Abstract
Frequent cannabis use among Black adolescents has increased disproportionately during the last decade, but little is known about the norms and mechanisms underlying cannabis use among Black adolescents, as Euro-centric models often disregard race-related factors. To address this gap, qualitative interviews were conducted with Black adolescents ages 14–19 reporting current cannabis use (N = 7; 57% male). Six themes were identified regarding the norms and experiences shaping primary socialization to cannabis use among Black adolescents. Findings highlight the importance of perceived parental permissiveness and environmental availability in shaping cannabis norms and point to potential mechanisms of cannabis-related socialization among Black adolescents.
Current and frequent cannabis use among U.S. adolescents has consistently increased during the past two decades and is now at near-record levels (Terry-McElrath et al., 2020). Historically, Black adolescents demonstrated lower rates of cannabis use compared to their non-Black counterparts (Miech et al., 2020). However, in 2013, rates of current (i.e., past-30-day) cannabis use among Black adolescents significantly exceeded that of their White counterparts, indicating an emerging health disparity in frequent cannabis use (Centers for Disease Control and Prevention [CDC], 2023; Johnson et al., 2015). Cannabis use has continued to climb among this group, with a national survey recording the highest rates of frequent cannabis use among Black adolescents observed in U.S. history in 2018 (Terry-McElrath et al., 2020). Rapid and disproportionate increases in frequent cannabis use among Black adolescents are concerning, given disparities in the health and social consequences of substance use impacting this group (Montgomery et al., 2022). Black adolescents and those who use cannabis frequently are more likely to transition to cannabis use disorder (CUD) relative to their White counterparts and those who use infrequently, respectively (Feingold et al., 2020; Finlay et al., 2012; Leung et al., 2020; Richter et al., 2017; Wu et al., 2014). This intersection suggests increases in frequent cannabis use among Black adolescents may exacerbate existing racial disparities in CUD and related consequences Black Americans currently face (Wu et al., 2014).
Changes in frequent cannabis use among Black adolescents indicate recent sociocultural changes influencing use. Generally, changes in rates of substance use are related to changes in contextual factors such as access to and availability of drugs and changes in social norms regarding the substances (Johnston et al., 2021). Although recent increases in public acceptance of cannabis use may help explain increasing rates of frequent cannabis use among adolescents in general, they are alone insufficient to explain the disproportionate increases among Black adolescents specifically. Models of adolescent substance use accounting for cultural factors (Petraitis et al., 1995) may help explain increases in cannabis use among this population; however, existing models often ignore race-related factors and thus, tend to poorly explain substance use mechanisms and outcomes among Black adolescents (Zapolski et al., 2020). To address this gap, the current study aimed to understand cannabis use norms among Black adolescents who currently use cannabis and the contextual factors shaping these norms and influencing use.
Conceptual Framework
The social-ecological model recognizes the complex nature of health behavior and posits these behaviors are influenced by the bidirectional interactions of five levels of influence: intrapersonal (e.g., attitudes), interpersonal (e.g., family and peer networks), institutional (i.e., formal and informal organization with operational regulations), community (e.g., neighborhoods, work, school), and policy (i.e., local, state, and national policies; McLeroy et al., 1988). Given its ability to capture complex and bidirectional interactions of influence across social-ecological levels, the social-ecological model has been increasingly utilized as the framework for understanding adolescent substance use (Chassin et al., 2009; Ennett et al., 2008). Similarly, given the social-ecological model's consideration of the context surrounding behavior, it allows for the examination of familial and peer socialization's role in shaping cannabis norms.
Regarding Black adolescents specifically, the social-ecological model is an appropriate framework given its flexibility for inclusion of culturally relevant influences. However, like other models or frameworks of adolescent substance use, the social-ecological model has largely been applied to substance use in a Euro-centric way (Chassin et al., 2009). That is, most models assume adolescents from different racial and ethnic groups experience equivalent exposures and vulnerabilities to substance use-related risk despite evidence that Black youth are differentially exposed to risk factors and processes impacting their substance use vulnerability as a function of their racialization in society (Banks & Zapolski, 2018; Wallace & Fisher, 2007; Watt, 2008). Euro-centric models often fail to capture the salient cultural contexts (historical and contemporary) shaping Black adolescent risk, such as racial discrimination, ethnic-racial identity, race-related esteem, and cultural differences in primary socialization agents. Thus, a model sufficient to explain cannabis use among Black adolescents requires the examination of race-related factors involved in cannabis use among this population across social-ecological levels.
Race-Related Social-Ecological Factors Involved in Black Adolescent Substance Use
At the community level, adverse neighborhood contexts such as crime, violence, perceived risk of physical violence, community physical and social disorder, and substance exposure are associated with substance use among adolescents (Fagan et al., 2015). Black adolescents are particularly vulnerable to the effects of neighborhood risks given historical and current segregationist policies disproportionately concentrating Black people in urban communities characterized by these risk factors (Blessett & Littleton, 2017; Heard-Garris et al., 2021). Accordingly, Black adolescents are more likely than their non-Black counterparts to perceive their neighborhoods as threatening (Reboussin et al., 2014). Among Black adolescents, neighborhood risk factors have been linked to higher frequency of substance use, including cannabis use, as well as a faster progression from non-use to frequent substance use (Burlew et al., 2009; Reboussin et al., 2014, 2015; Sigal et al., 2021; Tache et al., 2020).
