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. Author manuscript; available in PMC: 2025 Sep 22.
Published in final edited form as: J Racial Ethn Health Disparities. 2024 Jul 15;12(5):2840–2852. doi: 10.1007/s40615-024-02092-z

Young Adults’ Experiences with Cannabis Retailer Marketing and Related Practices: Differences Among Sociodemographic Groups and Associations with Cannabis Use-related Outcomes

Carla J Berg 1,2, Katelyn F Romm 3, Cassidy R LoParco 1, Matthew E Rossheim 4, Yuxian Cui 1, Elizabeth Platt 5, Y Tony Yang 2,6, Yan Wang 1,2, Erin Kasson 7, Hannah S Szlyk 7, Darcey M McCready 1, Patricia A Cavazos-Rehg 7
PMCID: PMC12450293  NIHMSID: NIHMS2044050  PMID: 39009926

Abstract

Objectives

Limited cannabis retail surveillance has been conducted, particularly assessing retailer practices in relation to consumer sociodemographic factors or use-related outcomes. This study examined young adults’: exposure to promotions, health claims, warnings, and age restrictions at cannabis retailers; demographic correlates of retail exposures; and retail exposures in relation to use-related outcomes.

Study Design

This study used the cross-sectional quantitative analysis.

Methods

We analyzed 2023 survey data among 876 young adults in states with legal non-medical cannabis, reporting past-month cannabis use and past-year retailer visits.

Results

In this sample (Mage = 27.1, 44.1% male, 31.7% sexual minority, 17.7% Black, 11.2% Asian, 25.1% Hispanic), 46.7% “at least sometimes” noticed free samples, 76.5% price promotions, 37.4% subpopulation-targeted promotions; 72.5% health claims on products/ads, 63.1% signage, and 70.5% from budtenders; 72.5% warnings on labels, 65.5% signage, and 38.9% from budtenders; and > 80% age verifications. Multivariable analyses identified sociodemographic correlates of exposure outcomes: greater promotion exposure was associated with Black race; greater health claim exposure with being heterosexual, Black, and less educated; less warning exposure with less education; and less age restriction exposure with being younger, male, and Black. Retail exposures were associated with use-related outcomes: more frequent cannabis use was associated with less health claim exposure; greater perceived social acceptability with greater promotion and age restriction exposure; greater perceived risk with greater warning and less age restriction exposure; more problematic use and driving after use with greater promotion and less age restriction exposure.

Conclusions

Cannabis retail exposure disparities and their associations with use-related outcomes highlight the importance of regulatory and prevention efforts.

Keywords: Cannabis, Marketing, Public health, Health policy, Health communication

Introduction

In the past decade, cannabis-related policy and retail have markedly changed in the US, corresponding to increases in adult use prevalence [1], particularly among certain subpopulations, including young adults, racial/ethnic minorities, and sexual/gender minorities (SGM) [1, 2]. Since 2012, 24 states and DC legalized non-medical (i.e., recreational) use [3], with most establishing cannabis markets and regulatory boards.

State cannabis retail regulations play important roles in protecting consumers [4]. Given the impacts of cannabis marketing on perceptions and use [5–14], marketing restrictions are crucial. Cannabis products and ads emphasize influential product attributes (e.g., safety, quality, higher CBD and/or THC content, certain product forms/flavors) [15–19] and health benefits (e.g., alleviating pain, insomnia, anxiety) [16, 20–22], which reduce perceived risk and increase appeal and use intentions [23, 24] and often target certain subpopulations (e.g., young people, racial/ethnic minorities) [18, 25, 26]. Additionally, cannabis retailers use price promotions (e.g., discounts, loyalty programs) and other price reduction strategies [27–30], which encourage use [31, 32], particularly among price-sensitive subpopulations (e.g., young adults, lower income) [33]. Beyond marketing restrictions, other important consumer protections include health warnings, which effectively educate consumers, communicate risks, and reduce population-level use (based on tobacco control research [34, 35] and emerging cannabis studies [18, 25, 26, 36–42]), as well as requiring age verification and minimum age signage [43, 44], which can prevent youth access and exposure, early use initiation, and subsequent consequences (e.g., chronic use) [45, 46].

Certain subpopulations may experience greater cannabis retail exposure and less consumer protections. The tobacco literature has documented greater retail density in neighborhoods with greater proportions of low-income and racial/ethnic minority populations [47, 48], as well as increased retail marketing in lower income neighborhoods and targeting subpopulations (e.g., menthol cigarettes in Black neighborhoods) [49]. Emerging evidence for cannabis retail suggests similar trends; some studies documented lower income [50, 51] and Hispanic neighborhoods [51] having disproportionate numbers of cannabis retailers [50] and unlicensed retailers [50, 51], which engage in more potentially harmful practices (e.g., more promotions, less youth restrictions) [27]. Additionally, a California-based study found disproportionate numbers of retailers near schools [52], with 84% lacking minimum age signage and 60% using exterior cannabis signage, > 75% promotions, 28% free samples, and 74% youth-targeted marketing (i.e., products, ads), practices that were more frequent among retailers closer to schools [52]. Ultimately, these exposures impact adolescent [9, 53] and adult use [54–57].

