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Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: Implications for health education and research: Perceptions of Tobacco and Marijuana
Abstract
Aims:
To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado.
Design:
Semi-structured qualitative interviews.
Setting:
Denver, Colorado, USA.
Participants:
Thirty-two young adults (18-26 years old) who used tobacco/marijuana/vaporizers. Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products.
Findings:
Young adults evaluated harms and benefits using five dimensions: (1) Combustion - smoking was considered more harmful than non-combustible products (e.g., e-cigarettes, vaporizers, and edibles); (2) Potency - edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of THC (tetrahydrocannabinol); (3) Chemicals - products containing chemical additives were seen as more harmful than "pure" or "natural" plant products; (4) Addiction - participants recognized physiological addiction to nicotine, but primarily talked about psychological or lifestyle dependence on marijuana; (5) Source of knowledge - personal experiences, warning labels, campaigns, the media, and opinions of product retailers and medical practitioners affected perceptions of harms and benefits.
Conclusions:
Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as "natural" and "pure" in the promotion or packaging of tobacco and marijuana products might be misleading.
... Respecto a los consumidores duales se ha reportado una menor percepción de riesgo hacia el consumo de cannabis que hacia el consumo de tabaco, este aspecto se ha observado particularmente en países donde hay una mayor aceptabilidad social para el consumo de cannabis derivado de la legalización de la sustancia, quienes en ocasiones refieren su uso como medicinal y recreativo Gravely et al., 2022;Nguyen et al., 2023). Popova et al. (2017) entrevistaron a 32 consumidores de cannabis y tabaco, los cuales reconocieron que fumar cualquiera de las dos sustancias era peligroso, sin embargo, el consumo de cannabis fue percibido como más seguro porque indicaron que tiene menos sustancias químicas y menor potencia adictiva. En la misma línea, Schauer et al. (2017) encontraron en una revisión sistemática que los participantes percibían a la mariguana menos dañina, más natural y al tabaco más adictivo y dañino. ...
... Por lo tanto, estudios previos han demostrado que un incremento en la percepción de riesgo de productos de tabaco y cannabis disminuye el consumo de ambas sustancias (Popova et al., 2017;Nguyen et al., 2023), sin embargo, existe una clara tendencia a considerar el consumo de cannabis como menos dañino que el consumo de tabaco (Popova et al., 2017). Además, el uso dual incrementa la dependencia de ambas sustancias lo que dificulta el logro de la abstinencia de una sola sustancia, sin embargo, es poco frecuente que los usuarios de estas sustancias se planteen dejar de fumar cannabis (McClure et al., 2019). ...
... Por lo tanto, estudios previos han demostrado que un incremento en la percepción de riesgo de productos de tabaco y cannabis disminuye el consumo de ambas sustancias (Popova et al., 2017;Nguyen et al., 2023), sin embargo, existe una clara tendencia a considerar el consumo de cannabis como menos dañino que el consumo de tabaco (Popova et al., 2017). Además, el uso dual incrementa la dependencia de ambas sustancias lo que dificulta el logro de la abstinencia de una sola sustancia, sin embargo, es poco frecuente que los usuarios de estas sustancias se planteen dejar de fumar cannabis (McClure et al., 2019). ...
El uso dual de cannabis y tabaco es una problemática social y de salud permeada por una percepción de riesgo, este fenómeno se ha observado en países donde hay mayor aceptabilidad social derivado de la legalización generando un bajo interés en la búsqueda de tratamiento. Por tal motivo el objetivo del presente trabajo fue identificar y analizar la percepción del riesgo, consecuencias del consumo y las razones para buscar tratamiento en consumidores duales de cannabis y tabaco. Se realizó un estudio con enfoque cualitativo donde se entrevistaron a dieciocho usuarios duales, las entrevistas se analizaron mediante el análisis de contenido. Los participantes reportaron una menor percepción de riesgo para el consumo de cannabis, dificultad para identificar consecuencias negativas de su consumo, así como desinterés en cesar el uso dual.
... The size of the samples varied greatly from 8 youth up to approximately 294 youth. Approximately half of the qualitative studies discussed that a limitation of their study was the lack of generalizability due to the small sample size; a claim common among positivist/post-positivists researchers (Akre et al., 2010;Antognoli et al., 2018;Bruce et al., 2013Bruce et al., , 2020Friese, 2017;Friese et al., 2016;Gilliard-Matthews et al., 2016;Popova et al., 2017;Price Wolf et al., 2019;Reed et al., 2020;Roditis & Halpern-Felsher, 2015;Weitzman et al., 2019). An example of a constructivist/ interpretivist stance can be viewed by (James et al., 2019), who stated that the aim of their study "was not to provide an objective view of young people's cannabis use. ...
... In the reviewed studies, several incorporated more than one data collection method (see Table 3). Almost all studies (n = 19) incorporated individual interviews (Akre et al., 2010;Antognoli et al., 2018;Berg et al., 2018;Bruce et al., 2013Bruce et al., , 2020Friese, 2017;Gilliard-Matthews et al., 2016;Haines-Saah et al., 2014;Hathaway et al., 2016Hathaway et al., , 2018James et al., 2019;Lankenau et al., 2018;McDonald et al., 2016;Moffat et al., 2013;Mostaghim & Hathaway, 2013;Popova et al., 2017;Price Wolf et al., 2019;Reed et al., 2020;Weitzman et al., 2019), six studies used focus groups or small group discussions (Akre et al., 2010;Demant & Ravn, 2010;Friese et al., 2016;Järvinen & Demant, 2011;Moffat et al., 2013;Roditis & Halpern-Felsher, 2015) two engaged in participant observation (Haines-Saah et al., 2014;Moffat et al., 2013), and two used reflexive journals/logs (Gilliard-Matthews et al., 2016;Moffat et al., 2013). For the studies that conducted interviews, the formats were mostly semi-structured, used a pre-established interview guide, and conducted on a one-time occasion. ...
... Only six of the reviewed studies collected data from the same participants more than once. For instance, Akre et al. (2010) Popova et al. (2017) and Reed et al. (2020) each interviewed their participants twice. Furthermore, two studies had described using reflexive journaling/logs within their study methods. ...
