Volume 154, July 2024, 108021Author links open overlay panel, , Highlights•

College students’ patterns of alcohol and cannabis use differed on frequency, intensity, and co-use.

•

Compared to their peers, college students in states with recreational cannabis legalization (RCL) less often showed patterns characterized by light and heavy alcohol use with no cannabis use, and more often reported abstinence.

•

In RCL states, college students more often reported patterns of frequent cannabis use with some alcohol use, or with heavy co-use of both substances.

AbstractObjective

Evidence is mixed on how young adults’ cannabis and alcohol use and co-use patterns have changed following recreational cannabis legalization (RCL). Incorporating measures of frequency and intensity of use we examined changes in college students' use and co-use patterns following RCL.

Method

Four-year college students (n = 845,589) ages 18–24 years participated in the National College Health Assessment between 2008 and 2018, including students from 7 states that enacted RCL and 42 that did not. Latent profile analyses identified six patterns of use from four indicator variables tapping frequency of cannabis use and frequency and intensity of alcohol use: Abstainers, Light Alcohol Only, Heavy Alcohol Only, Predominantly Heavy Cannabis Use, Moderate Co-use, and Heavy Co-use.

Results

Regression models that adjusted for time and person- and institution-level covariates indicated that students’ exposure to RCL was associated with lower odds of being in the two alcohol-only use classes, higher odds of being in the Predominantly Heavy Cannabis Use, Heavy Co-Use and Abstainers classes, and was not significantly related to Moderate Co-Use class membership.

Conclusions

RCL was positively associated with patterns of frequent cannabis use and frequent and intense co-use but also with abstinence. Use of alcohol-only became less prevalent after RCL. Research on how RCL influences the prevalence of problematic patterns of substance use will inform and improve prevention efforts.

Section snippetsMethods

Participants (n = 845,589) were undergraduate students ages 18 to 24 years from 589 four-year colleges, in 49 states (possibly including Washington D.C.; state identifiers are not released to researchers) who completed the National College Health Assessment (American College Health Association, 2021) which was administered biannually (Fall and Spring). Responses from Fall 2008 through Spring 2018 were used. Most institutions administered surveys during Spring and most participated every other

Results

Descriptive statistics on the participants who were exposed and not exposed to RCL are reported in Table 1.

Latent Profile Analysis.

Based on the model fit statistics (see Supplementary materials and Supplemental Table A) a 6-class solution was selected. Table 2 reports descriptive class labels and the mean and range of values for each indicator for each observed class. Abstainers reported essentially no alcohol or cannabis use. The Light Alcohol-Only class was characterized by relatively few

Discussion

In the present study we examined the extent to which RCL exposure was associated with college students’ alcohol and cannabis use patterns. To date, most RCL research has focused on binary outcomes (e.g., any vs. no use) regarding use of a single substance. Given growing public health interests in co-use and in substitution or complementarity effects following RCL, the present study is an important advance.

Six substance use patterns were identified using LPA, reflecting more ecologically valid

Conclusion

Understanding undergraduates’ alcohol and cannabis use patterns and the potential effects of RCL may inform prevention development. Given the complexity of substance use patterns it should not be surprising that RCL effects may be complex. The changes following RCL must be elucidated so that students, parents, college administrators, and policy makers can respond to the shifting policy landscape. For example, personal protective strategies and campus- and community-level prevention policies may

CRediT authorship contribution statement

Samantha E. Reed: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Conceptualization. David C.R. Kerr: Writing – review & editing, Writing – original draft, Supervision, Resources, Methodology, Investigation, Conceptualization. Frank J. Snyder: Writing – review & editing, Methodology.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (24)A.L. Haas et al.Identifying classes of conjoint alcohol and marijuana use in entering freshmen

Psychology of Addictive Behaviors

(2015)

W. Hall et al.The effects of cannabis use on the development of adolescents and young adults

Annual Review of Developmental Psychology

(2020)

View full text

© 2024 Elsevier Ltd. All rights reserved.