Perceived risk of regular cannabis use in the United States from 2002 to 2012: Differences by sex, age, and race/ethnicity

Highlights

• Perceived great risk of regular cannabis use decreased between 2002 and 2012.

• Non-daily cannabis use increased between 2002 and 2012.

• Daily cannabis use increased between 2002 and 2012.

Abstract

Introduction

Cannabis is one of the most widely used psychoactive substances in the United States (U.S.). Perceived risk of use is associated with substance use; the recent debate surrounding medicalization and legalization of cannabis in the U.S. has the potential to impact perceived risk of use. Recent estimates are needed to assess temporal changes in, and identify correlates of, perceived risk of cannabis use.

Methods

Utilizing data from the 2002–2012 survey years of the National Survey on Drug Use and Health, chi-squared statistics and logistic regression were used to describe temporal changes in perceived risk of regular cannabis use (i.e., once or twice a week), to explore correlates of perceived risk, and to report frequency of cannabis use.

Results

Between 2002 and 2012, perceived great risk of regular cannabis use varied significantly overall (p < 0.001). The prevalence of past year non-daily (p < 0.001) and daily use varied significantly during this time (p < 0.001). Controlling for survey year and other confounders, characteristics associated with increased odds of perceived great risk of regular cannabis use included: female sex; Non-White race/ethnicity; age 50+; and family income of $20,000-49,999. Characteristics associated with decreased odds of perceived great risk included: ages 12–17 and 18–25; high school education or greater; total family income of $75,000+; past year non-daily and daily cannabis use; and survey years 2008–2012.

Conclusions

Findings characterize trends of perceived risk of regular cannabis use, and past year non-daily and daily cannabis use. Longitudinal studies of the influence of legal status of cannabis at the state-level are needed.

Introduction

Cannabis is one of the most commonly used psychoactive substance in the United States (U.S.), with 7.3% of the U.S. general population reporting use in the past month in 2012 (SAMHSA, 2013). The widespread use of cannabis is of public health importance; cannabis use is associated with a host of social, psychological, and physical impairments, including financial difficulties, low energy levels, dissatisfaction with productivity levels, sleep and memory issues, and relationship and family problems (Gruber et al., 2003, Stephens et al., 2002). Most individuals receiving cannabis use disorder (CUD) treatment report difficulty quitting, and experience a withdrawal syndrome after cessation (Budney et al., 2007a). In light of the negative effects of cannabis use, continued examination of characteristics that are associated with cannabis use, particularly regular cannabis use, is prudent.

Prior research has identified numerous factors associated with cannabis use. Factors associated with cannabis use can differ among sex and age subgroups (Copeland and Swift, 2009, Guxens et al., 2007), warranting the need for stratified analyses. Cannabis use is associated with lower education achievement (Lynskey and Hall, 2000, Fergusson et al., 2003), lower productivity at work, higher neighborhood disorder and disadvantage (Wilson et al., 2005, Furr-Holden et al., 2011, Tucker et al., 2013), and higher risk of other illicit drug use (Lynskey et al., 2003). Regular cannabis use can lead to CUDs, particularly among individuals who initiate cannabis use early and have other risk factors such as using other substances, having substance-using peers, and reporting anxiety and depressive symptoms (Hall and Degenhardt, 2007, Wittchen et al., 2007, Buckner et al., 2008), and are more prevalent among males and younger adults (Compton et al., 2004, Copeland and Swift, 2009). A longitudinal study indicated that the probability of CUD increased with the increasing presence of risk factors for CUD (Brook et al., 2011). Moreover, there is an inverse relationship between marijuana use and perceptions of its harmfulness (Compton et al., 2005).

According to the Health Belief Model (Janz and Becker, 1984), perceived risk is an important factor in deciding whether or not individuals will engage in health-related behaviors. Continually evolving regulations governing the medicalization and legalization of cannabis use within the U.S. have the potential to impact perceived risk of cannabis use, which may influence individuals’ decisions to use cannabis. Cerda et al. (2012) showed that adults in states with medical cannabis laws have higher odds of cannabis use than residents of states without such laws. Compared to those without medical marijuana laws, National Survey on Drug Use and Health (NSDUH) participants in states with medical marijuana laws also had lower perceptions of risk associated with use as well as adolescent marijuana use (Wall et al., 2011). In Colorado, marijuana commercialization was also associated with decreased perception of great risk of marijuana use for adolescents and adults alike (Schuermeyer et al., 2014). Conversely, in an analysis of the National Survey on Drug Use and Health 2002–2009 data, Harper et al. (2012) found limited evidence for a causal effect of the presence of medical marijuana laws – in 2002–2003 eight states had legalized the use of medical marijuana, whereas in 2007–2008, 13 total states had medical marijuana laws – on measures of reported cannabis use. However, despite extant studies investigating perceived risk surrounding cannabis use (Lopez-Quintero and Neumark, 2010, Kilmer et al., 2007), and annual publications put out by the Substance Abuse and Mental Health Services Administration (SAMHSA), to our knowledge, no current research describes temporal changes in perceived risk of cannabis use using the most recent decade of aggregated data of the U.S. population 12 years and older. In particular, this gap includes perceived risk of regular use, temporal changes in frequency of cannabis use, subgroup analyses for each of the aforementioned temporal trends, and characteristics associated with perceived risk of use using a U.S. nationally representative sample.

To address current gaps in the literature, the present study had the following aims: (1) to examine the change in prevalence of perceived great risk of regularly using cannabis (i.e., once or twice a week) over an 11-year period using the most recent currently available NSDUH survey data (i.e., during the years 2002–2012), stratified by sex; and (2) to explore characteristics associated with perceived great risk of cannabis use. To accomplish these aims, we used data from a nationally representative survey of non-institutionalized individuals ages 12 and older living in the U.S.