At the interpersonal level, ethnic-racial socialization and racial discrimination have been linked to substance use. Ethnic-racial socialization refers to the process by which ethnic and racially minoritized youth receive verbal and non-verbal messages about the meaning and importance of race-related phenomena, including their racial identity development and membership and inter-race relations, to promote the successful navigation of diverse social contexts (Priest et al., 2014; Zapolski & Clifton, 2019). Within the broad process of ethnic-racial socialization, the specific process of cultural socialization (i.e., promotion of racial/ethnic pride, teaching about racial/ethnic heritage and history, and practicing of cultural customs and traditions) and preparation for bias (i.e., preparation for racial discrimination) have emerged as a potentially salient protective factors against negative health effects among ethnic/racial minoritized youth (Hughes et al., 2006; Neblett et al., 2010). For example, greater preparation for bias has been indirectly associated with lower lifetime substance use among Black adolescents by way of school-related factors (e.g., classroom climate; Clark & Nguyen, 2012). Additionally, cultural socialization has been indirectly associated with lower lifetime alcohol use among Black adolescents by way of negative alcohol expectancies (Zapolski & Clifton, 2019). Moreover, given the historical and contemporary context of racism and racial discrimination toward Black people in the United States, Black adolescents are particularly susceptible to race-based peer victimization, especially in settings where they are a numerical minority. Black adolescents report higher rates of perceived race-based physical peer victimization, having their property stolen, and being threatened or injured by a weapon compared to students of all other ethnic groups except Native American students (Felix & You, 2011). Accordingly, peer victimization has been associated with current substance use among Black adolescents (e.g., Sullivan et al., 2006; Tharp-Taylor et al., 2009), and both social class discrimination and racial discrimination from various sources have been found to predict cannabis initiation among this group (Ahuja et al., 2022; Jelsma & Varner, 2020).
Finally, at the intrapersonal level, the overt and subtle forms of racism prevalent in the lives of Black U.S. adolescents manifest as perceived racial discrimination (Benner et al., 2018; English et al., 2020; Lee et al., 2019). Among Black adolescents, perceived racial discrimination has been directly and indirectly associated with a range of negative health outcomes, including lifetime, past-year, past-6-month, and current substance use (Fuller-Rowell et al., 2012; Gibbons et al., 2012; Jelsma & Varner, 2020). Findings from a recent study suggested perceived racial discrimination was associated with both cannabis use initiation and transition to first CUD symptom among Black youth (Ahuja et al., 2022), providing some of the first longitudinal support for this pathway among Black youth. Racial and ethnic identity are also culturally relevant intrapersonal factors becoming more salient during adolescent development (e.g., Umaña-Taylor et al., 2014). For example, the development of more positive feelings about one's racial group (i.e., positive affect, positive public regard) has been associated with more positive psychosocial outcomes and the reduction of risk behavior, including substance use and the associated negative consequences (e.g., substance use disorders) among Black youth (Crichlow et al., 2024; Rivas-Drake et al., 2014a, 2014b; Zapolski et al., 2017). Various aspects of positive racial identity have also been linked to a lower frequency of cannabis use among Black adolescents (Arsenault et al., 2018) and emerging adults (Saint-Fleur & Anglin, 2021; Zapolski & Deppermann, 2023), highlighting its potential protective effects among this group. For example, a recent study found higher ethnic identity to be associated with lower 30-day cannabis use among Black highschoolers (Arsenault et al., 2018).
Substance Use Norms and Use
According to social norms theory, people tend to overestimate the frequency (descriptive norms) and acceptability (injunctive norms) of risk behaviors such as substance use, regardless of their own engagement in such behaviors (Berkowitz, 2005; Perkins & Berkowitz, 1986). Individuals who perceive risk behaviors to be normative are more likely to justify and engage in those behaviors, including substance use and other health-related behaviors, than people who do not perceive the behaviors to be normative. Social norms are constructed from group socialization and social observations of target behaviors (Rimal & Lapinski, 2015). These observations and social interactions can serve as a proxy for socially appropriate and socially adaptive behavior in various contexts.
Among adolescents who use cannabis in general, cannabis is often perceived as a safer, less “hard” drug, compared to other drugs, if it is perceived as a drug at all (Friese, 2017). Importantly, cannabis use norms have changed rapidly among U.S. adolescents, with the prevalence of disapproval and perceived risk for cannabis use estimated as being at their lowest in nearly 50 years (Johnston et al., 2021). Substance use norms are well-established predictors of individual substance use among adolescents. Longitudinally, greater perceived frequency and acceptability of peer substance use have been positively associated with individual substance use and substance use-related consequences (Amialchuk et al., 2019; Davis et al., 2019; Eisenberg et al., 2014; Pedersen et al., 2017). Similarly, greater perceived parental acceptance of use has been longitudinally and cross-sectionally associated with early cannabis initiation and greater cannabis use (Korn et al., 2021; Yang et al., 2022); however, peer cannabis norms and behaviors may have a greater impact on use than those of parents (Marziali et al., 2022).
