A Narrative Review of Research on Cannabis Advertising in the United States

Abstract

Purpose of Review

In the U.S., cannabis products containing at least 0.3% tetrahydrocannabinol (THC), are legal for adult use in 22 states (including the District of Columbia) and in 16 additional states for medicinal use. There is a growing body of literature to understand how these products are marketed. The objective of this narrative review is to summarize recent research examining cannabis advertising. We characterized the research reviewed across three primary domains: (1) content of cannabis advertising; (2) prevalence of cannabis advertising exposure; and (3) effects of cannabis advertising on user perceptions.

Recent Findings

Research indicates that cannabis is marketed in a variety of ways, including via tactics (e.g., price promotions) found to be effective in increasing use of other commercial products (e.g., tobacco). Moreover, cannabis marketing tactics may be appealing to youth or mislead consumers via unsubstantiated health claims. Exposure to cannabis advertising is common among both youth and adults, occurring through a variety of pathways including storefront signage, social media and billboards. Finally, several studies have found associations between exposure to cannabis marketing and cannabis use; however, studies designed to estimate causal effects of exposure were limited, warranting additional research in this area.

Summary

Understanding the prevalence and effects of exposure to cannabis advertising, along with the content of this advertising, can inform the operationalization and implementation of regulations and interventions designed to mitigate harms associated with advertising exposure.

Introduction

In the U.S., cannabis containing at least 0.3% tetrahydrocannabinol (THC) (heretofore referred to as cannabis) can be legally sold for recreational use in 22 states (including the District of Columbia) and in 38 states for medicinal use. In addition, 19% of U.S. early midlife adults, 14% of midlife adults, and 29% of young adults age 18–30 report past-month cannabis use [1]. As for any consumer product, advertising is a key way for cannabis retailers to generate product interest and sales. To date, restrictions on cannabis marketing are decentralized and vary from state to state. They typically include restrictions on misleading advertising (e.g., from New Jersey, cannabis shall not be advertised “…by way of any statement or illustration that is deceptive, false, or misleading” [2] and limits on youth-targeted advertising (e.g., from Maryland, that advertising “may not: … directly or indirectly target individuals under the age of 21 years” [3].

Literature from the study of other product marketing, namely tobacco and alcohol, has found that advertising for these products is a critical driver of initiation and continued use [4–6]. For example, tobacco advertising has been characterized as a causal agent of tobacco use [6], which has led to increased regulatory scrutiny and restriction on youth-appealing product design and marketing in the U.S [7]. Alcohol marketing has also been shown to be strongly associated with increased drinking intentions and consumption, although the alcohol industry is largely self-regulated [4]– [5]. Accordingly, there is a growing body of research focused on examining cannabis advertising to guide the development of effective policies and intervention strategies.

To address this, we conducted a narrative review of relevant literature. A narrative review summarizes, interprets and critiques a body of scholarly literature [8]. While narrative reviews often employ systematic approach (e.g., in identification and inclusion of relevant literature), they offer the “flexibility” suitable for “evolving knowledge and concepts” such as the emerging scholarship on cannabis advertising [9]. The objective of the current narrative review was to summarize extant research on cannabis advertising during a five-year period from 2019 to 2024. We focused on research that (1) describes the characteristics of cannabis advertising, (2) documents the prevalence of cannabis advertising exposure, and (3) examines potential outcomes of exposure to cannabis advertising. We searched for articles on PubMed and PsycInfo published between 2019 and 2024 using the search terms (cannabis OR marijuana) AND (marketing OR advertising OR labeling). Because different countries vary in how cannabis advertising is regulated, we limited our search to U.S. research to increase the specificity of the findings. Research on cannabis labeling, pricing, and other forms of communication about cannabis (e.g., in the media; unpaid social media posts) was outside the scope of this review and excluded from analysis. This search strategy retrieved 79 unique articles. After screening for relevance (i.e., that the article presents primary research focused on either describing the characteristics of cannabis advertising, examining the prevalence of exposure to cannabis advertising, or examined associations between exposure to cannabis advertising and related outcomes), the final sample was 45 articles. Screening and review of the articles was completed by two authors (ST and MM).

