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Publication
New Brief from SHADAC and UMN Cannabis Research Center: Using the Minnesota Student Survey to understand cannabis use and perceptions among high school students
As of 2023, Minnesota legalized cannabis for non-medical use by adults, becoming one of the now 24 states with such policies. Minnesota’s cannabis legislation limits legal cannabis use to adults aged 21 and older, similar to other states’ legislation for cannabis, tobacco, and alcohol use as well.
Despite the legislation prescribing this age restriction, many policymakers and other stakeholders are concerned with the impact legalized cannabis could have on public health in general and on youth populations, specifically.
“As cannabis policy continues to develop in Minnesota, and once legal sales of cannabis begin, it will be crucial to study youth cannabis use and to use those findings to fine-tune the state’s approach to minimize public health risks for youth,” says SHADAC and Cannabis Research Center (CRC) researcher Colin Planalp.
Commercial sales of legal cannabis in Minnesota have not yet begun, and they are not expected until 2025. However, the Cannabis Research Center (CRC) and SHADAC — both centers housed at the University of Minnesota’s School of Public Health — have already begun work to understand potential effects this legislation could have on youth. In fact, researchers purposefully wanted to start research and use data from before the beginning of commercial sales in order to provide key baseline evidence on cannabis use and perceptions among youth.
Thus, in their newest brief, researchers from the CRC and SHADAC used data from the Minnesota Student Survey (MSS) to study youth experiences with and perceptions of cannabis and other substances prior to legalization. This brief specifically looks at:
- Self-reported cannabis use
- Differences between demographic groups’ cannabis use
- Perceived prevalence of cannabis use by peers
You can read the brief in full here or by clicking the image to the right.
Interested in Minnesota cannabis policy? Want to learn more about the potential public health implications of cannabis use and legalization? Check out some of SHADAC and the CRC’s other collaborative pieces:
Blog & News
Understanding cannabis use and perceptions among Minnesota high school students
August 12, 2024:Most 9th and 11th graders report never having tried cannabis, but rates of recent use vary by demographic groups
In 2023, Minnesota became one of a growing number of states that have legalized cannabis for non-medical use by adults. When lawmakers crafted Minnesota’s legislation, they established a minimum age of 21 to use and purchase cannabis, similar to policies in other states that have legalized, and consistent with alcohol and tobacco policies.
The decision to limit legal access to cannabis to adults age 21 and older reflects common concerns about the potential for cannabis use to harm youth. While research on the public health implications of cannabis use is limited, studies have found associations between adolescent use of cannabis and a variety of negative outcomes, including lower educational attainment and worse school performance, as well as mental health and substance use disorders.1,2,3,4
Other states that legalized cannabis earlier and have had time to examine impacts of that legislation have generally not found clear increases in underage use since policies changed and legal sales began.5,6 Nevertheless, it will be important to monitor this issue in Minnesota, as experiences with alcohol and tobacco demonstrate that policies and enforcement matter when limiting substance use by youth.
Though commercial sales of legal cannabis in Minnesota aren’t expected to begin until 2025, researchers at the University of Minnesota School of Public Health’s Cannabis Research Center and SHADAC sought to get a head-start in understanding potential effects on youth. To do this, researchers began by studying youth experiences with and perceptions of cannabis and other substances prior to legalization. Our aim is to provide researchers, policymakers, and community members with key baseline evidence that can illuminate the current cannabis landscape, so it may be compared to post-legalization data in the coming years.
Cannabis and Other Substance Use Has Been Declining Among Youth in Minnesota
Using data from the Minnesota Department of Education’s Minnesota Student Survey, we produced estimates of the experiences and perceptions of Minnesota 9th and 11th graders (i.e., high school students) pertaining to cannabis, alcohol and tobacco, as well as some measures on nicotine-vaping products — a newer phenomenon for which less data is available.
