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The importance of cannabis culture in young adult cannabis use

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DOI: 10.3109/14659891.2013.790493

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ISSN: 1465-9891 (print), 1475-9942 (electronic)

J Subst Use, 2014; 19(3): 251–256

! 2014 Informa UK Ltd. DOI: 10.3109/14659891.2013.790493

ORIGINAL ARTICLE

The importance of cannabis culture in young adult cannabis use

Søren Holm1, Sveinung Sandberg2, Torsten Kolind3, and Morten Hesse3
1
Municipality of Skive, Skive, Denmark, 2Department of Criminology and Sociology of Law, University of Oslo, Oslo, Norway, and 3Centre for Alcohol
and Drug Research, Aarhus University, Aarhus, Denmark

Abstract Keywords
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Background: Research into drug use initiation has focussed on drug use as risky behaviour. Adolescents, cannabis, culture,
Qualitative research suggests that a culturally derived set of beliefs about the positive effects of experimental use
cannabis play an important role in the production and maintenance of cannabis use.
Methods: An online survey questionnaire was designed to measure both perceived positive and History
negative effects of cannabis. The questionnaire was submitted to a factor analysis, and two
factors were extracted: a positive and a negative effect scale. Using regression analyses, Received 12 December 2012
associations with cannabis use, perception of general use and perception of general Revised 15 March 2013
acceptance of use were assessed. Accepted 25 March 2013
Results: After removing respondents based on age and responses to questions, 1416 valid Published online 5 July 2013
survey questionnaires were collected. In bivariate analyses, both positive effects and negative
effects were associated with use (p50.001), perceived normative use (p50.001) and
acceptance of use (p50.001). In multivariate analyses, only glorification remained consistently
associated with perceived use, acceptance and all categories of use (p50.001).
For personal use only.

Conclusions: Positive beliefs about the effects of cannabis use are important and form part of a
cannabis culture, which are essential for understanding initiation and maintenance of cannabis
use. These findings have important ramifications for cannabis preventive work and also call on
further investigation into the relation between cannabis culture and individual use.

Introduction with greater dependence severity (Connor et al., 2011).

