged controversy,how to dry cannabis in conjunction with the dramatic legislative changes in the acceptability of marijuana use, elucidate some of the ambiguity around the legitimacy of the illegality of marijuana use. This in turn lends support to the proposition that marijuana use may be an ambiguous social issue for many individuals in society. This ambiguity is in turn reflected in research indicating that adolescents perceive each of the social domains to be relevant to the marijuana issue . Furthermore, with regard to adolescents specifically, risk-taking behaviors have come to be considered a quintessential part of the adolescent period and, arguably, an important part of the process of adolescent identity formation and social development . However, certain adolescent risk-taking behaviors, such as drug and alcohol use, have become particularly common and have generated a great deal of concern in the past few decades. In fact, adolescent engagement in marijuana use has gained greater public attention for the past several years. This is likely due to the fact that, with over 21% of youth reporting use, marijuana is the most highly used drug among adolescents, even surpassing the proportion of youth who use cigarettes . More specifically, findings from the 2016 Monitoring the Future Survey, suggest that 6% of high school seniors report daily marijuana use and about 35% report using marijuana in the past year .

Increases in the availability and commonality of marijuana, in conjunction with the controversy around the issue, have made marijuana a public ‘hot topic’ that continues to warrant debate and dubiousness among many individuals. In addition to the timeliness and relevance of this issues, the commonality of marijuana use among adolescents and the negative potential consequences early engagement in use can have on adolescents’ life trajectory make research about decisions to engage in marijuana use a valuable and relevant area of study. Moreover, common public belief and anecdotal cases have come to suggest that marijuana may be ‘gateway drug’ leading to experimentation with and use of even more dangerous and addictive drugs and lifestyle choices . Such concerns not only highlight the pragmatic relevance of the issue, but also further suggest the value of studying the cognitive processes that precede and predict adolescents’ decisions to engage in use. Ongoing research indicating both positive and negative consequences of marijuana use has contributed to the continuous confusion and controversy about it. For example, research has suggested that not only does marijuana use have temporary negative impact on cognitive functions such as memory, attention, learning, and decision-making, but it has also been linked to negative long-term consequences such as decreased academic performance and increased risk of poverty, unemployment, and anxious mood . On the other hand, research has also demonstrated several uniquely effective benefits of marijuana use, including relief from pain, nausea, insomnia, anxiety, or addiction to other substances . Advancing research and the resultant shifts in the public’s understandings and perceptions of risks involved in marijuana use have led to changes in behaviors. According to research by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, the percentage of adolescents who report perceiving ‘great risk’ in smoking marijuana once a month decreased from 34.4% to 24.2% from 2007 to 2013. Likewise, the rate of adolescents who perceived ‘great risk’ in smoking marijuana once or twice a week decreased from 54.6% to 39.5% within this same time frame. Along with this decrease in adolescents’ perceived risk of marijuana use came a respective increase in the prevalence of adolescents reporting engagement of marijuana use during this 2007 to 2013 time frame. Shifts in teens’ perceptions of the safety of marijuana use, and the associated behavioral changes that seem to have accompanied these shifts, further highlight the evolving nature of public understanding of this issue. These changes coupled with the dearth of conclusive scientific information about the short- and long- term consequences of engaging in use make research on reasoning about marijuana use particularly worthwhile. The examples discussed above regarding the ambiguity of marijuana use indicate that many factors and considerations could become salient and hold more or less weight when an individual is reasoning about the legitimacy of marijuana use. It is the multiplicity of facets involved in an issue that in fact make it ‘ambiguous,’ or otherwise known as ‘non-prototypical.’ Non-prototypical issues differ from those that are clearly within a single social domain because they involve considerations that cross different domains of reasoning, and thereby, require one to coordinate these the various consideration during the reasoning process. In contrast, prototypical issues do not typically summon multiple domain considerations. For example, judging the morality of murder does not conjure concerns about personal freedom or the right of the murder to kill his victim. Instead, issues of welfare, justice, and rights become salient, making the issue of murder clearly understood to be within the moral realm. Non-prototypical issues are thus by definition ‘not prototypes,’ or not typical of domain because they involve variable considerations that may fall within more than one domain .

