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. Author manuscript; available in PMC: 2026 Mar 10.
Published in final edited form as: J Stud Alcohol Drugs. 2025 May 26;87(1):154–163. doi: 10.15288/jsad.25-00026

Patterns of Cannabis Use and Perceived Accessibility Among Underage U.S. Young Adults: Implications for Policy and Prevention

Yvonne M Terry-McElrath a,*, Yuk C Pang a, Megan E Patrick a
PMCID: PMC12969664  NIHMSID: NIHMS2136978  PMID: 40420430

Abstract

Objective:

Using a national U.S. underage young adult sample, we examined prevalence of smoking, vaping, eating, drinking, and dabbing cannabis; perceived accessibility by product type; and perceived accessibility correlates (adolescent cannabis use, state cannabis policy context, sociodemographic characteristics).

Method:

Data were obtained from young adults under age 21 participating in the U.S. national Monitoring the Future Panel study from 2019–2023. Cannabis use prevalence by smoking, vaping, edibles, drinking, and dabbing was measured (n=3,075; 52.9% female). Perceived accessibility was measured for smoking, vaping, and edibles (n=1,227; 52.1% female). Covariate and accessibility associations were modeled using logistic regression.

Results:

Multiple cannabis use modalities were reported by 23.3% of all respondents and 63.5% of those reporting past-12-month use. Among all respondents, smoking (30.7%), vaping (19.7%) and edibles (18.2%) were the most prevalent; fewer reported dabbing (10.4%) or drinking (2.8%). Perceiving easy access to smoking, vaping, and edibles was reported by 95.0%, 91.3%, and 86.7% of those reporting past-12-month use (77.5%, 71.2%, and 71.8% of those reporting no use). Among those reporting no 12-month use, state recreational use policy was associated with perceiving easier access for smoking and edibles; full-time 4-year college attendance was associated with easier perceived access across modalities (vs. part-time/2-year college or not attending).

Conclusions:

Underage U.S. young adults are not legally able to purchase cannabis but reported easy access across products; those who used cannabis typically used multiple products. Among those reporting no past-12-month use, state policy and college attendance were strongly associated with perceived accessibility across products.

Introduction

Cannabis is one of the most widely-used substances among young adults (ages 19–30), and prevalence is rising (Hasin et al., 2019; Hasin & Walsh, 2021; Patrick et al., 2024). Monitoring the Future (MTF) data indicated substantial increases in young adult use from 2011 to 2023: 12-month use rose from 29.5% to 42.4%; daily use (20+ occasions in the past 30 days) from 5.9% to 10.4% (Patrick et al., 2024). Cannabis use during young adulthood is associated with serious consequences, including physical changes in brain development, psychological problems, lowered cognition, and increased car crash risk (Smith et al., 2022; Solmi et al., 2023; Volkow et al., 2016).

While smoking remains the primary form of adolescent and young adult cannabis use (Romm et al., 2021; Steigerwald et al., 2018; Tormohlen et al., 2019), other modes are becoming more common such vaping, edibles, cannabis-infused beverages, and dabbing (using highly concentrated forms of cannabis) (Corliss, 2024; Friese et al., 2016; Patrick et al., 2020, 2024; Scanlon, 2023). From 2017 to 2023, past-12-month cannabis vaping among U.S. young adults increased from 11.5% to 22.2% (Patrick et al., 2024). Among those ages 18–34 in 2017, an estimated 10.0% reported past-12-month edible use, 4.0% reported past-12-month dabbing/concentrate use, and 11.4% reported using multiple cannabis products (Steigerwald et al., 2018). More recent national product-specific prevalence estimates are needed. Specific use modes have unique risks, such as carcinogens in smoked marijuana (Lorenz et al., 2021), lung injury associated with vaping (Centers for Disease Control and Prevention, 2020; Harrell et al., 2022), and unintended poisoning with edibles (National Academies of Sciences, Engineering, and Medicine, 2017). A deeper understanding of product-specific cannabis use among young adults is important for public health perspective.

