We sent out the survey on September 27, 2017, and responses were completed by October 9, 2017. Participants are reminded to complete the survey 3 days after the initial survey is sent. As modest incentives to encourage survey completion, participants are entered into raffles or sweepstakes with both cash rewards and other prizes. Participants are provided with no more than six surveys a month and are expected to complete an average of four surveys a month. The median time for survey completion was 8 min. Sampling was stratified by legalization status of marijuana in the state of residence . California residents and young adults aged 18 to 26 years old were over sampled to facilitate a future investigation into the role of recreational legalization on use patterns among young adults in California. Sampling weights were provided by GfK. The University of California, San Francisco Committee on Human Research considered this study to be exempt.Details of survey development have been previously published.The survey development team comprised multidisciplinary research staff and investigators. We asked about a wide range of topics, including perception of risks and benefits associated with marijuana use, comparisons of marijuana to other substances , and pertinent public health questions relevant to implementing marijuana legalization. We also asked detailed questions about marijuana use and conducted reliability testing among 300 current marijuana users. Reliability testing was only conducted on questions related to marijuana use. Questions were either derived from previously published national surveys or created internally after several iterations and pilot tests with volunteers . Volunteers were comprised of a panel of patients from the investigator’s clinics and were offered no incentives to volunteer.We asked about the most influential source of information about marijuana as follows: Which information source about the benefits and risks of marijuana is the most influential for you?
Response options were friends, relatives, health professionals , politicians, law enforcement professionals, traditional media platforms , Google or other Internet searches, social media platform , advertisement ,rolling greenhouse tables marijuana dispensary or other marijuana industry sources , and other. Only one most influential source was allowed per respondent. For the purposes of analysis, some response categories were grouped as follows: friends or relatives; social media platform or the Internet; politician or law enforcement professional; and advertisement, marijuana dispensary, or other marijuana industry sources.We asked several questions aimed at assessing the extent to which individuals endorsed commonly circulated misinformation about marijuana. A Likert scale was used to respond to each question. The questions were as follows: smoking marijuana has preventative health benefits, how safe is it to expose adults to secondhand marijuana smoke?, how safe is it for pregnant women to use marijuana?, and how addictive is marijuana? A 4-point Likert scale was used to answer questions 1 through 3 and a 3-point Likert scale was used to answer question 4. We chose these statements given that the evidence to support these claims is lacking. The notion that marijuana has preventative health benefits remains unproven.While less is known about the harms of secondhand exposure to marijuana compared with secondhand exposure to tobacco,there is an emerging body of literature using animal studies and studies in humans suggesting that marijuana smoke may be toxic. In addition, exposure to particulate matter is associated with cardiovascular and respiratory risks.There is an emerging evidence base suggesting marijuana use during pregnancy may adversely affect fetal development.The American College of Obstetricians and Gynecologists recommends avoidance of marijuana use during preconception, pregnancy, and lactation, citing concerns for impaired neurodevelopment and maternal and fetal exposure to the adverse effects of smoking.
Finally, while the threshold for addiction to marijuana is higher compared with other addictive substances among adults, it is a recognized clinical problem which is encapsulated within the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition diagnosis of Bcannabis use disorder.Characteristics of the survey respondents and most influential sources of information were weighted using weights provided by GfK to approximate the US population based on age, sex, race/ethnicity, education, household income, home ownership, and metropolitan area. All analyses used weighting commands using the weight variable provided by GfK to generate national estimates. To determine how well our sample compared with a national federally sponsored survey on substance use and marijuana use, we first compared the socio-demographic characteristics of our survey respondents with those of the National Survey on Drug Use and Health .The NSDUH is an annual federal survey implemented by the Substance Abuse and Mental Health Services Administration , which is an agency of the Department of Health and Human Services . The NSDUH provides data on substance use epidemiology in the US.We conducted multivariate logistic regression analyses to examine the association between each source of information about marijuana , the belief of any or all statements defined as misinformation about marijuana adjusted for socio-demographic characters , and legalization status in the state of residence. There was a separate model for each source of information, and the referent in each model was all other sources of information. Analyses were performed using R statistical software .The most influential sources of information about marijuana were health professionals , traditional media platforms , friends or relatives , and social media or the Internet . Individuals reporting social media or the Internet , the marijuana industry , and friends or relatives as the most influential source of information about marijuana were more likely to believe any statement consistent with misinformation about marijuana in comparison with those who reported other sources as most influential .
