Top 5 Takeaways

  1. Declining Cannabis Use Trends: Between 2008–2021, cannabis use among male and female students in grades 8, 10, and 12 in King County, Washington, showed a significant decline.
  2. Sex-Specific Prevalence Shift: Initially, cannabis use was higher among male students. However, in 2021, for the first time, the prevalence of current cannabis use was lower among male students compared to female students.
  3. Grade-wise Prevalence: The highest prevalence of both current and frequent cannabis use was observed among 12th grade students, followed by 10th and 8th graders.
  4. Impact of Legalization and COVID-19: The legalization of nonmedical cannabis and the COVID-19 pandemic’s shift to remote learning environments may have influenced the observed trends in cannabis use among students.
  5. Focus on Tailored Interventions: Developing interventions that consider differences in risk and protective factors by sex or gender identity could improve equity in youth cannabis use reduction strategies.

Original Article Author and Citation

Corresponding Author

Precious Esie,

Suggested Citation

Esie P, Ta M. Cannabis Use Among Students in Grades 8, 10, and 12, by Sex — King County, Washington, 2008–2021. MMWR Morb Mortal Wkly Rep 2024;73:27–31. DOI:


This study analyzed cannabis use trends among students in grades 8, 10, and 12 in King County, Washington, from 2008 to 2021. It revealed a notable decline in cannabis use among both male and female students during this period. The study also found that while cannabis use was historically higher among male students, 2021 marked the first year where the prevalence of current cannabis use was lower among male students compared to female students.


The analysis utilized data from the Healthy Youth Survey, which is a representative, biennial, cross-sectional survey of health and health-related behaviors among public school students. The study focused on data collected from seven survey cycles between 2008 and 2021, specifically targeting King County students in grades 8, 10, and 12. The survey assessed both current (≥1 day use in the previous 30 days) and frequent (≥6 days use in the previous 30 days) cannabis use.


The decline in cannabis use could be associated with several factors, including the legalization of nonmedical cannabis for adults aged ≥21 years in Washington and the shift to remote learning during the COVID-19 pandemic. Interestingly, the study highlights a shift in sex-specific cannabis use trends, with females showing a higher prevalence of current use than males in 2021, reversing historical patterns.


The study emphasizes the importance of continuous monitoring of cannabis use trends among youths, especially considering the potential impacts of societal and legal changes. It also underscores the need for public health strategies that are tailored to address the unique risk and protective factors associated with different demographic groups, including sex and gender identity.

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