Assessing barriers to community engagement on cannabis policy: baseline survey of behavioral and public health professionals in California
Prevention Policy Group, Public Health Institute, Berkeley, CA, United States
Division of Prevention Science, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
Corresponding author. Ryan Whitacre, PhD, Prevention Policy Group, Public Health Institute, Berkeley, CA, United States. E-mail: rwhitacre@phi.orgAbstract
Background
Cannabis policy is a complex and rapidly evolving topic with significant implications for behavioral and public health. Behavioral and public health professionals have an opportunity to identify emerging problems, engage with communities to identify solutions and work to educate and guide policymakers to support cannabis policies that benefit public health. However, little is known about their engagement in cannabis policy.
Methods
A 2023 survey assessed barriers to community engagement on cannabis policy among a broad sample of behavioral and public health professionals throughout California. Professionals in behavioral health, substance use, public health, tobacco control, and youth prevention were invited.
Results
Responses were received from 246 people (44% response rate) working in three main sectors (50% nonprofit, 34% government, and 13% health care) and each of California’s 58 counties. Seventy percent of respondents reported they were interested in being involved in cannabis regulation. However, only 34% had ever worked in cannabis policy. They encountered structural barriers: restrictions on lobbying (38%), funding availability (38%), and staff time (34%). They also reported motivational barriers: few had confidence working on specific cannabis policy issues, including taxation policies (20%) and restricting intoxicating hemp products (29%); few were comfortable with certain community engagement activities, such as writing laws or policies (20%) or preparing written comments on proposed laws (31%). They reported their engagement would benefit most from additional financial resources (70%), training (59%), political support (48%), model laws (42%), and technical assistance (40%).
Conclusion
Behavioral and public health professionals have limited experience with engagement in cannabis policy issues. They face structural and motivational barriers. They need dedicated resources and support for their work. These findings may be relevant to advancing community engagement in cannabis in other states and countries.
Teaser
Behavioral and public health professionals in California have limited experience with community engagement on cannabis policy issues due to structural and motivational barriers. They need dedicated resources to support community engagement on cannabis policy effectively.
Implications
- Practice: Behavioral and public health professionals in California, including SAMHSA grantees and California Tobacco Control Programs, are highly interested in cannabis policy issues; however, restrictions on lobbying, funding, and staff time pose barriers to cannabis policy work.
- Policy: Behavioral and public health professionals need financial and technical resources to address the commercial determinants of health stemming from the rapidly evolving cannabis industry.
- Research: This survey, which involved behavioral and public health professionals in California, was the first study in the United States to assess community engagement in cannabis policy.
Introduction
Cannabis policy is a complex and rapidly evolving topic with significant implications for behavioral and public health. Studies show that cannabis use has benefits in the management of chemotherapy-induced nausea [1, 2], multiple sclerosis-associated spasticity [3], and certain forms of chronic pain [4]. However, studies also find that cannabis use and exposure are associated with harm to neonatal [5, 6], maternal [7], perinatal, adolescent [8], and mental health outcomes, some of which are exacerbated by increasing potency and frequency of use [9, 10]. Public policy must balance potential benefits with measures to mitigate harms.
Behavioral and public health professionals are well-positioned to support this balance through community engagement [11]. Leeman et al. proposed a conceptual framework for community engagement in tobacco control policy that includes five dynamic processes: document local problems, formulate evidence-based solutions, engage partners, raise awareness, and persuade decision-makers [12]. California’s experience with the tobacco prevention program (CTPP) demonstrates what sustained investment in community-based policy engagement can achieve, including substantial reductions in healthcare costs [13]. Similar approaches could help address cannabis-related harms.
California provides a unique context for studying this issue: it is home to the largest cannabis market in the world [14], and its “local control” regulatory structure allows jurisdictions to determine business licensing, taxation, and marketing [15–17]. These conditions create significant opportunities for local community engagement in policy development. However, professionals working in this space face unique challenges, including lobbying restrictions, funding limitations, and evolving regulatory environments.
