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. 2024 May 8;42:102755. doi: 10.1016/j.pmedr.2024.102755

Changes in online marketing and sales practices among non-medical cannabis retailers in 5 US cities, 2022 to 2023

Yuxian Cui a, Zongshuan Duan b, Cassidy R LoParco a, Katie Vinson c, Katelyn F Romm d, Yan Wang a, Patricia A Cavazos-Rehg e, Erin Kasson e, Y Tony Yang c,f,g, Carla J Berg a,g,⁎
PMCID: PMC11101894  PMID: 38764758

Highlights

  • •

    Non-medical cannabis retail, including online, has quickly expanded across the US.

  • •

    We examined online practices of 175 retailer websites in 5 US cities in 2022–2023.

  • •

    Over 85% leveraged online sales, discounts/samples, and/or social media marketing.

  • •

    About half posted health benefits, while about one-third showed health warnings.

  • •

    A fourth lacked age checks for site entry and/or used images targeting young people.

Keywords: Cannabis, Marijuana, Marketing, Health communication, Health policy

Abstract

Objectives

Given the evolving cannabis marketplace (e.g., products, marketing strategies), this study examined online cannabis marketing practices over time.

Methods

In 2022 and 2023, researchers assessed website content (e.g., age verification, sales, delivery, warnings, ad content, promotional strategies) among 175 randomly-selected cannabis retailers’ websites across 5 US cities (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles [LA], California, n=∼35/city). Analyses compared data from 2022 vs. 2023 and considered regulatory factors across cities.

Results

Similar to 2022, in 2023, 76.6 % required age verification for site entry, 85.1 % used social media promotion, and 90.9 % offered online sales (82.4 % of which required age verification and 34.6 % offered delivery). There were significant (p < .05) decreases from 2022 to 2023 in the proportions indicating medical card requirements (27.4 % to 15.4 %), purchase limits (59.4 % to 47.4 %), health warnings (38.9 % to 29.7 %), health benefits (60 % to 47.4 %), and discounts/price promotions (92.6 % to 86.3 %). In 2023, proportions differed across cities in ways reflecting whether state/local law allowed online sales (>90 % in Denver, Las Vegas, LA), allowed discounts/price promotions (100 % in Denver and Las Vegas), or required health warnings (48–60 % in Seattle and LA vs. < 20 % elsewhere). Despite all sites prohibiting youth-oriented content and all but Denver and Las Vegas prohibiting health claims, 30.3 % posted content targeting youth/young adults (LA = 8.1 % to Denver = 74.2 %) and 47.4 % health claims (Seattle = 27.0 % to Denver = 71.0 %).

Conclusions

Online cannabis retail presents risks for access and appeal to minors, emphasizes health benefits, and uses price promotions, regardless of restrictions, indicating need for greater regulatory efforts.

1. Introduction

As of March 2024, 24 states, 2 US territories, and DC have legalized non-medical (i.e., recreational) cannabis use, despite remaining federally illegal (Center and Tobacco, 2023). Within this context, the cannabis market has grown substantially, as has its contribution to the US economy and tax revenues (Flowhub, 2024). Important to this growth has been cannabis industry marketing (e.g., product types; price; promotions; advertising), which is a well-documented determinant of individual perceptions and use (Whitehill et al., 2020, Trangenstein et al., 2021, Trangenstein et al., 2019, Rup et al., 2020, Firth et al., 2022, Noël et al., 2021, Krauss et al., 2017, D’Amico et al., 2018, Tveleneva et al., 2022, Cohn et al., 2023, Ladegard et al., 2020, Wang et al., 2018). In addition to understanding how products are advertised, it is critical to assess the nature of cannabis products available, given their rapid diversification, as well as product price (Goodman et al., 2020), which impacts consumer behaviors (Faith, 2018), either by discouraging use via taxation (Boesen, 2023) or promoting use via discounts and promotions (Berg et al., 2018, Hoeper et al., 2022).

Regulations regarding retail and marketing, which are important for protecting consumers, often differ across states (Ling et al., 2022, Weisz, 2022). States have varied restrictions on products (e.g., beverages, synthetic THC), amount of product sale (Weisz, 2022), discounts, (Barry and Glantz, 2016), marketing that target minors (<21 years old), use of false or misleading information, and/or unsubstantiated health claims (Weisz, 2022). Unfortunately, research has documented retailer non-compliance with such regulations, for example, by offering price promotions (Berg et al., 2018, Nicholas et al., 2021, Berg et al., 2017, Berg et al., 2023), promoting cannabis health benefits (Berg et al., 2023), and targeting youth by selling youth-appealing products (e.g., candy flavored products) (Lenk et al., 2021, Shi and Pacula, 2021). Age verification compliance studies have shown mixed findings: some studies reported high (83–100 %) compliance for purchases (Berg et al., 2018, Nicholas et al., 2021, Berg et al., 2017, Berg et al., 2023, Lenk et al., 2021, Shi and Pacula, 2021); however, a California-based study found that only 12 % of retailers checked ID before entry (Shi and Pacula, 2021).

Online cannabis retail is a critical component of the industry’s activity. Retailers frequently use online channels and digital media to promote their business and products, facilitate online sales and deliver, and reach a broad range of consumers (Weisz, 2022). Although online cannabis retail is increasingly used (Ling et al., 2022, Bierut et al., 2017), relevant regulations are often non-existent, vague, or difficult to enforce, potentially increasing access for most consumers including youth (Ling et al., 2022).

Research focused on online cannabis retail practices is crucial to inform regulatory efforts (Berg et al., 2018, Nicholas et al., 2021, Berg et al., 2017, Berg et al., 2023, Lenk et al., 2021, Shi and Pacula, 2021). For example, US-based studies examining online cannabis retail in various states (Hoeper et al., 2022, Ling et al., 2022, Bierut et al., 2017, Cavazos-Rehg et al., 2019, Luc et al., 2020, Forzley, 2021),on social media (Anderdal Bakken and Kirstine, 2023, Jenkins et al., 2021), and on cannabis-specific online platforms (Childs et al., 2022) have shown that cannabis promotion often emphasizes diverse health claims (e.g., managing pain, nausea/vomiting, anxiety, insomnia) and positive psychoactive effects (e.g., enhancing creativity and pleasure), and may appeal to minors, (Hoeper et al., 2022, Bierut et al., 2017, Cavazos-Rehg et al., 2019, Luc et al., 2020) despite relevant state restrictions.