We sent out the survey on September 27, 2017, and responses were completed by October 9, 2017. Participants are reminded to complete the survey 3 days after the initial survey is sent. As modest incentives to encourage survey completion, participants are entered into raffles or sweepstakes with both cash rewards and other prizes. Participants are provided with no more than six surveys a month and are expected to complete an average of four surveys a month. The median time for survey completion was 8 min. Sampling was stratified by legalization status of marijuana in the state of residence . California residents and young adults aged 18 to 26 years old were over sampled to facilitate a future investigation into the role of recreational legalization on use patterns among young adults in California. Sampling weights were provided by GfK. The University of California, San Francisco Committee on Human Research considered this study to be exempt.Details of survey development have been previously published.The survey development team comprised multidisciplinary research staff and investigators. We asked about a wide range of topics, including perception of risks and benefits associated with marijuana use, comparisons of marijuana to other substances , and pertinent public health questions relevant to implementing marijuana legalization. We also asked detailed questions about marijuana use and conducted reliability testing among 300 current marijuana users. Reliability testing was only conducted on questions related to marijuana use. Questions were either derived from previously published national surveys or created internally after several iterations and pilot tests with volunteers . Volunteers were comprised of a panel of patients from the investigator’s clinics and were offered no incentives to volunteer.We asked about the most influential source of information about marijuana as follows: Which information source about the benefits and risks of marijuana is the most influential for you?

Response options were friends, relatives, health professionals , politicians, law enforcement professionals, traditional media platforms , Google or other Internet searches, social media platform , advertisement ,rolling greenhouse tables marijuana dispensary or other marijuana industry sources , and other. Only one most influential source was allowed per respondent. For the purposes of analysis, some response categories were grouped as follows: friends or relatives; social media platform or the Internet; politician or law enforcement professional; and advertisement, marijuana dispensary, or other marijuana industry sources.We asked several questions aimed at assessing the extent to which individuals endorsed commonly circulated misinformation about marijuana. A Likert scale was used to respond to each question. The questions were as follows: smoking marijuana has preventative health benefits, how safe is it to expose adults to secondhand marijuana smoke?, how safe is it for pregnant women to use marijuana?, and how addictive is marijuana? A 4-point Likert scale was used to answer questions 1 through 3 and a 3-point Likert scale was used to answer question 4. We chose these statements given that the evidence to support these claims is lacking. The notion that marijuana has preventative health benefits remains unproven.While less is known about the harms of secondhand exposure to marijuana compared with secondhand exposure to tobacco,there is an emerging body of literature using animal studies and studies in humans suggesting that marijuana smoke may be toxic. In addition, exposure to particulate matter is associated with cardiovascular and respiratory risks.There is an emerging evidence base suggesting marijuana use during pregnancy may adversely affect fetal development.The American College of Obstetricians and Gynecologists recommends avoidance of marijuana use during preconception, pregnancy, and lactation, citing concerns for impaired neurodevelopment and maternal and fetal exposure to the adverse effects of smoking.

Finally, while the threshold for addiction to marijuana is higher compared with other addictive substances among adults, it is a recognized clinical problem which is encapsulated within the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition diagnosis of Bcannabis use disorder.Characteristics of the survey respondents and most influential sources of information were weighted using weights provided by GfK to approximate the US population based on age, sex, race/ethnicity, education, household income, home ownership, and metropolitan area. All analyses used weighting commands using the weight variable provided by GfK to generate national estimates. To determine how well our sample compared with a national federally sponsored survey on substance use and marijuana use, we first compared the socio-demographic characteristics of our survey respondents with those of the National Survey on Drug Use and Health .The NSDUH is an annual federal survey implemented by the Substance Abuse and Mental Health Services Administration , which is an agency of the Department of Health and Human Services . The NSDUH provides data on substance use epidemiology in the US.We conducted multivariate logistic regression analyses to examine the association between each source of information about marijuana , the belief of any or all statements defined as misinformation about marijuana adjusted for socio-demographic characters , and legalization status in the state of residence. There was a separate model for each source of information, and the referent in each model was all other sources of information. Analyses were performed using R statistical software .The most influential sources of information about marijuana were health professionals , traditional media platforms , friends or relatives , and social media or the Internet . Individuals reporting social media or the Internet , the marijuana industry , and friends or relatives as the most influential source of information about marijuana were more likely to believe any statement consistent with misinformation about marijuana in comparison with those who reported other sources as most influential .