Perceived accessibility is a consistent young adult cannabis use risk factor (Levy et al., 2021; Martins et al., 2016). However, most cannabis-focused perceived accessibility studies have not differentiated product-specific access and have focused on adolescents (e.g., Harpin et al., 2018; King et al., 2012; Korn et al., 2021; Lee et al., 2021; Salas-Wright et al., 2017; Schleimer et al., 2019; Turel, 2020). Studies including young adults have not addressed product-specific accessibility (e.g., Azofeifa et al., 2016; Schulenberg et al., 2021) and typically have examined wide age ranges. Understanding underage young adult (ages 19–20) behavior is particularly important; individuals in this key subgroup often are characterized by having the highest daily cannabis prevalence or being part of steeply increasing prevalence trajectories (Patrick et al., 2024; Terry-McElrath et al., 2018). Further, individuals ages 19–20 are under the legal age for obtaining cannabis in states with legal medical and/or recreational sales. Prevention and intervention strategies addressing cannabis use behaviors among the high-risk young adult subgroup could potentially be enhanced by understanding how past and current use, policy environment, and sociodemographic characteristics are associated with product-specific perceived accessibility.

Past and current use

Research has long recognized past cannabis use as a strong predictor of current use although “past” and “current” definitions vary (Derzon & Lipsey, 1999; Little et al., 2013; Patrick et al., 2016). It is logical to hypothesize that young adults with prior cannabis use experience would be more likely than those without such experience to know how to currently access cannabis. Because young adults who have used cannabis within the past 12 months almost certainly know how to access it, perceiving easy access may be most relevant to use likelihood among those without past-12-month use. Research examining perceived access among young adults may be most informative when focusing on young adults who report no past-12-month use and controlling for 12th grade use. Doing so would help clarify the degree to which observed policy and sociodemographic characteristics are associated with perceived availability above and beyond prior use.

State policy

State cannabis policies vary significantly and are complex (Blanchette et al., 2022; Pacula et al., 2022; Pacula & Smart, 2017). However, analyses using national U.S. data from 2004–2013 found perceived accessibility increased following medical cannabis law enactment among individuals aged 26 and older while no significant change was observed in younger age groups (Martins et al., 2016). International data from 2017–2021 showed youth aged 16–19 were more likely to perceive cannabis as easily accessible in policy environments with legal medical use, or legal medical and recreational use (vs. no legal use; Reid et al., 2023). The degree to which recent data may show policy-related differences in product-specific perceived accessibility among underage young adults reporting no past-12-month cannabis use has not been examined.

Sociodemographics

Adolescent males tend to report higher perceived cannabis accessibility than females (King et al., 2012; Lee et al., 2021; Turel, 2020). Research also has identified racial and ethnic differences in perceived accessibility among adolescents (King et al., 2012; Lee et al., 2021), with higher accessibility perceived by those identifying as (a) multiracial versus White, and (b) White versus Black or Asian (Lee et al., 2021). Among those aged 18–22, full-time college students have been more likely than others to perceive easy overall accessibility (79.9% vs. 73.1%; Lipari & Jean-Francois, 2016). Sex, race and ethnicity, and college attendance differences in perceived access to specific types of cannabis products have not yet been examined among young adults.

Current study

This study used data collected during 2019–2023 from a national sample of underage young adults to examine three research questions (RQs):

  1. What was the prevalence of using cannabis by smoking, vaping, edibles, beverages, dabbing, and multiple product types among young adults?

  2. What was the perceived accessibility of the three primary cannabis product types—smoking, vaping, and edibles—among young adults who did and did not use cannabis in the past 12 months?

  3. Among young adults who did not use cannabis in the past 12-months, did product-specific perceived accessibility vary by 12th grade cannabis use, state policy context (no legal use, medical use only, recreational use), sociodemographic characteristics (sex, race and ethnicity, college attendance), or year of data collection?

Method

Sample

Data were obtained from the Monitoring the Future (MTF) Panel study (Patrick et al., 2024). Approximately 2,450 respondents are selected yearly for longitudinal follow-up from the prior year’s MTF nationally representative U.S. 12th-grade student sample (Miech et al., 2023). Follow-up participation is randomized to begin one or two years after high school (i.e., modal ages 19 or 20; Patrick et al., 2024). Consent procedures were followed; the study’s protocols were approved by a University of Michigan institutional review board. As cannabis product-specific accessibility was not measured at 12th grade, data for the current study were drawn from surveys completed at modal ages 19 and 20 during 2019–2023 (involving the 2017–2022 12th-grade cohorts; Supplement Table 1). The average response rate for these ages and years was 36.9% (range 26.4% to 44.0%; Patrick et al., 2024).1

Product-specific use was asked on a random 2/3 of surveys from 2019–2020, and all surveys from 2021 onward (see Supplement Table 2 and Supplement Figure 1). In brief, 3,485 respondents participated at follow-up using relevant surveys; 66 were ineligible (not age 18–20 or residing outside of the U.S.); 299 had missing data on key measures of age, past-12-month marijuana use, or product-specific use. An additional 46 cases were excluded due to identifying as “other” or “prefer not to answer” regarding sex (see “Measures” below). The final RQ1 analytic sample included 3,074 cases (89.9% of the eligible sample): 52.8% female, 47.2% male; 53.6% non-Hispanic White, 27.8% Hispanic, 9.4% non-Hispanic Black, and 9.2% multiple categories or another racial or ethnic group.