Notably, none of these studies examined changes over time, which is crucial to understand changes in the retail context as it grows and evolves (Grand View Research, 2023). Recent cannabis market reports indicated shifts in consumers (e.g., more adults trying cannabis, more women) and business leadership (i.e., more women and/or minorities) and reductions in cannabis prices (by 32 % since 2021), all of which could impact marketing and product types (Flowhub, 2024). Particularly relevant to the current study, cannabis buyers, especially frequent buyers, are increasingly preparing for a purchase by researching online (e.g., studying a local dispensary’s menu, identifying discounts/price promotions) (Flowhub, 2024), making ongoing surveillance of retail websites crucial.

This study analyzed cannabis retail website data from the Cannabis Regulation, Marketing & Appeal (CARMA) study, which examines non-medical adult-use cannabis regulation and retail. The parent study involves annual surveillance of cannabis retail websites (Duan et al., 2023) (2022–2025) and in-person cannabis retail audits (Berg et al., 2023) and mystery shopper audits (Romm et al., 2024) at 2 timepoints (2022, 2025). Retail surveillance primarily focuses on 5 cities with the most established non-medical cannabis markets: Denver, Colorado (established in 2014); Seattle, Washington (2014); Portland, Oregon (2015); Las Vegas, Nevada (2017); and Los Angeles (LA), California (2018). Given the diversity and geographic spread of online cannabis retailers and the various state and local laws that could apply, the website audits focused on websites from storefronts in these 5 cities in order to feasibly allow the consideration of state and local regulations and how the online context compares to the in-store experience. These websites likely target the local market, but are nonetheless available to all internet users.

Previously published findings from the 2022 website audits (Duan et al., 2023) and in-person retail (Berg et al., 2023) and mystery shopper audits (Romm et al., 2024) echoed findings from other studies (e.g., high rates of price promotions and health claims; few warnings) (Berg et al., 2023, Duan et al., 2023, Romm et al., 2024). Additionally, website audit data (Duan et al., 2023) showed mixed findings regarding whether retail activity by city reflected relevant state and local laws. (See Supplementary Table 1 for select state cannabis retail policies across these 5 cities.) For example, over half of Washington and Oregon retailers posted health claims despite state prohibition, price promotions were prevalent regardless of site-specific related restrictions (Washington, Oregon, California), and only 10 % had health warnings regarding use during pregnancy despite requirements in all 5 states (Duan et al., 2023).

Despite few changes in cannabis retail related regulations in these 5 sites from 2022 to 2023, the cannabis retail environment has likely changed, due to changes in the consumer base, industry leadership, product offerings, pricing strategies, and other factors (Flowhub, 2024). Given the evolving nature of the cannabis retail context – both irrespective and as a result of regulatory changes (Flowhub, 2024) – this study aimed to address the dearth of research systematically examining online cannabis marketing over time. We analyzed data from matched pairs of cannabis retail websites in 5 cities with legalized non-medical cannabis sales that were assessed in 2022 and 2023. Based on market research, (Flowhub, 2024) we hypothesized certain changes occurred, including increases in online sales and delivery, social media promotion, product diversity, and use of price promotions.

2. Methods

2.1. Website selection

This online website audit study was deemed exempt by the George Washington University Institutional Review Board. The sampling frame for websites assessed in 2022 is detailed elsewhere (Duan et al., 2023). In brief, we identified locations with non-medical cannabis retail licenses in these 5 cities in April 2022, using data from websites for their respective state cannabis regulatory agencies. Online searches and phone calls were conducted to verify whether the license referred to a brick-and-mortar storefront and had a website. Website audits were completed among a total of 195 websites (∼40/city) in April-June 2022.

In April-June 2023, we revisited these same websites to determine if they were still active and met eligibility criteria (i.e., sold cannabis, connected to a cannabis retail storefront). In 2023, 89.7 % (n = 175 of 195 stores audited in 2022) were eligible. Of the 20 websites that were ineligible, the majority (n = 13) were inactive (others: not connected to storefront, n = 3; changed name, n = 1; replaced by new cannabis retailer, n = 3; see Supplementary Figure 1 for flowchart). Those assessed in 2022 but ineligible for the 2023 follow-up (i.e., inactive, no storefront, changed name/ownership) were less likely to have online sales, offered fewer product types, and were less active on social media.

2.2. Data collection

2.2.1. Training and quality control

The same methods were used in 2023 as in 2022 (reported previously36). Ten graduate research staff were trained to conduct assessments. To ensure protocol comprehension and application and assess initial inter-rater reliability, staff were divided into pairs and each pair coded 3 randomly-selected websites from the target sample. All discrepancies were identified, discussed, and reconciled in group meetings. Subsequently, all websites were dual-coded by staff pairs. Once data collection began, staff met weekly to address data collection issues, ensure data quality, and discuss potential emergent themes. Initial kappa values exceeded.67 across items, with the vast majority exceeding.80 (substantial agreement) (McHugh, 2012) all discrepancies were rectified in group review to finalize the data

2.2.2. Assessment form

The assessment tool was adapted from prior measures assessing cannabis marketing, including online (Hoeper et al., 2022, Bierut et al., 2017, Cavazos-Rehg et al., 2019) and at brick-and-mortar stores, (Berg et al., 2018, Berg et al., 2017) and has demonstrated high inter-rater reliability (Duan et al., 2023). See Supplementary Table 2 for detailed description.

Retailer characteristics. We assessed whether the website represented multiple locations (i.e., chain) and any indication regarding ownership (e.g., racial/ethnic minorities, LGBTQ + individuals).

Age verification, online sales, delivery, and payment options. We assessed age verification to access the website, availability of online sales, and forms of payment. Among those offering online sales, we assessed: 1) age verification for online purchases; and 2) delivery, and if so, delivery restrictions (i.e., location or distance restrictions).

Restricted access and purchase limits. We assessed whether the website indicated medical card requirements to access specific products for online purchase and/or restrictions on purchase amount.

Health warning content. We coded any health warnings (physical health, mental health; warnings for youth/young adults or pregnant/postpartum women).

Products sold. We assessed types of THC-containing products (e.g., flower/bud, edibles, vaporizers/vaping devices, concentrates, topicals, tinctures, and cannabis beverages), alternative products like Delta-8 THC, CBD-only products, other substances (e.g., kratom, alcohol), apparel, etc.

