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.4, Objectives. The purpose of this study was to examine the relation- ship of marijuana use to mortality. MethoA The study population comprised 65 171 Kaiser Perman- ente Medical Care Program enroll- ees, aged 15 through 49 years, who completed questionnaires about smoking habits. including marijuana use, between 1979 and 1985. Mortal- ity follow-up was conducted through 1991. Results. Compared with nonuse or experimentation (lifetime use six or fewer urns), current marijuana use was riot associated with a signifi- cantly increased risk of non -acquired immunodeficiency syndrome (AIDS) nxxtality in men (relative risk [RR1 = 1.12, 95%confidence Interval [CU = 0.89, 1.39) or of total mortality in women (RR = 1.09.95%CI = 0.80, 1.48). Curran marijuana use was asstxiated with increased risk of AIDS mortality to men (RR = 1.90. 95% CI = 133.2.73), an association that probably was no(causal but most likely represented uncontrolled con- founding by male homosexual behav- ior. Tlus interpretation was supported by the lack of association of mari- juana use with AIDS mortality in men from a Kaiser Pennanente A[DS database.. Relauve risks for ever use of marijuana were similar. Conclusions. Marijuana use in a prepaid health care -based study co- hon had little effect on non -AIDS monabty in men and on total mortal- ity to women. (Am J Public Health. 1997;87:585-590) Marijuana Use and rtality Stephen Sidney, AID, Jerome E. Beck DrPll, Irene S. Tekawa. MA, Charles P. Quesenberry Jr, PhD, and Gary D. Friedman, AID Introduction Marijuana is the most commonly used illegal drug to the United States. Over 65 million Americans (31% of the US population aged 12 and older) 'are estimated to have used marijuana': its mean retail sales value In the United States is approximately $10 bdlion.t Despite its longstanding popularity and increasing use among youth in recent years.' i we still know little about long- term health risks associated with mari- juana use. Harvard policy analyst Mark Kleiman recently concluded that "aside from the almost self-evident proposition that smoking anything is probably bad for the lungs, the quarter century since large numbers of Americans began to use marijuana has produced remarkably little laboratory or epidemiological evidence of serious health damage done by the drug."*P251i Similar appraisals of the health effects of cannabis were offered in the two most comprehensive reviews tram the 19805.1.6 More currently, Hall and coauthors concluded that while there are no well-established health or psycho- logical effects of chronic cannabis use, the following were considered to be probable major adverse effects. respiratory diseases associated with smoking as the method of administration, including chronic bronchi- tis and premalignant histopathological changes In the lung, development of a cannabis dependence syndrome: and subtle forms of cognitive unpannent.'IPmi The only other large-scale study of marijuana use and mortality was per- formed In a cohort of 45 540 male Swedish conscripts, aged 18 through 2�0 years at baseline and followed for 15 years.' In this study. the relative risk (RR) for monality associated with marijuana use (more than 50 tinies) was 1.2 (95% confidence interval [C11 = 0.8, 1.9) after adjustment for social background. We report here the findings of a study of the relationship of marijuana use to mortality in a cohort of over 65 000 'members of a large prepaid health plan. Data on marijuana use in this cohort were collected before the "war on drugs" escalated in the latter half of the 1980s. which may have resulted in underreport- ing of illegal drug use.° Mortality is one of several health outcomes being studied: other endpoints Include cancer incidence and outpauent utilization for respiratory illnesses and Injuries. We hypothesiztd that marijuana use would be assmiated with increased risk of respiratory disease and injury. Methods Study Population A cohort of 65 171 men and women aged 15 through 49 years (mean age. 33 years) completed detailed self-adminis- tered research questionnaires on tobacco. marijuana. and alcohol use from mid - 1979 through 1985. The subjects were undergoing multiphasic health checkups in the San Francisco (until 1980) and Oakland Kaiser Permanente facilities. Monahty was followed dough Decem- ber 31. 1991, for a mean length of 10.0 years. Stephen Sidney. Irene S Tekawa Charles P Quewnbemy. Jr, and Gary D Friedman are with the Division of Research. Kaiser Permanente ,Medical Care Program (Northern California Region). Oakland. Calif. Jerome E. Beck is with the School of Public Health. University of California. Berkeley. Requests for reprints should be sent to Stephen Sidney. MD. Division of Research. Kaiser Permanente Medical Care Prugram 3505 Broadway. Oakland. CA 94611. This paper was accepted June 28, 1996. April 1997. Vol. 87. No. 4 American Journal of Public Health 585