Product-specific perceived accessibility was asked on a random 1/3 of surveys from 2019–2023 (see Supplement Table 2 and Supplement Figure 2).2 Briefly, 1,373 respondents participated using relevant surveys; 23 were ineligible (age or residency); 107 had missing data on key measures; and 16 were excluded due to identifying as “other” or “prefer not to answer” regarding sex (see “Measures” below), leaving 1,227 cases for the final RQ 2 and 3 analytic sample (90.9% of eligible sample). Of these, 52.1% identified as female, 47.9% male; 54.4% non-Hispanic White, 26.2% Hispanic, 10.7% non-Hispanic Black, and 8.8% multiple categories or another racial or ethnic group.

Measures

Product type.

Respondents were asked, “What methods have you used for [using marijuana; taking marijuana or hashish] during the last year? (Select all that apply.)” Response options in 2019 included smoking, vaping, eating in food, drink in a beverage, dabbing a concentrate (such as wax, honey oil, budder, or shatter), other. Response options for 2020 onward replaced smoking with the following: smoking a joint, smoking a blunt, smoking in a bong/water pipe, smoking in another type of pipe. For analysis, all smoking options were combined into a single dichotomous item. Additional dichotomies were coded for edibles (eating in food); beverages (drink in a beverage), dabbing, and “other.” Multiple product use was coded as both dichotomous (two or more of smoking, vaping, edibles, beverages, dabbing, other) and continuous (ranging from 0 to 6).

Perceived accessibility.

Respondents were asked how difficult they thought it would be to get each of the following if they wanted some: (1) marijuana to smoke, (2) marijuana to vape, and (3) marijuana edibles. Response options included 1=probably impossible, 2=very difficult, 3=fairly difficult, 4=fairly easy, and 5=very easy. As the resulting distributions were highly negatively skewed (skewness −1.73 to −2.15), perceived accessibility for each product type was dichotomized as easy (very easy, fairly easy) versus difficult (fairly difficult, very difficult, probably impossible).

Predictors of interest

In both 12th grade and young adult surveys, respondents were asked the number of occasions they used marijuana or hashish within the past 12 months, with response options of 0 occasions, 1–2, 3–5, 6–9, 10–19, 20–39, and 40 or more occasions. For analysis, 12th-grade past-12-month cannabis use was coded as 1=any, 0=none (see Supplement Appendix for sensitivity analyses using 12th grade past-12-month cannabis use as a continuous measure). Similarly, young adult past-12-month cannabis use was coded as 1=any, 0=none. Among respondents included in analyses for RQ2 and RQ3, any 12th grade cannabis use was reported by 13.8% (SE 1.86) of those reporting no past-12-month cannabis use as young adults, and 62.4% (SE 2.80) of those reporting any past-12-month use as young adults.

State cannabis policy was based on data collection year and state of residence, and coded as a trichotomy referencing policy status as of January 1 of each relevant year (ProCon.org, 2024a, 2024b): no legal use (neither medical nor recreational cannabis use), medical cannabis use only, or recreational use. All states with legal recreational use (which requires users to be 21 or older) also allowed medical use.

Sex and race and ethnicity were self-reported at 12th-grade. Sex response options for all years included male or female; “other or prefer not to answer” was added in 2021; in 2022–2023, separate categories were used for other and prefer not to answer. As the number of respondents who endorsed other or prefer not to answer was too small to allow robust analysis estimates, these cases were excluded from the analytic dataset. The final measure used was a female versus male dichotomy. Race and ethnicity response options included Black or African American; Mexican American or Chicano; Cuban American; Puerto Rican; Other Hispanic or Latino; Asian American; White; American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander; Middle Eastern (respondents were instructed to select one or more responses). Due to sample size limitations, race and ethnicity categories were recoded for analysis as Hispanic (any endorsement of Mexican American or Chicano; Cuban American; Puerto Rican; Other Hispanic or Latino, regardless of any other category endorsement), non-Hispanic Black, non-Hispanic White, or “another race/ethnicity” (Asian American; American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander; Middle Eastern; or those who endorsed more than one listed non-Hispanic option).

