Elizabeth D’Amico is a senior behavioral scientist at RAND and a licensed clinical psychologist. She is nationally known for her work on motivational interventions that help adolescents and young adults make healthier decisions, especially around alcohol and drug use. She leads a large and ongoing research project at RAND to examine substance use patterns among teens as they enter young adulthood.
On a major thoroughfare in Los Angeles congested not with cars but with billboards, advertising abounds for the latest legal controlled substance in town. No longer an outlaw, marijuana almost seems to be celebrating its new recreational status with jumbo-size ads touting “Blackout Brownies,” cannabis-infused pomegranate juice called “California Dreamin,” and a delivery service announcing “hello marijuana” and “goodbye stress.”
The ads for recreational marijuana have gotten out ahead of regulations that could restrict where and how teens are exposed to advertising of the drug. Studies have already shown that the more teens are exposed to cigarette and alcohol ads, the greater the likelihood they will use those substances. That’s where advertising regulations come in.
For example, marketing restrictions on tobacco products ban outdoor advertising within 1,000 feet of schools and playgrounds, and prohibit brand sponsorships of sports and entertainment events likely to have younger people in the audience.
The marijuana advertising teens are exposed to could have a profound effect on whether they use this drug.
The marijuana advertising teens are exposed to could have a profound effect on whether they use this drug, according to research my colleagues and I conducted for the nonpartisan RAND Corporation over a seven-year period beginning in 2010.
We recruited 6,500 racially and ethnically diverse adolescents from 16 middle schools in Southern California who went on to attend more than 200 high schools in the region. Teens were surveyed once a year about their exposure to medical marijuana advertising, their marijuana use and their beliefs about the drug.
In 2010, 25 percent of teens reported seeing at least one medical marijuana ad during the previous three months. By 2017, the exposure rate had nearly tripled to 70 percent.
Teens who reported seeing more medical marijuana advertising were more likely to report having used marijuana in the previous 30 days—and more likely to say they expected to use it within the next six months. They were also likely to express more positive beliefs about the drug, such as agreeing that using marijuana can help people relax, let them have more fun, or temporarily escape their problems.
These findings suggest that exposure to medical marijuana advertising may not only play a significant role in shaping teen attitudes about the drug, but it may also contribute to increased marijuana use and related negative consequences throughout adolescence.
Our research was inspired by a measure on the California ballot in 2010 to legalize recreational marijuana that ended up not passing. Our findings take on added importance since recreational marijuana become legal in the state as of 2018. The advertising landscape is bound to feature more ads focused on various ways to consume or purchase marijuana. Every ad is one more chance to influence teen behavior.
The California legislature is considering a bill that would further restrict marijuana advertising in the state. It draws firm lines that parallel tobacco-advertising guidelines and includes preventing advertising within 1,000 feet of daycare and youth centers, schools and playgrounds. And it includes one more directive open to interpretation: Forbidding advertising of cannabis or cannabis-related products “in a manner intended to encourage persons under 21” to use the drug.
Such restrictions would likely help limit teen exposure to marijuana advertising. At the same time, parents, teachers, and health care providers need to be prepared to help teens navigate this new information superhighway by being ready to share up-to-date information on both medical and recreational marijuana. For example, evidence suggests medical marijuana has some health benefits, including managing chronic pain and lessening chemotherapy-induced nausea and vomiting. However, most studies on medical marijuana have focused on adults. Little is known about the medicinal benefits of marijuana for adolescents.
Recreational marijuana use is another story. In fact, research shows that early initiation of marijuana and increased marijuana use during adolescence have been linked to problems that include cognitive deficits and depression.
Sharing honest information about the effects of marijuana is particularly important because research has shown that many teens think marijuana use is less dangerous than alcohol use. Only about 30 percent of high school seniors surveyed across the United States said they believe that regularly smoking marijuana is linked with risk, according to a national study. A separate study showed that younger drivers were most likely to think it was safe to drive after using marijuana.
