Definition

Percentage of adults 18 years of age and older who responded 1 or more days on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "During the past 30 days, on how many days did you use marijuana or hashish?"

Numerator

Weighted number of adults (18+) who responded 1 or more days on the BRFSS to the question: "During the past 30 days, on how many days did you use marijuana or hashish?"

Denominator

Weighted number of adults (18+) with complete and valid responses on the BRFSS to the question: "During the past 30 days, on how many days did you use marijuana or hashish?" excluding those with missing, "Don't know/Not sure," or "Refused" responses.

Data Interpretation Issues

The introduction to the Marijuana section on the BRFSS states: "The next questions are about recent use of marijuana. Your answers are strictly private and confidential and will only be used to help improve health services." The current use of marijuana question was asked as a state-added question on the standard and supplemental BRFSS surveys in 2015-2017 and on the standard BRFSS in 2018. Medical marijuana use was asked about on the supplemental BRFSS in 2015 and 2016. Primary mode of marijuana use was asked on the standard and supplemental survey in 2017.

Why Is This Important?

Long-term, regular marijuana use starting in the young adult years may impair brain development and functioning. The main chemical in marijuana is delta-9-tetrahydrocannabinol (THC), which, when smoked, quickly passes from the lungs into the bloodstream, which then carries it to organs throughout the body, including the brain. THC disrupts the brain's normal functioning and can lead to problems studying, learning new things, and recalling recent events.^1^ Frequent marijuana use has also been linked to increased risk of psychosis in individuals with specific pre-existing genetic vulnerabilities.^2,3^ Marijuana use--particularly long-term, chronic use or use starting at a young age--can also lead to dependence and addiction. These effects highlight the importance of prevention. [[br]][[br]] ---- {{class .SmallerFont 1. Crean RD, Crane NA, Mason BJ. An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions. Journal of Addiction Medicine 2011;5(1):1-15. 2. Di Forti M, Iyegbe C, Sallis H, Kolliakou A, et al. Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biological Psychiatry 2012;72(10):811-816. 3. Caspi A, Moffitt TE, Cannon M, et al. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biological Psychiatry 2005;57(10):1117-1127. }}

Healthy People Objective: Reduce the proportion of adults reporting use of any illicit drug during the past 30 days

U.S. Target: 7.1 percent

How Are We Doing?

The percentage of Alaska adults who reported marijuana use in the past 30 days was 16.4% for all Alaskans and 22.9% for Alaska Native people in 2018. Males were more likely to use (20.6%) than were females (11.9%) in 2018. Smoking marijuana was the most commonly reported primary method of consumption among all Alaskans (85.6%) and Alaska Native people (88.7%) in 2017. The prevalence of current marijuana use declined as age, education, or income increased. Married adults reported lower prevalence rates of current marijuana usage than those who were divorced/separated, never married, or living with a partner. Adults who were either unemployed (38.3%) reported significantly higher prevalence of current marijuana usage than either those employed (16.3%) or not in the workforce (11.3%). Adults who identified as gay, lesbian, or bisexual reported higher prevalence of current marijuana usage at 34.9% compared to 16.2% among those who identify as heterosexual. The prevalence of current marijuana use increased with poorer assessments of general health status or the number of domains of Adverse Childhood Exposures. Adult marijuana use prevalence rates from the BRFSS are initially presented for all Alaskans and Alaska Native people for 2015-2018. This is followed by the prevalence of current medical marijuana usage. Methods of marijuana usage are then reported. Subsequent analyses by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and Medicaid eligibility) are presented for 2015-2018. Crosstabulations were also conducted by body mass index, sexual orientation, general health status, and number of Adverse Childhood Experiences. Significant differences occurred within each comparison. Adult marijuana use prevalence rates are presented by regions of Alaska for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) the 7 Alaska Public Health Regions, 2) 11 behavioral health systems regions based upon aggregations of 20,000 population, and 3) the 12 Tribal Health Regions.

