Exposure to cannabis marketing in the United States and differences by cannabis laws: Findings from the International Cannabis Policy Study.

Abstract

A growing number of US states have legalized adult "recreational" cannabis; however, there is little evidence on the impact of cannabis policies on cannabis marketing exposure to date. The current study examined marketing exposure in the US, including differences between states where cannabis is illegal ('illegal' states), legal for medical use ('medical'), and legal for recreational use ('recreational'). Data are from the US component of the International Cannabis Policy Study: national repeat cross-sectional data from surveys conducted with 187,573 respondents aged 16-65 over 6 annual survey waves (2018-2023). Adjusted mixed effects logistic regression (GLIMMIX) models examined differences in self-reported exposure to cannabis marketing ('noticing') by state-level cannabis laws. Self-reported exposure to cannabis marketing differed across policy changes. Noticing cannabis marketing was lowest in illegal states and increased in the first 12-months following medical legalization (35.4 % vs. 39.2 %: AOR=1.16; 95 % CI=1.01-1.33; p = 0.034). Noticing marketing was highest in 'recreational' states, with increases in the first 12-months following legalization (50.0 % vs. 41.1 %: AOR=1.41; 95 % CI=1.34-1.48; p < .001), and additional increases 1-3 years (56.2 %: AOR=1.20; 95 % CI=1.14-1.25; p < .001) and 4 or more years following legalization (63.9 %: AOR=1.21; 95 % CI=1.16-1.27; p < .001). Noticing was highest among people who consume cannabis and younger ages. Self-reported exposure to cannabis marketing increases following medical and recreational legalization and is disproportionately noticed by underaged people. Cannabis regulations in 'legal' markets should account for marketing, which has been shown to promote cannabis use.