Theoretic Framework

To organize findings of the reviewed studies, we employed McGuire’s Input-Output Matrix, which is used to explain the processes through which advertising or other communications result in behavior change [10]. Briefly, this model posits that the advertising itself consists of various characteristics, including channel (e.g., social media, outdoor advertising, etc.) and message features (e.g., content, themes) that can result in a cascade of outcomes within audience members, beginning with exposure to the advertising and resulting in changes in beliefs, attitudes, and behaviors. Thus, we organize our summary of the literature by first focusing on the characteristics (channel and features) of the advertising itself. This section describes studies examining ways the cannabis industry markets its products. We then move on to describe literature describing patterns of exposure to cannabis advertising. Finally, we summarize literature focusing on effects of and outcomes associated with cannabis advertising. Within each of these three main topic heading, we employ sub-topic headings (e.g., Channels, Claims Related to Health) to further organize and characterize the main areas of focus within the literature. This is offered as an organizational structure to help summarize the literature, rather than as quantitative content codes for the articles. In the next sections, we summarize findings in each of these three main areas, describing specific studies to illustrate the breadth of research and/or to highlight notable findings.

Characteristics of Cannabis Advertising

Multiple studies have investigated the ways in which the cannabis industry markets their product, including the channels through which advertising occurs, the specific promotions, claims and other themes contained within the advertisements, and the ways in which the industry segments and targets specific audiences.

Channels

Cannabis advertising has been documented in multiple channels, including outdoor advertising (e.g., billboards [11]), print (e.g., magazine; [12]), and social media platforms [13–16]. Advertising materials are also common on cannabis retailer websites (e.g [17, 18])., and in physical retail store dispensaries (e.g [19]., – [20]). Some research has queried people about the channels through which they recalled being exposed to cannabis advertising, finding that social media [21–24], websites [21, 25, 26], apps [22], and storefronts [27]– [28] were common reported sources of exposure. Collectively, this research indicates that cannabis products are being advertised in a range of channels.

Claims Related to Health

Several studies found that cannabis advertising contained references to health and medicine, including health claims that may lack a strong evidence-base (e.g., that could be provided via controlled clinical trials). Some work has identified general attempts to associate cannabis with medicine to health, medicine, and scientific establishments. One study examining billboards in Oklahoma found that 52% of marketing included symbols related to the medical cross or medical staff symbols and 32% included the terms “health or medical” [29]. Other imagery included themes related to healthfulness [30], or references to scientific cannabis-related research [19]. Research has also identified more explicit health claims present in cannabis advertising (e.g [17–19, 31–36].,. For example, Berg et al. [19] found health claims made at 28.7% of dispensaries (N = 150) they studied, while Duan et al. [17] found that 59.0% of cannabis retailer websites (N = 195) they sampled contained unsubstantiated health claims. In a study of cannabis retailer advertising on Facebook and Twitter, Marinello et al. [30] found that 10.7% of posts included health claims. Several studies found such claims to include descriptions of health benefits related to treating pain, nausea/vomiting, anxiety, insomnia, and depression [18, 32, 34]– [35]. One study found that cannabis advertising included mentions of academic-industry partnerships to emphasize research-related health claims [37]. Cavazos-Rehg et al. [31] additionally found that warnings of side effects were mentioned in fewer than half (45%) of a random sample of 97 cannabis dispensary websites across 10 states. In light of state regulations that commonly prohibit misleading marketing claims, this body of research highlights an area worth further focus.

Claims Related to Non-Health Outcomes of Use

Some work has identified advertising claims related to use outcomes beyond those related to health. For example, Hoeper et al. [38] found that cannabis advertising mentioned various benefits of use, including creativity and euphoria. Studies also noted claims promoting effects related to socialization and social rewards, and effects regarding both physical and psychological relaxation ([12, 18, 39].

