Exploring the relationship of rurality and region: An analysis of adolescent marijuana use in the United States.

Marijuana use among adolescents and young adults has increased, however, there is a paucity of research concerning marijuana use among adolescents in rural areas. Current literature holds the assumption that adolescents in rural areas tend to use less marijuana and marijuana associated products compared with youth from urban and suburban areas. However, geographical features may contribute to unique stressors experienced by rural youth, resulting in distinct differences in usage that have been previously unexplored. The purpose of the current study was to explore the relationship between rurality and geographic region by examining patterns of lifetime marijuana use in 12th graders across various geographical backgrounds. Using data from the Monitoring the Future Study database, participants were classified based on rurality (rural, medium suburban/urban, large suburban/urban) and geographic region (Northeast, Midwest, South, West) and data was analyzed to investigate the differences in lifetime marijuana and hash usage. Results demonstrated that rural adolescents in the Northeast and West reported lifetime marijuana and hash product use at the same level as their urban/suburban counterparts; however, there were differences across rurality among Midwest and Southern regions. These results suggest that lifetime marijuana use among rural adolescents is not uniform across geographic regions, indicating that geography should be heavily considered when formulating preventative and educational marijuana programs.

Longitudinal associations of e-cigarette use with cigarette, marijuana, and other drug use initiation among US adolescents and young adults: Findings from the population assessment of tobacco and health study (Waves 1-6).

INTRODUCTION: Research examining prospective links of e-cigarette use with cigarette, marijuana, and other substance use has been limited largely to 1-2-year follow-up periods and focused on younger adolescents. This study examined longitudinal associations of e-cigarette use with cigarette, marijuana, and other substance use initiation among U.S. adolescents and young adults (AYAs) across an eight-year period. METHODS: Adolescent (ages 12-17) and young adult (ages 18-25) data from waves 1-6 of the nationally representative Population Assessment of Tobacco and Health study (2013-2021) were used. Discrete time survival models with time-varying weights were employed to examine the risk of cigarette, marijuana, and other drug use initiation over an eight-year follow-up period among AYAs with no lifetime use of e-cigarettes/other tobacco, lifetime but no past 30-day use of e-cigarettes/other tobacco, past 30-day e-cigarettes only, other tobacco use only, or past 30-day e-cigarette/other tobacco use. We compare our time-varying weighting approach to a traditional time-invariant/complete case weighting approach. RESULTS: Across six follow-up waves, all three past 30-day nicotine/tobacco use groups, including e-cigarettes only, had greater risk for cigarette, marijuana, and other drug use initiation relative to those not using nicotine/tobacco. The three past 30-day nicotine/tobacco use groups did not differ from each other in risk for marijuana use initiation. Associations were smaller in magnitude for young adults compared to adolescents, but significant for both age groups. CONCLUSIONS: Substance use initiation risks persist beyond 1-2 years for U.S. AYAs using e-cigarettes. Prevention strategies to reduce AYA e-cigarette use are needed to reduce cancer-related risk.

Disproportionate increase in cannabis use among people with serious psychological distress and associations with psychiatric service use in the United States, 2009-2019.

BACKGROUND: Cannabis use is on the rise, but it is unclear how use is changing among individuals with serious psychological distress (SPD) compared to the general population as well as what associations this may have with mental health service use. METHODS: Retrospective cohort study using the National Survey on Drug Use and Health (NSDUH) 2009-19 public use files of 447,228 adults aged ≥ 18 years. Multivariable logistic regression and predictive margin methods were used to estimate linear time trends in any and greater-than-weekly levels of cannabis use by year and SPD status and rates of psychiatric hospitalization and outpatient mental health care. FINDINGS: Rates of any and weekly-plus cannabis use increased similarly among individuals with SPD compared to those without from 200 to 2014 but more rapidly in SPD every year from 2015 to 2019 (p < 0.001). Among individuals with SPD, no use was associated with a 4.2 % probability of psychiatric hospitalization, significantly less than less-than-weekly (5.0 %, p = 0.037) and weekly-plus cannabis use (5.1 %, p = 0.028). For outpatient mental health care, no use was associated with a 27.4 % probability (95 % CI 26.7-28.1 %) of any outpatient care, significantly less than less than weekly use (32.6 % probability, p < 0.001) and weekly-plus use (29.9 % probability, p = 0.01). CONCLUSIONS: Cannabis use is increasing more rapidly among individuals with SPD than the general population, and is associated with increased rates of psychiatric hospitalization and outpatient service use. These findings can inform policy makers looking to tailor regulations on advertising for cannabis and develop public health messaging on cannabis use by people with mental illness.

