A systematic review of 15 U.S. studies found that cannabis use in youth aged 12-26 is driven by multi-level factors, from individual perceived risk and peer influence to neighborhood stress and cannabis legalization.
Youth prevention program designers, school health professionals, parents, cannabis policymakers
Risk and protective factors identified at individual, family, community, and policy levels
What the researchers found
Risk factors operated at every level: individual (older age, early initiation, low perceived harm, polysubstance use), interpersonal (peer influence, parental acceptance, family structure), community (neighborhood stress, social media, proximity to dispensaries), and societal (legalization, lower SES). Protective factors included peer disapproval, parental monitoring, school connectedness, and extracurricular involvement. Gender disparities in use are narrowing.
Why it matters
Effective cannabis prevention requires understanding that youth use is not driven by any single factor. This review maps the full landscape of influences using the Social Ecological Model, providing a framework for designing multi-level interventions rather than relying on individual-focused approaches alone.
The numbers in context
15 studies meeting inclusion criteria. Risk factors at 4 levels: individual, interpersonal, community, societal. Key protective factors: peer disapproval, parental monitoring, school connectedness, extracurricular involvement. Gender use gap narrowing. Youth ages 12-26.
How the study worked
Systematic review searching CINAHL, Medline (OVID), and PubMed (January 2019-September 2024) using PRISMA guidelines. 15 peer-reviewed, quantitative, U.S.-based studies of youth ages 12-26 met inclusion criteria. Analysis was guided by the Social Ecological Model.
What this study cannot tell us
Only 15 studies met criteria, limiting the comprehensiveness of each ecological level. U.S.-only studies may not generalize internationally. Search limited to three databases. Studies from 2019-2024 reflect a specific policy era. Cannot determine the relative importance of different risk/protective factors.
How to read the evidence
Strong evidence from a well-conducted systematic review using PRISMA guidelines and a validated theoretical framework, though limited by the number of included studies.
When this study was published
2025 systematic review covering U.S. studies from 2019-2024.
The bigger picture
As cannabis legalization expands, prevention efforts need to evolve beyond individual-focused messaging. This review demonstrates that effective prevention must address peer norms, family dynamics, community environments, and policy contexts simultaneously. The narrowing gender gap suggests prevention programs should equally target males and females.
Questions still open
- Which ecological level offers the greatest leverage for reducing youth cannabis use? How effective are multi-level interventions compared to single-level approaches? Do the same risk and protective factors apply in states that have not legalized cannabis?
Common questions
What protects youth from cannabis use?
Does living near a dispensary increase youth use?
Read the original research
Multilevel Risk and Protective Factors Influencing Cannabis Use Among Adolescents and Young Adults in the United States: A Systematic Review.
Comprehensive child and adolescent nursing, 48(4), 278-306
Citation
Phares, Belinda A; Driskill, Christie N; Basani, HimaBindu; Rodil, Aimee Rousella M; Barr, Emily Anne. (2025). Multilevel Risk and Protective Factors Influencing Cannabis Use Among Adolescents and Young Adults in the United States: A Systematic Review.. Comprehensive child and adolescent nursing, 48(4), 278-306. https://doi.org/10.1080/24694193.2025.2524680
Explore the wider topic
- Surviving 4/20 Sober: A Practical Survival Guide
- CBT for Cannabis Recovery: How Cognitive Behavioral Therapy Works
- The Cannabis Relapse Cycle: Quit, Feel Good, Get Complacent, Repeat
- Cold Turkey vs Tapering: Which Way to Quit Weed
- Dating Sober After Years of Being High: What Nobody Tells You
- Exercise as Medicine: Working Out After Quitting Weed
- Grieving Weed Itself: Mourning the Loss of a Companion
- How to Help Someone Quit Weed (When They're Not Ready)
- How to Quit Weed: A No-Judgment Step by Step Guide
- How to Talk to Your Teenager About Weed (Without Losing Them)
- Journaling Through Weed Withdrawal: Why Writing Helps You Heal
- My Kid's Friends Smoke Weed: A Parent's Guide
- MA vs SMART Recovery vs Therapy: Comparing Your Options
- Meditation and Mindfulness for Weed Withdrawal
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Your Partner Still Smokes Weed: How to Navigate It
- Quitting Weed While Your Partner Still Smokes
- The Pink Cloud Effect: When Quitting Weed Feels Too Good
- How to Quit Smoking Weed Cold Turkey: What to Expect
- Quit Weed or Cut Back: Which Is Right for You?
- I Quit Weed and Regret It: An Honest Look at Non-Linear Recovery
- Quitting Weed in Your 20s: Career, Social Life, Starting Over
- Quitting Weed in Your 30s: It's Not Too Late
- Quitting Weed After 10+ Years of Daily Use: What to Expect
- Quitting Weed During a Life Crisis: Divorce, Job Loss, and Other Bad Timing
- Quitting Weed and Working Out: How Exercise Helps Recovery
- Quitting Weed After Loss: When Grief Comes Flooding Back
- Quitting Weed When It's Legal Everywhere
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Weed Withdrawal Success Stories: Real People Who Made It Through
- Quitting Weed as a Teen or Young Adult
- Quitting Weed Long Distance: When You Can't Remove Triggers
- I Relapsed on Weed. Now What? A Practical Reset Guide
- I Relapsed After Quitting Weed: What Now?
- Should I Quit Weed? A Decision Framework (Not a Lecture)
- Quitting Weed at Music Festivals and Concerts: A Sober Survival Guide
- Supplements That Actually Help with Weed Withdrawal (And Ones That Don't)
- My Kid Is Smoking Weed: A Parent's Guide
- How to Tell Your Friends You're Quitting Weed
- Relapse Prevention Plan for Cannabis: A CBT-Based Approach
- Why Weed Relapse Happens: The Science Behind Going Back
- Replacing the Ritual: What to Do When You Quit Weed
- How Cannabis Damaged My Relationships: Before and After
- Social Media Detox from Weed Content