Abstract
This cross-sectional study examines the compliance of recreational cannabis dispensaries with underage access and exposure to products and marketing in California.
The increasing availability of cannabis to adults through legalization of recreational cannabis dispensaries (RCDs) raises concerns regarding underage access and exposure to products and marketing. The American Academy of Pediatrics “strongly recommends strict enforcement of rules and regulations that limit access, marketing, and advertising to youth.”1 Currently, all legalizing states prohibit sales to minors and require an identification (ID) check, and most ban marketing activities appealing to children.2 However, little is known about whether cannabis retailers comply. We assessed the compliance of RCDs with underage access and marketing restrictions in California.
Methods
In this cross-sectional study, a research team at University of California, San Diego identified and audited all the RCDs in California statewide (N = 700) between June 15 and September 15, 2019. The institutional review board at the University of California San Diego deemed this study nonhuman-subject research; therefore, this study was not subject to an institutional review board approval. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
A validated approach was used to construct a comprehensive list of RCDs.3 We complemented the state licensing directory with online crowdsourcing platforms, given research showing that more than half of active dispensaries in Los Angeles operated without a state-issued license.4 Trained researchers called dispensaries to verify the location, operation status, and requirements about patient ID card and doctor’s recommendation.
A validated instrument, the Standardized Marijuana Dispensary Assessment–Children Focused (SMDA-CF), was adapted to audit the call-verified RCDs.2 The SMDA-CF includes items on underage access and point-of-sale marketing activities, with particular attention to those appealing to children. The SMDA-CF items have moderate to high reliability overall, with a median κ score of 0.8.2 Trained researchers (aged 21-23 years) conducted the audits undercover in teams of 2 to improve data reliability. Observations on each dispensary were recorded right after the visit.
All data are reported as counts and proportions. Because our data included the universe of RCDs in California, no confidence intervals or other estimated statistics are reported. Statistical package Stata 16 (StataCorp LLC) was used for the analysis.
Results
Of the 700 RCDs assessed, 475 (67.9%) failed to comply with California laws requiring age-limit signage. California laws further require ID check before any purchase, and overall compliance with this rule was high at 678 RCDs (96.8%). However, only 82 (11.7%) checked ID before entry. The majority (596 [85.1%]) checked ID after entry, where additional marketing items were displayed. Despite a low violation rate of child-appealing marketing restrictions on the exterior of the RCDs, 247 (35.3%) had marketing items that appealed to children inside the RCDs. Product promotions were common at 600 (85.7%), with 440 (62.9%) providing first-time purchase discounts and 340 (48.6%) providing weekly or daily deals. Violations of the free-sample ban were also common (151 [21.6%] for take-away items; 113 [16.1%] for on-site consumption). Furthermore, 391 RCDs (55.8%) provided branded marketing materials and 272 (38.9%) promoted health benefits of cannabis (Table).
Table. Compliance With Underage Access and Marketing Restrictions in 700 Recreational Cannabis Dispensaries in California, 2019a.
| Auditing item | No. (%) | ||
|---|---|---|---|
| Exterior (before entry) | Interior (after entry) | Exterior or interior | |
| Access | |||
| Security personnel presentb | 176 (25.1) | 430 (61.4) | 542 (77.4) |
| Surveillance camera presentb | 652 (93.1) | 679 (97.0) | 683 (97.6) |
| License displayedb | 23 (3.3) | 463 (66.1) | 471 (67.3) |
| ID checkedb | 82 (11.7) | 596 (85.1) | 678 (96.8) |
| Age-limit signb | 120 (17.2) | 149 (21.3) | 225 (32.1) |
| On-site use restriction sign | NA | 258 (36.9) | NA |
| Point-of-sale marketing | |||
| Child-appealing itemsc,d | |||
| Advertisements | 8 (1.1) | 75 (10.7) | 80 (11.4) |
| Products | 1 (0.1) | 137 (19.6) | 138 (19.7) |
| Packages | 0 | 79 (11.3) | 79 (11.3) |
| Paraphernalia | 0 | 93 (13.3) | 93 (13.3) |
| Any child-appealing items | 9 (1.3) | 247 (35.3) | 249 (35.6) |
| Product promotions | |||
| Loyalty programs | NA | NA | 176 (25.1) |
| Daily or weekly deals | NA | NA | 340 (48.6) |
| Early bird or happy hour specials | NA | NA | 213 (30.4) |
| Price discounts | NA | NA | 287 (41.0) |
| First-time purchase discounts | NA | NA | 440 (62.9) |
| Social media review discounts | NA | NA | 110 (15.7) |
| Free samples with purchase, donation, or gambling | NA | NA | 120 (17.1) |
| Any product promotions | NA | NA | 600 (85.7) |
| Free samples to take awayd | NA | NA | 151 (21.6) |
| Free samples to consume on-sited | NA | 113 (16.1) | NA |
| Branded marketing materials | 25 (3.6) | 376 (53.8) | 391 (55.8) |
| Signs, posters, advertisements | |||
| Promoting health benefits | NA | 272 (38.9) | NA |
| Displaying health warnings | NA | 135 (19.3) | NA |
| Billboards related to cannabis | 81 (11.6) | NA | NA |
| Images or wording indicative of cannabis | 401 (57.4) | NA | NA |
| Biggest advertisements >1 m2 | 25 (3.3) | NA | NA |
| Other sources of exposure to cannabis | |||
| Observed anyone consuming cannabis | 15 (2.1) | 38 (5.4) | 51 (7.3) |
| Smelled cannabis before entering dispensary | 82 (11.7) | NA | NA |
Abbreviations: ID, identification; NA, not applicable.
Recreational cannabis dispensaries were defined as brick-and-mortar retailers that primarily sell cannabis products to adults aged 21 years or older without requiring a patient ID card or a physician’s recommendation.
Required by California state laws.
Child-appealing marketing activities in the Standardized Marijuana Dispensary Assessment–Children Focused were defined as advertisements, products, packages, and paraphernalia that are “characterized by promotional characters (e.g., cartoons, animals, toys, or children), shaped like commercially sold products usually consumed by children (e.g., gummy bears, lollipop, fruits) or using bright colors (in products, mostly edibles) or bubble-like fonts (on packages, branding, advertisements, or signage).”2(p74)
Prohibited by California state laws.
Discussion
Although RCDs in California were generally compliant with checking IDs, most RCDs did not check them until customers entered the premises. Considering the low rate of compliance with age-limit signage, minors may unintentionally or even intentionally enter RCDs. On entrance, they become exposed to marketing items hidden from casual outside observers, including advertisements, products, packages, and paraphernalia appealing to children; price promotions; free samples; brand awareness; and positive messaging. Limitations of this study include that the authors used California-specific, cross-sectional data with possibly limited generalizability, binary indicators of instruments without quantity information, and subjective evaluation of child-appealing items. The findings of this cross-sectional study suggest that, as more states liberalize cannabis, greater emphasis and resources must be dedicated to enforcement of random compliance checks to ensure that regulations aiming to minimize access and exposure to minors have the intended effects.
References
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