Recreational cannabis legalization has encouraged research regarding cannabis use among youth, especially the use of qualitative approaches. In fact, alcohol and drug use journals have recently encouraged qualitative submissions and provided criteria to ensure "high-quality" research. This study provides an objective account of the qualitative approaches used by researchers in this field and discusses implications for future research. A methodological review was conducted for studies published between January 2010 and November 2019. Targeted keyword searches in four research databases returned 1956 unique records. Pairs of reviewers independently screened records against eligibility criteria and charted data for study philosophical positioning, methodology , study aims, sampling, sample, data collection, and data analysis. 23 studies met the inclusion criteria. Several gaps in study quality criteria are observed: less than half of the studies specified the overarching methodology and just two stated philosophical positioning, with some methods unjustified. Implications for future research are discussed.
... Reasons included that vaping cannabis is safer, healthier, and/or less physically irritating than cigarettes or combustible tobacco; to reduce or quit smoking cigarettes or other combustible tobacco products, as well as cannabis; to control dosage or amount of cannabis consumed and/or to maintain a sustained high; experimentation; mixing with flavors; friends' use; because cannabis vaping is "trendy" and "cool"; because it is enjoyable; stress relief; relaxation; sleep improvement; mood improvement; and its discreetness or ability to circumvent smoking bans. One study reported a reason that may deter young adults from cannabis vaping, namely that vaping may be less safe than other forms of consuming cannabis [181]. ...
... Four studies reported on youth and young adults' harm perceptions of cannabis vaping [176,177,181,191]. One study reported that young adults perceived combustible (e.g., smoked, via a joint or pipe) cannabis as more harmful than vaporized cannabis; however, chemicals (e.g., butane) used make cannabis concentrates were thought to be a source of harm [181]. ...
... Four studies reported on youth and young adults' harm perceptions of cannabis vaping [176,177,181,191]. One study reported that young adults perceived combustible (e.g., smoked, via a joint or pipe) cannabis as more harmful than vaporized cannabis; however, chemicals (e.g., butane) used make cannabis concentrates were thought to be a source of harm [181]. Another study reported that most participants perceived using e-cigarettes to vape cannabis to be just as harmful or more harmful than joint use. ...
Purpose of Review
The purpose of this review was to describe the state-of-the-literature on research specific to cannabis vaping among youth and young adults.
Recent Findings
Out of 1801 records identified, a total of 202 articles met eligibility criteria for inclusion in this review. Most of this literature (46.0% of studies) was specific to the health effects of cannabis vaping, particularly EVALI (e-cigarette and vaping associated lung injury). Other research areas identified in the review included the etiology (24.3%) and epidemiology (24.8%) of cannabis vaping, in addition to articles on regulation (8.4%) and marketing (5.5%) of the same.
Summary
Cannabis vaping is increasingly common among youth and young adults and more prevalent is settings where recreational use for adults has been legalized. The literature documents a number of negative health effects of cannabis vaping for young people, along with risk factors and reasons for the same.
... By 2015, adolescents who reported higher perceived harm, wrongfulness, or parental disapproval were not associated with the prevalence of using combustible cannabis products, whereas these factors were associated with a lower prevalence of other modes of use, including edibles, vaping, and dabbing [39]. Further, in a survey of Colorado young adults aged 18-26 years old, Popova et al. found that combustible products were perceived as more dangerous than vaporizers and edibles [49]. Popova also found that the risk of unintentional overdose with higher potency products was perceived to be lower than the health risks of using combustible cannabis. ...
... One possible determinant of perceived harm may be counterbalancing claims of health benefits. Because cannabis is often described as "natural" and medical uses are canonized in medical cannabis policies and may be publicly touted, many youths view it as less harmful and less addictive than other drugs and medications including antidepressants, anxiolytics, and opioids [49]. Further, Bierut et al. surveyed licensed cannabis retailers and found that the majority in Colorado made health claims regarding cannabis use [21]. ...
... While access to substance use treatment is wholly inadequate, youth seldom recognize symptoms of problematic cannabis use. In a study of perceived harm Popova et al. found that many respondents could describe physiologic changes due to regular cannabis use, though they generally did not identify these signs of tolerance as indicative of problematic use or CUD [49]. However, many discussed using higher potency products or higher amounts to overcome these physiologic changes to achieve getting high. ...
Over the past two decades, cannabis policies have liberalized in the United States, culminating in the legalization of recreational cannabis in Colorado and Washington state in 2012. This review will focus on the impact of recreational cannabis legalization in Colorado. While the prevalence of past-year and past-month cannabis use has remained relatively steady among adolescents post-legalization, the prevalence of young adult use has continued to rise. Cannabis products with increased potency have become more prevalent and widely used. There are concerns that the use of products with increased potency will increase risk for cannabis use and comorbid mental health disorders, particularly cannabis-induced psychosis and suicidal behavior, although more research is needed to fully understand the impact of high-potency products. Since the legalization of recreational cannabis, numerous additional public health concerns have emerged: unintentional overdoses requiring acute care visits, electronic vaping-associated lung injury, increased motor vehicle collisions related to cannabis consumption, and higher rates of cannabis use during pregnancy. Lessons learned from the first decade of cannabis legalization emphasize the need for research efforts to provide evidence-based guidelines, inform prevention strategies, and implement selective interventions for at-risk populations including youth, individuals with comorbid mental health disorders, and individuals who are pregnant.
... Reasons for using measures vaped cannabis, vaped nicotine, and smoked cannabis All participants responded to parallel sets of measures to assess reasons for using vaped cannabis, vaped nicotine, and smoked cannabis. Selected items were adapted from studies in the published literature related to reasons for vaping cannabis or nicotine, as well as validated measures from national-level surveys (Lee et al., 2016;Aston et al., 2019;Berg et al., 2018;Etter, 2015;Hyland et al., 2017;McDonald et al., 2016;Popova et al., 2017;Shiplo et al., 2016). Participants indicated their agreement with each item as it related to their use of each product using a six-point scale ranging from 0 (not at all true) to 5 (very true). ...
... Taken together, this would suggest that vaping as a mode of drug delivery serves a purposeful application that differs by substance, with nicotine vaping being more closely related to reducing tobacco smoking-related harms, and cannabis vaping being more closely related to circumventing social problems commonly posed by cannabis smoking. These observations are consistent with studies examining each product individually (Lee et al., 2016;Saddleson et al., 2016;Aston et al., 2019;Popova et al., 2017;Pokhrel et al., 2015), and is likely reflecting broader differences in the legality and risk perceptions related to the substances themselves. Smoked tobacco is legal and is accurately perceived as harmful to health, while cannabis remains illegal in many areas and is increasingly perceived as less risky or health promoting due to increasing medical and therapeutic use (Azofeifa et al., 2016;Hall & Kozlowski, 2018; National Academies of Science Engineering and Medicine, 2017). ...
