Cannabis use is an increasing global health concern [1]. Although cannabis use may effectively address certain medical conditions [2], it may have negative health effects (e.g., immune function [3], respiratory function [4], mental health [5]) and socioeconomic (e.g., academic, employment) outcomes [6–8] and disproportionately impacts certain subpopulations (e.g., men, sexual minorities, racial/ethnic minorities) [9–13].

Despite these concerns, the global cannabis market has dramatically grown [14]. North American accounts for 96.8% ($22 billion) of the global legal cannabis market, with the US accounting for $20 billion (Canada $2 billion). Israel accounts for ~ 22% of the remainder of the market (second only to Germany, ~ 28%) [14]. Moreover, the US and Israel represent countries with the highest proportion of adults who consume cannabis [14]. Per 2020 data, 17.4% of US adults and 27.0% of Israeli adults reported past-year cannabis use [14]. Cannabis legislation in both countries has markedly changed over the past decades. As of November 2022, 38 states in the US have legalized medical cannabis [15]. Additionally, 21 states and the District of Columbia legalized non-medical (‘recreational’) cannabis use for adults (≥ 21 years-old) [15], the first of which date back to 2012 (Colorado, Washington) [15]. In Israel, in 2011, the Israel Medical Cannabis Agency was established to regulate medical cannabis [16], and non-medical cannabis use for adults (≥ 18 years-old) was decriminalized in 2019 [17, 18]. In 2020, 2 bills to allow non-medical cannabis sales passed preliminary readings in Israel’s parliament [19]. In 2021, another bill to legalize non-medical cannabis use was approved by the Ministerial Committee for Legislation, but rejected by parliament [20].

As legislative contexts have shifted in these 2 distinct countries with high cannabis use rates, cannabis-related perceptions and use-related behaviors are likely to change [21–27]. For example, cannabis legalization may be associated with more favorable perceptions (e.g., lower perceived risk, greater social norms) and increased use intentions among young adults [21], higher use prevalence and levels among youth [22, 28], greater use among adults with children living in the home [29], and changes in use motives (e.g., recreational vs. medical), modes of use, and product source among those using cannabis [13, 28, 30–32]. However, the evidence is mixed [33].

Understanding how adults address cannabis use within their homes or around children is critical in mitigating use-related risks among both adults and young people. One important consideration is the restrictiveness of home environments. For example, the literature regarding tobacco suggests that allowing use in the home is associated with greater secondhand smoke exposure and cigarette consumption, while prohibiting use is associated with lower consumption, more attempts to quit use, and higher quit rates [34]. Notably, children who live in homes that allow smoking are more likely to initiate smoking themselves [34]. Additionally, the literature underscores the importance of parenting, including parental substance use and monitoring, in influencing youth substance use [35, 36], including cannabis [37]. This is important given the literature indicating increased cannabis use among adults with children in the home post-legalization [29] and increased use among youth and young adults [21, 22, 28, 38].

Social Cognitive Theory (SCT) [39] highlights the dynamic interplay of one’s social context (e.g., social roles, social norms) and cognitions such as outcome expectancies (e.g., perceived risks or consequences vs. benefits) in relation to one’s behaviors. For example, an individual’s perceptions of how socially acceptable or normative cannabis use is likely depends on the nature and extent of their exposure to use within their social networks, and these perceptions ultimately impact their personal use [9–12, 37, 40–42]. Additionally, the expected outcomes of use – either positive or negative – influence whether one uses cannabis; if one expects positive outcomes, like a pleasurably psychological experience, they are more likely to use, while if one expects negative outcomes, like health risks or addiction, they may be less likely to use [9–12, 37, 40–42]. Moreover, if one perceives negative implications of others (e.g., family members or children in the home) being exposed to cannabis use (e.g., health risks, enticing youth), they may be more likely to implement restrictions about cannabis use in the home or in the presence of children. Indeed, in the tobacco literature, SCT has proven to be a useful framework for understanding the implementation of smoke-free homes to protect children and nonsmokers [43–47].

While SCT provides a useful model for identifying factors associated with substance use related outcomes and cannabis use outcomes [9–12, 37, 40–42], existing literature regarding how adults address cannabis use within their homes or in the presence of children is limited. Furthermore, little cross-country research has examined theory-based constructs related to cannabis-related outcomes in differing sociopolitical contexts.

To advance the literature and inform regulatory and prevention efforts, this mixed-methods study identified: 1) theory-based correlates (risk perceptions, social norms) of past-month cannabis use, next-year use intentions, and intentions to use in the home or near children if non-medical cannabis was legal among US and Israeli adults; and 2) qualitative themes regarding perceptions of cannabis use and policies.