Normalization of Cannabis and Cultural Appeals

Normalization of cannabis use was identified as an additional theme of advertisements. This included messaging to dispel negative stereotypes about cannabis users [13]. Additionally, strategies employed messages that influence consumer perceptions (social acceptability, health risks), such as descriptions of a company’s volunteerism or other corporate social responsibility actions, activism or other forms of community support [13, 17]. Additionally, content often emphasized cannabis use as ‘part of everyday life [12], and modeling cannabis use (for example, imagery or text depicting and describing cannabis use) was found in ad content [14]. Some research also identified advertisements that promoted overconsumption of cannabis (e.g., encouraging consumers to “go higher” [14]. Other work found that 77% of cannabis billboards identified in Oklahoma City and Tulsa, OK attempted to connect to “cannabis subculture” (e.g., by using slang), 36% referenced spirituality, 22% connected to concepts of wellness (i.e., holistic concepts of well-being beyond just physical health) [11]. Advertising was also found to leverage “greenwashing” [40] in which a company attempts to generate natural, nature-related or eco-friendly associations [11, 39]. Some work has found references to pop culture and use of celebrity endorsements [13, 19]. Collectively, these strategies could serve to foster consumer perceptions of cannabis companies as good corporate citizens and of cannabis as a natural and commonly used product that fits in with one’s daily life.

Promotions

Product promotions (offering coupons, discounts, deals, specials, samples, or giveaways) were another commonly used approach in cannabis advertising [11, 13, 17]– [14, 19]– [20, 31, 41]. Promotional tactics included price specials, drawings/raffles, giveaways, discounts (e.g., for first time customers), and time-based special pricing (e.g., happy hours, early bird [14, 19, 35]. There is some evidence that use of promotions may vary based on advertising channel. For example, McQuoid and colleagues [11] found that about one-third of billboard advertisements included promotions, while Duan et al. [17] found over 90% of cannabis retailer websites used this tactic.

Audience Targeting, Including Youth

Fewer studies have examined how the industry segments and targets specific population sub-groups via advertising. Research that has explored this topic found that the cannabis industry uses a variety of strategies to segment and target consumers based on sociodemographic characteristics [19] and cannabis use status (e.g., new customers, established users, medicinal users) [11, 33]. There is also some evidence that companies target advertisements to out-of-state consumers [19]. Notably, some work has found advertisements targeting teens and young adults (e.g [19]).,, or ads that contained youth appealing content like imagery related to socialization, coolness, or popularity [17, 33, 35, 42], animated characters or cartoons [32, 39], imagery of people under legal age [41] and food and flavor imagery [28]. While one study estimated that only 2% of recreational cannabis dispensaries near schools in California featured external advertising that was considered youth-appealing, youth appealing ads were found inside 74% of retailers [43]. Shi and Pacula [33] similarly found that of 700 cannabis retailers assessed in California, 247 (35.3%) had youth appealing advertising inside the store. Youth appealing advertising has additionally been identified on social media: Marinello et al. [32] conducted a content analysis of advertising on Facebook and Twitter from cannabis retailers in Illinois, and found that 9.3% of posts contained youth appealing content in violation of state law. As audience segmentation and targeting is an important marketing tool for many industries, it is important to better understand how the cannabis industry engages in this practice.

Prevalence of Population exposure to Advertising, Including Youth Exposure

Monitoring the extent to which individuals have been exposed to cannabis advertising, and through what channels, is important to both identify populations who may be targeted by the cannabis industry, and to inform policy efforts related to cannabis advertising. Research in this area of inquiry has found that exposure to cannabis marketing is relatively common among both youth and adults.

