State- and Trait-Level Depressive Symptoms and Marijuana Use Among Urban Youth

BACKGROUND: Marijuana is the most used illicit substance among youth, yet whether risk reflects stable or fluctuating depressive symptoms is unclear. OBJECTIVE: This study examined whether state-level and trait-level depressive symptoms affect marijuana use, informing nurse-led screening and prevention. METHODS: Guided by ecological systems theory, this secondary analysis of the Adolescent Health and Development in Context study used an ordered logistic regression model. Trait-level symptoms were each youth's average over time; state-level symptoms, deviations from the average. The model adjusted for caregiver education, sex, race, and age across 3 levels: observations within youth within families. RESULTS: We analyzed 2807 observations from 1516 youth, from 1456 households trait-level depressive symptoms (adjusted odds ratio [aOR] = 5.31; 95% confidence interval [CI], 2.82-10.00) and state-level symptoms (aOR = 2.70; 95% CI, 1.44-5.04) predicted higher frequency use. Male sex (aOR = 2.04; 95% CI, 1.16-3.60) and age (aOR = 1.79; 95% CI, 1.48-2.16) were significant. At age 12, any use was negligible; by age 18, up-to-twice-weekly use reached 13.3% for males and 7.3% for females at high trait-level symptoms. CONCLUSIONS: Trait-level symptoms carry the larger, chronic risk, while state-level elevations trigger additional short-term increase in use; interventions during acute distress may prevent escalation. Nurses can use depression screening to prevent use and flag underlying depression.