Perceptions of cannabis warnings and recommendations for improvement: a qualitative study with people who use cannabis from the United States

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BACKGROUND: Most states with legalized cannabis require warnings, but current cannabis warnings are unnoticed, difficult to read, and confusing. There is limited cannabis-specific research on which warning characteristics (e.g., size, content) effectively communicate the risks of cannabis use. This research explores perceptions of cannabis warning labels from a qualitative perspective. METHODS: We conducted six virtual focus groups (n = 36 participants) in March and April 2023 with U.S. adults (21+) who reported using cannabis in the past 30 days and resided in a state with legalized recreational cannabis. After exploring risk perceptions of cannabis products, participants were shown existing warnings on cannabis packages from states that have legalized cannabis and novel warnings on cannabis packages created by the study team and asked about cognitive and affective reactions. The resulting audio recordings were transcribed, and ATLAS.ti was used to perform thematic data analysis. RESULTS: Half of the participants identified as White, 22% as Black or African American, and 28% as another race. Participants' mean age was 30.5 years, and, on average, participants reported using cannabis 3.7 of the past 7 days. Themes that emerged from the data were that participants perceived the purpose of warnings as accurately educating or promoting safe use: "I would say to inform people of the health risk so they can make an educated decision." Participants did not notice existing warnings and wanted warnings to capture attention: "I've never noticed one […]" and "I would want some kind of a warning icon or symbol […]." Finally, participants were aware of both the benefits and risks of using cannabis: "I smoke for my anxiety" and "[…] I'll get some sort of like paranoia." CONCLUSIONS: Our findings highlight areas for cannabis warning improvement, particularly with the warning content, design, and placement. Cannabis warnings that inform, educate, and guide less risky use may be well-received by people who use cannabis. More research is needed on the health effects of cannabis use to aid in the development of evidence-based cannabis warnings, particularly around mental health concerns.

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