Minimal attention has been given to the norms-use associations among Black adolescents, independent of adolescents from other ethnic and racial groups (Brown, 2024). Although some congruence in cannabis and other substance use norms is expected among American youth, regardless of race, Black adolescents are influenced by differential cultural practices, risk factors, and consequences of use compared to their counterparts, which may impact their substance use norms and behaviors. Within the limited substance use norms-use literature among Black adolescents, findings generally support positive associations between pro-use norms and substance use such that higher pro-use norms are linked to higher rates of substance use (Banks et al., 2020; Burlew et al., 2000). Similarly, lower endorsements of pro-use and perceived pro-use norms of parents and peers are linked with less frequent use among Black adolescents (Conn & Marks, 2014; Epstein et al., 2020; Ford & Rigg, 2015; Lam et al., 2007; Wallace & Fisher, 2007). Importantly, Black youth and their parents and peers tend to have less approving substance use attitudes compared to their White counterparts (Lee et al., 2021; Zapolski & Clifton, 2019), a finding previously used to explain lower rates of some substance use among Black youth (e.g., alcohol; Zapolski et al., 2014). However, scholars have shown that the association between various substance use norms and substance use behavior is weaker among Black youth versus White youth (Banks et al., 2020; Banks & Zapolski, 2017; Conn & Marks, 2014), highlighting key cultural differences in the impact of substance use norms and pointing to other important factors influencing substance use behavior among Black youth.
Current Study
Although researchers have increasingly used the social-ecological model to document mechanisms of substance use among Black adolescents, little of this research has illuminated race-related determinants of cannabis use among this group. The disproportionate increase in rates of frequent cannabis use and its consequences (including CUD) among Black adolescents highlights the need to clarify culturally relevant mechanisms of use among this group. The current study aimed to address this gap in the literature using a grounded theory approach toward a culturally centered model of Black adolescent cannabis use that (a) identifies cannabis use norms among Black adolescents who currently use cannabis; (b) identifies the unique and interactive culturally relevant contextual and ecological factors shaping cannabis use norms and influencing cannabis use among this population.
Methods
Participants
Participants were drawn from a mixed-method study examining substance use among Black and White adolescents (Banks, 2020). Participants (N = 35; n = 15 Black) were recruited from a large Midwestern metropolitan area in 2019. Cannabis use was illegal in this area at the time. Inclusion criteria for the initial quantitative portion of the study included: aged 14–18 years, White or non-Hispanic Black/African American race (i.e., adolescents who identify their race as Black or African American and who do not identify as having ethnic origins in Central American, Latin American, or Spanish-speaking countries), enrolled in high school, exclusive access to a phone with text and data capabilities, and reported past 30-day use of at least one of alcohol, cannabis, and/or tobacco. The first part of the mixed-method study was the quantitative portion in which all 35 Black and White adolescents participated. The second, qualitative portion of the study aimed to examine psychosocial mechanisms of cannabis use, including co-use of cannabis and other substances, among Black adolescents specifically. Thus, additional inclusion criteria for qualitative interviews included Black or African American race and reported use of cannabis in the past two weeks. Black participants for qualitative procedures were drawn from a subset of the quantitative participants. As all Black adolescents in the quantitative portion used cannabis, all 15 were invited to participate. However, of the 15 eligible Black participants, only 7 (57.1% male; Mage=16.43, S = 1.60) opted to participate in the qualitative interviews, thus the small final sample size. The transcripts of these seven participants were used for the current study.
Procedures
Participants were recruited from flyers posted in the community, social media ads, and via community-based, adolescent-serving organizations. Informed consent for participants 18 and older and parental informed consent plus child assent for participants under the age of 18 was required prior to participation. After participating in a phone-based daily diary study, Black participants who indicated interest in participating in a follow-up interview during informed consent procedures were invited to participate in qualitative interviews. Interviews were conducted in person between November 2018 and March 2019 by the study's principal investigator [initials] and research assistants trained in qualitative interviewing. Participants were compensated $40 for completion of the interviews. Interviews were audio recorded and transcribed by a professional transcription service.
Measures and Analyses
Qualitative interviews followed an interview guide consisting of open-ended questions eliciting cultural norms and attitudes regarding substance use and the social and community context surrounding adolescent cannabis use. The following topics were covered during the interviews and were included in the analyses: substance use norms (e.g., “why do you think most kids your age use cannabis?”), substance use context (e.g., “tell me about a typical day when you use cannabis”), ease of access (e.g., “can you talk about how easy it is for you to get cannabis?”), peer substance use (e.g., “what does your friends’ substance use look like?”), substance use coping and motivation (e.g., “what do you like about using cannabis?”), and other cultural factors (e.g., “what do you think are the differences between the way Black and White kids your age use drugs and alcohol?”).
