Public Education Can Be Used to Increase Support for Equity in Cannabis Policy

Abstract

States that are legalizing cannabis for adult use are increasingly focused on equity, with the goal of repairing some of the harm caused by the War on Drugs (Title, 2021). This study (1) explains why states are emphasizing equity in cannabis policy; (2) shows how states are acknowledging the harm of the War on Drugs by calling for social equity programs, community reinvestment, and expungement of cannabis records within cannabis legislation; and (3) examines whether public education can be used to increase public support for equity-focused cannabis policies.

Why States Are Emphasizing Equity in Cannabis Policy

The War on Drugs is an example of systemic racism (Alexander, 2012). Systematically, over decades, Black and Latine people in the United States have been arrested for cannabis possession at higher rates than white people, although white people are more likely than Black people to report using cannabis at least once in their lives (American Civil Liberties Union, 2013; Edwards et al., 2020; Substance Abuse and Mental Health Services Administration, 2014, 2020a). Today, Black people are arrested for cannabis possession at nearly four times the rate of white people (Edwards et al., 2020). Racial inequities in cannabis law enforcement are not limited to arrests. In New York City from 1980 to 2003, Black and Latine people were not only more likely than white people to be arrested for using cannabis in public view, they were also more likely to be detained prior to arraignment, convicted, and sentenced to jail (Golub et al., 2007). These cannabis-related interactions with the criminal legal system contribute to the mass incarceration of Black and Latine people in the United States.

Numerous studies document the harm of incarceration, not only to individuals who are incarcerated, but to their families and communities. People who are incarcerated have increased exposure to violence, including sexual assault (Acker et al., 2019); higher rates of communicable disease, such as COVID-19 (Natoli et al., 2021); higher rates of chronic health conditions (Massoglia & Remster, 2019); and are likelier to have access to only nutritionally inadequate food, and live in dehumanizing conditions (Acker et al., 2019). Children of incarcerated parents experience the loss of a parent’s care; loss of stability; increased likelihood of poverty and homelessness; increased likelihood of entering foster care; and increased risk of physical and mental health conditions such as asthma and depression (Acker et al., 2019). At the community level, incarceration manifests as the erasure of young Black men. A 2016 study found that so many young Black men are incarcerated in the United States that national surveillance systems—which exclude institutionalized populations—underestimate health outcomes for Black men aged 18 to 25 (Kennedy et al., 2016). Because these systems are used to identify needs and allocate funding for programs (Centers for Disease Control and Prevention, 2018), reduced representation may lead to reduced federal funding for public health issues facing Black communities. At the individual, family, and societal level, the effects of incarceration reverberate long after imprisonment has ended, contributing to unstable housing, reduced job opportunities, lower-paying jobs, and worse long-term physical and mental health outcomes (Acker et al., 2019; Massoglia & Remster, 2019). In the words of a Boston leader whose mother was incarcerated during his childhood: “Removing my mother from my home didn’t make me safe. Didn’t make my siblings safe; didn’t make my community safe. It made us less safe. It destabilized us. It created trauma.” (Martinez, 2022).

Legal scholar Michelle Alexander concludes that any involvement with the criminal legal system, including fines, stops, detainments, probations, and arrests, can produce outcomes similar to incarceration (and can lead to incarceration itself) (Alexander, 2012). For example, because of the long history of criminalizing poverty in the United States, the inability to pay small legal fines and fees can lead to arrest and incarceration (Jahangeer, 2019). Encounters with the police—ranging from “stop and frisk” to police brutality—cause psychological and physical harm even when they don’t result in arrest (Alang et al., 2017; Cooper, 2015). Black and Latine men—especially those who identify as members of the LGBTQIA+ community—are at greater risk than white, straight, cisgender men of being stopped and frisked in New York City, regardless of their cannabis use (Khan et al., 2021). Even programs intended to reduce the harm of incarceration can be counterproductive. An evaluation of a cannabis criminal justice diversion program in Harris County, TX, found that Black men are overrepresented in the program, and that Black and Latine men are less likely than white men to finish the program—an outcome that is associated with increased subsequent involvement in the legal system (Sanchez et al., 2020).

