Athletes' attitudes about cannabis shaped whether their knowledge translated into use

Three attitude clusters emerged: Conservative (32.2%), Unsure (45.9%), and Liberal (21.9%). Attitudes significantly mediated the knowledge-to-use pathway. Liberal-attitude athletes answered knowledge questions correctly most often and were more likely to be current users. Among current users, liberal athletes tended to co-use THC and CBD and had used cannabis longer.

Cross-sectional survey (PEACE Survey) of 1,161 self-defined active adult athletes recruited via social media and email. Knowledge (4 questions), attitudes (11 questions with TwoStep Cluster analysis), and cannabis use assessed. Mediation analysis tested the knowledge-attitudes-behavior model.

Understanding how knowledge and attitudes interact to influence cannabis behavior in athletes can help design more effective education programs, particularly as cannabis becomes available for pain management and recovery.

Simply providing cannabis information may not change behavior. This study suggests that attitudes act as a filter between knowledge and action, implying that education programs need to address attitudes, not just facts.

Self-selected sample of athletes recruited through social media. Self-defined "active athlete" is subjective. Cross-sectional design cannot determine temporal ordering of knowledge, attitudes, and use. Social desirability may bias responses.