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Evaluation of marijuana users’ self-efficacy to use harm reduction strategies L. Ashrafioun, A.R. Hawley, S.W. Kraus, E. Kryszak, N. Cross, A.K. Davis, J. Leith, L.A. Osborn, H. Rosenberg, E.E. Bannon, S.R. Jesse, V. Carhart, Kyoung D. Baik Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
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Lisham Ashrafioun
Introduction
Results
Results
Background
Marijuana (MJ) use by university students is associated with a variety of negative academic, social, and health consequences (Caldeira, Arria, O’Grady, Vincent, & Wish, 2008; Hammersley & Leon, 2006; Shillington & Clapp, 2001).
Although marijuana-using students may benefit from employing harm reduction strategies, lack of self-efficacy to employ such strategies may reduce how often they are used and the harms to which users are exposed
We were not aware of any previous research designed to assess MJ users’ self-confidence to employ a variety of behavioral harm reduction strategies
Aims of the current study
To assess the extent to which regular MJ users feel confident that they could use each of 18 specific strategies to reduce potential negative outcomes from use
To assess whether self-efficacy to engage in each of the strategies varied as a function of their history or MJ-related problems
To examine whether particular MJ use characteristics were correlated with overall MJ harm reduction self-efficacy
Sample assigned to one of 3 groups based on RMPI scores: Low = 0 to 5 (n = 89); Moderate = 6 to 13 (n=89); High = 14+ (n=94).
HIGH PROBLEMS GROUP had significantly lower self-efficacy than those in both the LOW and MODERATE PROBLEMS GROUPS on 8 of 18 items (items noted by *#).
HIGH and MODERATE GROUPS had significantly lower self-efficacy than LOW GROUP on two items (items noted by *).
HIGH GROUP had significantly lower self-efficacy than LOW group on five items (items noted by *).
There were no significant differences in self-efficacy across the three groups for three of the strategies (items bolded).
After retaining all 18 strategies as a single scale, we found that those participants who reported lower self-efficacy to engage in marijuana harm reduction strategies reported a greater number of marijuana use problems and lower marijuana refusal self-efficacy.
Table with a summary of the regression analyses assessing relationships between key MJ variables and MJ harm reduction DV
IVs
M (SD) β
t-value
Marijuana harm-reduction
self-efficacy scores
RMPI scores
MRSEQ scores
Past 30-day MJ use
Age of 1st MJ use
11.9 (9.2)
64.1 (27.4) 
14.3 (10.2)
16.4 (2.4)
-.14
.55
-.03
-.01
-2.67*
10.17**
-0.62
-0.11
Overall F(4,259) = 41.01, p < .001, adjusted R2 = .38; **p < .001; *p < .01; DV – Dependent Variable; IV – Independent Variable; RMPI – Rutgers’ Marijuana Problems Index; MRSEQ – Marijuana Refusal Self-Efficacy Questionnaire; MJ - Marijuana
Table of means and standard deviations of the 18 MJ harm reduction strategies by level of problems
Harm Reduction Strategies
Overall Mean (SD)
Low problems a
Moderate problems b
High problems c
1. Avoid sprinkling other drugs on MJ
91.6 (24.4)
95.8 (18.0)
92.3 (24.7)
86.9 (28.4) *
2. Use a vaporizer instead of smoking MJ
78.5 (30.4)
80.5 (30.4)
79.2 (28.5)
75.9 (32.1)
3. Eat baked goods that contain MJ instead of smoking it
73.8 (33.4)
75.3 (34.4)
77.4 (31.5)
69.0 (33.6)
4. Use MJ with people you trust to take care of you if you’re too high
91.1 (22.5)
93.9 (17.4)
95.1 (17.8)
84.8 (28.7) *#
5. Avoid driving or cruising while high
72.2 (35.2)
83.8 (29.0)
74.4 (36.1)
59.2 (35.7) *#
6. Avoid using MJ offered by people you do not trust
83.8 (26.9)
90.2 (20.4)
86.5 (25.8)
75.0 (31.1) *#
7. Avoid carrying MJ and paraphernalia in public
87.6 (23.4)
94.5 (13.4)
88.2 (24.1)
80.5 (28.0) *
8. Avoid using MJ as a way to deal with your emotions
71.7 (31.5)
81.5 (28.6)
72.7 (30.1)
61.5 (32.6) *#
9. Avoid using MJ to help you sleep
68.0 (34.3)
79.3 (28.8)
66.3 (35.3) *
58.9 (35.4) *
10. Avoid drinking alcohol while high
76.7 (30.8)
78.8 (30.0)
78.6 (30.2)
73.0 (32.1)
11. Avoid using other drugs while high
90.3 (22.5)
94.5 (16.3)
92.5 (21.1)
84.2 (27.4) *#
12. Stop using any more MJ if you have a bad reaction
78.2 (30.5)
85.1 (26.6)
78.4 (32.7)
71.5 (30.6) *
13. Find a safe way to get someplace else while high
79.6 (30.7)
89.8 (20.7)
78.5 (29.9) *
71.1 (36.3) *
14. Let your friends know if you leave without them while you’re high
86.6 (24.6)
89.9 (21.4)
89.9 (21.7)
80.3 (28.8) *#
15. Use a condom if you engage in sexual activity while high
87.8 (26.5)
90.1 (24.0)
93.0 (21.3)
80.7 (31.5) *#
