Cannabis legalization and changes in young adult substance use, related health risk behaviors, and risk factors in Washington State: Within-state variation and the role of community-level factors

摘要 大麻在年轻人中的使用很普遍，国家研究表明近年来在 大麻使用情况，包括日常使用情况。截至2018年11月，美国10个州和华盛顿特区 哥伦比亚已将大麻用于21岁及以上成年人的非医疗(娱乐)用途合法化。 华盛顿州走在了这些变化的前列，2012年投票批准了合法化，并有效地 两年后实施这项立法。尽管合法化的一个主要论点是它有可能 减少与刑事司法介入相关的人力、社会和经济成本，这是意想不到的 有害后果可能涉及其对大麻和其他物质使用(SU)的影响。重要的是， 政策实施的影响在全州可能会有不同的感受。许多地区的地方司法管辖区 社区通过了对大麻市场施加限制的法令。此外，在市政当局 在没有禁令的地方，商店的地理分布是不均匀的，大麻零售店往往 集中在社会经济条件较差的社区。关于效果评价的研究 大麻使用合法化仅处于初级阶段；对SU的病因和相关健康知之甚少 危险行为，如醉酒驾车，以及社区和个人层面的大麻的作用- 大麻合法化背景下的具体风险因素。此外，还不清楚使用 不同的物质在实施过程中或在发展过程中可能会发生变化。的突出之处 已知的风险因素也可能在实施过程中、根据情况或在青壮年过程中发生变化。 这个项目利用了我们从西澳国务院收集的独特而丰富的数据 社会和卫生服务。佤邦青少年健康调查(YAHS)是一项加速的纵向调查 2014-2018年对18-29岁年轻人的队列研究，第一次数据收集发生在 在随后的四年中，合法的大麻商店每年都会开张，并增加更多的大麻种群。这项调查 将把数据与大麻政策数据库联系起来，该数据库表明大麻在当地的变化情况，包括 关于销售的法规和限制，以及关于商店密度和社区劣势的数据。这 该项目旨在研究大麻合法化对青少年SU和相关健康危险行为的影响 佤邦的成年人。我们还将评估州内SU结果的差异，因为它与社区层面有关 市县政策、大麻和酒精零售点的可用性以及社区等因素 劣势。此外，我们将研究SU的轨迹及其在杨氏过程中的相互作用 成年期与社区因素在青壮年SU病因及相关转归中的作用 在大麻合法化的背景下。了解这些影响将有助于(1)规划预防和 旨在改善健康结果和减少变化中的问题行为的干预努力 大麻政策背景；以及(2)与大麻有关的现有政策和新政策的监管规定。

ABSTRACT Cannabis use among young adults is widespread and national studies indicate increases in recent years in prevalence of cannabis use, including daily use. As of November 2018, 10 U.S. states and the District of Columbia have legalized cannabis for non-medical (“recreational”) use for adults aged 21 and older. Washington State was on the forefront of these changes, voting to approve legalization in 2012 and effectively implementing the legislation two years later. Although a major argument for legalization was its potential to decrease the human, social, and economic costs related to criminal justice involvement, an un-intended detrimental consequence might involve its impact on cannabis and other substance use (SU). Importantly, the impact of policy implementation may be felt differently across the state. Local jurisdictions in many communities passed ordinances that impose restrictions on the cannabis market. Further, in municipalities where no bans are in place, the geographic distribution of stores is uneven, with cannabis retail stores often concentrating in socio-economically disadvantaged neighborhoods. Research on the evaluation of the effects of legalization on cannabis use is only in its infancy; little is known about the etiology of SU and related health risk behaviors, such as driving while intoxicated, and the role of community- and individual level cannabis- specific risk factors in the context of legalized cannabis. Moreover, it is unclear how relationships among use of different substances may change during the course of implementation or developmentally. The salience of known risk factors may also change during implementation, by context or over the course of young adulthood. This project capitalizes on unique and rich data we collected with funding from the WA State Department of Social and Health Services. The WA State Young Adult Health Survey (YAHS) is an accelerated longitudinal cohort study of young adults ages 18-29 from 2014-2018 with the first data collection occurring before any legal cannabis stores opened and additional cohorts added in each of the four subsequent years. The survey data will be linked with a cannabis policy database that denotes local variation in cannabis context, including regulations and restrictions on sales, and with data on density of stores and neighborhood disadvantage. This project aims to examine effects of cannabis legalization on SU and related health risk behaviors among young adults in WA State. We will also assess within-state variation in SU outcomes as it relates to community-level factors such as city and county policy, cannabis and alcohol retail outlet availability, and neighborhood disadvantage. Moreover, we will examine the trajectories of SU and their interplay over the course of young adulthood and the role of the community-level factors in the etiology of young adult SU and related outcomes in the context of legalized cannabis. Understanding these effects will inform (1) planning of prevention and intervention efforts aimed at improving health outcomes and reducing problem behaviors in the changing cannabis policy context; and (2) regulatory provisions for the existing and new policies related to cannabis.