Presence of Content Appealing to Youth on Cannabis-Infused Edibles Packaging

Abstract

Background:

There is a lack of consistent regulation of cannabis edibles packaging to restrict youth-appealing content in the United States (U.S.)

Objective:

To describe content appealing to youth on U.S. cannabis-infused edibles packaging.

Methods:

We analyzed 256 photos of cannabis-infused edibles packaging collected from U.S. adults from 25 states, District of Columbia, and Puerto Rico between May 2020 to August 2021. We coded the presence of product knockoffs, human and non-human creatures, images indicating flavor, text indicating flavor, and the number of colors. We compared these codes across states’ legalization status (medical and non-medical cannabis, medical cannabis only, or limited cannabis legalization).

Results:

Overall, 15% of packages resembled product knockoffs, 23% contained human/non-human creatures, 35% contained flavor images, 91% contained flavor text, and median number of colors was 5 (range from 1 to 10+). Packages purchased in states with medical and non-medical cannabis, medical cannabis only, or limited cannabis legalization differed significantly on product knockoffs (11%, 26%, 38%, p=0.007), human/non-human creatures (19%, 33%, 63%, p=0.002), flavor text (93%, 81%, 100%, p=0.046), and number of colors (median of 5, 5, and 10, p=0.022).

Conclusions:

Existing laws have not adequately limited content appealing to youth on U.S. cannabis-infused edibles packaging. Robust and consistent regulations in the U.S. are needed to ensure that the packaging of such products does not contain content that appeals to youth and lead to initiation or inadvertent ingestion.

INTRODUCTION

According to the National Conference of State Legislatures, as of February 2022, 18 states, Guam, and the District of Columbia (D.C.) have legalized both medical and non-medical cannabis use, 19 states, the U.S. Virgin Islands, and Puerto Rico have legalized medical cannabis use only, 11 states have limited cannabis legalization for low tetrahydrocannabinol (THC) or high cannabidiol (CBD) products for medical reasons in limited situations, three states and American Samoa do not have any public cannabis access programs, and the Northern Mariana Islands have legalized non-medical cannabis use but not medical cannabis use (National Conference of State Legislatures, 2022). Longer duration of legal cannabis laws, higher dispensary density, and permitting home cultivation have been associated with an increased likelihood of youth trying cannabis-infused edibles (i.e., foods or drinks infused with THC or cannabis concentrates, hereafter referred to as edibles) (Borodovsky et al., 2017). The increasing social acceptance of non-medical cannabis use and wide availability of edibles resembling regular foods (e.g., candies, such as gummies and chocolates; snack foods, such as chips and cookies, beverages, etc.) raise concerns that more youth would find these products attractive and initiate the use of edibles. This could also increase the risk of unintentional ingestion among children and youth (Richards et al., 2017).

Cannabis use – including use of edibles – is common among U.S. youth. Between 2015–2018, among U.S. students in 12^th grade, 33% reported using cannabis in the past year.(Patrick et al., 2020) Among past-year cannabis users, the use of edibles increased from 32% in 2015 to 39% in 2018 (Patrick et al., 2020). Edibles are appealing to youth because of the product characteristics (e.g., color, shape, and taste) (O’Connor et al., 2016), and youth-oriented packages that mimic popular candies and sweets, utilize colorful designs, or feature cartoon characters that are particularly attractive to youth (MacCoun & Mello, 2015; O’Connor et al., 2016). Cannabis product packages with colorful branding are considered to be more appealing to youth ages 12–18 years compared with plain packaging or packages that only contain a brand logo (Goodman et al., 2019). Additionally, packaging designs of certain edibles resemble strategies used in tobacco and alcohol advertising campaigns to appeal to youth such as the use of cartoons, bright colors, and fruit or candy flavors (Padon et al., 2017; Padon, Rimal, DeJong, et al., 2018; Padon, Rimal, Siegel, et al., 2018).

While several states and territories that legalized medical and/or non-medical cannabis included policies to ensure cannabis products are in child-resistant packaging and prohibit packaging that portray objects, images, or cartoon figures, there is a lack of consistent regulation of edibles packages to ensure that they do not contain content that appeal to youth (Barrus et al., 2016). Moreover, there is little research examining content appealing to youth on edible packaging currently available in the market. This knowledge is important to inform robust packaging and advertising policies to ensure that edibles do not encourage youth initiation and unintentional ingestion. The objective of this brief report is to describe content appealing to youth in a convenience sample of edibles packaging obtained from an online survey among adult users and through personal contacts of the research team from 25 states, D.C., and Puerto Rico.

