Media Framing of Causes, Risks, and Policy Solutions for Cannabis-Impaired Driving: Does Medical vs. Non-Medical Cannabis Context Matter?

ABSTRACT

Driving under the influence of cannabis (DUIC) is a major cause of preventable death and a growing public health concern. News media coverage of DUIC may influence public perceptions of causal factors for DUIC, risks of DUIC, and potential policy solutions. This study examines Israeli news media coverage of DUIC, and contrasts media coverage according to whether news items refer to cannabis use for medical vs. non-medical purposes. We conducted a quantitative content analysis of news articles related to driving accidents and cannabis use (N = 299) from eleven of the highest circulation newspapers in Israel between 2008 and 2020. We apply attribution theory to analyze media coverage of accidents that were linked to medical cannabis, use compared with non-medical use. News items describing DUIC in the context of non-medical (vs. medical) cannabis use were more likely to: (a) emphasize individual causes (vs. social and political); (b) describe drivers in negative terms (vs. neutral or positive); (c) refer to an increased accident risk due to cannabis use (vs. inconclusive or low risk); and (d) call for increased enforcement rather than education. Results show that Israeli news media coverage of cannabis-impaired driving varied significantly depending on whether it referred to cannabis use for medical purposes, or non-medical purposes. News media coverage may influence public perceptions of the risks of DUIC, the factors that are associated with this issue, and potential policy solutions that may reduce the prevalence of DUIC in Israel.

As is true for various jurisdictions across the globe, Israel has recently gone through two major policy shifts in its approach to cannabis that may increase the prevalence of driving under the influence of cannabis (DUIC). First, Israel has been running a medical cannabis program since the 1990s, in which the Israeli Ministry of Health (MoH) is responsible for medical cannabis regulation. At the outset of the program, only a few hundred patients received medical cannabis licenses. However, over the last 15 years, there has been a sharp increase in the number of medical cannabis licenses authorized. At present, there are over 70,000 licensed patients in Israel (Israeli Ministry of Health - I.M.C.U. 2020; Sznitman, 2020). A medical cannabis reform in Israel (Government Resolution No. 1587) transferred the sale and distribution of medical cannabis from growers to pharmacies in 2021, and enabled more physicians to prescribe medical cannabis after completion of medical cannabis courses led by the MoH. The reform also established guidelines for the standardization of medical cannabis products. Another important recent policy change was the approval of the “Non-Assault of Liability” bill by the Knesset, which decriminalized personal use of cannabis for recreational purposes since April, 2019. Individuals caught using cannabis are now fined, rather than arrested and prosecuted. Only on the fourth offense is an individual subject to criminal proceedings.

Cannabis policies are both drivers of, and influenced by, cultural or attitudinal shifts which in turn can affect cannabis behavior including cannabis-impaired driving (Fell & Voas, 2006). A central question regarding the liberalization of cannabis policies being implemented in Israel and elsewhere is whether these policy changes make medical and non-medical cannabis use more socially acceptable, thus leading to increased use (Goodman et al., 2020; Hammond et al., 2020). If a greater percentage of the general population consume cannabis, even a small risk of adverse effects, such as car accidents, may have significant deleterious consequences for the health of the population (Rose et al., 2008). Certainly, research suggests that cannabis-impaired driving is a major health concern related to more liberal cannabis policies (Wilkinson et al., 2016).

A 2017 survey found that 37% of Israelis between the ages of 18 and 65 had consumed cannabis in the last year which is an increase from 9% in 2009. It should be noted that a yearly prevalence rate of 37% is one of the highest rates reported in the world (United Nations Office on Drugs and Crime [UNODC], 2017). At present, the Israeli Ministry of Health estimates undefined estimates that there are 120,000 patients with a license for medical cannabis (an increase from 10,000 in 2012), and approximately 1,500,000 others who consume cannabis for recreational purposes (illegal use). In the last decade, there has been an increase in road fatalities, from a record low of 290 in 2012 to 355 in 2019. This increase has been greater among younger drivers (18- to 20-year-olds), while the number of road deaths has decreased for older age groups (64 and older) (International Transport Forum, 2020).

The increased and widespread use of cannabis in Israel (for all purposes) may be associated with an increase in the prevalence of cannabis-impaired driving elevating the potential risk of accidents. Indeed, one study from Israel found that cannabis use is a strong predictor of reporting having been involved in driving violations among young people (Korn et al., 2017). A national report on the health effects of cannabis (The National Academies of Sciences, Engineering, and Medicine, 2017) concluded that there is substantial evidence of a positive association between cannabis use and increased risk of motor vehicle crashes. Another comprehensive review found that cannabis-impaired driving, as indicated by self-reported cannabis use or the presence of THC metabolite in blood, saliva, or urine, was associated with 20–30% higher odds of a motor vehicle crash (Rogeberg & Elvik, 2016).