Another important consideration is cannabis retail staff (i.e., “budtenders”). Mystery shopper research among cannabis retailers in five US cities documented that, regardless of restrictions, ~ 10% promoted free/inexpensive product, > 90% use for anxiety, insomnia, and/or pain, and 54% use for pregnancy-related nausea [58] (as previously found [59]). Only 26% warned against use during pregnancy, and 52% against driving after use [58], and qualitative research documented that many budtenders do not perceive their role to include providing these warnings [60].

This literature underscores important concerns regarding cannabis retail, including widespread use of promotions and unsubstantiated health claims, gaps in protecting consumers (e.g., risk-related warnings, youth restrictions), and potential targeting of disproportionately impacted groups. Ultimately, the implications for public health and inequity could be vast [61–63]. A range of approaches should be used to better understand the cannabis retail setting and consumers’ experiences within these settings, including retail audits, mystery shopper audits, and self-reports of consumers’ experiences—as each has specific benefits and limitations. For example, retail audits provide relatively objective data regarding observable characteristics but are limited in that they do not provide data on characteristics that are not easily observable (e.g., interactions between budtenders and consumers). Mystery shopper approaches provide some insights into consumer experiences but may not capture how real-world consumers, particularly those who are frequent customers (i.e., “regulars”), experience the retail setting. Self-reports from consumers provide unique insights but are subject to bias, for example, different individuals or subgroups may attend to different aspects of the retail environment or perceive similar experiences differently.

Importantly, while state regulations for cannabis retail vary [3], their ultimate goal is consumer protection. Thus, research is needed that assesses cannabis retail practices and consumer exposures both with regard to and regardless of regulatory context, as well as potential subpopulation differences in retail exposures, using various methods (e.g., consumer reports of their retail experiences).

This study takes an initial step at addressing limitations to existing research, by assessing young adults’ experiences within cannabis retail settings (i.e., exposure to promotions, health claims, warnings, and age restrictions), differences by sociodemographics, and associations with cannabis-related perceptions, use frequency, problematic use, and driving after use. This study provides a foundation for subsequent research integrating policy and other contextual data (e.g., neighborhood demography).

Methods

Study Design

The current study analyzed baseline survey data (June to November 2023) among a subset of young adults (ages 18–34) in the Cannabis Regulation, Marketing & Appeal (CARMA) study, a longitudinal study that examines non-medical cannabis retail, marketing, and impact on use (approved by the George Washington University Institutional Review Board) [64].

Participants and Recruitment

Eligible individuals (i.e., 18–34 years old, US resident, English-speaking) were recruited using purposive, quota-based sampling to ensure sufficient proportions of the sample represented past 30-day cannabis use (~ 50%), roughly equal numbers of males and females, and 40% racial/ethnic minorities to explore subgroup differences. Ads were posted on Facebook; after clicking on ads, individuals were messaged via chatbot on Facebook Messenger (verifying the individual had a Facebook account and precluding being invited/screened more than once). The chatbot provided an abbreviated study overview, asked individuals if they were willing to answer five questions, and then asked their age, country and state of residence, race, ethnicity, sex, sexual orientation, and past-month cannabis use status. Individuals deemed preliminarily eligible were provided a unique link to the full study description and consent form (in Alchemer), screened to confirm eligibility, notified that providing a working phone number and email address was required for enrollment, administered the baseline survey, and told that they would receive an email 7 days after completing the survey reiterating the study procedures/timeline and requiring them to “confirm” their participation. After confirming, they received their incentive ($10 Amazon e-gift card).

The participant flowchart is included in Fig. 1. Of 18,426 ad clicks, 8098 (43.9%) individuals began the Chatbot pre-screening, 6908 (85.3%) completed the Chatbot pre-screening, and 6128 (88.7%) were preliminarily eligible and provided study links. Of the 5827 (95.6%) who responded to the consent form, 5801 (99.0%) consented, 129 (2.2%) of whom were not allowed to advance because they either (a) did not complete the screening (n = 115) or (b) were ineligible (n = 14, outside of age range). Of the 5672 (97.8%) allowed to advance to the survey, 974 (17.2%) did not fully complete the survey (largely during the sociodemographics section at the beginning). Of the 4698 who completed the survey, 313 (6.7%) were not sent study confirmation links because they did not provide valid email addresses or phone numbers. Of the 4385 provided confirmation links, 4031 (91.9%) confirmed participation and were enrolled. (Those reporting past-month cannabis use were less likely to complete the survey and confirm participation. There were no differences by age, sex, or ethnicity, and minimal differences by race [64].)