... Further, the sample size limited our ability to utilize multivariate statistical techniques to classify data on reasons for individual product use and co-use, or formally reexamine subscale classifications related to nicotine and cannabis co-use. However, the associations observed within our data on reasons for use and use behaviors align with other published studies on this topic (Lee et al., 2016;Saddleson et al., 2016;Berg et al., 2018;Popova et al., 2017;Pokhrel et al., 2015), giving credibility to our findings in light of this limitation. Additionally, the list of items included in this study outlining reasons for product use was derived from the published literature and national surveys. ...
Background
Understanding similarities, differences, and associations between reasons people vape nicotine and cannabis may be important for identifying underlying contributors to their co-use.
Methods
A cross-sectional survey of 112 co-users of vaped nicotine and cannabis was conducted in 2020. A convenience sample of participants was recruited for the survey using Amazon Mechanical Turk. Participants responded to questions about their reasons for individual nicotine and cannabis product use and co-use and rated their level of agreement using numerical scales. Mean ratings for each reason for use subscale were examined across all participants and compared using paired samples t tests. Associations between reasons for use ratings and product consumption behaviors were examined using linear and logistic regression analyses.
Results
Cannabis vaping and smoking exhibited similar mean ratings for user experience and product/substance-related reasons for use. Mean ratings for reasons related to product utility were similar for cannabis vaping and nicotine vaping. Mean ratings for utility-related reasons for use were higher for cannabis vaping than cannabis smoking (mean (SD), 3.6 (± 1.0) vs. 2.6 (± 1.2), p < 0.0001). On average, harm reduction-related reasons for use were rated higher for nicotine vaping than cannabis vaping (2.4 (± 1.6) vs. 1.8 (± 1.4), p < 0.0001). Regression models showed higher average ratings for utility-related ( b = 0.32; 95% CI, 0.03-0.60) and harm reduction-related ( b = 0.21; 95% CI, 0.04-0.37) reasons for nicotine vaping were associated with more frequent nicotine vaping (both p < 0.05). Higher average ratings for instrumentality-related reasons for co-use corresponded with more frequent monthly nicotine vaping ( b = 0.26; 95% CI, 0.08-0.44) and higher odds of ever chasing cannabis with nicotine (aOR, 3.06; 95% CI, 1.29-7.30).
Conclusions
Vaping serves purposes that differ by substance; nicotine vaping was more closely related to reducing tobacco smoking-related harms, and cannabis vaping was more closely related to circumventing social problems posed by cannabis smoking. Lifetime sequential co-use practices and more frequent nicotine vaping were associated with enhancing the intoxicating effects of cannabis. While replication of these findings using non convenience-based sampling approaches is warranted, results underscore the need to consider shared and unique aspects of nicotine and cannabis vaping, as well as cross-substance interactions between nicotine and cannabis.
... In these retail environments, individuals are likely to encounter additional, more direct health and risk marketing (e.g., promotional material on display, product packaging). Dispensary employees have also been shown to be an influential source of product messaging, including promotion of health benefits (Cameron et al., 2023;Peiper et al., 2017;Popova et al., 2017). Thus, it is important to examine how packaging, retail environments, and interactions with retail employees (i.e., "budtenders" or "cannabis consultants," herein referred to as budtenders only) affect purchasing behaviors. ...
... In addition to learning about the purchasing behavior of customers, The CANNEX can be used to study budtender messaging within the dispensary environment, as storefront staff represent an important population that often provides both naïve and knowledgeable customers with details about products and their purported health benefits (Cameron et al., 2023;Peiper et al., 2017;Popova et al., 2017). Budtenders can be invited to The CANNEX to participate in interviews about how they sell certain products to customers, or scripts could be created for mock budtenders in The CANNEX to provide participants with recommendations or educational information when shopping in the store. ...
Objective: Cannabis retail dispensaries have proliferated in the United States in recent years, making it an important time for conducting research. Research is needed to learn more about consumer purchasing behaviors, including the impact of product marketing both inside and outside of retail spaces, and studies are needed to explore how both consumers and retail staff interpret the health benefits and potential risks associated with cannabis products within these environments. Current research on cannabis dispensaries often involves surveys or interviews with customers and dispensary staff outside of dispensary environments, but much can be learned through observational and experimental methods within dispensaries themselves. However, researchers have traditionally relied on surveillance methods, where researchers visit dispensaries to gain a deeper understanding of real-world encounters in these environments. Although these methods provide helpful insights into purchasing and selling behavior, as well as regulatory compliance, these studies are conducted in an uncontrolled environment, as products, messaging, and interactions are specific to the dispensaries in which the research is conducted. Method: We therefore created a mock cannabis dispensary to offer participants a retail experience that can be controlled and manipulated (e.g., adjustable cannabis product prices, placement of health and risk information in the dispensary, scripted interactions with dispensary staff) to help balance ecological and internal validity and answer questions about purchasing and selling behavior beyond what current methods allow. Results: We describe the process of developing and stocking the first known mock cannabis dispensary for research purposes, the Cannabis Annex (“The CANNEX”), including interior design, product selection, feedback solicitation from 20 cannabis industry workers, and plans for future research studies within the environment. Conclusions: By describing our process, we hope to aid researchers in developing their own similar mock dispensaries to continue learning about the health benefits, risks from use, and policy implications of cannabis in an increasingly legal recreational atmosphere.
... With the expansion of recreational laws and statutory classification as "medicinal" at the state level, perceived harmfulness of cannabis use continues to decline (2). In fact, some studies suggest that youths perceive concentrated THC products, particularly vapes or dab pens, as less harmful than combustible plant-based products (56,57). This is further complicated by the perception that cannabis use is helpful for mental health problems that may be exacerbated by cannabis use (58,59). ...
... This is paired with potential lack of insight into cannabis-related problems. For example, self-reported physiologic changes consistent with tolerance and withdrawal are often not recognized as problems related to cannabis use (57). Insufficient clinical screening and unrecognized substance-related problems may also result in clinicians missing problematic cannabis use entirely or inaccurately classifying adolescent cannabis use as misuse rather than a CUD. ...
