Multivariate modeling indicated that adolescents with a history of cannabis use had lower perceived risk of harm compared with those who had a history of using other substances. This is an important finding as studies have found that cannabis consumption decreases perceived risk of harm from using cannabis . Limitations to consider when interpreting results of this study include the inability to conclude causal relation, limited generalizability, and response biases. Although complex sampling was used to have the most generalizable adolescent population to the US, some differences in perceived risk of harm from cannabis use and history of substance use were detected between the full sample of US adolescents from the NSDUH dataset and the analytic subsample that had complete responses to the pertinent survey questions, thereby limiting generalizability. Furthermore, there is potential for response biases with retrospective, self-report questions that may result in under reporting or recall bias. For example, reported perception of peer use has been linked to a respondent’s own substance use . Recommendations for future research are to conduct prospective studies to confirm the findings of the current study. Furthermore, research analyzing longitudinal data to monitor trends in risk perceptions and consumption, differentiating by state is essential as cannabis laws differ by state. Additionally, research examining the effects of interactions between age or sex and peer influence on cannabis risk perception will be useful for adapting prevention services tailored for age and sex. Understanding the effects of legalization of cannabis on adolescent use can better inform state officials on ways to implement programs to educate adolescents about the risk of harms associated with its use. Adolescent cannabis use prevention programs might include age-appropriate messaging about the risk of harm from using cannabis and elements that bolster the protective influences of peers and schools.
The current study adds further evidence to justify capitalizing on the potency of peer and social influences in substance use prevention interventions. Adolescents in this study who perceived risk of harm from monthly cannabis use had lower odds of believing their peers used outdoor cannabis grow, higher odds of perceiving their peers disapproved of using cannabis, higher odds of their parents limiting their time out with friends during school nights, higher odds of regarding school as important, and higher odds of reporting participation in extracurricular activities. This study further emphasizes the need for effective, multidimensional programs that target adolescent attitudes and beliefs about cannabis use through peer education, enhancing school engagement, and promoting youth clubs, athletics and other school-based or community social events. Tobacco companies have long employed numerous tactics to advertise their products to youth and young adults , and young people who report viewing tobacco advertisements are at greater risk for tobacco use initiation, progression to regular use, and development of nicotine dependence.As a result, the 1998 Tobacco Master Settlement Agreement limited the marketing of tobacco products in ways that might entice under aged youth to use them and movies, use of cartoon characters such as “Joe Camel”. However, following passage of the MSA, more subtle product placement strategies continued to be used in TV and movie productions with tobacco products featured as a part of the plot or character development. Similar to direct tobacco advertising, viewing tobacco products on TV/movies is also positively associated with youth tobacco use . Several U.S. states, including California, legalized the sale, possession, and use of cannabis recreationally among adults, beginning in 2012.However, unlike with tobacco, there are relatively few restrictions on cannabis marketing, in part because cannabis is classified federally as a schedule I drug despite legal sales of recreational cannabis in 11 states and the District of Columbia . Consistent with studies that show viewing tobacco marketing increases risk for tobacco use, a small body of cross-sectional work has also shown that viewing cannabis advertisements is associated with higher odds of cannabis use , as is seeing cannabis use in TV/movies . The tobacco and emerging cannabis marketplaces have changed considerably over the past decade, resulting in a proliferation of new tobacco and cannabis products , which have become increasingly popular among YA . There is also evidence that tobacco and cannabis companies are marketing these products in new ways – through online platforms such as social media , which may disproportionately impact YA who rely on the Internet more heavily than older adults .
For example, a recent study examining JUUL’s marketing campaign revealed that thousands of Instagram posts, emails, and other advertisements were targeted to youth, and non-smoking populations.Similarly,Medmen recently initiated a well-funded national advertising campaign, including advertisements on the Howard Stern and Adam Carolla shows, YouTube videos, billboards, and social media advertisements . Given the increasing array of tobacco and cannabis products and methods for marketing them , it is important to identify the extent to which YA recall seeing marketing, for which products, and through which channels . Marginalized populations, including sexual and gender minorities, racial/ethnic minorities, and populations of lower socioeconomic status, use tobacco and cannabis products at higher rates, relative to the national average . Historically, these groups have also been disproportionately exposed to cigarette advertisements targeted specifically to minority populations . However, little is known about whether, or how viewing of marketing for new and emerging tobacco and cannabis products differs across sociodemographic characteristics, such as race/ ethnicity, gender identity, sexual identity, and socioeconomic status in YA. This study had two aims. First, we assessed prevalence of recalling online advertisements, as well as seeing product use in TV/movies, for a wide range of tobacco and cannabis products among a diverse sample of YA cannabis products in California from Southern California. Second, we assessed sociodemographic differences in recalling online advertisements and seeing product use in TV/movies for any tobacco products and any cannabis products. All analyses were limited to never-users of tobacco and cannabis products, respectively. Sociodemographic characteristics were first calculated, separately among never users of tobacco and cannabis products . Then, prevalence estimates were calculated for recalling seeing tobacco and cannabis marketing. Unadjusted estimates are reported for both Internet- and TV/movie-based marketing, and F-tests assessed whether prevalence differed significantly by marketing source for each product. Finally, sociodemographic differences were assessed for recall of marketing for any tobacco or cannabis products, separately for Internet- and TV/movie-based marketing channels.Multivariable logistic regressions also assessed associations between all sociodemographic characteristics, in combination, on recalling any tobacco and any cannabis marketing. All analyses were limited to never-users of tobacco and cannabis and were conducted in 2020 using Stata SE version 15. Sample characteristics of users vs. never-users of tobacco and cannabis were compared in Supplemental Table 1. This study assessed prevalence of, and sociodemographic differences in recalling tobacco and cannabis grow equipment product marketing among a sample of Southern California YA reporting no history of tobacco and cannabis use, respectively. For the majority of products – all combustible tobacco products, combustible cannabis, and edible cannabis – respondents had higher odds of seeing use of those products on TV/movies than they did seeing online advertisements. Portraying tobacco use in TV/movies has been an effective – and profitable – way to advertise tobacco products , increasing risk for tobacco use initiation among youth .
