Katarina Guttmannova, Ph.D. - US grants

DESCRIPTION (provided by applicant): The goal of this project is to understand the impact of marijuana-related legislation on adolescent marijuana and other substance use and related risk factors using time-series analysis of survey data from Colorado, Washington, and Oregon and two additional comparison states. This R21 (exploratory/developmental) study will examine changes in the age of onset, and prevalence of any use, and regular use of marijuana among youth in these states, and lay a foundation for a future nationwide examination of the impact of state-level marijuana legislation on marijuana-related risk factors and outcomes among youth. The recent legalization of recreational marijuana use for those over 21 years of age in Washington and Colorado and the failure of legalization in Oregon, along with the medical marijuana laws of earlier decades, have changed the legal and normative context for current and future generations of youth. One of the primary concerns for public health is that legalization may lead to more favorable attitudes and norms and lower perceived harm from marijuana use, which have been shown to predict earlier age of marijuana use onset and greater adolescent use, which, in turn, have been associated with a range of negative outcomes, including subsequent drug abuse and dependence and interference with a healthy and successful transition into adulthood. As the national discussion around legalization of marijuana proceeds, there is an urgent need for scientific evidence from timely, carefully implemented studies informing whether such changes in marijuana laws affect youth development. The proposed study will use an interrupted time-series design (ITS), including multiple baseline ITS, to examine statewide survey data from adolescents and thereby assess the long-term patterns of age of onset and youth marijuana use and marijuana-related attitudes, norms, and perceived harm of using marijuana among youth before and after (1) medical marijuana legalization (MML; passed in 1998 in WA and OR, and 2000 in CO), and (2) recreational marijuana legalization (RML; passed in 2012 in WA and CO, and was rejected by the voters in the same year in Oregon), with additional comparisons to state-wide survey data from Montana and Massachusetts (which enacted MML in 2004 and 2012, respectively; and neither had RML on the ballot). Moreover, it is possible that these legislative changes affect other adolescent substance use. Thus, this study will examine the patterns of change in youth alcohol, tobacco, and other drug use in these three states over time to assess the plausibility of the so-called substitution effect in which marijuana use substitutes (or, in contrast, exacerbates) other substance use. The data for the analytic part of the proposed R21 study will come from the existing and planned statewide student surveys from Grades 6-12 in Colorado, Washington, Oregon, and additional comparison states of Montana and Massachusetts.

ABSTRACT Cannabis use among young adults is widespread and national studies indicate increases in recent years in prevalence of cannabis use, including daily use. As of November 2018, 10 U.S. states and the District of Columbia have legalized cannabis for non-medical (?recreational?) use for adults aged 21 and older. Washington State was on the forefront of these changes, voting to approve legalization in 2012 and effectively implementing the legislation two years later. Although a major argument for legalization was its potential to decrease the human, social, and economic costs related to criminal justice involvement, an un-intended detrimental consequence might involve its impact on cannabis and other substance use (SU). Importantly, the impact of policy implementation may be felt differently across the state. Local jurisdictions in many communities passed ordinances that impose restrictions on the cannabis market. Further, in municipalities where no bans are in place, the geographic distribution of stores is uneven, with cannabis retail stores often concentrating in socio-economically disadvantaged neighborhoods. Research on the evaluation of the effects of legalization on cannabis use is only in its infancy; little is known about the etiology of SU and related health risk behaviors, such as driving while intoxicated, and the role of community- and individual level cannabis- specific risk factors in the context of legalized cannabis. Moreover, it is unclear how relationships among use of different substances may change during the course of implementation or developmentally. The salience of known risk factors may also change during implementation, by context or over the course of young adulthood. This project capitalizes on unique and rich data we collected with funding from the WA State Department of Social and Health Services. The WA State Young Adult Health Survey (YAHS) is an accelerated longitudinal cohort study of young adults ages 18-29 from 2014-2018 with the first data collection occurring before any legal cannabis stores opened and additional cohorts added in each of the four subsequent years. The survey data will be linked with a cannabis policy database that denotes local variation in cannabis context, including regulations and restrictions on sales, and with data on density of stores and neighborhood disadvantage. This project aims to examine effects of cannabis legalization on SU and related health risk behaviors among young adults in WA State. We will also assess within-state variation in SU outcomes as it relates to community-level factors such as city and county policy, cannabis and alcohol retail outlet availability, and neighborhood disadvantage. Moreover, we will examine the trajectories of SU and their interplay over the course of young adulthood and the role of the community-level factors in the etiology of young adult SU and related outcomes in the context of legalized cannabis. Understanding these effects will inform (1) planning of prevention and intervention efforts aimed at improving health outcomes and reducing problem behaviors in the changing cannabis policy context; and (2) regulatory provisions for the existing and new policies related to cannabis.

Abstract The demographic composition of small towns and rural communities in the U.S. has changed dramatically, in part because of the large in-migration of Latino families. For communities to support the health of their members, they must be able to reinforce factors that promote positive youth development (protective factors) and abate factors that hinder it (risk factors). However, much of what is known about risk and resilience comes from research on urban communities. There has been little longitudinal research on Latinos growing up in the rural U.S., and none with sufficient data to understand the etiology of substance use (SU), patterns of health disparities in SU, and factors influencing their health and wellbeing as young adults. We know little about the intersectionality of Latino ethnicity, immigrant status, and rural context and how these relate to the developmental mechanisms of health disparities. This knowledge gap limits prevention and intervention services, as the prevention science paradigm depends on accurately identifying risk and protective factors (RPFs) and developing prevention programs targeting these factors to reduce problem behaviors. The present application capitalizes on existing rich longitudinal data spanning childhood through early adulthood to examine influences on health and well-being of rural Latino youth. Using this existing data, we will examine health disparities in substance use and associated RPFs (a) between 3rd-generation rural Latino and non-Latino White youth, and (b) among rural Latino youth who are 1st-, 2nd- or 3rd-generation immigrants (i.e., children of immigrant or U.S.-born parents). In the supplemental analyses used for triangulation and validation, we will use national cross-sectional data and examine differences in the association between RPFs and alcohol, tobacco, marijuana, and other drug use for Latino youth by the type of residence (rural vs. small and large metro areas) at the historical time points and age ranges corresponding to the longitudinal study. Findings will provide rigorous scientific evidence regarding risk and protective processes for Latino youth in rural areas of the U.S. that may lead to prevention efforts to reduce health disparities in substance use and other health risk behaviors in young adulthood, and potentially reduce disparities in serious illness later in the life course.