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Consumer Perceptions of Cannabidiol (CBD) Health Claims

The Impact of Cannabidiol (CBD) Health Claims at Point-of-Sale on Consumer Perceptions and Behavior: Online Survey

Status
Completed
Phases
Unknown
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT06069713
Acronym
CBD
Enrollment
3504
Registered
2023-10-06
Start date
2023-10-09
Completion date
2023-11-20
Last updated
2026-03-20

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Perceptions

Keywords

CBD, Cannabidiol, Marketing, Health claims

Brief summary

Over 46 million US adults report use of cannabidiol (CBD), primarily to treat medical ailments. The growing CBD market spans the range of products that the US Food and Drug Administration (FDA) regulates including drugs, dietary supplements, food/beverages and cosmetics. CBD cannot be marketed as having therapeutic benefits (without FDA's approval), be false or misleading to consumers, or convey the products are approved or endorsed by the FDA. In addition, CBD cannot be marketed as a food additive or dietary supplement since it is an active ingredient in an approved drug, Epidiolex. Despite this, CBD products have been illicitly advertised to consumers with these claims including unsubstantiated health claims that promote benefits including curing cancer and preventing Alzheimer's disease. These types of claims may reduce perceptions of harm and increase perceived benefits of use. This study aims to evaluate how consumers perceive real-world CBD advertisements. To that end, we will implement an online survey and randomize adult participants (ages 18-65) to see various advertisements made about CBD to determine if they interpret advertisements as making health claims that are currently prohibited by the FDA.

Detailed description

Cannabidiol (CBD) products have rapidly gained popularity, spanning the retail market with a range of products that the US Food and Drug Administration (FDA) regulates including drugs, dietary supplements, food/beverages and cosmetics. The FDA mandates that CBD cannot be marketed as having therapeutic benefits (without FDA's approval), be false or misleading to consumers, or convey the products are approved or endorsed by the FDA. In addition, CBD cannot be marketed as a food additive or dietary supplement since it is an active ingredient in an approved drug, Epidiolex. Despite this, CBD products have been unlawfully advertised to consumers with these claims including unsubstantiated health claims that promote benefits including curing cancer and preventing Alzheimer's disease and providing chronic pain relief. This project, focused on informing regulatory actions for CBD, aims to evaluate consumer perceptions of real-world health claims documented in brick and mortar CBD retailers in three US states. Setting: The survey will be a single online experiment with one survey. The survey will last approximately 20 minutes. Recruitment: Adult CBD and non-CBD users, ages 18-65, will be recruited through NORC, an online survey panel company. Interested prospective participants will complete a screening questionnaire to determine their eligibility. If eligible, NORC will invite them to enroll in the study. Approximately 3525 participants will complete the study. Informed consent: Participants will provide online consent prior to the main survey, after determining eligibility. Randomization: After providing informed consent, participants will be randomly assigned to one of eleven panels. Participants will have an equal chance of being randomized to any of the eleven panels. Each panel will view 5 advertisements about CBD that was documented in a CBD retailer in the US. Assessment: Participants in the study will complete one survey that will take approximately 20 minutes. During the survey, participants will view 5 advertisements about CBD. Participants will be randomized to 1 of 11 panels, each containing 5 different advertisements. Within each panel, participants will be randomized to the order of the images they see and will be asked a series of questions after each advertisement to determine the appeal CBD and if they perceive the ad to be making health claims that are prohibited by the US FDA. After viewing all 5 ads in their assigned panel, participants will complete measures assessing outcome expectancies of CBD use, perceived benefits of daily CBD use, and willingness to try CBD (non-users only).

Interventions

BEHAVIORALCBD advertisements

Participants will view the 5 images of CBD advertisements in their assigned panel and answer questions about their perceptions of the advertisement.

Sponsors

Wake Forest University Health Sciences
Lead SponsorOTHER
National Institute on Drug Abuse (NIDA)
CollaboratorNIH
University of North Carolina, Chapel Hill
CollaboratorOTHER
Public Health Law Center
CollaboratorUNKNOWN

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE

Intervention model description

Conduct a cross-sectional online survey with a nationally representative probability-based sample of adults, ages 18-65 to assess consumer perceptions of 55 documented advertisements about CBD. Participants will be randomly assigned to 1 of 11 panels that each contain 5 advertisements about CBD.