The increase of cannabis use, particularly with the evolution of high potency products, and of cannabis use disorder (CUD) are a growing healthcare concern. While the harms of adult use and potential medicinal properties of cannabis continue to be debated, it is becoming evident that adolescent cannabis use is a critical window for CUD risk with potential lifelong mental health implications. Herein, we discuss mental health consequences of adolescent cannabis use, factors that contribute to the risk of developing CUD, and what remains unclear in the changing legal landscape of cannabis use. We also discuss the importance of preclinical models to provide translational insight about the causal relationship of cannabis to CUD-related phenotypes and conclude with highlighting opportunities for clinicians and allied professionals to engage in addressing adolescent cannabis use.
... 67 Hence, if not addressed, this perception could reinforce marijuana usage over time amongst schoolchildren leading to addiction. 68 Lastly, addiction was another SCT motivation for sustained marijuana use amongst discussants. ...
... 56,69,70 Over time, adolescents who use marijuana become highly dependent on it, which makes it difficult for them to live without it. 68 Typically, they cannot do without marijuana for a day as a result of the skills and joy they have developed in the act. There is therefore the need to pay attention to contextual factors that promote marijuana use leading to addiction amongst adolescents in illicit marijuana-growing contexts of South Africa. ...
Background: Although various reasons for adolescent marijuana use have extensively been explored, contextual factors that sustain the practice in settings where the plant is illegally cultivated, especially in South Africa, remain a grey area.
Aim: We aimed to explore the contextual factors of sustained adolescent marijuana use in two illicit marijuana-growing settings of the Ingquza Hill Local Municipality of South Africa, based on the differential opportunity theory (DOT) and subcultural theory (SCT).
Setting: The study was conducted in two illicit marijuana-growing communities in the Ingquza Hill Local Municipality of the Eastern Cape Province of South Africa.
Methods: Exploratory qualitative research, using focus group discussions approach, was conducted amongst 37 participants, four focus groups and in two communities in the Ingquza Hill Municipality of the Eastern Cape Province of South Africa. Purposive and snowball sampling techniques were used to select the communities and participants, respectively. The data were analysed using a thematic content analysis approach and presented under various themes.
Results: Nine themes, grouped under two broad factors, DOT influences (availability and affordability of marijuana, idleness and means of dealing with personal problems) and SCT influences (peer conformity, the pleasure derived from marijuana smoking, manipulation of appetite, health reasons, for higher cognitive function and addiction), emerged from the analysis.
Conclusion: As marijuana has been identified to be a gateway drug for the use of other illicit drugs, its sustained usage amongst adolescents poses a health challenge to the user, community and the country’s healthcare system at large. Hence, there is the need to intensify adolescent marijuana use prevention campaigns in illicit marijuana-growing contexts of South Africa, focussing on the differential opportunities and subcultural inclinations that promote the behaviour in those contexts.
... Participants in support of a 100% smoke-free campus policy alluded to the harmful nature of products containing tobacco, the promotion of a cleaner campus environment, and the protection against secondhand smoke that the policy could provide. A similar study conducted amongst young adults concluded with a similar perception that tobacco-containing products along with marijuana products were harmful to their users due to the effects of the chemicals at high concentration within the body 18 . Aside from damages posed to one's health, damages to the environment of the campus preceded the notion for this campus policy support. ...
INTRODUCTION
Implementation of a 100% tobacco-free policy at universities can assist in limiting the potential negative health impacts of tobacco use, such as susceptibility to lung and heart disease, cancer, addiction, and life-long use. This study’s goal was to gain the perspective of students and non-students across a large Midwestern university campus on implementation of a 100% tobacco-free policy.
METHODS
Students, faculty, and staff of a Midwestern university were recruited to complete a 19-question cross-sectional online survey on tobacco use on campus, awareness of the current tobacco-free policy, and their interest in supporting a 100% smoke-free policy on campus. The survey included open- and close-ended questions, and responses were analyzed qualitatively and quantitatively.
RESULTS
A total of 2389 respondents completed the survey, and 291 (12.2%) reported current tobacco use from April to July 2024. Participants with a higher probability of current tobacco use were associated with having a higher degree of exposure to secondhand aerosols (AOR=1.34; 95% CI: 1.10–1.62), more awareness of the current tobacco policy (AOR=1.19; 95% CI: 1.06–1.32), and disagreed with the petition statement in support of a 100% tobacco-free campus policy (AOR=2.47; 95% CI: 1.48–4.12). Participants that reported a higher degree of exposure to secondhand aerosols (AOR=2.18; 95% CI: 1.19–3.99) and agreed with the statement that a 100% smoke-free campus policy would promote a healthier college campus (AOR=2.18; 95% CI: 1.20–3.96) were significantly associated with supporting the petition for a 100% smoke-free policy on this university campus.
CONCLUSIONS
Supporting a 100% tobacco-free policy for a healthier and safer university campus was demonstrated to be associated with secondhand aerosol exposure among survey respondents.
... Despite the existing research around harm perceptions and substance use, few studies have compared risk perceptions for an array of nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients across age groups that include adolescents to adults. Qualitative research has found that adolescents and young adults perceive the harms of tobacco and cannabis products differently Popova et al., 2017), but we lack quantitative studies. Moreover, few studies include different types of substances and products within a single analysis to provide comparisons across products, and none include different types of e-cigarettes (e.g., disposable vs. pod-based vs. non-nicotine including THC and other ingredients) or other nicotine products such as Zyn/oral nicotine pouches (Patwardhan & Fagerström, 2022). ...
... On virtually all indicators, pre-roll, edible/beverage and absorbable products are not as appealing to young adults as other offerings, although some specific pre-rolls and edible gummies have slightly elevated sales or share ratios. The psychoactive effects of edible and beverage tend to be delayed, unpredictable or excessive, which may reduce their appeal among young adults [25,30]. Edible products are also substantially more expensive in terms of price/10 mg THC, estimated at $3 for edible versus 70 cents for vapor pen and 30-40 cents for flower [14]. ...
... Studies examining consumers' perceptions of different cannabis products have yielded inconsistent results. Some studies found that consumers perceived inhaled types (such as flowers) as less harmful compared to concentrates or edibles due to the potential risk of THC (tetrahydrocannabinol) overdose and delayed activation time associated with the latter (Loflin & Earleywine, 2014;Popova et al., 2017). However, another study found that consumers did not perceive harmful effects from consuming edibles, and they preferred edibles over inhaled products due to their longer-lasting yet less intense effects (Giombi et al., 2018). ...