Qualitative analyses were guided by modified grounded theory methodology, in which analyses are conducted once data collection has ended. Grounded theory methodology allows codes and patterns to emerge from the data itself, rather than from theory or past literature. Analyses began with each independent researcher reading all transcripts separately to get familiar with the data and to get a high-level overview of the data and important context, documenting these in personal notes to guide subsequent steps. The next step was open coding (Vollstedt & Rezat, 2019), an iterative process of coding, reliability assessment (during which time any lack of consensus between the coders was reviewed by a third independent researcher), codebook modification, and recoding were used during this stage (Hruschka et al., 2004). During this step, the first three transcripts (each coder had their own copies) were reviewed line by line by each coder independently until core ideas were identified and assigned an initial code. Then, through a series of meetings consisting of collaborative discussions between the independent coders, the initial codes and code descriptions were refined based on agreement between the coders and used to create a codebook with all codes and descriptions (n = 31). The two coders then coded all seven of the transcripts independently, according to the codebook. Recurring meetings were held between the two coders to discuss their codes for each transcript, updating the codebook codes and code descriptions as needed to improve the clarity and distinction of the codes. When there was a lack of consensus on specific coded text, the coders relied on the input of an outside third reviewer (KC), who was invited to the meetings to resolve any discrepancies until all three individuals agreed, reaching consensus. During these recurring, collaborative meetings, the codes and descriptions were further revised as needed. After all the transcripts were open-coded, axial coding was applied (Vollstedt & Rezat, 2019). Guided by Strauss & Corbin (1990)'s framework, axial coding involved identifying the relationship between the individual open codes by mapping them onto conceptual categories, referred to as axes, for which a core phenomenon was identified, according to the following paradigm: (a) causal conditions, (b) context, (c), consequences, (d) intervening conditions, and (e) strategies. The two coders met repeatedly to revise the paradigm map, modify the codebook as needed, and recode accordingly, with the final version of the paradigm including 23 codes. Through this iterative coding process, reinforced by frequency analyses identifying the most frequently emerging codes across all transcripts, a core phenomenon, normative perceptions of cannabis use, was identified. The final step was selective coding, whereby the core phenomenon became the central category, and the relationships between the axes were systematically and logically organized until additional coding no longer led to new insights. The relationships between the axes were mapped visually and used to develop the theoretical, explanatory model, where the axes were used to explain why and how the core phenomenon occurred.
With regard to reflexivity, the study was designed and analyzed by the first author (KB), a Black woman and clinical psychology doctoral student whose research focuses primarily on substance use among Black people, with analysis help from the second author (KC), another Black woman doctoral student with similar interests. Data was collected by the senior author (DB), a Black woman and licensed clinical psychologist specializing in race-related determinants of substance use development with expertise in qualitative research. Supervision and consultation regarding design, analysis, and interpretation were provided by the senior author as well as the third author (RW), a White woman and licensed clinical psychologist whose expertise includes identifying and reducing barriers to evidence-based treatments for substance use disorders.
Results
Six themes regarding the drivers of cannabis use were identified: (a) normative perceptions of cannabis use, (b) primary socialization to cannabis use, (c) ease of access to cannabis, (d) positive motives and helping effects, (e) protective behavioral strategies for social and legal consequences, and (f) protective behavioral strategies for health. The following sections summarize the themes and exemplify them with direct quotes from participants.
Normative Perceptions of Cannabis Use
Overall, participants believed cannabis use was extremely normative. Overwhelmingly, participants perceived cannabis to be safer, healthier, and more acceptable compared to other substances. Participants described the effects of cannabis as “not that bad” compared to tobacco and “harder drugs” such as cocaine, heroin, psychostimulants like methamphetamine, and ecstasy, which some of them attributed to cannabis being “natural” and “coming from the earth.” One participant stated, “[Marijuana] doesn’t really have as many [negative] effects [as other substances] and you’re not really psychologically dependent on marijuana.” Participants also discussed the perceived absence of physical and psychological consequences from cannabis use, which they instead associated with other substance use, such as missing or damaged teeth, and perceived uncontrolled addictive behaviors such as “running up and down the street naked.” They also perceived cannabis to have a lower addiction potential than other drugs, with one participant noting, “Opioids and stuff like that, it's very easy to overdose over that. You hear a lot of people overdose on that. You never hear somebody overdose on weed.”
Cannabis use was also perceived to be more normative than other drugs among the Black community specifically. Participants associated many of the perceived “hard drugs” mentioned previously with White people, while they associated cannabis use with Black people, including influential Black people such as rappers and athletes. For example, one participant stated, “Black kids, they might use marijuana here and there. But White kids, they do kind of everything, what I've seen.” Another participant even measured one's degree of Blackness with cannabis use, stating: A Black person that act Black, like ratchet, the Black Black people, they really probably smoke [cannabis] or they really don’t care [about cannabis use]. They going to keep smoking it … Black persons that act White … they probably think it's bad so they don’t want to do it or they tell other people not to do it.
Primary Socialization to Cannabis Use
Black adolescents described how primary socialization agents (predominantly parents and peers but also older relatives, siblings, and the parents of their peers) strongly influenced their initiation and maintenance of cannabis use. Regarding peers, nearly all participants reported they had close friends or romantic partners who also used cannabis and described their cannabis use as similar to that of their peers in terms of frequency and quantity. Some participants discussed how their own cannabis use started in the company of or due to the influence of peers. Although participants did report using cannabis alone, the behavior was largely discussed in the context of using with friends, with several participants describing smoking primarily or exclusively with their peers. For example, when asked how they would respond if their friends stopped smoking cannabis, one participant reported, “I would stop too because I want to do it with them.”
