Most at-risk teens maintained low cannabis use, but boys were more likely to show chronic or escalating patterns

Three cannabis use trajectories were identified: low (74%), chronic (12%), and escalating (14%). Boys were more likely to show escalating and chronic patterns. Conduct disorder symptoms showed the most robust bidirectional association with cannabis use trajectories, both predicting and being predicted by them.

Trajectory-based modeling in 401 predominantly Hispanic (90%) at-risk youth (46% female) tracked from ages 14-18, controlling for baseline substance use and demographics, with psychopathology measured as both predictor and outcome.

Most at-risk youth didn't develop problematic cannabis patterns, challenging assumptions about inevitability. The conduct disorder connection suggests behavioral problems and cannabis use fuel each other, creating a cycle that interventions could target.

That three-quarters of at-risk youth maintained low cannabis use is an important counterpoint to narratives about cannabis in vulnerable populations. The minority who escalate may be identifiable through conduct disorder symptoms, offering a potential screening and intervention target.

Predominantly Hispanic sample from one region limits generalizability. Four-year follow-up from ages 14-18 may miss later trajectory changes. Self-reported substance use. At-risk sample may not represent general population.