Trends in marijuana and heavy alcohol use by cigarette smoking status among US adults: An analysis of the 2002-2019 NSDUH.

BACKGROUND: Polysubstance use is associated with adverse health outcomes, yet little research has measured changes in polysubstance use. We aimed to 1) estimate trends in marijuana and heavy alcohol use by cigarette smoking and demographic subgroups, and 2) examine patient factors associated with concurrent use among adults who were smoking. METHODS: We conducted a repeated cross-sectional analysis of 687,225 non-institutionalized US adults ≥18 years from the 2002-2019 National Survey on Drug Use and Health. Participants were stratified into current, former, and never smoking groups. Main outcomes were prevalence of heavy alcohol use, marijuana use, and concurrent use of both substances. RESULTS: From 2002-2019, heavy alcohol use declined from 7.8 % to 6.4 %, marijuana use rose from 6.0 % to 11.8 %, and concurrent use of alcohol and marijuana remained stable. Among adults who were smoking from 2005 to 2019, higher education was associated with higher odds of heavy alcohol use, while older ages, female gender, non-White race/ethnicity, and government-provided health insurance were associated with lower odds. The odds of marijuana use decreased in females, older ages, and higher incomes while increasing in people with poorer health status, higher education, government-provided or no health insurance, and serious mental illness. Compared to White adults who were smoking, Black counterparts had higher odds of marijuana use (OR=1.23; 95 %CI: 1.15-1.29), while Hispanic (OR=0.68; 95 %CI: 0.63-0.72) and other racial/ethnic identities (OR=0.83; 95 %CI: 0.77-0.90) had lower odds. CONCLUSIONS: Our study suggests marijuana use might not be sensitive to changes in the use of tobacco and alcohol.

Changes in self-reported cannabis use in the United States from 1979 to 2022.

BACKGROUND AND AIMS: Multiple countries are considering revising cannabis policies. This study aimed to measure long-term trends in cannabis use in the United States and compare them with alcohol use. DESIGN AND SETTING: Secondary analysis of United States general population survey data. PARTICIPANTS: The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022. MEASUREMENTS: Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan-Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non-interference with state-level legalizations) and 2022 (most recent data available). FINDINGS: Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past-year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15-fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high-frequency drinking is less common. In 2022, the median drinker reported drinking on 4-5 days in the past month, versus 15-16 days in the past month for cannabis. In 2022, past-month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%). CONCLUSIONS: Long-term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers.

How have cannabis use and related indicators changed since legalization of cannabis for non-medical purposes? Results of the Canadian Cannabis Survey 2018-2022.