In contrast, those who reported health professionals , traditional media platforms , and politicians or law enforcement professionals as the most influential information source were less likely to believe any statement. Individuals reporting the marijuana industry as the most influential information source were more likely to believe all statements in comparison with those who reported other sources as most influential. Individuals reporting traditional media platforms as the most influential source were less likely to believe all statements. Findings on associations between sources of information and beliefs were also generally consistent when examined according to individual beliefs .In a nationally representative survey of US adults, the most influential sources of information about marijuana were health professionals, traditional media platforms, friends, relatives, social media, and the Internet. Individuals reporting social media or the Internet, the marijuana industry , and friends or relatives as the most influential source of information about marijuana were more likely to believe unsubstantiated claims about marijuana. We found that individuals who identified the marijuana industry as a source of information were more likely to believe misinformation. The marijuana industry is a growing multi-billion-dollar business, and it is supported by influential trade and lobbying groups and venture capital investment.Although there is little evidence to support these claims, the marijuana industry promotes marijuana as a potential treatment for nausea during pregnancy,ebb and flow rolling benches in addition to a potential treatment for conditions such as autism, cancer, and diabetes.Both Health Canada and the US Food and Drug Administration have issued warning letters to marijuana producers and distributors as a result of their advertising claims.In November 2017, the FDA issued warning letters to several online marijuana purveyors for making unsubstantiated claims that their products could prevent, diagnose, treat, or cure cancer. Thus, the marketing of marijuana, which inadequately regulated, may have a role in shaping misinformed public views on marijuana. Without more effective marketing regulations, the marijuana industry may continue to disseminate unfounded claims about marijuana with potentially harmful public health consequences.Unlike the growth of the tobacco industry, which came of age prior to the advent of the Internet, the marijuana industry has the opportunity to promote its expansion with marketing on the Internet and social media, where regulation is minimal and relatively undefined.Despite policies restricting marijuana advertising on Facebook and Google,prior work has demonstrated the predominance of positive messaging about marijuana and normalization of its use on Twitter and other Internet sources .
Furthermore, there is an abundance of articles listing unproven health benefits of marijuana on the Internet, many targeting consumers in different countries. Given the extent of misinformation about marijuana on the worldwide web, it is not surprising that adults who believed misinformation were more likely to obtain information from social media and the Internet. Public health campaigns that use social media are necessary to combat misinformation about marijuana. Unregulated promotion on the Internet and social media has public health ramifications for consumers worldwide and poses a challenge to public health leaders and policymakers. Our findings point to the need for investment in public health campaigns to better communicate risks to the public. Moreover, these results suggest the need for a targeted and cohesive strategy on the part of health providers to address misinformation with patients. Due to a lack of evidence and possible therapeutic benefit of some forms of cannabis for specific indications, physicians have not been able to provide a clear or unified message to the public. In contrast, individuals who reported traditional media platforms as the most influential information source were less likely to believe misinformation. There is roughly equal representation of pro- and anti-legalization viewpoints by traditional news outlets,and it is possible that balanced reporting could have counteracted the development of misperceptions. The lower risk of believing misinformation could also reflect restrictions on marijuana advertising on traditional media outlets.However, it is important to note that several unrelated factors could contribute to this association, including unaccounted for demographic information or the intended audience of a traditional media outlet .The response rate of our survey was 55%. However, the response rate was similar to that of other Internet surveys.Use of an Internet survey might limit generalizability because individuals who choose to join an ongoing Internet panel may be different from individuals who choose not to participate. However, studies that have examined non-response to panel recruitment in GfK’s Knowledge Panel have found no evidence of non-response bias in the panel on core demographic and socioeconomic variables. In addition, while there were some differences in income distribution in the sample compared with the NSDUH, the respondents of both panels were very similar in terms of age, gender, race/ethnicity, education, household size, and employment status. Additionally, it is important to note that the survey questions and response items analyzed in this paper could have been interpreted differently by respective respondents. We did not conduct reliability testing of the opinion questions, and it is possible that the wording of the questions introduced bias that may have impacted interpretation by the respondents. Specifically, describing information sources as Bmost influential may be perceived differently between respondents. Additionally, we did not offer an BOther or BUnknown category for respondents when choosing an answer. Though a deliberate decision to force participants to choose an answer to obtain an understanding of prevailing views, this may have biased responses. Future research should include more psychometric testing of the items to minimize bias introduced by the content and order of the questions. Finally, we were unable to examine causal relationships between sample characteristics and endorsement of misinformation. Our results are only able to demonstrate association.Marijuana use is legal for medical and/or recreational purposes in thirty-three states, including the District of Columbia.Use of marijuana has steadily increased along with growing availability through legalization. The National Survey on Drug Use and Health found past-year marijuana use among US adults doubled over the last decade, rising to 13.3% in 2014.Of those who used marijuana in the last year, 90.2% reported recreational use only, 6.2% reported medical use only, and 3.6% reported use for both purposes.However, commercialization of marijuana along with direct to consumer advertising in recreational dispensaries, on the internet, and through social media allows self-medication without the involvement of healthcare professionals. In addition, the increasing rate of marijuana use has been paralleled by a decreasing perception of harm. Therefore, many Americans may be using marijuana for reasons not supported by evidence.Chronic pain has been more widely studied than other conditions, with most trials focusing on neuropathic pain.While many of these trials demonstrated benefits in reducing pain, most used pharmaceutical cannabis extracts not available in the USA or federally available research-grade marijuana that differ considerably from products used by consumers. Therefore, a recent review by the National Academy of Sciences concluded that more evidence is needed to explore the proper forms, routes, and dosages of marijuana for use in chronic pain.