The movement to legalize cannabis for adult use is in part a response to the racist policies of and harm caused by the War on Drugs. Although ballot language in the first states to legalize — Colorado, Washington, Alaska, Oregon—did not explicitly reference the War on Drugs, news reports suggest it was a theme of public discussion (Martin & Seattle Times, 2012). Within several years of the first states legalizing cannabis, however, it became clear that legalization had not eliminated racial inequities in cannabis arrest rates. Although the total number of cannabis arrests declined in states that legalized cannabis, racial inequities worsened (Edwards et al., 2020; Firth et al., 2019; Gunadi & Shi, 2022; Sheehan et al., 2021). Of the eight states that legalized cannabis before 2018, racial inequities in arrest rates increased in two states and remained unchanged in one (Edwards et al., 2020). Although racial inequities in arrest rates declined slightly in Massachusetts after its 2016 cannabis legalization—which had an emphasis on equity—they were still higher than the national average in 2018 (Edwards et al., 2020). Despite cannabis being decriminalized statewide in New York in 2019 leading to substantial declines in the total number of cannabis arrests in New York City, a 2020 study concluded that people from Black and Latine communities represented 95% of all cannabis arrests and 96% of all criminal court summons for cannabis in New York City (The Legal Aid Society, 2021).

Using Public Education to Increase Support for Equity in Cannabis Policy

With equity now an explicit cannabis policy goal for some states, cannabis regulators, public health professionals, and people working to advance racial justice may be reflecting on how they can support the development and successful implementation of equity-focused cannabis policies. We consider public education a promising approach for two reasons. First, public education is a powerful tool that has been used successfully in public health for decades, including to increase support for policy (Allen et al., 2015; Centers for Disease Control and Prevention, 2007; Niederdeppe et al., 2008; Tobacco Free NYS, 2018). Second, states that are legalizing cannabis for adult use are already using public education campaigns to inform people about the new law, prevent accidental ingestion and overconsumption of edibles, discourage driving under the influence, and discourage use among people who are pregnant, breastfeeding, or under 21 years of age (Colorado Department of Public Health and Environment (CDPHE), 2019; Doonan SM. et al., 2020). Expanding public education campaigns to include equity messaging could promote public support for specific equity-focused cannabis policies and help states achieve their equity goals. At least one state is already taking this approach. In June 2022, the New York State Office of Cannabis Management released the first broadcast TV ad in the United States to address the issue of equity in cannabis as part of its Cannabis Conversations campaign. The ad highlights “how decades of cannabis overpolicing harmed Black and Latino New Yorkers, and the work [the New York State Office of Cannabis Management is] doing to address these devastating wrongs,” (New York State Office of Cannabis Management, 2022).

This study describes public support for equity-focused cannabis policies among New Jersey adults and assesses whether public education can be used to increase awareness of and support for equity-focused cannabis policies. To our knowledge, this is the first study to explore the use of public education to increase support for equity in cannabis policy.

METHODS

Study Design and Implementation

We conducted an online survey with an embedded experimental design to (1) assess public support for equity-focused cannabis policy among New Jersey adults and (2) determine whether a simple, educational message can increase support for equity-focused cannabis policy. From August 23 through September 15, 2021, we recruited 893 New Jersey adults aged 21 and older through advertisements on Twitter and Facebook (hereafter referred to as “social media”). The people depicted in the social media advertisements were racially diverse. The study protocol, social media advertisements, consenting documents, survey, and educational messages were approved by RTI’s IRB. The 15-minute survey was optimized for use on mobile devices.

People who clicked on the social media advertisements were asked to provide informed consent before taking the study screener. The screener included multiple checks to verify that respondents were residents of New Jersey aged 21 or older. Specifically, we began the screener by asking people “How old are you?” and “What state do you live in?” Later in the screener, we asked people their date of birth and 5-digit zip code. We screened people out of the survey if their age and location data did not align. We asked about race and cannabis use in the screener to intentionally create a nonprobability sample that was racially diverse and had good variation across cannabis use status, with a specific goal to oversample Black and Latine people. We consider it a priority to emphasize the perspectives of Black and Latine people in research about possible reparative actions relating to the War on Drugs, because Black and Latine people have been, and still are, disproportionately harmed by the War on Drugs. Another goal was to ensure that we developed a sample with a range of cannabis use experiences. Because people who use cannabis continue to be stigmatized and criminalized as a result of cannabis policy, we believe it is important to emphasize their perspectives in research that may shape future policy. Although data are weighted to the population of New Jersey, oversampling specific populations leads to greater precision of estimates for these populations. We monitored screener data daily during data collection and closed the survey to specific populations as they became sufficiently represented in the sample for the purposes of our study.

To protect cannabis consumers, who were reporting on cannabis use and purchasing behaviors that were legal in New Jersey at the time of the survey but illegal at the federal level, we advised respondents to take care to protect their survey responses. We also programmed the survey so that one question appeared on each screen, and it was not possible to move backward within the survey. This practice protects respondent privacy by locking each survey response immediately upon entry.