BACKGROUND: Cannabis use for non-medical purposes was legalized and regulated in Canada through the Cannabis Act in October 2018. This paper examined trends in use of cannabis for non-medical purposes and related indicators from pre- to post-legalization in Canada (2018-2022). METHODS: Data from 5 years of the Canadian Cannabis Survey, an annual web-based survey administered to Canadians 16 years of age or older, were used in the analysis (n2018=12,952; n2019=11,922; n2020=10,821; n2021=10,733; n2022=10,048). Cannabis measures include questions about use, types of products, sources, risk perceptions and beliefs, and exposure to public education campaigns and health warnings. Adjusted logistic regression models tested differences in outcomes over time. RESULTS: Past 12-month cannabis consumption increased among Canadians from 22 % in 2018 to 27 % in 2022 (AOR=1.41;99 % CI:1.28-1.54). Similarly, daily/almost daily (DAD) consumption increased from 5 % in 2018 to 7 % in 2022 (AOR=1.36;99 % CI:1.16-1.59). Consumption of dried flower, hash/kief, and concentrates/extracts (e.g., wax, shatter, budder) decreased since 2018, whereas consumption of edibles, beverages and vape pens/cartridges increased (p < 0.001). Legal purchasing increased from 4 % in 2018 to 69 % in 2022, while accessing cannabis through social and illegal sources decreased over time (p < 0.001). CONCLUSION: More Canadians are reporting cannabis consumption since legalization and regulation of cannabis for non-medical purposes, continuing a pre-existing trend despite an increase in awareness of the risks of consuming cannabis. Trends in product use indicate a transition from dried flower and concentrates/extracts towards consumption of cannabis foods, drinks and vape pens/cartridges. The legal market is increasingly displacing the illicit cannabis market in Canada.

Historical Trends in Cannabis Use Among U.S. Adults Ages 19-55, 2013-2021.

OBJECTIVE: The current study used U.S. national data to examine trends in cannabis use from 2013 to 2021, focusing on changes in cannabis prevalence during young and middle adulthood and whether trends differed by sociodemographic characteristics. METHOD: Data from 2013 to 2021 from 21,182 respondents ages 19-30 and 29,871 ages 35-55 in the national Monitoring the Future panel study (followed since they were in 12th grade in 1976-2020) were used to model historical trends in cannabis prevalence (any 12-month use, any 30-day use, and near-daily use [≥20 occasions in the past 30 days]). RESULTS: Prevalence of 12-month, 30-day, and near-daily cannabis use significantly increased from 2013 to 2021 for both young and middle adults. Trends for all three behaviors indicated either consistent linear increases or two-slope increases in which the slope estimate was larger in more recent years. Historical increases in 12-month and 30-day use were similar for young and middle adulthood; the historical increase in near-daily use among middle adults had some evidence for a possible pandemic-related deviation. Historical trends did not differ by race/ethnicity or college degree. Trends for 12-month and 30-day use differed by sex, with women increasing more than men over time, especially during middle adulthood. CONCLUSIONS: Significant increases in the prevalence of cannabis use have occurred over the past decade for young and middle adults across sociodemographic groups, with some indication that near-daily use increased among middle adults at the onset of the pandemic. Although men continue to have a higher prevalence than women, the gap has narrowed, with greater increases in cannabis use among women.

Evolving Disparities in Cannabis Use Among Youth by Demographics and Tobacco and Alcohol Use in the U.S.: 2013-2021.

INTRODUCTION: This study investigated the prevalence of past 30-day cannabis use among U.S. youth by cigarette use, alcohol use, demographics, and state-of-residence cannabis legal status in 2021 and examined whether changes in cannabis use prevalence were modified by these factors from 2013 to 2021. METHODS: Data were drawn from the 24 states that collected cannabis use data participating in the Youth Risk Behavior Surveillance System from 2013 to 2021. Logistic regression analyses estimated past 30-day cannabis prevalence in 2021 and produced AORs by current cigarette, alcohol, and state-of-residence cannabis legal status. The same method was used with year as the exposure, adjusting for sex, race, and ethnicity, to assess trends in prevalence from 2013 to 2021. RESULTS: In 2021, cannabis use was more common among female youth (16.75% vs 13.83% [AOR=1.26, 95% CI=1.16, 1.37]) and non-Hispanic Black and Hispanic youth than among non-Hispanic White youth (17.19%, 16.14% vs 14.60% [AOR=1.25, 95% CI=1.12, 1.39 and AOR=1.16, 95% CI=1.04, 1.29, respectively]). Cannabis use was much more common among youth who reported any past 30-day cigarette or alcohol use (44.90% vs 6.48% [AOR=11.80, 95% CI=10.57, 13.18]). Declines in cannabis use were observed independent of state-level cannabis law from 2013 to 2021, and cannabis use prevalence did not differ significantly by state-of-residence cannabis legal status among the 24 participating states in 2021. CONCLUSIONS: Public health officials should carefully consider the potential impact of expanding commercialization of cannabis as a wellness product on youth cannabis use, especially with regard to minoritized populations and co-use with tobacco and alcohol. National and state-level public health education on cannabis use and youth-oriented prevention of cannabis uptake are long overdue.