Many participants also reported past or current cannabis use by their parents, with several attributing their initiation of cannabis use to their parents. For example, one participant noted the “only reason” they initiated cannabis use was because they observed their parents using it, while another reported their first time using was with their mother. Mirroring discussions of peer cannabis use, participants discussed how smoking with their parents drove their cannabis use behavior, with one participant stating, “I just [recently] stopped smoking every day because my mama stopped smoking.” Regardless of whether their parents currently, previously, or never used cannabis, participants largely reported parental awareness of their cannabis use and described a spectrum of perceived parental tolerance. At one end of the spectrum, perceived tolerance included knowledge about parents not approving cannabis use and likely to be “disappointed” without punishing participants or trying to prevent them from using. At the other end, parental tolerance included explicit permissiveness. For example, one participant described how he smoked exclusively with his mother's permission: We talk about [smoking weed]…. I tell her it helps me calm down … it doesn’t do the same thing to me that it does to other people…. I'll tell her: “Okay, so can I smoke today?” And she asks me why, and I'll tell her my reason why, and she tell me yes or no. And we go from there.
Participants who reported parental cannabis use also tended to describe more explicit parental permissiveness. For example, one participant who reported his father used stated his father initially disapproved of his cannabis use and even kicked him out of the home as punishment, but eventually became tolerant of the participant's cannabis use when the participant reached his mid-teens.
Ease of Access to Cannabis
Black adolescents also described how the ease of access to cannabis impacts their maintenance of cannabis use. Some participants discussed how acquiring or smoking cannabis came with inconveniences related to costs, access to wrappers, and communication with people from whom they acquire cannabis. However, despite these inconveniences, cannabis was most commonly discussed as being available and accessible. Participants reported avoiding financial inconveniences by acquiring cannabis from family and friends, such as older cousins, older siblings, and the siblings and parents of friends who also smoke cannabis. Some participants reported acquiring cannabis only from this trusted social group. For example, one participant reported, “I only get it from [my friend's mom] or somebody she knows or I don’t get it at all.”
Even in cases where participants did not get access to cannabis from trusted family members and friends, most of them mentioned knowing where, how, and from whom to get cannabis whenever they wanted in their neighborhoods due to close proximity to the drug trade. Some participants were in closer proximity to the drug trade than others, living with parents and siblings who sold cannabis. Others knew “people at school” and spouses of friends who sold cannabis and other drugs. The process of acquiring cannabis was frequently described as calling or texting several known contacts who sold cannabis and having cannabis delivered. For example, one participant reported, “I know people around my neighborhood [who sell cannabis]. So, I could tell somebody to pull up on me and give me things…. If I want it, I know exactly who to go to.”
Positive Motives and Helping Effects
Adolescents described how positive cannabis motives and perceived helping effects of cannabis maintained their use. Participants discussed smoking cannabis as a fun pastime, with one participant reporting, “I only [smoke cannabis] for fun or when I’m bored.” They also discussed cannabis use as something facilitating a good time, often in the context of smoking with their friends while doing an activity (e.g., playing games). Thus, social facilitation was discussed in a variety of ways from conformity (i.e., to “fit in” or “be cool”), to conversation and bonding (i.e., “getting to know people”). For example, one participant described how cannabis use facilitated meeting new people: It's cool if you both smoke because you could just chill and talk…. I think that [smoking cannabis is] a good way to talk to people, conversation while people are sitting and talking and laughing and stuff instead of if we go to the movies, we’re not really going to be talking and stuff like that.
Participants also perceived several positive effects of cannabis on their mood and cognition, ranging from relaxation to focus, with one stating: “[cannabis] makes me feel good. It don’t give bad effects, literally. You’re either chill or hyped.” Most commonly, participants perceived cannabis to be calming or to “ease your mind” and result in euphoric bodily sensations. Accordingly, participants perceived cannabis use to be very effective for coping with negative affect, whether related to racial or everyday stressors. For example, one participant stated, “Black people, they stressed … if you’re stressing, [cannabis] helps you calm down.” Other participants reported cannabis use to help mitigate symptoms of mental health disorders they had been diagnosed with, including ADHD, bipolar disorder, and depression, and described the effects of cannabis as medicinal. Similarly, participants discussed how cannabis helped them cope with negative life problems more broadly, such as the death of loved ones and friends, or with interpersonal problems: People think it be like a stress reliever sometimes, but I don’t think it's a stress reliever, I just think it takes my mind away from the moment. And I still may think about it even, I may think about it even more, but it's just, I don’t know. It just gives me a different feeling than what I'm feeling at this moment.
In addition to helping mitigate stress or sadness, participants also found cannabis helped them with self-regulation, mitigating their anger and making them more laid-back and mild-tempered. Another perceived helping effect of cannabis was making participants more motivated and focused, whether the task at hand was schoolwork or a video game. Participants also found it to help with problem-solving, processing, and creativity: Because when I smoke by myself, I usually just smoke and I lay down, turn all the lights out, the TV, everything, and I’ll just sit, staring, and thinking about stuff … ‘cause I get a hundred thoughts all at once, and it slows it down a little bit. It help me process it. And I can think about it clearly. And it makes more sense.