Fig. 1.

Fig. 1

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Participant flowchart

Current analyses focused on participants living in states with legalized non-medical cannabis who reported past 30-day cannabis use and past 12-month cannabis retailer visits (n = 876), using the items described below.

Measures

Cannabis Use-related Factors

Cannabis was described as follows: “Marijuana (i.e., cannabis, pot, weed) including dried herb, edibles, oils, hash, kief, concentrates, marijuana drinks, tinctures, and lotions (do not include hemp-derived cannabinoids, like Delta-8)” [65]. Participants reported the following: (1) past-month use—“In the past 30 days, how many days did you use marijuana?”; (2) use per day—“On average, how many times do you use marijuana on the days that you use it?”; and (3) mode of use—“How do you use marijuana most of the time: dried herb (smoked or vaped); oils/liquids for vaping; oils/liquids taken orally (e.g., drops, capsules); tinctures (concentrated amounts containing alcohol ingested orally or under the tongue); concentrates (e.g., wax, shatter); hash or kief; edibles, foods or drinks; topical ointments; other.”

Cannabis Retail Access

We assessed the following: (1) number of times they visited a cannabis retailer in the past 12 months (0/never; 1; 2–5; 6–10; 11–20; ≥ 21) [66, 67]; (2) travel time to nearest retailer—“How long would it take you to get to the nearest marijuana shop using your usual mode of transportation? < 5 min; 5–10; 10–20; 20–30; 30–40; 40–50; 50–60; > 1 h; don’t know” [8]; and (3) usual product source—“How do you usually buy or get your marijuana products: licensed recreational retailer; licensed medical dispensary; licensed internet delivery service; unlicensed internet delivery service; dealer; family member or friend; made/grew my own; grocery store, gas station, mall, convenience store; tobacco specialty store (vape/smoke shop); other.” To contextualize responses, we asked, “Do you have a medical marijuana card?” and “Do you use marijuana for medical or recreational purposes? only medical, primarily medical but occasionally recreational, primarily recreational but occasionally medical, only recreational.”

Cannabis Retail Exposures

Participants were asked, “Please consider your experiences at marijuana shops in the past 12 months. When you have gone to a marijuana shop, how often have/were you….” Four exposure themes were assessed using three items each: (1) promotion exposure—“offered free samples or products (with or without purchase of another product),” “offered price promotions or discounts,” and “noticed promotions or merchandise specifically geared to a particular racial or ethnic group, LGBTQ, college students, military, etc.”; (2) health claim exposure—“noticed product labels/ads indicating potential health benefits of marijuana use (e.g., for pain, sleep),” “noticed signs outside of ads indicating potential health benefits of marijuana use,” and “told by shop staff that marijuana has any potential health benefits”; (3) warning exposure—“noticed health warning labels on products/ads (e.g., harm to pregnant women, DUI),” “noticed signage indicating marijuana-related health warnings or potential risks,” and “cautioned by shop staff about risks related to marijuana use”; and (4) age restriction exposure—“noticed age requirement signs,” “asked for identification to verify age upon entering the shop,” and “… upon making a purchase” (0 = never, 1 = rarely, 2 = sometimes, 3 = frequently, 4 = always) [66, 67]. Summary scores (item averages) were created for the four exposures (Cronbach’s alphas of 0.65, 0.80, 0.79, and 0.76, respectively). Additionally, those reporting signs, ads, or staff indicating health benefits were asked, “Which ‘health claims’ were displayed on products, ads, or signs or mentioned by staff: helps with—anxiety/stress; insomnia/sleep; depression; nausea due to pregnancy; nausea due to chemotherapy; pain and/or inflammation; fighting cancer; other.”

Cannabis-related Perceptions

Participants were asked three parallel questions: “How [socially acceptable; harmful to your health; addictive] do you think the use of marijuana is?” (1 = not at all to 7 = extremely). A perceived risk score was calculated as the average of perceived harm and addictiveness (Cronbach’s alpha = 0.52).

Problem Use Indicators

Participants reporting past-month use were asked about the following: (1) driving after cannabis use—“During the past 6 months, how many times did you drive a car or other vehicle when you had been using marijuana?” (0, 1, 2–3, 4–5, ≥ 6; dichotomized as any vs. none); and (2) problematic use—participants were asked to “Rate the extent to which each item has impacted you; using marijuana has….” (1 = not at all to 5 = very much) with regard to items adapted from previously developed measures [68, 69] assessing social–interpersonal consequences (“made people who are important to me disapprove of me”); impaired control (“impaired my judgment, endanger myself or others, or do things I regret”); risk behaviors (“gotten me in trouble with the law”); physical consequences (“made me feel bad physically, e.g., dry mouth, red eyes, racing heart”); cognitive consequences (“reduced my ability to pay attention or remember things”); psychological consequences (“had unpleasant psychological effects, e.g., mood swings, depression, paranoia”); self-care consequences (“made me less active or feel less energetic”); and academic/occupational consequences (“made me neglect obligations to family, work, or school”). Exploratory factor analysis indicated a single factor; responses were averaged (Cronbach’s alpha = 0.87).

