Adolescence is a time when community context becomes an increasingly important developmental influence . The communities where young people live shape their substance use perceptions and behaviors by how the environment encourages or prevents substance use, e.g., via the attitudes of their parents and peers or the availability of drugs and alcohol in their neighborhood. The Community Domain is the primary domain of influence for this study of city policy impacts and community-level influences on adolescent marijuana use and thus is reviewed in greater detail below. Geographic variables such alcohol and marijuana outlet density in neighborhoods have been found to be correlated with greater localized use of these products . The availability of alcohol and tobacco within cities and neighborhoods contributes to adolescents’ perceptions of the normalcy and social acceptability of substance use , which is, in turn, related to an increased propensity to use these substances . Kuntsche and colleagues concluded that adolescents who have more opportunities to obtain alcohol develop the impression that underage drinking is “common and socially endorsed” in their community. Thus, marijuana outlet density in a city could be expected to contribute to social norms encouraging marijuana use, even if it does not create easier access. Regardless of the fact that curing cannabis use remains illegal for minors throughout the U.S., state and city marijuana laws that increase access for adults do present important implications for youth access to marijuana and social norm change.
Although studies have examined the effect of city-level alcohol and tobacco policies on alcohol and tobacco use and perceptions of risk among adolescents , these studies have not been replicated to study the impact of city ordinances regulating marijuana. For example, a 2012 study of adolescents in drug treatment in Colorado found that 75% had used someone else’s medical cannabis within the previous year . However, it is not known if city policies that allow for more convenient adult access to cannabis in a community will necessarily be associated with greater use among adolescents. For example, while cannabis legalization advocates have theorized that legitimizing the market for cannabis products by allowing dispensaries in a community will result in the eventual collapse of the illicit market , the continued presence of a robust illicit market for marijuana in California may compete with city policy as a determinant of the availability of marijuana in a community. Alternatively, changes in attitudes and social norms toward cannabis related to city policy or external social influences may have a more important influence on the likelihood of young people experimenting with adolescent cannabis use than their access on a local level. This dissertation will test both theories. Comprehensive theoretical models of adolescent substance use such as the Social Ecological Model highlight the importance of interrelated risk and protective factors operating on multiple levels of influence. Yet, conceptual models integrating sociocultural risk and protective factors across contexts are so complex as to be nearly impossible to test.
It is methodologically impossible to measure and analyze all of the factors that could influence adolescent substance use at once. As a consequence, comprehensive theoretical models like the Social Ecological Model are rarely tested in their entirety . Given the breadth and complexity of the Social Ecological Model, more specific methodological frameworks have been developed to operationalize and implement theoretical constructs that specifically influence adolescent substance use. The rapid liberalization of attitudes toward marijuana is an important backdrop to this research and calls for a theoretical framework that accounts for the influence of social norm change. Normalization is the idea that behavior once considered deviant by mainstream society can gradually become accepted as “normal’. The Drug Normalization Framework was developed to explain the increasing presence of drug use in mainstream culture and has been used to guide empirical research on the social integration of illicit drug use over the last 20 years . Based on Parker and colleagues studies of drug normalization in the United Kingdom, the Drug Normalization Framework has since been expanded to include the following seven components: 1. Drug trying, 2. Availability/Accessibility; 3. Recent and regular drug use; 4. Being “drug wise”; 5. Social accommodation; 6. Cultural accommodation; 7. Drug policy and global processes. Drug trying refers to lifetime drug use prevalence and experimentation. Drug availability and accessibility refers to the likelihood of being offered drugs or situations where one might access drugs. Recent and regular use refer to rates of use beyond lifetime prevalence. Being “drug wise” refers to knowledge of drug-related experiences among both users and non-users.