Among the most important findings include:
- Almost 9 in 10 (86%) Minnesota high school students said in 2022 that they had never used cannabis, and the rate of students saying they had never used cannabis has been increasing over time.
- Less than 1 in 10 (8%) Minnesota high school students reported having used cannabis in the past month, but that percentage varied across demographic groups. For instance, only 3% of Asian students reported using cannabis in the past month, but 17% of American Indian and Alaska Native students reported they had used cannabis in the past month.
- Minnesota high school students appear to overestimate the prevalence of cannabis use by their peers. While half (50%) said they believed most of their peers use cannabis monthly, only 7% reported that they themselves use cannabis monthly — a similar pattern of apparent overestimation of substance use by peers as for alcohol and tobacco use.
More Research on Youth Use Necessary Once Legal Cannabis Sales Begin
The findings of our study are somewhat reassuring: despite the stereotype of teenagers experimenting with substances, most Minnesota high school students report they aren’t using cannabis — or alcohol, tobacco, and nicotine-vaping products.
However, even with 8% of Minnesota high school students reporting cannabis use, that represents tens of thousands of youth in the state. That is concerning, based on research that suggests various risks related to underage cannabis use.
Research from other states suggesting that legalization doesn’t necessarily lead to an unavoidable increase in underage cannabis use is reassuring, but we shouldn’t take that for granted. As cannabis policy continues to develop in Minnesota, and once legal sales of cannabis begin, it will be crucial to study youth cannabis use and to use those findings to fine-tune the state’s approach to minimize public health risks for youth.
Click here to read the full brief on this subject.
[1] National Academies of Sciences, Engineering, and Medicine. (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. The National Academies Press. https://doi.org/10.17226/24625.
[2] Volkow, ND, Swanson, JM, Evins, AE, et al. (2016). Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry. 73(3), 292-297. doi:10.1001/jamapsychiatry.2015.3278
[3] Winters, KC, Lee, CY. (2008). Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. Drug and Alcohol Dependence. 92(1-3), 239-247. https://doi.org/10.1016%2Fj.drugalcdep.2007.08.005
[4] Tervo-Clemmens, B, Gilman, J, Evins, E. (2024). Substance Use, Suicidal Thoughts, and Psychiatric Comorbidities Among High School Students. JAMA Pediatrics. 178(3), 310-313. doi:10.1001/jamapediatrics.2023.6263
[5] Esie P, Ta M. (2024). Cannabis Use Among Students in Grades 8, 10, and 12, by Sex — King County, Washington, 2008–2021. MMWR Morbidity and Mortality Weekly Report. 73:27–31. https://www.cdc.gov/mmwr/volumes/73/wr/mm7302a1.htm
[6] Colorado Department of Public Health and Environment. (2022). CDPHE releases latest Healthy Kids Colorado Survey data. https://cdphe.colorado.gov/press-release/cdphe-releases-latest-healthy-kids-colorado-survey-data-0
Blog & News
Research Assistant
Cancer Screening Data: Adults Who Have Received Recommended Cancer Screenings by Coverage Type, Education Level, and Race/Ethnicity in 2022
May 03, 2024:Cancer screening for adults plays a pivotal role in early detection, increasing the chances of successful treatment and preventing thousands of cancer deaths. Despite their life-saving potential, many adults may choose to delay or skip these screenings due to various barriers, such as limited access, transportation issues, fear of diagnosis, or poor understanding of the importance. To effectively address the root causes of underutilization, it's crucial to first understand the landscape of cancer screening rates for varied populations and communities.
State Health Compare offers a comprehensive view of state-level data on adults receiving recommended cancer screenings, for the civilian noninstitutionalized population. This valuable resource provides insights into screening rates across different coverage types, education levels, and racial/ethnic groups. Screenings in this data include:
- Pap smears (cervical cancer screening)
- Colorectal cancer screenings
- Mammograms (breast cancer screening)
In this blog post, SHADAC researchers delve into the breakdowns between the different groups to understand disparities and/or differences of cancer screening rates for various populations. For this analysis, we used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) on State Health Compare.