The importance of expectancies for gender, and the onset age
Cannabis is the most commonly used illicit drug in the world.
of cannabis use, onset age of abuse, abuse and dependence
As many as 200 million people use cannabis worldwide
have also been revealed (Guillem et al., 2011). By including
(Degenhardt & Hall, 2012). Cannabis use is associated with a
positive expectancies to drug use, the CEQ makes it possible
significant risk of psychotic disorders (Rossler et al., 2012).
to study how positive and negative individual expectations
Although risk is lower for cannabis than for several other
influence drug use.
substances, a considerable proportion of users eventually
Cannabis can be seen as symbolic consumption, situated in
become dependent on cannabis (Degenhardt & Hall, 2012).
language (Booth, 2004; Matthews, 2003). When cannabis was
Evidence links early onset of cannabis use to later problems,
introduced on a large scale in the West during the 60 s, it was
including both psychosis and dependence (Schneider, 2008).
It is thus not surprising that perceived personal risks are
associated with new age beliefs, interest in Eastern philoso- 14
20
phy and vague political opposition, and became a symbol
negatively associated with cannabis use (Beaudoin & Hong,
amid the political struggles of the 1960s (Booth, 2004; Clarke
2012), and that prevention efforts often rest on the assumption
et al., 2000; Pedersen, 2009; Young, 1971). Although the
that information about drug use should increase risk aware-
symbolic status of cannabis originates in the social move-
ness, or improve desistence skills such as resisting peer
ments of the 60 s and 70 s, it has later developed and merged
pressure (Peretti-Watel & Moatti, 2006).
with other cultural currents such as Rastafarian culture
However, emphasis on risks associated with use may only
(Hamid, 2002) and hip-hop culture (Golub, 2005). It is in
tell half the story. The Cannabis Expectancy Questionnaire
these hybrid cultures that the present day ‘‘cannabis culture’’
(CEQ) was designed to study both negative and the positive
can be identified. Today, cannabis users remain supportive of
use outcome expectancies (Young & Kavanagh, 1997).
anti-authoritarian groups (Pedersen, 2009; Stevenson, 2012),
Recent studies using this questionnaire link positive expec-
and attend rock festivals at high rates (Hesse et al., 2010;
tancies with higher consumption and negative expectancies
Lim et al., 2010).
The cultural meaning of cannabis has received little
attention in the understanding of individuals’ use of cannabis,
Correspondence: Dr Torsten Kolind, Centre for Alcohol and Drug
Research, Aarhus University, Bartholins Allé 10, bygn. 1322, Aarhus, and in cannabis preventive strategies. There have also been
Aarhus C Denmark. E-mail: tk@crf.au.dk few attempts to link qualitative studies of the symbolic
 252 S. Holm et al.
meaning and narratives of cannabis, with quantitative studies
of cannabis expectancies and use. Moreover, positive
expectancies to cannabis use (Connor, et al., 2011; Guillem,
et al., 2011) have not been studied in a Scandinavian context
previously.
In a qualitative study including interviews with 100
cannabis users in Norway, we found that apart from
describing cannabis as harmless or common, users elaborate
on the benefits of cannabis use, by describing the cannabis
high as peaceful, spiritual, a sharpening of senses, and
cannabis users as open-minded, creative and anti-authoritar-
ian (Sandberg, 2012). Moreover, in both the Danish and
Norwegian study, cannabis users emphasize the fact that
cannabis is a natural product and that it has medical value
(Dahl & Frank, 2011; Pedersen & Sandberg, 2013). Together,
such beliefs and more general narratives of cannabis users can
be seen as part of current cannabis culture, that is, a relatively
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homogeneous set of symbols, rituals and narratives
(Sandberg, 2013). This study seeks to identify these qualita-
tive findings and the relation between beliefs and cannabis
use in a general population sample of students in a catchment
area. The beliefs associated with cannabis culture were
measured on a positive effect scale, and their importance for
use was compared with beliefs associated with the risks of
cannabis use on a negative effect scale. More specifically, the
study was exploratory, aspiring to: (a) develop a measure of
the cannabis culture, the Cannabis Culture Questionnaire
For personal use only.
(CCQ); (b) assess the factor structure of the CCQ; (c) identify
what if any CCQ subscales are significantly associated with
cannabis use; and (d) identify what if any CCQ subscales are
associated with acceptance of use among never-users. Our
hypothesis was that the beliefs of the cannabis culture are
relatively widespread among adolescents and that for canna-
bis use, positive beliefs are more important than beliefs
associated with risks of use.
Methods
The setting was 10 educational programs offering education
for students aged 16–18 years in a single catchment area
(Skive Municipality) in Denmark, an area with small towns
and rural areas. School programs included high schools,
technical schools that offer skills, a high school equivalence
program and a program offering a mixture of educational and
work activities to young people who are not participating in
regular education. All schools (N ¼ 10) in the municipality
participated, and all students present in all classes filled in the
questionnaire during lessons. Perceived norms were measured
by asking two questions: ‘‘How large a proportion of the
students at my school have used cannabis more than once in
the past month?’’ and ‘‘How many students at my school find
it OK to smoke cannabis’’. Response options for both
questions ranged from ‘‘10%’’ to ‘‘100%’’.
To assess never-users’ openness to try cannabis, we asked
two questions: ‘‘I think it is quite OK to smoke cannabis once
in a while’’ and ‘‘My friends would think that it was OK
if I smoked cannabis’’. For both questions, the response
options were ‘‘Yes’’, ‘‘No’’ or ‘‘Don’t know’’. Students were
asked to self-report their cannabis use by indicating if they
had ever smoked cannabis (lifetime), if they had done so more
J Subst Use, 2014; 19(3): 251–256
than once in the past month (‘‘monthly’’) and if they
generally used cannabis more than once per week
(‘‘weekly’’).
The CCQ was developed based on qualitative data from
previous studies (Dahl & Frank, 2011; Pedersen & Sandberg,
2013; Sandberg, 2012, 2013). Items in the positive effects
scale were directly replicating the dominant cultural meanings
and narratives that appeared in interviews with cannabis
users. As opposed to the CEQ (Young & Kavanagh, 1997),
and in line with the way cannabis user spoke in interviews,
they were not stated to refer to an individual person, but rather
as general statements. Harms and benefits of cannabis
previously described by cannabis users were in the CCQ
rephrased into 27 brief items. Responses were then subjected
to factor analysis to derive scales (see below). Each item was
answered on a 5-point Likert scale ranging from ‘‘strongly
disagree’’ to ‘‘strongly agree’’.
Statistical analyses
The 27 items in the CCQ were subjected to a series of
exploratory factor analyses in a random subset of the
respondents (n ¼ 747). The first analyses were based on a
random half of the sample of respondents. Because items
were scored on a Likert scale, the factor analyses were done
using the polychoric correlations. Parallel analysis was used
to decide the number of factors. Based on permutation of
sample values, 500 random correlation matrices were
produced. Factors were retained if they explained more than
was explained by the 95th percent of random correlation
matrices (Timmerman & Lorenzo-Seva, 2011). Factors were
extracted using the unweighted least squares estimator, and
results were rotated using Promin rotation. After conducting a
preliminary factor analysis with all items, items were
excluded if they had a communality lower than 0.5
(MacCallum et al., 2001; Zimmer & Morgan, 1997), or if
they had loadings 40.3 on more than one factor. The factor
structure was then replicated using the remaining 772
respondents who completed all items, and the coefficient of
congruence was used to compare the factor solutions. For
the coefficient of congruence, values above 0.95 indicate that
two factors can be considered equal (Lorenzo-Seva & ten
Berge, 2006). Factor analysis was carried out using FACTOR
(Lorenzo-Seva & Ferrando, 2006).
When the scales were extracted, a series of regression
analyses were conducted to assess correlates of the derived
sub-scales of the CCQ. Multinomial logistic regression was
conducted to predict the relative risk of use in four categories
(never used, lifetime use, used monthly, used weekly). Among
never-users, multinomial logistic regression was used to
predict the likelihood that a respondent would think that it
was acceptable to smoke, and the expectation that their
friends would think that it is acceptable if they smoked, with
the response variables ‘‘yes’’, ‘‘no’’ and ‘‘maybe’’ for both
variables. We reversed the negative effects scale and
standardized both scales to have a mean of zero and a
standard deviation of one in order to make coefficients for the
two factor-derived scales comparable in regression analyses.
All analyses were controlled for differences between
schools, and the gender and age of the respondent.
 DOI: 10.3109/14659891.2013.790493 Cannabis culture 253