General Prevalence of Exposure Among Youth and Adults

Limited evidence exists on the prevalence of exposure to cannabis advertising in the U.S. overall and by specific sub-groups. Most research in this area focuses on recalled exposure to cannabis advertising among youth and has found that a considerable proportion of youth recall exposure to cannabis advertising [21, 28, 44] in states where recreational cannabis sale is legal, even though state regulations typically prohibit cannabis retailers from advertising to this population. For example, one study found that among adolescents, 22.1% of individuals recalled seeing cannabis advertising “most of the time” or “always” on Instagram, 21.8% on billboards, and 15.7% on Facebook [44]. A large online panel survey of California adolescents revealed that 45.6% of participants had reported seeing cannabis marketing [28]. Rup and colleagues [21] reported that youth aged 16–20 had a higher likelihood of reporting noticing cannabis marketing, compared to older adults. Together, these studies indicate that a considerable proportion of people have been exposed to cannabis advertising.

Exposure Among Sub-Groups

Some work has explored factors associated with exposure or attempted to identify sub-groups who are disproportionately exposed to cannabis advertising. Among a sample of young adults in Southern California, women had higher odds of recalling seeing cannabis advertising online (aOR = 1.4). LGBT individuals (compared to straight individuals) had higher odds of recalling seeing cannabis advertising online (aOR = 1.7) [25]. Similarly, Romm et al. found that adult sexual minority females (compared to heterosexual females) reported greater marketing exposure. Living in a school district with a ‘closer average proximity’ to cannabis retail stores was also positively associated with recalled exposure to advertising [24–26]. Other research has also suggested that odds of recalled advertising exposure were significantly higher for girls compared to boys (aOR = 1.38 for 8th graders and 1.62 for 11th graders) and were lower for Hispanic or Latino youths compared with non-Hispanic White youths (aOR = 0.81 for 8th graders and 0.59 for 11th graders) [26]. Fiala and colleagues also found that youths living with an adult who uses cannabis (compared to those without a household adult cannabis user) had a higher odds of exposure to cannabis advertising (aOR, 1.85 for 8th graders). One study found that individuals with less than a high school education were less likely to report noticing cannabis advertising compared to those with higher education levels [21]. Another study that assessed young adults’ experiences to cannabis marketing in retail stores found that greater promotion exposure was associated with Black race (β = 0.53) [45]. Given inequities in exposure to advertising for other products, such as tobacco [46]– [47], this is an area worthy of additional focus.

Effects of and Outcomes Associated with Cannabis Advertising

Several studies examined associations of exposure to cannabis advertising with potential outcomes of exposure, ranging from beliefs or product perceptions to use behavior. These studies used a range of tactics to measure cannabis advertising exposure, including self-reported recalled exposure (e.g., “During the past 30 days, how often did you see any ads or promotions for cannabis or related products that were outdoors on a billboard or could be seen from outside a store?” [44], self-reported receptivity to cannabis advertising (e.g., openness to owning branded products [23], and exogenous measures (e.g., density of cannabis advertising in one’s area [48]). Measurements of advertising exposure included those specific to certain channels (e.g., exposure to advertising on social media) and general exposure measures (e.g., past-30-day exposure via any channel). Despite the range of exposure measures used, studies consistently found that cannabis advertising exposure was associated with use behavior and cannabis-related beliefs and perceptions.

Beliefs and Perceptions

Research has found that exposure to cannabis advertising is associated with positive beliefs about or perceptions of cannabis [45, 48–50]. For example, Firth et al. [49] found that past-month recalled exposure to cannabis advertising via storefronts or the sidewalk was associated with reduced harm perceptions of cannabis among 8th graders (POR: 0.87). Cohn et al. [50] found a similar relationship among a sample of adults, and additionally found that past 30-day recalled cannabis advertising exposure was associated with positive attitudes towards cannabis (β = 0.07), and that the number of sources through which one was exposed to cannabis advertising was associated with increased likelihood of reduced harm perceptions (AOR = 1.05). Cohn et al. [50] additionally found that exposure to cannabis marketing via outdoor marketing (AOR = 1.34) and social media (AOR = 1.24) were associated with reduced harm perceptions.