College attendance was coded as 2=full-time at a four-year college (full-time 4-year); 1=part-time at a two- or four-year college or full-time at a two-year college (part-time/2-year); 0=not attending.

Year of data collection was coded using individual year indicators for 2019–2023; 2020 was chosen as referent due to the COVID pandemic.

Analysis

Descriptive analyses were conducted in SAS v9.4 using survey commands (SAS Institute Inc., Cary, NC), and Mplus 8.8 (Muthén & Muthén, 1998–2022). Mplus was used for regression models using the MLR estimator and Monte Carlo integration; missing sociodemographic data were addressed by using full information maximum likelihood (FIML) (Arbuckle et al., 1996; Enders, 2001). All analyses used MTF Panel analysis weights designed to account for panel sample selection eligibility (including oversampling of 12th graders reporting drug use) and panel attrition (Patrick et al., 2022).

For RQs 1 and 2 (product-specific prevalence and perceived accessibility), weighted estimates of product-specific use prevalence and perceived accessibility were obtained among all respondents and those reporting young adult past-12-month cannabis use. For RQ2, data were transposed into a “skinny” dataset where each respondent had up to three possible cases (one each for smoking, vaping, and edibles); Rao Scott chi square tests were used to compare perceived accessibility by product type stratified by young adult cannabis use status (models accounted for clustering by respondent).

For RQ3 (covariate associations with perceived accessibility), analyses were limited to respondents reporting no young adult past-12-month cannabis use. Weighted estimates of product-specific perceived accessibility by each covariate were obtained. Multivariable logistic regression models were then fit regressing a single accessibility outcome on 12th grade cannabis use, state policy, sex, race and ethnicity, college attendance, and year of data collection.

Results

Table 1 provides descriptive statistics for both product-type and perceived accessibility analyses.

Table 1.

Sample Descriptives

Product Type Analyses Perceived Accessibility Analyses
n(total)a n(cell) %/Mean (SE) n(total) n(cell) %/Mean (SE)
Mean age [range=18.0–20.9] 3,074 19.6 (0.01) 1,227 19.6 (0.02)
12th grade past-12-month cannabis use 3,033 1,209
 Yes 873 30.0 (1.14) 376 34.0 (1.87)
 No 2,160 70.0 (1.14) 833 66.0 (1.87)
 Mean 4.6 (0.29) 5.0 (0.42)
Young adult past-12-month cannabis use 3,074 1,227
 Yes 1,141 36.6 (1.17) 501 41.7 (1.89)
 No 1,933 63.4 (1.17) 726 58.3 (1.89)
 Mean 6.6 (0.33) 7.6 (0.53)
State cannabis policy 3,000 1,201
 Recreational use 876 31.4 (1.14) 343 32.3 (1.84)
 Medical use only 1,092 36.4 (1.17) 459 36.8 (1.83)
 No legal use 1,032 32.1 (1.15) 399 30.9 (1.78)
Sex 3,057 1,216
 Female 1,865 52.8 (1.22) 745 52.1 (1.93)
 Male 1,192 47.2 (1.22) 471 47.9 (1.93)
Race and ethnicity 3,056 1,219
 Hispanic 805 27.8 (1.12) 307 26.2 (1.74)
 NH Black 247 9.4 (0.74) 102 10.7 (1.27)
 NH White 1,697 53.6 (1.21) 689 54.4 (1.92)
 Another NH race/ethnicity or NH multiracial 307 9.2 (0.72) 121 8.8 (1.04)
College attendance 3,032 1,211
 Full-time 4-year 1,600 46.2 (1.20) 637 44.6 (1.87)
 Part-time/2-year 591 20.2 (0.97) 246 21.4 (1.51)
 Not attending 841 33.6 (1.21) 328 34.0 (1.98)
Year of administration 3,074 1,227
 2019 467 23.1 (1.07) 232 28.7 (1.80)
 2020 469 19.0 (0.95) 244 23.9 (1.58)
 2021 715 21.4 (1.05) 275 18.7 (1.60)
 2022 698 15.9 (0.83) 245 13.1 (1.21)
 2023 725 20.6 (0.90) 231 15.6 (1.20)
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Notes: NH = non-Hispanic.

a

Full information maximum likelihood (FIML) was used in analyses to address missing data on covariates.

