We combined data from different generations to serve as a comparison group for the Baby Boomer cohort. These different generations do not necessarily have the same prevalence of use or patterns of consumption. As a result, it would be inappropriate to use the results from this comparison group as predictive; for example, the observation of negative associations between retirement and cannabis use may reflect low rates of cannabis use among adults older than Baby Boomers rather than a characteristic of retirement. Finally, California legalization of recreational cannabis use proceeded in two stages, with use and personal grows legalized in 2016, and recreational retail sales legalized in 2018, meaning that if use of recreational cannabis among Baby Boomers increased after 2016, we would not have observed this shift. However, research on recreational retail sales suggests that because legalized sales increase accessibility, they have a greater effect on consumption than legalization of personal use and grows.In the United States, a majority of states have legalized the use of cannabis for some purposes, and California has been a forerunner in cannabis legalization. California was the first state to legalize medical cannabis use in 1996. To date, 35 states have legalized medical cannabis; 15 of these 35 have also legalized adult recreational cannabis, and another 13 states permit the use of products with low tetrahydrocannabinol for medical purposes. Modes of cannabis use include smoking, vaping, and as an edible. Cannabis when smoked may be wrapped in paper or placed within a hollowed-out cigar . In 2018, modes of recent cannabis use among young adults in California were reported as 81% smoking ; 47% vaping; 43% blunt use; and 35% eating/drinking; 78% reported more than one method. Potential mental health harms of cannabis use include increased risk of developing schizophrenia and other psychoses, with heavier cannabis use associated with greater risk. Depression, anxiety, and suicidal thoughts also have been linked to cannabis use. Whether the associations are causal is unknown. Smoking cannabis can affect lung health, with regular use associated with chronic bronchitis.
Smoking cannabis during pregnancy is associated with low birthweight; studies of adverse effects of prenatal cannabis use on offspring behavior and cognitive development have been equivocal.To characterize the evidence on the health benefits of cannabis use,grow tray stand the National Academies of Sciences, Engineering, and Medicine published a comprehensive in depth review of 10,000 studies. The report found strong evidence from randomized control trials to support the conclusions that cannabis or its constituents are effective for treating chronic pain; as antiemetics in the treatment of chemotherapy induced nausea and vomiting; and for improving patient-reported multiple sclerosis spasticity symptoms. With regards to mental health, other research has found an anxiolytic-like effect of cannabidiol in patients with social anxiety disorder. There also is moderate evidence for cannabinoids, mainly nabiximols, in improving short-term sleep outcomes in those with chronic medical conditions. Few studies have examined cannabis’s effects on well-being, a construct related to quality of life, and findings have been mixed. Since 1990, there has been an increasing trend in favor of legalizing cannabis in the United States. The Pew Research Center reported that 59% of Americans favor legalizing cannabis for medical and recreational use, while another 32% support cannabis use for medical purposes only; only 8% opposed legalizing cannabis. Since 2002, adult use of cannabis has been increasing. In 2019, 31.6 million Americans reported cannabis use in the past 30 days, with prevalence of 23% among adults aged 18- to-25 and 10.2% among adults 26 years and older. Data from the 2018 California Health Interview Survey showed that among adults 18 years and older, 33% reported cannabis use within the past month. In California, on November 8, 2016, voters passed Prop 64, the Adult Use of Marijuana Act, supporting the legalization of recreational cannabis use for adults 21 years or older. Prop 64 proposed to create a system to regulate the cannabis market and impose taxes on the retail sale and cultivation of cannabis; and allowed for use in a private home or at a business licensed for onsite consumption, and prohibited use while driving and in public areas including federal areas such as parks, as it is illegal under federal law. On January 1, 2018, California was authorized to begin issuing licenses to operate recreational cannabis businesses, legalizing sales from licensed retail outlets and the purchasing of cannabis for recreational use.
States that legalized recreational cannabis use had a higher prevalence of cannabis use and greater use of products such as cannabis edibles, drinks, and high potency concentrate than in those that had not . Among the first four states that legalized cannabis for recreational purposes , there were increases in frequent cannabis use and cannabis use disorder among adults aged 26 and older following recreational cannabis legalization. A recent California study found no increase in cannabis use after legalization of recreational cannabis; however, the study sample was restricted to young adults aged 18–24 who used tobacco, so the findings may not generalize to the broader population. Beliefs on the health benefits of cannabis was found to be higher in states that had legalized cannabis for recreational use. With expanding legalization and increases in cannabis use, examining patterns of cannabis use and the factors that might drive cannabis use trends over time is needed. With California’s legalization of recreational cannabis use, we sought to characterize, from pre- to post-policy implementation, adults’ use patterns, exposure to others’ cannabis use, and perceptions of the benefits or harms of cannabis use to physical and mental health and well being. We hypothesized an increase in adult cannabis use and exposure to others’ use as well as more positive health perceptions of cannabis use over time.In this prospective observational study on cannabis policy changes in California, legalized recreational cannabis use was associated with greater self-reported past 30-day use one-month post-legalization, and in the univariate model, remained significantly higher at 6-months post legalization. Compared to California state data, our study sample had a lower frequency of past 30-day cannabis use. Likely related, the sample had more harmful perceptions of cannabis use: 43% of respondents at baseline and 42% at 1-month post-legalization perceived cannabis use to be harmful, whereas United States data from the Substance Abuse and Mental Health Services Administration estimated 12% of young adults 18 to 25 years old and 29% of adults 26 years or older perceived great risk from smoking cannabis monthly. Surprisingly, exposure to others’ use of cannabis did not change from pre- to post-legalization of recreational cannabis use in our study time frame; however, it is possible that exposure to cannabis smoke may have increased earlier among our study population. A California Department of Public Health survey found that the rate of cannabis exposure in 2016 among adults aged 18 to 64 years was 21.5%, and by 2018 had doubled to 40%, which is similar to our findings on cannabis exposure.