This study investigates the impact of visual branding cues on consumer responses in the cannabis market. Visual communication plays a critical role in shaping consumer behavior and perception. However, limited research exists on how consumers evaluate visual branding cues in the context of cannabis products. This study focuses on the effects of branded versus unbranded cannabis packaging for edible and inhalable products. It explores consumer product trust, product attitude, purchase intention, and willingness to pay in relation to visual branding cues. By investigating the impact of visual branding cues in the cannabis market, this study contributes new insights into the applicability of cue utilization theory and the theory of reasoned actions through this novel context.
... Therefore, future research needs to be more robust, such as systematic reviews and meta-analyses, translational qualitative studies, and controlled trials, to understand the causal relationship between cannabis use and the development of mental illness among young populations by adjusting potential non-measurable confounders [61,62]. Furthermore, the increasing prevalence of cannabis use among high school and college students, due to its perceived harmless nature and lack of dependence, suggests the need for intervention by integrating teachers, parents, courses, and community health professionals to make them aware of its potential negative mental health outcomes [63,64]. Additionally, policy-level interventions to discourage cannabis use among young populations are necessary [65]. ...
Cannabis is a widely used substance among the youth population, with an estimated 2.8% currently smoking cannabis. Its popularity is growing due to the perception of its harmless nature and lack of dependence. However, this increase in use has been linked to mental health issues, especially since its partial decriminalisation in some part of the United States and Australia. The objective of this scoping review was to investigate the mental health impact of cannabis use among young people in Australia and the United States. A scoping review was conducted according to the Joanna Briggs Institute (JBI) protocol, and articles were searched from ProQuest Central and EBSCO Host (MEDLINE and CINAHL databases). A total of 24 articles were analysed, including systematic reviews, meta-analyses, and cohort, longitudinal, and cross-sectional studies. The findings indicate that cannabis use is associated with depression, psychosis, suicide, cannabis use disorder, dependence, decline in cognitive function, and the development of externalising behaviour, particularly attention deficit hyperactivity disorder. However, the relationship between cannabis use and anxiety is equivocal. Mental health issues were more prevalent with increased frequency, duration, intensity, and type of use. Female, minority, LGBTQI, African American, Aboriginal, and Torres Strait Islander youth and the age of onset of cannabis use were significant factors for the development of mental health problems. The increasing prevalence of cannabis use among high school and college students suggests the need for intervention by teachers, parents, and community health professionals to make them aware of its potential negative mental health outcomes. Moreover, policy-level interventions by the government are required to discourage young people from using cannabis.
... The finding that negative images affected nicotine intentions, but not cannabis intentions, might also be because young adults view nicotine and cannabis differently. Cannabis has a strong association with medicine and therapeutics [24,25]; therefore, different messaging or additional education interventions may be needed to increase knowledge about the specific risks of cannabis vaporizer use. ...
Background:
Inhaling aerosolized nicotine and cannabis (colloquially called "vaping") is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging use of both products received national media attention during the 2019 outbreak of E-Cigarette or Vaping-Associated Lung Injury (EVALI).
Objective:
This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults' perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future.
Methods:
Participants (N=1,229) ages 18-25 (M=21.40, SD=2.22) were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (50.3%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) X 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive, aesthetically pleasing selfies. Positive text was supportive and uplifting regarding quitting use of vaporized products. Negative images and text were graphic and fear-inducing. After viewing three posts, participants reported perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on intentions to use nicotine and cannabis vaporizers. Analyses adjusted for product use history.
Results:
Compared to viewing positive images, viewing negative images resulted in greater perceived harm of nicotine and cannabis vaporized products (ps<.05), greater perceived risk of nicotine vaporizers (ps<.05), and lower odds of intentions to use nicotine (p<.05), but not cannabis (p>.05) vaporizers in the future. There were no significant main effects of text valence and no significant image and text valence interactions (p-values>.05).
Conclusions:
Negative imagery in Instagram posts about EVALI may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post's text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI.
... Previous studies of perceived harms of tobacco and cannabis were mostly cross-sectional, with few longitudinal studies assessing changes over time (Gali, Winter, Ahuja, Frank, & Prochaska, 2021;Strong et al., 2019). Several studies examining perceived harms of both substances indicated lower perceived harm toward cannabis compared to tobacco products (Berg et al., 2015;Popova et al., 2017;Roditis and Halpern-Felsher, 2015). However, two of these studies were qualitative and the quantitative study was conducted in 2013. ...
Purpose:
Perceived harm is associated with substance use. Changes in product and policy landscapes may impact perceived harms of tobacco and cannabis. This study aimed to examine changes in young adults' perceived harms of tobacco and cannabis and their associations with use behavior during a period including both before and after legalization of cannabis.
Methods:
We conducted a panel survey of California Bay Area young adults (mean age = 23.5 years old, 64.4% female) in 2014 and 2019-2020. Participants (N = 306) reported past 30-day use and perceived harms of tobacco and cannabis at both waves. Perceived harms to health of cannabis and tobacco (cigarettes, e-cigarettes, hookah, smokeless tobacco, and secondhand tobacco smoke) were measured from 1-"Not at all harmful" to 7-"Extremely harmful." Mixed-effects logistic regressions examined associations between perceived harms and use of tobacco and cannabis, controlling for demographics.
Results:
Participants perceived lower harm for cannabis than for tobacco products. Perceived harms of e-cigarettes, hookah, and smokeless tobacco significantly increased over time; while perceived harms of cigarettes, secondhand tobacco smoke, and cannabis did not change. Increased perceived harm of e-cigarettes was associated with lower odds of any tobacco use (OR = 0.72, 95%CI = 0.56, 0.92), and increased perceived harm of cannabis was associated with lower odds of any cannabis use (OR = 0.51, 95%CI = 0.42, 0.62).
Conclusions:
Findings suggest that perceived harms of e-cigarettes and cannabis play important roles in driving young adult use behaviors. Risk communication efforts that increase perceptions of health harms related to e-cigarettes and cannabis may decrease use of tobacco and cannabis among young people.