Sociodemographics

We assessed age (continuous), sex assigned at birth (categorized: male, female, other), sexual orientation (categorized: heterosexual vs. sexual minority), ethnicity (Hispanic vs. non-Hispanic), race (categorized: White, Black, Asian, other), and education level (categorized: < Bachelor’s degree, ≥ Bachelor’s).

Data Analysis

First, descriptive analyses were conducted to characterize the subsample (n = 876) including sociodemographics, cannabis use, retail access, retail exposures (i.e., promotions, health claims, warnings, age restrictions), and use-related outcomes. Then, multivariable linear regressions examined sociodemographics in relation to each cannabis retail exposure. Finally, retail exposures were examined in relation to the following: (1) number of days used in the past month; (2) perceived social acceptability; (3) perceived risk; (4) problematic use; and (5) driving after cannabis use, using multivariable regressions (#1–4 linear; #5 binary logistic). Analyses were conducted in SPSS.v27, and significance was set at p < 0.05.

Results

Participant Characteristics

Shown in Table 1, this subsample (n = 876) was on average 27.07 years old (SD = 4.34), 44.1% male, 31.7% sexual minority, 25.1% Hispanic/Latino, 17.7% Black, 11.2% Asian, 7.8% another race, and 58.2% educated < Bachelor’s degree.

Table 1.

Characteristics of young adults in states with legal non-medical cannabis, reporting past 30-day cannabis use and past 12-month cannabis retailer visits (N = 876), 2023

Variables n (%) or M (SD)
Sociodemographics
 Age, M (SD) ╪ 27 (4.34)
 Male, n (%) 386 (44.1)
 Sexual minority, n (%) 278 (31.7)
 Hispanic, n (%) 220 (25.1)
 Race, n (%)
  White 514 (58.7)
  Black 155 (17.7)
  Asian 98 (11.2)
  Other 68 (7.8)
  Education ≥ bachelor’s degree, n (%) 366 (41.8)
Cannabis use characteristics
 Number of days used, past 30 days, M (SD) 14.79 (11.21)
 Average number of times used per day, M (SD) 4.66 (6.88)
 Most common mode of cannabis use, n (%)
  Dried herb 466 (53.2)
  Edibles, foods, or drinks 189 (21.6)
  Cannabis oils or liquids for vaping 110 (12.6)
  Cannabis oils or liquids taken orally 27 (3.1)
  Tinctures 17 (1.9)
  Concentrates 35 (4.0)
  Hash or kief 11 (1.3)
  Topical ointments 15 (1.7)
 Medical cannabis card, n (%) 142 (16.2)
 Use for medical or recreational purposes, n (%)
  Only medical 63 (7.2)
  Primarily medical but occasionally recreational 191 (21.8)
  Primarily recreational but occasionally medical 286 (32.6)
  Only for recreational 303 (34.6)
Cannabis-related perceptions, M (SD) §
 Perceived social acceptability 5.69 (1.54)
 Perceived risk 3.38 (1.49)
  Perceived harm 2.87 (1.67)
  Perceived addictiveness 3.89 (1.94)
Problematic use indicators
 Problematic use, M (SD)# 2.04 (0.88)
 Driving after cannabis use, n (%) 290 (33.6)
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M mean, SD standard deviation

╪

18–20-year-olds (n = 55), of whom n = 8 reported having a medical cannabis card. Sex: other/prefer not to answer (n = 5). Sexual identity: prefer not to answer (n = 11). Ethnicity: don’t know/prefer not to answer (n = 15). Race: other (i.e., American Indian or Alaskan Native n = 31, native Hawaiian or Pacific Islander n = 4, multiracial n = 33), prefer not to answer (n = 41)

§

1 = not at all to 7 = extremely. Perceived risk = average of perceived harm and addiction (Cronbach’s alpha = .52)

^

0 = not at all to 10 = absolutely

#

Problematic use, average of eight items on scale of 1 = not at all to 5 = very much (Cronbach’s alpha = .87). Other/prefer not to answer responses: mode of use most often: prefer not to answer (n = 6). Medical card: prefer not to answer (n = 30). Medical vs. recreational purposes: not sure (n = 12), prefer not to answer (n = 21). Driving after cannabis use: prefer not to answer (n = 14)

Cannabis Use and Retail Access

Participants used cannabis an average of 14.79 days (SD = 11.21) in the past month, most commonly used flower (53.2%), edibles (21.6%), or vapes (12.6%), and primarily obtained cannabis from licensed non-medical retailers (57.1%; other responses: 13.9% medical dispensary, 10.6% tobacco specialty stores, 10.5% family/friends, 9.5% dealer). Most could get to a retailer within 10 min (53.0%) or between 11 and 30 min (35.4%). Almost all (85.3%) reported multiple past-year retailer visits (50.6% > 6 times; 20.3% > 21 times).

