Youth Exposure to Recreational Cannabis Legalization: Moderation of Effects by Sex and Parental Cannabis Use during Adolescence.

OBJECTIVE: Few studies of recreational cannabis legalization (RCL) have assessed adolescents both before and after RCL or considered moderators of RCL effects. The present study tested whether RCL was more strongly associated with cannabis use for girls and among youth whose parents had a history of cannabis use during adolescence. METHOD: Data were pooled from 940 adolescents from three intergenerational studies that began in Washington (where RCL was enacted in 2012), Oregon (RCL year = 2015), and New York (RCL year = 2021). Youth were assessed repeatedly from ages 13 to 18 years (k = 3,650 person-years) from 1999 to 2020 (prior to RCL in New York). Parent cannabis use at or before age 18 years (yes/no) was assessed prospectively during the parent's adolescence. Multilevel models focused on the between-subjects effects of years of youth exposure to RCL on adolescents' mean cannabis use likelihood, and interactions with child sex and parent use history. RESULTS: Child exposure to RCL was associated with a higher likelihood of cannabis use if their parents had a history of adolescent use, (Estimate [SE] = 0.67 [0.25], p = 0.008), versus no such history (Estimate [SE] = -0.05 [0.28], p = 0.855). RCL effects were not moderated by child sex. CONCLUSIONS: The effects of RCL on adolescents' cannabis use may depend on their parents' history of using the drug. Identifying other moderators of RCL effects, and understanding the mechanisms of these risks and the ways that parents and communities can offset them, are prevention priorities.

(1) Adolescents' use of cannabis may have intergenerational consequences, making it more likely their future offspring will use cannabis. (2) Whether or not recreational cannabis legalization influences adolescents' cannabis use may depend on their parents' cannabis use history. (3) Parenting in a state with liberalized cannabis policies may present new challenges and require that novel prevention resources be developed.

The Potential for Prevention Science in Middle and Late Adulthood: a Commentary on the Special Issue of Prevention Science.

This commentary on the special issue of Prevention Science, "Toward a Lifespan Prevention Science: A Focus on Middle and Late Adulthood" reviews the studies included in the issue, compares findings, and makes recommendations for future directions in this emerging field. Articles in this issue addressed a number of the key elements of prevention science, including identifying proximal and distal risk and protective factors that play a role in middle and late adult health and well-being, providing preliminary evidence for a preventive intervention to moderate stress reactivity, and proposing a theoretical approach to preventing substance misuse across the lifespan. Our commentary centers around three critical areas for mid and later life prevention science: the importance of theory building, a focus on alcohol and its role in midlife health, and health disparities. Each of the articles in this issue touched on at least one of these areas. We conclude that a focus on prevention in mid and later life has strong potential, and further research is needed.

Testing Cross-Generational Effects of the Raising Healthy Children Intervention on Young Adult Offspring of Intervention Participants.

This study tested whether effects of a preventive intervention delivered in elementary school showed benefits for the young adult offspring of intervention recipients over 20 years later. The Raising Healthy Children (RHC) intervention, trialed in 18 public schools in Seattle, Washington, from 1980-1986 (grades 1-6), sought to build strong bonds to family and school to promote school success and avoidance of substance use and illegal behavior. Four intervention groups were constituted: full, late, parent training only, and control. Participants were followed through 2014 (age 39 years). Those who became parents were enrolled in an intergenerational study along with their oldest offspring (10 assessments between 2002 and 2018). This study includes young adult offspring (ages 18-25 years; n = 169; 52% female; 4% Asian, 25% Black, 40% multiracial, 4% Native American, 2% Native Hawaiian/Pacific Islander, 25% White, and 14% Hispanic/Latinx) of participants in the original RHC trial. Offspring outcome measures included high school noncompletion, financial functioning, alcohol misuse, cannabis misuse, cigarette use, criminal behavior, internalizing behavior, social skills, and social bonding. A global test across all young adult outcome measures showed that offspring of parents who received the full RHC intervention reported better overall functioning compared to offspring of control group parents. Analyses of individual outcomes showed that offspring of full intervention group parents reported better financial functioning than offspring of control group parents. Findings show the potential of universal preventive interventions to provide long-term benefits that reach into the next generation. ClinicalTrials.gov Identifier: NCT04075019; retrospectively registered in 2019.

