Recreational Marijuana Legalization, Local Retail Availability, and Alcohol and Marijuana Use and Co-Use among California High School Students


Objective:

This study examined whether recreational marijuana legalization (RML) and local retail availability were associated with marijuana and alcohol use and co-use among adolescents.


Method:

We investigated associations between RML and past 30-day marijuana and alcohol use and co-use, and moderating effects of retail availability of marijuana and alcohol, using data from the 2010-11 to 2018-19 California Healthy Kids Surveys (CHKS) of 9th and 11th grade students in 38 California cities. Multi-level mixed-effects logistic regression analyses were conducted, controlling for secular trends and student and city demographics. Additional analyses examined associations of RML and retail availability with co-use among subgroups of drinkers and marijuana users.


Results:

For the full sample, RML was inversely associated with alcohol use, but was not significantly associated with marijuana use or co-use with alcohol. However, significant interactions between RML and marijuana outlet density showed there were increases in marijuana and alcohol co-use and alcohol following legalization in cities with higher densities of marijuana outlets. RML was positively associated with co-use among non-heavy and heavy drinkers, but inversely related to co-use among occasional and frequent marijuana users. A significant positive interaction between RML and marijuana outlet density indicated that RML was associated with increases in co-use for occasional marijuana users in cities with higher densities of marijuana outlets.


Conclusions:

RML was associated with increases in marijuana and alcohol co-use and alcohol use among California high school students, particularly those in cities with higher densities of retail cannabis stores, though this varied across alcohol and marijuana use subgroups.


Keywords:

adolescent; alcohol; co-use; legalization; marijuana; use.

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