Abstract
IMPORTANCE: Cannabis edibles have increased in popularity, particularly among young adults and in states with recreational cannabis legalization. Little is known about the association of cannabis packaging regulations with health warning recall and perceptions. OBJECTIVE: To evaluate whether features of packaging are associated with ability to recall health warnings as well as perceptions of cannabis edible products among young adults. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from October 6 to 18, 2023, in 23 states and Washington, DC, that legalized recreational cannabis. Participants included young adults aged 18 to 29 years, including cannabis users and nonusers. EXPOSURES: In the between-individual 3 (packaging styles) × 3 (health claims) × 7 (health warning themes) full-factorial randomized online experiment, participants viewed an image of the packaging of cannabis edible products with random variations in package styles (plain, normal branded, and youth-appealing packaging), health claims (none, pain relief, and sleep aid), and health warning themes (long-lasting effects, pregnancy-related harms, driving impairment, mental health problems, harms to youths, harms of high potency products, and delayed effects). MAIN OUTCOMES AND MEASURES: Five self-reported outcomes, including warning recall (ability to correctly recall the warning label shown), product appeal rating, relative harm, adult-oriented appearance, and target age group. RESULTS: Participants comprised 4500 young adults aged 18 to 29 years, including 3000 cannabis users and 1500 nonusers. These participants included 2287 men (50.8%); 1095 participants (24.3%) were aged 18 to 20 years, and 1905 (42.3%) were aged 21 to 25 years. Compared with normal branded packaging, plain packaging was associated with increased odds of correct warning recall (correct rate, 52.9%; odds ratio [OR], 1.47 [95% CI, 1.27-1.70]), decreased appeal ratings (mean appeal rating, 5.2 of 10; OR, 0.70 [95% CI, 0.61-0.80]), and increased perceived relative harm (mean harm rating, 2.6 of 5; OR, 1.48 [95% CI, 1.27-1.74]). Compared with normal branded packaging, youth-appealing packaging was associated with increased appeal ratings (OR, 1.40 [95% CI, 1.20-1.64]), particularly among younger adults aged 18 to 20 years. Compared with no health claims, the pain relief and sleep aid claims were associated with increased appeal ratings (pain relief: OR, 1.31 [95% CI, 1.17-1.46]; sleep aid: OR, 1.36 [95% CI, 1.24-1.50]), particularly among past-year nonusers. CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study of the features of cannabis edible packaging suggested that requiring plain packaging, prohibiting youth-appealing features, and regulating unsubstantiated health claims may improve warning recall and accurate harm perceptions among young adults. Future observational studies evaluating the effects of these regulations are recommended.