Methods
To begin, we first needed to understand the total number of adults who received recommended cancer screenings. We found that, in 2022, 62.6% of US adults received recommended cancer screenings.
We then conducted statistical testing of rates within each of the previously mentioned demographic categories to see if they were significantly higher or lower than the national rate.
Breakdown by Coverage Type
This breakdown examined cancer screening rates for adults by multiple types of insurance coverage.
Some coverage groups had significantly lower cancer screening rates compared to the national rate. Uninsured adults had the lowest rate of cancer screenings in 2022, with 34.0% receiving recommended cancer screenings. Adults that were insured through Medicaid in 2022 also had a significantly lower rate of receiving annual cancer screenings, with a percentage of 57.7%.
Explanations of why these differences occur vary. One possible explanation is the cost of screenings. Those who are uninsured would be required to pay for cancer screenings out of pocket, which can be expensive and cost prohibitive, leading to people forgoing these services. Additionally, many people and families covered under Medicaid are low-income. Even with insurance coverage, individuals may not be able to pay for preventative screenings, have transportation to appointments, be able to take off work or find childcare, etc.
On the other hand, some coverage groups had significantly higher rates of cancer screenings compared to the national rate. Adults with public insurance and Medicare both had significantly higher rates of receiving cancer screenings, with rates of 66.4% and 70.7%, respectively.
Again, possible explanations for this vary. One explanation is that under the Affordable Care Act, Medicare must cover cancer screenings. This guaranteed coverage could explain the higher rate of individuals with Medicare receiving their recommended screenings.
Of those with individual insurance, 59.0% reported receiving recommended screening, which was not statistically different from the US rate. Adults with private and employer/military insurance also did not have a significant rate of annual cancer screenings compared to the US rate, with 62.5% and 63.2%, respectively, reporting receiving annual cancer screenings.
Breakdown by Education Level
Multiple levels of cancer screening data by educational attainment were examined displayed in the graph below.
Two of these groups had significantly lower rates of adults receiving recommended cancer screenings. First was US adults with less than a high school degree, with 47.2% receiving recommended cancer screenings in 2022 (significantly lower than the US rate). The rate for adults who are high school graduates (without further higher education) is also significantly lower than the US rate at 58.8%.
There is no significant difference between the US rate (62.6%) and the rate for adults with some college or an Associate’s degree (63.0%).
Finally, 68.0% of US adults with a Bachelor’s degree or higher reported receiving recommended screenings, which is significantly higher than the US rate. A possible explanation for this higher rate is that individuals with higher educational attainment may be more knowledgeable regarding the importance of receiving preventative care, as well as having the means to seek preventative care.
As individuals with lower educational attainment have lower rates of cancer screening, they also have higher prevalence of modifiable cancer risk factors. Modifiable risk factors for cancer include smoking, excess body weight, alcohol intake, physical inactivity, and poor diet. There are notable educational disparities in cancer prevention in terms of incidence, treatment, and mortality. This reveals the importance of tailoring screening programs and providing educational material to individuals with lower education levels.
Breakdown by Race/Ethnicity
Finally, we were able to create a breakdown of cancer screening rates by racial/ethnic groups.
Note: these groups were selected based on available data. State Health Compare does not have available data for some race/ethnic groups, due to low response rates. However, SHADAC is hopeful this data gap will be addressed in the future in order to conduct equitable analyses.
Compared to the US rate, Hispanic/Latino adults and adults of other/multiple races had significantly lower rates of receiving recommended cancer screenings in 2022, with respective rates of 55.6% and 56.9%.
Approximately two-thirds of both African American/Black adults (64.6%) and White adults (64.9%) reported receiving recommended cancer screenings—both of which are significantly higher than the US rate.