In contrast, those who reported health professionals , traditional media platforms , and politicians or law enforcement professionals as the most influential information source were less likely to believe any statement. Individuals reporting the marijuana industry as the most influential information source were more likely to believe all statements in comparison with those who reported other sources as most influential. Individuals reporting traditional media platforms as the most influential source were less likely to believe all statements. Findings on associations between sources of information and beliefs were also generally consistent when examined according to individual beliefs .In a nationally representative survey of US adults, the most influential sources of information about marijuana were health professionals, traditional media platforms, friends, relatives, social media, and the Internet. Individuals reporting social media or the Internet, the marijuana industry , and friends or relatives as the most influential source of information about marijuana were more likely to believe unsubstantiated claims about marijuana. We found that individuals who identified the marijuana industry as a source of information were more likely to believe misinformation. The marijuana industry is a growing multi-billion-dollar business, and it is supported by influential trade and lobbying groups and venture capital investment.Although there is little evidence to support these claims, the marijuana industry promotes marijuana as a potential treatment for nausea during pregnancy,ebb and flow rolling benches in addition to a potential treatment for conditions such as autism, cancer, and diabetes.Both Health Canada and the US Food and Drug Administration have issued warning letters to marijuana producers and distributors as a result of their advertising claims.In November 2017, the FDA issued warning letters to several online marijuana purveyors for making unsubstantiated claims that their products could prevent, diagnose, treat, or cure cancer. Thus, the marketing of marijuana, which inadequately regulated, may have a role in shaping misinformed public views on marijuana. Without more effective marketing regulations, the marijuana industry may continue to disseminate unfounded claims about marijuana with potentially harmful public health consequences.Unlike the growth of the tobacco industry, which came of age prior to the advent of the Internet, the marijuana industry has the opportunity to promote its expansion with marketing on the Internet and social media, where regulation is minimal and relatively undefined.Despite policies restricting marijuana advertising on Facebook and Google,prior work has demonstrated the predominance of positive messaging about marijuana and normalization of its use on Twitter and other Internet sources .

Furthermore, there is an abundance of articles listing unproven health benefits of marijuana on the Internet, many targeting consumers in different countries. Given the extent of misinformation about marijuana on the worldwide web, it is not surprising that adults who believed misinformation were more likely to obtain information from social media and the Internet. Public health campaigns that use social media are necessary to combat misinformation about marijuana. Unregulated promotion on the Internet and social media has public health ramifications for consumers worldwide and poses a challenge to public health leaders and policymakers. Our findings point to the need for investment in public health campaigns to better communicate risks to the public. Moreover, these results suggest the need for a targeted and cohesive strategy on the part of health providers to address misinformation with patients. Due to a lack of evidence and possible therapeutic benefit of some forms of cannabis for specific indications, physicians have not been able to provide a clear or unified message to the public. In contrast, individuals who reported traditional media platforms as the most influential information source were less likely to believe misinformation. There is roughly equal representation of pro- and anti-legalization viewpoints by traditional news outlets,and it is possible that balanced reporting could have counteracted the development of misperceptions. The lower risk of believing misinformation could also reflect restrictions on marijuana advertising on traditional media outlets.However, it is important to note that several unrelated factors could contribute to this association, including unaccounted for demographic information or the intended audience of a traditional media outlet .The response rate of our survey was 55%. However, the response rate was similar to that of other Internet surveys.Use of an Internet survey might limit generalizability because individuals who choose to join an ongoing Internet panel may be different from individuals who choose not to participate. However, studies that have examined non-response to panel recruitment in GfK’s Knowledge Panel have found no evidence of non-response bias in the panel on core demographic and socioeconomic variables. In addition, while there were some differences in income distribution in the sample compared with the NSDUH, the respondents of both panels were very similar in terms of age, gender, race/ethnicity, education, household size, and employment status. Additionally, it is important to note that the survey questions and response items analyzed in this paper could have been interpreted differently by respective respondents. We did not conduct reliability testing of the opinion questions, and it is possible that the wording of the questions introduced bias that may have impacted interpretation by the respondents. Specifically, describing information sources as Bmost influential may be perceived differently between respondents. Additionally, we did not offer an BOther or BUnknown category for respondents when choosing an answer. Though a deliberate decision to force participants to choose an answer to obtain an understanding of prevailing views, this may have biased responses. Future research should include more psychometric testing of the items to minimize bias introduced by the content and order of the questions. Finally, we were unable to examine causal relationships between sample characteristics and endorsement of misinformation. Our results are only able to demonstrate association.Marijuana use is legal for medical and/or recreational purposes in thirty-three states, including the District of Columbia.Use of marijuana has steadily increased along with growing availability through legalization. The National Survey on Drug Use and Health found past-year marijuana use among US adults doubled over the last decade, rising to 13.3% in 2014.Of those who used marijuana in the last year, 90.2% reported recreational use only, 6.2% reported medical use only, and 3.6% reported use for both purposes.However, commercialization of marijuana along with direct to consumer advertising in recreational dispensaries, on the internet, and through social media allows self-medication without the involvement of healthcare professionals. In addition, the increasing rate of marijuana use has been paralleled by a decreasing perception of harm. Therefore, many Americans may be using marijuana for reasons not supported by evidence.Chronic pain has been more widely studied than other conditions, with most trials focusing on neuropathic pain.While many of these trials demonstrated benefits in reducing pain, most used pharmaceutical cannabis extracts not available in the USA or federally available research-grade marijuana that differ considerably from products used by consumers. Therefore, a recent review by the National Academy of Sciences concluded that more evidence is needed to explore the proper forms, routes, and dosages of marijuana for use in chronic pain.