Media coverage and risk perceptions related to cannabis and driving

The public’s perceptions of cannabis-related risks, including the risk of driving under the influence of cannabis are influenced, in part by media coverage of this topic (Felson et al., 2019). There is a growing body of research that has examined media coverage of cannabis and cannabis-related policy, including content analyses of media coverage from Australia (Hughes et al., 2011), the U.S. (e.g., McGinty et al., 2016; Robledo & Jankovic, 2017; Stryker, 2003), and Israel (Lewis et al., 2015). Prior research also shows that exposure to news media coverage related to cannabis influences public attitudes toward cannabis and cannabis-related policy (Beaudoin & Hong, 2012; Felson et al., 2019; Park & Holody, 2018; Stringer & Maggard, 2016; Stryker, 2003). However, none of these studies have explicitly focused on media coverage of cannabis-impaired driving, nor on comparing news coverage that refers to cannabis use for medical vs. non-medical purposes. As noted above, this is an important public health issue related to changing cannabis policies (Wilkinson et al., 2016), in particular in countries where cannabis consumption has increased, such as Israel (Chiu et al., 2021), and where policy is vague, and enforcement is inadequate.

We apply attribution theory (Gilbert & Malone, 1995; Heider, 1958) to examine media coverage of this topic in Israel between 2008 and 2020, when we contrast media coverage of DUIC in the context of medical cannabis use vs. non-medical use. Although medical and non-medical cannabis policies are often developed through independent policy processes, research shows that these are highly overlapping areas and that exposure to medical cannabis media content may influence attitudes and behavior toward non-medical cannabis use (Sznitman & Lewis, 2018). It is thus particularly important to understand whether media coverage of DUIC varies depending on whether or not the news story refers to accidents that are associated with medical or non-medical cannabis use.

Media framing of attributions of responsibility, risk, and policy solutions

The way in which the media describes a public health issue can influence public perceptions of responsibility, risk and severity, and support for proposed solutions to reduce risk. Research on media framing shows that media coverage may shape public knowledge and attitudes by presenting the topic in certain ways (Scheufele & Tewksbury, 2007). By emphasizing particular interpretations of an issue, media coverage can shape the way in which the public understand who is responsible for a specific issue or solving it, and may also influence their support for specific policy options (Chong & Druckman, 2007; Dunaway & Graber, 2022; Scheufele & Tewksbury, 2007).

In contrast to prior studies that have analyzed the prevalence of alternative media frames for cannabis (e.g., Golan, 2010; Kaiser, 2011; Lynch, 2021), in this study we focus on three factors within news items that may influence public opinion toward DUIC: (a) attribution of causes for DUIC; (b) description of the risk of DUIC; and (c) proposed policy solutions for DUIC. This contributes to research that aims to understand what particular elements or features within media content may influence public perceptions of risk and support for policy (e.g., Lee et al., 2014; McGlynn & McGlone, 2019; Sun et al., 2016). We do not test the effects of these elements on audiences, but examine the way in which Israeli news media describes these factors, and the degree to which media discourse related to responsibility, risk, and proposed solutions varies depending on whether the accident is related to cannabis use for medical or non-medical purposes.

Theories of attribution (Gilbert & Malone, 1995; Heider, 1958; Weiner, 1993) argue that people make sense of issues (such as DUIC) by assigning responsibility for the condition in question to either internal or external factors. Thus, people develop attitudes based on their perception that an event can be attributed to external (i.e., factors beyond the individuals’ control), or internal factors (such as the individual’s behavior). For many public health issues, such as obesity (e.g., Kim & Willis, 2007; Sun et al., 2016), research suggests that media discourse favors an individualistic frame, which emphasizes personal responsibility for the issue, in contrast to a societal frame, which emphasizes broader social and institutional determinants. Media coverage that adopts an individual-centered approach may influence audience perceptions of what causes the problem (i.e., causal attribution), as well as who or what is responsible for solving the problem (i.e., treatment attribution).

In this study, we test whether media coverage of DUIC is more likely to allocate responsibility for the accident/s to individual factors, compared with social/political factors (such as policymakers or the legal system). Based on studies that have found that the individualistic frame tends to be dominant in media coverage of health-related topics (e.g., Kim & Willis, 2007; Sun et al., 2016), we expect that there will be a higher proportion of news items (overall) that emphasize individual responsibility for DUIC, allocating primary blame to the driver for choosing to drive after consuming cannabis.

Cannabis use is an interesting case study for research as it is a behavior that can be performed for medical or non-medical purposes, but should have equivalent effects on driving risk, seeing that the majority of medical as well as non-medical cannabis use is based on herbal cannabis plant administered by smoking/vapor (Aviram et al., 2022; Fitzcharles et al., 2020; Mills et al., 2022). With regard to attributions of individual choice, cannabis use for medical purposes may be seen as more morally “justified” than use of the same substance for recreational purposes, and less a matter of personal choice. In contrast, recreational cannabis use is likely to be considered a personal choice for which the individual bears responsibility. Therefore, we hypothesize that individual responsibility attribution will be more prevalent in news items discussing recreational cannabis use and DUIC, compared with items referring to medical cannabis use.