Adult Social Environments and the Use of Combustible and Electronic Cigarettes: Opportunities for Reducing Smoking in the 30s.

INTRODUCTION: Reducing cigarette use is a major public health goal in the United States. Questions remain, however, about the potential for the social environment in the adult years-particularly in the 30s and beyond-to influence cigarette use. This study tested pathways hypothesized by the social development model to understand the extent to which social environmental factors at age 33 (eg, involvement with smokers or with physically active people) contribute to changes in cigarette use from age 30 to age 39. Both combustible and electronic cigarette use were investigated. METHODS: Data were from the Seattle Social Development Project, a longitudinal study of 808 diverse participants with high retention. Self-reports assessed social developmental constructs, combustible and electronic cigarette use, and demographic measures across survey waves. RESULTS: At age 30, 32% of the sample reported past-month cigarette use. Using structural equation modeling, results showed high stability in cigarette use from age 30 to 39. After accounting for this stability, cigarette-using social environments at age 33 predicted personal beliefs or norms about smoking (eg, acceptability and social costs), which in turn predicted combustible cigarette use at age 39. Cigarette-using environments, however, directly predicted electronic cigarette use at age 39, with no significant role for beliefs about smoking. CONCLUSIONS: Cigarette use was highly stable across the 30s, but social environmental factors provided significant partial mediation of this stability. Pathways were different for combustible and electronic cigarette use, however, with personal smoking norms playing an important role for the former but not the latter. IMPLICATIONS: This study addresses the need for longitudinal investigation of social mechanisms and cigarette use in the 30s. Findings reinforce efforts to prevent the uptake of cigarettes prior to the 30s because, once started, smoking is highly stable. But social environmental factors remain viable intervention targets in the 30s to disrupt this stability. Addressing personal norms about smoking's acceptability and social costs is likely a promising approach for combustible cigarette use. Electronic cigarettes, however, present a new challenge in that many perceived social costs of cigarette use do not readily translate to this relatively recent technology.

Reciprocal Effects of Positive Future Expectations, Threats to Safety, and Risk Behavior Across Adolescence.

We examined the reciprocal relationships among positive future expectations, expected threats to future safety, depression, and individual substance use and delinquency using 4 waves of data (N = 248-338) from African American and Latino adolescent male participants in the Chicago Youth Development Study. Individual positive future expectations and expected threats to safety were assessed at each wave and modeled as latent constructs. Individual substance use and delinquency were assessed at each wave and represented as ordinal variables ranging from low to high. Categorical autoregressive cross-lagged structural models were used to examine the hypothesized reciprocal relationships between both aspects of future expectations construct and risk behavior across adolescence. Analyses show that future expectations has important effects on youth substance use and involvement in delinquency, both of which in turn decrease positive expectations and increase expectation of threats to future safety across adolescence. Similarly, low positive expectations for the future continued to predict increased substance use and involvement in delinquency. The expected threats to safety construct was significantly correlated with delinquency within time. These effects are observed across adolescence after controlling for youth depression and race. Findings support the reciprocal effects hypothesis of a negative reinforcing cycle in the relationships between future expectations and both substance use and involvement in delinquent behavior across adolescence. The enduring nature of these relationships underscores the importance of future expectation as a potential change mechanism for intervention and prevention efforts to promote healthy development; vulnerable racial and ethnic minority male adolescents may especially benefit from such intervention.

Effectiveness of Facebook Groups to Boost Participation in a Parenting Intervention.