Prior work on alcohol and tobacco control has identified both structural (e.g. time, funding, and organizational constraints) and motivational (e.g. knowledge and confidence) barriers to policy engagement [18] but little is known about how these barriers manifest in cannabis policy. This gap is particularly relevant for behavioral and public health professionals, who may have transferable skills yet face distinct constraints in this policy arena.
The study aimed to assess structural barriers (e.g. staff time, funding, lobbying, and technical resources) and motivational barriers (e.g. knowledge, comfort, and confidence) in community engagement related to cannabis policy issues. We hypothesize that differences may exist between professionals with different work experiences and types of funding, acknowledging, for example, that publicly funded tobacco control programs may have different perspectives and capacities than youth prevention programs supported by philanthropies and focused on using other substances. We also posit that these professional groups may be essential to community engagement in cannabis policy. Understanding how best to support their needs is vital for strengthening community engagement activities.
Methods
Study design
This study employed a cross-sectional design to assess experiences in cannabis policy among a varied group of behavioral and public health professionals in California.
Population and sampling frame
The sampling frame included 560 professionals associated with behavioral, public health, and substance use organizations. Invitations were issued to the universe of contacts in the State of California for all CA tobacco prevention program grantees (n = 164), county behavioral health directors (58), county health officers (59), drug-free communities grantees (44), local prevention coordinators (95), and Substance Abuse and Mental Health Services Administration (SAMHSA) funding recipients (126), and selected other relevant nongovernmental and voluntary organizations (14).
These groups were selected based on their unique health sector experiences relevant to cannabis policy work. All members of each group were invited without exclusion; thus, no other sampling criteria were employed.
Survey instrument development
We developed a novel survey tool to assess barriers to community engagement in cannabis policy among behavioral and public health professionals. Given the absence of prior validated or standardized instruments to measure barriers to this work, we first formulated relevant constructs to assess by reviewing related research on community engagement in tobacco control and substance use (discussed above). We identified a range of potential barriers, which we conceptualized as “structural barriers,” such as opposition from politicians and prohibitions on advocacy or lobbying [18], and “motivational barriers,” including comfort, confidence, and feelings of limited efficacy, which may dissuade one from engaging [19–21]. We further synthesized and extrapolated possible barriers to community engagement activities related to cannabis policy based on our previous research and experience developing model cannabis laws and assessing existing local laws [17]. We assembled synthesized findings into a logic model to conceive plausible pathways linking structural and motivational barriers to the community engagement activities represented in Leeman’s conceptual framework [12] and the broad impacts of improved community engagement on cannabis policy (Fig. 1). This logic model underlay the survey instrument development. A small group of professionals, resembling potential survey participants with expertise in cannabis, tobacco control, and alcohol policy, help developed and pilot the instrument.
Measures
The survey sought to elucidate the perspectives of behavioral and public health professionals on community engagement in cannabis policy issues, with a focus on the structural and motivational barriers they face and needed resources for ongoing engagement on cannabis policy issues. Participants were asked to report on their professional experiences and the experiences of their organizations. Full survey measures are reported in Supplementary Table S1.
Data collection procedures
Ethical approval was obtained from the Institutional Review Board of the Public Health Institute (no. I22-008). The survey was administered online between 12 February 2023 and 31 March 2023. Email reminders to participate were sent weekly throughout the 6 weeks. Participants were asked to forward the invitation to colleagues directly involved in community engagement for cannabis policy. Each participant was offered a $10 Amazon.com e-gift card as an incentive for completion.
Statistical analysis
Independent t-tests or one-way analysis of variance (ANOVA) were used to compare subgroups across funding sources (only public vs. any private funding received, whether alone or in addition to public funding), professional sector (e.g. nonprofit, government), and current organizational engagement in focus areas (e.g. alcohol, tobacco, public health) and county-level cannabis retail legalization on outcomes of interest. Pairwise comparisons with Tukey’s HSD were conducted to identify differences in means between the subgroups with more than two groups (e.g. professional sector and work area focus). Fisher’s exact test was used when cell sizes were <5. Spearman’s correlations were run to assess the relationship between current organizations’ engagement in each focus area. In many cases, only a few subgroup differences were found, and in these cases, the results are noted in text only.
