Associations of recreational cannabis retailer availability, storefront signage and promotions with cannabis-related healthcare encounters in California

Abstract Background This study examined the associations between the availability of recreational cannabis retailers and marketing features and cannabis-related healthcare encounters in California. Methods We conducted a cross-sectional secondary data analysis at the ZIP code level in California in 2019. Three cannabis-related healthcare outcomes were assessed, including population-adjusted emergency department (ED) visits, population-adjusted inpatient discharges, and a binary indicator of any poison center calls. Primary predictors included objectively measured retailer density and the share of retailers with storefront signage and point-of-sale promotions. Poisson and logistic regression models with spatial lags were used to estimate associations in the full sample and separately for adults (21 +) and youth (< 21). Results In the full sample, each additional retailer per square mile was associated with an 11.63% (95% CI: 5.23%, 18.53%) higher rate of ED visits and an 11.63% (95% CI: 4.50%, 19.72%) higher rate of inpatient discharges. Each percentage-point increase in the share of retailers offering point-of-sale promotions was associated with a 0.14% (95% CI: 0.0063%, 0.27%) higher rate of inpatient discharges. These associations were also observed among adults. No evidence was found for associations between retailer availability or marketing features and cannabis-related poison center calls. Higher rates of ED visits and inpatient discharges were also observed in ZIP codes adjacent to areas with higher retailer density and greater share of storefront signage and point-of-sale promotions. Conclusions Greater retailer density and a higher share of retailers with storefront signage or point-of-sale promotions in local or neighboring ZIP codes were associated with higher rates of cannabis-related ED visits and inpatient discharges in California.