Teens need to be reminded that ads don’t ever tell the entire story about anything. By design, they are marketing snippets presenting best-case, often fantasy scenarios engineered to influence decisionmaking. With American society once again on the edge of a novel advertising frontier, both ad guidelines and parental guidance are needed.
Your recent studies have focused on marijuana advertising. What have you been finding out?
We’ve been following several thousand adolescents since 2008, asking them about their experiences, their perceptions, and their substance use. In our latest study, we looked at their exposure to medical marijuana advertising. In 2010, around 25 percent of them reported seeing a medical marijuana ad in the past three months. By the time we hit 2017, it was about 70 percent. Youth who reported that they’d seen more ads also reported greater marijuana use and more positive beliefs about marijuana; they also said that they were more likely to use marijuana in the future and they experienced more consequences from their use. Now that recreational marijuana is legal in California, we will be asking youth about their exposure to those ads as well. We know that tobacco and alcohol advertising affect adolescent substance use, and those ads are regulated. It just amazed me that there were not more specific regulations around marijuana advertising in California.
Why is that concerning?
The way teens view marijuana is very different from the way they view alcohol. I’ve noticed that the way teens view marijuana is very different from the way they view alcohol, and part of that is the way it’s marketed. When I talk to teens, they’ll say, “Oh, I would never drink and drive, I know that’s really dangerous. But I could use marijuana and drive because it helps me focus, and it’s safe.” So I think the way it’s been marketed—it’s medicinal, it’s safe, it’s natural—gives them a different perspective. Ads say: “Goodbye stress, hello marijuana.” That’s advertising that you don’t really see for alcohol.
Do you have any tips for parents?
As a parent myself, the main thing I do is explain what medicinal marijuana means, that it’s typically for people who have health problems like cancer, and just because recreational marijuana is legal now doesn’t mean it’s something for teens to use. Their brains are still developing and substance use can affect that development. Alcohol is legal, too, but we don’t want 15-year-olds drinking beer. We have this extra component here, where marijuana is recreational but it’s also medicinal, and I think a lot of kids don’t quite get it. It’s important for parents and providers to be educated and explain the differences between the two.
Are there any efforts to rein in some of this advertising?
Los Angeles County used our work to create an ordinance that limits where you can have marijuana billboards and says you can only have one sign outside a store. That’ll be important, that they can’t have a ton of signage around their stores. We’ve also been contacted by the California Senate about how to best regulate advertising, like how tobacco and alcohol advertising are regulated. Every state is different in terms of what they allow.
You’ve focused throughout your career on addressing substance use and abuse. Why?
When I was 16, I really wanted this convertible yellow Mustang. I told my parents, “I want to figure out how we can get this yellow Mustang.” They didn’t laugh at me, they didn’t shut me down. They were like, “OK, we’ll talk to you about it after dinner.” I’d love to tell you that I got the yellow convertible Mustang. I didn’t, but my parents always made me feel like I was listened to. I feel like a lot of teens don’t get listened to, and so sometimes they make poor decisions. I was always interested in trying to talk to people and empower them to make healthier choices. My parents gave me a lot of choices where I could have gotten into trouble and I didn’t; and some of my friends who didn’t have choices did get into trouble. So I think it’s very important how we talk to teens and empower them to think, “Well, this is my life, this is my choice.”
What’s next in your research?
We just got funding to follow these same youth for four more years, so that’ll take us through when they’re 24, starting from when they were age 11. We’re looking at so many different things with that data. We do a lot of work trying to understand disparities; one of our papers found that as young as high school, minority youth already experience more negative consequences at the same levels of alcohol and marijuana use compared with white youth. We’re also looking at transitions to young adulthood, like going to college, starting relationships, and getting a job, and how alcohol and drug use might affect these transitions.
The exciting thing is that we’re going to follow these young people as they turn 21, the legal age for drinking and now marijuana use. So we’ll be able to look at a lot of things around that big transition and how turning 21 may affect their alcohol and drug use.