RQ1: Product type prevalence

Table 2 shows cannabis product prevalence for all respondents and those reporting past-12-month use. Among all respondents, 30.7% reported smoking, 19.7% vaping, 18.2% edibles, 10.4% dabbing, 2.8% beverages, and 1.3% other; 23.3% reported multiple product use. Among those reporting past-12-month use, respective prevalence estimates were 83.8%, 53.9%, 49.8%, 28.5%, 7.8%, and 3.6%; 63.5% reported multiple product use (mean=2.3 product types).

Table 2.

Past-12-month Cannabis Product Type Use Prevalence and Perceived Accessibility among U.S. Young Adults Aged 19–20, 2019–2023

All respondents Respondents reporting no past-12-month cannabis use Respondents reporting past-12-month cannabis use
% (SE) % (SE) % (SE) p a
Product Type Use Prevalence
Smoking 30.7 (1.11) -- 83.8 (1.54)
Vaping 19.7 (0.94) -- 53.9 (2.02)
Edibles 18.2 (0.96) -- 49.8 (2.01)
Beverages 2.8 (0.43) -- 7.8 (1.15)
Dabbing 10.4 (0.78) -- 28.5 (1.88)
Other 1.3 (0.32) -- 3.6 (0.87)
Two or more product types 23.3 (1.02) -- 63.5 (1.95)
Count of product types:
0 63.4 (1.17) --
1 13.4 (0.84) 36.5 (1.95)
2 9.3 (0.68) 25.4 (1.69)
3 7.1 (0.61) 19.4 (1.56)
4 4.9 (0.56) 13.3 (1.44)
5 1.5 (0.27) 4.0 (0.74)
6 0.5 (0.23) 1.5 (0.63)
Mean 0.8 (0.03) 2.3 (0.05)
Perceived Easy Accessibility by Product Type
Smoking 84.8 (1.30) 77.5 (1.97) 95.0 (1.31) <.001
Vaping 79.6 (1.52) 71.2 (2.22) 91.3 (1.66) <.001
Edibles 78.0 (1.62) 71.8 (2.26) 86.7 (2.18) <.001
 pb (smoking vs. vaping) <.001 0.014
 pb (smoking vs. edibles) 0.002 <.001
 pb (vaping vs. edibles) 0.709 0.029
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Notes: Unweighted ns for Methods: All respondents n=3,074; any past-12-month use n=1,141. For Access: All respondents n=1,227; no past-12-month use n=726; any past-12-month use n=501. Easy accessibility defined as fairly or very easy.

a

p-values from Rao-Scott chi square tests of perceived accessibility of one product type between young adults reporting no past-12-month use and those reporting use.

b

p-values from Rao-Scott chi square tests comparing perceived accessibility between product types within a young adult past-12-month use subgroup.

RQ2: Product-specific perceived accessibility

The percentage of all underage young adults perceiving easy accessibility was 84.8% for smoking, 79.6% for vaping, and 78.0% for edibles (Table 2). When examining perceived accessibility by past-12-month cannabis use status, easy accessibility prevalence was significantly higher (p<.001) among those reporting any use versus none: 95.0% versus 77.5% for smoking; 91.3% versus 71.2% for vaping; and 86.7% versus 71.8% for edibles. When comparing perceived accessibility by cannabis use subgroups, among young adults reporting 12-month use, more respondents perceived easy access to smoking than vaping (p=0.014) or edibles (p<.001), and for vaping than edibles (p=0.029). Among young adults not reporting use, similar results were found for smoking versus vaping (p<.001) and edibles (0.002); no differences were observed between vaping and edibles.

RQ3: Covariate associations with perceived accessibility among those reporting no past-12-month cannabis use

Multivariable associations between covariates and perceived accessibility among those reporting no past-12-month cannabis use are presented in Table 3. Those reporting 12th grade cannabis use (vs. none) perceived easier access to vaping (AOR 2.38, p=0.038).3 Compared to respondents living in states with no legal use, those living in states with recreational use perceived easier access to smoking (AOR 1.95, p=0.023) and edibles (AOR 2.72, p=0.001). Compared to non-Hispanic White respondents, non-Hispanic Black respondents had lower odds of perceiving easy accessibility to vaping (AOR 0.33, p = 0.005) and edibles (AOR 0.46, p=0.044). Full-time 4-year college respondents were more likely to perceive easy access across products than those not attending college (smoking AOR 1.88, p=0.032; vaping AOR 1.81, p=0.028; edibles AOR 2.83, p=<.001); no differences were observed between part-time/2-year respondents and those not attending. Additional models (not tabled) showed full-time 4-year respondents also were more likely to perceive easy access across products than part-time/2-year respondents (smoking AOR 1.86, p=0.041; vaping AOR 1.88, p=0.025; edibles AOR 2.54, p=0.002). Compared to respondents surveyed in 2020, those surveyed in 2021 were more likely than to perceive easy access to vaping (AOR 2.10, p=0.032; no other significant year differences). Among young adults reporting no past-12-month cannabis use, perceived accessibility was not associated with sex.