Our analysis shows that there are differences in cancer screening rates between racial/ethnic groups—with our analysis seeing Hispanic and other/multiple race individuals with the lowest screening rates in the US. Other research supports and, in fact, shows even greater inequities than this. Racial disparities not only impact screening rates, but also cancer diagnosis and treatment. Persons of color may receive later stage cancer diagnoses compared to their White counterparts, due to disparities in screening quality and delays in diagnostic evaluations.
Also, persons of color may not be seeking out cancer screening services due to distrust in the healthcare system, discrimination, bias, or unpleasant past experiences.
Final Thoughts
Examining recommended annual cancer screening rates by coverage type, education level, and racial/ethnic group reveals that although the national rate may seem relatively high, there are still groups that face disparities in accessing and utilizing such a vital tool for improving cancer treatment and preventing death.
While this blog has looked at singular category breakdowns, it is important to note the intersectionality between insurance coverage, education level, race/ethnicity, and many other factors. For example, individuals without a high school diploma have the highest uninsurance rates. Race/ethnicity also appears to be correlated with rates of uninsurance. When looking at race and uninsured rates, there are higher uninsurance rates for American Indian or Alaska Native (AIAN), Hispanic, Black, and Native Hawaiian or Pacific Islander (NHPI) individuals compared to their White counterparts.
Therefore, of the groups that have significantly lower rates of cancer screenings compared to the US rate, many individuals may fall into multiple of these sub-categories. Further research and analysis could shed light on how these many factors interact and lead to different (and varied) results and outcomes.
By understanding these disparities, not only can we draw attention to improving public health education and literacy for these populations, but also find meaningful ways to identify and address barriers (individual and structural) that may be hindering these same individuals from accessing the preventative care they need.
Interested in learning more about disparities and health equity in the United States? You can explore the data yourself using the State Health Compare Tool here.
You can also read some of our other products highlighting State Health Compare data, like:
Publication
Perceptions and Opinions Relating to Cannabis in Minnesota
Using data from the National Survey on Drug Use and Health (NSDUH), this brief explores people’s perceptions and opinions related to cannabis and cannabis use prior to its 2023 legalization in Minnesota. The brief begins with an overview of the context of cannabis policy and use in the United States before moving into analysis of perceptions on cannabis prior to legalization. Specifically, researchers analyzed respondents’ opinions on:
- How easy or hard it would be to obtain cannabis
- Perceived risk associated with smoking cannabis
- Disapproval (or lack thereof) of cannabis use by adults (age 18+) and youth (age 12-17)
Researchers from the University of Minnesota School of Public Health’s State Health Access Data Assistance Center (SHADAC) and Cannabis Research Center (CRC) present data on these three topics for Minnesota specifically and for the U.S. as a whole.
Examining data prior to legalization helps both researchers and the public understand Minnesota’s perceptions and attitudes surrounding cannabis before policy changes – then, as we move forward, we can compare this to post-policy data to understand what has changed, what hasn’t changed, and, hopefully, begin to answer common questions regarding cannabis use and legalization.
Will cannabis use increase with legalization? Will increased consumption lead to greater public health harms? Will rates of use increase for youth? Will perceived risk of use decrease with legalization?
“The answer [to these questions] may depend, in part, on whether the changing legal status of cannabis also changes social norms and people’s perceptions about cannabis, such as reducing social stigma associated with cannabis use,” says SHADAC and CRC Researcher Colin Planalp.
The data in this brief are intended to provide information to Minnesota policymakers as they set up the state’s regulatory framework surrounding cannabis. It also aims to give Minnesotans helpful information as they navigate the new choices that come with the lifting of decades of cannabis prohibition.
Continued research and monitoring of these and other issues will be crucial as cannabis policy, attitudes, and social norms evolve. Examining and understanding these opinions and perceptions can potentially reveal hints at how the cannabis landscape may change as a result of legalization.
Read the brief in full here. Additionally, SHADAC and the CRC authored a companion brief using the same survey data to examine the potential public health implications of cannabis policy in Minnesota. You can find that brief here.