The NEO Five-Factor Inventory ascertained characteristics according to the five factor model of personality: degree of neuroticism, extraversion, openness, agreeableness, and conscientiousness. Parents were given the Child Behavior Checklist to assess level of psychopathological syndromes. The SWM task consisted of 18 21-second blocks that alternated between resting fixation, baseline vigilance, and working memory conditions. Each block began with a one-second word cue that indicated the type of upcoming block. In the SWM condition, the word “WHERE” cued subjects to remember the locations of abstract line drawings that were individually presented in one of eight spatial locations on a screen. Subjects were instructed to press a button every time a figure appeared in the same location as a previous design within that block, regardless of the shape. Unbeknownst to subjects, repeat location stimuli were 2-back, and 3 of 10 trials in each block were targets. The baseline vigilance condition began with the word “DOTS”, followed by presentation of the same abstract stimuli shown in the same possible spatial locations as in the SWM condition; subjects were to press a button every time a figure appeared with a dot above it . Resting blocks displayed the word “LOOK” followed by presentation of a fixation cross in the center of the screen. For both the vigilance and working memory conditions, stimuli were presented for 1000 ms with an interstimulus interval of 1000 ms . All teens were trained with a 4-minute version of the task and monitored to ensure comprehension of task instructions prior to scanning. Responses were collected with a fiber optic button box. The toxicology procedure was designed to minimize the possibility that participants used substances in the 28 days prior to fMRI assessment. Cannabinoid metabolites remain detectable in urine for at least four days and 27 days on average in heavy users .

Urine samples were collected 2 – 3 times per week during the 28 days prior to the fMRI session to detect metabolites indicating recent use of cannabis grow systems,amphetamines, methamphetamines, benzodiazepines, cocaine, barbiturates, codeine, morphine, phencyclidine, and ethanol. Samples were analyzed in the VA Medical Center laboratory using cloned enzyme donor immunoassay assay kits . Observed sample collection reduced the possibility of participant tampering. Quantitative indices from samples were tracked to determine if cannabinoid metabolite levels decreased over the 28 days. Youths with initial samples positive for cannabis remained eligible if the values continued to decrease. If levels increased, the participant was given one chance to restart the 28-day toxicology screening process. Three quarters of marijuana users successfully completed this toxicology screening indicating abstinence for 28 days before scanning, and only these 15 subjects were included in analyses. Participants who were unable to complete 28 days of abstinence were not scanned, and were more likely to be male and slightly heavier users than those who remained abstinent. Imaging data from each teen were processed and analyzed using Analysis of Functional NeuroImages . Prior to statistical analyses, the time series data were corrected for motion by registering each acquisition to a selected repetition with an iterated least squares algorithm , creating an output file specifying adjustments made for three rotational and three displacement parameters for each participant. Using deconvolution processing , the time series data were correlated with a reference function coding the hypothesized BOLD signal across the task and modeling anticipated delays in hemodynamic response . This multiple linear regression approach yielded a fit coefficient for each subject in each voxel, representing the relationship between the observed and hypothesized signal change while controlling for linear trends and degree of motion correction applied. Fit coefficients were obtained for contrasts between SWM and vigilance conditions, SWM and fixation, and vigilance and fixation. Anatomical and functional datasets were warped into standard space , and functional data were resampled into 3.0 mm 3 voxels and smoothed with a 5.0 mm full-width half-maximum Gaussian filter. Group differences in BOLD response contrast to SWM relative to vigilance were evaluated using independent samples t-tests in each brain voxel.

Single sample t-tests identified regions of task-related brain response in each group separately. Tocontrol for Type I error, significant group difference clusters consisted of contiguous significant voxels that exceeded 1328 µl in volume, yielding an overall clusterwise α = 0.05. To understand the nature of group differences between SWM and vigilance brain response, we performed follow-up analyses examining SWM relative to fixation, and vigilance relative to fixation, in each significant cluster. Exploratory follow-up regressions among MJ teens determined the influence of substance use and behavioral characteristics on BOLD response in brain regions demonstrating significant group differences. This study examined fMRI brain activation during a spatial working memory task among marijuana using teens and controls after 28 days of monitored abstinence, verified by biweekly urine toxicology screens. Despite similar overall patterns of brain response to SWM, group differences were observed in right dorsolateral prefrontal cortex, right posterior parietal cortex, medial superior occipital cortex, and medial inferior occipital cortex. MJ teens displayed reduced SWM BOLD response relative to control teens in right dorsolateral prefrontal cortex, which is consistently implicated in spatial working memory . In contrast, our previous work revealed increased SWM response in this region among heavy alcohol and marijuana usingteens who had been abstinent an average of just 8 days . Kanayama and colleagues also observed greater dorsolateral prefrontal response among adult heavy marijuana users on a similar SWM task 6 – 36 hours after marijuana use. However, after 25 days of abstinence, adult marijuana users showed decreased left dorsolateral prefrontal blood flow during a modified Stroop task . Moreover, during visual attention, active marijuana users with positive urine toxicology screens evidenced greater reductions in right prefrontal fMRI response than abstinent users . Considered together with the results of the current study, these findings suggest a change in neural recruitment throughout the course of abstinence. This could relate to residual drug effects or withdrawal symptoms during early abstinence, less need for neural compensation, or a change in neurocognitive strategy as the brain adapts to different stages of sobriety.

We did not observe a correlation between brain response and recency of marijuana use in this sample, but most neuropsychological recovery appears to occur during the first week of abstinence . Thus, there may be little change in neurocognitive functioning after 28 days of abstinence, or such an effect may be too subtle to detect with a relatively small sample. Careful examination of neural response within the first month of abstinence may better clarify this relationship. Compared to controls, MJ teens demonstrated increased SWM activation in right posterior parietal cortex,ebb and flow cannabis a region involved in SWM and attentional processes . Research on parietal functioning during working memory among individuals with substance use disorders has been somewhat inconsistent. Using the same SWM task, our previous work failed to observe parietal abnormalities among adolescent users of alcohol and marijuana , though teens with alcohol use disorders alone showed increased posterior parietal brain response compared to controls despite similar task performance between groups. Greater fMRI activation in posterior parietal cortex has also been observed during SWM among adult marijuana users as well as during verbal working memory among adolescent marijuana users experiencing nicotine withdrawal . Heightened activation among individuals with substance use disorders may be associated with compensatory neural responding to perform well on a task . MJ teens in the current study displayed increased response in parietal cortex, yet diminished activation in prefrontal cortex, both of which play important roles in SWM . Frontal cortex may be primarily involved in general executive functioning components of working memory tasks, while superior parietal cortex may more specifically sub-serve attentional allocation and visuospatial rehearsal demands of SWM . Thus, abstinent MJ teens may rely more on spatial rehearsal and attention rather than general executive abilities to perform the task, resulting in increased recruitment of posterior parietal cortex, but decreased right dorsolateral prefrontal activity. This altered pattern is consistent with previous evidence of reorganized attention networks in MJ users . Further, estimated typical blood alcohol concentration achieved was negatively associated with parietal response among MJ teens, which could indicate that heavier drinking MJ teens may demonstrate less neural compensation or be less likely to utilize spatial strategies as those with lighter alcohol use histories. This is consistent with previous findings of diminished parietal activation during SWM among alcohol use disordered young adults , and suggests a potential interaction between heavy alcohol and marijuana use in youth . We previously characterized the relationship between age and fMRI response among 49 typically developing teens ages 12 – 17 using the same SWM task . Younger teens evidenced increased response in superior portions of posterior parietal cortex, while older teens utilized more inferior aspects of posterior parietal cortex. This shift in localization of parietal response across adolescence indicates a change in strategy, with younger teens relying on rote spatial rehearsal and older teens implementing more spatial storage. MJ teens in the current study demonstrated increased SWM activity relative to controls in superior portions of right parietal cortex, paralleling response patterns of younger adolescents. Thus, MJ teens may employ spatial rehearsal strategies more consistent with those used by younger youths. This may suggest the possibility of altered neuromaturation among adolescent marijuana users, which could implicate an adverse influence of marijuana on the developing brain or preexisting neural differences that may have contributed to the initiation of substance use.