Results
Respondent characteristics
We received 246 responses (44% response rate) from participants across all 58 California counties, representing non-profit (50%), government (34%), and health care (13%) sectors (Table 1). Over half (57%) worked in jurisdictions with legalized cannabis retail sales. Funding sources included state programs (37% from the California Tobacco Control Program; 25% from California mental/behavioral health funding), local government (33%), and federal programs (25%). Most respondents’ organizations were active in tobacco (70%), cannabis (68%), alcohol (62%), other substance use (71%), and public/behavioral health (67%) policy or prevention.
| n (%) | |
|---|---|
| Organizational focus areas | |
| Other substances | 174 (71) |
| Tobacco | 172 (70) |
| Cannabis | 166 (68) |
| Public health | 163 (67) |
| Alcohol | 152 (62) |
| Professional sector | |
| Nonprofit | 123 (50) |
| Government | 84 (34) |
| Health care | 32 (13) |
| Education | 22 (9) |
| Other | 20 (8) |
| Research/think tank/policy institute | 6 (2) |
| Main funders | |
| State government | 177 (72) |
| Federal government | 84 (34) |
| Local government | 84 (34) |
| Private foundations, donors, or health insurance | 42 (17) |
| Health insurance | 15 (6) |
| Other (e.g. unknown) | 4 (2) |
| Only publica | 186 (77) |
| Any privatea | 55 (23) |
| Ever worked in cannabis policy | 84 (34) |
| Retail legalization status | M (SD) |
| % of jurisdictions with legal retail | 57% (26%) |
Interest in cannabis regulation was high (70%), though only 34% had prior policy experience. Common activities included public education (66%), raising awareness (58%), and engaging partners (51%), with fewer reporting direct policy engagement, such as advocating for a local policy (29%), submitting written comments (28%), or speaking at policy bodies (25%).
Structural barriers
Major barriers included lobbying restrictions, funding limitations, and staff time constraints (each ≈ one-third of respondents) (Fig. 2; Table 2), with political opposition reported by 29%. Organizational support, technical resources, and community priorities were less frequently major barriers.
| Structural barriers to engagementa | Never worked in cannabis policy | Ever worked in cannabis policy | ANOVA P-value | Spearman’s correlation coefficient |
|---|---|---|---|---|
| Staff time | 1.35 | 1.09 | .09 | −0.16 |
| Organizational restrictions on lobbying | 1.30 | 1.10 | .32 | −0.10 |
| Organizational restrictions on advocacy | 1.07 | 0.74 | .04 | −0.19* |
| Organizational support | 0.91 | 0.46 | <.01 | −0.29** |
| Funding availability | 1.30 | 1.23 | .62 | −0.05 |
| Funder interest | 1.00 | 0.88 | .48 | −0.07 |
| Funder lobbying restrictions | 1.08 | 1.18 | .62 | 0.05 |
| Technical resources | 1.00 | 0.76 | .11 | −0.16 |
| Politician opposition | 1.02 | 1.00 | .89 | −0.01 |
| Community priority | 0.98 | 0.75 | .15 | −0.14 |
Those with only public funding reported more barriers than those with any private funding, particularly advocacy and lobbying restrictions, organizational support, and technical resources (Table 3). Structural barriers were generally consistent across focus areas (Table 4), though those working on cannabis topics more often cited staff time as a barrier. Organizational support was more often a barrier for government employees than for nonprofit or other sectors.
