An examination of marijuana use among a vulnerable

population in CanadaNicholas Spence, PhDSamantha Wells, PhD

Julie George, PhDKathryn Graham, PhD

Social Issue: Marijuana• Most commonly used illicit drug• Lifetime use Canada (15+) in 2010: 41.5%• Perceived risk decreasing over time• Innocuous? – 1/10 ever use; 50% of daily users = dependent– Links to licit and illicit drugs– Poor education– Health links to poor respiratory health, accidents,

psychosis, other mental health disorders, cancer risk, all cause mortality

– Contribution to the burden of disease significant• High use group: Indigenous populations

Social Inequality in Canada: Human Development Index (HDI) 2001

Canada Non-Aboriginal

Canadian Registered First Nation

Gap

Life Expectancy 78.7 72.9 5.8

Median Income (2000 PPP$) 27617 14824 12793

Education (Proportion 18-24 with secondary school certificate or higher)

0.79 0.44 0.35

HDI Country Rank 8 54 46

Adapted from White, Beavon, Spence (2007), Aboriginal Well-Being

Social Determinants of (Aboriginal) Health

• Traditional non-Aboriginal specific determinants• Aboriginal specific: Colonization, oppression, loss of

culture, land and ways of life, racism Intergenerational trauma and unresolved grief

Social illsMaladaptive social and behavioural

patterns, including substance use •Research gap

-marijuana use-survey research approaches

Research Question

• What are the factors associated with frequent marijuana use among First Nations on reserve?

Methods

• Researching Health in Ontario Communities (RHOC), funded by CIHR

• Mental health, substance use, violence• Sample (N=340), adults (18+) Kettle and Stony

Point First Nation community

Measures & Descriptive StatisticsVariables Mean (SD) Ever used marijuana more than once a week

Yes 53.2%Age 41.2 (14.4)Gender Male 45.1%

Measures & Descriptive Statistics

Variables Mean (SD) Education Less than high school 34.6%Completed high school 16.9%Any post-secondary education 48.4%Marital Status Married or living with partner 50.6%Divorced, separated, or widowed 22.6%Single 26.7%

Measures & Descriptive StatisticsVariables Mean (SD)Income < $20 000 36.1%$20 000-$39 999 29.5%$40 000-$59 999 12.4%$60 000 + 22.0%Body Mass Index (BMI) 30.7 (6.2)Cigarettes (Ever smoker) Yes 86.4%

Measures & Descriptive StatisticsVariables Mean (SD)Alcohol (Ever drank) Yes 94.0%Historical Loss Scale (0-60) 22.4 (13.5)Childhood Trauma Scale (0-8) 2.6 (2.0)MIRE Interpersonal Racism Scale (0-40) 15.2 (8.7)Met criteria for major depression or anxiety disorder in past 12 months Yes 27.5%

Analysis

• General linear model (logistic regression)-Yes, responded has ever used marijuana more than once a week

• Odds Ratios • Bivariate (unadjusted), Multivariate (adjusted)• * = p<0.05

Results: Bivariate & Full Model

Variables Unadjusted OR (95%CI)

Adjusted OR (95% CI)

Age 0.96* (0.95, 0.98) 0.96* (0.93. 0.98)Gender --- ---Female (reference) 1.00 1.00Male 2.86* (1.76, 4.64) 3.34* (1.87, 5.95)Body Mass Index 0.96* (0.92, 0.99) 0.96 (0.92, 1.01)

Tobacco: Ever smoker --- ---No (reference) 1.00 1.00Yes 4.90* (2.21, 10.88) 5.50*(2.17, 13.97)

Discussion: Age, Gender, Smoking

• Patterns of use: Age, Gender, Smoking• Gendered approach across addiction cycle• Elevated use among younger age groups important in

light of demography – 50% of First Nations <25 years of age vs. 30% of non-

Aboriginals• Cigarette smoking: existing concern

-Rates >3X rest of Canada-Co-occurring tobacco & cannabis use magnifies

potential risk

Discussion: Normalization of Marijuana Use

• Prevalence rate = 53.2% reported ever using marijuana more than once a week

• Normalization– Social norms limit diversity and influence

behavior– E.g., changes in drug use patterns of

emigrants• Why? –Decline in perceived risk

Discussion: Program & Policy Implications

• Focusing service priorities given normalization• Public health campaigns

-harm-dependence-appropriate (timely, responsive, flexible)

• Advocacy efforts founded on empirical research to secure resources

Conclusion

• High prevalence rate• Gender, age, life course approach• Link - licit and illicit substance use• Public health programs: norms, gender, age,

lifestyle• Continued focus on Aboriginal specific

measures (colonialism, intergenerational trauma, historical loss, racism)