Eligibility

Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes

Inclusion criteria

* Age 18-65 * US Residents * Satisfies one of the following categories: 1. Current CBD users 2. Ever CBD users 3. Non-CBD users * Members of the AmeriSpeak™ panel

Exclusion criteria

* Non-English speakers * Younger than 18 or older than 65 * Not US residents * Not members of the AmeriSpeak™ panel

Design outcomes

Primary

MeasureTime frameDescription
Perceived Claim ScoresMinute 15The primary outcome is consumer perception of the claims in the ads (n=55) and whether perceptions of prohibited claims vary by CBD use status. After viewing each of the 5 assigned ads participants will respond to six items that assess their perception of the prohibited claims made in the ads, including 1) drug effect 2) FDA approved/ endorsed 3) dietary supplement 4) food additive 5) false/misleading (scientific) and 6) false/misleading (targeting youth). The Study Team will use a 5-point response scale, (1) Not at all to (5) Extremely to assess perception of each prohibited claim type. For each use status group, the Study Team will report the overall mean score (all ads together) for each claim type to indicate if perception of prohibited claims differed by use status.

Secondary

MeasureTime frameDescription
Perceived Product Safety ScoresMinute 15For each ad that the participant views (n=5), the Participant will respond to a one-item measure that assesses the extent to which the participant perceives that CBD is safe to consume. Response options are on a 1 to 5 scale, with higher scores representing more perceived safety (i.e. 1- Not at all safe to 5- Extremely safe). For each use status group, the Study Team will report the mean score of perceived safety to indicate if the perceived safety of CBD in the advertisements differed by use status.
Appeal ScoresMinute 15For each ad that the participant views (n=5), the Participant will respond to a one-item measure to assess the extent to which the ad makes CBD appealing to them. Response options are on a 1 to 5 scale, with higher scores representing more appeal (i.e. 1- Not at all appealing to 5- Extremely appealing). For each use status group, the Study Team will report the mean score of appeal to indicate if the appeal of CBD in the advertisements differed by use status.

Countries

United States

Contacts

PRINCIPAL_INVESTIGATORKimberly Wagoner, Dr.PH, MPH

Wake Forest University Health Sciences

Participant flow

Recruitment details

21 people were consented but dropped out of the study prior to being assigned a panel. 428 people were excluded from analysis due to poor data quality: The excluded ppts did not meet sufficient completion criteria. Participants must have met both of the following criteria to be included in the study: 1) at least 75% of the outcome variables answered (not skipped) and 2) survey completion time of \> 5min

Participants by arm

ArmCount
Panel 1
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
262
Panel 2
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
281
Panel 3
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
276
Panel 4
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
262
Panel 5
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
289
Panel 6
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
280
Panel 7
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
253
Panel 8
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
266
Panel 9
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
302
Panel 10
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
312
Panel 11
This panel consists of 5 photos that were found in CBD retail assessments. Photos were coded as at least one of six FDA prohibited claim types or contained product descriptors that may be potentially misleading to consumers. Photos did not differ substantially between panels and panels were only used to reduce participant burden, as 55 photos were to be included in the survey
293
Total3,076