Cannabis Retail Exposures

Table 2 shows average retail exposures by item and summary scores. For descriptive purposes, we also summarized items using a threshold of “at least sometimes” (i.e., sometimes/frequently/always vs. never/rarely). “At least sometimes” was reported frequently for each exposure, i.e., noticing: free product (46.7%), price promotions/discounts (76.5%), subpopulation-targeted promotions/products (37.4%); health claims on product labels/ads (37.4%), on non-ad signage (63.1%), from budtenders (70.5%); warnings on product labels/ads (72.5%), on signage (65.5%), from budtenders (38.9%); minimum age signage (87.1%), requiring ID upon store entrance (86.4%) or purchase (84.4%). Health claims involved anxiety/stress (74.2%), insomnia/sleep (71.3%), depression (51.8%), pain/inflammation (50.4%), chemotherapy-related nausea (22.1%), fighting cancer (11.7%), and pregnancy-related nausea (11.1%).

Table 2.

Cannabis retail experiences among young adults in states with legal non-medical cannabis, reporting past 30-day cannabis use and past 12-month cannabis retailer visits (N = 876), 2023

Variables n (%)
Usual product source
 Licensed recreational marijuana shop or retailer 378 (43.2)
 Licensed medical dispensary 122 (13.9)
 Tobacco specialty store 93 (10.6)
 Family member or friend 92 (10.5)
 Dealer (in person, unaffiliated with a license) 83 (9.5)
 Grocery/convenience store, gas station, mall 36 (4.1)
 Licensed internet delivery service or mail order 32 (3.7)
 I made or grew my own 16 (1.8)
 Unlicensed internet delivery service or mail order 4 (0.5)
Amount of time to nearest cannabis shop
 Within 10 min 464 (53.0)
 11 to 30 min 310 (35.4)
 More than 30 min 94 (10.7)
Number of cannabis shop visits, past 12 months ^
 1 time 129 (14.7)
 2–5 times 304 (34.7)
 6–10 times 174 (19.9)
 11–20 times 91 (10.4)
 21 or more times 178 (20.3)
M (SD) At least sometimes n (%)
Experiences in cannabis shops, past 12 months #
 Been offered free samples or products 1.41 (1.29) 409 (46.7)
 Been offered price promotions or discounts 2.28 (1.19) 670 (76.5)
 Noticed promotions/merchandise targeting subgroups * 1.18 (1.26) 328 (37.4)
  Promotion exposure a 1.62 (0.95) –
 Noticed product labels/ads indicating potential health benefits 2.21 (1.28) 635 (72.5)
 Noticed signs outside of ads indicating potential health benefits 1.89 (1.31) 553 (63.1)
 Been told by shop staff of cannabis’ potential health benefits 2.08 (1.29) 618 (70.5)
  Health claim exposure b 2.06 (1.10) –
 Noticed health warning labels on products or ads 2.45 (1.33) 659 (75.2)
 Noticed signs indicating health warnings or potential risks 2.10 (1.36) 574 (65.5)
 Been cautioned by shop staff about cannabis risks 1.29 (1.41) 341 (38.9)
  Health/risk warning exposure c 1.94 (1.14) –
 Noticed age requirement signs ╪ 3.02 (1.18) 113 (87.1)
 Been asked for ID to verify age upon entering 3.13 (1.28) 757 (86.4)
 Been asked for ID to verify age upon purchase 3.01 (1.31) 739 (84.4)
  Age restriction exposure d 3.05 (1.03) –
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M mean, SD standard deviation

^

Among 18–20-year-olds: 1 visit in the past year, n = 11 (20.0%); 2–5 times, n = 24 (43.6%); 6–10 times, n = 9 (16.4%); 11–20 times, n = 7 (12.7%); 21 or more times, n = 4 (7.3%)

#

0 = never, 1 = rarely, 2 = sometimes, 3 = frequently, 4 = always

*

Racial/ethnic, LGBTQ, college students, military, etc.

