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A Comparison of Engagement in Cannabis-related Protective Behavioral Strategies across Sex and Cultures

Cannabis-related protective behavioral strategies (PBS) are behaviors used before, during, and/or after using cannabis to reduce its associated harms. Despite the effectiveness of PBS in reducing both cannabis use and negative cannabis-related consequences, few studies have examined whether there are sex and cultural differences in PBS use. In the present study, we compare PBS use across males and females and across five countries. We also examine whether the associations of PBS use with cannabis-related outcomes differ by sex and country. We recruited 1,175 college students (63.3% female; Mage = 20.96, SD = 3.95; 45.1% Freshman, 20.2% Sophomore, 16.6% Junior, 9.7% Senior, 8.4% other) who reported past-month cannabis use from eight universities in five countries (U.S., Spain, Argentina, Uruguay, and the Netherlands) to complete an online survey. The online survey included the Marijuana Use Grid (MUG; Pearson & Marijuana Outcomes Study Team, 2020), Protective Behavioral Strategies for Marijuana scale (PBSM; Pedersen et al., 2016; revised by Pedersen et al., 2017), and Brief-Marijuana Consequences Questionnaire (B-MACQ; Simons et al., 2012). Results of a series of ANOVAs suggested differences across countries on the PBSM total score, F(4, 1,126) = 20.93, p < .001, such that participants in the U.S. (M = 4.53, SD = 1.11) and Spain (M = 4.48, SD = 0.95) endorsed the most frequent PBS use and participants in the Netherlands (M = 3.46, SD = 1.49) endorsed the least frequent PBS use. There were many item-level differences in PBS use across countries with a pattern similar to that for the PBSM total score. Results of a series of independent sample t-tests suggested that females (M = 4.51, SD = 1.11) scored higher than males (M = 4.17, SD =1.09) on the PBSM total score, t(1,123) = -4.88, p < .001, as well as nearly every item. The correlations between PBSM total score and cannabis-related outcomes across gender and countries were mostly in the expected direction: more frequent PBS use was associated with less cannabis use and fewer cannabis-related consequences. These correlations were largest for the U.S. sample. Interestingly, however, the correlation between the PBSM total score and B-MACQ was positive for the Argentina sample and every correlation between the PBSM total score and cannabis-related outcome was positive for the Netherlands sample. The results of the present study suggest there are several gender and cultural differences in the use of cannabis-related PBS. However, future studies are needed to replicate these findings, especially given the relatively small samples for some of the countries in the present study (our smallest sample size was for Uruguay [n = 46]). Gender and cultural differences in PBS use should be considered in developing and tailoring PBS interventions, especially because the PBSM was validated with a U.S. sample and most existing interventions were developed for use with U.S. participants.