Background: A growing number of US states have legalized adult “recreational” cannabis. Promotional restrictions are a key component of cannabis regulations in legal markets; however, there is little evidence on the impact of restrictions to date.
Objectives: To examine differences in exposure to cannabis marketing in US states where cannabis was illegal (‘illegal states’), legal for medical use (‘medical states’), and legal for recreational use (‘legal states’). This study also examined differences in exposure by the comprehensiveness of promotional restrictions among ‘legal’ states.
Methods: Data are from the US component of the International Cannabis Policy Study: repeat cross-sectional data from national surveys conducted with 148,975 respondents aged 16-65 over 5 annual waves (2018-2022). Regression models examined self-reported measures of ‘noticing’ cannabis promotions and associations with the state-level legal status of cannabis, the ‘strength’ of marketing restrictions in ‘legal’ states, and sociodemographic factors.
Results: Exposure to cannabis promotions was highest among individuals in ‘legal’ states, followed by ‘medical’, and ‘illegal’ states (all contrasts p<.05). Younger respondents reported higher levels of exposure, and exposure was highest from retail stores and digital media channels. Trends in exposure were similar between ‘legal’, ‘medical’, and ‘illegal’ states, although differences narrowed over time. Finally, the strength of state-level promotional restrictions in legal jurisdictions was associated with lower exposure to cannabis promotions.
Implications: Cannabis legalization is associated with greater exposure to cannabis advertising and promotions, including among young people; however, stronger restrictions in legal jurisdictions demonstrate a protective effect.