What Is Being Done?

Marijuana affects everyone differently based on personal characteristics like body type and history of use. It's important to recognize your limits. THC levels can be much higher in today's marijuana products, and the effects of marijuana can be significantly delayed, particularly with edibles. Also, driving while impaired is illegal, regardless of the substance you are using. If you are not sure whether you are impaired, do not drive. Marijuana may be harmful to developing brains, so do not use marijuana if you are pregnant or breastfeeding. Smoking marijuana or consuming edible cannabis products can expose your baby to potentially harmful substances. If you have young children or teenagers at home, store your marijuana in a child-resistant container and make it inaccessible to them.

Evidence-based Practices

Experts attest that an optimal mix of prevention interventions is required to address substance use issues in communities because they are among the most difficult social problems to prevent or reduce. The Substance Abuse and Mental Health Services Administration's (SAMHSA's) program grantees should consider comprehensive solutions that fit the particular needs of their communities and population, within cultural context, and take into consideration unique local circumstances, including community readiness. Some interventions may be evidence-based, while others may document their effectiveness based on other sources of information and empirical data. Early intervention also is critical to treating mental illness before it can cause tragic results like serious impairment, unemployment, homelessness, poverty, and suicide. The [https://www.samhsa.gov/grants/block-grants/mhbg Community Mental Health Services Block Grant (MHBG)] directs states to set aside 5% of their MHBG allocation, which is administered by SAMHSA, to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders. [https://www.samhsa.gov/sites/default/files/mhbg-5-percent-set-aside-guidance.pdf The Guidance for Revision of the FY2014-2015 MHBG Behavioral Health Assessment and Plan] provides additional information. To prevent marijuana use before it starts, or to intervene when use has already begun, parents and other caregivers as well as those with relationships with young people--such as teachers, coaches, and others--should be informed about marijuana's effects in order to provide relevant and accurate information on the dangers and misconceptions of marijuana use. Comprehensive prevention programs focusing on risk and protective factors have shown success preventing marijuana use.^4,5^ Evidence-based strategies or best practices in community level prevention efforts can be used to assess, build capacity, plan, implement, and evaluate initiatives.^6^ Review SAMHSA's [https://www.samhsa.gov/capt/practicing-evidence-based-prevention guides] for substance use prevention.[[br]][[br]] ---- {{class .SmallerFont 4. Center for the Application of Prevention Technologies. Prevention programs that address youth marijuana use. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2014. 5. Mason WA, Fleming CB, Haggerty KP. Prevention of marijuana misuse: School-, family-, and community-based approaches. In M. T. Compton (Ed.), Marijuana and Mental Health. Arlington, VA: American Psychiatric Publishing. In press. 6. Substance Abuse and Mental Health Administration. Practicing effective prevention. [https://www.samhsa.gov/find-help/prevention]. Accessed on September 24, 2019. }}

Available Services

Services Available to the Public: The U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) has a toll-free referral helpline. The number is: 1-800-662-HELP (4357).

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

'''Definition:''' Percentage of adults aged 18 and older who responded 1 or more days on the Behavioral Risk Factor Surveillance System (BRFSS) to the question: "This second question is about medical marijuana use only. During the past 30 days, on how many days did you use medical marijuana as recommended by a doctor or other health care provider for treatment of a medical condition?" '''Numerator:''' Weighted number of adults (18+) who responded 1 or more days on the BRFSS to the question: "During the past 30 days, on how many days did you use medical marijuana as recommended by a doctor or other health care provider for treatment of a medical condition?" '''Denominator:''' Weighted number of adults (18+) who responded to the current medical marijuana use question on the BRFSS, excluding those with missing, "Don't know/not sure," or "Refused" responses. The BRFSS question on use of medical marijuana was only asked on the 2015 supplemental survey.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Current marijuana users could report one or more methods of usage so the percentages will not sum to 100%.