... Like nicotine-containing solutions, fruit and candy flavored cannabinoid products are popular among adolescents and contributed to early, electronic cigarette initiation (45). As seen with other electronic cigarettes, cool "vaping culture" have emerged in schools that has promoted cannabinoid vaping among peers (46). Social influences, underestimation of risk, greater access to cannabinoid products, psychobehavioral co-morbidities, and other substance abuse can also contribute to their continued use (38, 47). ...
... Yet throughout the interview process participants questioned their beliefs and understandings. They described the cigarette companies as having stronger risk messaging on packaging than cannabis companies (Popova et al., 2017). In turn, they thought that more research was needed to explain risks (e.g., tar, chemicals in cannabis, lung tissue changes) to themselves and the public. ...
Cannabis use is increasing especially in younger individuals in Nova Scotia. In the university setting, there is a growing body of literature seeking to understand why individuals choose to use cannabis for management of symptoms. As one third of Nova Scotians 15 years and older report consuming cannabis it was important to understand the perspectives and experiences of university students. Young adults utilize cannabis for wide ranging symptoms, anxiety, depression, social acceptance, and pain and many are not managed by a health care professional. Therefore, we sought to understand why students choose to use cannabis. We utilized a qualitative descriptive approach to seek rich, thick descriptions. We interviewed six young adults using a semi-structured approach. University ethics were sought and granted. A letter of information and informed consent were utilized. Interviews were conducted following pandemic guidelines and utilizing an e-platform. Data was transcribed verbatim. The researchers read, re-read, and thematically analyzed the transcripts. Themes were identified following a thematic analysis process. Findings were shared with participants and presented at a university research event. The following themes emerged from the data: (1) perceived benefits of cannabis on ones' symptoms; (2) perceived risks of cannabis use; and (3) reasons for use instead of medically prescribed medications. This small qualitative study shares the experiences of university students using cannabis to manage symptoms. Participants self-medicate their symptoms, e.g., anxiety, depression, and social and family stressors. They engage in a trial-and-error process to get the right amount of cannabis to manage symptoms. They also use cannabis to numb stressors and to feel normalized in social situations. Participants also described risks associated with cannabis use, overuse and unanticipated side-effects including risk of addiction. Finally, they choose cannabis as there continues to be stigma associated with discussing mental health issues with their physician, and it is easy to access cannabis without a prescription. More research is needed to fully understand the role of cannabis as it shifts its use and access with legalization.
... High rates of e-cigarette and marijuana use among youth may also be due in part to more favorable attitudes towards use of e-cigarettes and marijuana compared to cigarettes. [37][38][39][40] Studies of attitudes and perceptions around e-cigarettes and marijuana show that adolescents hold more favorable attitudes towards and attribute fewer health and social risks to e-cigarettes and marijuana compared to other tobacco products 41,42 , particularly combustible cigarettes, and that those who have used e-cigarettes or marijuana hold more positive attitudes towards them. 43 Prevention campaigns similar to those done for conventional cigarettes, focusing on the risks of adolescent use of marijuana and e-cigarettes and reducing their perceived appeal, may be effective to combat these differences in attitudes and perceptions towards these substances. ...
Objective
There is evidence linking youth use of electronic (e-) cigarettes to subsequent cigarette and marijuana use, raising public health concerns. We examined the sequence of use of e-cigarettes, conventional cigarettes, and marijuana in a longitudinal sample of adolescents, to determine if use of e-cigarettes often preceded use of other substances.
Methods
We collected self-reports from 1123 Oregon adolescents (52% female; 37% Hispanic) longitudinally from 8 th to 11 th grade (8 total surveys) regarding their lifetime (ever use) and current use (last 30 days) of e-cigarettes, cigarettes, and marijuana. If applicable, students also reported the delivery method of their current marijuana use.
Results
Almost 10% of adolescents reported using e-cigarettes prior to use of cigarettes or marijuana, and the majority of these youth initiated use of marijuana, cigarettes, or both by 11 th grade. More youth transitioned from e-cigarette use to marijuana use then from e-cigarettes to use of conventional cigarettes. Participants who were co-using e-cigarettes and marijuana in 11 th grade had an increased likelihood of consuming marijuana via vaping, dabbing, and edibles, compared to those who were only using marijuana.
Discussion
E-cigarettes were often the first substance used in this longitudinal sample, and more of these youth subsequently used marijuana compared to cigarettes. While research has focused on the progression from e-cigarettes to cigarettes in youth, these findings indicate that more attention should be focused on the subsequent initiation of marijuana.
... If trends continue to diverge and more evidence of decoupling is found, however, prevention and treatment efforts for this age group could devote increased attention to cannabis-specific risk factors (e.g., perceived harm of cannabis use and descriptive and injunctive norms about cannabis use). These factors are distinct from substance-specific risk for other types of substances [31], have shown evidence of increasing [10], and may be addressed through targeting of specific dimensions of young adults' perceptions regarding cannabis [31,41]. ...
Purpose
Liberalization of cannabis laws may be accompanied by changes in the use of substances other than cannabis and changes in associations of cannabis use with other types of substance use. This study assessed (1) trends in alcohol, nicotine, and nonprescribed pain reliever use and (2) changes in associations of cannabis use with these other substances among young adults in Washington State after nonmedical cannabis legalization.
Methods
Regression models stratified by age (18–20 vs. 21–25) were used to analyze six annual waves of cross-sectional survey data from a statewide sample from 2014 through 2019 (N = 12,694).
Results
Prevalence of past-month alcohol use, heavy episodic drinking (HED), and cigarette use and prevalence of past-year pain reliever misuse decreased, while the prevalence of past-month e-cigarette use increased since 2016 (the first year assessed). Across years and age groups, the prevalence of substance use other than cannabis was higher among occasional and frequent cannabis users compared to cannabis nonusers. However, associations between both occasional (1–19 days in the prior month) and frequent (20+ days) cannabis use and pain reliever misuse and between frequent cannabis use and HED weakened over time among individuals ages 21–25.
Discussion
Contrary to concerns about spillover effects, implementation of legalized nonmedical cannabis coincided with decreases in alcohol and cigarette use and pain reliever misuse. The weakening association of cannabis use with the use of other substances among individuals ages 21–25 requires further research but may suggest increased importance of cannabis-specific prevention and treatment efforts.
... Marijuana use could lead to addiction, although it is often questioned and treated as not a serious addiction problem [11]. However, marijuana is highly addictive with serious adverse effects [3,[12][13][14]. Studies indicate marijuana use is associated with various psychosocial and medical problems in young adults [10,15,16]. ...
Marijuana is the most common illicit substance globally. The rate of marijuana use is increasing in young adults in the US. The current environment of legalizing marijuana use is further contributing to an increase of users. The purpose of this study was to explore the characteristics of adults who abuse marijuana (20–49 years old) and analyze behavior and social relation variables related to depression and suicide risk using machine-learning algorithms. A total of 698 participants were identified from the 2019 National Survey on Drug Use and Health survey as marijuana dependent in the previous year. Principal Component Analysis and Chi-square were used to select features (variables) and mean imputation method was applied for missing data. Logistic regression, Random Forest, and K-Nearest Neighbor machine-learning algorithms were used to build depression and suicide risk prediction models. The results showed unique characteristics of the group and well-performing prediction models with influential risk variables. Identified risk variables were aligned with previous studies and suggested the development of marijuana abuse prevention programs targeting 20–29 year olds with a regular depression and suicide screening. Further study is suggested for identifying specific barriers to receiving timely treatment for depression and suicide risk.
... On biopsy, the internal bronchial lining tissue of chronic marijuana smokers showed massive cellular amendment, some of which can be considered premalignant. Marijuana and tobacco smoking act as supplements, leading to the consequences of cellular aberrations (Popova et al., 2017). Many case studies have revealed that a large portion of marijuana smokers have lung or aerodigestive tract cancers, including oral cavity, larynx, and pharynx cancer. ...
Cannabis sativa, widely known as ‘Marijuana’ poses a dilemma for being a blend of both good and bad medicinal effects. The historical use of Cannabis for both medicinal and recreational purposes suggests it to be a friendly plant. However, whether the misuse of Cannabis and the cannabinoids derived from it can hamper normal body physiology is a focus of ongoing research. On the one hand, there is enough evidence to suggest that misuse of marijuana can cause deleterious effects on various organs like the lungs, immune system, cardiovascular system, etc. and also influence fertility and cause teratogenic effects. However, on the other hand, marijuana has been found to offer a magical cure for anorexia, chronic pain, muscle spasticity, nausea, and disturbed sleep. Indeed, most recently, the United Nations has given its verdict in favour of Cannabis declaring it as a non-dangerous narcotic. This review provides insights into the various health effects of Cannabis and its specialized metabolites and indicates how wise steps can be taken to promote good use and prevent misuse of the metabolites derived from this plant.
... As others have noted, there may be a lack of information from government agencies on the health risks of e-cigarettes [60], and, particularly for young people, we recommend that clear, evidence-based scientific information be made available in guidelines and incorporated into tobacco-related health education for primary, secondary and tertiary education students. ...
Background
Smoking prevalence in Ireland is falling in all age groups, but e-cigarette use is rising among young people. This qualitative study explores young people’s accounts of e-cigarette use in Ireland.
Methods
Semi-structured individual (22) and focus group (8) interviews were conducted with 62 young people aged 18–22 years, recruited from a higher-education institution and youth organisations working with early school-leavers across Dublin. All were smokers or ex-smokers; 41 had tried e-cigarettes, 11 continued as dual users. We identified themes using thematic data analysis.
Results
Three broad themes were identified: incentivising features, disincentivising features, and ambivalent and unsuccessful cessation, named putative smoking cessation. Incentivising features included price, pleasing taste/ flavours, and the possibility of indoor use. Disincentivising features related to adverse health effects (pain, discomfort, sore throat, coughing, headache) and unpleasant physical effects (bad taste, problems resulting from device faults). Other disincentives were over-consumption arising from inability to control intake, "greater addictiveness", product taste, and device faults. Putative cessation refers to the conflict between participants' expected use of e-cigarettes as a smoking cessation/reduction aid and their observed reality of e-cigarettes’ failure in this regard, with reported outcomes including: failure to quit or reduce; continued or resumed cigarette and/or roll-your-own smoking; dual use of e-cigarettes and other tobacco products; and inability to quit e-cigarettes.
Conclusions
Participants were sceptical about e-cigarettes’ "purported relative healthiness", concerned about addictiveness and potential long-term health consequences, and critically aware of advertising and industry strategies. E-cigarettes were viewed as being less denormalised, in part because they could be used in indoor spaces where smoking is banned in Ireland. Although price, taste, and perceived renormalisation were important motivators for young people's use of e-cigarettes, they wanted to quit smoking. The regulation of e-cigarettes through age restriction of access, licensing of outlets, pricing, point of sale and advertising restrictions as well as through the banning of indoor use should be considered by legislators and tobacco control policymakers.
... Previous studies on the effects of cannabis legalization speci cally on young adults' cannabis attitudes and use have been predominately quantitative and often focus on changes in perceived harm (i.e. the perception of harm or damage to the physical body associated with using cannabis) or perceived availability [6][7][8][9][10]12 . Beyond perceived harm, recreational legalization might also stimulate changes in perceived social or legal risk of use 6 . ...
Background
Only July 1, 2017, Nevada became the fifth U.S. state to allow the legal sale of recreational cannabis products for adults ages of 21 and over. This study investigates young adults’ cannabis-related attitudes, perceptions, and behaviors in a state where recreational and medical cannabis use was recently legalized.
Methods
We conducted 8 focus groups stratified by cannabis use (regular users, occasional users, and nonusers) with 32 college students ages 18 to 24. Data were analyzed using the inductive qualitative thematic analysis method.
Results
Four themes emerged during analyses: “sort of legal,” “mitigating harm through legalization,” “Increasing acceptance,” and “seeking safety when purchasing cannabis.” Despite their limited knowledge of cannabis regulation, the majority of the participants supported recreational cannabis legalization from a harm reduction perspective. Most participants did not believe that cannabis legalization had affected their use behavior. However, participants, especially cannabis users, perceived that recreational cannabis legalization created a context where cannabis use was legally, socially, and behaviorally “safer” than in an illegal context, even for those below the legal age of sale.
Conclusions
Most studies focus on the role of perceived health risk on cannabis use. If there are population-level long-term effects of recreational cannabis legalization on use behavior, findings suggest that they will be mediated by the perceived legal, social, and behavioral risk of using cannabis.
... Previous studies on the effects of cannabis legalization specifically on young adults' cannabis attitudes and use have been predominately quantitative and often focus on changes in perceived harm (i.e., the perception of harm or damage to the physical body associated with using cannabis) or perceived availability [6][7][8][9][10]12]. Beyond perceived harm, recreational legalization might also stimulate changes in perceived social or legal risk of use [6]. ...