Relatedly, some participants discussed increased behavioral activation after smoking cannabis “I usually get motivated when I smoke [cannabis]. I don’t really get lazy and hungry and stuff. I get motivated to do more things…. I feel like I accomplish something and it feels great. It's good.”
Finally, participants discuss how cannabis use facilitates physiological needs, namely sleeping and eating. Some of the participants described smoking cannabis before bed or eating as if it were simply part of their daily routine, while a few of the participants explicitly noted challenges with appetite and/or sleep for which they used cannabis.
Protective Behavioral Strategies for Social and Legal Consequences
Participants perceived being able to avoid the social consequences of cannabis use they expected from parents and other social agents. In particular, this perception arose from successful strategies to conceal their cannabis use. Strategies included having a safe place to smoke (e.g., at a friend's house, in the woods, in their personal room or car), smoking when their parents were at work, and smoking around close family members who wouldn’t tell their parents to reduce the chances of getting caught or punished. One participant noted they would “spray myself, spray wherever area I’m smoking in” to mask the smell of cannabis from their parents. Participants also discussed the importance of being mindful of when they smoked, including refraining from smoking before important events or in settings in which they “want to impress somebody,” such as school or an interview. For example, one participant noted, “It smells, too, so I don’t like to go to work right after. Have to be smart about that.” Participants also reported concern and awareness of legal consequences related to cannabis use. However, they largely reported avoiding or evading those consequences with relative ease, with one participant stating, “I try to [smoke cannabis] in a smart way … so [law enforcement] can’t catch me with it or whatever.” Some of the practices the participants described to help avoid getting caught by the authorities included using in areas not heavily policed or where they perceived protection from police intervention, using out of sight of cameras, using in discreet places not so secluded that their presence would raise suspicion, and not smoking alone where they would stand out. Participants reported having encountered law enforcement but avoiding legal consequences: “I’ll get pulled over with it, but it hasn’t caused me any trouble.” Some participants described evading legal consequences by hiding their cannabis in their cars, where they believed law enforcement wouldn’t think to check (e.g., “inside gasoline bottles” and “inside shoes”) while others described a lack of legal consequences even when caught with cannabis, highlighting the consensus of potential legal consequences not posing a significant barrier to cannabis use.
Protective Behavioral Strategies for Health
Participants engaged in protective behavioral strategies shaped by their awareness of and concern for the addiction potential of cannabis. Some participants expressed concern about the potential for dependence and addiction based on their family histories of substance use behavior, while others were concerned with avoiding some of the behaviors they observed among people who use drugs, demonstrating stigma toward people with substance use disorder. For example, one participant described reducing their substance use after watching videos of people in active addiction and realizing they didn’t want to be “like addicts.”
Accordingly, participants discussed behaviors they engaged in to avoid or reduce potential health consequences of cannabis use—primarily cutting down or temporarily quitting. Adolescents attempted to self-manage their cannabis use in response to symptoms they perceived to represent addiction potential or to not be normative such as hallucinations and paranoia they experienced while under the influence of cannabis. Other health-related protective behavioral strategies included avoiding driving after using and not using cannabis with psychotropic medication to prevent counterbalancing.
Finally, participants discussed a range of protective strategies for avoiding contaminated cannabis, noting the importance of knowing the contents of their cannabis and “watching what people give you … because some people lace their [cannabis].” These strategies included having parents or other adults inspect and test the cannabis before smoking it themselves, buying cannabis from the same trusted individuals, and avoiding smoking cannabis from unknown sources. One participant noted, “I only smoke when I buy, ‘cause I don’t know what other people have, so I smoke and brung my own.”
Theoretical Model
The data suggest the central phenomenon driving cannabis use among Black adolescents is normative perceptions of cannabis use. Black adolescents who used cannabis believed it was highly normative among their peers, safer compared to “hard” drugs, and culturally acceptable and even expected of them as members of the Black community. Cannabis norms were largely shaped by primary socialization agents (i.e., parents, relatives, and peers) toward cannabis use and the relative ease of access to cannabis. Black adolescents were aware of and exposed to cannabis use, often at a young age, by their parents, relatives, and peers. Cannabis use was tolerated if not promoted by parents, sending adolescents the message that cannabis use was acceptable or at least “not that bad.” Cannabis was also easily accessible due to parents and other relatives’ cannabis use or involvement in the drug trade, peer use, and availability in other social institutions, including one's neighborhood and school. Trusted socialization agents from whom adolescents could acquire cannabis without cost further increased access to cannabis, and reinforced normative perceptions.
Through cannabis socialization and norms, often shaped by observations of key socialization agents (i.e., family, peers, and celebrity role models), Black adolescents perceived helping effects of cannabis use. They directly and indirectly received messages, despite its potential risks, about cannabis use being helpful overall, even medicinal. These perceptions were reinforced by their own experiences of cannabis use being a fun pastime, facilitating socialization among their close social groups, and alleviating negative psychological and physiological symptoms.
