Youth Cannabis Use Is Shaped by Individual, Family, Peer, Community, and Policy Factors at Every Level

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.

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.

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.

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.

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.