| Structural barriers to engagement | Funding source | |
|---|---|---|
| Only public n (%) | Any private n (%) | |
| Staff time | 69 (61.1) | 18 (56.3) |
| Organizational restrictions on lobbying | 61 (54.0) | 10 (31.3) |
| Organizational restrictions on advocacy | 57 (50.0) | 7 (21.9) |
| Organizational support | 47 (42.0) | 6 (18.8) |
| Funding availability | 70 (62.5) | 17 (53.1) |
| Funder interest | 50 (43.9) | 10 (31.3) |
| Funder lobbying restrictions | 49 (43.0) | 12 (37.5) |
| Technical resources | 57 (50.4) | 11 (34.4) |
| Politician opposition | 52 (46.0) | 10 (31.3) |
| Community priority | 50 (44.3) | 16 (51.6) |
| Structural barriers to engagement | Organizational focus area(s) | ||||
|---|---|---|---|---|---|
| Alcohol n (%) | Cannabis n (%) | Tobacco n (%) | Other substances n (%) | Public health n (%) | |
| Staff time | 55 (59.1) | 64 (61.5) | 64 (62.1) | 61 (58.7) | 58 (59.8) |
| Organizational restrictions on lobbying | 51 (54.8) | 55 (52.9) | 53 (51.5) | 56 (53.9) | 53 (54.6) |
| Organizational restrictions on advocacy | 46 (48.9) | 49 (46.7) | 45 (43.3) | 50 (47.6) | 46 (46.9) |
| Organizational support | 33 (35.9) | 37 (35.9) | 36 (35.3) | 35 (34.0) | 36 (37.5) |
| Funding availability | 58 (63.0) | 71 (68.3) | 62 (60.2) | 62 (59.6) | 59 (60.8) |
| Funder interest | 39 (41.5) | 45 (42.9) | 45 (43.3) | 44 (41.9) | 43 (43.9) |
| Funder lobbying restrictions | 42 (44.7) | 47 (44.8) | 41 (39.4) | 45 (42.9) | 42 (42.9) |
| Technical resources | 46 (49.5) | 51 (49.0) | 50 (48.5) | 50 (48.1) | 50 (51.6) |
| Politician opposition | 39 (41.9) | 46 (44.2) | 43 (41.8) | 44 (42.3) | 44 (45.4) |
| Community priority | 43 (46.2) | 50 (48.5) | 48 (46.6) | 46 (44.2) | 49 (50.5) |
Motivational barriers
Confidence was highest for restricting products appealing to youth, flavored inhalable products, protecting smoke-free air, and providing health information (Fig. 3). Fewer felt confident in restricting intoxicating hemp products, setting taxes, or implementing equity in licensing. Comfort was highest for education, public speaking, and advocacy, but lowest for drafting laws and lobbying (Fig. 4).
Most respondents did not see knowledge gaps as a barrier. Familiarity with technical resources varied: 47% knew of the PHI California Local Cannabis Policy Scorecards, 39% of PHI retail model ordinances, and 24% of cannabis taxation model ordinances. These were used for jurisdictional comparisons, categorizing policy issues, and policymaker engagement (Fig. 5).
Needs for engagement
Top needs were additional funding (70%), training (59%), and political support (48%). Model laws, technical assistance, and technical resources were also frequently cited. Funders showed greatest interest in youth education (65%) and legalization decisions (49%), with lower interest in taxation (33%), substance co-use (32%), and smoke-free air (21%).
Discussion
This study provides the first systematic assessment of barriers to cannabis policy engagement among behavioral and public health professionals in California. While these findings are rooted in the California context, they have broader relevance given that all states with legalized recreational cannabis use local control models that similarly create opportunities for policy engagement.
Our results show that while most behavioral and public health professionals are interested in cannabis policy engagement, fewer have participated in policy-specific actions such as drafting laws, submitting written comments, or lobbying decision-makers. The most frequently cited structural barriers—lobbying restrictions, limited funding, and lack of staff time—mirror challenges seen in other public health domains but are amplified in the cannabis context by rapidly changing regulations and well-resourced industry opposition. Motivational barriers, including lower confidence in working on taxation, equity in licensing, or restricting intoxicating hemp products, point to areas where targeted capacity building could have a substantial impact.
