The Future of Substance Abuse Now: A Study of ENDS Devices as a Marijuana and Synthetic Cannabinoid Delivery System among Youth in the U.S.

This dissertation included three papers and sought to explore trends and risk factors for the uses of marijuana and synthetic cannabinoids, and the combination of such drugs and electronic nicotine delivery system (ENDS) devices, among youth in the U.S. The second and third papers utilized three sets of cross-sectional national data among 8th, 10 th, and 12th graders across time points (2014, 2015, and 2016). Logistic regression analyses were conducted in the second and third papers. The gateway theory, stigma theory and the health belief model guided this dissertation and its three papers. The first paper sought to systematically review the literature on the adolescent uses and health outcomes of e-cigarettes, marijuana and synthetic cannabinoids in order to build an in-depth understanding of current issues of such psychoactive drugs among youth in the U.S. The second paper examined the trends of using ENDS devices and marijuana products via ENDS and identified the presence of a gateway effect in the use of ENDS devices among youth from 2014 to 2016. The third paper examined the trends of using marijuana and synthetic cannabinoids and identified risk factors in the use of illicit drugs among youth from 2014 to 2016. First, this dissertation supported the notion that ENDS use clusters with marijuana use among adolescents. Secondly, the studies determined that adolescents may increase, but at least will not decrease their marijuana use if use is legalized. Thirdly, the evidence highlighted the need to understand associated health outcomes and what adolescent consumption patterns will be if marijuana is widely accessible. Fourthly, it is in urgent need that health professionals intervene with evidence-based efforts to prevent younger adolescents from using synthetic drugs as younger adolescents appeared to have a higher prevalence of not knowing what was in their ENDS device than older adolescents. Lastly, the findings stressed the need to reconsider the tremendous impact of marijuana legalization on adolescents