Risk and Protective Factors Associated with Cannabis Use in Massachusetts Youth

Cannabis policies are continuously evolving, over half of U.S. youth now live in a state with a form of legalized cannabis. Monitoring risk and protective factors is critical to ensure evidence-based youth prevention in this post cannabis-prohibition era. Massachusetts has enacted and implemented three forms of legalization: (1) Decriminalization (2008), (2) medical cannabis (2012), and (3) adult-use cannabis (2016). This study used state Youth Risk Behavior Survey (YRBS) data of participants in grades 9-12 from 2007-2017 (N=17,691). Logistical regression models were run to assess effects of varying cannabis policy and risk or protective behaviors on cannabis use outcomes: (1) Lifetime use; (2) Past 30-day; and (3) Past 30-day heavy use. The enactment of cannabis policies was not associated with greater odds of youth reporting Lifetime and Past 30-day cannabis use behaviors. Any adult-support [heavy use OR=0.43 (95% CI=0.37,0.50), p<.001], better grades [heavy use OR=0.25 (95% CI=0.21,0.29), p<.001], and being heterosexual [heavy use OR=0.42 (95% CI=0.34,0.51), p<.001] were associated with lower odds of all cannabis use outcomes. Multiple risk factors broadly categorized under: risky sexual behaviors, non-heterosexual orientation, weapon carrying/exposure, hopelessness and suicidality behaviors, driving behaviors, and disability were associated with greater odds of cannabis use. Sensitivity analyses showed only one risk behavior was moderate by cannabis policy enactment. Results suggest that cannabis prevention efforts should not occur in a silo, rather evidence-based models for reducing risky behaviors generally may have the largest impact. Building and supporting relationships with trusted adults for youth at higher risk should be emphasized.