MJ teens demonstrated increased vigilance response compared to controls in two regions of medial occipital cortex: superior portions of the cuneus, and lingual gyrus/inferior cuneus. Occipital cortex has been associated with visual attention, and may become more active as attentional capacity is reached yet less active during practiced tasks . Greater occipital response among MJ teens may indicate less efficient processing and greater attentional demand during vigilance blocks. Such occipital hyper activation among MJ teens was not observed during SWM blocks, during which attentional resources were not focused solely on visual selective attention, but allocated to accommodate working memory processing. Previous studies have implicated diminished attention capacity in heavy marijuana using adults and adolescents . During SWM, MJ teens may allocate limited attentional resources to spatial processing, depriving attentional input to executive systems, resulting in increased parietal and decreased frontal activation. A SWM task with greater executive demand may require more attention input to frontal systems, diminishing response capability in parietal cortices. Among adolescent marijuana users, those who began regular use earlier in adolescence demonstrated greater abnormalities in occipital brain response.Similarly, adults who began using during early adolescence showed greater neural dysfunction during spatial attention and poorer functioning on tests of attention , and verbal abilities and short term memory . Animal models also indicate that cannabinoid exposure during adolescence is associated with greater impairments in working memory and spatial learning than adult exposure . Thus, evidence suggests that marijuana use during adolescence may influence the course of brain development, and those who begin using at a younger age may be more susceptible to dysfunction with continued use. Brain response differences between groups may also relate to aberrant cerebral blood flow among MJ teens. Adult marijuana users have demonstrated reduced resting frontal and cerebellar blood flow during short-term abstinence . Further, elevated cerebrovascular resistance and systolic blood flow remained high after a month of abstinence, suggesting lasting blood flow abnormalities . These blood flow abnormalities could affect the magnitude of the observed BOLD response . Specifically, reductions in frontal blood flow may contribute to diminished frontal SWM activation among MJ teens. Future investigations could more closely account for resting perfusion when examining BOLD response among marijuana users.This study raises several questions. First, most MJ users in this study were moderate to heavy drinkers. Though this is representative of adolescent marijuana users, the functional impact of marijuana use alone is difficult to determine. Studies with larger samples and variability in drinking patterns will help elucidate the substance-specific neurocognitive effects. MJ and control teens were comparable on demographics, behavior, personality and intellectual functioning, and differed slightly on mood, but none of these measures accounted for group differences in brain response. However, abnormal activation patterns among MJ teens may relate to preexisting traits that were not measured.

Computer IP addresses were tracked in the study. If the respondent’s computer indicated that the survey had already been completed, the Qualtrics system would not allow the participant to regain access to the survey. Participants’ contact information was stored in a separate file unlinked to survey responses and destroyed immediately following the study. Identifiable research information was protected by a Certificate of Confidentiality from the National Institutes of Health. All materials and procedures were approved by the Institutional Review Board at the University of Cincinnati.The Nicotine and Marijuana Interaction Expectancy questionnaire is a 14-item measure designed to examine client’s perceptions of the interaction between cigarettes and marijuana. Participants rated each of the items on a Likert scale ranging from 1 to 5 . The NAMIE includes three scales: the effects of marijuana use on cigarette smoking ; the effects of cigarette use on marijuana smoking ; and smoking cigarettes to cope with urges to use marijuana . Participants’ tobacco and marijuana history and use were assessed using items from the National Survey on Drug Use and Health . Tobacco use measures included age of first tobacco use, days of past month tobacco use, type of cigarettes smoked and use of other tobacco products . Marijuana use measures included age of first use, days of past month marijuana use and days of past month blunt use. Participants who reported past month blunt use and cigarette use were categorized as “blunt co-users”, while participants who reported cigarette use but no past month blunt use were categorized as “non-blunt co-users.” The survey also assessed past month use of other drugs,commercial plant racks including cocaine, opioids, and alcohol.Descriptive statistics and Cronbach’s alpha coefficients were estimated to characterize the sample and examine the reliability of the NAMIE sub-scales among African American young adults.