Use Intentions

Chaffee et al. [28] found that, among adolescent never-users of cannabis in California, past 30-day exposure to cannabis advertising was associated with increased likelihood of intention to use in the next year (AOR = 2.10). Hust et al. [51] found that, among 13–17 year-olds in Washington, exposure to cannabis advertising (aggregated across a range of channels) was positively associated with use intentions (β = 0.14). Cohn et al. [50] found that past 30-day exposure to cannabis advertising was associated with interest in obtaining a medical cannabis license (β = 0.14). Together, this work indicates that exposure to cannabis advertising is positively associated with intentions to use cannabis in the future.

Use Behaviors

Several cross-sectional studies found that cannabis advertising exposure was associated with use behavior [16, 23]– [24, 29]– [30]. For example, in a study of 15–19 year olds, Trangenstein et al. [23] found that engaging with cannabis business pages on social media, having a favorite cannabis brand, and receptivity to cannabis-branded merchandise (e.g., a t-shirt with a cannabis brand name on it) had higher odds of having used cannabis in the past year. Whitehill et al. [16] similarly found that among this population, exposure to cannabis advertising on social media (Facebook, Twitter and Instagram) was associated with increased odds of past-year cannabis use. These researchers also found that, among a sub-group of this sample who had ever used cannabis, self-reported exposure to cannabis advertising was associated with both more frequent cannabis use (4 + times per week) and cannabis use disorder. For example, those who reported noticing cannabis advertising via billboards “most of the time”/“always” had 7.28 greater odds of frequent cannabis use and 5.69 greater odds of cannabis use disorder (measured using the CUDIT-R [52]) compared to those who reported never seeing cannabis advertising via billboards [44].

Han and Shi [48] paired data from an objective assessment of the cannabis point-of-sale advertising (storefront signage about cannabis availability and signs about cannabis health benefits) with data from a cross-sectional survey of adults in California, and found that a higher density of signs that promote the health benefits of cannabis use was associated with increased likelihood of past-month recreational cannabis use (OR = 3.50), but only for stores within a 2–4 mile range of one’s home. Firth et al. [49] additionally found that self-reported past-month exposure to cannabis advertising via storefronts or the sidewalk was associated with increased likelihood of using edibles (POR = 1.80), dabbing (POR = 1.94), vaping (POR = 1.85) and smoking cannabis (POR = 1.31) among 8th graders and using edibles (POR = 1.40), dabbing (POR = 1.39) and vaping (POR = 1.45) among 11th graders. Noel et al. [22] found that among 18–25 year olds in Rhode Island, exposure to cannabis advertising via apps (b = 0.54) and social media (b = 0.49) was associated with an increased cannabis use frequency (AOR = 4.36). This study also found that exposure to cannabis ads via apps was associated with higher odds of driving under the influence of cannabis (AOR = 3.96). Although the bulk of this work involved cross-sectional studies and cannot be used to infer causal effects of cannabis advertising exposure, the associations between exposure and beliefs, use intentions, and behavior are worthy of further study.

Mediating and Moderating Factors

Little work has examined factors that could mediate or moderate associations between cannabis advertising exposure and cannabis-related outcomes. In a longitudinal study, DiGuiseppi et al. [53] examined potential mechanisms underpinning associations between cannabis advertising exposure and cannabis vaping behavior, finding that while exposure to cannabis advertising was not directly associated with future cannabis vaping, there was an indirect effect mediated by positive cannabis use expectancies (e.g., that it “relaxes you”, “let’s you have more fun”). Turel et al. [54] found that perceived ease of access to cannabis increased the magnitude of the cross-sectional association between cannabis advertising exposure and cannabis use. Two qualitative studies identified adolescent and young adult responses to cannabis advertisements, which can provide insight about potential advertising characteristics that could mediate effects of cannabis advertising exposure. Drake et al. [55] found that adolescents in Nevada felt that price promotions and themes related to partying/socialization were appealing. Liu et al. [56] found that among their sample of 17–21 year-olds in California, participants recalled seeing cannabis advertising that was positive and “uplifting”, which they found to be appealing.

