Cannabis Ads Linked to Increased Likelihood of Use

Global changes in cannabis legislation have raised concerns about the potential impact of cannabis advertising on cannabis use and intentions to use. This systematic review and meta-analysis evaluated the relationship between self-reported exposure to cannabis advertising across various media platforms and self-reported cannabis use and use intentions. Systematic review and meta-analysis of eligible quantitative studies using random-effects models. All included studies were conducted in the United States or Canada. Participants ranged in age from 11 to 65&#x2009;+&#x2009;years across 21 included studies. Studies measured self-reported exposure to cannabis-related advertising and either cannabis use or intentions to use cannabis. Three types of exposure were examined: [1] general cannabis advertising (a composite measure including billboards, storefront/sidewalk, magazines, social media, and other types of advertising avenues), [2] internet/social media advertising, and [3] storefront/sidewalk advertising. A total of 2588 records were identified through database searches (PubMed, Scopus, and PsycINFO; January 2024). After title and abstract screening, 45 underwent full text review; of these, 21 studies met inclusion criteria. Most were cross-sectional (86%, n&#x2009;=&#x2009;18), and three were longitudinal. Ten cross-sectional studies were eligible for meta-analysis, which found a statistically significant association between cannabis advertising exposure and cannabis use (adjusted odds ratio [aOR]&#x2009;=&#x2009;1.77, 95% confidence interval [CI] [1.32, 2.30]). Statistically significant heterogeneity was found (Q [11] = 22.73, P&#x2009;<&#x2009;0.05, I2&#x2009;=&#x2009;42.3%) and therefore, based on methodological comparability, three additional meta-analyses were conducted by exposure type. General cannabis advertising (3 studies) exposure was statistically significantly associated with cannabis use (aOR&#x2009;=&#x2009;1.67, 95% CI [1.27, 2.21]); internet/social media advertising (5 studies) also showed a statistically significant association (aOR&#x2009;=&#x2009;3.38, 95% CI [1.07, 10.66]); exposure to storefront/sidewalk advertising (3 studies) was not statistically significantly associated with cannabis use (aOR&#x2009;=&#x2009;1.25, 95% CI [0.95, 1.66]). Across studies, methodological quality was mostly good (48%) or satisfactory (43%), with 10% rated as unsatisfactory. There appears to be a generally positive association between exposure to cannabis advertising and cannabis use, with a consistent positive relationship observed between advertising exposure and intentions to use.