ANTI SMOKING LOBBY

Legalization of cannabis threatens clean indoor air and public health

Most localities that allow onsite cannabis smoking lounges do not protect nonsmokers from the ill effects of secondhand cannabis smoke, researchers report in the American Journal of Preventive Medicine

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Ann Arbor, September 7, 2021 – After years of progress on protections against secondhand tobacco smoke, multiple states and local governments now allow indoor smoking of cannabis at licensed cannabis businesses. A new study in the American Journal of Preventive Medicine, published by Elsevier, found that over 50 localities in the United States allow indoor smoking at these businesses, exposing customers and employees to secondhand cannabis smoke (SHCS).

“While many states maintain strong tobacco smoking and vaping bans to protect public health, our research reveals that some state and local laws exempt cannabis smoke from clean air laws and open the door to smoke-filled businesses, defeating decades of public health advances,” said first author Thomas L. Rotering, MPH, of the Center for Tobacco Control Research and Education, and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.

The researchers systematically searched legal databases, public reporting, government websites, and local laws that address cannabis smoking lounges. They found wide variation in how state and local governments address SHCS exposure in these businesses. All of the 11 states that have legalized adult-use cannabis as of June 2020 prohibit consumption in public places, but six states (Alaska, California, Colorado, Illinois, Massachusetts, and Michigan) allow onsite consumption in licensed cannabis businesses subject to local government approval. No state prohibits local governments from implementing more rigorous requirements. Massachusetts only allows onsite consumption through vaporization or other nonsmoking forms of consumption involving heat.

Although the only effective means of preventing the health problems associated with SHCS is to require a smoke-free environment, most local laws either do not address SHCS or use ineffective ventilation or engineering requirements. Of the 56 localities that permit onsite cannabis consumption businesses, only 9% require that indoors be smoke-free. Twenty-three percent of local governments provide for smoking in isolated rooms but only require that the smoke not drift to nonsmoking areas or that there be a smoke-free employee viewing area. Other common local legal requirements address onsite odor control, ventilation/filtration, and building location. Such requirements are often vague, and the investigators observe that they resemble the tobacco industry’s “accommodation” framework by allowing smoking inside and positioning ventilation or engineering controls as solving secondhand smoke.

“After decades of progress in clearing the indoor air of tobacco smoke, we are seeing it replaced with cannabis smoke using the same discredited arguments the tobacco industry used in its unsuccessful fight against tobacco smoke restrictions. We need to learn from the past and keep the air clean for all,” commented senior investigator Stanton A. Glantz, PhD, retired from the Center for Tobacco Control Research and Education, and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.

Some cannabis advocates argue that designating indoor spaces for renters, tourists, and people experiencing homelessness to smoke or vape is the only reasonable alternative to illegally consuming in public or exposing nonsmokers to SHCS. The investigators suggest that reasonable alternatives may include permitting outside, out-of-view cannabis use at retailers, or allowing only the use of non-inhalable modes of administration that do not pollute the air. Local officials could consider allowing multiunit housing or other places serving these groups to create outdoor, designated consumption smoking areas out of public view.

Policymakers should be made aware that ventilation and other engineering interventions cannot fully protect workers and patrons. “Health authorities and local leaders should educate policymakers on the science of secondhand smoke remediation and advocate for the same standards for secondhand cannabis smoking and vaping that apply to tobacco, particularly because other cannabis administration modes do not pollute the air,” said the authors in their paper. “Where onsite smoking or vaping is permitted, even measures such as truly separate indoor and outdoor smoking areas may reduce but not eliminate SHCS exposure to patrons, staff, and residents.”

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JOURNAL

American Journal of Preventive Medicine

DOI

10.1016/j.amepre.2021.05.012 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Emerging Indoor Air Laws for Onsite Cannabis Consumption Businesses in the U.S.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases

Research Letter 

Substance Use and Addiction

September 7, 2021

Association of Marijuana Legalization With Marijuana Use Among US High School Students, 1993-2019

D. Mark Anderson, PhD¹; Daniel I. Rees, PhD²; Joseph J. Sabia, PhD³; et alSamuel Safford, MA³

Author Affiliations Article Information

JAMA Netw Open. 2021;4(9):e2124638. doi:10.1001/jamanetworkopen.2021.24638

Introduction

Thirty-six states have legalized medical marijuana and 18 states have passed recreational marijuana laws (RMLs). Organizations such as the American Academy of Pediatrics are concerned that legalization will encourage youth marijuana use.¹ Marijuana use during adolescence may adversely affect areas of the prefrontal cortex, which control important cognitive processes.¹

Using data from the Youth Risk Behavior Survey (YRBS) for the period 1993-2017, Anderson et al² found that RML adoption was associated with an 8% decrease in the odds of marijuana use among high school students. These authors, however, had prelegalization and postlegalization data from only 7 states and pre– and post–recreational sales data from only 3 states, calling into question the generalizability of their results.³

Using data from the YRBS for the period 1993-2019, this study provides updated estimates of the association between legalization and adolescent marijuana use. During this extended period, pre- and post-RML data from the YRBS are available from 10 states; 7 states contributed more than one wave of post-RML data, and these same 7 states contributed data to the YRBS before and after the first dispensary sales began. Anderson et al³ had multiple waves of post-RML data from 3 states.