Discussion/Implications

This review synthesized research from the past 5 years related to advertising for cannabis products. Table 1 provides an overview. Studies fell into three broad topic areas. First, research focused on characterizing the content of and strategies used to advertise cannabis. Most notably, cannabis advertising uses tactics that could mislead consumers – such as unsubstantiated health claims - and tactics that could appeal to youth. Second, research characterized the prevalence of exposure to cannabis advertising. This work found that exposure to cannabis advertising is widespread in states where cannabis is legal for sale. Of note, exposure among young people, including youth under the age of 21, is common, despite the legal age for cannabis consumption in states with recreational programs being ≥ 21. Some work identified disparities in exposure to cannabis advertising, finding that girls and women (compared to boys and men), and LGBT people were more likely to recall exposure to cannabis advertising. Finally, research sought to explore potential effects of exposure to advertising. Broadly, this work found significant associations between exposure to cannabis advertising and positive beliefs about cannabis, intentions to use cannabis, general cannabis use, and problematic cannabis use.

Table 1.

Summary of key findings and relevant articles

Key process from McGuire’s Input-Output Matrix	Summary of findings	Relevant articles identified
Advertising characteristics	Advertising contains potentially misleading tactics and tactics that could appeal to youth.	McQuoid et al. (2023)[11];Carlini et al. (2020)[12]; Jenkins et al. (2021)[13]; Moreno et al. (2022)[14]; Spillane et al. (2021)[15]; Whitehill et al. (2020)[16]; Duan et al. (2024)[17]; Luc et al. (2020)[18]; Berg et al. (2023)[19]; Livingston et al. (2023)[20]; Rup et al. (2020)[21]; Noel et al. (2024)[22]; Trangenstein et al. (2019)[23]; Trangenstein et al. (2022)[24]; Krueger et al. (2021)[25]; Fiala et al. (2020)[26]; Goodman & Hammond (2021)[27]; Chaffee et al. (2024)[28]; Romm et al. (2024)[29]; Reboussin et al. (2024)[30]; Cavazos-Rehg et al. (2019)[31]; Marinello et al. (2024)[32]; Shi & Pacula (2021)[33]; Romm et al. (2024)[34]; Cui et al. (2024)[35]; Ling et al. (2022)[36]; Caputi (2022)[37];Hoeper et al. (2022)[38]; Rhee & Jung (2023)[39]; Carlini et al. (2022)[41]; Ompad et al. (2022)[42]; Cao et al. (2020)[43]
Exposure to advertising	A notable proportion of individuals in states with cannabis legal for sale report exposure to cannabis advertising. Youth under age 21 report exposure to cannabis advertising. Some work identified disparities in exposure to advertising (e.g., girls/women and LGBT people more likely to recall exposure).	Rup et al. (2020)[21]; Krueger et al. (2021)[25]; Fiala et al. (2020)[26]; Chaffee et al. (2024)[28]; Trangenstein et al. (2021)[44]; Berg et al. (2024)[45]
Effects of and outcomes associated with advertising	Exposure to cannabis advertising is associated with positive beliefs about cannabis, intentions to use cannabis, general cannabis use, and problematic cannabis use. More research is needed to better establish causal effects.	Whitehill et al. (2020)[16];Noel et al. (2024)[22]; Trangenstein et al. (2019)[23]; Trangenstein et al. (2022)[24]; Chaffee et al. (2024)[28];Romm et al. (2024)[29]; Reboussin et al. (2024)[30]; Trangenstein et al. (2021)[44]; Berg et al. (2024)[45]; Han & Shi (2023)[48]; Firth et al. (2022)[49]; Cohn et al. (2023)[50];Hust et al. (2020)[51]; DiGuiseppi et al. (2023)[53]; Turel (2020)[54]; Drake et al. (2024)[55]; Liu et al. (2020)[56]