Six multiple regression models examined the relationship between each of three NAMIE sub-scales and marijuana use and initiation and tobacco use and initiation.To control for multiple comparisons but allow for meaningful patterns to emerge from the data, significance level was set at .01. The sample was mostly male and had an average age of 23.7 . Most participants were college graduates and had full-time jobs . Approximately 49% of the sample reported legal trouble. Cigars, cigarillos, and little cigars were the second most popular tobacco product used in the past month following cigarettes . Participants also reported smoking menthol cigarettes and drinking alcohol in the past month. The majority of the sample also reported smoking blunts in the past year , and in the past month . In the month preceding the study, participants reported smoking marijuana for an average of 12.6 days and tobacco for an average of 20.4 days. As shown in Table 1, relative to non-blunt co-users, blunt co-users were more likely to have some college experience or be a college graduate and reported drinking alcohol in the past month. The current study examined the interaction expectancies of African American young adults who reported marijuana and cigarette use in the past month. Expectations regarding the interaction of marijuana and tobacco as measured by the NAMIE showed strong internal consistency, supporting use of this measure in the African-American population. Reliability compares to that among a predominately White sample of marijuana and tobacco co-users participating in a national online survey ; however mean scores were relatively higher in the current study compared to the Ramo et al study on all three NAMIE scales. It is unclear whether the scores are statistically different across groups. This could not have been accounted for solely by the extent of blunt use in this African-American sample, as scores were higher for non-blunt co-users in the current study as well. More work is needed to clarify ethnic differences in interactions expectancies more fully.

African American young adults reported the highest rating on scale 1 , which might partially explain why tobacco initiation often follows marijuana use among African American young adults . Longitudinal research is needed to examine the relationship between co-use expectations and marijuana and tobacco initiation among African American young adults. Relative to blunt co-users, non-blunt co-users were more likely to report that smoking cigarettes increased their marijuana use and urges and that smoking cigarettes helps them to cope with their marijuana use and urges. Blunt smokers are exposed to nicotine when preparing blunts with the outer wraps of cigars and cigarillos , while non-blunt marijuana users are not exposed to nicotine in the same way. Non-blunt co-users might lean more heavily on cigarettes for exposure to nicotine and therefore may be more likely to believe that cigarettes have a more powerful role in the interaction between marijuana and tobacco. It might follow that nonblunt co-users would smoke more cigarettes than blunt co-users, however, findings here do not support that notion. It is important to note that all of the participants in this sample reported 20 or more days of past month tobacco use, and 87.2% reported smoking menthol cigarettes in the past month, consistent with other African-American smoking samples . Additional research with a wide range of light and heavy menthol and non-menthol cigarette smokers is needed. Notably, we found that days of past-month marijuana use were associated with co-use expectations among blunt co-users but not among other co-users. This could indicate that the NAMIE is a better assessment tool for blunt co-users than non-blunt co-users, or that substituting tobacco for marijuana and vice-versa is equally common among non-blunt cousers of all levels. Research with larger samples is needed to clarify this further. In addition to a small sample size, there are a few other limitations that should be noted. First, the cross-sectional design of the study prevents causal interpretation of the findings. Second, the sample is mostly male and may not be generalizable to a more diverse sample of African American young adults.

The study relied on self-reported, anonymous data; however, the targeted recruitment method increases the validity of the data. Despite these limitations, the current findings highlight preliminary evidence for the significant relationship between drug use outcomes and co-use expectancies among African American young adults that has important research and clinical implications. Our findings highlight the extent to which tobacco and marijuana use can perpetuate use of the other substance, and the importance of treatments targeting thoughts and expectations about the interaction of these two substances. Understanding the relationship between marijuana and tobacco will increase the effectiveness of existing interventions and facilitate the development of new interventions that target cognitions related to co-use among African American young adults, especially among individuals who co-use cigarettes and blunts.Marijuana is commonly used in adolescence, yet the impact on the developing brain is unclear. Working memory impairments have been observed in adult marijuana users after recent use, but may remit after a month of abstinence. The differential effects related to recent use and abstinence have not been delineated in adolescents. To address this question, three studies examined functional magnetic resonance imaging brain response during spatial working memory among adolescents.Adolescent brain development may be influenced by heavy marijuana use, yet the neural underpinnings of SWM have not been well described in adolescents. Study 1 investigated fMRI response to SWM across normal adolescent development. Participants were 49 youths ages 12 – 17 without histories of neurological or psychiatric disorders. Results demonstrate the emergence of left prefrontal activity and superior-to-inferior shift in localization of parietal response with increasing age, suggesting that younger teens utilize more rote spatial rehearsal,ebb and flow tray while older teens rely more on spatial storage and verbally-mediated strategies. Study 2 evaluated fMRI response during SWM among 15 heavy marijuana using adolescents after 28 days of verified abstinence relative to 17 non-abusing controls, ages 16 – 18 years old. Marijuana users demonstrated decreased right prefrontal and increased right superior parietal response relative to controls, which could suggest greater reliance on spatial strategies and less general executive control among marijuana users. These results were observed after 28 days of abstinence, suggesting persisting differences in brain functioning among heavy marijuana users. Study 3 characterized the differential residual and persisting changes in neural activation patterns associated with adolescent marijuana use by examining fMRI during SWM among adolescent marijuana users after recent use or after one month of abstinence.

