CANNABIS LEGALIZATION: UNDERSTANDING HOW EVOLVING POLICY LANDSCAPES AFFECT EMERGING ADULTS’ CANNABIS-RELATED BEHAVIORS IN THE US
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Authors
Drake, Cara
Issue Date
2023
Type
Dissertation
Language
Keywords
cannabis legalization , cannabis policy , emerging adults
Alternative Title
Abstract
BackgroundAn increasing number of US states have legalized cannabis for recreational, or adult, use, where access to cannabis products is limited only by age. The largest proportion of cannabis users are among emerging adults (EAs) compared to younger and older people. EAs are a unique population group, transitioning from adolescence into adulthood, where substance use experimentation is more common than in other life stages; therefore, it is important to understand the effects of cannabis legalization on this group.PurposeThe three objectives of this dissertation were to 1) map and summarize the scientific literature on cannabis advertising effects on perceptions and behaviors, 2) describe cannabis use behaviors among EAs in the US and compare use behaviors in states with and without adult-use legal sales and among EAs under (18-20 years old) and over (21-25 years old) the legal age to purchase cannabis, and 3) test the effects of cannabis advertising stress relief messaging on cannabis-related perceptions and intentions among EAs who are under the legal age to purchase cannabis (18-20 years old).MethodsIn study one, scoping review methods were used to map and summarize the scientific literature on cannabis industry advertising effects on cannabis-related perceptions, beliefs, attitudes, and behaviors. In study two, a cross-sectional study design was used to understand EAs’ cannabis use patterns by adult-use legal sales status and age group. A subsample of EAs from the 2021 US data were drawn from the International Cannabis Policy Study (ICPS) (n=3,467), an online survey administered annually that identifies the impacts of cannabis legalization on cannabis perceptions, use, and retail sales. EAs’ use frequency, mode, multi-modal use, cannabis source, and source legality were described and differences by state legality and age group were analyzed using adjusted logistic and linear regression. In study three, participants aged 18-20 years participated in a between groups eye tracking experiment, where they were randomized to a control (cannabis availability messaging) or an experimental (stress relief messaging) group to view cannabis ads. Pre-appointment survey, eye tracking, and post-survey data were collected. To understand any differences, group means were compared and linear regression was used to understand the association between the eye tracking measures and perception outcomes.ResultsStudy one
There were 17 studies that fit the eligibility criteria which were charted and summarized using two themes: cannabis-related perceptions, attitudes, and beliefs and cannabis-related intentions and behaviors. Most studies used cross-sectional designs and participant self-reported recall to measure advertising exposure. The majority of studies found that cannabis advertising exposure was associated with positive cannabis-related perceptions, attitudes, and use behaviors.Study twoAmong EAs aged 18-25 years old, 33% (95% CI: 30.9, 35.2) used cannabis in the past 12-months (P12M) and half reported being a never user. Among P12M users (n=1,248), over-age EAs (21-25 years old) in legal states had higher odds of using multiple modes of use (aOR 1.34; 95% CI: 1.04, 1.72) than over-age EAs in non-legal states. Both under- (18-20 years old) and over-age EAs in legal states had higher odds of obtaining cannabis from a dispensary than in non-legal states (aOR 2.14; 95% CI: 1.31, 3.48 and aOR 6.02; 95% CI: 4.40, 8.24, respectively). Over-age EAs in legal states had lower odds of obtaining cannabis from a dealer than over-age EAs in non-legal states (aOR 0.3; 95% CI: 0.24, 0.44). Under-age EAs in legal states who used cannabis concentrates used them on almost 34 more days in the P12M than under-age EAs in non-legal states (95% CI: 10.33, 56.21). All EAs in legal states reported obtaining almost 25% more legally sourced cannabis in the P12M than EAs in non-legal states (95% CI: 19.32, 29.94).Study threeThere were 90 participants who viewed the ads; overall, no group differences were found for the eye tracking fixation data nor for the perception outcomes. The results from the linear regressions showed that longer fixation duration on the stress relief messaging (experimental group) was associated with increased belief in stress relief (β=0.39; p=0.0285), lowered harm perceptions (β=-0.61; p=0.0016), and greater intention to use (β=0.87; p=0.0021). No associations between fixations and the perception outcomes were found in the cannabis availability messaging group. Additionally, the stress relief messaging lowered harm perceptions among non-past 30-day (P30D) cannabis users while the cannabis availability messaging had no effect on non-P30D users (2.35 vs. 2.71, p=0.0550).ConclusionsUnderstanding the effects from legalization on EAs’ perceptions and behaviors is vital for informing future research and state policy. The research presented in this dissertation shows that cannabis advertising exposure, such as billboards, print ads, and internet ads, affects perceptions, attitudes, and behaviors. EAs’ cannabis use patterns are also associated with adult-use legal sales in the US, where under-age EAs in states with legal sales reported more concentrated cannabis use and greater access to legal cannabis dispensaries and products. These findings suggest that increased access to cannabis through the legal marketplace and perceived normalization of use in the US might be mechanisms driving increases in use, particularly use of concentrates. Additionally, the eye tracking experiment revealed that among under-age EAs, there was an association between longer fixation times on the stress relief messaging and increased belief in stress relief, lowered harm, and greater intentions to use. Future studies could investigate the influence of health and wellness advertising messaging on cannabis-related perceptions and behaviors. Eye tracking technology may be a particularly useful tool for understanding viewing patterns for ads in general or for specific messaging. Research studies could also explore under-age EAs’ experiences obtaining cannabis and their perceptions on the social norms related to use. Policy recommendations include addressing cannabis advertising density in an effort to reduce exposure and limiting stress relief messaging on cannabis advertisements due to the potential influence on under-age EAs. Often, cannabis regulations aim to limit advertising appeal and subsequently, use, among youth and children. Therefore, policies that expand their definitions of appeal to include those of older adolescents and EAs would offer greater protection from influential messaging, thereby reducing harm among a population at increased risk of use.