We asked eligible respondents to provide informed consent a second time to take the main survey. After providing consent, respondents were randomly assigned to a control or experimental condition. We asked all respondents whether they had ever heard of the concept of equity in relation to cannabis legalization. After measuring unaided awareness of equity, all participants swiped through three screens that defined equity (Figure 1). Participants in the control condition then went on to the rest of the survey. Participants in the experimental condition had to swipe or click through seven screens with equity-focused messaging (Figure 1) before proceeding to the remainder of the survey. All questions in the main survey were skippable.

Figure 1.

Messages Viewed by Study Participants

We implemented fraud prevention and detection measures developed by our organization’s social media data collection team to ensure that respondents were humans (not bots), were located in New Jersey, were age 21 or older, and each took the survey only once. We screened out respondents who failed either of two mid-survey attention checks. We sent all respondents who completed the survey a $15 digital gift card.

RESULTS

DISCUSSION

This study provides preliminary support that states that are prioritizing equity in cannabis policy may be able to use public education to educate the public about the rationale for an equity focus and increase support for specific equity-focused policies. Two aspects of the data presented here suggest that this topic area is one in which public education could have a substantial impact. First, a very small proportion of New Jersey adults (25%) had heard of the concept of equity in cannabis policy. When a concept is relatively new, it is easier for public messaging to have a large impact on beliefs about and perceptions of that concept (Davis et al., 2016). Second, a substantial proportion of study participants endorsed a “neutral” or “don’t know” response when asked about their support for specific equity-focused policies. We have found that it is easier to shift beliefs and perceptions when they are not strongly held (Davis et al., 2016). These two findings—low unaided awareness of the concept and substantial neutral/don’t know responses—reflect the novelty of the concept of equity in cannabis policy and an opportunity for public education. Cannabis regulators, public health professionals, and people working to advance racial justice may be able to advance state equity goals and remedy some of the harm from the War on Drugs by expanding existing or planned public education campaigns to include equity messages.

One unpublished study provides context for our findings. A 2020 survey of 240 New Jerseyans aged 18 and older found that 60% of respondents agreed that New Jersey should implement a loan or grant fund to support those negatively impacted by the War on Drugs; 78% agreed that New Jersey should prioritize expungement of prior cannabis records (Azad et al., 2020). These estimates are higher than our control condition results, in which 45% supported expungement, 39% supported loans, and 26% supported grants for those harmed by past enforcement of marijuana policy. The difference in results may be explained by different study methodologies.

This study has a number of limitations. First, we used social media recruitment to invite participants to this study. A limitation of this recruitment method is that it produces a nonprobability sample; in this case, a study sample that is not representative of the people of the state of New Jersey. Furthermore, social media recruitment may systematically exclude people living in communities that were formerly redlined due to differential broadband access (Armstrong-Brown et al., 2021). In this way, social media recruitment (and online data collection) can exacerbate systemic racism. However, a benefit of this method is that it makes it easier to include specific populations of interest (Guillory et al., 2016; Guillory et al., 2018). Probability samples often do not produce a sufficient sample of Black and Latine participants, which historically has translated into a lack of evidence about the effects of public health interventions for these populations (Allen et al., 2011). By their nature, state-level probability samples require investigators to spend the majority of their data collection budget collecting data from white people. Thus, we believe it is important to embrace emerging data collection methods like social media recruitment when engaged in research designed to dismantle systemic racism. Second, the study was conducted with New Jersey adults; findings may not be generalizable to other states. Third, we measured message effects immediately following message exposure, and therefore do not know whether effects are enduring. Fourth, we forced message exposure to participants in the experimental condition, achieving a level of exposure that no real-world campaign could replicate (Hornik, 2002). Fifth, because our measure of unaided awareness of the concept of equity did not specify “social equity” it is possible that some participants interpreted our question as relating to stocks or shares in cannabis companies. Sixth, the equity message conveyed to participants in the experimental condition represented multiple ideas, including three equity-focused policy approaches, and required study participants to read quite a bit of text. A public education campaign that focused on a primary message and made use of effective message characteristics may be able to produce stronger effects (Niederdeppe et al., 2008). Seventh, public education campaigns that seek to change knowledge and beliefs in novel topic areas tend to have a greater influence than those that seek to create change in topic areas that are more well-known (Davis et al., 2016). Thus, the effects of equity-focused messaging may be greater in states that implement them first, and effects may diminish as public knowledge about equity in cannabis becomes more widespread.

A great deal more research is needed to understand public perceptions of and support for equity-focused policy, as well as whether equity-focused cannabis policies can mitigate some of the harms caused by the War on Drugs. An important area for future research will be identifying effective message characteristics for this policy area. As equity-focused cannabis policies are implemented, we will be better-positioned to evaluate the effects of those policies on individuals and communities that have been harmed by the War on Drugs.

Funding and Acknowledgements

REFERENCES