Impacto de la legalización del consumo recreativo del cannabis / Impact of the legalisation of recreational cannabis use

En los últimos años se han producido importantes cambios legislativos en numerosos países respecto al consumo de cannabis con fines medicinales y/o recreativos, que han facilitado su accesibilidad. Actualmente, Uruguay, Canadá y algunos estados de EE.UU. han legalizado el consumo recreativo, aplicando distintos modelos legislativos. El objetivo de la presente revisión es analizar los efectos que ha tenido la legalización del cannabis recreativo sobre su consumo y sus consecuencias. En general, las evidencias indican que la legalización se ha asociado a un descenso en el precio, mayor concentración de THC (potencia), mayor diversidad de presentaciones para su consumo, una menor percepción de riesgo y un incremento en el consumo en adultos y de forma moderada en adolescentes (aunque sea ilegal el consumo para ellos), así como un aumento de las consecuencias adversas derivadas del consumo en la salud pública. Se ha producido un descenso en los arrestos relacionados con el consumo, pero el mercado ilegal sigue utilizándose de forma habitual. No se ha detectado un incremento de la demanda de tratamiento por este consumo. Por el momento, estos cambios legislativos no han conseguido alcanzar sus objetivos principales que eran suprimir el mercado ilegal y proteger a los grupos más vulnerables, mientras que, por el contrario, parecen implicar un incremento de algunos aspectos negativos asociados al consumo de cannabis. Sin embargo, teniendo en cuenta que la mayoría de estos cambios legislativos han entrado en vigor hace relativamente poco tiempo, se requiere un periodo de seguimiento mayor para poder extraer conclusiones definitivas. (AU)

In recent years, there have been important legislative changes in many countries regarding the use of cannabis for medicinal and/or recreational purposes, which have facilitated access to it. Uruguay, Canada and some of the US states are the only jurisdictions that have legalised recreational consumption, applying different legislative models. The aim of this review is to analyse the effects that the legalisation of recreational cannabis has had on its use and its consequences. In general, the evidence accumulated to date indicates that the legalisation of cannabis has been associated with a decrease in the price of the substance, higher concentration of THC (potency), greater diversity of presentations for consumption, lower risk perception and an increase in consumption in adults and moderately in adolescents (even though it is illegal for them to consume), as well as an increase in the adverse consequences derived from cannabis consumption on public health. There has been a decrease in drug-related arrests, but the illegal market continues to be frequently used. No increase in the demand for treatment due to cannabis consumption has been detected. Therefore, these legislative changes have so far failed to achieve their main objectives, which were to suppress the illegal market and protect the most vulnerable groups, while on the contrary, they seem to imply an increase in some of the negative aspects associated with cannabis consumption. However, taking into account that most of these legislative changes have entered into force relatively recently, a longer follow-up period is required to be able to draw definitive conclusions. (AU)

¿Es posible crear la adecuada sensación de riesgo entre los consumidores de cannabis medicinal? / Can we increase risk perception among medical cannabis users?