METHODS

Cannabis-infused edibles packaging image collection methods

We examined photos of cannabis product packaging that were collected as part of a larger cross-sectional study about the use of new cannabis products conducted from May 2020 to August 2021. A convenience sample of participants was recruited via word-of-mouth, posts to social media accounts, and paid advertisements on Facebook and Twitter. Packaging was collected from two sources: (1) respondents to an online survey of people from U.S. states and territories who were age 18 or older and had used a cannabis product at least once in the last three months and (2) personal contacts of study team members. For both sources, we asked for a state of purchase. We did not verify whether participants purchased the product from a legal dispensary or another source. Dates of purchase were not available. Survey respondents were asked to upload images of up to two cannabis products they currently used through the Qualtrics survey application. They were not told that these images would be analyzed to assess youth-appealing content on edibles packaging. Participants could upload up to two images per product. Photos from personal contacts were collected via email and text message. All images were downloaded to a folder in a cloud-based file sharing application (Dropbox) and stripped of their meta-data. Images were logged into a database along with the state of purchase, image source (i.e., personal contact or survey), date and time, and type of product depicted (e.g., flower, concentrate, vapes, or edible product). The study was reviewed and approved by the New York University Institutional Review Board.

Coding of content appealing to youth

For this analysis, we included only packages of edibles, defined as foods or drinks that contain cannabis.(Denver Public Health, n.d.) We excluded non-edible products such as bud/flower, vapes, oils, concentrates, and non-food products that are orally consumed such as tinctures, syrups, or sublinguals. We excluded 2 packages that were labeled as containing only CBD and did not contain THC. This process yielded 268 photos of edibles packages. Of these, 43 packages were duplicates of 18 products. We excluded 12 packages that were duplicates from the same state of purchase (4 from California, 4 from Colorado, and 1 each from Illinois, Maryland, New York, and Oregon) and retained 31 packages that were duplicates but from different states. This resulted in a total of 256 packages included in this analysis.

During the study period, New York legalized non-medical cannabis on March 31, 2021, and Connecticut legalized non-medical cannabis on June 22, 2021. There were 21 packages from New York collected prior to March 31, 2021, and 5 packages collected after legalization (between May 2 and May 24, 2021). However, as of August 2021, the Office of Cannabis Management of New York has not yet issued licenses for the non-medical cannabis use program.(New York State Office of Cannabis Management, n.d.) There were three packages from Connecticut in our data and all were collected prior to legalization in Connecticut. Therefore, we categorized packages from New York and Connecticut together with those from medical cannabis legalization only states as the legalization of non-medical cannabis was not yet been fully implemented during the study period and the majority of packages were collected prior to the dates of legalization.

Three authors developed and refined the coding scheme to categorize content appealing to youth on packages of edibles. The coding scheme was adapted from those used by Padon and colleagues^6–8 for coding alcohol and tobacco advertising that is appealing to youth. The codes used in this study were: 1) Product knockoff, defined as packaging or labeling of a non-cannabis consumer product of a type that is typically consumed by, or marketed to, children or youth, such as a candy or baked good; 2) Human or non-human creatures, defined as packaging containing containing images of a cartoon, human, animal, anthropomorphized animal or creature such as a robot or toy; 3) Images indicating flavor, defined as packaging containing images of fruit, sweets (e.g. candy, gummies), or dessert flavors (e.g. chocolate, cookies); 4) Text indicating flavor, defined as packaging containing text of fruit, sweets (e.g. candy, gummies), or dessert flavors (e.g. chocolate, cookies); and 5) Number of colors, scored from 1–10+ based on the number of distinct colors present (e.g., black, white, red, orange, yellow, blue).

Appendix 1 illustrates two examples of edibles packaging containing content appealing to youth. A package of “Stoner Patch Dummies” resembled a popular brand of candy typically marketed to children (Sour Patch Kids), portrayed non-human creatures (tiki statues), included images of flavors (tropical fruits), included the phrase “tropical flavor,” and contained over 10 colors. A container of “Wana Sour Gummies” resembled multivitamins marketed to children, included images of fruit and text indicating “assorted flavors”, and contained 8 colors.