Although family-based prevention programs have been shown to be effective at reducing adolescent substance use, it is often difficult and costly to recruit and retain parents in programs administered in person. The current study tested whether program engagement and parenting practices could be improved by offering parents in a self-directed family program access to a private Facebook group. Parents of middle school children (N = 103) were recruited through paid Facebook ads to a 5-week self-directed teen substance use prevention program to be completed at home together by parents and their children. Two thirds of parents (N = 72) were randomly assigned to a moderated private Facebook group that provided a forum for parents in the study to interact with each other, and one third (N = 31) were randomized to use the intervention materials without additional support. Relatively few parents participated in the Facebook group and most did not find the experience useful. However, satisfaction with the program assessed 3 months after program completion was high among all parents and most parents engaged with the materials, irrespective of Facebook group assignment. Overall, parents reported significantly lower conflict and more household rules 6 months post-intervention compared to baseline. Parenting practices did not change more among those assigned to the Facebook group than among parents who used the materials on their own. The current findings suggest that providing opportunities for parents to interact online while participating in a self-directed family intervention may not help to increase engagement or improvements in parenting practices, particularly when few parents engage with each other.

General and Specific Predictors of Comorbid Substance Use and Internalizing Problems from Adolescence to Age 33.

The current study examines the continuity in comorbidity between substance use and internalizing mental health problems from adolescence to adulthood and investigates the general and specific predictors of comorbidity across development. Participants were drawn from the Seattle Social Development Project (N = 808), a gender-balanced, ethnically diverse longitudinal panel. Structural equation modeling was used to examine risk factors for comorbid substance use and internalizing problems in family and peer social environments; substance use- and mental health-specific social environments (family tobacco, alcohol, and marijuana use; family history of depression); and individual risk factors (behavioral disinhibition). Latent factors were created for comorbid substance use and mental health problems at ages 13-14 and comorbidity of substance abuse and dependence symptoms and mental health disorder symptoms at ages 30-33 and included indicators of anxiety, depression, alcohol, tobacco, and marijuana problems. Comorbid problems in adolescence predicted later comorbidity of disorders in adulthood. In addition, family tobacco environment and behavioral disinhibition predicted adolescent comorbidity, while family history of depression was associated with adult comorbidity. Finally, family and peer substance use in adolescence predicted substance use (alcohol, tobacco, and marijuana) both in adolescence and adulthood. The pattern of results suggests that comorbidity in adolescence continues into adulthood and is predicted by both general and behavior-specific environmental experiences during adolescence. Findings clarify the etiology of comorbid internalizing and substance use problems and suggest potential preventive intervention targets in adolescence to curb the development of comorbidity in adulthood.

Adolescent Age of Sexual Initiation and Subsequent Adult Health Outcomes.

OBJECTIVES: To examine the mechanisms of the association between age of sexual initiation and adult health. METHODS: Data from the Seattle Social Development Project (n = 808), in Seattle, Washington, included outcomes when participants were in their 30s (2005-2014): substance use disorders, depression, poor health, and obesity. Sexual consequence mediators included sexually transmitted infection, adolescent pregnancy, and a high number of sexual partners. We used linear logistic regression to model main effect and mediated associations. RESULTS: Age of sexual initiation was related to nicotine and marijuana disorders, physical health, and obesity, but not alcohol disorder or depression. Mediated association with nicotine disorder was not significant; association with marijuana disorder was reduced; significant relationships with poor health and obesity remained. CONCLUSIONS: The relationship between age of sexual initiation and substance use was largely explained by consequences of sexual behavior. Earlier sexual initiation was linked to poorer physical health outcomes, though the nature of the association remains unclear. Public Health Implications. Prevention approaches need to address multiple risk factors and emphasize contraceptive methods to avoid sexual consequences. For physical health outcomes, broad prevention approaches, including addressing early sexual initiation, may be effective.

Using Facebook to Recruit Parents to Participate in a Family Program to Prevent Teen Drug Use.

