With the majority of US states having adopted legislation to medically and/or recreationally legalize cannabis,
public perception of the drug is now overwhelmingly favorable. Increased access and prevalence of use are
accompanied by perceptions of low health risk and/or of therapeutic benefits associated with cannabis use.
Aside from evidence for symptom relief in certain medical conditions, evidence regarding therapeutic effects of
cannabis for many conditions remains elusive, leaving the decision regarding when and how to use cannabis
to the user. Both therapeutic and recreational reasons (motives) for CU are largely shaped through exposure to
messages about the effects of cannabis, yet little is known about the source of messaging, how it is transmitted
to users, how it shapes their thinking, and ultimately its association with CU patterns. The proposed study will
gather critical information about message sources, cannabis-promoting content, and risk warnings being
disseminated to cannabis users as well as the messages being received, their effects on CU motives, and
subsequent CU. The mixed-methods design will include two phases. Phase 1 involves semi-structured
interviews conducted with 1) cannabis users, as well as with message sources, including 2) cannabis
dispensary and retail outlet staff (budtenders), 3) growers, and 4) health care providers who discuss cannabis
with patients. Additionally, extraction and coding of messaging content will be conducted across internet and
social media messaging platforms. Observational coding of recreational/medical cannabis outlets will be
conducted using validated surveillance tools. Together, these data permit characterization of cannabis
messaging content across various types of sources and platforms (Aim 1) that will in turn inform Phase 2
methods. Phase 2 consists of a three-burst 4-week ecological momentary assessment (EMA) study with a
sample (N=300) of weekly 18-74 year-old cannabis users. Participants will complete brief smartphone-based
measures of exposure to messaging (source and content), cannabis motives, and use patterns in the natural
environment. With these quantitative data, this will be the first study to examine prospective associations
between a user’s exposure to cannabis messaging and motives and other cognitions (Aim 2). Further, we will
test whether cannabis motives are a mechanism underlying the association between cannabis messaging and
CU at both the between-person and within-person levels (Aim 3). Finally, we will explore user characteristics
and message source characteristics as potential moderators of the effects of cannabis messaging and CU
(Aim 4). This combination of complementary and highly rigorous data collection approaches will provide the
most nuanced understanding of the messages being disseminated about the effects of cannabis to the
cannabis user. Findings will arm policy makers and cannabis regulatory science with evidence-based
information about the impact of cannabis messaging that can ultimately reduce potential harms from misuse.
