EXPOSURE TO CANNABIS MARKETING IN THE UNITED STATES: DIFFERENCES BY CANNABIS LAWS AND THE STRENGTH OF RESTRICTIONS IN ‘RECREATIONAL’ CANNABIS MARKETS

Abstract

Background: A growing number of U.S. states have legalized adult “recreational” cannabis. Restrictions on advertising and promotions to prevent marketing exposure among vulnerable populations are a key component of cannabis regulations in legal markets; however, there is little evidence on the impact of restrictions to date.

Objectives: To examine differences in exposure to cannabis marketing across U.S. states where cannabis is illegal (‘illegal states’), legal for medical use (‘medical states’), and legal for recreational use (‘recreational states’). This study also examined differences in exposure by the strength of marketing restrictions among recreational states.

Methods: Data are from the U.S. component of the International Cannabis Policy Study: repeat cross-sectional data from national surveys conducted with 187,573 respondents aged 16-65 over 6 annual survey waves (2018-2023). Exposure to cannabis marketing was assessed by asking respondents to report whether they have noticed any cannabis marketing across 11 channels in the past 12 months (‘noticing’ of cannabis marketing). The ‘strength’ of marketing restrictions was measured using data sourced from regulatory documents in each recreational state with legal sales and categorized into four strength levels. An index of the strength of marketing restrictions was then created for each recreational state with legal sales. Mixed effects logistic regression models (GLIMMIX) were fitted to analyze differences in self-reported noticing of cannabis marketing across medical and recreational policy changes, as well as by the strength of marketing restrictions in states with legal recreational sales. Analyses also examined exposure measures and associations with sociodemographic factors.

Results: Self-reported exposure to cannabis marketing differed across policy changes. Noticing cannabis marketing was lowest in illegal states, with higher levels of noticing in states in the first 12 months following medical legalization (39.24% vs. 35.37%: AOR=1.16; 95% CI=1.01-1.33; p=0.034). Levels of noticing were higher in the first 12 months following recreational legalization relative to established medical markets (49.96% vs. 41.12%: AOR=1.41; 95% CI=1.34-1.48; p<.001), with additional increases 1-3 years and 4 or more years following the policy change (56.21%: AOR=1.20; 95% CI=1.14-1.25; p<.001, and 63.90%: AOR=1.21; 95% CI=1.16-1.27; p<.001, respectively). Noticing cannabis marketing also differed by the strength of restrictions in recreational states. In states with legal recreational sales, jurisdictions with the high (Level 3) restriction strength reported the lowest exposure to cannabis marketing (53.39% noticed), and exposure was similar across Level 1 and Level 2 restriction states. There was insufficient data to examine long-term trends for restriction levels.

Conclusions: Self-reported exposure to cannabis marketing increases following medical and recreational cannabis legalization. Overall, stronger marketing regulations may reduce exposure in legal markets; however, underaged people report the greatest noticing of cannabis marketing. Research should continue to monitor trends in marketing exposure over time, as more states begin legal recreational sales and legal markets mature.