Cannabis Marketing Restrictions and Exposure to Cannabis Marketing in Legal US Cannabis Markets: Findings From the International Cannabis Policy Study

INTRODUCTION: A growing number of US states have legalised adult 'recreational' cannabis. Restrictions on advertising and promotions are a key component of cannabis regulations in legal markets; however, there is little evidence on the impact of restrictions. This study examines differences in cannabis marketing exposure by the strength of marketing restrictions among US states with legal recreational sales. METHODS: Data are from the International Cannabis Policy Study: repeated cross-sectional surveys conducted annually (2018-2023) with 99,132 respondents aged 16-65. The 'strength' of marketing restrictions was measured using regulatory documents in 20 states with legal recreational cannabis sales. Adjusted mixed effects logistic regression models were fitted to analyse differences in past-12 month noticing of cannabis marketing by the strength of marketing restrictions overall and within specific marketing channels. RESULTS: People in states with low and moderate strength marketing restrictions reported similar exposure to cannabis marketing (61.4% and 61.8%, respectively). Compared to those with moderate strength restrictions, people in states with the highest strength restrictions reported the lowest exposure (53.4%: p = 0.037), with no significant differences for states with low strength restrictions (p = 0.067). Comprehensive restrictions on marketing via billboards and posters, and at sports events were associated with reductions in reported exposure to these channels. Cannabis marketing exposure was highest among people below the minimum legal age (16-20 years old; 63.0%: p < 0.001). DISCUSSION AND CONCLUSIONS: Stronger regulations may reduce exposure to marketing in states with recreational cannabis markets; however, existing regulations appear to be inadequate to prevent advertising and promotions from reaching young people.