Geolocation of Maryland Medical Marijuana Dispensaries by Community Income and Racial Characteristics: An Ecological Design

Exploring the association between neighborhood disadvantage and cannabis retail density: A multi-measure analysis

INTRODUCTION

There is growing interest in the relationship between neighborhood disadvantage and increased cannabis retail density, driven by evidence suggesting higher density is associated with increased cannabis use. Yet little is known on how this relationship varies across different measures of cannabis retail density. This study explores how measures of neighborhood advantage and disadvantage relate to four cannabis retail density measures in the US.

METHODS

Data on licensed recreational cannabis retailers (n = 5586) were obtained from 18 state agency websites, geocoded, and spatially joined to 3369 census tracts to calculate four retail density measures: count per tract, cannabis retailers per 1000 population, per square mile, and per 10 miles of roadway. Multilevel regression models assessed the association between three Index of Concentration at the Extremes (ICE) measures-capturing tract concentration of racial and economic advantage/disadvantage-and the four cannabis retail density measures.

RESULTS

Census tracts with the highest concentrations of economic and racialized/economic disadvantage exhibited greater odds of increased cannabis retail density across all measures, compared to tracts with the highest concentration of advantage. Tracts with the greatest concentration of racialized populations did not show a higher count or density per population but did exhibit higher density per square mile and per roadway.

CONCLUSION

On average, cannabis retail density is higher in neighborhoods with the greatest structural disadvantage. Researchers, public health agencies, and policymakers should use multiple measures of cannabis retailer density in surveillance and evaluation efforts to identify policy strategies that would most effectively reduce the clustering of cannabis retailers in areas primarily occupied by low-income or racialized populations.

Neighborhood demographics in relation to marketing and regulation-related factors among cannabis retailers in 5 US cities

OBJECTIVES

This study assessed differences in cannabis retailer practices by neighborhood sociodemographics, which can inform disparity-relevant interventions.

METHODS

Multilevel multivariable logistic regressions examined retailers' census tract demographics (percent <21 years-old; non-Hispanic White, Black, or other race, Hispanic; median household income [MHHI]) in relation to 2022 audit data regarding marketing (youth-oriented signs, health-claims, exterior ads, price specials, membership programs, delivery/pick-up) and regulatory compliance (pregnancy and health-risk warning signage, exterior minimum-age signage) among 150 randomly-selected retailers in 5 US cities/states (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California).

RESULTS

20.7 % had youth-oriented signage, 28.7 % health-claim signage, 27.3 % exterior ads, 75.3 % price specials, 39.3 % membership programs, 28.0 % delivery/pick-up, 72.0 % pregnancy warnings, 38.0 % health-risk warnings, and 64.0 % minimum-age signage. Retailers in tracts with higher percent <21 and non-Hispanic White had lower odds of youth-oriented signage. Higher MHHI had higher odds of health-claims; higher percent Hispanic had lower odds of health-claims. Higher MHHI had lower odds of exterior ads. Higher percent <21 had lower odds of price specials. Higher percent non-Hispanic White had higher odds of membership programs. Higher percent non-Hispanic White, other race, and Hispanic had higher odds of delivery/pick-up; higher MHHI had lower odds of delivery/pick-up. Higher percent non-Hispanic White had higher odds of pregnancy warnings. Higher percent <21 had lowers odds of health-risk warnings. Demographics were unrelated to minimum-age signage.

CONCLUSIONS

Given key findings (e.g., less regulation-related signage in racial/ethnic minority communities), cannabis retail could exacerbate disparities, underscoring the need for related regulatory and prevention efforts.

State licenses for medical marijuana dispensaries: neighborhood-level determinants of applicant quality in Missouri

BACKGROUND

When state governments impose quotas on commercial marijuana licenses, regulatory commissions use an application process to assess the feasibility of prospective businesses. Decisions on license applications are often met with formal appeals and legal challenges from rejected applicants. Although prior research has examined substate disparities in the availability of marijuana dispensaries, less attention has been given to the quality of license applications. The present study analyzed the relationship between neighborhood-level characteristics and the quality of prospective dispensary businesses.

METHODS

During Missouri's first applicant pool for medical marijuana dispensaries in 2019, a total of 606 census tracts contained the location site of at least one dispensary applicant. Using data from the Missouri Department of Health and Senior Services and the American Community Survey, fractional and binary logistic regression models were used to estimate the relationship between census-tract characteristics and application outcomes.

RESULTS

License applications received higher evaluation scores when proposed dispensary sites were in census tracts with greater population densities and no majority in racial/ethnic composition. Census tracts with poorer socioeconomic conditions attracted a disproportionate share of low-scoring applicants from the bottom quartile of scores. These effects were stronger for certain application subsections, particularly those assessing the quality of an applicant's business plan and on-site security.

CONCLUSIONS

Some communities tend to attract prospective license holders who possess better quality resources, business practices, and industry experience. State disparities in commercial licensing requirements and application processes may lead to the inequities in legal product access found in some prior studies.

Toward reducing racialized pain care disparities: Approaching cannabis research and access through the lens of equity and inclusion

There is growing interest in cannabis use for cancer pain. This commentary aims to discuss the evidence surrounding cannabis use for cancer pain in the context of the long-racialized landscape of cannabis policies and the disparity in pain control among cancer patients holding minoritized racial identities. Much evidence surrounding both the benefits and harms of cannabis use in cancer patients, and all patients in general, is lacking. Although drawing on the research in cancer that is available, it is also important to illustrate the broader context about how cannabis' deep roots in medical, political, and social history impact patient use and health care policies. There are lessons we can learn from the racialized disparities in opioid risk mitigation strategies, so they are not replicated in the settings of cannabis for cancer symptom management. Additionally, the authors intentionally use the term "cannabis" here rather than "marijuana.: In the early 1900s, the lay press and government popularized the use of the word "marijuana" instead of the more common "cannabis" to tie the drug to anti-Mexican prejudice.

Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities

As cannabis retail expands in the US, its surveillance is crucial to inform regulations and protect consumers. This study addresses this need by conducting point-of-sale audits examining regulatory compliance (e.g., age verification, signage), advertising/promotional strategies, products, and pricing among 150 randomly-selected cannabis retailers in 5 US cities (30/city: Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California) in Summer 2022. Descriptive and bivariate analyses characterized the retailers overall and across cities. Age verification rates were high (>90%). The majority of retailers had signage indicating restricted access (e.g., no minors; 87.3%), onsite consumption (73.3%), and distribution to minors (53.3%). Retailers were likely to post warnings regarding use during pregnancy/breastfeeding (72.0%), followed by health risks (38.0%), impacts on children/youth (18.7%), and DUI (14.0%). Overall, 28.7% posted health claims, 20.7% posted youth-oriented signage, and 18.0% had youth-oriented packaging. Price promotions were prevalent, particularly price specials (75.3%), daily/weekly/monthly specials (66.7%), and membership programs (39.3%). One-fourth had signs/promotions indicating curbside delivery/pick-up (28.0%) and/or online ordering (25.3%); 64.7% promoted their website or social media page. The most potent cannabis products were most often e-liquids (38.0%) or oils (24.7%); the least potent were often edibles (53.0%). The most expensive product was often bud/flower (58.0%); the least was joints (54.0%). The vast majority (≥81%) sold vaporizers, wrapping papers, and hookah/waterpipes/bongs, and 22.6% sold CBD products. Marketing strategies differed across cities, reflecting differences in state-specific regulations and/or gaps in compliance/enforcement. Findings underscore the need for ongoing cannabis retail surveillance to inform future regulatory and enforcement efforts.