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Cannabis legalisation may reduce perceptions of cigarette smoking harm

While ordinary smoking has been declining for decades in the US, adults who use cannabis daily do not perceive smoking a pack a day as being as harmful as those who do not use cannabis, found a Columbia University study in Nicotine & Tobacco Research.

Findings from a recent Columbia University Mailman School of Public Health study showed increased cigarette use is one possibility.

“In the context of recent findings that perception of risk plays a key role in predicting substance use, and that perception of risk associated with cannabis use has declined steadily along with legalisation, these findings were a surprise,” said Renee Goodwin, PhD, a professor in the Department of Epidemiology at Columbia Mailman School of Public and professor of Epidemiology at The City University of New York, and lead author.

The researchers used data from adults age 18 and older in the 2020 National Survey on Drug Use and Health, a representative survey of Americans. Participants’ responses to a question about how much people risk harming themselves physically and in other ways by smoking one or more packets of cigarettes per day were compared between those who use cannabis daily and those who did not use cannabis in the past year; 62% of adults who use cannabis daily perceived pack-a-day cigarette use to be of “great” risk to health, compared with 73% of those who had not used cannabis in the past year.

“Tobacco control has done a tremendous job in public education on the physical health risks associated with tobacco use, and cigarette smoking in particular, over the past several decades,” noted Goodwin. Her prior work shows that cigarette use, however, is much more common among those who use cannabis and that cannabis legalisation may contribute to observed increases in cannabis use and cannabis-cigarette co-use among adults.

“We wondered why that might be. Our findings suggest that diminished risk perception of pack-a-day cigarette use might be one contributing factor.”

At a recent Suffolk County Legislature Public Hearing on Introductory Resolution 1417: A Local law to Regulate the Packaging of Cannabis (Marijuana) Products to Dissuade its Appeal to Children, Goodwin discussed her work and, in particular, that of Canadian colleagues. The resolution, proposed by legislator Kara Hahn, aims to ban cannabis packaging that appeals to children in Suffolk County, New York.

Findings from Canada, which made cannabis legal federally, show increases in adult cannabis use but as of the most recent study in 2022, no significant increases in cannabis use among adolescents. “Data from Canada suggest that plain packaging is one measure that can maximise the safe and effective rollout of cannabis legalisation that ensures and protects the health, safety and well-being of our community,” Goodwin said.

“Enacting legislation at local and state level reducing the appeal of cannabis products to youth vis-a-vis prohibiting product packaging that mimics foods and candies that are traditionally marketed to children (e.g., pop-tarts, Oreos) may reduce potential unintended harms to the most vulnerable members of our community via accidental ingestion/poisonings, which have exploded in number in recent years in the US, with child and adolescent intentional use of these products,” she added.

Study details

Everything old is new again: Creating and maintaining a population-level ‘shared reality’ of health risks associated with cigarette use toward both reducing the prevalence and eliminating disparities in cigarette use among all Americans

Renee Goodwin, Meng Xi Sun, Keely Cheslack-Postava

No abstract available at the time of this edition’s deadline.


Published in Nicotine and Tobacco Research on 27 July 2022


See more from MedicalBrief archives:


Legal cannabis stores linked to fewer opioid deaths in the United States – BMJ


Cannabis use on a high after legalisation and lockdown – UN report


Canada’s legalisation of cannabis is a success story, despite a shaky first act


Luxembourg first in Europe to legalise cannabis; Canada sees mostly good results



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