Additional control variables are described in the text below.
Due to multiple significance tests, a was set to 0.001.
Results
Participants
A total of 1769 students accessed the survey, and 1599
completed all items. Factor analyses were conducted with the
1519 subjects who completed the CCQ and were within the
age range of 16–22. After removing respondents younger than
16 years and older than 21 years (n ¼ 174), and all respond-
ents who gave the same response to every question (n ¼ 20),
1416 were left for analysis (i.e. 66% of all students in the
area). The mean age of the respondents was 18.1 years
(SD ¼ 1.2), and the sample was comprised of 710 women and
706 men.
Of all subjects, 57% were never-users of cannabis, 30%
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identical. The items and the loadings from the replication
are shown in Table 1. In the replication subsample, the
internal consistency of the resulting Positive Effect scale was
a ¼ 0.84, and the internal consistency of the Negative Effect
scale was a ¼ 0.89. Goodness of Fit Index for the model was
0.99, and the Root Mean Square of Residuals was 0.05,
indicating acceptable model fit.
The first factor was comprised of nine items describing
mainly negative consequences of cannabis use. Examples
include dropping out of normal society, poor brain function-
ing, the presence of negative consequences and negative
impact of cannabis on the ability to work or finish an
education. We have chosen to call this factor ‘‘negative effect
scale’’, because it includes information that points to the
dangers of cannabis use. The second factor was comprised of
eight items mainly describing cannabis or cannabis users in a
positive way. Examples include describing cannabis users as

were lifetime users, 7% were past month users and 6% were

weekly users.
Factor analysis
An initial factor analysis of all items supported a two-factor
solution. Of the 27 items, 10 either had communalities 50.5
or loadings 40.3 on both factors. When conducting the final
factor analysis, the Kaiser–Meyer–Olkin test (KMO)
was ¼ 0.92 (very good), and the parallel analysis confirmed
that a two-factor solution was optimal for the data. Factor 1
can be described as negative effects. The items of the factor
For personal use only.
relaxed, as a source of creativity and as a positive contribution
to culture. We labelled this factor ‘‘positive effect scale’’, and
we view these kind of statements as indicative of the cannabis
culture which positively shapes the symbolic meaning of the
drug (‘‘celebrating the drug’’; Sandberg, 2012).
Associations with frequency of use
The bivariate Spearman correlations between variables used
in the analyses are shown in Table 2. Note that for all
analyses, higher scores on the Negative Effects scale represent