Hypothesis 1:

News items about DUIC accidents will be more likely to attribute responsibility for the accident/s to individual factors, compared with social and political factors.

Hypothesis 1a:

There will be a higher prevalence of individual attribution of responsibility for DUIC in news items referring to non-medical cannabis use (vs. medical use).

We then test hypotheses related to attribution theory, using additional steps, to examine whether media coverage of DUIC that is associated with recreational use includes a greater proportion of negative references to the driver, compared with those linked to medical use. Specifically, we focus on the way in which the driver is portrayed (overall valence), and, if the age of the driver is noted, whether s/he is younger/older. We hypothesize that drivers will be portrayed in more negative terms, and will be described as younger (implicating irresponsibility or recklessness) when the item refers to recreational cannabis use, compared with medical use. This expectation draws from research that shows that reporters often use pejorative value judgments about drug use and users (Elliott & Chapman, 2000) and tend to demonize drug use and users (Slater et al., 2006). In contrast, for items related to medical cannabis use, we expect that there will be a more neutral portrayal of the drivers, as the context for use is justified by medical reasons. Thus, we propose the following hypotheses:

Hypothesis 1b:

News items describing DUIC accidents will be more likely to refer to the driver using negative terms (vs. neutral or positive) when the item is related to non-medical cannabis use, compared with items describing accidents related to medical cannabis use.

Hypothesis 1c:

News items describing DUIC accidents will be more likely to refer to the driver as younger (40 or under vs. older than 40) when the item is related to non-medical cannabis use, compared with items describing accidents related to medical cannabis use.

Risk and severity of DUIC

We also examine whether the risk relationship between cannabis use and severity of DUIC consequences presented in news items varies depending on cannabis use context. Prior research on media coverage of drugs, including cannabis, has found that reporters tend to emphasize the threat of drugs and drug users to society when reporting on drug issues (Brownstein, 1991; Taylor, 2008). For cannabis use, the distinction between consumption for medical and non-medical purposes may shape journalistic norms and judgments of the severity of DUIC and its consequences. That is, journalists may be more likely to see cannabis use as risky when the driver used cannabis for recreational purposes, compared with medical purposes. Similarly, for accidents involving drivers who had used cannabis for medical purposes, journalists may be more likely to explicitly note when the accident did not result in casualties. Thus, we propose the following hypotheses:

Hypothesis 2a:

News items referring to cannabis use for non-medical purposes will state that cannabis use is associated with increased risk of accidents (vs. inconclusive or low risk), compared with items referring to cannabis use for medical purposes.

Hypothesis 2b:

News items describing DUIC accidents will be more likely to explicitly state that there were no casualties as a result of the accident when the item refers to cannabis use for medical purposes (vs. non-medical use).

Policy solutions for DUIC

Research on attribution theory, including Weiner’s theory of perceived responsibility and social motivation (Weiner, 1993, 2006), argue that causal attributions of responsibility for social issues influence support for policy solutions to address the problem. This proposition has been supported in research in the context of drug abuse, cancer, poverty, and obesity (Barry et al., 2009; Oliver & Lee, 2005; Niederdeppe et al., 2014; Sun et al., 2016; Weiner, 2006). For example, studies testing responsibility attribution manipulations have found that internal attribution may negatively influence attitudes related to HIV/AIDS patients (Hoeken & Hustinx, 2007; Jansen et al., 2005; Philip et al., 2014). In this study, we examine whether news items call for policy solutions for DUIC, and whether the cited policies are focused on individual factors (such as education and awareness campaigns), or social factors (such as increased enforcement) and whether this differ based on medical and non-medical cannabis use context. Thus, we pose the following research question:

RQ1:

Will there be differences in calls for proposed policy solutions among news items referring to cannabis use for medical purposes vs. non-medical purposes?

Finally, we will test whether the volume of media coverage of DUIC is related to variation in the phenomenon itself, as measured by the proportion of drivers involved in drug-related accidents during the study period. We expect that these two factors may be correlated, although the direction of this relationship may be complex. Increases in cannabis use during the study period may have led to an increase in the number of drivers involved in drug-related accidents and thus also increased media coverage of the topic. However, it is also possible that increases in the proportion of drivers involved in drug-related accidents (including DUIC) would draw greater media attention to this topic. Thus, we pose the following research question:

RQ2:

Is there an association between the (yearly) proportion of accidents linked to drug use and the volume of media coverage of DUIC (2008–2020)?

