As cannabis legalization expands, understanding how policies shape the retail environment — and how that environment affects consumers — is essential. Dr. Carla Berg, PhD, MBA, LP, professor in the Department of Prevention and Community Health at the Milken Institute School of Public Health and Associate Center Director for Population Sciences and Policy at the George Washington Cancer Center, is leading research at this intersection. 

Her work examines the social determinants of substance use, particularly tobacco and marijuana, from more institutional and systemic influences like policy and marketing to individual and interpersonal factors. Since 2021, the Center for Public Health Law Research has been working with Dr. Berg and her team at George Washington University on a project funded by the National Institutes of Health to research, build, and code state-level retail marijuana laws, with a particular focus on point-of-sale and advertising restrictions, each year from 2022 through 2025.

CPHLR: How does the study described in this paper relate to the rest of the CARMA project? 

Dr. Berg: This line of research responds to concerns related to cannabis retail practices and consumer exposures, as well as potential subpopulation differences, to inform regulatory and surveillance efforts.  

CPHLR: What surprised you the most as you were reviewing the results of this research? 

Dr. Berg: The one thing that stands out about the findings from this study so far is how consistent the data has been in terms of: 1) industry non-compliance with regulations; 2) the clear disparities among subpopulations in terms of cannabis use and targeted marketing; and 3) how these issues reflect similar concerns documented in the tobacco and alcohol literature. 

In one part of the study, we conducted retail audits and mystery shopper audits among 150 non-medical cannabis retailers in the five cities (Denver, Los Angeles, Las Vegas, Portland, Seattle) in the Summer of 2022. Most retailers complied with age verification and required signage, but a proportion engaged in prohibited or restricted activities. For example, some posted youth-oriented signs and/or health claims (e.g., anxiety, sleep, pain, nausea), staff frequently endorsed use for health conditions, including pregnancy-related nausea, most stores had price promotions, and some even offered free products. Also notable was that retailers were using strategies to make accessing products easier, via online marketing and sales, curbside pick-up, or delivery services. 

We also found that stores differed in their practices depending on their communities. For example, we found more youth-oriented signage and fewer required warnings in diverse or lower-income neighborhoods. 

When we asked young adults (ages 18–34) participating in our longitudinal survey study about their retail experiences, we also identified key disparities. Black participants and those with less education reported higher exposure to promotions and health claims, while younger and male participants noticed fewer warnings. Notably, these exposures were related to such outcomes as lower perceived risk, more frequent cannabis use, and more problematic use, including driving after use. 

CPHLR: Some of your findings show that certain policies — like discount bans, online advertising restrictions, and required warnings — didn’t always produce the expected effects, while others did. What do these mixed results tell us about how cannabis regulations are working in practice, especially for young adults? 

Dr. Berg: When we looked at reports of young adults within the context of their state regulations for cannabis, several policy drivers showed the anticipated effects. For example, in states where there were laws requiring driving-related warnings in ads, there were fewer reports of driving after use. Additionally, restricting health claims on products was associated with lower health claim exposure, and restricting giveaways was associated with less frequently noticing giveaways. These findings suggest that the industry is generally responsive to some regulations and that certain regulations may have the intended population impact. 

However, some findings were less straightforward. For example, restricting discounts was associated with more frequently noticing discounts, and while restricting billboard ads was associated with less billboard ad exposure, no other restrictions on advertising channels showed such associations. Additionally, limits on retail licenses were associated with young adults less frequently visiting retailers, but some other restrictions did not appear to have their intended effects. These findings are difficult to interpret and require replication from other studies to determine whether these findings are robust and the mechanisms accounting for them. 

CPHLR: When tracking cannabis policy across 19 states, what role did MonQcle play in helping your team organize and validate the legal data? 

Dr. Berg: The legal experts at Temple have been integral research team members, using MonQcle to code and organize state cannabis regulations on an annual basis since 2022. Thanks to the Temple team, I believe that we have developed a highly robust dataset with detailed information about retail and marketing regulations that is accessible to anyone to use. We are also expanding this work to include hemp-derived products and equity initiatives. 

CPHLR: How would you encourage policymakers to interpret the results of this work? What recommendations might you give if they’re interested in reducing access and use, particularly for young people? 

Dr. Berg: Our findings to date show that certain subpopulations may be exposed to less protection within cannabis retail settings and that these exposures have implications for use-related outcomes, including perceived risk, increased use, and problematic use, including driving under the influence. These findings underscore the need for regulations regarding promotions, health claims, warnings, and minimum age, as well as enforcement – and highlight the need to draw from the tobacco and alcohol literature to determine effective regulatory language and enforcement strategies that will enhance the effects of regulations and reduce cannabis-related disparities. 

CPHLR: You write that “ongoing research assessing population impact and industry compliance is needed.” What next steps are you most excited about? 

Dr. Berg: Our team just completed a second round of retail and mystery shopper audits across the same five cities as in 2022, and we are also conducting these audits among smoke shops across multiple US cities in order to capture the marketing of hemp-derived cannabis products, like delta-8 THC, as well as other under-regulated products. This is an exciting endeavor, given the wealth of information these audits provided in 2022, and what we stand to learn from expanding to this under-regulated market of smoke shops. We’re also excited about the opportunity to continue to produce manuscripts from our young adult cohort data, as we have some fascinating findings about medical cannabis use, the effects of advertising messages and warnings, family dynamics regarding cannabis use, and more.