Es cada vez mayor el número de investigaciones relacionadas con las posibles aplicaciones terapéuticas de los cannabinoides. Aunque en algunas enfermedades los resultados obtenidos son esperanzadores, la investigación en desarrollo está en sus etapas iniciales. Para algunos síntomas se ha probado la efectividad medicinal de los cannabinoides. Pero, en muchos casos no se dispone todavía de la adecuada evidencia al respecto, ni son suficientes los datos existentes sobre los riesgos asociados al consumo de cannabis medicinal. (AU)

Characterizing substance use in a sample of lesbian, gay, bisexual, and transgender adults in Mexico.

Background: Research from high-income countries on substance use among lesbian, gay, bisexual, and transgender (LGBT) adults is growing; however, limited empirical research exists on LGBT adults in Mexico. Filling this gap is critical as LGBT adults experience unique stressors that may place them at risk for substance use-related health outcomes. Objectives: This study sought to characterize substance use prevalence and magnitude among a convenience sample of Mexican LGBT adults. Methods: A cross-sectional online survey was conducted using a sample of Spanish-speaking, self-identified LGBT adults (n = 92) residing in Mexico who were recruited through online forums of LGBT-focused organizations. Descriptive and frequency analyses were conducted. Results: Participants predominantly identified as cisgender men (n = 44) and gay/lesbian (n = 68). Participants reported high rates of past 90-day legal substance use (>93% for alcohol and >57% for tobacco). The most commonly reported illicit drug used in the past 90 days was marijuana (>29%). Conclusions: While the sample reported lower prevalence and magnitude of substance use relative to other Mexican or United States LGBT samples, the findings highlight that legal and illicit substance use presents health risks for Mexican LGBT individuals. LGBT identity-affirming substance use treatment may reduce substance use-related health burden among this population.

Inteligencia emocional rasgo y habilidad como factores asociados al consumo de cannabis en la adolescencia / Trait and ability emotional intelligence as factors associated with cannabis use in adolescence

Diversos organismos internacionales alertan sobre el incremento deconsumo de cannabis y de su uso extendido entre los adolescentes.El presente estudio ha sido uno de los primeros con el objetivo deanalizar el papel de la inteligencia emocional rasgo y habilidad, basada en el modelo de Mayer y Salovey, en relación al consumo decannabis en adolescentes. En este estudio participaron 799 jóvenesespañoles con edades comprendidas entre los 12 y los 16 años. Seadministró un autoinforme de inteligencia emocional (IE) rasgo, untest de rendimiento máximo de IE y se preguntó sobre los hábitosrelacionados con el consumo de cannabis. Este estudio de tipo transversal se llevó a cabo a través de una metodología de corte cuantitativoy de tipo correlacional. Los principales resultados obtenidos mediantelos análisis de regresión una vez controlados el género, la edad y elcontexto de centro, revelaron asociaciones negativas entre los factoresde comprensión y reparación emocional de la IE rasgo y las variablesde consumo de cannabis, al contrario que la atención emocional. Porotro lado, en relación con la IE habilidad, los factores de percepción yfacilitación se asociaron de manera inversa al consumo de cannabis enlos adolescentes. Los resultados de este estudio sugieren que tanto laIE rasgo como la IE habilidad son constructos complementarios queayudan a explicar el consumo de cannabis. Estos hallazgos proporcionan evidencias empíricas que podrían orientar intervenciones clínicas y educativas enfocadas a la prevención del consumo en esta etapa. (AU)

Many international organisms have warned of the increased consumption of cannabis and its extensive use by adolescents. Thisstudy is one of the first with the aim of analyzing the role of abilityand trait emotional intelligence, based on the model of Mayer andSalovey, with regards to the consumption of cannabis by adolescents.The study participants were 799 Spanish nationals aged 12 to 16.They were administered a self-report on trait emotional intelligence(EI), a test of maximum EI performance and were asked about theirhabits relating to cannabis consumption. This cross-sectional studyused a quantitative, correlational methodology. The main resultsobtained from the regression analysis once gender, age and context ofresidence were controlled for, revealed negative associations betweenthe factors of understanding and emotional repair of trait EI and thecannabis consumption variables, in contrast to emotional attention.On the other hand, with regards to ability EI, the factors of perceptionand facilitation were inversely associated with cannabis consumptionin adolescents. The results suggest that both trait and ability EI arecomplementary constructs that help to explain cannabis consumptionduring this life stage. These findings offer empirical evidence thatmay help guide clinical and educational interventions focused onprevention of consumption during this period. (AU)

