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. Commercialization and marketing of cannabis products began shortly afterwards . 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 sub irrigation 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/moviebased marketing channels. Pairwise comparisons assessed whether response categories of each sociodemographic characteristic differed significantly from one another. 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 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 TVMA 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 nonsmokers, 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 .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 . Additional research is needed to understand YA exposure to pro-tobacco and cannabis marketing across a wider range of marketing platforms. Further, tobacco products are marketed online largely via organic social media posts not labeled as advertising . Since respondents were asked generally about seeing ads “when using the internet,” we were unable to disentangle the various types of online marketing YA saw. Fifth, patterns of media consumption vary among YA , and heavy media users may recall more tobacco and cannabis marketing than light media users. While respondents were able indicate if they did not use the Internet or if they did not watch TV/movies at all, we were otherwise unable to account for the frequency or timing of their Internet or TV/ movie consumption. Sixth, these data are from a cohort of YA from Southern California, and so may not reflect national or regional trends in perceived marketing exposure. However, the sample was similar to population characteristics of Los Angeles, CA in terms of race/ethnicity and educational attainment . To reduce survey burden, respondents were not asked to report on all characteristics that may potentially be related to substance use . Finally, small sample sizes in some of the sociodemographic subgroups and in some of the specific products marketed resulted in wide confidence intervals on some of our estimates, vertical grow and also precluded us from testing sociodemographic differences in viewing marketing across the various products. The legalization of recreational cannabis use is associated with an increase in both consumption as well as risk of cannabis-use disorder in adolescents and adults . Early research found cannabis use to be an independent risk factor for the development of schizophrenia, allowing for psychiatric and substance use comorbidity . A variety of studies have subsequently supported an association between cannabis use and the development of schizophrenia, with cannabis use in adolescents having a particular impact on cortical development in males with genotypical susceptibility to schizophrenia . Schizotypy is a continuum of personality characteristics and experiences, ranging from normal dissociative states to extreme mental states related to psychosis that can extend to a clinical diagnosis of schizophrenia. Schizotypy is useful in the study of schizophrenia spectrum disorders as it can provide a framework upon which the etiological and developmental pathways to schizophrenia spectrum disorders can be tracked and dissected . Both schizotypy and schizophrenia comprise a similar multi-dimensional structure, with much evidence converging on the presence of three dimensions: positive, negative, and disorganised . The cognitive deficits associated with schizotypy are also well-recognised, and include difficulties in selective and sustained attention, incidental learning, and memory .