Interested in learning more about cannabis policy in Minnesota, substance use, and related topics? Check out the following resources:
- SHADAC blog accompanying this brief - “Measuring Perceptions and Opinions on Cannabis Use in Minnesota”
- Brief on the United States Opioid Crisis – “Opioid Crisis in the Pandemic Era”
- Cannabis Research Center Website
- Explore data on the topic of substance use, alcohol-involved deaths, and more on State Health Compare
Blog & News
Measuring Perceptions and Opinions on Cannabis Use and Access in Minnesota
April 18, 2024:Even before legalization, most Minnesotans reported that cannabis was easy to obtain; only one-third disapproved of use by adults
During the past decade, the United States’ cannabis policy landscape has changed dramatically. By the end of 2023, 24 states had legalized cannabis for non-medical use by adults — meaning the majority of the U.S. population lives in a state with legalized recreational cannabis.
These changes in the landscape of U.S. cannabis policy have coincided with evolving public opinion and perceptions about cannabis and cannabis legalization. Researchers have documented changing public attitudes about cannabis policy. For example, according to the polling firm Gallup, the share of people in the U.S. who support legalization of marijuana has grown from 50% in 2012 to 70% in 2023, just over a decade later1. But the complexities of cannabis and the attitudes surrounding it are much more nuanced than simply whether people support or oppose cannabis legalization.
In 2023, Minnesota became the 23rd state to legalize cannabis for non-medical use by adults. To help policymakers and Minnesotans understand the potential public health implications of that policy change, researchers from the University of Minnesota School of Public Health’s State Health Access Data Assistance Center (SHADAC) and the newly formed Cannabis Research Center (CRC) have analyzed data on people’s perceptions and opinions relating to cannabis, both for Minnesota and the U.S. as a whole.
SHADAC and the CRC used data from the federal government’s National Survey on Drug Use and Health (NSDUH). This research so far has included a focus on pre-legalization data, to better understand the people’s perspectives, opinions, and experiences with cannabis before Minnesota’s policy shift. Using the NSDUH, we report pre-legalization baseline data on several issues and commonly cited concerns associated with cannabis legalization:
- Ease or difficulty of obtaining cannabis under a policy of prohibition
- Perceived risk of smoking cannabis on a weekly basis
- Disapproval, or lack of disapproval, of cannabis use by adults (age 18 and older) and youth (age 12-17)
These particular measures are important because they may offer hints about the potential public health effects of cannabis legalization. Much of the concern about legalization hinges on the assumption that it will increase cannabis use, in turn resulting in possible consequences such as increases in prevalence of cannabis use disorder. But is it not clear whether legalization will increase cannabis use in the Minnesota context, or whether increased cannabis use will result in subsequent harms.
Data on Minnesotans’ perceptions and opinions of cannabis can offer us clues as to how legalization might affect the state. In our analysis, we found that most Minnesotans age 12 and older reported that cannabis was very or fairly easy to obtain, even before it was legalized. That could mean that increased availability of cannabis through legalization might not have a substantial impact on use, as people already reported easy availability when cannabis was prohibited.
We also found that roughly half of Minnesotans believed that smoking cannabis once or twice a week carried no risk or only slight risk of harm. And, while our analysis found that only one in three Minnesota adults (age 18 and older) reported disapproving of adults using cannabis, four in five Minnesota youth (age 12 to 17) said they disapproved of peers using cannabis. That suggests that adults may be less inhibited to try cannabis than youth under legalization — though those attitudes could change.
Our plan is to continue monitoring the cannabis landscape in Minnesota, measuring the impacts of legalization and the consequences — positive or negative — for public health. The findings of this study offer us early hints, but it will be crucial to continue to research these issues once commercial sales of cannabis begin and as new data become available.
Find more details and data analysis in the full version of this brief by clicking on the image to the right, or at the link here.
Interested in Minnesota cannabis policy and research? Check out the following resources to learn more about this growing field:
