Daily cannabis users less likely to consider heavy tobacco use dangerous

A growing number of Americans are using cannabis as it becomes legalized for recreational use in a rapidly increasing number of U.S. states. Questions abound about what impact legalization will have on adult and youth health.

A new study led by Dr. Renee Goodwin, Professor at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH), shows that increased cigarette use is one possibility. While cigarette use has been declining for decades in the U.S., a new study finds that adults who use cannabis daily do not perceive smoking a pack a day as being as harmful as those who do not use cannabis in the U.S. 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 legalization, these findings were somewhat of a surprise.

The researchers used data from adults age 18 and older in the 2020 National Survey on Drug Use and Health, a representative survey of U.S. individuals. Participants’ responses to a question asking how much people risk harming themselves physically and in other ways by smoking one or more packs of cigarettes per day were compared between those who use cannabis daily and those who did not use cannabis in the past year. Sixty-two percent 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 did not use 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,” says Goodwin, also an adjunct professor at Columbia Mailman School of Public Health. Her prior work shows that cigarette use, however, is much more common among those who use cannabis and findings suggesting that cannabis legalization may lead to increases in cannabis use and cannabis-cigarette co-use among adults. 

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

Dr. Goodwin discussed her work, and in particular that of Canadian colleagues, at a recent public hearing for a law that would ban cannabis packaging that appeals to children in New York’s Suffolk County. Findings from recent studies in Canada, where cannabis is legal on a federal level, show increases in adult cannabis use but as of the most recent study in 2022, no significant increases in cannabis use among adolescents.

“The data suggests that plain packaging is one measure that can maximize the safe and effective rollout of cannabis legalization that ensures and protects the health, safety and wellbeing of all members of our community,” Goodwin said. “Prohibiting product packaging that mimics foods and candies that are traditionally marketed to children 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 U.S., and child and adolescent intentional use of these products.” 

Renee D Goodwin, Meng Xi Sun, Keely Cheslack-Postava, 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, Nicotine & Tobacco Research, 2022;, ntac177

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About CUNY SPH

The CUNY Graduate School of Public Health and Health Policy (CUNY SPH) is committed to promoting and sustaining healthier populations in New York City and around the world through excellence in education, research and service in public health and by advocating for sound policy and practice to advance social justice and improve health outcomes for all. sph.cuny.edu