Baseline characteristics

CharacteristicTotalPanel 1Panel 2Panel 3Panel 4Panel 5Panel 6Panel 7Panel 8Panel 9Panel 10Panel 11
Age, Continuous43.6 years
STANDARD_DEVIATION 13.5
42.4 years
STANDARD_DEVIATION 13.1
43.8 years
STANDARD_DEVIATION 12.8
43.5 years
STANDARD_DEVIATION 13.8
43.9 years
STANDARD_DEVIATION 13.7
43.9 years
STANDARD_DEVIATION 14.3
43.2 years
STANDARD_DEVIATION 13.1
43.7 years
STANDARD_DEVIATION 13.8
43.9 years
STANDARD_DEVIATION 13.3
44.0 years
STANDARD_DEVIATION 13.4
43.8 years
STANDARD_DEVIATION 14
43.1 years
STANDARD_DEVIATION 13.5
Education Level
Bachelor's Degree
763 Participants70 Participants72 Participants57 Participants63 Participants55 Participants66 Participants74 Participants75 Participants65 Participants89 Participants77 Participants
Education Level
HS graduate or equivalent
514 Participants43 Participants56 Participants48 Participants41 Participants53 Participants49 Participants33 Participants34 Participants55 Participants48 Participants54 Participants
Education Level
Less than High School
198 Participants15 Participants13 Participants26 Participants17 Participants23 Participants20 Participants13 Participants15 Participants13 Participants19 Participants24 Participants
Education Level
Post grad study/professional degree
475 Participants36 Participants53 Participants46 Participants37 Participants43 Participants36 Participants44 Participants48 Participants54 Participants37 Participants41 Participants
Education Level
Vocational/tech school/some college/associates
1126 Participants98 Participants87 Participants99 Participants104 Participants115 Participants109 Participants89 Participants94 Participants115 Participants119 Participants97 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
416 Participants44 Participants34 Participants49 Participants29 Participants51 Participants26 Participants36 Participants36 Participants39 Participants38 Participants34 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
2660 Participants218 Participants247 Participants227 Participants233 Participants238 Participants254 Participants217 Participants230 Participants263 Participants274 Participants259 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
17 Participants0 Participants3 Participants2 Participants0 Participants0 Participants3 Participants1 Participants2 Participants2 Participants4 Participants0 Participants
Race (NIH/OMB)
Asian
118 Participants11 Participants15 Participants6 Participants15 Participants8 Participants7 Participants7 Participants10 Participants14 Participants15 Participants10 Participants
Race (NIH/OMB)
Black or African American
414 Participants35 Participants26 Participants34 Participants31 Participants46 Participants37 Participants33 Participants39 Participants40 Participants48 Participants45 Participants
Race (NIH/OMB)
More than one race
150 Participants8 Participants13 Participants15 Participants13 Participants20 Participants10 Participants15 Participants16 Participants12 Participants12 Participants16 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
9 Participants2 Participants1 Participants1 Participants0 Participants0 Participants1 Participants0 Participants0 Participants2 Participants2 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
126 Participants11 Participants10 Participants19 Participants8 Participants13 Participants8 Participants10 Participants9 Participants12 Participants15 Participants11 Participants
Race (NIH/OMB)
White
2242 Participants195 Participants213 Participants199 Participants195 Participants202 Participants214 Participants187 Participants190 Participants220 Participants216 Participants211 Participants
SES
$10,000 to less than $25,000
343 Participants20 Participants42 Participants32 Participants32 Participants27 Participants33 Participants25 Participants33 Participants34 Participants30 Participants35 Participants
SES
$25,000 to less than $50,000