Cronbach’s alphas: a.65; b.80; c.79; d.76

╪

Among 18–20-year-olds: noticed age requirement signs: never, n = 6 (10.9%); rarely, n = 10 (18.2%); sometimes, n = 13 (23.6%); frequently, n = 14 (25.5%); always, n = 12 (21.8%); asked for ID to verify age upon entry: never, n = 13 (23.6%); rarely, n = 4 (7.3%); sometimes, n = 17 (30.9%); frequently, n = 9 (16.4%); always, n = 12 (21.8%); asked for ID to verify age upon purchase: never, n = 11 (20.0%); rarely, n = 4 (7.3%); sometimes, n = 14 (25.5%); frequently, n = 8 (14.5%); always, n = 18 (32.7%). Information not show in table: product source: other (n = 4), don’t know (n = 6), prefer not to answer (n = 10). Distance: don’t know (n = 8)

Sociodemographic Factors Associated with Cannabis Retail Exposures

Multivariable analyses (Table 3) indicated the following sociodemographic factors were associated with retail exposures: (1) greater promotion exposure: being Black (vs. White); (2) greater health claim exposure: being heterosexual (vs. sexual minority), Black, and educated < Bachelor’s degree (vs. ≥ Bachelor’s); (3) greater warning exposure: < Bachelor’s degree; and (4) greater age restriction exposure: being older, female, and White (vs. Black). Additionally, number of cannabis retailer visits was positively associated with greater promotion and warning exposure.

Table 3.

Multivariable linear regression results indicating sociodemographic factors related to cannabis retail exposure outcomes among young adults in states with legal non-medical cannabis, reporting past 30-day cannabis use and past 12-month cannabis retailer visits (N = 876), 2023

Promotion exposure Health claim exposure Warning exposure Age restriction exposure
Variables B 95% CI p B 95% CI p B 95% CI p B 95% CI p
Sociodemogmphics
 Age −0.01 −0.05,0.04 .800 0.04 −0.01,0.09 .114 0.02 −0.04, 0.07 .502 0.07 0.03,0.12 .002
 Male (ref: female) −0.01 −0.40, 0.37 .950 −0.43 −0.88, 0.01 .057 −0.36 −0.82,0.11 .134 −0.58 −1.002,−0.16 .006
 Sexual minority (ref: straight) −0.40 −0.81,0.01 .058 −0.48 −0.96,−0.01 .047 −0.38 −0.88, 0.11 .129 0.23 −0.22,0.68 .314
 Hispanic (ref: not) −0.04 −0.48, 0.41 .878 −0.10 −0.61,0.42 .711 −0.06 −0.60, 0.48 .830 −0.24 −0.72, 0.25 .337
 Race (ref: White)
  Black 0.53 0.20, 1.04 .042 0.62 0.03, 1.21 .039 0.42 −0.20, 1.03 .181 −0.76 −1.31,−0.20 .007
  Asian 0.25 −0.40, 0.89 .455 −0.51 −1.26,0.23 .178 −0.59 −1.36, 0.19 .139 −0.16 −0.85,0.54 .664
  Other −0.17 −0.89, 0.54 .638 0.11 −0.72,0.94 .798 0.20 −0.66, 1.06 .646 0.18 −0.60, 0.95 .658
 ≥ Bachelor’s degree −0.13 −0.54, 0.28 .528 −0.47 −0.94,−0.001 .049 0.71 0.22, 1.20 .005 −0.29 −0.73,0.15 .194
# cannabis retailer visits 0.36 0.22, 0.50 <.001 0.15 −0.02, 0.31 .082 0.20 0.03, 0.37 .024 0.11 −0.05,0.26 .164
 Adjusted R-square .032 .025 .027 .028
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Cannabis Retail Exposures in Relation to Cannabis-related Outcomes

Shown in Table 4, multivariable analyses (controlling for days used for #2–5, number of visits, and sociodemographics) indicated exposure factors associated with use-related outcomes: (1) more days of use: less health claim exposure; (2) greater perceived social acceptability: greater promotion and age restriction exposure; (3) greater perceived risk: greater warning and less age restriction exposure; (4) more problematic use: greater promotion and less age restriction exposure; and (5) driving after use: greater promotion and less age restriction exposure.

Table 4.

Multivariable regression results indicating cannabis retail exposures related to cannabis use outcomes among young adults in states with legal non-medical cannabis, reporting past 30-day cannabis use and past 12-month cannabis retailer visits (N = 876), 2023

