The majority of ballot measures regarding adult use of recreational and medicinal cannabis have been included in the same voting cycle as presidential and midterm elections however, the effect these elections have on public awareness of cannabis as a health topic is not yet known. Within healthcare specifically, cannabis has been discussed as an alternative therapeutic option to reducing the prevalence of opioid prescription use, including the abuse of these drugs (Wen and Hockenberry 2018 The October democratic debate transcript 2019). Healthcare, mental health, and addiction have been highly influential topics among presidential debates, of which, cannabis is only increasing in public awareness. The potential economic and public health ramifications make legalization a polarizing issue. Cannabis continues to spark political debate regarding legalization for medicinal and recreational purposes (National Institute on Drug Abuse 2019). In 2016, 22.2 million Americans over the age of 12 reported having used cannabis in the last 30 days (National Academies of Sciences, Engineering 2017). We recommend establishing a cannabis repository of evidence-based information, providing physician education, and a dosing guide be created to enable physicians to provide high quality care around the issue of cannabis. Consequently, the results of this study may be important to physicians since they will likely receive an increased volume of questions relating to cannabis and its therapeutic uses during election season from interested patients. These results may indicate the growing awareness of cannabis in the US and mark a possible target for the timely dissemination of evidence-based information regarding cannabis and its usage/side-effects during future elections. Of the five selected control policies, only two showed an increase in internet search interest during both Presidential Elections and neither exceeded the internet search increase of cannabis. Conclusionīased on these results, we expect public interest in cannabis will spike prior to the Presidential election in 2020. Climate Change increased by 3.5% in 2012 and 20.1% in 2016 while Global Warming increased by 1.1% in 2012 and 4.6% in 2016. Of the five additional policies that were searched as topics, only two showed an increase in internet search interest during each Presidential Election. States with higher access to legal cannabis were associated with higher relative internet search volumes for cannabis (Coeff (95% CI), 0.31 (0.15–0.46)). Relative internet search rates for cannabis from 2008 to 2019 were also associated with increased cannabis usage in the past month (Coeff (95% CI), 3.1 (2.5–3.7)). In 2016, significant state-level findings included an increase in relative internet search rates for cannabis in states with higher usage rates of cannabis in the past month (Coeff (95% CI), 3.4 (2.8–4.0)) and past month illicit drug use except cannabis rates (Coeff (95% CI), 17.4 (9.8–25.0)). For the US, observed internet search interest during each Presidential Election was 26.9% greater than expected in 2012 and 29.8% greater than expected in 2016. Public internet search interest for “cannabis” increased during the voting month above the previous mean internet search interest for all 18 bills. Individual variables were compared using a linear regression analysis for the beta coefficients performed in Stata Version 15.1 (StataCorp). We used the autoregressive integrated moving average (ARIMA) algorithm to forecast expected relative internet search interests for the 20 Presidential Elections. These policies included Education, Gun Control, Climate Change, Global Warming, and Abortion. To evaluate whether any associations with changes in the volume of cannabis internet searches were specific to the cannabis topic, or also occurred with other topics of general interest during an election year, the authors ran additional analyses of previously popular debated policies during Presidential Elections that may act as control topics. We then compared the internet search interest for cannabis before and after each election. These state elections were referenda, not legislative votes. Google Trends data were extracted during the time period of to for the United States (US) and select states (18) within the US including: Alaska, Arizona, Arkansas, California, Colorado, Florida, Maine, Massachusetts, Michigan, Missouri, Nevada, North Dakota, Ohio, Oregon, Oklahoma, South Dakota, Utah, and Washington when cannabis was on the ballot. We searched Google Trends for “cannabis” as a health topic. Given that 72% of internet users seek out health information using an internet search engine (Google being the most popular) we sought to investigate the public internet search interest in cannabis as a health topic when cannabis legislation appeared on state ballots and during presidential elections.
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