Two coders analyzed a random sample of 20 packages independently and achieved high intercoder reliability (Krippendorf’s alpha ranged from 0.85 to 1.00) across the six codes. Next, one coder proceeded to code the remaining packages. We compared the presence of youth-appealing content between packages purchased from states based on legalization status (medical and non-medical cannabis legalization, medical cannabis legalization only, or limited cannabis legalization) using Fisher’s Exact tests for the categorical codes (using Bonferroni correction for multiple comparisons) and the K-sample equality-of-medians test for the colors code.

RESULTS

Table 1 summarizes the place of purchase of the packages by legalization status and the categories of products. We analyzed photos of 256 unique packages of edibles from 25 states, D.C., and Puerto Rico. Of these, 13 states and D.C. had medical and non-medical cannabis legalization, 8 states and Puerto Rico had medical cannabis legalization only, and 4 states had limited cannabis legalization. The majority of packages were from medical and non-medical cannabis legalization states (76%), while 21% were from medical cannabis legalization only states and 3% were from limited cannabis legalization states. Among the packages, 54 (21%) were obtained from personal contacts of the study team, and 202 (79%) were obtained from survey respondents. Over half of the packages were from 5 states: California (22%), Colorado (11%), New York (10%), Massachusetts (8%), and Oregon (7%). Categories of edibles included gummies (41%); candy, such as fruit chews and jellies (31%); chocolate (13%); baked goods, such as cookies and brownies (7%); mints (5%); and miscellaneous products, such as drinks and coffee beans (3%).

Table 1.

Summary of the Cannabis-Infused Edibles Packages (n=256)

Characteristics	N(%)
Legalization status of the states/territories where packages were purchased in August 2021
Medical and non-medical cannabis legalizationa	194 (76)
Medical cannabis legalization onlyb	54 (21)
limited cannabis legalization statesc	8 (3)
Source of photos
Personal contacts	54 (21)
Survey respondents	202 (79)
Type of edibles
Gummies	106 (41)
Candy, such as fruit chews and jellies	80 (31)
Chocolate	33 (13)
Baked goods, such as cookies and brownies	17 (7)
Mints	12 (5)
Miscellaneous, such as drinks and coffee beans	8 (3)

Notes.

^aMedical and non-medical cannabis legalization states/territories include Alaska, Arizona, California, Colorado, Illinois, Massachusetts, Maine, Michigan, Montana, New Mexico, Nevada, Oregon, Washington, and District of Columbia.

^bMedical cannabis legalization only states/territories were Hawaii, Maryland, Minnesota, Ohio, Oklahoma, Pennsylvania, Puerto Rico, Connecticut, and New York. New York legalized non-medical cannabis on March 31, 2021 and Connecticut legalized non-medical cannabis on June 22, 2021, which occurred during the data collection period. Our data included 21 packages from New York collected prior to March 31, 2021 and 5 packages from New York collected between May 2 and May 24, 2021. There three packages from Connecticut in this data and they were collected prior to legalization. We considered that the New York and Connecticut legalizations of non-medical cannabis were not fully implemented during the study period and therefore coded packages from New York and Connecticut as medical cannabis legalization only states.

^climited cannabis legalization states were South Carolina, Tennessee, Texas, and Wisconsin.

Table 2 summarizes the proportions of packages that contained youth appealing content. Among these packages, 15% were product knockoffs (resembling children’s candy brands, multivitamins, and cookies), 23% contained human/non-human creatures (e.g., robots, cartoons, and animals), 35% contained images indicating flavor (e.g., pictures of fruit, nuts, and chocolates), and 91% contained text indicating flavor (e.g., strawberry, pineapple, caramel, and chocolate). The median number of colors on the packages was 5 colors and mean was 5.6 (standard deviation = 2.3) colors. The number of colors ranged from 1 to 10 or more colors and 39 packs (15%) had 10 or more colors. Youth appealing features on packages from states with medical and non-medical cannabis legalization (194 packages), medical cannabis legalization only (54 packages), and limited cannabis legalization (8 packages) included, respectively, product knockoffs (11%, 26%, 38%), human/non-human creatures (19%, 33%, 63%), images indicating flavor (38%, 24%, 50%), text indicating flavor (93%, 81%, 100%), and multiple colors (median 5, 5, and 10). The presence of product knockoffs (p=0.007), human/non-human creatures (p=0.002), text indicating flavor (p=0.046), and number of colors (p=0.022) differed significantly between packages purchased in medical and non-medical cannabis legalization, medical cannabis legalization only, or limited cannabis legalization states. The presence of images indicating flavor (p=0.117) was not significantly different by legalization status of the state of purchase. Packs from medical cannabis legalization only states were more likely to resemble knockoffs than packs from medical and non-medical cannabis legalization states (p=0.014) while packs from limited cannabis legalization only states were more likely to contain human/non-human creatures (p=0.010) than those from medical and non-medical cannabis legalization states.