Adolescent Marijuana Use in the United States and Structural Breaks: An Age-Period-Cohort Analysis, 1991-2018.

To investigate temporal patterns, sociodemographic gradients, and structural breaks in adolescent marijuana use in the United States from 1991 to 2018, we used hierarchical age-period-cohort logistic regression models to distinguish temporal effects of marijuana use among 8th, 10th, and 12th graders from 28 waves of the Monitoring the Future survey (1991-2018). Structural breaks in period effects were further detected via a dynamic-programing-based method. Net of other effects, we found a clear age-related increase in the probability of marijuana use (10.46%, 23.17%, and 31.19% for 8th, 10th, and 12th graders, respectively). Period effects showed a substantial increase over time (from 16.23% in 2006 to 26.38% in 2018), while cohort effects remained stable throughout the study period. Risk of adolescent marijuana use varied by sex, racial group, family status, and parental education. Significant structural breaks during 1995-1996, 2006-2008, and 2011-2013 were identified in different subpopulations. A steady increase in marijuana use among adolescents during the latter years of this time period was identified. Adolescents who were male, were non-Black, lived in nonintact families, and had less educated parents were especially at risk of marijuana usage. Trends in adolescent marijuana use changed significantly during times of economic crisis.

Marijuana use does not affect the outcomes of bariatric surgery.

BACKGROUND: The decriminalization of marijuana and legalization of derived products requires investigation of their effect on healthcare-related outcomes. Unfortunately, little data are available on the impact of marijuana use on surgical outcomes. We aimed to determine the effect of marijuana use on 30-day complications and 1-year weight loss following laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). METHODS: At a large academic center, 1176 consecutive patients undergoing primary bariatric surgery from 2012 to 2017 were identified and separated into cohorts according to marijuana use. The only exclusions were 19 patients lost to follow-up. Propensity score matching, using logistic regression according to preoperative age, gender, BMI, and comorbid conditions, yielded 73 patient pairs for the control and study arms. All patients were followed two years postoperatively. RESULTS: Excess BMI lost did not differ between marijuana users and controls at 3 weeks (23.0% vs 18.9%, p = 0.095), 3 months (42.0% vs 38.1%, p = 0.416), 6 months (60.6% vs 63.1%, p = 0.631), 1 year (78.2% vs 77.3%, p = 0.789), or 2 years (89.1% vs 74.5%, p = 0.604). No differences in the rate of major 30-day postoperative complications, including readmission, infection, thromboembolic events, bleeding events and reoperation rates, were found between groups. Follow-up rate at two years was lower in marijuana users (12.3% vs 27.4%, p = 0.023). CONCLUSION: This study suggests marijuana use has no impact on 30-day complications or weight loss following bariatric surgery, and should not be a contraindication to bariatric surgery.

Reduction and Cessation of Alcohol, Cannabis, and Stimulant Use: Prospective Associations With Changes in Depressive Symptoms Across Two Cohort Studies of Sexual and Gender Minorities.