Regulations, including prohibitions on certain advertising tactics (e.g., misleading claims; youth-targeting) and required warning labels [57], are in place in many jurisdictions to help mitigate the effects of cannabis advertising. However, operationalization of prohibitions on advertising tactics can be ambiguous – what, exactly constitutes a misleading claim or youth targeting and what criteria are in place to identify advertising that violates such policies? Evidence from studies in this review indicates that the cannabis industry could potentially subvert regulations such as prohibitions on unsubstantiated claims about health benefits by using generic or ambiguous tactics associated with health, medicine or wellness (e.g., imagery of medical crosses or staff; general mentions of health [11]. Thus, additional evidence is needed to better assess compliance with advertising regulations as well as the use of tactics that may be in compliance with the letter, but not the spirit, of the law. Studies examining how tactics used to subvert regulations impact individuals will be useful to support policy development and enforcement.

Further, it is not entirely clear whether required warning labels can compete with the vivid and compelling advertising tactics used by the cannabis industry. Moreover, significant gaps in compliance have been documented, both regarding appropriate use of warnings [17, 19] and regarding use of prohibited advertising tactics [14]. The existing work described in this review begins to inform these regulatory needs by providing much-needed information regarding how cannabis is advertised to consumers, who is exposed to the advertisements, and what potential impacts these advertisements have on beliefs, attitudes and behavior. This information can illuminate problematic advertising tactics for regulators to focus on (such as the use of misleading claims and youth appealing tactics) identity populations at-risk for cannabis use and inform intervention strategies designed to mitigate the impact of cannabis advertising exposure.

Despite the potential impact this research holds for regulation and public health intervention, our review revealed several gaps that future work could fill. First, few studies centered on equity, particularly as it relates to differences based on racial/ethnic identity, socioeconomic status, sexual and gender identity, and mental health status. This is a critical area to focus on, as the limited research we reviewed in this area indicates there are inequities in recalled exposure to cannabis advertising. Moreover, research on tobacco and alcohol advertising highlights the ways these industries have used advertising to target vulnerable populations (e.g [58–61]).,. Thus, it is critical to understand the extent to which minoritized groups, or groups made structurally vulnerable, are similarly targeted by the cannabis industry or otherwise disproportionately exposed to cannabis advertising.

Second, future work should leverage methodological techniques designed to more precisely estimate causal effects of advertising exposure (e.g., randomized controlled experiments, regression discontinuity approaches). Additionally, although some research reviewed here used exogenous measures of exposure [48], most work relied on self-reported measures in which participants were asked to recall exposure to cannabis advertising. While self-reported measures of advertising exposure are commonly used and can be useful and efficient measures of exposure [62]– [63]), they are still subject to limitations such as recall bias [62]– [63]. Thus, increased diversity of measures is needed to support a robust body of research, including supplementing self-reported measures of exposure with exogenous measures that assess the likelihood of exposure (e.g., based on geographic proximity to advertising) or using self-report techniques such as ecological momentary assessment, in which individuals provide just-in-time information about their advertising exposure as a way to limit recall bias (e.g [64–66]).,.

Very few studies examined the effect of specific advertising characteristics with consumer perceptions or behavior. Multiple studies documented the use of potentially problematic advertising tactics, such as unsubstantiated health claims that could mislead consumers and youth-appealing content. More work is needed to understand the effects of these tactics. For example, studies could explore whether unsubstantiated health claims truly mislead consumers and affect use intention and product selection, or whether content characterized as youth-appealing is truly appealing to this population. Experimental studies that manipulate presence/absence of advertising characteristics can help build this evidence base. Additionally, qualitative methods were uncommon among studies included in this review and could be a viable avenue to further explore these areas.

Finally, more work is needed to examine how specific product characteristics are communicated to consumers via advertisements, and with what effect. There are many different cannabis products that differ on factors including strain, cannabinoid and terpene content, and route of administration. The extent to which these characteristics are mentioned in advertisements, and with what effect is important to understand whether advertising for these different products could have different consequences for consumer perceptions, use behavior, and health outcomes.

