Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study

Yuxian Cui, Cassidy R. LoParco, Yael Bar-Zeev, Zongshuan Duan, Hagai Levine, Lorien C. Abroms, Yan Wang, Amal Khayat, Carla J. Berg*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: In the US and Israel, non-medical (‘recreational’) cannabis use is illegal at the national level; however, use rates are high and decriminalization and legalization is spreading. Thus, theory-based intervention efforts, especially for youth prevention, are crucial. Methods: This mixed-methods study of adults in the US (n = 1,128) and Israel (n = 1,094) analyzed: 1) cross-sectional survey data (Fall 2021) to identify theory-based correlates (risk perceptions, social norms) of past-month cannabis use, next-year use intentions, and intentions to use in the home or among children if non-medical cannabis was legal, using multivariable regression; and 2) qualitative interviews regarding perceptions of cannabis policies and use (US n = 40, Israel n = 44). Results: 16.7% reported past-month use; 70.5%, 56.3%, and 82.6% indicated “not at all likely” regarding next-year use and use in the home and among children if legal. Lower perceived risk and greater social norms were associated with past-month use, greater use intentions, and greater intentions to use in the home or among children. Past-month use was more prevalent among US (vs. Israeli) participants (22.0% vs. 11.2%); however, in multivariable regression controlling for past-month use, being from Israel was associated with greater use intentions (next-year; in the home/among children). Qualitative themes indicated: concerns about use (e.g., increasing use, health risks, driving-related risks) and legalization (e.g., impact on society/economy, marketing), and perceived benefits of use (e.g., medical) and legalization (e.g., access/safety, economic, individual rights). Conclusions: Despite differences in cannabis perceptions and use across countries, perceived risk and social norms are relevant intervention targets regardless of sociopolitical context.

Original languageAmerican English
Article number54
JournalSubstance Abuse: Treatment, Prevention, and Policy
Issue number1
StatePublished - Dec 2023

Bibliographical note

Funding Information:
Data analyzed in this study were collected in a study funded by the US National Cancer Institute (NCI) (R01CA239178, MPIs: Berg, Levine). To conduct these secondary analyses, the lead and second authors were supported by other funds from NCI (R01CA215155, PI: Berg) and National Institute on Drug Abuse (NIDA) (R01DA054751, MPIs: Berg, Cavazos-Rehg). Dr. Berg is supported by other US National Institutes of Health funding, including NCI (R01CA215155, PI: Berg; R01CA278229, MPIs: Berg, Kegler; R01CA275066, MPIs: Yang, Berg; R21CA261884, MPIs: Berg, Arem), Fogarty International Center (D43TW012456; MPIs: Berg, Paichadze, Petrosyan), National Institute of Environmental Health Sciences/Fogarty (D43ES030927, MPIs: Berg, Caudle, Sturua), and NIDA (R01DA054751, MPIs: Berg, Cavazos-Rehg).

Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.


  • Cannabis use
  • Global health
  • Health behavior
  • Health policy
  • Non-medical cannabis
  • Recreational cannabis
  • Theory


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