Despite strong evidence that family programs are effective in preventing adolescent substance use, recruiting parents to participate in such programs remains a persistent challenge. This study explored the feasibility of using Facebook to recruit parents of middle school students to a self-directed family program to prevent adolescent drug use. The study used paid Facebook ads aiming to recruit 100 parents in Washington and Colorado using marijuana- or parenting-focused messages. All ad-recruited parents were also invited to refer others in order to compare Facebook recruitment to web-based respondent-driven sampling. Despite offering a $15 incentive for each successfully referred participant, the majority of the screened (70.4%) and eligible (65.1%) parents were recruited through Facebook ads. Yet, eligibility and consent rates were significantly higher among referred (76.6 and 57.3%, respectively) than Facebook-recruited parents (60.0 and 36.6%, respectively). Click-through rates on Facebook were higher for marijuana-focused than parenting-focused ads (0.72 and 0.65%, respectively). The final sample (54% Facebook-recruited) consisted of 103 demographically homogeneous parents (female, educated, non-Hispanic White, and mostly from Washington). Although Facebook was an effective and efficient method to recruit parents to a study with equal to better cost-effectiveness than traditional recruitment strategies, the promise of social media to reach a diverse population was not realized. Additional approaches to Facebook recruitment are needed to reach diverse samples in real-world settings and increase public health impact of family programs.

Predictors of Adult Marijuana Use Among Parents and Nonparents.

The current study examined predictors of marijuana use among adults, including subsamples of adults who are actively parenting (i.e., have regular face-to-face contact with a child) and those who have no children. Participants were a community sample of 808 adults and two subsamples drawn from the full group: 383 adults who were actively parenting and 135 who had no children. Multilevel models examined predictors of marijuana use in these three groups from ages 27 to 39. Becoming a parent was associated with a decrease in marijuana use. Regular marijuana use in young adulthood (ages 21-24), partner marijuana use, and pro-marijuana attitudes increased the likelihood of past-year marijuana use among all participants. Being a primary caregiver (among parents) was associated with less marijuana use. Overall, predictors of marijuana use were similar for all adults, regardless of parenting status. Study results suggest that the onset of parenthood alone may be insufficient to reduce adult marijuana use. Instead, preventive intervention targets may include changing adult pro-marijuana attitudes and addressing marijuana use behaviors of live-in partners. Lastly, universal approaches targeting parents and nonparents may be effective for general adult samples.

Time-varying effects of families and peers on adolescent marijuana use: Person-environment interactions across development.

Studies have demonstrated that the effects of two well-known predictors of adolescent substance use, family monitoring and antisocial peers, are not static but change over the course of adolescence. Moreover, these effects may differ for different groups of youth. The current study uses time-varying effect modeling to examine the changes in the association between family monitoring and antisocial peers and marijuana use from ages 11 to 19, and to compare these associations by gender and levels of behavioral disinhibition. Data are drawn from the Raising Healthy Children study, a longitudinal panel of 1,040 youth. The strength of association between family monitoring and antisocial peers and marijuana use was mostly steady over adolescence, and was greater for girls than for boys. Differences in the strength of the association were also evident by levels of behavioral disinhibition: youth with lower levels of disinhibition were more susceptible to the influence of parents and peers. Stronger influence of family monitoring on girls and less disinhibited youth was most evident in middle adolescence, whereas the stronger effect of antisocial peers was significant during middle and late adolescence. Implications for the timing and targeting of marijuana preventive interventions are discussed.

The Relationship Between Marijuana and Conventional Cigarette Smoking Behavior from Early Adolescence to Adulthood.

