Marijuana and Adolescents in the United States

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Marijuana is one of the most used drugs among adolescents in the United States (Forman-Hoffman, Glasheen & Batts, 2017). More than 147 million people use cannabis, also known as Marijuana worldwide, which includes an increase use among adolescents (Miguez, Chan, Espinoza, Tarter & Perez, 2019). There has been a movement to legalize marijuana for medical use and recreational use in the United States, and since 1996 medical use of marijuana has been legalized in 23 states (Keyes et al., 2016). The first two states to legalize marijuana for adult recreational use was Washington and Colorado in 2012, and by 2016, seven more states joined the legalization movement for recreational use (Cerda et al., 2001). Legalization of marijuana has become a public health concern for adolescents in the United States by creating the perception that marijuana is safe to use decreasing the risk in using it (Miech, Johnston & O’Malley, 2017). States with medical marijuana law in place currently have the highest use by adults and adolescents (Keyes et al., 2016).

In Colorado where marijuana is legal for both medical and recreational use, children’s perception of harm towards marijuana decreased from 2011 to 2013 (Keyes et al., 2016). Adolescents view on the risk of using marijuana is affected by the attitude of the community, the policies, and the laws that are in place (Keyes et al., 2016). Since the legalization of recreational marijuana were allowed in some states among adults in 2012, adolescents views on the risk of using marijuana have changed compared to adolescents who live in states where marijuana has not been legalized (Cerda et al., 2001). Discouraging adolescents in using marijuana is difficult when the states are allowing use for medical and recreational use. Legalization of marijuana for medical use minimizes the perceived risks in using it for recreational purposes, especially among young adolescent users jeopardizing their growth development (Miech, Johnston & O’Malley, 2017). Legalizing marijuana will provoke an increase use among adolescents at an age that is dangerous to their neurobiological development, causing adverse effects that can last well into their adulthood (Keyes et al., 2016). The younger in initiating use of marijuana, the greater the negative effects will be. The ease of obtaining marijuana will make its way into the hands of younger adolescents, which can end up in misuse, abuse and addiction.

In New York, medical marijuana has been legal since 2014, and legalization for recreational marijuana is on the works for 2019. When it comes to adolescents and young adults suffering from drug addiction, New York has been one of the top ten states with an average of 9.8%, 1% higher than the national average (Zeshan et al., 2017). In 2012, a total of 39,216 drug poisonings were reported by the New York State Department of Health, and 11,773 of those cases were reported from the Bronx, with 12% between ages of 15 and 24 and marijuana was the highest drug reported (Zeshan et al., 2017).

My goal as a health educator is to initiate and propose a program to help reduce marijuana initiation use among freshman students in the high schools of the South Bronx. Starting use of marijuana at an early age will be the beginning of their drug use history, and increasing frequency of use will intensify the risk for marijuana use disorder (MUD) which results in little response to treatment and can cause long-term problems (Forman-Hoffman, Glasheen & Batts, 2017). Long term use of marijuana has also been linked to decrease in educational successes and increase in school dropout. (“What You Need to Know About Marijuana Use in Teens | Fact Sheets |Marijuana and Public Health | CDC”). An adolescent’s brain is continuously developing, and will not fully mature until they reach their mid-20’s (“What You Need to Know About Marijuana Use in Teens | Fact Sheets | Marijuana and Public Health | CDC”).

Marijuana can affect the brain by increasing activity among the Brain Derived Neurotrophic Factor (BDNF) receptors, which are important in brain and cognitive development and fundamental functions to drug addiction (Miguez, Chan, Espinoza, Tarter & Perez, 2019). Study show the effect marijuana has on the increase levels of BDNF after 12 months of use, which continues to increase with continued use of marijuana (Miguez, Chan, Espinoza, Tarter & Perez, 2019). The increase levels of BDNF will persist even after discontinuation of marijuana proving that negative effects continue well after cessation (Miguez, Chan, Espinoza, Tarter & Perez, 2019).

Studies show that marijuana use is higher among high school students with 26% and 7% for middle school students (Miguez, Chan, Espinoza, Tarter & Perez, 2019). The National Institute on Drug Abuse established that 22.9% of high school senior students smoked within the last month (Hoffman, 2017). A behavioral determinant of marijuana use is the use of cigarette and alcohol which have decline by 43%, 55% and 62% among 8, 10 and 12th grade respectively since 2005 (Miech, Johnston & O’Malley, 2017). In considering the decrease in cigarette and alcohol use among teenagers and the increase effect it has on marijuana use among teenagers, we would be experiencing a much higher rate of marijuana use than what we are seeing today. A non-behavioral determinant of marijuana use among teenagers is the legalization of marijuana and the common use by adults and by the peers in school.
A survey from 2015 National Survey on Drug Use and Health (NSDUH) recorded the highest initiation of marijuana use compared to reports between 2002 and 2008 (Forman-Hoffman, Glasheen & Batts, 2017). I would like to help prevent another spike increase of marijuana initiation use coming from the Bronx, as recreational marijuana will soon be legalized.

