Abstract
As global jurisdictions shift toward cannabis legalization, 2 areas of public health importance relate to exposure to youth and to truthful promotion. Although Canada's Cannabis Act specifies many prohibitions related to cannabis promotion, no systematic monitoring or enforcement among licensed firms exists. Compliance with marketing regulations has effects beyond Canadian citizens because of the global outreach of websites and social media. To evaluate compliance among licensed firms with the Cannabis Act and analyze trends among violations regarding promotional material. This cross-sectional study evaluated cannabis-licensed firms after cannabis legalization. Data were extracted from online public platforms, including company websites, Facebook, Instagram, and Twitter, from October 1, 2019, to March 31, 2020. Descriptive statistics, Poisson regression, and logistic regression were used to analyze the associations of covariates with promotion violations. The primary outcome was characterization of type and prevalence of promotion violations. Secondary outcomes were the role of various covariates (namely, licensed firm characteristics and online platforms) in the frequency and probability of violations. Hypotheses were formulated before data collection. Among 261 licensed firms, 211 (80.8%) had an online platform, including 204 (96.7%) with websites, 128 (60.7%) with Facebook, 123 (58.3%) with Instagram, and 123 (58.3%) with Twitter. Of all licensed firms with an online platform, 182 (86.3%) had at least 1 violation. Compared with websites, the risk of violations was significantly higher on Facebook (rate ratio [RR], 1.24; 95% CI, 1.11-1.39) and Instagram (RR, 1.19; 95% CI, 1.05-1.34). The most common violations included lack of age restrictions, brand glamorization, and omission of risk information. With websites as the reference group, lack of age restrictions was approximately 15 times more likely to occur on Facebook (odds ratio [OR], 14.76; 95% CI, 8.06-27.05); the odds of an age restriction violation were also higher on Instagram (OR, 2.48; 95% CI, 1.43-4.32) and Twitter (OR, 4.03; 95% CI, 2.29-7.09). For unsubstantiated claims, the odds of violations were significantly decreased on Facebook (OR, 0.23; 95% CI, 0.11-0.48) and Instagram (OR, 0.28; 95% CI, 0.14-0.57). The odds of glamorization were associated with an increase on Instagram (OR, 2.90; 95% CI, 1.72-4.88). In this cross-sectional study, widespread violations were observed in online Canadian cannabis promotion. To protect public health and safety amid legalization, decision-makers should make explicit federal regulation and enforcement regarding promotional activities of cannabis retailers. These results suggest that policy and enforcement of cannabis promotion in Canada would have an international impact, from ease of access to online media and downstream consequences of unregulated promotion.
Highlights
Cannabis promotion is the subject of global health policy discourse amid jurisdictional legalization within the past decade
The risk of violations was significantly higher on Facebook and Instagram (RR, 1.19; 95% CI, 1.05-1.34)
With websites as the reference group, lack of age restrictions was approximately 15 times more likely to occur on Facebook; the odds of an age restriction violation were higher on Instagram (OR, 2.48; 95% CI, 1.43-4.32) and Twitter (OR, 4.03; 95% CI, 2.29-7.09)
Summary
Cannabis promotion is the subject of global health policy discourse amid jurisdictional legalization within the past decade. In 2012, Colorado and Washington were the first jurisdictions to grant licenses to regulate and promote cannabis.[1,2] In October 2018, Canada legalized recreational cannabis under Bill C-45—the legislation that encompasses cannabis promotion.[3] Legalization was driven by 3 federal values: protecting youth, mitigating illegal profits through criminalized sales, and protecting public health and safety.[1,3] Legalization is widely regarded as sound social and health policy for many reasons yet comes with unique challenges. It is unclear whether cannabis promotion is held to the same rigorous enforcement as that for other recreational substances, such as tobacco, or medical substances, such as pharmaceutical products
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