The inverse relationship between perception of harm and substance use is clearly supported by decades of research – youth are less likely to engage in substance use when it is seen as harmful. However, despite strong theoretical and practical reasons to focus on perception of harm as a change-producer in prevention programming, little is known about what is effective in impacting perception of harm for youth marijuana use.

To investigate the impact of existing prevention efforts designed to influence youth perception of harm and, consequently, youth marijuana use, we reviewed seven privately- or federally-funded online registries (e.g., Blueprints for Healthy Youth Development, Substance Abuse and Mental Health Administration’s National Registry of Evidence Based Programs and Practices) to identify evidence-based programs with marijuana-related outcomes for youth. We found 36 registry-identified programs with demonstrated impact on youth marijuana use. Although many of these programs may have actively or passively sought to alter perception of harm, only ten measured marijuana- or drug-related perception of harm as an intermediate outcome. Drawing on the commonalities of evidence-based programs with significant impacts on youth marijuana perception of harm, as well as lessons learned from other health behavior change efforts, we recommend best practices to provide state and local decision-makers with information on altering youth perception of harm for marijuana and on evaluating the impact of these efforts.

Key Take Away Points

  • Prevention programs that influence youth perception of harm for marijuana are multi-faceted, combining education-based strategies on improving knowledge about marijuana-related harms with additional emphasis on how interpersonal influence impacts drug-related decision-making.
  • Although many youth marijuana prevention programs actively or passively seek to alter perception of harm, few actually measure youth perception of harm for marijuana as an intermediate outcome. When perception of harm is a core program component but is not assessed or is inadequately assessed, programs are unable to articulate whether they demonstrated outcomes according to hypothesized mechanisms.
  • The prevention field would be well-served by developing a stronger understanding of how perception of harm plays a role in marijuana-related prevention and comprehensively evaluating its impact in our evidence-based programs.

