What do You Consider Marijuana Use? Limitations of Current Surveillance Systems to Monitor Adolescent Marijuana Use

ABSTRACT

Purpose: Adolescent health surveillance systems are critical for understanding patterns of marijuana use and generating data to evaluate changes in use following marijuana legalization and during the COVID-19 pandemic. The wording of survey questions may be misaligned with adolescents’ language about marijuana use and the ways they consume it. Our objectives were to compare terminology and prevalence of marijuana use between data from a local surveillance system and from a participatory research study. Methods: To understand marijuana use trajectories over the course of adolescence/young adulthood, we conducted the “Model Building with Adolescents on Peers, Partners, and Substance Use” (MAPPS) study. MAPPS was IRB-approved and included participatory group model building (GMB) with youth in Baltimore City. MAPPS participants were recruited from a health clinic and through community partners. Participants’ marijuana use was assessed with the eligibility screener, an enrollment survey, and through GMB exercises that were conducted over the course of four two-hour workshops. GMB exercises included structured activities with youth, including behavior over time graphs and documenting their mental models in real time. Two independent reviewers interpreted youths’ graphed estimates of marijuana use. Lifetime and past 30-day marijuana use prevalence estimates from MAPPS were compared to estimates from the Baltimore Youth Risk Behavior Survey (YRBS), which is conducted in partnership with CDC’s National YRBS program. Results: MAPPS participants (n=20) had an average age of 18;7 (35%) were male and 19 (95%) were Black. MAPPS participants almost exclusively used the terms weed and blunts for marijuana, whereas the Baltimore YRBS used the term marijuana, and mentioned that it was also called “pot, weed, or cannabis.” Results from MAPPS revealed several discrepancies between different assessments of marijuana use;100% reported lifetime use during GMB activities, whereas 50% (n=10) reported lifetime use on the eligibility screener and 60% (n=12) reported lifetime use on the enrollment survey. Collectively, MAPPS participants estimated that 86% of Baltimore 16-year-olds use marijuana, whereas data from the Baltimore YRBS indicate that 30.2% of eleventh graders report past 30-day use. MAPPS participants perceived that there was a high frequency of use among youth who use and explained that youth who “hit a blunt” off someone else, but who do not buy marijuana themselves, would be unlikely to self report as having used marijuana. Conclusions: Our participatory research with urban, Black youth suggests that the terminology they use for marijuana (i.e., weed, blunt) differs from terms used in local surveillance (e.g., marijuana, pot). We also found that they would consider prevalence estimates from surveillance studies to be underestimated because youth who consume peers’ blunts would not characterize themselves as having used marijuana. Therefore, surveillance questionnaires may be misestimating marijuana use due to discrepancies in terminology in questions versus in spoken language, and because collective use is not considered. Misestimations of use limit effective prevention programming, and bias studies that quantify changes in marijuana use following policy changes or during the pandemic. A more comprehensive understanding of patterns of marijuana use is an important step for improving surveillance, evaluation, and clinical assessment. Sources of Support NIH K01DA035387.