Implications for practice
Findings suggest several concrete strategies to strengthen engagement capacity: Training and technical assistance focused on legal parameters of advocacy, drafting ordinances, and framing cannabis policy within broader public health narratives. Funding mechanisms that earmark cannabis tax revenues for local public health policy engagement, modeled after tobacco settlement-funded initiatives. Partnership development with nontraditional allies (e.g. school boards, zoning commissions, and housing advocates) to broaden the base of policy support. Policy reforms by funders to reduce overly restrictive lobbying prohibitions that limit effective engagement while maintaining compliance with applicable laws.
Generalizability and future research
Local and regional differences in regulatory frameworks, political climates, and funding availability will shape the extent to which these findings apply in other states. Jurisdictions without dedicated cannabis tax-funded prevention programs, for example, may face even more pronounced funding barriers. Comparative studies across states could clarify which strategies are most adaptable and effective.
Behavioral and public health professionals will be critical to a multistakeholder approach to managing the complexities of cannabis policy. They have the professional experience and confidence to engage on various cannabis policy issues, especially those related to understanding and preventing the impacts of commercial cannabis on smoke-free air and youth mental health. They generally do not have conflicts of interest, unlike other actors involved in cannabis regulation in California [22].
How behavioral and public health professionals manage relationships with communities will be a crucial area of work for successful community engagement on cannabis policy issues. However, this survey did not assess specific approaches to community engagement, strategies for equitable involvement, or ways of representing the community’s voices. Experimenting with different approaches to community engagement should be a priority topic for future research.
Strengths and limitations
This research included a large sample of professionals in California’s behavioral and public health organizations and was drawn from the universe of individuals associated with these organizations. It was explicitly focused on understanding the engagement of sectors that could uplift public health concerns in the policymaking process.
The response rate was moderate at 44%, consistent with the average response rate for online surveys in published research, as reported in a meta-analysis by Wu et al. [23]. Limitations include administering the web-based survey instruments for 6 weeks and offering it exclusively in English. Professionals from other sectors relevant to cannabis policy, such as criminal justice, land use, law enforcement, social justice, education, or agriculture, were not surveyed. While the sample of professionals was highly engaged in cannabis policy and related work, some potential participants reported a lack of organizational capacity to complete the survey in addition to their normal scope of activities.
Two-thirds (66%) of the respondents completed all survey measures. Participants who took the survey may have a greater interest in cannabis policy or more dedicated support and/or time to prioritize survey completion than those who declined participation. For these reasons, results may overrepresent behavioral and public health professionals with greater engagement in cannabis. However, by including the entire population within the sampling frame, the study reduces concerns related to sampling bias and noncoverage, allowing for more generalizable insights within this defined group.
Conclusion
Behavioral and public health professionals have the interest and foundational skills to contribute meaningfully to cannabis policy development, but face both systemic and self-efficacy-related barriers. Addressing these challenges will require coordinated investment in training, funding, political support, and policy reforms that enable rather than constrain local engagement. Such actions could strengthen the public health voice in shaping cannabis regulation in California and beyond.
Supplementary Material
Supplementary Data
Supplementary material is available at Translational Behavioral Medicine online.
Funding Source
This project was supported by funds provided by The Regents of the University of California, Tobacco-Related Diseases Research Program, Agreement No. T32IR5110. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The opinions, findings, and conclusions herein are those of the author and not necessarily represent those The Regents of the University of California, or any of its programs.
Conflicts of Interest
The authors declare they have no conflicts of interest.
Human Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Welfare of Animals
This article does not contain any studies with animals performed by any of the authors.
Transparency Statements
Study Registration
This study was not formally registered.
Analytic Plan Pre-Registration
The analysis plan was not formally pre-registered.
Analytic Code Availability
The analytical code used to conduct the analyses presented in this study is not available in a public archive. However, it may be available by emailing the corresponding author.
Materials Availability
Materials used to conduct the study are not publicly available. AI was not used in the development of this manuscript.
Data Availability
De-identified data from this study are not available in a public archive. De-identified data from this study will be made available (as allowable according to institutional IRB standards) by emailing the corresponding author.