Commercial Determinants of Cannabis-Related Health Inequities Among Māori and Pacific Youth in Aotearoa New Zealand: A Secondary Data Analysis

In New Zealand, Maori and Pacific youth are disproportionately affected by heavy colonization and racism, particularly in relation to cannabis use. There are significant gaps in understanding how marketing, retail availability, and policy contribute to health disparities. This systematic review aimed to explore the commercial factors contributing to health inequities among Maori and Pacific youth (ages 12-24) concerning cannabis use, utilizing secondary data, geographical patterns, and policy interventions. The cross-sectional study analyzed data (n=847,230) from the Integrated Data Infrastructure, Health Survey, Youth 19 Survey, and geographic data spanning 2015-2024. The analyses included descriptive epidemiology by ethnicity, geographic analysis of outlet density, policy impacts, and multilevel regression of commercial determinants. Findings revealed that Maori youth had higher cannabis use rates (28.7% compared to 15.3% for Europeans), started using cannabis earlier (14.8 years versus 16.1 years), and had higher usage rates (18.7% versus 9.8%). Cannabis outlets were predominantly located in high-deprivation areas, with 83% of hotspots in neighborhoods where at least 25% of the population were Maori or Pacific youth. Exposure to cannabis was greater among Maori (48.7%) and Pacific (45.2%) youth compared to European youth (38.9%). Maori (6.8 per 1,000) and Pacific (4.9 per 1,000) youth utilized health services more frequently than European youth (2.7 per 1,000). Maori youth also faced higher rates of cannabis-related charges (1.58) and convictions (OR 1.73). Although the 2019 reforms led to a 23% reduction in charges, ethnic disparities remained. Multilevel regression indicated a stronger correlation between outlet density and cannabis use among Maori youth. In conclusion, commercial factors significantly contributed to cannabis-related health inequities among Maori and Pacific youth through the strategic placement of dispensaries, marketing exposure, and product availability. Current regulatory policies fail to adequately address these structural inequalities. Comprehensive policy changes targeting commercial determinants are necessary to achieve health equity for Indigenous and Pacific communities in Aotearoa New Zealand.