The pilot program designed for high school freshman students in the South Bronx is called “The Truth on Marijuana.” The goal of this evidence-based program on marijuana initiation prevention is to provide the students with the skills they need to make decisions on marijuana refusal, and avoid pressures of using marijuana by their peers and other environmental forces. This program will provide exercises and lesson plans to help develop self-esteem, develop problem-solving skills and help learn to cope with anger and social pressures. It will help them developed healthy relationships and avoid peer pressure from unhealthy ones.

After doing research on successful evidence-based drug prevention programs geared to teach middle school and high school students about drug prevention, I came across a couple of programs using psychosocial theories to relate the message to students in an effective way.

The first program I looked into is called “Life Skills Training.” This program is geared towards middle school and high school students. This program is currently implemented in about 12% of middle and high schools in the United States and has confirmed reduction in different types of drug abuse among adolescents (Prevention Program,”n.d.). They provide lessons helping children achieve skills necessary in making the right choices in drug prevention by building up their self-esteem and positive decision-making choices. The “Life Skills Training” program has demonstrated a decrease in marijuana use by 75% (Prevention Program,”n.d.).

The other program that uses the same theory in teaching about drug prevention is called “Project ALERT” which also teaches children skills necessary to refuse drugs. Through lesson curriculums providing skills in changing the pro-drug mentality, “Project ALERT” has resulted in a decrease of 60% in marijuana use and has earned almost a perfect score by the National Registry of Evidence-based Programs and Practices (“Substance abuse prevention,”n.d.). After researching the effectiveness of the programs and the theories used to make them successful, I have created a similar program with the psychosocial theory in mind to help the high schools of the South Bronx experience a reduction in marijuana use among their high school students and to be aligned with the target set by Healthy People 2020 to increase the portion of adolescents who have refrained from marijuana initiation from 94.3% to 96.3% (U.S. Department of Health and Human Services, Healthy People 2020 (2014).

Minorities heavily populate the Bronx with the majority of 57.1% Hispanics and 39.8% Blacks (“Population of Mott,” n.d.). The Bronx is one of the poorest districts nationwide with 52% of its community deep in poverty (Conde, 2017). The worst the neighborhood is, the more they experience increase in crime, poor school performance, lower education and unemployment among the community (Conde, 2017). All of these risks factors have been correlated with marijuana as the most illicit drug of choice among teenagers (Zeshan et al., 2017). Study show that more than half of high school students do not consider marijuana harmful increasing population of the K2 synthetic cannabinoid (SC) making it the second most used drug among high school students which have resulted in about 700 emergency room visit in the Bronx (Zeshan et al., 2017). K2 is easy and cheap to get with difficulty to detect in toxicology tests, and the possibility of increasing in use with the legalization of marijuana (Zeshan et al., 2017). Achieving effective school-based programs to help children fight against drugs can be challenging when you are faced with neighborhoods living in poverty, poor living conditions, high level of unemployment, high level of violence, and poor health in the South Bronx (“Mott Haven,” 2018).

In a district where 93% of students are living in poverty and 1 out of 10 students are homeless with no high performing schools within the district, and having the lowest proficiency in reading and math compared to other districts, evidence-based school programs that derive from psychosocial theories are not only a necessity but are in high demand (Ryley, Badia, Otis, & McShane, 2015).

Promoting preventative initiatives are ideal within school settings in order to communicate with large audience of adolescents. Most drug initiation starts with younger to older adolescent’s social environment and continues through adulthood. The younger a child experiments with drugs, the greater risk of long term use and addiction, negatively affecting their health, behavioral, and social wellbeing (Griffin & Botvin, 2011). Finding which program works best has been challenging. Explaining to the students about drugs, their negative effects, and insisting they avoid using them is not an effective plan (Griffin & Botvin, 2011). They have to change the way they think about drugs, and how to deal with the negative circumstances. Programs that provide children with social skills, drug resistance skills, and focus on negative risk factors have been very effective (Griffin & Botvin, 2011). The purpose of psychosocial theories is to focus on teaching skills such as; social resistance skills in understanding influences that promotes drug use and how to resist temptation, normative education which provides factual information on the dangers of drugs and competence-enhancement skills which teaches adolescents about life skills such as problem-solving, decision making, self-control and coping strategies (Griffin & Botvin, 2011).

