Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US

Key Points

Question

What are the sociodemographic characteristics of adults who engage in high-frequency cannabis use?

Findings

In this survey study including 387 157 US adults residing in 21 states conducted in 2016 through 2019, young, male, Black, and Native American individuals and individuals with low educational attainment and income were more likely to engage in higher frequency cannabis use.

Meaning

Higher-frequency use among these populations may warrant more attention from policymakers and public health officials in the form of screening, risk stratification, and treatment given the known and emerging adverse health effects of cannabis.

Abstract

This survey study of 21 US states and 2 US territories examines social and demographic characteristics associated with the frequency of cannabis use among adults.

Abstract

Importance

Cannabis use has increased, but there are few studies on frequent and daily cannabis use among US adults. Individuals who engage in higher frequency use may suffer more health consequences.

Objective

To examine frequency of cannabis use and associated factors among US adults.

Design, Setting, and Participants

This survey study included data from 21 US states and 2 US territories reported in the Behavioral Risk Factor Surveillance System surveys from 2016 to 2019. Cross-sectional data on US adults ages 18 years and older were used to estimate demographic, socioeconomic, and behavioral risk factors for cannabis use, taking into account the survey strata and sampling weights for the 4 years of combined data. Using a multivariable ordinal logistic analysis, the association of demographic, socioeconomic status, and behavioral risk factors with past month cannabis frequency were examined.

Exposures

Sociodemographic characteristic, ie, age, gender, race and ethnicity, educational attainment, employment status, and annual household income.

Main Outcomes and Measures

Ordinal categorization of number of days of cannabis use in the past 30 days in terms of nonuse, infrequent use (1-5 days), frequent use (6-29 days), and daily use.

Results

Among the 387 179 respondents, 58 009 (27.9%) were ages 18 to 34 years, 186 923 (50.3%) were ages 35 to 64 years, and 142 225 (21.8%) were age 65 years or older (mean [SD] age, 48.3 [0.1] years). The sample included 28 345 (9.8%) Black, 36 697 (22.6%) Hispanic, and 292 210 (57.3%) White respondents. Smoking was the most common form of cannabis use. The frequency of cannabis use varied significantly by age, gender, race, marital status, education, and employment. Higher frequency cannabis use was associated with younger age (ages 18-34 years: adjusted odds ratio [aOR], 4.12; 95% CI, 3.63-4.68; ages 35-64 years: aOR, 2.22; 95% CI, 1.98-2.49), Black (aOR, 1.46; 95% CI, 1.33-1.71) and Native American (aOR, 1.25; 95% CI, 1.04-1.52) race, and less educational attainment (high school or less: aOR, 1.09; 95% CI, 1.02-1.17; some college: aOR, 1.27; 95% CI, 1.19-1.35). Being married (aOR, 0.54; 95% CI, 0.51-0.58) or identifying as Asian (aOR, 0.60; 95% CI, 0.51-0.71) or Hispanic (aOR, 0.71; 95% CI, 0.65-0.77) was associated with lower-frequency cannabis use after accounting for other baseline factors.

Conclusions and Relevance

This nationally based study found that higher-frequency cannabis use is more common among young and racial minority populations, as well as respondents with low socioeconomic status. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to high-frequency use among underserved populations in the form of screening, risk stratification, and treatment.