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Adolescent cannabis use associated with other health risk behaviours – CDC

A study from the Centres for Disease Control in the United States suggests that adolescent marijuana use is associated with numerous other health risk behaviours in high school students, including other substance use, injury and violence, and sexual behaviours. The association is pronounced among youngsters who have established patterns of marijuana use.

Clinicians can screen for marijuana use among youth and engage in interventions both to prevent use among those who have not initiated and to help young people who have initiated to avoid ongoing, established use patterns that may carry additional risks.

An article on the study appeared in the American Journal of Preventative Medicine on 24 September 2020, titled “Adolescent Marijuana Use and Related Risk Behaviours, National Findings From 2015 to 2017”.

It was authored by Gillian L Schauer from the CDC Foundation; Heather B Clayton from the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; and Rashid Njai and Alehat M Grant from the Centers for Disease Control and Prevention (CDC). Below is a slightly shortened article introduction, followed by the abstract.


Marijuana or cannabis is the most commonly used federally illicit substance in the US, with 27.7 million people aged ≥12 years reporting past-month use.

Past-month use among adolescents has remained stable over the past decade nationally, with 19.8% of high school students reporting past-month marijuana use.

However, daily use among 8th and 10th graders has increased in recent years, and vaping marijuana more than doubled between 2018 and 2019, with more than 1 in 5 12th graders and nearly 1 in 5 10th graders reporting marijuana vaping.

Although marijuana remains illegal at the federal level, in America 33 states and the District of Columbia (DC) have approved medical marijuana, and 11 of those states and DC have legalised marijuana for nonmedical use among adults aged ≥21 years as of March 2020.

A public health objective

As policies legalising non-medical marijuana increase, preventing and delaying the onset of adolescent marijuana use is an increasingly important public health objective.

Although the health effects of marijuana use are still poorly understood, the adolescent brain continues to develop until age 25 years, and data suggest that tetrahydrocannabinol or THC – the psychoactive component in marijuana – affects the developing brain.

Heavier marijuana use and earlier age of initiation have been associated with greater impairment in attention, learning and memory, with potentially negative implications for educational attainment.

Data also suggest strong evidence of increased risk of schizophrenia and other psychoses, especially among heavy users, individuals who initiate marijuana use at a younger age, and those already prone to psychoses. Data have shown a strong association between early initiation of marijuana and subsequent marijuana dependence or addiction in adulthood and increased risk of misuse of other substances.

Adolescents marijuana users, compared with non-users, have increased risk of substance use, injury/violence behaviours/victimisation, and sexual risk behaviours.

However, previous studies assessing risk-taking behaviour and marijuana use in adolescence have typically focused on single behaviours.

At present, no studies exist that use national data to assess health risk behaviours among adolescents with past-month marijuana use or that assess how risk behaviours may differ by youth who have more established patterns of marijuana use versus less established patterns of use. This approach has been used in tobacco control to help identify higher-risk youth on whom to focus prevention efforts.

Informing prevention efforts

Gaining an understanding of the relationship that marijuana use has with other risk behaviours in adolescence, especially by use pattern, can help inform prevention efforts.

Accordingly, this study uses nationally representative data to describe the prevalence of a number of risk behaviours (eg substance use, injury/violence, sexual) among high school students who used marijuana in the past but were not current marijuana users and among current marijuana users by more established versus non-established use patterns.

On the basis of previous research, the authors hypothesise that current marijuana use will be associated with a higher prevalence of other risk behaviours and that more established patterns of use will be associated with the highest prevalence of risk behaviour compared with noncurrent and non-established pattern of use.


Adolescent Marijuana Use and Related Risk Behaviours, National Findings From 2015 to 2017

American Journal of Preventative Medicine. Published on 24 September 2020


Gillian L Schauer, Heather B Clayton, Rashid Njai and Althea M Grant

Affiliations: Schauer is from the CDC Foundation; Clayton is from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; and Njai and Grant are with the  Centers for Disease Control and Prevention


As policies legalising non-medical marijuana have increased in states, understanding the implications of marijuana use among adolescents is increasingly important. This study uses nationally representative data to assess behavioural risk factors among students with different patterns of marijuana use.


Data from the 2015 and 2017 Youth Risk Behaviour Surveys, cross-sectional surveys conducted among a nationally representative sample of students in Grades 9–12 (n=30,389), were used to examine the association between self-reported current marijuana use status and self-report of 30 risk behaviours across 3 domains: substance use, injury/violence, and sexual health.

Among current marijuana users, authors assessed differences between established (≥100 lifetime uses) and non-established (<100 uses) users. Multivariable models were used to calculate adjusted prevalence ratios. Data were analyzed in 2019.


Current marijuana users (regardless of use pattern) had a significantly greater likelihood of engaging in 27 of the 30 behaviours assessed across the 3 domains than the noncurrent users.

Those with established use patterns (versus nonestablished) had a greater risk of lifetime use of most other substances (licit and illicit, including tobacco, alcohol, heroin, misuse of opioids), some injury/violence behaviours (including driving while using marijuana and suicide ideation and attempt), and sexual risk behaviours.


Both established and non-established patterns of adolescent marijuana use are associated with a number of other risky behaviours.

In addition to interventions focused on preventing youth initiation of marijuana, clinicians and public health professionals should consider interventions to help adolescents who have non-established use patterns to avoid continued, established use.


[link url=""]Adolescent Marijuana Use and Related Risk Behaviours, National Findings From 2015 to 2017[/link]


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