Children that often experience problems with stress, depression and low self-esteem, usually come from an unstable home with very little social support and may experience problems with drugs, poor academics, inactivity, poor nutrition and suicidal thoughts (Stuart, 2006). The children that displayed high self-esteem and dealt with stress at a better capacity, expressed themselves in positive ways paralleled to having a healthy life at home with positive support system, and were able to shield themselves from depression and practiced strong and positive self-esteem (Stuart, 2006). In a study discussed by Stuart (2006), children that were in a healthy group experienced no drug use, no depression or any other negative emotions while the children that were in the stressed group experienced multiple negative symptoms. Psychosocial therapy supports intervention programs that help promote life social skills needed to live a healthy and happy life, and have the ability to deal with stressful situations in a healthy manner.

The objective of “The Truth on Marijuana” program is to equip high school freshman students with the necessary skills to attain strong characteristic traits to be able to deter any encouragement and impulse of using marijuana. The four-month program will focus on delivering lessons in attaining skills to help students develop social-emotional skills to make wiser choices while learning about the negative effects marijuana has on mental, physical, and behavior health. The goal of implementing programs that facilitate social skills especially in neighborhoods where children are facing many negative risk factors, can be effective not only in drug prevention but in having the ability to deal with negative situations in a healthy and positive way.

The 16-week marijuana initiation prevention pilot program will be delivered to students attending the Mott Haven Community High School and International Community High School both of which are located in the South Bronx. The objective of this program is to provide comprehensive education on marijuana use, legalization of, and the negative effects it has on a personal, and a community level. This program is highly recommended in these schools because of the high rate of drug use in the South Bronx and the legalization of recreational marijuana that will come into effect in the state of New York very soon. An advisory committee involving teachers, parents, superintendent of the schools and students will be involved in the planning process of the program. Once the Board of Education and any other Institutional Review Boards (IRB) involved approves the program, it will be part of a 4-month program for students starting high school. There will be a 2-month planning phase to put all of the materials together and providing the lesson plans for the teachers. The teachers will learn the material that will be on power point presentations, role-play scripts, written materials for pre-test and post-test of the program and review the material (true/false, open-ended questions) students will complete at the end of every session. Each session will also have a short video representing other high school students that have used marijuana in the past, and the problems they encountered. Each session will be 45 minutes long and will take place in class. All written material students hand in will be anonymous.

“The Truth on Marijuana” program will be include short presentations explaining what marijuana, cannabis and THC is, the different forms of marijuana (synthetic, edibles, vaping) and the increase of its potency, which will be presented via power point presentations along with handouts given to the students on the materials learned. The material given to the students will cover the short-term effects (memory loss, problems thinking and solving problems) and long-term effects (changes in the brain, health and emotional complications) of using marijuana. It will also cover the social consequences such as driving under the influence, drug testing for work, the effects of working under the influence and how legalization (medical and recreational) affects society. There will be short interactive scripts for the students to role-play characters in different scenarios exhibiting situations of peer pressure, experiences of low self-esteem, coping with anger and decision making. The interactions of role-playing is one of the most important tools of this program by allowing students to act out situations and to prepare them in making healthy choices about drug use. The scripts will be based on situations that affect communities, families and their peers. The role-playing interaction will be entertaining, will help the student act out different situations and will involve everyone in class. Posters of “The Truth on Marijuana” fact sheets will be posted everywhere in the school, hallway, bathroom and cafeteria. The information will also be sent to all parents of the students attending the program.

Improving interpersonal and communication skills among the students will reduce any peer pressure that may encourage drug use. The lessons learned through role-playing will help them prepare against situations that can lead to substance abuse by practicing refusal skills and will better prepare them in handling negative situations in a positive way. This social skill development program will not only elicit marijuana avoidance behavior but will help build skills adolescents need to invest in healthy relationships now and in their adult life. The program will be evaluated with a pre-test and post-test the students will take and hand in anonymously. A second post-test will be taken at the end of the school year to see if passing of time changed their first post-test result. The schools will benefit from a successful program minimizing marijuana use and improving social skills students can apply to any anatomical part of their lives.

According to the Healthy People 2020 initiatives, reaching the goal of decreasing adolescent marijuana use to 6% may be a little challenging considering regular user are currently at 25% (Miguez, Chan, Espinoza, Tarter & Perez, 2019). The goal of this program is to reduce initiation of marijuana use among adolescents and help Healthy People 2020 get closer to its goal.

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Marijuana and Adolescents in the United States. (2021, Jun 03). Retrieved from https://papersowl.com/examples/marijuana-and-adolescents-in-the-united-states/

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