Marketing strategies. We assessed content (i.e., text, imagery) indicating health benefits (medical, mental health). We also coded content targeting/representing specific populations including youth/young adults, veterans, LGBTQ + individuals, and racial and ethnic minorities. As noted in Supplementary Table 2, these codes reflected images of people representing the respective groups, and symbols (e.g., candy for youth, rainbow flag for LGBTQ + ) or text (e.g., celebrating specific holidays) reflecting interests of these groups. The youth-oriented code drew upon definitions of youth-oriented advertising used in the state laws. Given that it is difficult to ascertain the age, sexual orientation, or race/ethnicity of individuals in photos, these codes were used with caution, and ‘young adult’ was added to the ‘youth’ code. We also coded content with key themes (party/cool/popularity imagery (Ling et al., 2022), celebrity/influencer endorsement (Leos-Toro et al., 2021), exclusivity/luxury imagery (Gilbert, 2021, Asquith, 2021), sexualized imagery (McCausland et al., 2020).

We also assessed indicators of: 1) price promotions (i.e., discounts, samples, and/or promotions; subscription/membership programs); 2) community engagement (i.e., activism for underrepresented groups or social causes, local event sponsorship, information/links to medical/mental health resources); and 3) other marketing channels used (e.g., social media, print/newspapers/magazines, radio/podcasts).

2.3. Data analysis

Analyses were conducted using SPSS v28.0 and STATA MP18.0, and significance was set at p < .05. First, we conducted descriptive analyses to characterize websites at the 2 timepoints. Next, to explore our primary research question regarding longitudinal changes on online cannabis retail practices, we conducted bivariate analyses examining overall differences in matched pairs between 2022 and 2023 (presented in Table 1, Table 2, Table 3). Bivariate analyses used McNemar Tests for matched pairs, chi-square tests, and Fisher exact tests for cell sizes ≤ 5.

Table 1.

Retailer characteristics and factors related to age verification, sales, and delivery among cannabis retail websites in 5 US cities in 2022 and 2023 among matched pairs at each time point, N = 175.

Year 2022 Year 2023
N = 175 N = 175
Variables n (%) n (%) p-value
Retailer characteristics
Website represents multiple locations (e.g., chain) 75 (42.9) 82 (46.9) .184
Ownership diversity/population representation
White/Caucasian 21 (12.0) 17 (9.7) .571
Underrepresented racial/ethnic groups 12 (6.9) 10 (5.7) .774
Other underrepresented groups (LGBTQ+, veterans, etc.) 7 (4.0) 8 (4.6) .999
Not indicated 135 (77.1) 144 (82.3) .188
Age verification, online sales, and delivery
Age verification to enter site 141 (80.6) 134 (76.6) .230
Online sales available 165 (94.3) 159 (90.9) .180
Among websites offering online sales N = 165 N = 159
Age verification to purchase online 138 (83.6) 131 (82.4) .486
Age verification for pickup or delivery 95 (57.6) 62 (39.0) <.001
Delivery available 52 (31.5) 55 (34.6) .503
Payment options N = 175 N = 175
Forms of payment accepted
Cash 142 (81.1) 145 (82.9) .700
Debit 59 (33.7) 71 (40.6) .045
Credit 10 (5.7) 20 (11.4) .031
Mobile 7 (4.0) 8 (4.6) .549
Not indicated 31 (17.7) 28 (16.0) .690
Advertise access to ATM in store 58 (33.1) 68 (38.9) .089
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Table 2.

Product access, health warnings, and product types sold among cannabis retail websites in 5 US cities in 2022 and 2023 among matched pairs at each time point, N = 175.

 Year 2022
 Year 2023
N = 175
 N = 175
Variables n (%) n (%) p-value
Restricted access and purchase limits
Indicates medical card required for specific products 48 (27.4) 27 (15.4) .002
Indicates restrictions on product amount purchased 104 (59.4) 83 (47.4) .009
Includes links for how to get medical cannabis card 28 (16.0) 23 (13.1) .332
Health warning content
No health warnings found 107 (61.1) 123 (70.3) .038
Any health warnings indicated 68 (38.9) 52 (29.7)
Physical health only 37 (21.1) 23 (13.1)
Mental health only 3 (1.7) 1 (0.6)
Both medical and mental health 28 (16.0) 28 (16.0)
Health warning content for specific populations
Youth or young adults 16 (9.1) 18 (10.3) .855
Pregnant or postpartum women 17 (9.7) 6 (3.4) .019
Products sold
Cannabis product types
Flower 172 (98.3) 166 (94.9) .070
Edibles 170 (97.1) 165 (94.3) .180
Vaporizers/vaping devices 166 (94.9) 162 (92.6) .424
Concentrates 170 (97.1) 163 (93.1) .065
Topical/tincture 164 (93.7) 158 (90.3) .210
Cannabis beverages 125 (71.4) 156 (89.1) <.001
Delta-8 14 (8.0) 1 (0.6) <.001
CBD-only products 78 (44.6) 73 (41.7) .640
Equipment for cannabis use
Vaping devices 151 (86.3) 158 (90.3) .210
Bongs/pipes 102 (58.3) 116 (66.3) .071
Rolling machines/rolling paper 119 (68.0) 127 (72.6) .291
Apparel, hats, backpacks, etc. 72 (41.1) 82 (46.9) .155
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Notes: No retailers sold kratom; less than 2% sold alcohol.

Table 3.

Marketing strategies among cannabis retail websites in 5 US cities among matched pairs at each time point, N = 175.