Days of use Perceived social acceptability Perceived risk
Variables B 95% CI p B 95% CI p B 95% CI p
Cannabis retail experience
 Promotion exposure −0.05 −0.29, 0.19 .696 0.05 0.01, 0.09 .022 0.03 −0.003, 0.07 .070
 Health claim exposure −0.26 −0.50, −0.03 .028 0.02 −0.02, 0.06 .240 0.02 −0.02, 0.06 .312
 Warning exposure 0.16 −0.06, 0.38 .155 −0.01 −0.05, 0.02 .479 0.09 0.05, 0.13 < .001
 Age restriction exposure −0.05 −0.29, 0.19 .696 0.05 0.01, 0.08 .008 −0.07 −0.11, −0.04 < .001
# cannabis retailer visits 4.01 3.54, 4.48 < .001 0.02 −0.06, 0.11 .583 0.01 −0.08, 0.09 .838
# days of use – – – 0.03 0.02, 0.04 < .001 −0.003 −0.01, 0.01 .536
Sociodemographics
 Age 0.09 −0.06, 0.23 .250 −0.002 −0.03, 0.02 .855 −0.04 −0.06, −0.02 .001
 Male (ref: female) 0.53 −0.73, 1.80 .409 −0.10 −0.31, 0.10 .320 0.07 −0.13, 0.27 .496
 Sexual minority (ref: straight) 1.69 0.34, 3.04 .014 0.27 0.05, 0.48 .017 −0.09 −0.30, 0.12 .410
 Hispanic (ref: not) −1.10 −2.55, 0.36 .140 −0.21 −0.44, 0.03 .085 0.05 −0.18, 0.27 .696
 Race (ref: White)
  Black 0.39 −1.29, 2.07 .649 −0.05 −0.32, 0.23 .737 0.25 −0.01, 0.51 .059
  Asian −2.73 −4.84, −0.62 .011 −0.25 −0.60, 0.09 .145 0.01 −0.32, 0.34 .958
  Other −1.40 −3.74, 0.94 .239 −0.12 −0.50, 0.25 .521 0.08 −0.28, 0.45 .665
 ≥ Bachelor’s degree −3.87 −5.20, −2.53 < .001 0.03 −0.19, 0.24 .822 0.31 0.10, 0.52 .004
 Adjusted R-square .330 .073 .079
Problematic use Driving after use
Variables B 95% CI p aOR 95% CI p
Cannabis retail experience
 Promotion exposure 0.09 0.07, 0.11 < .001 1.14 1.08, 1.21 < .001
 Health claim exposure 0.01 −0.01, 0.03 .238 1.02 0.97, 1.08 .456
 Warning exposure 0.01 −0.02, 0.02 .620 1.03 0.97, 1.09 .321
 Age restriction exposure −0.05 −0.07, −0.03 < .001 0.93 0.89, 0.99 .012
# cannabis retailer visits −0.01 −0.06, 0.04 .586 1.04 0.91, 1.19 .534
# days of use −0.01 −0.02, −0.01 < .001 1.04 1.02, 1.05 < .001
Sociodemographics
 Age −0.02 −0.03, −0.003 .015 1.04 1.02, 1.05 .083
 Male (ref: female) 0.15 0.03, 0.26 .011 1.41 1.03, 1.92 .032
 Sexual minority −0.04 −0.16, 0.08 .529 0.87 0.62, 1.22 .406
 (ref: straight)
 Hispanic (ref: not) −0.06 −0.19, 0.06 .328 0.68 0.39, 1.21 .037
 Race (ref: White)
  Black −0.17 −0.32, −0.02 .028 1.51 1.02, 2.24 .038
  Asian 0.17 −0.02, 0.36 .082 0.68 0.39, 1.21 .187
  Other 0.07 −0.13, 0.28 .490 0.99 0.55, 1.78 .972
 ≥ Bachelor’s degree 0.11 −0.01, 0.23 .084 1.02 0.73, 1.43 .907
 Adjusted R-square .167 .148 *
Open in a new tab

aOR adjusted odds ratio, CI confidence interval

*

Nagelkereke R-square

Additionally, number of cannabis retailer visits was positively associated with days used, and days used was associated with greater perceived social acceptability, less problematic use, and driving after use. Being older was associated with lower perceived risk and less problematic use, being male was associated with more problematic use and driving after use, identifying as sexual minority was associated with more days used and greater perceived social acceptability, identifying as Black was associated with less problematic use but greater odds of driving after use, and being more educated was associated with fewer days used and greater perceived risk. No other differences (e.g., by race or ethnicity) were found.

Discussion

In this sample of young adults living in states with legalized non-medical cannabis and reporting past-month cannabis use and past-year cannabis retail visits, the majority “at least sometimes” noticed price promotions or health claims (via ads, signs, or budtenders)—generally reflecting retail audit data [27–30] and previously documented claims (e.g., for anxiety, insomnia/sleep) [16, 20–22]. These rates are concerning given the impact of price promotions [33] and health claims [23] on perceptions and use. While the majority “at least sometimes” noticed warnings, only ~ 40% had budtenders provide warnings, reflecting prior mystery shopper [58] and qualitative findings [60]. This finding, paired with the fact that over 70% of participants reported hearing health claims from budtenders, underscores the need for regulations clearly addressing budtender communication regarding unsubstantiated health benefits and potential risks of use, as well as measures (e.g., required trainings) to ensure appropriate budtender communication. Additionally, nearly half of participants “at least sometimes” noticed free samples and promotions/products targeting racial, ethnic, sexual minorities, college students, etc. However, > 80% “at least sometimes” noticed minimum age signage and age verification requirements, similar to retail audit findings [27–30].