concern health and social consequences of cannabis. Factor 2
can be described as a positive view of cannabis that broadly
identifies a range of positive effects for both the individual
and society. For the purpose of this article, we shall call this
factor Positive Effects.
When the same variables were analysed with the second
half of the sample, KMO was 0.90, the recommended number
of factors was 2 and the coefficients of congruence were
0.982 for Negative Effects and 0.981 for Positive Effects,
indicating that the factor structures can be considered
disagreement with negative effects. All cannabis variables
were significantly inter-related, and male gender was
associated with positive effects, negative effects and fre-
quency of use. As would be expected, self-reported frequency
of use was associated with estimated frequency of use at the
school and with the perceived proportion of people who
would accept cannabis use at the school.
The purpose of the first regression analyses was to assess
associations between positive effects, negative effects and
frequency of use (see Table 3). In the first regression analyses,

Table 1. Items and factor structure (replication sample, n ¼ 772)1.

Mean2 SD F1 F2 H2
1. People who smoke cannabis are more relaxed in the way they are together 2.81 1.09 0.213 0.777 0.430
2. People who do not smoke cannabis stress over all sorts of meaningless things 3.40 1.19 0.192 0.582 0.227
3. People get lazy and lose initiative when they smoke cannabis 2.42 1.02 0.667 0.203 0.306
4. People get more ideas and become more creative when they smoke cannabis 3.13 1.06 0.059 0.572 0.375
5. People can expand their consciousness and gain greater insight in life by smoking cannabis 3.34 1.05 0.082 0.560 0.381
6. People who smoke cannabis regularly have somewhat dropped out of ‘‘normal society’’ 2.73 1.22 0.678 0.086 0.389
7. When people start to smoke cannabis, their brains will function poorly 2.16 1.10 0.666 0.005 0.449
8. Alcohol is more harmful than cannabis 2.78 1.26 0.008 0.577 0.327
9. Cannabis has contributed positively to our culture (e.g. in relation to music or humour) 2.81 1.24 0.049 0.759 0.530
10. The cannabis plant is doing more good than harm, among other things because it can be 2.68 1.06 0.044 0.749 0.518
used as medicine
11. It is important to remember that cannabis is a natural product 2.74 1.22 0.066 0.721 0.462
12. Most people could not finish an education or look after a job if they smoke cannabis every night 2.40 1.31 0.704 0.068 0.437
13. People who smoke cannabis become less ambitious and career minded 2.45 1.14 0.841 0.123 0.585
14. Cannabis can cause dependence 1.64 1.00 0.627 0.075 0.337
15. Smoking cannabis will often lead to ‘‘hard drugs’’ 2.49 1.19 0.683 0.024 0.489
16. If someone smokes cannabis, it will often affect their lives in a negative way 2.37 1.13 0.778 0.106 0.726
17. If someone smokes cannabis, it will often affect their lives in a positive way 3.70 1.08 0.463 0.334 0.532
Eigenvalue 6.520 2.073

F1: Factor 1. F2: Factor 2.

1
Factor scores with salient loadings in the construction sample are in boldface.
2
On a Likert scale from 1 (complete agree) to 5 (completely disagree).
 254 S. Holm et al. J Subst Use, 2014; 19(3): 251–256