Longitudinal analyses investigated (a) the co-occurrence of marijuana use and conventional cigarette smoking within time and (b) bidirectional associations between marijuana and conventional cigarette use in three developmental periods: adolescence, young adulthood, and adulthood. A cross-lag model was used to examine the bidirectional model of marijuana and conventional cigarette smoking frequency from ages 13 to 33 years. The bidirectional model accounted for gender, school-age economic disadvantage, childhood attention problems, and race. Marijuana use and conventional cigarette smoking were associated within time in decreasing magnitude and increased cigarette smoking predicted increased marijuana use during adolescence. A reciprocal relationship was found in the transition from young adulthood to adulthood, such that increased conventional cigarette smoking at age 24 years uniquely predicted increased marijuana use at age 27 years, and increased marijuana use at age 24 years uniquely predicted more frequent conventional cigarette smoking at age 27 years, even after accounting for other factors. The association between marijuana and cigarette smoking was found to developmentally vary in the current study. Results suggest that conventional cigarette smoking prevention efforts in adolescence and young adulthood could potentially lower the public health impact of both conventional cigarette smoking and marijuana use. Findings point to the importance of universal conventional cigarette smoking prevention efforts among adolescents as a way to decrease later marijuana use and suggest that a prevention effort focused on young adults as they transition to adulthood would lower the use of both cigarette and marijuana use.

HIV/Sexually Transmitted Infection Prevention Messaging: Targeting Root Causes of Sexual Risk Behavior.

INTRODUCTION: Sexual risk behaviors (SRBs) often lead to sexually transmitted infections (STI), yet little is known about what drives SRB and whether this differs by sex. METHOD: Participants (n = 920; 75% white) were drawn from the Raising Healthy Children study, enrolled in 1993 and 1994 in grades 1 to 2, and followed up through age 24/25 years. Lifetime STI diagnosis was defined by self-report or seropositivity for Chlamydia trachomatis or herpes simplex virus 2. Multivariable models assessed individual (social skills, behavioral disinhibition) and environmental factors (family involvement, school bonding, antisocial friends) predictive of STI diagnosis as mediated by 3 proximal SRB (sex under the influence of drugs or alcohol, condom use, lifetime number of sex partners). RESULTS: Twenty-five percent of participants had ever had an STI. All SRBs differed by sex (P < 0.001), and female participants were more likely to have had an STI (P < 0.001). Behavioral disinhibition and antisocial friends in adolescence were associated with more SRB for both sexes, whereas social skills were associated with less SRB in female but more in male participants. Considering SRB and individual and environmental factors together, lifetime number of sex partners (adjusted relative risk [ARR], 1.04per partner; 95% confidence interval [CI], 1.03-1.05) and inconsistent condom use (ARR, 1.10per year; 95% CI, 1.04-1.16) were associated with increased risk of STI, whereas social skills were associated with decreased risk of STI (ARR, 0.84; 95% CI, 0.75-0.93). Behavioral disinhibition seemed to drive SRB, but family involvement mitigated this in several cases. CONCLUSIONS: Adolescent environmental influences and individual characteristics drive some SRB and may be more effective targets for STI/HIV prevention interventions than proximal risk behaviors.

A Test-Replicate Approach to Candidate Gene Research on Addiction and Externalizing Disorders: A Collaboration Across Five Longitudinal Studies.

This study presents results from a collaboration across five longitudinal studies seeking to test and replicate models of gene-environment interplay in the development of substance use and externalizing disorders (SUDs, EXT). We describe an overview of our conceptual models, plan for gene-environment interplay analyses, and present main effects results evaluating six candidate genes potentially relevant to SUDs and EXT (MAOA, 5-HTTLPR, COMT, DRD2, DAT1, and DRD4). All samples included rich longitudinal and phenotypic measurements from childhood/adolescence (ages 5-13) through early adulthood (ages 25-33); sample sizes ranged from 3487 in the test sample, to ~600-1000 in the replication samples. Phenotypes included lifetime symptom counts of SUDs (nicotine, alcohol and cannabis), adult antisocial behavior, and an aggregate externalizing disorder composite. Covariates included the first 10 ancestral principal components computed using all autosomal markers in subjects across the data sets, and age at the most recent assessment. Sex, ancestry, and exposure effects were thoroughly evaluated. After correcting for multiple testing, only one significant main effect was found in the test sample, but it was not replicated. Implications for subsequent gene-environment interplay analyses are discussed.