While considerably less research has assessed the role of seeing cannabis products in TV/movies on initiation of cannabis use among young people, cannabis brands have been successful in negotiating product placements with entertainment studios, and with almost no regulation . While it is impossible to discern the degree to which respondents saw tobacco and cannabis products in TV/movies through intentional product placements and/or through the artistic discretion of the TV/filmmakers, our results highlight that shows and movies reaching young people include a considerable amount of tobacco and cannabis product use. Effective measures to reduce exposure to this form of marketing may include giving programs that display tobacco or cannabis use R and TV-MA ratings and prohibiting the display of recognizable brand names, among other actions. Consult the Truth Initiative for a full list of measures endorsed by the organization . While there is ample evidence that JUUL and other e-cigarette brands are indeed promoted on TV/movies , respondents in this sample had higher odds of recalling seeing online advertisements for these products. Given that youth and YA remain the largest demographic group of Internet users , and that the proportion of young people using e-cigarettes has risen , online advertisements for e-cigarettes may disproportionately influence underaged youth and YA to experiment with, and become regular users of e-cigarettes. A future direction for effective tobacco regulation might include limiting online marketing for e-cigarette products. While logistically challenging, online marketing should ideally be regulated in such a way that ensures first amendment protections to e-cigarette companies, while also limiting exposure among YA never users . A number of sociodemographic differences were also found with regard to viewing tobacco and cannabis marketing. For example, women reported seeing online cannabis advertisements at higher rates than men. Compared to men, greater percentages of women also reported seeing tobacco and cannabis products on TV/movies. It is possible these findings stem from documented gender differences in processing and recall of advertising details, with women recalling details of advertisements more clearly than men . However, it is also plausible that young women who recall seeing tobacco and cannabis products in TV/movies may be at especially high risk for using those products themselves. In prior longitudinal work among non-smokers, young women who watched a favorite actor smoke on screen had a nearly twofold increase in risk for smoking themselves. This association was not significant among young men . In multivariable analysis, LGB-identified YA also recalled seeing online cannabis advertisements at a higher rate than straight respondents, and prior research has shown that LGB youth have a greater willingness to use cannabis products than their straight peers . Together, these findings highlight that young women and LGB people may be priority populations for public health efforts to prevent tobacco and cannabis use. Several racial/ethnic differences were found. Interestingly, racial/ ethnic minority respondents had lower odds of recalling marketing, across a number of comparisons. For example, Asian YA had about half the odds of recalling seeing online cannabis advertisements and seeing use of cannabis products in TV/movies, compared to White respondents. Further, compared to White respondents, Black respondents had about 40% odds of recalling both tobacco and cannabis use in TV/movies, and respondents reporting an “other” race/ethnicity had about 50% odds of recalling cannabis use in TV/movies. While cigarette companies have a long history of targeting advertisements to Black populations , our results suggest that among never-users, White YA are more likely to see online advertisements for tobacco and cannabis, or to see those products used in TV/movies.
However, it should be noted that while this analysis was focused on identifying sociodemographic disparities in seeing marketing, all groups did recall seeing some degree of marketing . Several steps have been taken at the state and federal levels to regulate underage exposure to tobacco marketing . However, while many U.S. states have legalized the sale of cannabis products, they remain illegal federally. This limits the ability to effectively regulate accessibility to cannabis products for adults and those who may benefit from them , while also limiting exposure to those most vulnerable to misuse . Respondents in this sample were below the legal purchasing age for cannabis products in California, yet a large proportion of them – all of whom reported never using cannabis in the past – reported seeing online advertisements and use of these products in TV/movies. These results highlight a need for more research related to cannabis marketing exposure and subsequent use among YA, and the role of regulations to limit exposure. While individual states may be unable regulate online advertisements, they would be able to regulate local advertisement , should they be shown to deliberately and effectively target underage youth. More work is still needed to understand how to effectively regulate pro-use messages online and in TV/movies. First, our main outcome measure was self-reported recall of tobacco and cannabis marketing, which may not reflect actual marketing efforts to place ads where YA will see them. Instead, our measure signifies where YA were most likely to notice tobacco and cannabis advertisements. Second, these analyses were cross-sectional; we were unable to assess whether recalling marketing was associated with tobacco and cannabis use initiation. Third, this study assessed whether respondents recalled seeing marketing both online and in TV/movies, though there exist a host of other ways in which tobacco and cannabis products are marketed .