Despite their continued use and perceived acceptability of cannabis, Black adolescents were aware of societal stigma toward cannabis use, possibly leading to social and legal consequences, and acknowledged potential health and addiction-related consequences of substance use. Even participants who reported high parental tolerance of cannabis use described strategies they employed to mitigate potential consequences. Participants found these mitigation strategies largely successful, and when they were not successful, participants learned to better avoid consequences. Similarly, participants found that potential health concerns about cannabis use could be mitigated through a range of protective behavioral strategies. Their perceived success with these strategies, despite the context of cannabis stigma and criminalization, reinforced their normative perceptions and facilitated the maintenance of their cannabis use.
Discussion
The current qualitative model of adolescent cannabis use aligns well with the social-ecological model, as the drivers of Black adolescent cannabis use can be understood through the interactions of the following levels: intrapersonal (e.g., cannabis norms, affect-related motives, positive expectancies, and protective behavioral strategies), interpersonal (e.g., socialization to cannabis use by primary socialization agents), and institutional/community (e.g., the evasion of social and legal consequences, neighborhood and school availability of cannabis, and proximity to the drug trade). Thus, this model reflects general social-ecological models of substance use, which have not accounted for race-related factors (Chassin et al., 2009) while highlighting those factors Black adolescents find most salient. Previous research has demonstrated the interactive impact of neighborhood factors, peer networks, and parent-child relations on substance use involvement, highlighting that peer substance use and delinquency are stronger predictors of substance use relative to other social-ecological factors (Cambron et al., 2018; Mason et al., 2016; Zimmerman & Farrell, 2017). However, none of these studies included parental permissiveness of substance use, which Black adolescents in the current study described as a key driver of cannabis use, eclipsing the impact of peers and neighborhood availability, because it was associated with cannabis availability in the home and family network. The current results support those of a recent qualitative study among Black youth with parents who use opioids, which found parent-child cannabis use was common and viewed as a relatively safe way to use and a way to bond with their parents (Powell et al., 2023). Taken together, these findings suggest Black parents’ cannabis use behaviors and tolerance for use are key in the development and reinforcement of cannabis norms and use among Black adolescents.
Despite its overlap with general social-ecological models, the current model does illuminate culturally relevant (i.e., race-related) mechanisms contributing to injunctive and descriptive cannabis norms, and in turn, cannabis use, among Black adolescents. Aligned with previous research among Black youth who use cannabis, youth in the current study believed most people their age used cannabis (Matson et al., 2023). This was related to their perception of cannabis being easily available in their neighborhood and schools, with youth often reporting personal contacts from whom they could get cannabis for free. Findings from previous studies among Black adolescents suggest greater perceived neighborhood violence, neighborhood drug activity (i.e., proximity to neighborhood drug use and trade), and threats to safety are associated with the initiation of cannabis use, greater cannabis use among adolescents who use cannabis (Lambert et al., 2004; Reboussin et al., 2014), and a more rapid progression from infrequent to frequent and problematic use (Reboussin et al., 2015). An important consideration in light of these associations is that predominantly Black urban neighborhoods and White urban neighborhoods often have similar neighborhood drug activity, but Black adolescents decline in cannabis use at slower rates than their White counterparts and are more likely to experience more detrimental consequences of use than White adolescents (Warner, 2016). Thus, rather than neighborhood conditions conferring differential access to cannabis use by race, they may confer differential risk for consequences as a function of race-related environmental stressors disproportionately prominent in Black neighborhoods (Amaro et al., 2021).
Black adolescents learned not only from their own communities but also from the media that cannabis use was associated with Blackness. Aligned with the social identity theory and concepts of ethnic/racial socialization, cannabis use among Black adolescents may contribute to the development of, membership in, and maintenance of belongingness toward their Black identities and communities (Tajfel, 1978). Given that ethnic/racial socialization is often associated with a reduction of substance use (e.g., Grindal & Nieri, 2016; Su et al., 2020), it being descriptively associated with cannabis use was unexpected. Conversely, the current study suggests intergenerational cannabis use and its perceived social facilitation among Black adolescents and their families represent a previously unexplored pathway for cultural and drug-related socialization among this group. Aligned with a recent study finding that some Black adolescents perceive cannabis use as a safe and effective bonding activity to engage in with their parents and family members (Powell et al., 2023), Black adolescents may also perceive cannabis use as a Black cultural custom, posing risk for a greater persistence of use across the lifespan.
The findings of the current study suggest specific targets for the prevention of Black adolescent cannabis use. Specifically, Black children and adolescents whose parents use or are otherwise permissive of cannabis use, who have close proximity to the drug trade, who live in communities with high drug accessibility, and who have strong positive cannabis expectancies may be at greater risk not only for early cannabis initiation but also maintenance, which can contribute to negative health and social consequences over the lifespan. In particular, the impact of primary socialization agents and their maintenance of positive cannabis norms among Black adolescents suggests interventions will benefit from being multilevel, incorporating parents and/or peers, and focusing on reducing cannabis use exposure and correcting norms. Such interventions could provide accurate psychoeducation not only to adolescents, but also to their parents, about the negative psychological, physical, and social consequences of cannabis use during adolescence, with specific attention to disproportionate consequences affecting Black adolescents. For example, social norms marketing (Su et al., 2018) targets normative perceptions of cannabis use by providing education on early cannabis use, including accurate comparisons to other substances (namely, regarding quantity and frequency of use). Social norms marketing has demonstrated success with correcting overestimated alcohol use norms and decreasing subsequent use among young adults (Su et al., 2018), suggesting this approach may generalize to youth who use cannabis. Approaches targeting norms may be supplemented by harm reduction education, intended to increase safety and reduce harm to youth who use substances in ways aligned with their lifestyles and development (Jenkins et al., 2017). For example, a school-based harm reduction drug educational program aiming to increase youth's knowledge of substances and harm reduction strategies was found to reduce substance use post-intervention, despite it not being a targeted outcome (Fischer, 2022). Given increasing injunctive norms (i.e., decreasing rate of cannabis disapproval) and the current findings suggesting cultural socialization towards cannabis use from Black parents to Black youth, harm reduction approaches may be particularly relevant among this group.