Year 2022 Year 2023
N = 175 N = 175
Variable n (%) n (%) p-value
Content claiming health benefits of cannabis use
No benefits indicated 70 (40.0) 92 (52.6) .011
Any benefits indicated 105 (60.0) 83 (47.4)
Medical benefits only 9 (5.1) 7 (4.0)
Mental health benefits only 16 (9.1) 14 (8.0)
Both medical and mental health benefits 80 (45.7) 62 (35.4)
Content targeting/representing specific populations
Youth or young adults 45 (25.7) 53 (30.3) .358
Veterans 50 (28.6) 39 (22.3) .118
LGBTQ+ 10 (5.7) 10 (5.7) .999
Racial/ethnic minorities 8 (4.6 %) 37 (21.1) <.001
Content themes
Party/cool/popularity imagery 51 (29.1) 62 (35.4) .215
Celebrity/influencer endorsement 33 (18.9) 36 (20.6) .755
Exclusivity/luxury imagery 10 (5.7) 66 (37.7) <.001
Sexualized imagery 3 (1.7) 22 (12.6) <.001
Price promotions
Offer discounts, samples, or promotions 162 (92.6) 151 (86.3) .035
Offer membership or loyalty programs 110 (62.9) 118 (67.4) .268
Community engagement
Activism for underrepresented groups or social causes 61 (34.9) 58 (33.1) .775
Local event sponsorship 35 (20.0) 45 (25.7) .212
Information/links to medical/mental health resources 45 (25.7) 6 (3.4) <.001
Other marketing channels
Any social media links 148 (84.6) 149 (85.1) .999
Instagram 129 (73.7) 129 (73.7) .999
Facebook 114 (65.1) 110 (62.9) .617
Twitter 99 (56.6) 92 (52.6) .281
Other^ 53 (30.3) 51 (29.1) .868
Print/newspapers/magazines 11 (6.3) 6 (3.4) .125
Radio/podcasts 3 (1.7) 1 (0.6) .500
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Notes:^Other included: YouTube, Yelp, LinkedIn, Pinterest, Leafly, Snapchat, Tik Tok, Weedmaps, Tumblr, Google, etc.

The small sample size per city limited power for city-specific comparisons or examinations of change over time; however, we conducted exploratory analyses to examine: 1) differences across cities in 2023 (given the prior publication of the 2022 analysis by city36); and 2) differences in matched pairs between 2022 and 2023 for each city. To minimize reader burden, analyses examining differences across cities in 2023 are presented in Supplementary Tables 3-5, and notable findings from matched pairs analysis comparing 2022 and 2023 (which identified few differences) are indicated in text only. Findings by city – both at the 2023 cross-section and over time – were considered within the context of relevant site-specific state or local laws (see Supplementary Table 1) and noted accordingly in text.

3. Results

3.1. Age Verification, online sales, delivery, and payment options

In 2023, 76.6 % required age verification for site entry, and 90.9 % indicated online sales, of which, 82.4 % required age verification to purchase online, 34.6 % offered delivery, and 39.0 % required age verification for pickup or delivery (Table 1). There were no significant differences from 2022, except the proportion requiring age verification for pickup or delivery decreased (from 57.6 % in 2022, p < .001). In 2023, 82.9 % accepted cash, 40.6 % debit cards (increased from 33.7 % in 2022, p = .045), and 11.4 % credit cards (increased from 5.7 % in 2022, p = .031; Table 1).

In 2023, age verification for site entry or purchase did not differ across cities (Supplementary Table 3). However, proportions allowing online sales differed across cities reflecting whether state/local law allowed online sales (>90 % in Denver, Las Vegas, LA).

3.2. Restricted access and purchase limits

Shown in Table 2, from 2022 to 2023, the proportions of retailers decreased that indicated medical card requirements for specific products from 27.4 % to 15.4 % (p = .002) and purchase amount restrictions from 59.4 % to 47.4 % (p = .009). In 2023 (Supplementary Table 4), retailers across cities differed with regard to indicating medical card requirements (range: Seattle and LA = 2.7 % to Portland = 36.1 %) and purchase amount restrictions (range: LA = 21.6 % to Las Vegas = 67.6 %), despite relevant restrictions in each site.

3.3. Health warnings

There were decreases in the proportions of retailers showing any health warnings from 38.9 % in 2022 to 29.7 % in 2023 (p = .038) and health warning content for pregnant or postpartum women from 9.7 % to 3.4 % (p = .019; Table 2). In 2023 (Supplemental Table 4), proportions differed across cities reflecting whether state/local law required health warnings (48.6 % in LA and 59.5 % in Seattle vs. < 20 % elsewhere).

3.4. Product types

Almost all retailers (>90 %) sold flower, edibles, vaporizers, concentrates, and topicals/tinctures, while less than half (41–45 %) sold CBD-only products across timepoints (Table 2). The proportion selling cannabis beverages increased from 71.4 % to 89.1 % (p < .001), while there was a decrease for Delta-8 THC from 8.0 % to 0.6 % (p < .001).

In 2023 (Supplemental Table 4), CBD-only product availability varied across cities (range: LA = 13.5 % to Las Vegas = 73.5 %), despite no restrictions in any site. In Los Angeles (LA), where Delta-8 and similar hemp-derived products are regulated like other cannabis products, the proportion of retailers selling these products decreased from 21.6 % to 2.7 % (data not shown in tables). Conversely, in other locations where these products were banned, <10 % sold them in 2022, and by 2023, none did.

3.5. Content themes

There were decreases in the proportion of retailers indicating any health benefits from 60 % in 2022 to 47.4 % in 2023 (p = .011). Across timepoints, similar proportions of retailers had website imagery targeting teens or young adults (25.7 %-30.3 %), veterans (22.3 %-28.6 %), and LGBTQ + individuals (5.7 %), but there were increases in the proportions with imagery targeting racial/ethnic minorities (from 4.6 % to 21.1 %, p < .001), content emphasizing exclusivity/luxury (from 5.7 % to 37.7 %, p < .001), and content with sexualized imagery (1.7 % to 12.6 %, p < .001).

Despite all sites prohibiting youth-oriented content and all but Denver and Las Vegas prohibiting health claims, 30.3 % posted content targeting youth/young adults (range: LA = 8.1 % to Denver = 74.2 %) and 47.4 % health claims (range: Seattle = 27.0 % to Denver = 71.0 %; Supplementary Table 5). Retailers across cities also differed in the proportions with content targeting veterans (range: Portland = 8.3 % to Las Vegas = 44.1 %), LGBTQ + individuals (range: Seattle = 0 % to Denver = 22.6 %), and racial/ethnic minorities (range: Seattle = 5.4 % to Las Vegas = 47.1 %).

3.6. Price promotions

At both timepoints, ∼65 % offered membership or loyalty programs, and the proportion that offered discounts, samples, or promotions decreased from 92.6 % to 86.3 % (p = .035; Table 3). In 2023, cities differed in ways reflecting state/local laws (i.e., only Colorado and Nevada allow discounts/price promotions; Supplementary Table 5). All Denver and Las Vegas retailers offered discounts, samples, or promotions (vs. elsewhere: 69.4 % [Portland] to 86.5 % [Seattle]) and 88.2 % in Las Vegas and 83.9 % in Denver offered membership or loyalty programs (vs. elsewhere: 36.1 % [Portland] to 70.3 % [LA]).