Table 3.

Associations between Covariates and Product-specific Perceived Accessibility of Cannabis among U.S. Young Adults Aged 19–20 Reporting No Past-12-month Cannabis Use, 2019–2023

Cannabis to smoke Cannabis to vape Cannabis edibles
Easy accessibility Multivariable Easy accessibility Multivariable Easy accessibility Multivariable
% (SE) AOR (95% CI) p % (SE) AOR (95% CI) p % (SE) AOR (95% CI) p
12th grade past-12-month cannabis use
 Yes 86.5 (5.37) 2.32 (0.90, 5.99) 0.082 81.1 (5.84) 2.38 (1.05, 5.40) 0.038 72.4 (7.31) 1.41 (0.67, 3.01) 0.368
 No 76.3 (2.14) (ref) 69.7 (2.42) (ref) 71.8 (2.38) (ref)
State cannabis policy
 Recreational use 81.5 (3.22) 1.95 (1.10, 3.45) 0.023 76.2 (3.63) 1.73 (1.00, 3.01) 0.052 80.2 (3.37) 2.72 (1.54, 4.83) 0.001
 Medical use only 78.3 (3.15) 1.37 (0.78, 2.40) 0.270 69.7 (3.58) 1.10 (0.66, 1.84) 0.709 74.0 (3.40) 1.64 (0.98, 2.76) 0.061
 No legal use 72.6 (3.90) (ref) 67.6 (4.31) (ref) 62.6 (4.47) (ref)
Sex
 Female 76.6 (2.66) 0.79 (0.48, 1.30) 0.351 72.9 (2.71) 1.07 (0.68, 1.68) 0.763 72.6 (2.83) 1.00 (0.62, 1.60) 0.990
 Male 78.7 (2.93) (ref) 69.7 (3.61) (ref) 71.0 (3.63) (ref)
Race and ethnicity
 Hispanic 75.9 (3.84) 0.76 (0.45, 1.29) 0.311 71.7 (4.13) 0.77 (0.45, 1.31) 0.333 68.6 (4.63) 0.67 (0.38, 1.17) 0.157
 NHa Black 72.3 (8.16) 0.58 (0.24, 1.43) 0.240 54.6 (9.02) 0.33 (0.15, 0.72) 0.005 60.9 (8.94) 0.46 (0.22, 0.98) 0.044
 NH White 80.4 (2.38) (ref) 75.6 (2.58) (ref) 76.8 (2.54) (ref)
 Another NH race/ethnicity or NH multiracial 75.0 (7.08) 0.60 (0.25, 1.45) 0.256 65.1 (8.94) 0.52 (0.24, 1.12) 0.093 67.0 (9.25) 0.57 (0.26, 1.22) 0.145
College status
 Full-time 4-year 83.4 (2.37) 1.88 (1.05, 3.35) 0.032 77.8 (2.65) 1.81 (1.07, 3.08) 0.028 82.5 (2.44) 2.83 (1.65, 4.85) <.001
 Part-time/2-year 73.2 (4.30) 1.01 (0.55, 1.88) 0.970 66.1 (4.70) 0.97 (0.53, 1.75) 0.906 65.3 (4.88) 1.12 (0.61, 2.04) 0.723
 Not attending 74.1 (4.04) (ref) 66.9 (4.62) (ref) 62.9 (4.77) (ref)
Year of administration
 2019 82.2 (3.77) 1.75 (0.88, 3.50) 0.113 71.2 (4.77) 1.49 (0.81, 2.72) 0.197 67.0 (4.95) 1.08 (0.58, 2.00) 0.816
 2020 74.1 (4.33) (ref) 64.1 (4.80) (ref) 68.7 (4.70) (ref)
 2021 82.7 (4.50) 1.64 (0.76, 3.51) 0.206 79.2 (4.57) 2.10 (1.06, 4.13) 0.032 78.5 (5.03) 1.78 (0.88, 3.61) 0.112
 2022 73.6 (4.67) 0.97 (0.50, 1.87) 0.922 68.6 (4.95) 1.22 (0.65, 2.30) 0.531 72.2 (4.71) 1.25 (0.65, 2.41) 0.501
 2023 71.4 (4.51) 0.93 (0.48, 1.78) 0.816 74.6 (4.36) 1.80 (0.93, 3.48) 0.079 76.8 (4.23) 11.72 (0.87, 3.40) 0.120
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Notes: Unweighted n=726 (full information maximum likelihood [FIML] was used in analyses to address missing data on covariates). AOR = adjusted odds ratios from multivariable logistic regression model. “Easy accessibility” defined as fairly or very easy. Bold font indicates p<.05