OBJECTIVE: Sexual and gender minorities (SGM) are at increased risk for substance use and depression. However, little research has examined the directionality of associations between substance use and depression in this high-risk population, and we are not aware of any to parse associations between depression and changes in the frequency of substance use versus substance use cessation. Such research can help to inform the development of future interventions to address health disparities affecting SGM. METHOD: We used data from two longitudinal cohorts of SGM assigned male at birth (SGM-AMAB; N = 1,418) to examine associations between changes in frequency of alcohol, cannabis, and stimulant use and depressive symptoms. Multilevel models tested whether changes in substance use predicted changes in depressive symptoms and vice versa. RESULTS: Results indicate that when SGM-AMAB decreased their alcohol use or ceased alcohol, cannabis, or stimulant use, they experienced concurrent decreases in depressive symptoms. Only reducing stimulant use (not alcohol or cannabis use) was associated with decreases in depressive symptoms over the subsequent 6 months. Depressive symptoms did not prospectively predict cessation or reduction in the use of any substance. CONCLUSIONS: These findings suggest that clinical interventions targeting substance use may simultaneously reduce depressive symptoms and that reductions in alcohol use (even in the absence of cessation) may simultaneously benefit mental health among SGM-AMAB. The limited evidence of prospective effects over 6 months suggests that studies with shorter lags may be better equipped to examine the directionality of the association between depressive symptoms and substance use/reduction.

Testing the drug use and condomless anal sex link among sexual minority men: The predictive utility of marijuana and interactions with relationship status.

BACKGROUND: The association between drug use and condomless anal sex (CAS) is well documented among sexual minority men (SMM). Less is known about whether this association generalizes to marijuana and across relationship status and sexual agreements groups (single, partnered monogamous, partnered open -outside partners permitted, and partnered monogamish -outside partners permitted when main partners are together). METHODS: A nationwide sample of SMM (N = 65,707) were recruited through a geosocial networking app between November 2017 and November 2019. Participants reported on drug use and instances of CAS with casual partners in the previous 30 days. RESULTS: Both marijuana and club drug use were associated with the occurrence of CAS with casual partners among single men. Only club drug use was associated with CAS frequency in this group. The association between marijuana and the occurrence of CAS did not differ significantly among monogamous men, while the associations between club drug use and the occurrence as well as frequency of CAS were significantly weaker. Meanwhile, the associations between club drug use and the occurrence as well as frequency of CAS did not differ significantly between single and non-monogamous (open and monogamish) subgroups; however, the association between marijuana and the occurrence of CAS was significantly weaker. CONCLUSIONS: Findings largely replicated the robust association between club drug use and CAS with casual partners. They support the assertion that marijuana use predicts sexual risk for some SMM subgroups. Finally, they illustrate the potential for relationship status - and sexual agreements - to contextualize associations between drug use and CAS.

Racial and gender inequities in the implementation of a cannabis criminal justice diversion program in a large and diverse metropolitan county of the USA.

BACKGROUND: Diversion programs are considered alternatives to the arrest and incarceration of non-violent drug offenders, including those found in possession of smaller amounts of cannabis in states with prohibitive laws. Despite the progressive nature of such programs, the inability to complete diversion program requirements can often result in greater involvement with the criminal justice system than traditional case adjudication. Few studies have evaluated racial group differences in cannabis diversion program completion. METHODS: The current study examined a sample of 8323 adult participants in Harris County, Texas' Marijuana Misdemeanor Diversion Program (MMDP) between March 2017 and July 2019. Gender, age, and race/ethnicity were examined as predictors of program completion and time to completion using Chi square, Kruskal Wallis tests, and Cox proportional hazard regression models. RESULTS: Both males and African Americans were over-represented (80 % and 50 %, respectively) among participants of Harris County's MMDP. African American (HR = 0.782, 95 % CI [.735-.832], p < .001) and Latino American MMDP participants (HR = .822, 95 % CI [.720-.937], p = .003) had significantly lower odds of MMDP completion and a longer interval to program completion as compared to non-Latino White participants. CONCLUSIONS: The current study identified racial/ethnic and gender disparities in a large county's cannabis diversion program. These findings may be related to law enforcement disparities which disproportionately target males and people of color. Findings may serve to inform the continued reform of the criminal justice system, particularly laws relating to cannabis.