3.7. Community engagement and other marketing channels

In 2022 and 2023, similar proportions on websites engaged in activism for underrepresented groups or social causes (about one-third) and local event sponsorship (20–26 %). However, the proportion providing information/links to medical/mental health resources decreased from 25.7 % in 2022 to 3.4 % in 2023 (p < .001). Social media was highly used at both timepoints (∼85 %), particularly Instagram (∼74 %) and Facebook (∼65 %). Cities differed in their overall use of social media (range: Portland = 69.4 % to LA = 94.6 %; Supplementary Table 5), despite no specific restrictions on social media use in these sites.

4. Discussion

This study examined changes in online cannabis retail from 2022 to 2023 among websites of 175 cannabis retailers across 5 US cities, given the ongoing evolution of the cannabis market (Flowhub, 2024) and concerns regarding regulatory compliance. Roughly consistent across timepoints, one-fourth lacked age verification for site entry, and ∼ 90 % offered online sales. Among those with online sales, one-fifth lacked age verification procedures at point-of-purchase, and one-third offered delivery. These rates are higher than those documented in audits of brick-and-mortar stores (10 % lacked age verification, 25 % offered delivery) (Berg et al., 2023). Given that only ∼ 5 % of our original list of retailers lacked associated websites, these findings suggest the importance of integrated surveillance of both brick-and-mortar stores and their websites, which show evidence of different approaches (Cavazos-Rehg et al., 2019). Furthermore, at both timepoints, ∼85 % used social media, which is concerning given the high reach (including to those underage) and loopholes in social media policies prohibiting paid cannabis advertising (Ling et al., 2022). Also interesting, retailers assessed in 2022 but lost to follow-up in 2023 were less likely to have online sales and less active on social media, suggesting the importance of these activities for retailer success. Although rates of online sales or delivery and use of social media did not increase, this was likely due to the already high rates in 2022 (i.e., ceiling effect). Taken together, the high rates of use of social media, online sales, and delivery (especially without clear age verification procedures) raise concerns regarding underage access (Gaiha et al., 2020) and emphasize the need for regulations that prohibit online sales and delivery.

Several retail practices showed change over the one-year period, although the reasons for such changes are unclear (e.g., maturation effects, simple variation over time, meaningful change). Nonetheless, these changes warrant consideration. The proportion of websites showing health warnings decreased over time (38.9 % to 29.7 %), which is concerning given that each of these states mandates specific warnings at the point-of-sale. Another significant concern is that the proportion posting health warning content for pregnant or postpartum women decreased from 10 % in 2022 to 3 % in 2023, despite requirements for such warnings at the point-of-sale in all 5 states. Furthermore, there were decreases in the proportions indicating medical card requirements (27 % to 15 %) and purchase limits (59 % to 47 %). Although unclear, it is possible that retailers believe that consumer knowledge about these regulations increased and, thus, such signage was seemingly unnecessary. However, indicating medical card requirements was most prevalent in Denver, which has the longest-standing cannabis market, suggesting other reasons may underly this decrease. Additionally, posting purchase limits was most common in Las Vegas, the only city in a state that has this required signage in brick-and-mortar stores. These findings underscore the need for research to determine the reasons for noncompliance and the impact of such signage, given the mixed evidence for such regulatory (Britt et al., 2006, Wolfson et al., 1996, Forster et al., 1994) and health warning signage (Budenz et al., 2022, Wolfson and Poole, 2023, Coady et al., 2013).

Across retailers, a wide variety of products were sold at both timepoints, and those lost to follow-up offered less product variety, potentially suggesting the importance of variety to consumers (Shi et al., Dec 2019, Zhu et al., 2020). Most retailers also sold products to facilitate cannabis use (e.g., vaporizers), and nearly half sold CBD-only products. However, few sold products like as Delta-8 THC (which reduced from 2022 to 2023); these findings may reflect increasing awareness and regulation of these products, as 4 of the 5 states implemented their Delta-8 bans in 2021 or 2022 (News, 2023).

Regarding promotional content, while the proportion indicating health benefits decreased, nearly half posted health benefits in 2023, which may reflect an underestimation of health claims conveyed at points-of-sale, as suggested by mystery shopper studies (Berg et al., 2021, Dickson et al., 2018). Across timepoints, ∼25–30 % had imagery targeting youth/young adults, similar to rates documented in brick-and-mortar audits (Berg et al., 2023). These issues were most represented in Denver, despite Colorado’s regulatory language being similar to the other 4 states. At both timepoints, few retailers (∼5%) showed evidence of targeting LGBTQ + individuals. However, there were increases in the proportions targeting racial/ethnic minorities (>20 % in 2023), most commonly in Las Vegas, which has greater racial/ethnic diversity than the other cities except LA (Niche, 2023). Additionally, there were increases in content emphasizing exclusivity/luxury or sexuality, which may appeal to specific populations (e.g., young people) (Hoeper et al., 2022, MacKillop and Prioritizing, 2018, Fiala et al., 2018, Berg et al., 2018). Interestingly, compared to rates documented at brick-and-mortar stores (∼3%), (Berg et al., 2023) a higher proportion (∼25 %) targeted veterans, most commonly in Las Vegas which resides in a state with high representation of military and veterans (US News World Report, 2023).

Across both timepoints, ∼65 % offered membership/loyalty programs, and > 85 % offered discounts, samples, or promotions in 2023, despite unexpected decreases from 2022. Notably, these strategies were used most commonly in Denver and Las Vegas, where there are no restrictions. These findings echo prior findings showing the prevalent use of price promotions (Berg et al., 2017, Cavazos-Rehg et al., 2019, Buller et al., Nov 2016) and underscore the need to monitor these practices, given their impact on use, (Wang et al., 2022, Choi et al., 2019) particularly among more price-sensitive subpopulations (e.g., young adults, lower-income individuals) (Liber et al., 2022).

4.1. Limitations

Findings have limited generalizability given that this sample of 175 websites represented only 5 cities in 5 states and excluded other types of retailers, such as home delivery services or websites without a storefront. This was chosen to feasibly allow the consideration of state and local regulations and for other analyses to compare the online versus in-store context. Other studies are needed to assess the broader range of online cannabis retail activities, as well as their impact on consumers. The sample size also restricted power for certain analyses, such as comparisons over time within cities and assessments of compliance, particularly when regulations varied between states. Additionally, given the relatively short (one-year) time-period between assessments and unknown reasons for documented changes (e.g., maturation, simple variation, meaningful changes), additional research examining longer-term trends and potential mechanisms of change are needed to support assertions regarding regulatory implications. Finally, the assessment tool requires ongoing revision to enhance its utility and remain relevant to the changing cannabis market.