Method

Sample

We sampled all news items that focused on DUIC that were published in the 11 highest circulation Israeli print and online news sources (Hebrew and English) from January 2008 through August 2020. These sources include general news outlets (Yisrael Hayom, Haaretz, Maariv, Walla, Mako/N12), news sources focused on financial news (Calcalist, Globes), and the most popular English language news sources (The Jerusalem Post, Haaretz – English edition, and the Times of Israel). The study was exempt from IRB review. To generate a sample frame of relevant news stories, we used the following search terms (in English and equivalent terms in Hebrew): “cannabis*” or “grass/pot/weed” and/or “marijuana*” or “hashish” or “joint” or “smoking” or “THC” or “CTP” or “drug*” or “substance use” or “high” or “stoned” or “DUIC” AND “drive*” or “car” or “accident” or “road*” or “crash” or “speed” or “traffic*” or “impaired” or “road*” or “arrested.” From this sampling frame (N = 308), we excluded duplicate items and those that did not relate to the study topic, resulting in a sample of 299 news items.

Content analysis

We developed a coding instrument that assessed media coverage of DUIC, including reference to cannabis use (for medical or non-medical purposes), identification of the driver and victims of accidents, call for policy related to DUIC, and references to the relationships between cannabis use and accident risk. Two trained coders independently coded a randomly selected subset of 80 items (27% of the sample) to assess interrater reliability using Krippendorff’s Alpha. After ensuring acceptable inter-coder reliability (K ≥ .80, Hayes & Krippendorff, 2007) the remaining news articles were coded. We provide examples of the codes from the items in Table 1.

Table 1. Examples of the codes from news items.

Codes	Examples of the codes
Causes of DUIC
Individual (driver)	Jerusalem Post (15.11.2018). “Driver in accident that killed family of 8 charged with manslaughter” “The Southern District prosecutor on Thursday filed an indictment against Loren Ankri, the driver involved in a road accident that killed a family of eight, charging him with manslaughter, illegally overtaking another vehicle and driving under the influence of drugs … The defendant was driving his jeep on Route 90, heading south to the north, while under the influence of cannabis … . he decided to overtake the vehicle in front of him, which he did even though the route was not clear.”
Social/Institutional factors	Ynet (18.10.2010) “Who is under the influence? Also a driver who smoked a joint a month ago” “The new driving regulations allow police to charge drivers for driving under the influence, long after the person smoked. Opponents claim that the new policy targets drivers who consume medical cannabis. The police refute: The policy is intended to reach ‘heavy’ offenders only.”
Driver portrayal
Negative	Jerusalem Post (28.09.2011). “Tal Mor convicted in June hit-and-run death of cyclist” “Mor, 27 was convicted of manslaughter and was also convicted of driving under the influence of drugs and alcohol. Mor had not told the truth about the accident. Eyewitnesses testified that the road had been relatively clear of traffic, visibility had been good and that Cheshin (the victim) had been wearing reflective clothes. Mor did not stop his car or call for help … Mor also later lied about the fact that he had consumed copious quantities of beer. and denied smoking marijuana. Mor had a habit of smoking drugs.”
Neutral	Ynet (10.02.2011). “Connected to his license: Ran Sarig can continue to drive” “The scriptwriter, who was accused of driving under the influence of drugs, despite having been granted a medical license for cannabis use – can return to drive. This was the decision of the regional court in Tel-Aviv. The police said they will appeal to the upper court.”
Positive	Ynet (20.12.2014). “Smoked and drove: Was convicted of using medical cannabis” “The lack of consistency in enforcement continues with regard to people who smoke medical cannabis … The Court did not accept the motorcyclists’ argument that he had used medical cannabis, and that according to the terms of his cannabis license he was allowed to drive after waiting six hours from having smoked. The judge, Dalit Vered, convicted him of driving under the influence of drugs.”
Risk Relation
Increased risk	Ma’Ariv (31.10.2018). “A fireball with a radius of 6–7 meters: Witnesses to the accident describe the horror” The accident took the lives of Shoshi and Yariv Atar and six of their children … cannabis was found in the vehicle of the driver that was consumed for medical reasons, but he did not possess a license for medical use.”
Neutral/conflicting	Walla (15.11.2017). “Cannabis? You should be worried about drivers who take prescription drugs” “Millions take prescription drugs each year… but not a single shekel is invested in warning of the harmful consequences. Instead, the police make a show of arresting a driver with cannabis in his blood, as if the effects of the substances were the same… However, studies show while alcohol has a dramatic effect on a driver’s ability to focus, cannabis use does not cause drivers to move from their lane, and only when consumed at a higher volume.”
Low risk	Ynet (21.11.2018). “Do you smoke drugs sometimes? This is the new law that threatens your drivers’ license” “The law was passed that allows the police to demand a saliva test from a driver if there is suspicion that the person was driving under the influence. What about someone who smoked drugs with a license, and may have traces of the substance in their body, without this having any practical effect on their ability to drive?… If a person smoked a week ago, and even with a medical license, and drives a few days after he is totally fine but the test would show he is under the influence. His situation is problematic.”
Call for policy – DUIC
Prohibition of use	Mako (20.07.2011). “The police: Revoke the drivers’ license of people who use medical cannabis” “Despite the efficacy of cannabis to reduce patients’ pain, the police are concerned about the sharp increase in the number of users and promoting this action to reduce the number of unsubstantiated applications for licenses”
Education/Awareness	Ynet (10.11.2010). “The investigation of Ran Sarig: Populism or a justified battle against drug use” “Patients with a license for medical marijuana are crying out – It is unclear when we are able to drive again after using cannabis … The patients claim that they were not informed that they are not supposed to drive after a specific period of time. In light of conflicting information from the Ministry of Transportation and the Ministry of Health, and the new regulations of the police, they call for urgent clarification.”
Enforcement and infrastructure	Ha’aretz (23.10.2011). “12 years jail time for Tal Mor who killed Shneior Hesin and abandoned him” “During the sentences the judge said that he felt it was necessary to give a severe punishment as a message for anyone else who drives under the influence … Hesin’s widow said that the ruling will help reduce the chance of another accident, and is justified so that young people will know that it is not acceptable to drive under the influence of drugs and alcohol, to kill and to leave the victim at the scene.”
Cannabis legalization	Ha’aretz (03.06.2013). “Instead of Opium for the Masses – Marijuana” “The time has come to remove marijuana from the category of illegal drugs and recognize that it has the ability to make our lives easier, particularly in the tense and fearful place we live … . In Colorado the new laws allow the police to check the level of drugs in a driver’s blood, and that could be done in Israel as well.”