16. Avoid going somewhere with people you don’t know while high
85.0 (25.5)
91.8 (19.0)
88.2 (20.6)
75.4 (31.6) *#
17. While high, avoid making decision you’ll regret later
86.7 (20.9)
91.1 (17.3)
87.3 (21.1)
81.8 (22.9) *
18. Avoid going to work or school while high
77.8 (30.6)
87.8 (24.9)
77.4 (32.7)
68.6 (30.7) *
* Indicates significantly lower self-efficacy scores compared to Low Problems scores, p < .05
# Indicates significantly lower self-efficacy scores compared to Moderate Problems scores, p < .05
Note. Response options ranged from 0% = “Not at all confident to 100% = “Completely confident” in increments of 10
Discussion & Conclusions
We found that those participants in the HIGH PROBLEMS GROUP had significantly lower self-efficacy than those in the MODERATE and/or LOW GROUPS for 15 of the 18 strategies.
After retaining all 18 strategies as a single scale, we found that those participants who reported lower self-efficacy to engage in marijuana harm reduction strategies reported a greater number of marijuana use problems and lower marijuana refusal self-efficacy after controlling for the variance explained by other variables (i.e., frequency, age of first use).
The results of this study are similar to those found among university student drinkers. For example, Rosenberg and colleagues (2011) found that, among a sample of university student drinkers, those who reported a greater number of alcohol-related problems reported lower self-efficacy to engage in drinking-related harm reduction strategies compared to participants who reported fewer alcohol-related problems.
Limitations
Although the MJ-HRS provides a wide range of potential harm reduction strategies that university students could employ, there may be other MJ harm reduction strategies that we did not include in this measure.
We assessed only current confidence to employ these strategies, and did not assess use of these harm reduction strategies in the past or about future intentions to use such strategies.
Potential Applications
Researchers and clinicians could use these strategies as a tool to assess whether one’s confidence to engage in any one or more of these harm reduction techniques increases during counseling designed to enhance such self-efficacy.
The MJ-HRS may be helpful in identifying drug-use situations in which clients have little confidence in their ability to employ harm reduction strategies.
Other potential applications of this study include: evaluating the self-efficacy of using these strategies in student health settings and university counseling centers to provide a baseline assessment of marijuana users’ confidence in limiting and/or preventing various harms associated with use.
Method
notices regarding study sent to 8000 randomly selected BGSU undergraduates
326 consented
54 deleted for reporting use of marijuana < 1x/month/past 6 months and/or did not rate all 18 strategies
272 eligible & consenting students who rated their self-efficacy on all of the 18 marijuana harm reduction strategies
Completed the Rutgers Marijuana Problems Index, Marijuana Refusal Self-efficacy Questionnaire, Demographic & Marijuana Use History Questionnaire
Mean age 20.9 yrs. (SD = 3.2); 56% male; 82% self-identified as Caucasians
Participants used marijuana an average of 14.6 (SD = 10.3) days/month; consumed the equivalent of 4.2 (SD = 2.7) “typical-sized joints” per week; reported an average of 1.8 sessions/day; mean level of intoxication = 3.9 (SD = 0.8) on a five-point scale (1 = “Not at all high” to 5 = “Very high”)
Respondents had reported using the following drugs at least once in their lives: Spice/K2 (52%), amphetamines (49%), prescription opioids (47%), and ecstasy (45%). 
Rosenberg, H., Bonar, E. E., Hoffmann, E., Kryszak, E., Young, K. M., Kraus, S. W., Ashrafioun, L., Bannon, E. E., & Pavlick, M. (2011). Assessing university students’ self-efficacy to employ alcohol-related harm reduction strategies. Journal of American College Health, 59,
Caldeira, K. M., Arria, A. M., O’Grady, K. E., Vincent, K. B., & Wish, E. D. (2008). The occurrence of cannabis use disorders and other cannabis-related problems among first-year college students. Addictive Behaviors, 33,
Hammersley, R., & Leon, V. (2006). Patterns of cannabis use and positive and negative experiences of use amongst university students. Addiction Research and Theory, 14, 189−205.
Shillington, A., & Clapp, J. (2001). Substance use problems reported by college students: Combined marijuana and alcohol use versus alcohol-only use. Substance Use and Misuse, 36, 663.
**The authors have no financial disclosures or conflicts of interests to report.