Missouri College Students’ Intentions Towards Initiating or Changing Cannabis Use in a Shifting Legal Landscape

Abstract

Background: With cannabis legal in nearly half of U.S. states, important concerns about the public health impact remain, particularly for states yet to legalize. The present study, using data collected in the initial phase of cannabis legalization in Missouri, examined predictors of the intention to initiate (in the cannabis naïve) and increase use (in those with past-year use) in a representative sample of Missouri college students. Methods: Data (n_{cannabisnaïve} = 2,716; n_cannabisuse  = 1,591) were collected from 25 Missouri college campuses. Four pre-registered multilevel models examined the associations of theory-driven predictors with the intention to initiate cannabis use and to increase use. Results: 33.4% of all students surveyed reported past-year cannabis use, 9.9% of cannabis naïve students reported intending to initiate cannabis use, and 22% of those with previous cannabis use reported intending to increase cannabis use. Multilevel modes found that being gay or lesbian (AOR = 3.03; CI = [1.72, 5.34]), bisexual (AOR= 3.52; CI = [2.41, 5.14]), or queer (AOR = 2.51; CI = [1.71, 3.69]) was associated with intending to initiate use, while greater flourishing (AOR = 0.98; CI  = [0.96, 0.99]) was associated with decreased odds of intending to initiate use. Endorsing more cannabis motives (AOR = 1.13; CI = [1.08, 1.19]), age of first use (AOR = 1.09; CI = [1.03, 1.15]), and being gay or lesbian (AOR = 2.19; CI = [1.27, 3.76]) were associated with intending to increase use. Endorsing more cannabis-related negative consequences was associated with intending to decrease use (AOR = 0.91; CI = [0.89, 0.94]). Discussion: Multiple theory-driven factors were associated with intending to initiate or increase cannabis use following legalization. Future research should examine how intentions to change cannabis use translate to actualized behavior following legalization and factors that may create increased risk for minoritized sexual identities.