Table 2. Intercorrelations of variables (n ¼ 1416). Table 4. Prediction of perceived peer acceptance of use among never-
users by multinomial logistic regression analyses (n ¼ 803).
NO Perceived Perceived
GLOR HARM Age Gender accept norm Model 1 Model 2
NO HARM 0.49 b Z b Z
Age 0.04 0.05
Gender 0.27 0.26 0.05 Not OK to smoke REF REF
Perceived accept 0.25 0.14 0.02 0.00 OK to smoke
Perceived norm 0.19 0.05 0.05 0.05 0.62 GLOR *1.47 7.90 *1.15 5.88
Frequency of use1 0.43 0.32 0.08 0.23 0.33 0.27 NO HARM *1.25 7.83 *0.94 5.54
Don’t know
Spearman correlations. GLOR: Glorification. NO HARM: Rejection of GLOR *0.70 4.25 0.33 1.83
harms. Correlations in boldface are significant at p50.001. NEUT *1.09 6.99 *0.98 5.91
1
On a scale from 0 (never) to 4 (more than once per week).
REF: Reference value. GLOR: Glorification. NO HARM: disagreement
with harm-related items.
Table 3. Prediction of frequency of use by multinomial logistic Model 1: Controlling for age, gender, differences between schools.
regression analyses (n ¼ 1416). Model 2: Same as above, plus GLOR and NO HARM entered together.
*p50.001.
Model 1 Model 2 Model 3
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b Z b Z b Z Table 5. Prediction of perceived peer acceptance of use among never-

users by multinomial logistic regression analyses (n ¼ 803).
Never used REF REF REF
Lifetime
GLOR *0.79 7.56 *0.70 6.44 *0.61 5.20 Model 1 Model 2
NO HARM *0.47 5.11 *0.43 4.50 0.22 2.08 b Z b Z
Monthlyþ
GLOR *2.19 11.20 *2.01 9.99 *1.68 7.77 Would not accept REF REF
NO HARM *1.40 8.87 *1.33 8.15 *0.76 4.28 Would accept
Weeklyþ GLOR *0.96 5.32 *0.74 3.85
GLOR *2.85 12.33 *2.59 10.84 *2.19 8.71 NO HARM *0.79 4.93 0.54 3.14
NO HARM *1.76 10.03 *1.62 8.85 *0.93 4.63 Don’t know
GLOR *0.82 5.53 0.54 3.33
For personal use only.

REF: Reference value. GLOR: Glorification. NO HARM: disagreement NO HARM *0.89 6.46 *0.70 4.71
with harm-related items. Monthlyþ: Use more than once per month.
Weeklyþ: Use more than once per week. REF: Reference value. GLOR: Glorification. NO HARM: disagreement
Model 1: Controlling for age, gender, differences between schools. with harm-related items.
Model 2: Controlling for age, gender, differences between school, Model 1: Controlling for age, gender, differences between schools.
perceived acceptance and perceived norm. Model 2: Same as above, plus GLOR and NO HARM entered together.
Model 3: Same as model 2, plus GLOR and NO HARM entered together. *p50.001.
*p50.001.