The current study must be interpreted with consideration of its limitations. Limitations include the purposive sampling of participants who were selected based on their endorsement of recent substance use. Although this approach was appropriate for the current study given its purpose, the exclusion of Black adolescents who are likely exposed to many of the same risk factors and cultural context as those included in the current study but who reported no recent cannabis use prevented us from understanding the role of protective factors in the current model. Additionally, qualitative data were derived from an extremely homogenous sample (i.e., all participants were Black adolescents, from the same geographic area, in the same age range, who all used cannabis), requiring a smaller sample size to achieve saturation compared to a more heterogeneous sample (Hennink & Kaiser, 2022). Although the current findings may translate to other models of substance use or to non-Black adolescents who use cannabis, the transferability of our findings must be considered in this context. Another limitation of the study is data on the participants’ neighborhood contexts were not collected. Therefore, in-depth inferences and implications about the participants’ neighborhood contexts (e.g., whether they lived in Black neighborhoods, neighborhood exposure to and availability of cannabis and other drugs) were not possible. This is meaningful given that certain neighborhood factors, such as drug exposure and availability, perceived safety, and perceived cohesiveness, have been associated with substance use risks and outcomes among adolescents (Blessett & Littleton, 2017; Fagan et al., 2015; Heard-Garris et al., 2021; Reboussin et al., 2014). Finally, interviews were conducted in 2019 in a region where cannabis use was criminalized at the time. This context limits the interpretation and generalizability of the results, particularly those themes related to cannabis norms and protective behavioral strategies, both of which could plausibly change at the intrapersonal level in response to continuing changes to cannabis policy, which are more permissive of use.
Although some of the findings in the current study reflect what has long been demonstrated in the literature (e.g., parents and peers being primary socialization agents among youth, perceived availability of cannabis driving use), the unique contributions of the findings are found within the nuances of these themes, contributing to the overall strength of the study and cultural significance of the findings. First, not only were the participants exposed to substances and had access to cannabis (e.g., in their homes, in their communities, and through their peers), but many adolescents also endorsed initiating and using cannabis with their parents and older relatives. Parents or older relatives and underaged children recreationally using cannabis together is not represented in the adolescent substance research, highlighting the important and novel contribution of our findings. Another strength and novel finding of our study is the discussion on cannabis socialization among agents other than parents and peers. Existing adolescent substance use research almost exclusively examines parents and peers as socialization agents, most commonly through the associations between the perceived (dis)approval of peer and parental substance use or actual peer and parental substance use behaviors on adolescent substance use behaviors. However, cannabis socialization agents in the current study included cousins, other relatives, romantic partners, and the parents of their peers as agents who were providing access to cannabis and with whom they were using cannabis. Conversely, most of the available adolescent substance use research focuses on the descriptive and injunctive norms of parents and peers while excluding other socialization agents. This finding is key given the differential structure and dynamics within the Black family system compared to their White counterparts, and the role of siblings, extended family, and fictive kinship socialization agents on Black youth risk behaviors. Finally, the finding about cannabis use not only being normalized among Black youth, but being perceived as an expectation for their membership in the Black community, is also novel in the literature.
In sum, the current findings suggest beliefs about cannabis's safety, commonness, and acceptability are key drivers of cannabis use among Black adolescents. These beliefs are shaped by parental permissiveness and perceived availability of cannabis. Mechanisms identified in the current model can inform culturally responsive interventions for Black adolescent substance use, which are currently sparse relative to those targeting other racial/ethnic groups (Banks et al., 2023). Specifically, identifying ways to correct cannabis use normative perceptions and mitigate primary socialization and parental permissiveness of cannabis use may be key targets for intervention. Moreover, providing concurrent, unbiased education of the positive and negative consequences of cannabis use, as well as how to optimize the former while minimizing the latter, may offer Black adolescents the tools they need to make informed decisions regarding cannabis use. Together, these approaches may promote abstinence, delayed initiation, or safer cannabis use among this population.
Footnotes
Ethical Considerations
The current study was a secondary, retrospective study not requiring IRB approval from the University of Missouri – St. Louis. The original study was approved by the Institutional Review Board (IRB) at Indiana University (no. 1710513714A005) on November 29, 2018. Informed consent for participants 18 and older and parental informed consent plus child assent for participants under the age of 18 was required prior to participation in the study.
Consent to Participate
Not applicable.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute of Health (NIH)/National Institute on Drug Abuse (NIDA) under Grant F31DA044728.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.