Academic Journal
Cannabis use patterns among American Indian and Alaska Native adults across U.S. state cannabis policy environments.
| Title: | Cannabis use patterns among American Indian and Alaska Native adults across U.S. state cannabis policy environments. |
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| Authors: | Ebling T; Pennsylvania State University, College of Nursing, University Park, PA, USA. Electronic address: txe5134@psu.edu., de Silva GS; Pennsylvania State University, College of Nursing, University Park, PA, USA. Electronic address: svd6082@psu.edu., Azagba S; Pennsylvania State University, College of Nursing, University Park, PA, USA. Electronic address: spa5695@psu.edu. |
| Source: | Addictive behaviors [Addict Behav] 2026 Nov; Vol. 182, pp. 108790. Date of Electronic Publication: 2026 Jul 02. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Science Country of Publication: England NLM ID: 7603486 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-6327 (Electronic) Linking ISSN: 03064603 NLM ISO Abbreviation: Addict Behav Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford : Elsevier Science Original Publication: Oxford, Elmsford, N. Y., Pergamon Press. |
| MeSH Terms: | Alaska Natives*/statistics & numerical data , Marijuana Use*/epidemiology , Marijuana Use*/legislation & jurisprudence , Indians, North American*/statistics & numerical data , American Indian or Alaska Native*/statistics & numerical data , Marijuana Smoking*/epidemiology, United States/epidemiology ; Humans ; Female ; Male ; Adult ; Young Adult ; Middle Aged ; Adolescent ; Prevalence ; Behavioral Risk Factor Surveillance System ; Legislation, Drug |
| Abstract: | Background: Cannabis legalization has expanded rapidly across the United States, yet little is known about how cannabis use patterns vary across state policy environments among American Indian/Alaska Native (AI/AN) adults. We examined whether cannabis use and frequency differed across state cannabis policy environments. Methods: We analyzed 2022 Behavioral Risk Factor Surveillance System marijuana module data from 22 states, restricted to respondents classified as AI/AN (N = 1723). States were categorized as no legal cannabis, medical-only legal cannabis, or recreational legal cannabis. Outcomes were current cannabis use (any past-30-day use) and frequency (days used among current users). Analyses incorporated survey design and stabilized inverse probability of treatment weighting, with additional covariate adjustment for sex, age, education, income, marital status, and employment. Results: Overall, 22.0% (95% CI: 18.8%, 25.2%) reported current cannabis use. Weighted prevalence of current cannabis use was 17.97% in no-legal states, 24.01% in medical-only states, and 21.80% in recreational states. In the full sample, adjusted odds ratios for current cannabis use were not statistically different between respondents in medical-only or recreational states and those in no-legal-cannabis states. Cannabis use frequency among current users was higher in medical-only (IRR = 1.32, 95% CI: 1.09-1.60) and recreational states (IRR = 1.28, 95% CI: 1.02-1.61) relative to no-legal states. Stronger associations were observed in state-context analyses, particularly in states with federally recognized tribes and states with higher AI/AN sample representation. Conclusions: Among AI/AN adults, statistically significant differences across state cannabis policy environments were observed for cannabis use frequency, but not for current use prevalence. Associations were stronger in selected state contexts. (Copyright © 2026 Elsevier Ltd. All rights reserved.) |
| Competing Interests: | 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. |
| Contributed Indexing: | Keywords: American Indian/Alaska Native; Cannabis legalization; Cannabis policy; Cannabis use; Indigenous health; Minority health |
| Entry Date(s): | Date Created: 20260709 Date Completed: 20260723 Latest Revision: 20260723 |
| Update Code: | 20260724 |
| DOI: | 10.1016/j.addbeh.2026.108790 |
| PMID: | 42424862 |
| Database: | MEDLINE |
| ISSN: | 1873-6327 |
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| DOI: | 10.1016/j.addbeh.2026.108790 |