Social Ecological Influences on Early Cannabis Initiation

Abstract

Although the disease burden associated with cannabis is low, cannabis use may nonetheless have major implications for health and its social determinants across the life course. The likelihood of experiencing cannabis-related health consequences is strongly associated with age of initiation. Contextualized by rapid and ongoing policy changes surrounding cannabis in the United States, this dissertation presents three epidemiologic studies of the impact of social environmental factors on early cannabis initiation. The first study examines the degree to which early cannabis initiation can be predicted by mother’s cannabis use during a child’s lifetime. This study found that children of cannabis-using mothers initiate earlier than children whose mothers do not use cannabis. The study further found that the likelihood of initiating during young adulthood or adulthood was unaffected by mother’s use, but that the likelihood of early initiation was strongly influenced by mother’s use. When analyses were stratified by race, effects were strongest among non-Hispanic, non-black children and Hispanic boys. The second study investigated the impact of prior employment on the hazard of adolescent cannabis initiation. The study found that employment during adolescence increased the hazard of subsequent cannabis initiation prior to age 18; however, after stratifying by race and family income, the effect appeared to be driven almost entirely by a strong association among whites, and Hispanics from families with high income. The final study examined whether parenting style impacted the relationship between employment and adolescent cannabis initiation. The study found that while employment and non-authoritative parenting styles were both associated with an increased likelihood of adolescent cannabis initiation across adolescents of all races, among adolescents who reported parents with an uninvolved style, employment was associated with a decreased likelihood of adolescent cannabis initiation. However, this effect modification was only present among white adolescents. The work presented in this dissertation represents the first time these relationships have been examined with specific attention to the issue of early cannabis initiation, using longitudinal methods and nationally-representative samples. These findings suggest social environment may have a strong impact on early cannabis initiation, but that these relationships are strongly dependent on race and gender.