Understanding the interplay of individual and social-developmental factors in the progression of substance use and mental health from childhood to adulthood.

This study examines the interplay between individual and social-developmental factors in the development of positive functioning, substance use problems, and mental health problems. This interplay is nested within positive and negative developmental cascades that span childhood, adolescence, the transition to adulthood, and adulthood. Data are drawn from the Seattle Social Development Project, a gender-balanced, ethnically diverse community sample of 808 participants interviewed 12 times from ages 10 to 33. Path modeling showed short- and long-term cascading effects of positive social environments, family history of depression, and substance-using social environments throughout development. Positive family social environments set a template for future partner social environment interaction and had positive influences on proximal individual functioning, both in the next developmental period and long term. Family history of depression adversely affected mental health functioning throughout adulthood. Family substance use began a cascade of substance-specific social environments across development, which was the pathway through which increasing severity of substance use problems flowed. The model also indicated that adolescent, but not adult, individual functioning influenced selection into positive social environments, and significant cross-domain effects were found in which substance-using social environments affected subsequent mental health.

The Relationship between Interpersonal Violence Victimization and Smoking Behavior across Time and by Gender.

The current study examined relationships between interpersonal violence victimization and smoking from childhood to adulthood. Data were from a community-based longitudinal study (N = 808) spanning ages 10 - 33. Cross-lag path analysis was used to model concurrent, directional, and reciprocal effects. Results indicate that childhood physical abuse predicted smoking and partner violence in young adulthood; partner violence and smoking were reciprocally related in the transition from young-adulthood to adulthood. Gender differences in this relationship were not detected. Social work prevention efforts focused on interpersonal violence and interventions targeting smoking cessation may be critical factors for reducing both issues.

The developmental progression of age 14 behavioral disinhibition, early age of sexual initiation, and subsequent sexual risk-taking behavior.

BACKGROUND: Research has demonstrated a consistent relationship between early sexual experience and subsequent sexual risk-taking behaviors. We hypothesized that this relationship is due to a general predisposition toward behavioral disinhibition (BD), and that relationships among BD, early sex, and subsequent risky sexual behavior may be influenced by common genetic influences for males and common environmental influences for females. METHODS: A prospective sample of 1,512 same-sex adolescent twins (50.2% female) was used. Adolescent BD was measured by clinical symptom counts of conduct disorder, oppositional defiant disorder, and self-reported delinquent behavior (age 14). Age of sexual initiation was defined as first age of consensual oral or penetrative sex (mean age ~17). Adult risky sexual behavior was defined by sexual behaviors under the influence of drugs and alcohol and number of casual sexual partners in the past year (age 24). RESULTS: Multivariate analyses showed evidence for substantial common genetic variance among age 14 BD, age at sexual initiation, and adult risky sexual behavior for males, but not females. There was no significant difference in the degree of common environmental influence on these variables for females compared to males. Notably, age of sexual initiation was not significantly correlated with age 24 risky sexual behavior for females. CONCLUSION: The relationship between early sex and later risky sex can be better understood through a general liability toward BD, which is influenced primarily by genetic factors for males. The association between age 14 BD and age of sexual initiation was influenced through a combination of genetic and environmental factors for females; however, age of sexual initiation does not appear to be a salient predictor of adult women's sexual risk-taking behavior. Findings suggest that prevention programs aimed at reducing sexual risk behavior might target youth exhibiting BD by age 14, particularly males. More research is needed on what predicts adult sexual risk-taking behavior for females.

Long-term Effects of the Raising Healthy Children Intervention on Family Functioning in Adulthood: A Nonrandomized Controlled Trial.

