LAUSR

BACKGROUND Research has identified many factors associated with past 30-day (P30D) marijuana use among youth, but has not assessed factors that may differentiate youth who use frequently from youth who do not. We took a multilevel approach to identify and compare risk and protective factors associated with frequent and non-frequent P30D marijuana use among high school students. METHODS Individual-level data were obtained from the 2019 Nevada Youth Risk Behavior Survey (completed by 4,980 high school youth from 99 schools); school-level data were obtained from the state's Department of Education. A multinomial, multilevel model was used to estimate the association between risk and protective factors at the individual and school levels and a three-level frequency of use outcome: no P30D use (0 times), non-frequent P30D use (1 - 19 times), and frequent P30D use (20+ times). RESULTS At the individual level, other P30D substance use, exposure to adverse childhood experiences (ACEs), perceived ease of access, and perceived risk were associated with both frequent and non-frequent use, but the relationships were generally stronger for frequent use. Past 30D non-prescription drug use and school connectedness were associated with frequent use only. At the school level, number of students with individualized education programs, number of incidents involving possession of controlled substances, and school type were associated with frequent use only. CONCLUSIONS Individual and school-based interventions designed to address the factors uniquely or strongly associated with frequent marijuana use may prevent escalation from occasional use to more frequent use among high school youth.