Measures

Cannabis use: each newspaper article was coded in terms of the type of cannabis use that was mentioned in the context of DUIC (α = 0.82). We coded cannabis use in relation to whether the item described cannabis use for medical purposes (n = 70), cannabis use for non-medical purposes (n = 188), or referred to cannabis use for both medical and non-medical purposes (n = 41).

Driver portrayal: we coded items that described a specific accident/s (n = 220) according to whether they described the driver in a negative light (e.g., as a criminal, liar, or drug addict (n = 139), using neutral terms (n = 54)), or in a positive, sympathetic light (n = 27) (α = 0.83).

Age of driver responsible for accident: we coded items that mentioned the age of the driver involved in the accident (n = 108) to distinguish between cases in which the driver was said to be 40 years old or younger (n = 79), or over 40 years old (n = 29) (α = 0.83).

Risk relation: was coded in terms of whether newspaper articles reported the relation between cannabis use and risk of car accidents (n = 239), using the following mutually exclusive categories: (1) cannabis use increases risk of accidents (n = 206); (2) cannabis use does not increase the risk of accidents (n = 10); and (3) the relation between cannabis use and accidents is described as inconclusive or conflicting (n = 23). Items were coded according to a primary focus of the article and three news items that did not fit any of these categories were coded as missing (α = 1.0).

Accident casualties: Every newspaper item that described an accident/s in the context of DUIC (n = 146) was coded in terms of whether it referred to casualties or victims of accidents (n = 110) or explicitly noted that there were no casualties or victims resulting from the accident (n = 36). References to accident victims included cases in which the driver and/or passengers, or other individuals at the scene were injured or killed (n = 108), or the item (n = 2) provided statistics relating to DUIC-related accident victims (α = 1.0).

DUIC policy: we coded items to note whether the item included a call for policy to address DUIC (yes/no). If the item included an explicit call for policy change (n = 67), we noted whether the proposed solution was: (1) to prohibit cannabis use for anyone with a license to drive (n = 10); (2) to support education and awareness campaigns (n = 24); (3) to allocate resources for police enforcement and alternative means of transportation (n = 14); or (4) to legalize cannabis use (n = 19) (α = 0.81).

Drug-involved accidents: To examine trends in media coverage of DUIC and drug-involved accidents over time (RQ2) a variable was created that indicated the number of drivers involved in alcohol and drug-related traffic accidents. We report data from Israel’s Central Bureau of Statistics for the years 2008–2020. We were not able to access data related to cannabis-impaired driving specifically, as this was not gathered.

Data analyses

Data were analyzed using SPSS (27.0), using chi-square tests for bi-variate correlations. We report continuity coefficient statistics (C) for the effect size of the chi-square test, when the values indicate weak (0.10–0.20), moderate (0.20–0.40) and strong (0.4 and above) associations. The unit of analysis for the content analysis is individual newspaper articles. In order to test hypotheses related to media framing of DUIC in articles referring to medical vs. non-medical cannabis use (see hypotheses H1–H3) we relied on univariate descriptions of the distribution of variables. For analyses in which we contrast cannabis use context, we excluded news items that referred to both types of cannabis use (n = 41), because this group was too small for group comparison analysis, leaving an analytic sample of 258. We examined whether changes in the volume of media coverage of DUIC (for medical and non-medical cannabis use) were associated with variation in the prevalence of drug-related accidents (RQ2). This was done by graphing the trend in the proportion of drug-related drivers involved in accidents each year and the volume of media coverage of DUIC (related to medical and non-medical cannabis).

