A Decade After Legalization: Cannabis Risk Factors Associated With Community Retail Cannabis Exposure Among Adolescents in the Pacific Northwest.

Abstract

This study assessed the associations between exposure to cannabis retail sales outlets and risk of cannabis use among high-school students after legalization of adult use in Washington (2012) and Oregon (2014). Cross-sectional school-based survey data were collected from more than 200,000 10th-grade (Washington) and 11th-grade (Oregon) students between 2016 and 2023. The authors used mixed effects regression to examine time-varying associations between 9 cannabis measures (frequency of use, norms, and perceived access) and exposure to cannabis retailers. Exposure was defined using 3 different measures of geospatially determined Euclidian distance between each school and the nearest active cannabis retailers per survey year. Analyses were stratified by state. When exposure was defined as a continuous variable on the basis of distance to the nearest 5 retailers, all examined outcome variables were significantly associated with exposure in both states. For categorically defined distances between schools and the single nearest cannabis retailer, this study found statistically significant associations between having a cannabis retail outlet within 1 mile of a school and increased cannabis use and cannabis risk factors and decreased cannabis protective factors among high-school students (3 of 5 outcomes for Oregon, 8 of 9 outcomes for Washington). Categorically defined exposure associations all showed risk patterns suggestive of a dose-response relationship, regardless of statistical significance. Greater exposure to cannabis retail outlets may increase cannabis-related risks and use among youth. Effects likely vary by state context and regulatory structures. Despite general declines in substance use during recent years, youth prevention efforts are needed after legalization.