a

NH = non-Hispanic.

Discussion

Using a national sample of underage U.S. young adults, this study found most (63.5%) young adults reporting past-12-month cannabis use reported using multiple products; smoking, vaping, and edibles were the most commonly reported, and easy access to smoking, vaping, and edibles was nearly universal. Among underage young adults who reported no past-12-month cannabis use, state recreational use policy and full-time 4-year college attendance (vs. part-time/2-year attendance or no attendance) were the strongest predictors of perceiving easy cannabis access across product types.

Perceived accessibility has been a consistent risk factor for young adult cannabis use (Levy et al., 2021; Martins et al., 2016). In the current study, perceived easy accessibility for smoking, vaping, and edibles among the 41.7% of underage young adults who reported past-12-month cannabis use ranged from 86.7% (edibles) to 95.0% (smoking). Such high levels of perceived accessibility were expected given that if an individual uses cannabis, they almost certainly know how to access it. However, approximately three out of every five young adults (58.3%) reported not using cannabis use in the past 12 months. Among these respondents, perceived easy access was lower, but still the vast majority: 71.2% for vaping, 71.8% for edibles, and 77.5% for smoking. In other words, among those who did not use cannabis, roughly one quarter reported that it would not be easy to access cannabis smoking, vaping, and edible products. Prevention efforts surrounding accessibility may be especially impactful for these underage young adults who are not currently using cannabis.

When considering the prevention and intervention implications for perceived accessibility of cannabis across products, it may be useful to consider similar efforts for substances with legal adult use across states, such as alcohol and tobacco. Alcohol and tobacco have experienced very high levels of perceived accessibility across population subgroups including young adults (Schulenberg et al., 2021), but both substances have decreased historically (Patrick et al., 2024). Some state and community policy levers used to reduce alcohol and tobacco accessibility may be relevant for cannabis, including price, product availability, retailer density/locations, and marketing (Centers for Disease Control and Prevention, 2023; Chaloupka et al., 2019; Luke et al., 2017). Additional policy issues specific to cannabis include potency levels (Pacula et al., 2022), home cultivation restrictions (Blanchette et al., 2022), and online dispensary practices (Terala et al., 2023). Research has begun to examine cannabis marketing; one study found exposure to cannabis-related marketing was positively associated with younger age, higher educational attainment, and income (Cohn et al., 2023). Other research focusing on cannabis social media (in states where recreational use is legal and state-based marketing regulations have been implemented) found a meaningful percentage of messaging appeared to violate state cannabis marketing policy, including youth appeal messaging (Moreno et al., 2022).

The current study found that among underage young adults reporting no past-12-month cannabis use, perceived accessibility to cannabis for smoking and edibles was higher in states with recreational cannabis policies (vs. no legal use). As noted before, state cannabis policies are complex (Blanchette et al., 2022; Pacula et al., 2022; Pacula & Smart, 2017), with significant variations across details such as advertising restrictions, delivery to recreational consumers, packaging and labeling restrictions, product design restrictions and requirements, retail price restrictions, and taxes (Blanchette et al., 2022). Age verification procedures and implementation policies for online dispensaries also vary widely (Terala et al., 2023). Future research could examine state-level differences in such details to better understand associations between policy (including implementation and enforcement) and the actual and perceived accessibility of cannabis products to underage young adults.

