Original Study
Psychosocial Correlates of Marijuana Use among Pregnant and Nonpregnant Adolescent Girls

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Abstract

Study Objective

Pregnant and nonpregnant populations in the United States report marijuana as the most commonly used illicit drug. Patterns of marijuana use and psychosocial correlates are unclear among non–treatment-seeking teenage girls.

Design, Setting, Participants, Interventions, and Main Outcome Measures

The objective of this study was to use cross-sectional data to examine the psychosocial correlates of recent marijuana use among a sample of 646 pregnant and nonpregnant adolescent girls presenting to urban primary care clinics (mean age = 15.6 years, SD = 1.9 years; 65% African American; 8.8% pregnant).

Results

In Poisson regression analysis, frequency of marijuana use was significantly associated with greater likelihood of pregnancy (incident rate ratio [IRR], 1.30; 95% CI, 1.03-1.65), alcohol use (IRR, 1.11; 95% CI, 10.08-1.14), condomless sex (IRR, 1.95; 95% CI, 1.61-2.37), parents’ drug use (IRR, 1.04; 95% CI, 1.02-1.05), and negative peer influences (IRR, 1.12; 95% CI, 1.10-1.16).

Conclusion

Marijuana use among adolescent girls in this sample was associated with a number of risk behaviors as well as parental and peer influences. Culturally sensitive screening and intervention approaches for marijuana use among adolescent girls should address multiple individual, relationship, and community factors, to prevent unwanted pregnancy as well as to reduce marijuana use during this vulnerable time.

Introduction

Marijuana is the most prevalent illicit drug used among adolescent girls and its use is on the rise.1 National surveys have shown that approximately 6.5% of adolescent girls between the ages of 12 and 17 years reported current marijuana use, and 12.3% reported past year use.2 A significant number of pregnant adolescents continue to use marijuana throughout their pregnancy and their use is greater than same-age, nonpregnant peers—recent data from a large national survey of 14,400 pregnant and 395,600 non-pregnant female respondents showed that a staggering 14% of pregnant adolescent girls (ages 12-17 years), compared with 6.45% of nonpregnant girls, reported past month marijuana use.3 Adolescent women, compared with adults 18 years and older, comprised the only age group for whom marijuana prevalence was higher during pregnancy, with non-Hispanic African American pregnant women reporting the highest prevalence (6.45%).3

Although the literature yields equivocal findings, research has shown associations between marijuana use and adverse fetal outcomes, including increased odds of being placed in the neonatal intensive unit after birth.4 Furthermore, the American College of Obstetricians and Gynecologists recommends abstinence from marijuana for women who are pregnant or breastfeeding.5 Compared with adolescent girls who do not use marijuana, those who do are more likely to engage in risky sexual behavior. Studies support an association between marijuana use and an increased risk of sexually transmitted infections (STIs) among adolescents, particularly through increased risky behaviors, including condomless sex or multiple sex partners.6 Among the 20 million new STIs each year, almost half occur in adolescents and young adults.7

Social–ecological frameworks, such as the Ecodevelopmental model, can provide an understanding of the interplay among individual risk and social context associated with substance use, and can inform intervention efforts.8, 9 Risk factors associated with marijuana use in youth include individual level factors of age, race/ethnicity, health including mental health concerns (ie, anxiety and depression symptoms), and risk behaviors (eg, alcohol and other drug use; risky sex). Relationship-level risk factors include social and family risk factors (eg, parental drug use and peer influences). Previous work has identified protective factors including school and religious involvement, perceived parental disapproval, and high level of parental monitoring. Nonetheless, although previous research has studied these in adolescents more broadly,9 psychosocial correlates associated with marijuana use in pregnant and nonpregnant adolescent girls remain unclear. In the current study, guided by the ecodevelopmental framework and previous literature in adolescents, we conducted secondary data analyses to examine the demographic characteristics, psychosocial, and risk behavior correlates in relation to past 3-month marijuana use among adolescent girls presenting to urban primary care clinics.

Section snippets

Participants and Procedure

Participants were 646 female patients (ages 12-18 years old) who presented for primary care services to 7 federally qualified community health centers located in urban areas of the Midwestern United States. A total of 1664 female patients were approached for the study and 248 (14.9%) declined participation. Data collection took place between April 2007 and December 2009. Informed consent/assent was obtained from all individual participants and their parents. Adolescents who were 18 years old

Results

Our sample included 646 adolescent girls, with an average age of 14.6 years (SD = 1.9 years), 64.6% of the sample identified as African American, and 8.8% (n = 57) of the sample was pregnant (Table 1). Bivariate correlates showed past 3-month frequency of marijuana use was positively associated with: pregnancy, older age, alcohol use, other drug use, depression and anxiety symptoms, condomless sex, negative peer influences, and parents' drug use (Table 1). Marijuana frequency was negatively

Discussion

The current study examined demographic, psychosocial, and risk behavior correlates of recent marijuana use among a sample of 646 pregnant and nonpregnant adolescent girls presenting to urban primary care clinics. Guided by the ecodevelopmental model, these results help to identify a risk profile of adolescent girls who report marijuana use. Being pregnant was positively associated with frequency of marijuana use among our teenage sample, consistent with the literature and recent reports,15

Acknowledgments

The authors thank Ms Linping Duan for statistical support. This research was supported by grant DA020075 from the National Institute on Drug Abuse. During her work on this project, Dr Bonar was supported by a career development award from the National Institute on Drug Abuse (036008).

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  • Cited by (1)

    • The association of cannabis use late in pregnancy with engagement and retention in perinatal substance use disorder care for opioid use disorder: A cohort comparison

      2020, Journal of Substance Abuse Treatment
      Citation Excerpt :

      The rate of cannabis consumption late in pregnancy (18%) among our patients with opioid use disorder in PSUD care was lower than previously published for other cohorts (Krans et al., 2018; O'Connor et al., 2017). Our rate was highest among some of the socio-demographic groups previously identified including young adults and older teens (Chabarria et al., 2016; Corsi et al., 2019; Crume et al., 2018; Luke et al., 2019; O'Connor et al., 2017; Stein et al., 2019; Wernette et al., 2018; Young-Wolff et al., 2019). We found women of color and those opting not to report race/ethnicity to have higher rates of use, although the proportion of women in each groups was very small.

    The authors indicate no conflicts of interest.

    This trial is registered at ClinicalTrials.gov: NCT01329315.

    These findings were presented, in part, at the American Psychological Association Convention in Washington, DC, August, 2017.

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