Author Biography

Kristen Quinlan, Ph.D., is an Evaluator with SAMHSA’s Center for the Application of Prevention Technologies and an Epidemiologist for the Suicide Prevention Resource Center at the Education Development Center. Her past and current work with states, communities and grassroots agencies seeks to build in-house evaluation capacity on all aspects of the evaluation process, including logic model development, the development of fidelity tools, the design and selection of measurement tools, and dissemination of results. Dr. Quinlan seeks to translate research to practice, interpreting and disseminating emerging research findings to practitioners. She has conducted literature reviews examining contributing factors and effective strategies for preventing consumption of new substances of abuse, such as the non-medical use of prescription drugs and the non-medical use of marijuana, resulting in increased capacity of States, tribes, jurisdictions and their sub-recipient communities in substance abuse prevention practice. Dr. Quinlan has published evaluation-related guidance documents and decision-support tools that have been widely distributed to a national audience of prevention practitioners. Dr. Quinlan holds a Bachelor of Science in Psychology from Providence College, a Master of Science in Experimental Psychology and a Ph.D. in Behavioral Science from the University of Rhode Island. Maria Valenti, Ph.D., works for SAMHSA's Center for the Application of Prevention Technologies (CAPT) as a Science Writer and Epidemiology Technical Assistance Provider. As a science writer, she conducts literature searches to support product development, crafts materials in conjunction with instructional designers, and develops and delivers webinars on critical prevention science topics. As epidemiology technical assistance provider, Dr. Valenti provides training and technical assistance to states in the Northeast regarding substance use prevention surveillance activities, data-driven decision-making, and assists with the presentation and dissemination of epidemiological findings. Before assuming this position, Dr. Valenti served as the Service to Science Lead for the Northeast CAPT where she oversaw the evaluation training and technical assistance provided to participating substance use prevention programs, and led a team of experts who assisted local program directors, developers, and evaluators in documenting evidence of program effectiveness. Dr. Valenti earned her PhD in ecological-community psychology from Michigan State University, and has a background in program evaluation with special expertise in sexual minority issues. Gisela Rots, MS, has ten years of experience in managing and coordinating substance abuse prevention programs and training and technical assistance efforts. Currently, she is responsible for directing training and technical assistance to SAMHSA grantees in the Northeastern United States as they seek to reduce the impact of substance abuse. She works with grantees to prepare and implement state service plans, manages expert technical assistance providers, and delivers training and technical assistance services to grantees. She is well-versed in relevant risk and protective factors related to and programs designed to reduce the consumption and consequences of various substances, including non-medical use of prescription drugs, opioids, and marijuana. Her specific expertise includes developing social marketing campaigns, managing award-winning training programs, providing technical assistance to community coalitions, and developing cross-sector partnerships. She has effectively led the creation and implementation of responsible beverage service training program; and, in partnership with local health departments, has succeeded in decreasing use of alcohol among 8th graders by implementing and evaluating a social marketing campaign that helped parents reduce social access to alcohol. She also has experience working in HIV/AIDS prevention programs, youth programming, and international relations. She received her BA in Political Science-International Relations from the University of Maryland at College Park and her Master of Science in Gender and Social Policy from the London School of Economics. For more than 20 years, Kim Dash, PhD, MPH, has translated research and practice on disease and risk prevention into evidence-informed interventions that improve public health. By collaborating with diverse clientele, including healthcare professionals and prevention practitioners, she supports the uptake, adoption, and implementation of best practice in real-world health settings. Dash currently serves as the scientific advisor for SAMHSA’s Center for Application of Prevention Technologies (CAPT), where she works with training and technical assistance teams to ensure that services and products incorporate accurate scientific content; are informed by advances in substance abuse prevention; and are designed to facilitate learner engagement, skills building, and virtual interactivity. Dr. Dash has extensive experience in the area of youth risk behaviors: managing federally-funded research projects to develop and test innovate parent education and school-community interventions—Reach for Health Middle Childhood Risk Prevention Study (Saving Sex for Later) and Multi-level Bystander Strategies for Preventing Youth Violence—to reduce risky sexual and violent behaviors; developing innovative curricula—Teenage Health Teaching Modules and Aggressors, Victims, and Bystanders—that promotes healthy decision-making; and evaluating programs designed to reduce underage drinking, meet children’s social and emotional needs, and increase the number of ethnic and minority youth choosing to pursue careers in the health professions. In addition, Dash served as Senior Associate and Acting Director of the USED’s National Training Center for Middle school Drug Prevention and School Safety Coordinators. She has her MPH from the University of North Carolina and a PhD in child, youth, and family policy from Brandeis University. Josh Esrick, MA is a Policy Analyst with Carnevale Associates, LLC. During his tenure with the firm, he has researched and written publications for the federal government and nongovernmental organizations, developed and conducted evaluations, and facilitated strategic planning and rulemaking. Mr. Esrick has extensive experience with a variety of federal, state, and local behavioral health organizations, providing technical assistance on topics ranging from best practices for collaborative efforts to the latest research on prevention and treatment interventions. He has also been heavily involved in behavioral health evaluations, including of the District of Columbia Department of Behavioral Health (DCDBH) State Youth Treatment grant. Mr. Esrick helped research, develop, and present four Substance Abuse and Mental Health Services Administration (SAMHSA) Center for the Application of Prevention Technologies' (CAPT) Decision Support Tools regarding prescription drug misuse and abuse and other substance abuse and other CAPT products. He has also worked extensively on other projects with DCDBH, SAMHSA's Center for Financing Reform and Innovation (CFRI) and Center for Substance Abuse Prevention (CSAP), The National Alliance for Model State Drug Laws, and other organizations. Mr. Esrick is an expert in the Affordable Care Act's provisions and implementation, particularly its effects on Medicaid and behavioral health financing. Mr. Esrick has published in the International Journal of Drug Policy. He holds a Bachelor of Arts in Political Science from the State University of New York at Buffalo and a Masters of Public Policy from George Washington University.


Disclaimer: Support for this work was provided by and administered through the Center for Substance Abuse Prevention, Contract Number #HHSS283201200024I/HHSS28342002T, Reference number 283-12-2400. The content of the publication does not necessarily reflect the views or policies of the Department of Health and Human Services, and the views expressed in this paper are those of the authors.

Correspondence concerning this article should be addressed to Kristen J. Quinlan, Education Development Center, Inc., 43 Foundry Avenue, Waltham, MA 02453. Contact: Kquinlan@edc.org