Limitations

This narrative review was meant to provide a summary, interpretation and critique of recent literature related to advertising for recreational cannabis products in the United States. As such, we did not apply systematic codes to the studies, nor did we calculate estimates of statistics/effect sizes across studies, as would be done in a systematic review or meta-analysis. We additionally did not compare studies conducted in different states or between states with different cannabis legalization status. As cannabis legalization status in different states evolves and the body of research related to cannabis advertising continues to expand, future studies employing these approaches will add to our understanding of the issue.

Conclusion

Cannabis advertising is an emerging and important area for research inquiry. Our review of relevant literature between 2019 and 2024 found that cannabis advertising uses a range of problematic techniques, that a considerable portion of individuals studied, including youth, report exposure to cannabis advertising, and that exposure to cannabis advertising is associated with product beliefs, use intentions and use behavior, including problematic use behavior. As this body of literature continues to grow, studies centering on equity, employing techniques designed for more precise estimates of causal influence, and examining effects of specific advertising tactics will be useful to further inform regulatory and public health intervention.

Key References

• Berg CJ, Romm KF, Pannell A, Sridharan P, Sapra T, Rajamahanty A, Cui Y, Wang Y, Yang YT, Cavazos-Rehg PA. Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities. Addict Behav. 2023 Aug;143:107696. https://doi.org/10.1016/j.addbeh.2023.107696.

  • ○ Examined marketing strategies used in 150 cannabis retailers in 5 US cities.
• Firth CL, 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 May;75:102795. https://doi.org/10.1016/j.healthplace.2022.102795.

  • ○ Examined associations between self-reported exposure to cannabis advertising with cannabis use and perceptions among 24,154 Oregon 8^th and 11^th grade students.
  Han B, Shi Y. Associations of recreational cannabis dispensaries' availability, storefront signage and health benefit signs with cannabis use: findings from a representative adult sample in California, United States. Addiction. 2023 Jul;118(7):1270-1279. https://doi.org/10.1111/add.16132.

  • ○ Examined associations between proximity and density of retail cannabis dispensaries and storefront signage with cannabis use outcomes among 3,385 adults in California.
  Drake CS, Sloan K, Anderson M, Clements-Nolle KD, Pearson JL. "I like the vibes it bives": Adolescent perspectives on cannabis billboards and print advertising in Nevada. J Drug Issues. 2024 Apr;54(2):238-252. https://doi.org/10.1177/00220426231159017.

  • ○ Qualitative study of adolescents’ perceptions of cannabis advertising in Nevada.
  McQuoid J, Lowery BC, Wright LS, Cohn AM. Outdoor medical cannabis advertising in Oklahoma: Examining regulatory compliance and social meanings in billboard content. Subst Use Misuse. 2023;58(11):1425-1437. https://doi.org/10.1080/10826084.2023.2223299.

  • ○ Content analysis of a wide range of themes and features among cannabis billboards in Oklahoma.

Author Contributions

The review was conceptualized by authors MBM, AZ, LC and ST. MBM and ST conducted the initial review of the literature and wrote the first draft of the manuscript. MBM, AZ, LC, JT, TRS, RV, and ST reviewed, revised and made additional intellectual contributions to the manuscript.

Funding

This research was supported by the National Institute on Drug Abuse.

(R01DA059584). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Human and Animal Rights and Informed Consent

No animal or human subjects were used by the authors in this study.

Competing Interests

Dr. Moran served as a paid witness in litigation sponsored by the Public Health Advocacy Institute against RJ Reynolds. Dr. Vandrey has served as a paid consultant or scientific advisory board member to Jazz Pharmaceuticals, Charlotte’s Web, Schedule 1 Therapeutics, Syqe Medical Ltd., and WebMD. The remaining authors have no conflicts of interest to declare relevant to this work.