Results

The full sample consisted of 299 articles, of which 70 referred to medical cannabis use and DUIC (including articles that referred to cannabis use for both medical and non-medical purposes), 188 that referred to recreational cannabis use, and 41 to both types of cannabis use.

Causes of DUIC

The majority of news items in our sample (N = 299) allocated responsibility for DUIC to individual causes (60.8%), rather than to social or political causes (39.2%), supporting Hypothesis 1. Furthermore, news items that referred to non-medical cannabis use were more likely to attribute blame for DUIC to individual factors (i.e., the driver), than news items referring to medical cannabis use (see Table 2, N = 258). These differences (71.7% vs. 45.9%) were significant, supporting H3a, χ2 (1, N = 143) = 7.99, C = .23, p = .005, supporting Hypothesis 1a.

Table 2. Sample characteristics (N = 258).

	Medical Cannabis N (%)	Recreational Cannabis N (%)	Total N (%)	p-value
	70 (27.1)	188 (62.9)	258 (100)
Causes of DUIC
Individual (driver)	17 (45.9)	76 (71.7)	93 (60.8)	.005
Social/Institutional factors	20 (54.1)	30 (28.3)	60 (39.2)
Driver portrayal
Negative	20 (37.0)	117 (75.5)	139 (63.2)	<.001
Neutral	19 (35.2)	32 (20.6)	54 (24.5)
Positive	15 (27.8)	6 (3.9)	27 (12.3)
Driver age
> = 40 years old	3 (30.0)	73 (77.7)	79 (73.1)	.001
over 40 years old	7 (70.0)	21 (22.3)	29 (26.9)
Risk Relation (cannabis and accidents)
Increased risk	42 (77.8)	138 (91.4)	206 (86.2)	.012
Neutral/conflicting link	10 (18.5)	8 (5.3)	23 (9.6)
Low risk	2 (3.7)	5 (3.3)	10 (4.2)
Accident casualties
Reference to accident casualties	17 (70.8)	91 (82.0)	110 (75.3)	.216
Explicit statement – no casualties	7 (29.2)	20 (18.0)	36 (24.7)
Call for policy – DUIC
No call for policy solution	51 (73.9)	155 (83.8)	226 (77.1)	.001
Prohibition of use	4 (5.8)	3 (1.6)	10 (3.4)
Education/Awareness	10 (14.5)	6 (3.2)	24 (8.2)
Enforcement and infrastructure	0 (0.0)	13 (7.0)	14 (4.8)
Legalization of cannabis use	4 (5.8)	8 (4.3)	19 (6.5)

p-value based on Chi-square.

Results (see Table 2) also showed that news coverage of accidents involving nonmedical cannabis use was more likely to refer to the driver in negative terms (75.5%), followed by neutral terms (20.6%), or positive terms (3.9%). In contrast, for items about accidents involving medical cannabis use, there was a similar proportion of items in which drivers were portrayed in negative (37.0%), neutral (35.2%), or positive terms (27.8%). These differences were significant, supporting Hypothesis 1b, χ2 (2, N = 209) = 35.28, C = .38, p < .001.

Hypothesis 1c, that drivers would be described as younger when items focused on non-medical (vs. medical) cannabis use, was supported (see Table 2). In news coverage of DUIC accidents related to non-medical cannabis use, a higher proportion of items (77.7%) described the driver as aged 40 or younger, compared with items linked to medical cannabis use (30.0%), χ2 (1, N = 104) = 10.44, C = .30, p = .001.

DUIC risk

News items that refer to non-medical cannabis use were more likely to refer to an increased risk of accidents for cannabis use, compared to items focused on cannabis use for medical purposes (91.4% vs. 77.8%). In contrast, news items that discussed cannabis use for medical purposes were more likely to describe an inconclusive risk association, compared with items focused on non-medical cannabis use and DUIC (18.5% vs. 5.3%, see Table 2). For both cannabis use news item groups, only a few items referred to cannabis use as having low or no risk of accidents (medical use: 3.7%; non-medical: 3.3%), χ2 (2, N = 205) = 8.78, C = .20, p = .012. Thus, Hypothesis 2a is supported.

DUIC severity

There was no significant difference in the proportion of news articles that explicitly state that there were no casualties as a result of the accident/s when the item referred to medical cannabis use (29.2%), compared to non-medical use (18.0%), χ2 (1, N = 135) = 1.53, C = .11, p = .216. Thus, Hypothesis 2b is not supported.