In regards to non-policy correlates of perceived accessibility, among underage young adults reporting no past-12-month cannabis use, those who identified as non-Hispanic White were more likely than those identifying as non-Hispanic Black to perceive easy accessibility to cannabis for vaping or edibles. Wagner et al. (2021) found significant racial and ethnic differences in how 12th-grade students obtained cannabis: White (vs. Black) respondents were more likely to obtain from a friend or someone else’s medical cannabis recommendation; Black (vs. White) respondents were more likely to obtain from a relative. Also, research with a young adult Texas convenience sample found individuals identifying as Black (vs. White) were less likely to report multiple (vs. single) modes of cannabis use (North et al., 2024). Such differences in cannabis source and use mode preference may impact perceived accessibility differentially for different products.

Full-time 4-year college attendance (vs. part-time/2-year attendance or not attending) was associated with perceiving easy accessibility across product types among underage young adults reporting no past-12-month cannabis use. No significant differences were observed between part-time/2-year attendance and not attending. If most underage young adults obtain cannabis from friends (as is the case with adolescents; Wagner et al., 2021), such access particularly may be facilitated in 4-year college campus environments which are densely populated with similar-aged peers as well as those age 21 and older. Some studies find cannabis-related advertising exposure does not evidence strong educational differences (Krauss et al., 2017), but other research indicates advertising exposure may be higher among those with higher educational attainment (Cohn et al., 2023).

The time period over which data were collected (2019–2023) included the COVID pandemic which began in 2020. Research generally has indicated the pandemic was not associated with significant changes in young adult cannabis use trends (Patrick et al., 2024; Tang et al., 2024). While perceived access to cannabis among adolescents declined during the pandemic (Miech et al., 2021), the current study found little evidence of a similar overall decline among underage young adults.

Limitations and future directions

The study was based on nationally-representative samples of U.S. 12th-grade students; individuals who were no longer attending school in 12th grade were not eligible to participate as young adults. As school dropout is associated with higher cannabis use (Davis et al., 2023), this sample may underrepresent young adults with adolescent cannabis use experience (although individuals reporting 12th grade substance use were oversampled; Patrick et al., 2024). Further, the sample has experienced attrition; use of analysis weights mitigates response bias by adjusting for known predictors of attrition including substance use (Patrick et al., 2022). Due to sample size limitations, models were unable to disaggregate racial and ethnic subgroups or examine outcomes among individuals who did not identify as female or male. Research has found significant differences in substance use prevalence across Hispanic and Asian subgroups (Bersamira et al., 2017; Webb et al, 2024), as well as higher use overall and with more products among sexual and gender minorities (Schofield et al., 2023). While the current study found no strong evidence that the COVID pandemic impacted perceived accessibility for cannabis products among young adults, specific types of access (e.g., friend, relative) may have been impacted differentially. Future research could examine accessibility in greater detail, including sources and methods and whether they vary across cannabis products.

Conclusions

Underage young adults who used cannabis typically used more than one product; almost all of those who reported any past-12-month cannabis use perceived easy accessibility across products. While perceived access was notably lower among those not reporting past-12-month use, approximately three-quarters of underage young adults who were not using cannabis said they could easily access all three types of cannabis products. Perceived easy accessibility was even higher among full-time 4-year college-attending young adults (vs. part-time/2-year college students and those not attending) or those living in states with legal adult recreational use. Reducing actual and perceived accessibility to cannabis across product types among underage young adults who do not currently use cannabis should remain a high public health priority.

Supplementary Material

Supplementary Material

Role of Funding Source:

Data collection, analysis, and manuscript preparation were supported by research grants from the National Institute on Drug Abuse (R01DA001411 and R01DA016575). The study sponsors had no role in the study design, collection, analysis, or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the study sponsors.

Footnotes

CRediT author statement: Yvonne M. Terry-McElrath: Conceptualization, methodology, formal analysis, writing—original draft. Yuk C. Pang: methodology, formal analysis, writing—original draft. Megan E. Patrick: Conceptualization, methodology, writing—review and editing, project administration, funding acquisition. All authors have reviewed and approved the final article.

Conflict of Interest: No conflict declared.

1

Response rates calculated using American Association for Public Opinion Research (AAPOR) 2023 Response Rate 6 definition. Response rates did not significantly differ by modal age. The average response rate in 2019 was lower than 2023 (0.333 vs. 0.379 [modal ages 19 and 20 combined]; p=0.005). See Patrick et al., 2024.

2

Because product-specific prevalence and perceived accessibility were not consistently asked on the same survey versions, analyses examining cross-sectional associations between use prevalence and perceived accessibility for specific products were not conducted.

3

Sensitivity analyses (Supplement Appendix) using 12th grade cannabis use as a continuous measure found no significant associations between 12th grade use and perceived accessibility.

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