Social vulnerability and prenatal cannabis safety messaging from cannabis retailers in California.

Abstract

Prenatal cannabis use is increasing, and pregnant individuals often seek guidance from cannabis retailers. It is unknown whether budtender messaging varies by community social vulnerability. This cross-sectional mystery shopper study included 505 randomly selected California licensed cannabis retailers (2/26/2024-1/28/2025). Social vulnerability within a 15-minute drive-time buffer around retailers was measured by the CDC Social Vulnerability Index (SVI; range 0-1; four domains: socioeconomic status, household characteristics, racial/ethnic minority status, housing/transportation). The primary outcome was a 4-category prenatal cannabis risk communication measure: clear risk messaging [reference], mode-specific lower-risk messaging, no clear safety/risk messaging, and safety-affirming messaging. Secondary outcomes included product recommendations, fetal or infant health risks, information sources, and guidance to consult a clinician. Logistic and multinomial logistic regression models assessed associations between SVI and outcomes; SVI was multiplied by 10, so estimates reflect odds associated with a 0.1 increase in SVI. Greater household vulnerability was associated with safety-affirming messaging (OR=1.26;95%CI:1.01-1.56) and no clear safety/risk messaging (OR=1.25; 95%CI:1.05-1.50) versus clear risk messaging. Greater racial/ethnic minority vulnerability was associated with safety-affirming versus clear risk messaging (OR=1.21; 95%CI:1.00-1.47). Greater housing/transportation vulnerability was associated with mode-specific lower-risk messaging versus clear risk messaging (OR=1.42; 95%CI:1.06-1.91). Citing warnings was more common in areas with greater socioeconomic vulnerability (OR=1.23; 95%CI:1.01-1.51). Other outcomes did not differ by SVI. Budtenders in more vulnerable areas were more likely to provide safety-affirming, mode-specific lower-risk, or no clear safety/risk messaging rather than clear prenatal cannabis risk messaging. Findings highlight the need for consistent, evidence-based communication in retail settings.