DUIC policy

Results (see Table 2) showed significant differences with regard to explicit calls for policy to address DUIC between items focused on medical vs. non-medical cannabis use (RQ1), χ2 (4, N = 254) = 18.96, C = .26, p < .001. Table 2 shows differences between the cannabis use types were in regard to calls for education and awareness campaigns, and for increased resources toward enforcement. Items describing medical cannabis use were more likely to call for increased investment in education (14.5% vs. 3.2%), while those referring to non-medical cannabis use were more likely to call for increased resources for enforcement (7% vs. 0.0%).

Figure 1 shows that during the period in question (2008–2020), there was an observable drop in the proportion of drivers involved in drug-involved accidents in Israel (from 32% to below 15%), which follows a linear negative trend (B = −.22, SE = .02, p < .001). During the same period, media coverage of cannabis-impaired driving fluctuated, peaking in volume of coverage in 2018 and then dropping afterward. Thus, results show that there were no parallel trends between the proportion of accidents in which drivers were impaired by drug use and the volume of media coverage of DUIC between 2008 and 2020 (addressing RQ2).

Figure 1. Time trends of media coverage of DUIC and proportion of substance-use accidents.

Discussion

This quantitative content analysis of Israeli news media coverage of cannabis impaired driving offers initial evidence to suggest that media reporting of this topic may provide inconsistent information about the nature of the relationship between the use of cannabis for medical and recreational purposes and risk of driving accidents. There were several notable differences in the way that this topic was presented that raise important questions about the role of the media in shaping public perceptions of DUIC, and support for policy.

One of the key findings was that media coverage of DUIC emphasized different causes of, and solutions to this issue depending on the context of cannabis use. In articles describing non-medical cannabis use, DUIC was more frequently attributed to individual factors (i.e., the driver’s choice) than in items that referred to medical cannabis use. Similarly, when news items described a particular accident/s, the driver was portrayed in a negative light more frequently when the news item referred to non-medical cannabis use. In contrast, for news items referring to medical cannabis, there was an even split between news items referring to the driver in positive, neutral, and negative terms. The driver was also described as younger more frequently in news items related to non-medical cannabis use and accidents, compared with items referring to accidents in the context of medical cannabis, and the effect sizes of these relations were generally of moderate size. This finding may be related to differences in the prevalence of medical cannabis use among younger drivers, who are at higher risk of accidents and also more likely to consume cannabis for non-medical purposes (Fairman, 2016; Reinarman et al., 2011). In Israel and elsewhere, research on correlates of cannabis use has found that licensed users of cannabis tend to be older than recreational users (Fairman, 2016; Sznitman, 2020).

This study offers important theoretical implications for health communication research on attribution framing in news coverage. Prior research on media coverage of health-related topics, such as obesity (e.g., Hawkin & Linvill, 2010; Kim & Willis, 2007; Yoo & Kim, 2012), has found that the news media typically prefer to frame topics using an individual frame (i.e., highlighting individual causal and solution responsibility), rather than a societal frame (i.e., societal causal and solution responsibilities). In this study, we go beyond this proposition to test whether media attribution of internal responsibility is more prevalent in items that refer to non-medical (vs. medical) cannabis use. The findings support this hypothesis, and suggest that media attribution of responsibility for a health issue or condition may further depend on contextual factors (i.e., the context in which cannabis was consumed). Thus, when journalists presume that an accident was due to cannabis use to treat a medical condition, they may be more hesitant to blame the driver as the primary cause of the accident, and be more open to considering social and policy factors that may also account for accident risk.

News items about medical cannabis were more likely to describe the risk relation between cannabis use and accidents as inconclusive. In contrast, almost all news items that discussed DUIC in reference to non-medical cannabis use described cannabis as increasing the risk of accidents. For a public audience, this inconsistent pattern of risk communication might suggest that medical cannabis consumption could pose a lower risk of accident (for the driver, passengers, or others), compared with non-medical cannabis use. The consequence of this reporting may be to confuse the public, who may (incorrectly) infer that using medical cannabis could be a less risky behavior related to driving than using cannabis for non-medical purposes. Research from the U.S. shows that cannabis from medical and non-medical markets also have similar THC concentrations in the products sold (Cash et al., 2020). While medical cannabis can sometimes be rich in CBD and low in THC, potentially making it less risky in terms of driving competencies, research shows that Israeli medical cannabis patients use cannabis with relatively high THC concentration (Aviram et al., 2022). Thus, in the Israeli case, cannabis use (for any purpose) may impair one’s ability to drive, and increase the risk of accidents, regardless of the reason for use.