4.2. Conclusions

This study offers an important perspective on online cannabis retail practices and marketing strategies. Findings highlight notable lapses in regulatory compliance, especially in terms of accessibility (like age verification, and online sales and delivery), as well as the presence of regulatory and health warning signage. Additionally, the study revealed evidence of targeting specific subpopulations (such as young people and veterans) and the promotion of health benefits. In conclusion, these findings underscore the need for ongoing surveillance of online cannabis retail over a longer time-period, more precise regulatory language, and enhanced enforcement.

Funding information

This work was supported by the National Institute on Drug Abuse (R01DA054751, MPIs: Berg, Cavazos-Rehg). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

CRediT authorship contribution statement

Yuxian Cui: Writing – original draft, Supervision, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Zongshuan Duan: Writing – review & editing, Supervision, Methodology, Investigation, Data curation, Conceptualization. Cassidy R. LoParco: Writing – review & editing, Data curation, Conceptualization. Katie Vinson: Writing – review & editing, Data curation, Conceptualization. Katelyn F. Romm: Writing – review & editing, Methodology, Investigation, Conceptualization. Yan Wang: Writing – review & editing, Methodology, Investigation, Conceptualization. Patricia A. Cavazos-Rehg: Writing – review & editing, Supervision, Project administration, Methodology, Investigation, Funding acquisition, Conceptualization. Erin Kasson: Writing – review & editing, Methodology, Investigation, Conceptualization. Y. Tony Yang: Writing – review & editing, Conceptualization. Carla J. Berg: Writing – original draft, Validation, Supervision, Resources, Project administration, Methodology, Investigation, Formal analysis, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.pmedr.2024.102755.

Appendix A. Supplementary data

The following are the Supplementary data to this article:

Supplementary Data 1
mmc1.docx (54.2KB, docx)

Data availability

Data will be made available on request.