Methods

Following Anderson et al,² national and state YRBS data were pooled in this repeated cross-sectional study. Ethical review was not required because analyses of secondary, deidentified data are considered exempt from requiring institutional review board approval by the San Diego State University Institutional Review Board. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

Multivariable logistic regression was used to estimate the association between legalization and marijuana use. Effective legalization dates come from Anderson and Rees.⁴ To control for time-invariant factors at the state level and common trends, all models were adjusted for 50 state and 13 survey wave indicators. Alternative models were further adjusted for individual- and state-level characteristics; event-study estimates were produced by replacing the RML indicator with a series of leads and lags. Two-sided hypothesis tests were used, and estimates were considered significant if P < .05. Analyses were conducted with STATA 16.1 (StataCorp).

Results

The mean (SD) age of YRBS respondents was 15.9 (1.23) years, 51.4% of respondents reported as female, and 57.6% reported as non-Hispanic white. The first two columns of the Table show estimated odds ratios (ORs) of current and frequent marijuana use, adjusted for state and survey-wave indicators. In the third and fourth columns, ORs were further adjusted for individual- and state-level covariates.

Based on the pooled YRBS data, and in the fully adjusted models, RML adoption was not associated with current marijuana use (OR, 1.00; 95% CI, 0.92-1.10) or frequent marijuana use (OR, 0.98; 95% CI, 0.90-1.07). In the fully adjusted models, medical marijuana law (MML) adoption was associated with a 6% decrease (OR, 0.94; 95% CI, 0.89-0.98) in the odds of current marijuana use and a 7% decrease (OR, 0.93; 95% CI, 0.87-0.99) in the odds of frequent marijuana use. Estimates from separate analyses of the national and state YRBS and estimates of the association between the opening of the first recreational dispensary and marijuana use were qualitatively similar to those above (Table).⁵

Finally, the Figure shows RML event-study estimates (Panel A). Prior to legalization, there was no association with marijuana use, suggesting the parallel-trends assumption held. After 2 or more years, RML adoption was associated with a decrease in marijuana use (OR, 0.85; 95% CI, 0.76, 0.95). Panel B of the Figure shows an event study for MML adoption.

Discussion

Consistent with estimates from prior studies, there was little evidence that RMLs or MMLs encourage youth marijuana use.^2,6 Contrary to results of the study by Anderson et al² the overall association between RML adoption and marijuana use among adolescents was statistically indistinguishable from zero. One limitation of this study is that RMLs are a relatively new phenomenon. As more postlegalization data become available, researchers will be able to draw firmer conclusions about the relationship between RMLs and adolescent marijuana use.

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Article Information

Accepted for Publication: July 8, 2021.

Published: September 7, 2021. doi:10.1001/jamanetworkopen.2021.24638

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Anderson DM et al. JAMA Network Open.

Corresponding Author: D. Mark Anderson, PhD, Department of Agricultural Economics and Economics, Montana State University, PO Box 172920, Bozeman, MT 59717-2920 (dwight.anderson@montana.edu).

Author Contributions: Dr Sabia had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Anderson, Sabia, Safford.

Drafting of the manuscript: Anderson, Rees, Sabia.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Rees, Sabia, Safford.

Obtained funding: Anderson, Sabia.

Supervision: Anderson, Sabia.

Conflict of Interest Disclosures: Dr Sabia reported grants from Troesh Family Foundation and grants from Charles Koch Foundation during the conduct of the study. No other disclosures were reported.

Funding/Support: Dr Anderson acknowledges partial support from a Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH) research infrastructure grant, R24 HD042828, to the Center for Studies in Demography and Ecology at the University of Washington. Dr Sabia and Mr Safford acknowledge partial support from the Center for Health Economics & Policy Studies (CHEPS) at San Diego State University, including grant funding received from the Charles Koch Foundation.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

References

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Coley  RL, Kruzik  C, Ghiani  M, Carey  N, Hawkins  SS, Baum  CF.  Recreational marijuana legalization and adolescent use of marijuana, tobacco, and alcohol.   J Adolesc Health. 2021;69(1):41-49. doi:10.1016/j.jadohealth.2020.10.019PubMedGoogle ScholarCrossref