Some universal prevention programs, such as Raising Healthy Children (RHC), have shown persisting and wide-ranging benefits in adulthood, long after the intervention has ended. Recent studies suggest that benefits may continue into the next generation as well. This study examines whether the RHC intervention, delivered in childhood, may promote healthy family functioning among participants who now have families of their own. Participants were drawn from the Seattle Social Development Project (SSDP), a nonrandomized controlled trial of the RHC intervention prospectively following youths from 18 elementary schools in Seattle, Washington from 1985 to 2014. Participants who became parents were enrolled in an intergenerational study, along with their oldest biological child and an additional caregiver who shared responsibility for raising the child. Ten waves of data were collected between 2002 and 2018. The present analysis includes 298 SSDP parents, 258 caregivers who identified as a parent or partner of SSDP parent ("co-parent"), and 231 offspring. The SSDP parent sample was composed of 41.6% male, 21.1% Asian or Pacific Islander, 24.2% Black or African American, 6.4% Native American, and 48.3% white individuals. No significant intervention effects were found on adult romantic relationship quality; offspring bonding to co-parent; or co-parent past-month use of cannabis, cigarettes, or binge drinking. Findings highlight the continued need to understand how the benefits of theory-guided universal preventive interventions are sustained across the life course and how they may or may not shape family functioning for those who go on to have families and children of their own.ClinicalTrials.gov Identifier: NCT04075019.

Effects of Cannabis Legalization on Adolescent Cannabis Use Across 3 Studies.

INTRODUCTION: Canada, Uruguay, and 18 states in the U.S. have legalized the use of nonmedical (recreational) cannabis for adults, yet the impact of legalization on adolescent cannabis use remains unclear. This study examined whether cannabis legalization for adults predicted changes in the probability of cannabis use among adolescents aged 13-18 years. METHODS: Data were drawn from 3 longitudinal studies of youth (spanning 1999-2020) centered in 3 U.S. states: Oregon, New York, and Washington. During this time, Oregon (2015) and Washington (2012) passed cannabis legalization; New York did not. In each study, youth average age was 15 years (total N=940; 49%-56% female, 11%-81% Black/African American and/or Latinx). Multilevel modeling (in 2021) of repeated measures tested whether legalization predicted within- or between-person change in past-year cannabis use or use frequency over time. RESULTS: Change in legalization status across adolescence was not significantly related to within-person change in the probability or frequency of self-reported past-year cannabis use. At the between-person level, youth who spent more of their adolescence under legalization were no more or less likely to have used cannabis at age 15 years than adolescents who spent little or no time under legalization. CONCLUSIONS: This study addresses several limitations of repeated cross-sectional studies of the impact of cannabis legalization on adolescent cannabis use. Findings are not consistent with changes in the prevalence or frequency of adolescent cannabis use after legalization. Ongoing surveillance and analyses of subpopulations are recommended.

Alcohol-Tolerant Workplace Environments Are a Risk Factor for Young Adult Alcohol Misuse on and off the Job in Australia and the United States.

The workplace has been understudied as a setting for the prevention of young adult alcohol misuse. This study examined if alcohol-tolerant workplace environments are associated with greater risk for alcohol use and misuse on and off the job among young adults. Data were collected in 2014 from state-representative, sex-balanced samples (51% female) of 25-year-olds in Washington, U.S. (n = 751) and Victoria, Australia (n = 777). Logistic regressions indicated that availability of alcohol at work, absence of a written alcohol policy, and alcohol-tolerant workplace norms and attitudes were independently associated with a 1.5 to 3 times greater odds of on-the-job alcohol use or impairment. Alcohol-tolerant workplace norms were associated also with greater odds of high-risk drinking generally, independent of on-the-job alcohol use or impairment. Associations were mostly similar in Washington and Victoria, although young adults in Victoria perceived their workplaces to be more alcohol-tolerant and were more likely to use alcohol or be impaired at work and to misuse alcohol generally than young adults in Washington. Cross-nationally, workplace interventions that restrict the availability of alcohol, ban alcohol at work, and reduce alcohol-tolerant norms have the potential to prevent and reduce young adults' alcohol use and misuse on and off the job.