630 Participants44 Participants48 Participants51 Participants60 Participants64 Participants61 Participants52 Participants49 Participants70 Participants67 Participants64 Participants
SES
$50,000 to less than $75,000
573 Participants59 Participants54 Participants60 Participants47 Participants56 Participants59 Participants40 Participants46 Participants50 Participants50 Participants52 Participants
SES
$75,000 to less than $100,000
438 Participants37 Participants43 Participants33 Participants31 Participants52 Participants40 Participants47 Participants39 Participants31 Participants43 Participants42 Participants
SES
Less than $10,000
144 Participants9 Participants9 Participants19 Participants9 Participants17 Participants14 Participants6 Participants16 Participants12 Participants18 Participants15 Participants
SES
More than $100,000
948 Participants93 Participants85 Participants81 Participants83 Participants73 Participants73 Participants83 Participants83 Participants105 Participants104 Participants85 Participants
Sex/Gender, Customized
Current Gender Female
1632 Participants132 Participants156 Participants146 Participants142 Participants159 Participants143 Participants142 Participants140 Participants157 Participants159 Participants156 Participants
Sex/Gender, Customized
Current Gender Male
1353 Participants121 Participants119 Participants121 Participants113 Participants121 Participants131 Participants105 Participants119 Participants133 Participants142 Participants128 Participants
Sex/Gender, Customized
Current Gender Transgender
18 Participants1 Participants2 Participants3 Participants2 Participants0 Participants1 Participants1 Participants2 Participants3 Participants2 Participants1 Participants
Sex/Gender, Customized
Did not answer
54 Participants7 Participants4 Participants6 Participants4 Participants6 Participants4 Participants3 Participants1 Participants6 Participants7 Participants6 Participants
Sex/Gender, Customized
None of the Above Genders
19 Participants1 Participants0 Participants0 Participants1 Participants3 Participants1 Participants2 Participants4 Participants3 Participants2 Participants2 Participants
Sex/Gender, Customized
Sex assigned at birth Did not answer
64 Participants6 Participants5 Participants6 Participants5 Participants7 Participants5 Participants3 Participants2 Participants8 Participants7 Participants10 Participants
Sex/Gender, Customized
Sex assigned at birth Female
1640 Participants134 Participants157 Participants146 Participants143 Participants157 Participants144 Participants142 Participants142 Participants160 Participants160 Participants155 Participants
Sex/Gender, Customized
Sex assigned at birth Male
1372 Participants122 Participants119 Participants124 Participants114 Participants125 Participants131 Participants108 Participants122 Participants134 Participants145 Participants128 Participants
State Cannabis policy
CBD/Low THC states
663 Participants54 Participants61 Participants62 Participants58 Participants65 Participants59 Participants52 Participants53 Participants72 Participants68 Participants59 Participants
State Cannabis policy
Medical and Recreational states
1686 Participants151 Participants149 Participants135 Participants145 Participants163 Participants155 Participants143 Participants143 Participants161 Participants172 Participants169 Participants
State Cannabis policy
Medical only states
639 Participants48 Participants62 Participants71 Participants54 Participants53 Participants57 Participants54 Participants60 Participants62 Participants62 Participants56 Participants
State Cannabis policy
No cannabis access states
88 Participants9 Participants9 Participants8 Participants5 Participants8 Participants9 Participants4 Participants10 Participants7 Participants10 Participants9 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
0 / 1,0080 / 1,0530 / 1,015
other
Total, other adverse events
0 / 1,0080 / 1,0530 / 1,015
serious
Total, serious adverse events
0 / 1,0080 / 1,0530 / 1,015