Social accommodation refers to the idea of recreational drug use as an integrated or tolerated part of mainstream social life among users and nonusers . Cultural accommodation refers to the way drugs and drug use attitudes are portrayed in mainstream media. Drug policy and global processes refer to macro-level considerations of how drug policy and globalization impact substance use and accessibility . The Drug Normalization Framework is attractive from a primary prevention standpoint because the focus on the social integration of drug use among mainstream populations fits the current context of cannabis use better than theoretical approaches that characterize substance use within a disease or deviance model, which are less appropriate to explain widespread moderate substance use and harm reduction approaches to limiting use of products available in a legal and profit-motivated market . It will not be possible to measure every theoretical construct within the Drug Normalization Framework in this dissertation, but the Drug Normalization Framework nevertheless provides a valid epistemological structure to account for the backdrop of social influences against which local trends in accessibility, perceptions of risk and marijuana use behaviors occur in LA County. A central critique of the Drug Normalization Framework has been that it overemphasizes the societal domain at the cost of adequately accounting for differences in adolescents’ experiences due to social, economic, and structural factors . Subsequent research has supported the idea of “differentiated normalization” , i.e., that structural factors such as social inequality, family structure, and peer networks may lead to different drugs and ways of using becoming normalized for different groups of adolescents . In support of this idea, recent research investigating differences in the normalization of cannabis use among young adults found that accessibility, acceptability, and recent use differed by gender, nativity, and peer network cannabis use prevalence , indicatingthat where possible it is important to control for these effects when investigating youth access, attitudes, and marijuana use. A primary cannabis policy is to prevent increased adult access to cannabis resulting in rising rates of youth use . Recent data from the Monitoring the Future study, a longitudinal, population-based survey, indicates that high school students perceive little difficulty obtaining cannabis dryer if they want it. The report states that 81% of 12th grade students report that it would be “fairly” or “very” easy to get marijuana if they wanted some. The proportion of North American high school students who have reported the same ease of access has been between 80% and 90% since 1975 . Thus far there is little evidence to suggest that increased availability of marijuana for adults at a state or national level has resulted in easier access for youth or increases in youth use. This lack of evidence to date is in contrast to alcohol and tobacco research and could be due to higher standards of compliance with laws and regulations that prevent youth access in the current marijuana industry in comparison to business practices and compliance among alcohol and tobacco outlets.
Recent premise surveys of marijuana outlets indicate that compliance with ID checks is almost universal , even among unlicensed outlets . ID checks are likely to be the most effective way to prevent youth accessing marijuana directly from dispensaries, but do not prevent adults from supplying marijuana to adolescents in other contexts. Therefore, the question of whether youth are more likely to be able to obtain marijuana in communities where adults have more convenient access to dispensaries merits further study. City ordinances banning dispensaries could impact the availability of marijuana to underage youth if young people can purchase marijuana directly from a dispensary or if adults sell marijuana near the dispensary where it was obtained. New research on compliance with regulations intended to prevent youth access to marijuana indicates that dispensaries in three states almost universally required ID checks , suggesting that obtaining marijuana directly from a dispensary is the least likely of these options. Empirical research on the ability of underage youth to get adults to buy marijuana from a nearby dispensary is lacking, as is reliable data on adults offering marijuana to youth near dispensaries, although video evidence of this practice occurring in cities within LA County has been reported in news media . For example, in 2015, the Compton Unified School district went so far as to sue the City of Compton, alleging that the City’s lax enforcement of its marijuana ban made it easy for students to obtain marijuana from some of the more than dozen dispensaries that were operating illegally in the city, three of which were operating within 500 feet of schools . Students’ perceptions of the risk of frequent marijuana use represent a potential moderating factor in the likelihood of marijuana use. City policies allowing dispensaries may communicate to young people that marijuana use is socially acceptable in their community or that their local leaders consider it to present little risk to their health. Students’ perceptions of the risk of frequent marijuana use could then be expected to moderate their likelihood of using marijuana . Research on marijuana normalization has found that perception of health risk is an important driver of increased social acceptance . Barely over a quarter of 12th graders in the United State now report that regular marijuana use poses a great risk, which is half the proportion from 20 years ago . The increase in favorable opinions about the health benefits of cannabis may prove to be warranted over time but to date much of the change in attitudes toward the safety and potential benefits of marijuana use is not based in reports of empirical, peer-reviewed research, let alone randomized controlled trials with human subjects. A comprehensive report from the U.S. National Academies of Science, Engineering, and Medicine found that there was adequate evidence to support cannabis use as a treatment for only a few of the many disorders for which it is commonly recommended. Adolescent perceptions of the risk of marijuana use may also be based on the many recent changes in state laws in the U.S., where since California legalized use of medical marijuana in 1996, 33 other states have followed suit by approving “comprehensive, publicly available medical marijuana programs” and an additional 12 states allow “allow use of “low THC, high cannabidiol ” products for medical reasons in limited situations or as a legal defense” . Multi-state epidemiological studies on the impact of state marijuana laws on adolescent perceptions of marijuana risk have shown that changes in cannabis risk perceptions are similar between states that pass medical cannabis laws and states that have not . Several researchers have theorized that differences in adolescents’ attitudes toward marijuana may have been attenuated by nationwide media coverage of medical cannabis law passage that diffused the attitudinal effects of medical marijuana laws across state borders . Furthermore, as mentioned earlier, perceptions of marijuana use representing a low risk to health may be an important driver of normalization but may not necessarily drive greater rates of use as they once did .An important construct for this dissertation is the idea that dispensaries located in communities could act as a visual cue to substance use similar to advertising. Exposure to visual reminders of the presence of alcohol and drugs in communities is a central theme in the literature about social norms and their impact on adolescent substance use and in the Drug Normalization Framework . Students seeing a dispensary frequently because it is located near an area where they spend much of their time could represent repeated exposure to visual cues to marijuana use, which research has shown increases the likelihood of marijuana use .