References

  1. Anderdal Bakken S., Kirstine H.S. From dealing to influencing: online marketing of cannabis on Instagram. Crime Media Cult. 2023;19(1):135–157. doi: 10.1177/17416590221081166. [DOI] [Google Scholar]
  2. Asquith K. The visual clichés of legal cannabis promotion on social media. Crit. Stud. Media Commun. 2021;38(4):336–349. doi: 10.1080/15295036.2021.1937669. [DOI] [Google Scholar]
  3. Barry R.A., Glantz S. A public health framework for legalized retail marijuana based on the US experience: avoiding a new tobacco industry. PLoS Med. 2016;13(9):e1002131. doi: 10.1371/journal.pmed.1002131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Berg C.J., Henriksen L., Cavazos-Rehg P., Schauer G.L., Freisthler B. The development and pilot testing of the marijuana retail surveillance tool (MRST): assessing marketing and point-of-sale practices among recreational marijuana retailers. Health Educ. Res. 2017;32(6):465–472. doi: 10.1093/her/cyx071. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Berg C.J., Henriksen L.A., Cavazos-Rehg P., Haardoerfer R., Freisthler B. The emerging marijuana retail environment: Key lessons learned from tobacco and alcohol retail research. Addict. Behav. 2018;81:26–31. doi: 10.1016/j.addbeh.2018.01.040. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Berg C.J., Henriksen L., Cavazos-Rehg P., Schauer G.L., Freisthler B. Point-of-sale marketing and context of marijuana retailers: Assessing reliability and generalizability of the marijuana retail surveillance tool. Prev. Med. Rep. 2018;11:37–41. doi: 10.1016/j.pmedr.2018.05.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Berg C.J., Barker D.C., Meyers C., et al. Exploring the point-of-sale among vape shops across the United States: audits integrating a mystery shopper approach. Nicotine Tob. Res. 2021;23(3):495–504. doi: 10.1093/ntr/ntaa041. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Berg C.J., Romm K.F., Pannell A., et al. Cannabis retailer marketing strategies and regulatory compliance: a surveillance study of retailers in 5 US cities. Addict. Behav. 2023;143 doi: 10.1016/j.addbeh.2023.107696. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bierut T., Krauss M.J., Sowles S.J., Cavazos-Rehg P.A. Exploring marijuana advertising on Weedmaps, a popular online directory. Prev. Sci. 2017;18:183–192. doi: 10.1007/s11121-016-0702-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Boesen, U. A Road Map to Recreational Marijuana Taxation. Available from: https://taxfoundation.org/research/all/federal/recreational-marijuana-tax/. Accessed Aug 2, 2023.
  11. Britt H., Toomey T.L., Dunsmuir W., Wagenaar A.C. Alcohol sales to underage youth: propensity for and correlates of alcohol sales to underage youth. J. Alcohol Drug Educ. 2006:25–42. [Google Scholar]
  12. Budenz A., Moser R.P., Eck R., et al. Awareness of alcohol and cancer risk and the california proposition 65 warning sign updates: a natural experiment. Int. J. Environ. Res. Public Health. 2022;19(19):11862. doi: 10.3390/ijerph191911862. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Buller D.B., Woodall W.G., Saltz R., Starling R. Pseudo-underage assessment of compliance with identification regulations at retail marijuana outlets in colorado. J. Stud. Alcohol Drugs. Nov 2016;77(6):868–872. doi: 10.15288/jsad.2016.77.868. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Cavazos-Rehg P.A., Krauss M.J., Cahn E., et al. Marijuana promotion online: an investigation of dispensary practices. Prev. Sci. 2019;20(2):280–290. doi: 10.1007/s11121-018-0889-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Public Health Law Center. Commercial Tobacco and Marijuana. 2023. Available from: https://www.publichealthlawcenter.org/topics/commercial-tobacco-control/commercial-tobacco-and-marijuana. Accessed March 10, 2024.
  16. Childs A., Bull M., Coomber R. Beyond the dark web: navigating the risks of cannabis supply over the surface web. Drugs: Education, Prevention and Policy. 2022;29(4):403–414. doi: 10.1080/09687637.2021.1916439. [DOI] [Google Scholar]
  17. Choi K., Chen J.C., Tan A.S., Soneji S., Moran M.B. Receipt of tobacco direct mail/email discount coupons and trajectories of cigarette smoking behaviours in a nationally representative longitudinal cohort of US adults. Tob. Control. 2019;28(3):282–288. doi: 10.1136/tobaccocontrol-2018-054363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Coady M.H., Chan C.A., Auer K., Farley S.M., Kilgore E.A., Kansagra S.M. Awareness and impact of New York City's graphic point-of-sale tobacco health warning signs. Tob. Control. 2013;22(e1):e51–e56. doi: 10.1136/tobaccocontrol-2011-050261. [DOI] [PubMed] [Google Scholar]
  19. Cohn A.M., Alexander A.C., Ehlke S.J., et al. Seeing is believing: How cannabis marketing exposure is associated with cannabis use attitudes and behavior in a permissive medical cannabis policy environment. Am. J. Addict. 2023 doi: 10.1111/ajad.13390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. D’Amico E.J., Rodriguez A., Tucker J.S., Pedersen E.R., Shih R.A. Planting the seed for marijuana use: changes in exposure to medical marijuana advertising and subsequent adolescent marijuana use, cognitions, and consequences over seven years. Drug Alcohol Depend. 2018;188:385–391. doi: 10.1016/j.drugalcdep.2018.03.031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Dickson B., Mansfield C., Guiahi M., et al. Recommendations from cannabis dispensaries about first-trimester cannabis use. Obstet. Gynecol. 2018;131(6):1031. doi: 10.1097/AOG.0000000000002619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Duan, Z., Kasson, E., Ruchelli, S., et al. Assessment of online marketing and sales practices among recreational cannabis retailers in Five U.S. Cities. Cannabis Cannabinoid Res. Sep 12 2023;doi:10.1089/can.2022.0334. [DOI] [PMC free article] [PubMed]
  23. Faith, D.O. A review of the effect of pricing strategies on the purchase of consumer goods. International Journal of Research in Management, Science & Technology (E-ISSN: 2321-3264) Vol. 2018;2doi:10.1002/14651858.CD009186.pub2.
  24. Fiala S.C., Dilley J.A., Firth C.L., Maher J.E. Exposure to marijuana marketing after legalization of retail sales: oregonians’ experiences, 2015–2016. Am. J. Public Health. 2018;108(1):120–127. doi: 10.2105/AJPH.2017.304136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Firth C.L., Carlini B., Dilley J., Guttmannova K., Hajat A. Retail cannabis environment and adolescent use: the role of advertising and retailers near home and school. Health Place. 2022;75 doi: 10.1016/j.healthplace.2022.102795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Flowhub. 2024 Marijuana Industry Statistics & Data Insights: How the industry is performing and where it's headed. 2024. Available from: https://flowhub.com/cannabis-industry-statistics. Accessed March 10, 2024.
  27. Forster J.L., McGovern P.G., Wagenaar A.C., Wolfson M., Perry C.L., Anstine P.S. The ability of young people to purchase alcohol without age identification in northeastern Minnesota USA. Addiction. 1994;89(6):699–705. doi: 10.1111/j.1360-0443.1994.tb00956.x. [DOI] [PubMed] [Google Scholar]
  28. Forzley S. Cannabis and web marketing strategies-a study of Colorado cannabis vendors. Br. Food J. 2021;123(11):3393–3403. doi: 10.1108/BFJ-04-2019-0247. [DOI] [Google Scholar]
  29. Gaiha S.M., Lempert L.K., Halpern-Felsher B. Underage youth and young adult e-cigarette use and access before and during the coronavirus disease 2019 pandemic. JAMA Netw. Open. 2020;3(12):e2027572–e. doi: 10.1001/jamanetworkopen.2020.27572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Gilbert A.N. Cannabis: the uncertain path from agricultural commodity to luxury consumable. Luxury. 2021;7(1):35–53. doi: 10.1080/20511817.2021.1946285. [DOI] [Google Scholar]
  31. Goodman S, Wadsworth E, Leos-Toro C, Hammond D, team ICPS. Prevalence and forms of cannabis use in legal vs. illegal recreational cannabis markets. Int. J. Drug Policy. 2020;76:102658. doi:10.1016/j.drugpo.2019.102658. [DOI] [PubMed]
  32. Grand View Research. U.S. cannabis market size, share & trends analysis report by end-use (medical, recreational, industrial), by source (marijuana, hemp), by derivative (CBD, THC), and segment forecasts, 2023 - 2030. https://www.grandviewresearch.com/industry-analysis/us-cannabis-market.