Of the never-smokers, 19% indicated that their friends

in which positive effects and negative effects were both
entered alone, both were associated with all categories of use
(i.e. lifetime, monthly and weekly use). These associations did
not change substantially when perceived norms and perceived
accept of cannabis use were controlled (model 2). Positive
effects and negative effects both remained significantly
associated with all categories of use. However, only positive
effects was associated with all categories of use, when both
positive and negative effects were entered into the regression
model together, whereas negative effects was not associated
with lifetime use (model 3).
Associations between cannabis culture variables and
openness to try hash among never-users
A total of 803 respondents had answered that they had never
used cannabis, and could be included for these analyses. Of
the never-smokers, 22% indicated that it was OK to smoke
occasionally, 55% indicated that it was not OK and 23% were
undecided. The adjusted associations from multinomial
logistic regression are shown in Table 4. Both the positive
effects scale and the negative effects scale were associated
with both being undecided and endorsing this item. When
positive effects and negative effects were entered together, all
remained significant, except that positive effects was no
longer associated with being undecided.
would accept if they smoked, 47% indicated that their friends
would not accept it and 33% were uncertain. The adjusted
associations from multinomial logistic regression are shown
in Table 5. Both positive effects and negative effects were
associated with both being undecided and answering ‘‘yes’’ to
this item. When positive effects and negative effects were
entered together, the only significant association was between
positive effects and answering yes to the item that friends
would accept it if they smoked.
Discussion
The items of the CCQ loaded on two latent factors, which we
have here labelled negative effects scale and positive effects
scale. These two factors represent correlated but distinct sets
of beliefs: the first set of beliefs concerns the harmful social
and physical consequences of cannabis use. The second set of
beliefs draws on the cannabis culture, which describes the
drug positively in terms of its effects on both the individual
and society. Positive effects are associated with cannabis use,
and also associated with acceptance of use among never-
users.
Both scales were associated with all categories of cannabis
use, from having ever tried use to using cannabis more than
once per week. This held after controlling for two widely used
 DOI: 10.3109/14659891.2013.790493
indicators of risk of substance use, perceived normative use
and perceived acceptance of cannabis use. However, when
both positive effects and negative effects were entered
together, positive effects came out as the variable that
remained significantly associated with all categories of
cannabis use. Additionally, both scales were associated with
openness to use cannabis among never-users.
Cannabis is an important part of identity (Hammersley
et al., 2001). The importance of positive beliefs for use has
also been found in studies from Australia (Connor et al.,
2011), Canada (Osborne & Fogel, 2008), France (Guillem,
2011) and the UK (Hammersley & Leon, 2006). There is thus
reason to believe that regardless of culture positive beliefs are
important for cannabis users. This study adds to this picture,
but also adds a new aspect. Previous qualitative studies of
cannabis in Scandinavia identify a relatively coherent set of
beliefs about the positive effects of cannabis. The beliefs
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describe cannabis not only as ‘‘harmless fun’’ or ‘‘a good
feeling’’, but also as a valuable contribution to creativity,
culture and thinking, and as a ‘‘natural product’’ and a
medicine with great potential. The findings in this study show
that such beliefs are endorsed by cannabis users and
identifiable in young people undergoing education. To
understand the frequency of use, these beliefs are as important
as whether cannabis use is perceived as harmful, immoral or
deviant. These findings have important implications for
research. First, it is important to understand how these
For personal use only.
different sets of beliefs develop in relation to cannabis use. It
is possible that beliefs about positive effects begin to develop
prior to experimental use of cannabis and that such beliefs are
important precursors of cannabis use. It is also feasible that
the endorsement of these beliefs develops concurrently with
the development of cannabis use and that they may, in
addition or only, be important for the maintenance of cannabis
use. Longitudinal research is needed to answer these
questions.
A second question is how the beliefs are developed and
endorsed in friendship groups. Designs that focus on social
networks may inform our knowledge on the processes
whereby such beliefs are transmitted and interpreted in
social groups. Additionally, research should further address
the relationship between cannabis culture and social identity,
including ethnic identity, social class, gender and social
status. Such research could question the coherency of the
cannabis culture, that is, investigate if different elements of
the cannabis culture are more important than others depend-
ing on the social identity of the user and the context of use.
Previous cannabis prevention research has revealed the
importance of perceived individual and societal risks
(Beaudoin & Hong, 2012). The findings in this study suggest
that prevention efforts that acknowledge positive expectancies
and positive cultural beliefs associated with cannabis use may
be more effective than prevention strategies focusing solely
on the risks of using cannabis. Moreover, because the beliefs
of cannabis culture are interrelated, it is unlikely that
challenging individual statements about cannabis as
‘‘myths’’ will be effective. Instead, we suggest a dialogue
with young people acknowledging the complexity of the
issues related to perceived cannabis benefits and discussing
cannabis in terms of the whole picture.
Cannabis culture 255
The study had some limitations. First, it was derived from
one area in one country, and it is uncertain whether and how
the results will generalize to other countries, especially those
culturally different from the North European context in which
this study was carried out. In addition, we had limited
information about respondents’ socioeconomic status and
nothing about their ethnic status. The catchment area for the
study was mainly small town and rural, and the area is
predominantly Danish, ethnically and culturally. As opposed
to the CEQ, the CCQ also includes fewer questions and is thus
less sensitive. However, the study also had strengths. The
questionnaire was designed based on a four-year qualitative
study. We covered a wide range of educational institutions,
and the respondents were at an age where initiation of
cannabis use is likely to occur. In addition, we had an
acceptable response rate, and only a small number of
questionnaires had to be excluded.
Conclusion
Young people who use cannabis endorse a relatively coherent
set of beliefs about the positive effects of cannabis. These are
indicative of a cannabis culture, which seems to be as
important for use as perceived risks and beliefs that cannabis
is commonly used and accepted by schoolmates.
Declaration of interest
This study was supported by the Danish Health and
Medicines Authority. Morten Hesse has received funding
from Reckitt Benckiser for an unrelated study.
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