Table 2.

Summary of Cannabis-Infused Edibles Packaging Containing Content Appealing to Youth (n=256)

	Packages from all states (n=256)	Packages from states that legalized medical and non-medical cannabis (n=194)	Packages from states that legalized only medical cannabis (n=54)	Packages from limited cannabis legalization states (n=8)	Fisher’s exact test (p-value)	K-sample equality of medians test (p-value)
Product knock off (%)	15%	11%a	26%a	38%	0.007	-
Animate creature (%)	23%	19%b	33%	63%b	0.002	-
Images indicating flavor (%)	35%	38%	24%	50%	0.117	-
Text indicating flavor (%)	91%	93%	81%	100%	0.046	-
Median number of colors	5	5	5	10	-	0.022

Notes. Superscripts sharing the same letter indicate significant difference comparing each code for content appealing to youth between states of purchase by legalization status based on the Fisher’s exact test, correcting for multiple comparisons using Bonferroni correction.

DISCUSSION

Based on this analysis of 256 product packages, the most common content appealing to youth on edibles packaging was the presence of text indicating fruit, sweet, or dessert flavors. Less common among the packages we analyzed were designs that resembled candies or available food products that appeal to youth, human/non-human creatures, and images portraying flavors. Product packaging also had multiple colors. These findings indicate that existing laws have not adequately addressed the risks of packaging of multiple brands of edibles containing content that appeal to youth. We note that product knockoffs are less common in medical and non-medical cannabis legalization states compared with medical cannabis legalization only states and human/non-human creatures are less common in medical and non-medical cannabis legalization states compared with limited cannabis legalization states. However, based on these findings, we are not able to infer that variations in the presence of pack characteristics appealing to youth are related to the poorer enforcement or industry self-regulation in medical cannabis only or limited cannabis legalization states. Future research to examine whether states with medical and non-medical cannabis legalization tend to also have stronger enforcement and industry regulation to prevent the use of youth appealing packaging will be needed.

This study was limited by the convenience sample of packages of edible products and not generalizable to all states and brands of edible products that are available in the marketplace. Packages from states with medical cannabis legalization only (21%) or limited cannabis legalization (3%) were under-represented in the sample. Packages from Washington state were under-represented although it was one of the first states with medical and non-medical cannabis legalization. Future work is needed to systematically obtain and analyze edibles packaging from various states. We note, however, that a representative sample of packages is likely impossible to assemble given the clandestine and often unregulated nature of cannabis edibles production in some settings, even in states with medical and non-medical cannabis legalization. The photos of packages were submitted by adult participants and personal contacts of the study team. We reviewed each photo and the metadata and did not find any that looked like professional commercial photos. However, we could not exclude the possibility that some photos may have been downloaded from websites. We did not obtain photos from youth participants. Therefore, the packages included in this study do not necessarily reflect edibles that youth are using. Additional research is needed to assess the content on packages from youth who use edibles. Data on place of purchase were limited to state; however, we do not know if products were purchased from state-authorized sellers or from unauthorized sellers. Moreover, it is possible that products with a state-specific emblem were sold in a different state. For example, one investigator (DCO) has observed stacks of empty bud/flower packaging available for sale in a New York City store. Therefore, although stronger regulation and enforcement may limit content appealing to youth from being used by legal dispensaries on their edibles packaging, young people may still encounter packages from unauthorized sellers of edibles. Photos that were submitted may not have captured all sides of packages of edible products, therefore, we may have missed certain illustrations and text that indicate additional content appealing to youth. Due to the patchwork of laws restricting packaging between states and local ordinances within states and the subjective nature of assessing compliance to these laws, we were not able to analyze whether the packages obtained in this study were compliant with local and state laws.

Despite these limitations, this work represents a first step in describing the variety of content that is appealing to youth in a sample of edibles packaging from multiple states. These findings provide the basis for informing more robust and consistent regulations in states that legalized medical and/or non-medical edibles to ensure that the packaging of such products does not contain content that appeals to youth and leads to initiation or inadvertent ingestion.

Data availability statement:

Data supporting the results or analyses are available upon request from the authors.