Abstract
In response to increasing public support for cannabis legalization, understanding associations of state and federal policy changes related to cannabis legalization with patterns of cannabis use is important. A challenge for public health monitoring and research is significant variation in data availability related to cannabis use behaviors and perceptions across and within states and over time, including the availability of prelegalization vs postlegalization data. To review data available on cannabis use and related behaviors over time in Massachusetts and the US. This case series examined state and national surveys on public health and related behaviors and outcomes to review availability of cannabis-related data for Massachusetts for 8 key indicators over time. Additionally, the Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System for all states were reviewed. The analysis was conducted between February 1, 2019, and March 18, 2020. Surveys that enable state-level estimation of cannabis use and related behaviors. Eight key indicators related to cannabis use behaviors and perceptions: lifetime cannabis use, age of initiation, frequency of use, location of use, method of use, source of cannabis, perceptions of cannabis, and reason for use (ie, medical vs nonmedical). There were 7 surveys that monitored cannabis use and related behaviors in Massachusetts for adolescents and adults. No surveys monitored all 8 indicators of interest, and availability over time was limited. In the most recent BRFSS, 24 states asked cannabis-related questions, meaning BRFSS data on cannabis use was lacking for more than half of the US adult population. In the Youth Risk Behavior Surveillance System, 36 states asked standard cannabis questions; most other states had at least 1 question related to cannabis use and frequency. These findings of limitations of existing surveys, and particularly the lack of national questions in the BRFSS and Youth Risk Behavior Surveillance System, suggest that available data have substantial limitations for monitoring cannabis use. As cannabis policy changes continue, there is a need to remain focused on the availability of high-quality data sources that allow for critical public health research.
Highlights
As of December 2019, 11 states and the District of Columbia (DC) have legalized cannabis for adult nonmedical use[1] and 33 states and DC have legalized cannabis for medical purposes.[2]
As cannabis policy changes continue, there is a need to remain focused on the availability of high-quality data sources that allow for critical public health research
There is some overlap in these surveys, as the National Youth Risk Behavior Surveillance Survey (YRBSS) and Massachusetts Youth Risk Behavior Survey (MYRBS) are conducted simultaneously
Summary
As of December 2019, 11 states and the District of Columbia (DC) have legalized cannabis for adult nonmedical use[1] and 33 states and DC have legalized cannabis for medical purposes.[2]. Variation in available data across states highlights the need to better understand the extent of existing data in measuring effects of state and federal policy changes associated with cannabis legalization. Given ongoing policy and regulatory changes (eg, retail markets, packaging, labeling),[5,7,10] it is critical to understand whether data are available to monitor a number of cannabis use indicators associated with specific legislative or regulatory provisions. These provisions continue to evolve as states implement legalization with varying policy and regulatory structures. Specific cannabis-related behaviors of importance include frequency, location, and methods of use; these behaviors may be risk factors for problematic cannabis use and associated outcomes.[11,12,13,14,15] Understanding data availability to monitor cannabis use in nationally comparable surveys is critical to be able to compare findings from different states,[7,9,16,17,18]
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