Recreational Marijuana Markets: Evaluation of Social Media, Policy Compliance, Use and Related Fatalities

Over the past decade, 18 states of the United States (U.S.) have legalized commercial recreational marijuana markets, which allow for the legal production, distribution, and sale of marijuana at retail locations (known as dispensaries) for those aged 21 and older. Understanding dispensary marketing practices and the impact of legalized recreational markets on health are of great public health importance. The first chapter of this dissertation evaluates recreational marijuana dispensary compliance on social media with advertising regulations in the state of Illinois. A quantitative content analysis was conducted to analyze primary data collected from dispensary Facebook and Twitter accounts in the first year of legal sales. Violations of advertising regulations were organized into three categories: advertisements that may be appealing to youth (< 21 years old), advertisements that make health claims, and other advertising violations. Results revealed substantial and persistent non-compliance. Overall, nearly one third of posts had at least one violation and approximately one in ten posts met the criteria for appealing to youth or contained health claims. The second chapter examines product promotions, branding, and promotional pricing on Illinois dispensary social media accounts using the same dataset as chapter one. Posts that mentioned marijuana products were classified into one or more of the following product categories: flower, pre-roll, edible, vaporizer pen or cartridge, concentrate, and other. Posts could be further classified as a branded advertisement and price promotion. Findings of this study showed flower and edibles were consistently the most heavily promoted products during the study period. The results also showed a substantial rise in branded advertisements and price promotions throughout the year. Chapter three investigates the impact of recreational markets on prevalence of marijuana use and initiation of use among those aged 12 to 17, 18 to 25, and 26 and older in five states: Colorado, Washington, Oregon, Alaska, and Nevada. The synthetic control method with staggered treatment adoption was used to estimate the pooled effect of these markets up to four years after implementation. Results revealed negligible increases in initiation of use and prevalence of use among adolescents aged 12 to 17. Adults aged 18 to 25 saw moderate increases in both initiation of use and prevalence of use. Finally, adults aged 26 and older had minor increases in initiation of use and large increases in prevalence of use. Chapter four examines the impact of recreational marijuana markets on three causes of death that are associated with use: motor vehicle accidents, suicide, and opioid overdose. Drawing on death certificate data, this study used a difference-in-differences research design to estimate the causal impact of recreational markets on deaths in six states: Colorado, Washington, Oregon, Alaska, Nevada, and Massachusetts. In the analysis, states with comprehensive medical marijuana programs during the entire post-treatment period with similar pre-trends in deaths were used as comparisons. Results from the analysis revealed an increase in motor vehicle accident deaths in two early adopter states, Colorado and Oregon, and no evidence of an increase in suicides or a reduction in opioid overdose deaths.