Data Notes

'''Definition:''' Percentage of adults 18 years of age and older who responded affirmatively to the question: "During the past 30 days, how did you use marijuana? (Allow multiple responses)" 1. It was vaporized (e-cigarette like vaporizer) 2. It was smoked (in a joint, bong, pipe, blunt) 3. It was eaten in food (in brownies, cakes, cookies, candies) 4. It was consumed in a beverage (tea, cola, alcohol) 5. It was dabbed 6. It was used in some other way. The methods of marijuana usage were asked on the 2015 standard survey as a multiple responses to a single question and on the 2015 supplemental survey as individual "yes" or "no" questions.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

The sex of the respondent is only asked if necessary.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Respondents are asked, "What is your age?, which is coded in years. Responses of Refused are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

** = Data not available due to fewer than 50 responses in the denominator.

Data Notes

Race/ethnicity is determined by responses to three questions: [[br]] 1) "Are you Hispanic, Latino/a, or Spanish origin?" "If yes, are you...?" One or more categories may be selected from categories of (1) "Mexican, Mexican American, Chicano/a"; (2) "Puerto Rican"; (3) "Cuban"; (4) "Another Hispanic, Latino/a, or Spanish origin".[[br]] 2) "Which one or more of the following would you say is your race?" Response categories consist of "White", "Black or African American", "American Indian or Alaska Native", "Asian" (with subcategories of Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or Other Asian), "Pacific Islander" (with subcategories of Native Hawaiian, Guamanian or Chamorro, Samoan, or Other Pacific Islander), Other, or No additional choices. [[br]] 3) If more than one response to race, then "Which one of these groups would you say best represents your race?" with choices from the list enumerated above. Responses of Don't Know/Not Sure or Refused are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Ethnicity is defined independent of race. It is based upon responses to the question, "Are you Hispanic, Latino/a, or Spanish origin?" Responses of "Don't Know/Not Sure" or "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Marital status is determined by the question, "Are you ...?" with responses of "Married", 'Divorced", "Widowed", "Separated", "Never married," or "A member of an unmarried couple". Responses of "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Education is based upon education completed by or after 25 years of age. Individuals less than 25 years of age are excluded. Education is assessed by responses to the question: "What is the highest grade or year of school you completed?" Responses are "Never attended school or only attended kindergarten", "Grades 1 through 8 (Elementary)", "Grades 9 through 11 (Some high school)", "Grade 12 (High School Graduate)", "College 1 year to 3 years (Some college or technical school)", "College 4 years or more (College graduate)", or "Refused". Refusals are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Employment status is assessed by the question: "Are you currently ...?" with responses of "Employed for wages", "Self-employed", "Out of work for 1 year or more", "Out of work for less than 1 year", "A Homemaker", "A Student", "Retired", "Unable to work" or "Refused". Refusals are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Income is measure by the question: "Is your annual household income from all sources ---" with categories of "Less than $10,000", "Less than $15,000", "less than $20,000", "less than $25,000", "less than $35,000", "less than $50,000", "less than $75,000", "$75,000 or more", and "Don't know / Not sure" or "Refused". Responses of "Don't know / Not sure" or "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Poverty thresholds are intended for use as a statistical yardstick, not as a complete description of what people and families need to live. Poverty thresholds are the dollar amounts assigned by the U.S. Census Bureau to determine poverty status. Poverty thresholds are assigned based upon the size of the family and the ages of the members (i.e., adults versus children). The same thresholds are used throughout the United States. Poverty thresholds were originally derived in the 1963-1964 using U.S. Department of Agriculture food budgets designed for families under economic stress and data about what proportion of their income families spent on food. The thresholds are updated annually for inflation using the Consumer Price Index for All Urban Consumers (CPI-U). How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]

