Gender convergence of cannabis use, dependence, and risk in the U.S.

Historically, males exhibited higher prevalence of cannabis use, greater dependence, and viewed cannabis as less risky. However, as U.S. cannabis policy shifts rapidly, accompanied by cultural changes in normalization and destigmatization, research has been mixed on whether the male-female gap is increasing or decreasing. Using twenty years (2002-2021) of nationally representative National Survey on Drug Use and Health data and Age-Period-Cohort-Interaction (APC-I) models, we examined trends by gender in past-month and daily cannabis use, dependence, and risk perceptions. Framed within the Theory of Constrained Choices and by highlighting the interdependency of age-period-cohort over time, we demonstrate substantial overall gender convergence across all four cannabis metrics. While this convergence over time was especially pronounced in adolescence and early adulthood, some degree of convergence has occurred for at least some outcomes across all age groups. The form of convergence varied by outcome and life course stage within the same outcome. Generally, convergence seen in any past month use and dependence among adolescents is driven by decreases among males and stable or rising female values, while convergence in daily use is from rising female consumption. Convergence in use and dependence at age 21 and older is typically driven by greater increases among females. Perceptions of risk decreased considerably for both, but especially for females, narrowing gaps across age groups. Sub-analyses indicate that convergence occurred similarly across policy contexts. This convergence underscores that prevention and intervention efforts should continue to incorporate gender-specific needs to improve population health due to differing impacts of comparable use.