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Aims Design Setting and participants Measurements Findings Conclusions To measure the association between state cannabis policies and use among adults and youth in the United States from 2002 to 2019, given rapid policy liberalization and complex state cannabis policy environments.Repeated cross‐sectional time series analysis. Three sets of models assessed the linear association between the Cannabis Policy Scale (CPS), an aggregate measure of 17 state cannabis policy areas that weights each policy by its efficacy and implementation rating, and prevalence of cannabis use. The first included year and state fixed effects; the second added state‐level controls; the third replaced state fixed effects with state random effects. Standard errors were clustered at the state level in all models.United States.Past‐month prevalence of cannabis use is from the National Survey on Drug Use and Health Small Area Estimates, a nationally and state‐representative cross‐sectional survey of household population ages 12 and older for years 2002–2003 to 2018–2019. Exposure data include the CPS.A 10 percentage‐point increase in the CPS (i.e. greater cannabis policy restrictiveness) was associated with lower past‐month use prevalence by 0.81 (95% confidence interval [CI] = ‐1.05 to −0.56) to 0.97 (95% CI = ‐1.19 to −0.75) percentage‐points for the population ages 12 years and older. When models were stratified by age, a 10 percentage‐point increase in the CPS was associated with a 0.87 (95% CI = ‐1.13 to −0.61) to 1.04 percentage‐point (95% CI = ‐1.03 to −0.84) reduction in past‐month use prevalence for adults ages 18 years and older, and a 0.17 (95% CI = ‐0.24 to −0.09) to 0.21 percentage‐point (95% CI = ‐0.35 to −0.07) reduction for youth ages 12–17 years.More restrictive US cannabis policies appear to be associated with reduced cannabis use for both adults and youth. [ABSTRACT FROM AUTHOR]

For the past 25 years, a growing number of U.S. states have been progressively legalizing cannabis markets, first through the early adoption of medical cannabis laws, which enabled the purchase [...]

Objective: A crucial question regarding the public health impacts of cannabis legalization is its impact on alcohol consumption and alcohol-related harm. However, little is known about whether these changing cannabis policies are occurring in liberal or in restrictive alcohol policy environments, either of which likely affect public health outcomes. We constructed comprehensive state-level alcohol and cannabis policy indices and explored relationships between them. Method: We assessed relationships between the Alcohol Policy Scale (APS) and the Cannabis Policy Scale (CPS) from 1999 to 2019. The APS and CPS were based on 29 and 17 state-level policies, respectively, and each policy was weighted for its relative efficacy and degree of state-year implementation. Results: From 1999 to 2019, average state APS scores increased modestly (became more restrictive) by 4.11 points (2019 M = 43.23, range: 24.44-66.31) and average CPS scores decreased (became less restrictive) by 15.33 points (2019 M = 76.40, range: 29.40-95.74) on a 100-point scale. In 2019, average APS scores were similar among states that prohibited (criminalized) possession of cannabis (42.00), decriminalized possession (41.33), legalized medical cannabis (44.36), and legalized recreational cannabis (43.32). Across states, there was no correlation between the restrictiveness of state-level alcohol and cannabis policies (r = .03, p = .37) in unadjusted models, although there was some variation by time, geographic region, and political party, with a weak negative correlation in state fixed-effects models. Conclusions: Although cannabis policies liberalized rapidly from 1999 to 2019, alcohol policies stayed relatively stable and did not differ by degree of cannabis policy liberalization. In general, there were weak associations between cannabis and alcohol policies among states; however, there was some temporal, regional, and political variation. [ABSTRACT FROM AUTHOR]