Data Notes

Poverty thresholds computed using the BRFSS assume that householders are less than 65 years of age as the ages of the household heads are not recorded. The maximum of the income range provided for the household is used to evaluate the proportion of the poverty threshold. This is a conservative approach as there are no errors of misclassification into the lowest poverty group. The category of Poor represents less than 100% of the poverty threshold. Near Poor is 100% through 199% of the poverty threshold. Middle/High income families are 200% or higher of the poverty threshold. How the Census Bureau Measures Poverty - U.S. Census Bureau [https://www.census.gov/hhes/www/poverty/about/overview/measure.html]

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Body Mass Index (BMI) is computed based upon responses to the questions, "About how much do you weight without shoes?" and "About how tall are you without shoes?" Responses of "Don't know / Not sure" or "Refused" to either questions are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Sexual orientation is assessed by the question: "Now I'm going to ask you a question about sexual orientation. Do you think of yourself as A. Gay or lesbian, B. Straight, that is, not lesbian or gay, C. Bisexual, or D. something else?" Responses of "Straight, that is not lesbian or gay" are contrasted with the combined responses to "Gay or lesbian" and "Bisexual". Responses of "Something else", "Don't Know / Not sure", or "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

General health is assessed by the question: "Would you say that in general your health is excellent, very good, good, fair, or poor?" Responses of "Excellent" and "Very good" are combined, as are "Fair" and "Poor." Responses of "Don't know/Not sure" and "Refused" are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

The presence of one or more Adverse Childhood Experiences (ACEs) is assessed using either the 10 domains that are grouped into: [[br]] '''Abuse:'''[[br]] 1) Verbal Abuse[[br]] 2) Physical Abuse[[br]] 3) Sexual Abuse][[br]] '''Dysfunctional Households:'''[[br]] 4) Substance Abuse[[br]] 5) Mental Illness[[br]] 6) Domestic Violence[[br]] 7) Separation/Divorce[[br]] 8) Incarceration among household members[[br]] '''Neglect:'''[[br]] 9) Emotional Neglect[[br]] 10) Physical Neglect[[br]] The presence of an Adverse Childhood Experience have grouped into scores of 0 (no exposure), 1 (single exposure to an ACE), 2-3 (exposure to 2 or 3 ACEs), and 4+ (exposure to 4 or more different ACEs) The questions associated with each type of ACEs is described in the [http://ibis.dhss.alaska.gov/indicator/index/Alphabetical.html respective reports]. A summary ACEs score is computed for those with valid responses to all domains. Respondents with refusals to one or more of the ACEs questions are excluded.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Geographic descriptions of the public health regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_phr.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Notes

Geographic descriptions of the behavioral health systems assessment reporting regions can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_bhs.aspx].

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

References and Community Resources

'''References:''' 1. Crean RD, Crane NA, Mason BJ. An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions. Journal of Addiction Medicine 2011;5(1):1-15. 2. Di Forti M, Iyegbe C, Sallis H, Kolliakou A, et al. Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biological Psychiatry 2012;72(10):811-816. 3. Caspi A, Moffitt TE, Cannon M, et al. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biological Psychiatry 2005;57(10):1117-1127. 4. Center for the Application of Prevention Technologies. Prevention programs that address youth marijuana use. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2014. 5. Mason WA, Fleming CB, Haggerty KP. Prevention of marijuana misuse: School-, family-, and community-based approaches. In M. T. Compton (Ed.), Marijuana and Mental Health. Arlington, VA: American Psychiatric Publishing. In press. 6. Substance Abuse and Mental Health Administration. Practicing effective prevention. [https://www.samhsa.gov/find-help/prevention]. Accessed on September 24, 2019. '''Resources:''' DrugFacts: Marijuana | National Institute on Drug Abuse (NIDA) [https://www.drugabuse.gov/publications/drugfacts/marijuana] Get the facts about marijuana for your family [http://dhss.alaska.gov/dph/Director/Pages/marijuana/facts.aspx] Marijuana (Cannabis) - SAMHSA [https://www.samhsa.gov/atod/marijuana]