Outcome results

Primary

Perceived Claim Scores

The primary outcome is consumer perception of the claims in the ads (n=55) and whether perceptions of prohibited claims vary by CBD use status. After viewing each of the 5 assigned ads participants will respond to six items that assess their perception of the prohibited claims made in the ads, including 1) drug effect 2) FDA approved/ endorsed 3) dietary supplement 4) food additive 5) false/misleading (scientific) and 6) false/misleading (targeting youth). The Study Team will use a 5-point response scale, (1) Not at all to (5) Extremely to assess perception of each prohibited claim type. For each use status group, the Study Team will report the overall mean score (all ads together) for each claim type to indicate if perception of prohibited claims differed by use status.

Time frame: Minute 15

Population: participants were pre-specified to be reported per CBD user status

ArmMeasureGroupValue (MEAN)Dispersion
Current CBD UsersPerceived Claim ScoresDrug Effect2.96 score on a scaleStandard Error 0.02
Current CBD UsersPerceived Claim ScoresFDA2.03 score on a scaleStandard Error 0.03
Current CBD UsersPerceived Claim ScoresFalse and Misleading (Youth)2.68 score on a scaleStandard Error 0.02
Current CBD UsersPerceived Claim ScoresDietary Supplement2.44 score on a scaleStandard Error 0.02
Current CBD UsersPerceived Claim ScoresFood Additive2.32 score on a scaleStandard Error 0.03
Current CBD UsersPerceived Claim ScoresFalse and Misleading (Science)2.57 score on a scaleStandard Error 0.03
Ever CBD UsersPerceived Claim ScoresFood Additive2.06 score on a scaleStandard Error 0.02
Ever CBD UsersPerceived Claim ScoresFalse and Misleading (Science)2.27 score on a scaleStandard Error 0.02
Ever CBD UsersPerceived Claim ScoresDietary Supplement2.23 score on a scaleStandard Error 0.02
Ever CBD UsersPerceived Claim ScoresDrug Effect2.81 score on a scaleStandard Error 0.02
Ever CBD UsersPerceived Claim ScoresFalse and Misleading (Youth)2.55 score on a scaleStandard Error 0.02
Ever CBD UsersPerceived Claim ScoresFDA1.76 score on a scaleStandard Error 0.02
Non CBD UsersPerceived Claim ScoresFalse and Misleading (Youth)2.57 score on a scaleStandard Error 0.02
Non CBD UsersPerceived Claim ScoresDrug Effect2.71 score on a scaleStandard Error 0.03
Non CBD UsersPerceived Claim ScoresDietary Supplement2.18 score on a scaleStandard Error 0.02
Non CBD UsersPerceived Claim ScoresFood Additive2.00 score on a scaleStandard Error 0.02
Non CBD UsersPerceived Claim ScoresFalse and Misleading (Science)2.11 score on a scaleStandard Error 0.02
Non CBD UsersPerceived Claim ScoresFDA1.64 score on a scaleStandard Error 0.02
Secondary

Appeal Scores

For each ad that the participant views (n=5), the Participant will respond to a one-item measure to assess the extent to which the ad makes CBD appealing to them. Response options are on a 1 to 5 scale, with higher scores representing more appeal (i.e. 1- Not at all appealing to 5- Extremely appealing). For each use status group, the Study Team will report the mean score of appeal to indicate if the appeal of CBD in the advertisements differed by use status.

Time frame: Minute 15

ArmMeasureValue (MEAN)Dispersion
Current CBD UsersAppeal Scores2.82 score on a scaleStandard Error 0.02
Ever CBD UsersAppeal Scores2.42 score on a scaleStandard Error 0.02
Non CBD UsersAppeal Scores1.81 score on a scaleStandard Error 0.02
Secondary

Perceived Product Safety Scores

For each ad that the participant views (n=5), the Participant will respond to a one-item measure that assesses the extent to which the participant perceives that CBD is safe to consume. Response options are on a 1 to 5 scale, with higher scores representing more perceived safety (i.e. 1- Not at all safe to 5- Extremely safe). For each use status group, the Study Team will report the mean score of perceived safety to indicate if the perceived safety of CBD in the advertisements differed by use status.

Time frame: Minute 15

ArmMeasureValue (MEAN)Dispersion
Current CBD UsersPerceived Product Safety Scores3.34 score on a scaleStandard Error 0.02
Ever CBD UsersPerceived Product Safety Scores3.11 score on a scaleStandard Error 0.02
Non CBD UsersPerceived Product Safety Scores2.92 score on a scaleStandard Error 0.03
Other Pre-specified

Outcome Expectancies Scores

Ten items will measure participants' perceptions about the possible effects of CBD. Response items are on a 1 to 5 scale, with higher scores representing more agreement with the stated effect (i.e. 1- Strongly disagree to 5- Strongly agree).

Time frame: Minute 15

Other Pre-specified

Perceived Benefit Scores

Seventeen items will measure participants' perceived benefits of daily CBD use to treat various medical conditions. Response items are on a 1 to 4 scale (1-Worsen the condition; 2- No effect on the condition; 3-Improve the condition; 4- I don't know)

Time frame: Minute 15

Other Pre-specified

Willingness to Try Cannabidiol (CBD) (Non-CBD Users Only) Scores

One item will be used to measure non-user's willingness to try CBD. Response items are on a 1 to 5 scale, with higher scores representing more likelihood to try CBD (i.e. 1- Extremely Unlikely to 5- Extremely Likely)

Time frame: Minute 15

Source: ClinicalTrials.gov · Data processed: Mar 21, 2026