This finding has important practical implications for public understanding of risk. Research suggests that media coverage of the risks and consequences of DUIC may influence public perceptions that this behavior is risky to oneself and/or others (Davis et al., 2016). Cannabis users may underestimate the risk of cannabis use for accidents, even among those who believe that alcohol elevates crash risk (Danton et al., 2003; McCarthy et al., 2007; Terry & Wright, 2005). Some evidence also suggests that cannabis users believe that cannabis intoxication promotes better driving (Terry & Wright, 2005). Thus, inaccurate risk perceptions related to cannabis-impaired driving among the public may be associated with increases in cannabis impaired driving and car crashes.

The results also show differences in calls for policy to reduce the prevalence of cannabis-impaired driving in media items focused on medical vs. non-medical cannabis use. In items referring to DUIC related to medical cannabis use, there was a higher proportion of items that called for investment in educational campaigns to inform the public about DUIC and increase awareness of the topic. In contrast, for media items that discussed DUIC in the context of recreational cannabis use, the most common calls for policy were for additional investment in enforcement, and for the creation of alternative transportation options (infrastructure). These differences in recommended policy solutions may reflect a more sympathetic policy approach for DUIC in cases where the driver was using cannabis for medical purposes, compared with a more punitive approach for DUIC related to recreational cannabis use. However, in light of the small sample size in this study, this finding should be interpreted with caution.

Finally, the results show that the (overall) volume of media coverage of DUIC did not follow the trends in accidents linked to drug use during the same period. This finding suggests that the volume of media coverage of this topic may be influenced by other factors, such as changes in cannabis-related policy. We had hoped to contrast trends in media coverage prior to and following the decriminalization of cannabis (April, 2019), but our study timeline did not provide enough power to contrast these periods. In terms of medical cannabis policy, the Israeli licensing program has increased in volume over the time period, but we could not detect any parallel positive and linear trend in news reporting. Examining associations with policy trends is complicated due to the fact that there have been multiple parliamentary hearings and conferences related to both medical and non-medical cannabis policy over the time period included here. All of these may have influenced journalistic reporting on the issues related to cannabis and driving.

Limitations

Reported results must be seen in light of study limitations. The focus on traditional newspaper media and their online versions was chosen as the mass media still plays an important role in setting the public news agenda, even in our digital environment, in conjunction with social media channels that may further amplify these effects (Gibbs, 2021). Furthermore, it an estimated that 76% of the public in Israel (40% of Jews and 66% of Arabs) consume news content on social media at least once a day (Shwartz Altshuler, 2020). Thus, these news outlets remain an important source of information that may shape public opinion and support for policy related to DUIC. Nevertheless, there is a need to examine news media coverage of this topic in other media outlets. This is especially true since commercial interests affiliated with the cannabis industry may be particularly likely to influence social media content (Whitehill et al., 2020). Furthermore, the sample included Hebrew and English language news articles; thus, it is not clear whether the results are generalizable to Arabic. It is also unclear whether the findings reported here may apply to news media coverage in other countries, which differ with regard to cannabis and DUIC-related policy.

Lastly, the nature of this study does not permit an analysis of how the public’s exposure to news media coverage of DUIC would influence their attitudes and behavior. As noted at the outset, it is likely that news media coverage of DUIC influences and is influenced by policy. Time series analysis may have enabled an analysis of which of the two variables lags behind the other. Yet, this would require a larger sample than what was achievable in the current study (Yaffee & McGee, 2000) rendering time series analysis unfeasible for the current study.

Conclusion

In the context of changing cannabis policies and increasing use of cannabis in Israel and in other jurisdictions, it is important to investigate the nature of media coverage related to cannabis-impaired driving. This article investigates the way in which this topic is presented in Israeli news media coverage, to determine whether certain elements or features are associated with the context of cannabis use (for medical or recreational purposes). Quantitative content analysis of 299 articles has illustrated that there are some clear differences in the way in which this topic is described, which are related to the context of cannabis use. News stories about cannabis impaired driving are framed as less problematic and critical in various ways when cannabis use is presented as medical compared to non-medical.

Previous research has shown that media messages relating to medical cannabis may influence attitudes related to non-medical cannabis use and policy (Beaudoin & Hong, 2012; Felson et al., 2019; Gunning & Illes, 2021; Park & Holody, 2018; Stringer & Maggard, 2016; Stryker, 2003; Sznitman & Lewis, 2018). Thus, while news stories related to non-medical cannabis policies may influence the general public to be more critical and cautious about detrimental effects of cannabis related to driving capabilities, this may be countered by medical cannabis news stories that paint less of critical picture of the potential consequences of driving under the influence of cannabis. Israel represents a special case study in terms of its unique medical cannabis policy history, and relatively high recreational cannabis prevalence rates. Future research should examine media coverage of this topic in other countries to better understand the similarities and differences in the way this topic is covered, and the resulting influence of exposure to news content on public attitudes and behavior.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by a grant by Israel’s Insurance Companies Research Fund.