Little research has examined differences in cannabis retail practices depending on the consumers or neighborhoods they serve [27, 50–52]. Current results reflect findings in the tobacco literature [49] and the nascent prior research regarding cannabis retail [27, 50–52]: certain subpopulations experience fewer consumer protections. Black individuals noticed more promotions and health claims and less age restrictions, those less educated noticed more health claims and less warnings, and younger participants noticed less age restrictions, resonating with prior research suggesting greater exposure to cannabis retail/marketing, particularly retailers likely to engage in more concerning practices (e.g., youth-targeting, discounts) [27, 51, 52]. To protect disproportionately impacted groups, ongoing cannabis retail surveillance is needed, particularly attending to place and consumer characteristics, and to both observable factors like signage and less visible factors, like budtender interactions.

Exposure to more promotions was associated with greater perceived social acceptability, problematic use, and driving after use, similar to previously documented associations with appeal, social norms, and use [5–14], likely leading to problematic use patterns. Additionally, similar to survey-based experimental findings [26, 38, 70], seeing more warnings at cannabis retailers was associated with greater perceived risk [38]. Finally, less age restriction exposure was associated with more problematic use and driving after use, suggesting that underage access may contribute to detrimental use trajectories [45, 46]. A less intuitive finding is that males noticed less age restrictions; the limited differences found in the tobacco literature indicated greater likelihood of sales to underage females [71–74]. This finding and other difficult to interpret results (e.g., negative associations between health claim exposure and use frequency, and between age restriction exposure and perceived risk) require further research.

Regarding sociodemographic factors and use-related outcomes, as documented previously, males reported more problematic use and driving after use [75–77], sexual minority individuals reported more frequent use [78] and social acceptability [79], and less educated individuals reported more frequent use and lower perceived risk [80, 81]. Interestingly, Black individuals were more likely to drive after use but reported less problematic use. Some studies show no racial differences regarding problematic use or driving-related risks [82]; others suggest delayed problematic use among Black individuals [83], emphasizing the importance of understanding use trajectories among disproportionately impacted populations.

Current findings have significant implications for research and practice. First, as noted previously, additional research using a range of methods is needed to better understand the cannabis retail setting and consumers’ experiences, such as retail audits, mystery shopper audits, and self-reports of consumers’ experiences, given that each approach has unique benefits and limitations. Second, policymakers and practitioners must draw on our prior experiences, for example, from tobacco retail [47–49], to protect against disproportionate impacts of the cannabis retail industry among certain subpopulations (e.g., racial minorities).

Limitations

This study is limited in generalizability, given social-media based recruitment and purposive sampling of ~ 50% reporting past-month cannabis use. Additionally, measures were self-reported, introducing potential bias. Current analyses did not include state or local policy factors; however, the next step in this research is to incorporate such policy indicators to determine if policy context influences retail experiences, for which retail audit data provides mixed evidence [22, 29, 58]. Finally, data were cross-sectional, precluding causal inference.

Conclusions

Current findings provide insight into whether cannabis retail practices differ based on the consumers they serve, suggesting that certain subpopulations (e.g., racial minorities, less educated) may be exposed to less protections within cannabis retail settings and that these exposures have implications for use-related outcomes, including perceived social acceptability and risk, problematic use, and driving after use. Ultimately, findings raise concerns regarding implications for cannabis-related health inequities and underscore the need for regulations regarding promotions, health claims, warnings, and minimum age, as well as enforcement.

Funding

This work was supported by the National Institute on Drug Abuse (R01DA054751, MPIs: Berg, Cavazos-Rehg). Dr. Berg is also supported by other US NIH funding, specifically the National Cancer Institute (R01CA215155, PI: Berg; R01CA239178, MPIs: Berg, Levine; R01CA278229, MPIs: Berg, Kegler; R01CA275066, MPIs: Yang, Berg; R21CA261884, MPIs: Berg, Arem), Fogarty International Center (R01TW010664, MPIs: Berg, Kegler; D43TW012456, MPIs: Berg, Paichadze, Petrosyan), and the National Institute of Environmental Health Sciences/Fogarty (D43ES030927, MPIs: Berg, Caudle, Sturua). Dr. Romm is supported by the American Cancer Society (134128-IRG-19-142; PI: Romm), the Oklahoma Tobacco Settlement Endowment Trust (TSET) contract #R22-03, and the National Cancer Institute grant awarded to the Stephenson Cancer Center (P30CA225520). 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.

Footnotes

Ethics Approval This study was approved by the George Washington University Institutional Review Board (NCR224124).

Consent to Participate All participants provided informed consent.

Competing Interests The authors declare no competing interests.

Availability of Data and Materials

The datasets used and/or analyzed in the current study are available from the corresponding author on reasonable request.

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Associated Data

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

Data Availability Statement

The datasets used and/or analyzed in the current study are available from the corresponding author on reasonable request.

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