Participants were 15- to 18-year-olds: 13 marijuana users who used in the week before scanning, 13 marijuana users who were abstinent for 27 – 60 days before scanning, and 18 demographically similar controls. Recent users demonstrated increased medial/left superior frontal and right parietal response relative to abstinent users, which could suggest greater neural effort for inhibitory control and spatial rehearsal. Although cross-sectional, results may indicate a shift in neural processing strategies through early abstinence.Marijuana is the most commonly used illicit drug among teenagers, and most users first try marijuana in adolescence . While 17% of 8th graders have tried marijuana, almost half of 12th graders have used cannabinoids . Frequency of use escalates so that by 12th grade, 20% report past-month use and 5% reveal daily use . During this period of increasing marijuana use, the brain remains in an active state of development, characterized by synaptic refinement , myelination , and improved cognitive and functional efficiency . In particular, working memory abilities improve throughout childhood and adolescence as the brain regions sub-serving these functions mature. Yet working memory may be adversely impacted by marijuana use, as marijuana most likely affects frontal and parietal brain regions involved. Given continued development of these systems in adolescence, heavy marijuana use during youth could negatively impact working memory functioning. The possible influence of marijuana use in adolescence and the potential for recovery with abstinence have not been well delineated, but could have important implications for academic, occupational, and social achievement among both current and former users. This dissertation aims to characterize the influence of chronic marijuana use on functional magnetic resonance imaging brain response during spatial working memory in adolescents through the completion of three studies. In order to understand the effects of chronic marijuana use in youth, a better depiction of neural response patterns in normal adolescents is needed. To this end, Study 1 investigated fMRI response to SWM across normal adolescent development. Study 2 then evaluated fMRI response during SWM among heavy marijuana using adolescents after 28 days of verified abstinence relative to non-abusing controls. Finally, Study 3 characterized the differential neurocognitive impact of recent adolescent marijuana use relative to the potentially persisting effects by examining fMRI during SWM among adolescent marijuana users within one week of use or after one month of abstinence. The results of these three studies provide a better understanding of the neural impact of heavy marijuana use during adolescence.Modern neuroimaging techniques have a provided a wealth of information about human brain development. Whereas it was once believed that the human brain was largely developed by the onset of puberty, it has now been established that the brain continues to develop throughout adolescence and well into adulthood . A recent longitudinal investigation demonstrated that higher order association cortices, such as superior temporal, posterior parietal, and prefrontal cortex, develop later than primary sensorimotor cortices, with the dorsolateral prefrontal cortex developing last . This late occurring development is predominantly a function of the progressive and regressive processes of myelination and synaptic pruning that result in increasing white matter volumes and cortical thinning and a more efficient central nervous system. During adolescence and this time of active neural maturation, many cognitive processes are also developing. One such process is working memory. Working memory refers to the ability to actively store and manipulate information online over brief periods of time . This ability is fundamental to intact performance in a variety of other cognitive domains, including language comprehension, abstract reasoning, and learning and memory . Verbal and spatial working memory abilities improve throughout childhood and adolescence , with accuracy and reaction times increasing and decreasing respectively during spatial n-back and spatial delayed response tasks . It is likely that these behavioral improvements in working memory are the result of the described neuromaturational processes that are occurring during the child and adolescent years. With the advent of functional magnetic resonance imaging , the neural substrates of working memory functioning have begun to be identified.