Medical marijuana laws (MMLs) provide legal protection from state-level criminal penalties for patients qualified to use medical marijuana. Very few studies, however, have examined the potential impact of these laws on cigarette consumption, and evidence is mixed on how MMLs impact alcohol use.  This study identifies the effect of medical marijuana legalization on cigarette smoking, and also tests the mediating role of alcohol in this relationship.

Method:

Drawing upon individual-level data from the Behavioral Risk Factor Surveillance System surveys from 1994-2010 (N=1,655,578), this study employs a difference-in-difference estimation strategy to estimate the effect of implementing MMLs at the state level on the probability of individual cigarette smoking while controlling for alcohol use.  This approach exploits changes in smoking trends within states over time and controls for fixed unobserved state-level characteristics. Estimates are also generated for males and females, different age groups, and various race/ethnicity groups.

Results:

Approximately 24% of the sample reported being current smokers.  Preliminary estimates suggest that MMLs lead to a significant increase in the probability of cigarette smoking by 1.4 percentage points.  Similarly, individuals aged 30-39 experience a statistically significant increase in the probability of cigarette smoking by 1.7 percentage points.  The initial estimates also point to potential differences by race/ethnicity.

Conclusions:

Given that cigarette smoking accounts for nearly 1 in 5 deaths and is the leading cause of preventable disease in the U.S., this paper illustrates the importance of understanding the unintended consequences of medical marijuana laws on tobacco use.

CDPHE contracted with an evaluator to implement a three-year evaluation plan to assess the effectiveness of CDPHE’s retail marijuana education campaigns to:

• Increase knowledge of the retail marijuana laws and the health impacts of marijuana use, using the literature reviews from the Retail Marijuana Public Health Advisory Committee.
• Increase perceptions of risk for marijuana use while pregnant/breastfeeding, underage use, over-consumption, or secondhand marijuana smoke exposure.
• Increase self-reported prevention behaviors, specifically among marijuana users, parents and health care providers:
• Link the campaign awareness to changes in the above knowledge, perceptions and behaviors.

Baseline assessments were completed prior to the campaign launch in January, 2015. Follow-up assessment will occur June, 2015. All data from the baseline and follow-up assessments will be analyzed and reported to the Colorado General Assembly on November 1, 2015, in time to present the final data analysis on campaign effectiveness at this conference.

To better inform local government officials and outline potential areas for regulatory improvement, CDPHE outlined the categories of state policy changes that incorporated lessons learned from alcohol and tobacco, including increases to unit price, smoke-free policies, strict licensing and regulations, restricting hours of sale, limiting density, set-backs, advertising restrictions and more. Boulder County Public Health, a local public health agency, partnered with CDPHE to describe how each of these state level laws or regulations could be strengthened at the local level to further prevent youth access to the substance.

CDPHE and Boulder County Public Health will share lessons learned from the adaptation of effective tobacco and alcohol policy strategies to retail marijuana and the implementation of those laws and regulations at the state and local level. CDPHE and local public health agencies will continue to monitor the implementation of effective policy strategies applied to retail marijuana in Colorado.