  33. Hoeper S., Crosbie E., Holmes L.M., et al. “The perfect formula:” evaluating health claims, products and pricing on cannabis dispensary websites in two recently legalized states. Subst. Use Misuse. 2022;1–8 doi: 10.1080/10826084.2022.2069267. [DOI] [PubMed] [Google Scholar]
  34. Jenkins M.C., Kelly L., Binger K., Moreno M.A. Cyber-ethnography of cannabis marketing on social media. Subst. Abuse Treat. Prev. Policy. 2021;16(1):1–10. doi: 10.1186/s13011-021-00359-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Krauss M.J., Sowles S.J., Sehi A., et al. Marijuana advertising exposure among current marijuana users in the U.S. Drug Alcohol Depend. 2017;174:192–200. doi: 10.1016/j.drugalcdep.2017.01.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Ladegard K., Thurstone C., Rylander M. Marijuana legalization and youth. Pediatrics. 2020;145(Supplement 2):S165–S174. doi: 10.1542/peds.2019-2056D. [DOI] [PubMed] [Google Scholar]
  37. Lenk K.M., Wiens T., Fabian L.E., Erickson D.J. Practices and policies of marijuana retail stores in the first two US states to legalize recreational marijuana sales. Drugs: Education, Prevention and Policy. 2021;28(4):340–348. [Google Scholar]
  38. Leos-Toro C., Fong G.T., Hammond D. The efficacy of health warnings and package branding on perceptions of cannabis products among youth and young adults. Drug Alcohol Rev. 2021;40(4):637–646. doi: 10.1111/dar.13240. [DOI] [PubMed] [Google Scholar]
  39. Liber A.C., Sánchez-Romero L.M., Cadham C.J., et al. Tobacco couponing: a systematic review of exposures and effects on tobacco initiation and cessation. Nicotine Tob. Res. 2022 doi: 10.1093/ntr/ntac037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Ling P.M., Crosbie E., Holmes L.M., Hoang C., Hoeper S. Cannabis dispensary online marketing practices in response to COVID-19 lockdowns. Subst Abuse. 2022;43(1):1116–1119. doi: 10.1080/08897077.2022.2060434. [DOI] [PubMed] [Google Scholar]
  41. Luc M.H., Tsang S.W., Thrul J., Kennedy R.D., Moran M.B. Content analysis of online product descriptions from cannabis retailers in six US states. Int. J. Drug Policy. 2020;75 doi: 10.1016/j.drugpo.2019.10.017. [DOI] [PubMed] [Google Scholar]
  42. MacKillop J., Prioritizing B.JW. University of Toronto Press; 2018. research on cannabis use among Canadian Veterans; pp. 2–5. [Google Scholar]
  43. McCausland K., Maycock B., Leaver T., et al. E-cigarette promotion on twitter in Australia: content analysis of tweets. JMIR Public Health Surveill. 2020;6(4):e15577. doi: 10.2196/15577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. McHugh M.L. Interrater reliability: the kappa statistic. Biochem Med (zagreb). 2012;22(3):276–282. [PMC free article] [PubMed] [Google Scholar]
  45. NBC News. The U.S. has a chance to regulate delta-8 THC. Will it? 2023. Available from: https://www.nbcnews.com/health/health-news/delta-8-thc-regulation-loophole-may-make-hard-know-cannabis-products-rcna102961. Accessed March 10, 2023.
  46. Niche. 2023 most diverse cities in America. Available from: https://www.niche.com/places-to-live/search/most-diverse-cities/. Accessed March 10, 2024.
  47. Nicholas W., Washburn F., Lee G., Loprieno D., Greenwell L., Berg C. Assessing the retail environments of licensed and unlicensed cannabis dispensaries: adapting the marijuana retail surveillance tool to inform cannabis regulation in los angeles county. J. Public Health Manag. Pract. 2021;27(4):403–411. doi: 10.1097/PHH.0000000000001224. [DOI] [PubMed] [Google Scholar]
  48. Noël C., Armiento C., Péfoyo A.K., Klein R., Bédard M., Scharf D. Adolescent exposure to cannabis marketing following recreational cannabis legalization in Canada: a pilot study using ecological momentary assessment. Addict. Behav. Rep. 2021;14 doi: 10.1016/j.abrep.2021.100383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Romm K.F., Cavazos-Rehg P.A., Williams R., et al. Cannabis retailer communication about cannabis products, health benefits, and risks: a mystery shopper study of licensed retailers in five US Cities. J. Stud. Alcohol Drugs. 2024;85(1):100–108. doi: 10.15288/jsad.23-00034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Rup J., Goodman S., Hammond D. Cannabis advertising, promotion and branding: Differences in consumer exposure between ‘legal’and ‘illegal’markets in Canada and the US. Prev. Med. 2020;133 doi: 10.1016/j.ypmed.2020.106013. [DOI] [PubMed] [Google Scholar]
  51. Shi Y., Pacula R.L. Assessment of recreational cannabis dispensaries’ compliance with underage access and marketing restrictions in California. JAMA Pediatr. 2021;175(11):1178–1180. doi: 10.1001/jamapediatrics.2021.2508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Shi Y., Cao Y., Shang C., Pacula R.L. The impacts of potency, warning messages, and price on preferences for Cannabis flower products. Int. J. Drug Policy. Dec 2019;74:1–10. doi: 10.1016/j.drugpo.2019.07.037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Trangenstein P.J., Whitehill J.M., Jenkins M.C., Jernigan D.H., Moreno M.A. Active cannabis marketing and adolescent past-year cannabis use. Drug Alcohol Depend. 2019;204 doi: 10.1016/j.drugalcdep.2019.107548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Trangenstein P.J., Whitehill J.M., Jenkins M.C., Jernigan D.H., Moreno M.A. Cannabis marketing and problematic cannabis use among adolescents. J. Stud. Alcohol Drugs. 2021;82(2):288–296. doi: 10.15288/jsad.2021.82.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Tveleneva A., Kim S.J., Minich M., et al. Yet again conversations matter: the importance of interpersonal discussions, educational campaigns, and advertising on cannabis-related risk perceptions, attitudes, and intentions in at-risk young adults. J. Health Commun. 2022;27(10):717–726. doi: 10.1080/10810730.2022.2153291. [DOI] [PubMed] [Google Scholar]
  56. US News & World Report. These States Have the Highest Percentages of Veterans. 2023. Available from: https://www.usnews.com/news/best-states/slideshows/where-veterans-live?slide=11. Accessed March 10, 2024.
  57. Wang G.S., Davies S.D., Halmo L.S., Sass A., Mistry R.D. Impact of marijuana legalization in Colorado on adolescent emergency and urgent care visits. J. Adolesc. Health. 2018;63(2):239–241. doi: 10.1016/j.jadohealth.2017.12.010. [DOI] [PubMed] [Google Scholar]
  58. Wang Y., Duan Z., Weaver S.R., et al. The short-term and long-term associations between receiving tobacco discounts or coupons and smoking cessation among US adult cigarette smokers with intention to quit. Nicotine Tob. Res. 2022 doi: 10.1093/ntr/ntac216. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Weisz BR, Michael. CANNABIS STATE-BY-STATE REGULATIONS. Available from: https://www.thompsoncoburn.com/docs/default-source/blog-documents/ranking-of-state-cannabis-regulations.pdf. Accessed October 12, 2022.
  60. Whitehill J.M., Trangenstein P.J., Jenkins M.C., Jernigan D.H., Moreno M.A. Exposure to cannabis marketing in social and traditional media and past-year use among adolescents in states with legal retail cannabis. J. Adolesc. Health. 2020;66(2):247–254. doi: 10.1016/j.jadohealth.2019.08.024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Wolfson L., Poole N. Supportive alcohol policy as a key element of fetal alcohol spectrum disorder prevention. Womens Health. 2023;19 doi: 10.1177/17455057231151838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Wolfson M., Toomey T.L., Forster J.L., Wagenaar A.C., McGovern P.G., Perry C.L. Characteristics, policies and practices of alcohol outlets and sales to underage persons. J. Stud. Alcohol. 1996;57(6):670–674. doi: 10.15288/jsa.1996.57.670. [DOI] [PubMed] [Google Scholar]
  63. Zhu, B., Guo, H., Cao, Y., An, R., Shi, Y. Perceived importance of factors in cannabis purchase decisions: a best-worst scaling experiment. Int J Drug Policy. May 29 2020:102793. doi:10.1016/j.drugpo.2020.102793. [DOI] [PMC free article] [PubMed]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Data 1
mmc1.docx (54.2KB, docx)

Data Availability Statement

Data will be made available on request.

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