In late-2016, Prop 64 was voted on and approved by voters of California and could explain the increase of secondhand cannabis exposure from 2016 to 2018. Significant correlates of cannabis use at all time points included depression diagnosis, while having an other mental illness diagnosis was significantly associated with cannabis use only 6-months post-legalization. A recent study found that from 2005 to 2017, the prevalence of cannabis use among people in the United States with depression was increasing and that those with depression experienced a rapid decrease in perception of risk of cannabis use. While not tested in our study, it is possible those with depression or other mental illness experienced decreasing perceptions of risk of cannabis use. Despite the growing evidence of cannabis use as an effective treatment in chronic pain and its use in mitigating side effects of cancer therapies, our study showed that those with pain and those with a history of cancer were not significantly more likely to use cannabis. Among our California study sample of adults between the ages of 23 to 86 with a mean age of 56 years, we found younger age associated with cannabis use pre and post-legalization. These findings are consistent with previous national studies on adults in the United States where cannabis use decreased with increasing age. By 6-months post-legalization, perceived health benefits of cannabis use significantly increased, and in the multivariate model, health perceptions were associated with cannabis use over time. Notably, perceptions of health benefits of cannabis use for mental health showed the largest increase. The literature suggests potential anxiolytic effects of CBD, but also points to the association of mental health harms with high-potency cannabis use. Though our sample had an overall positive perception of cannabis use in benefiting physical health and well being,garden racks for sale there was no significant association between cannabis use with pain or cancer, common conditions for which cannabis has been used to treat. Mass marketing and health promotions from cannabis dispensaries also may have contributed to the increase in perceived health benefits of cannabis. Since the legalization of recreational cannabis in California, which includes the selling of cannabis, dispensary ads and mass marketing campaigns promoting uses of cannabis have proliferated. Endorsements from social media influencers and celebrities, may also be adding to overall positive perception of cannabis use. As a response to the mass marketing, Los Angeles and San Diego counties have proposed restrictions on where cannabis ads and billboards can be placed. Much is to be learned on whether these restrictions will impact perceptions and use. To ensure health harms are not ignored, public health interventions such as educational programs and health communications are needed to increase awareness. Study limitations include that the data were self reported by a relatively small convenience sample, and thus may not be generalizable to other populations. The sample was more non-Hispanic White than the general population in California; however, a similar percentage of Californians voted in favor for Proposition 64.
Another limitation is the high level of missing demographic data and high attrition rate. Rather than remove respondents who did not complete all the surveys and conduct a complete case analysis that could lead to less power and biased results, we used GEE analyses, which is useful in dealing with missing data and does not require imputation. Missingness was not associated with cannabis use, and therefore consistent with the assumption that outcome data were missing completely at random. To account for missing data, we did adjust for employment, which was associated with attrition, in all models. If perceptions of the health benefits of cannabis use increase over time and become more widespread , cannabis use may increase further. Cannabis dependency may also increase, which has been linked to other substance use, depression and low satisfaction with life. We found the number of days of cannabis use increased on average from 11 days pre-legalization to 13 days post-legalization, which may reflect movement toward cannabis abuse and dependency. A study in California found a link between the density of cannabis dispensaries and neighborhood ecology on cannabis abuse and dependency before the legalization of recreational cannabis. Of interest is whether the density of dispensaries in California overall, and particularly in economically disadvantaged neighborhoods, occurred post-legalization and if cannabis use and dependency has risen disproportionately in some areas. Further research examining the long-term effects of legalized recreational cannabis on health outcomes, perceptions, and use, especially among young people and those with depression and other mental illness, is warranted. Studies should also focus on the characteristics of cannabis used such as potency, as well as the environmental and social impacts. Public health communications and evidence-based interventions on the potential health benefits and consequences of cannabis use are needed.Agriculture in the United States has undergone massive consolidation over the past 50 years and the same is true in California. Several economic and market factors have contributed to farm consolidation, but new regulations on agriculture have also played a role . Compliance costs associated with increased regulatory burdens can decrease producer profits and limit market entry . Small producers may be particularly harmed by the need to achieve compliance, as economies of scale provide larger producers an advantage . Small firms may lack sufficient capital to change production methods to comply with regulations, or even to manage the burdens associated with reporting.