Background
Only July 1, 2017, Nevada became the fifth US state to allow the legal sale of recreational cannabis products for adults ages of 21 and over. This study investigates young adults’ cannabis-related attitudes, perceptions, and behaviors in a state where recreational and medical cannabis use was recently legalized.
Methods
We conducted 8 focus groups stratified by cannabis use (regular users, occasional users, and nonusers) with 32 college students ages 18 to 24. Data were analyzed using the inductive qualitative thematic analysis method.
Results
Four themes emerged during analyses: “sort of legal,” “mitigating harm through legalization,” “Increasing acceptance,” and “seeking safety when purchasing cannabis.” Despite their limited knowledge of cannabis regulation, the majority of the participants supported recreational cannabis legalization from a harm reduction perspective. Most participants did not believe that cannabis legalization had affected their use behavior. However, participants, especially cannabis users, perceived that recreational cannabis legalization created a context where cannabis use was legally, socially, and behaviorally “safer” than in an illegal context, even for those below the legal age of sale.
Conclusions
Most studies focus on the role of perceived health risk on cannabis use. If there are population-level long-term effects of recreational cannabis legalization on use behavior, findings suggest that they will be mediated by the perceived legal, social, and behavioral risk of using cannabis.
... Previous studies on the effects of cannabis legalization speci cally on young adults' cannabis attitudes and use have been predominately quantitative and often focus on changes in perceived harm or perceived availability [6][7][8][9][10]12 . ...
Background Only July 1, 2017, Nevada became the fifth state to allow the legal sale of recreational cannabis products for adults over the age of 21 years. This study investigates young adults’ cannabis-related attitudes, perceptions, and behaviors in a state where recreational and medical cannabis use was recently legalized.
Methods We conducted 8 focus groups stratified by cannabis use (regular users, occasional users, and nonusers) with 32 college students aged 18 to 24. Data were analyzed using the inductive qualitative thematic analysis method.
Results Four themes emerged during analyses: “sort of legal,” “mitigating harm through legalization,” “cannabis use… less risky and more accepted,” and “seeking safety.” Despite their limited knowledge of cannabis regulation, the majority of the participants supported recreational cannabis legalization from a harm reduction perspective. Most participants did not believe that cannabis legalization had affected their use behavior. However, participants, especially cannabis users, perceived that recreational cannabis legalization created a context where cannabis use was legally, socially, and behaviorally “safer” than in an illegal context, even for those below the legal age of use.
Conclusions Most studies focus on the role of perceived health risk on cannabis use. If there are population-level long-term effects of recreational cannabis legalization on use behavior, findings suggest that they will be mediated by the perceived legal, social, and behavioral risk of using cannabis.
... Social competence training could also reduce the tendency towards drug abuse and alcohol use. This is consistent with the findings of Khaledian et al. [46][47][48][49][50]. Those studies reported the effectiveness of teaching each of the components of social competence in reducing the tendency to use drugs in adolescents and addicts. ...
Objective: High-risk behaviors are seriously threatening health and wellbeing, and increasing the likelihood of physical, psychological, and social consequences. High-risk behaviors, such as tobacco use, drug abuse, alcohol use, or malicious behaviors can endanger the health and wellbeing of adolescents and hinder their success and future growth. Today, the prevalence of high-risk behaviors among adolescents has become one of the most important concerns in society and despite the provisions made in recent years, its rate has increased. One of the vulnerable groups is orphaned/abandoned adolescents who face various social and psychological problems during their stay in welfare bearding centers that requires special skills to deal with. This study aimed to investigate the effect of social competence training on the tendency towards high-risk behaviors in male adolescents living in welfare boarding centers.
Materials & Methods: This is a quasi-experimental study with a pre-test-post-test design. The study population included all male adolescents aged 12-18 years living in welfare boarding centers located in Sabzevar and Mashhad cities in Iran. For sampling, 15 adolescents were selected from a boarding center in Sabzevar City by census method and assigned to the experimental group, and 15 from a boarding center in Mashhad City selected randomly and assigned as controls. The experimental group received social competence training program in twelve 60-min sessions, while the control group received only two 8-hour first aid training. Iranian Adolescents Risk-Taking Scale (IARS) and a demographic form were used to collect data before and after the intervention. The collected data were analyzed by Multivariate Covariance Analysis (MANOVA) in SPSS V. 22.
Results: The mean IARS scores in the experimental group decreased from 93.9 to 86.81 after the intervention, and the t test results indicated a significant difference between the mean scores before and after the intervention (t=2.97, P=0.010). The MANCOVA results revealed a significant difference between the mean overall score of IARS (F=24.08, P
... Past research found that mere mention of chemicals in e-cigarettes was associated with increased perceived risk of e-cigarettes among adults (Owusu et al., 2020;Popova et al., 2017). For youth in our study, this connection did not appear to be as strong. ...
Introduction
Growing rates of e-cigarette use among youth have reached epidemic proportions. Media messages have been deployed to counteract this trend, but their evaluations are lacking. We assessed youth’s and parents’ reactions to various existing e-cigarette prevention messages.
Methods
In 2019, 12 focus groups were conducted with youth (n=63) and parents (n=27). Participants discussed their reactions to 9 existing messages with various topics.
Results
Information on chemicals in e-cigarettes was seen as new and scary, but unknown chemical names created confusion. Youth appreciated novel ways to visualize health effects of e-cigarettes (parasites in the body) and nicotine’s effect on behavior (mood swings), but they cautioned that some of these effects (irritability) are not always caused by nicotine. Some participants did not know if e-cigarette companies were “big tobacco.” Some found it hard to argue with the financial costs of vaping, but others did not think they were too great. Participants recommended messages featuring testimonials from diverse adolescents and messages aimed at youth who are struggling with addiction to e-cigarettes.
Conclusion
Messages would be particularly effective if they featured real youth and did not look like adults created them for youth. Another area that is currently not covered in media messages is talking to youth who are using e-cigarettes and might be already addicted but do not know where to turn for help. These adolescents need to be referred to resources for cessation.
... However, the packaging suggestions drawn from the tobacco control literature must be tested with cannabis due to differences between the two products and their respective users. For instance, cannabis can be used for medical purposes where tobacco is only used recreationally (Popova et al., 2017) and thus, suggestions from the tobacco control literature may appropriately apply to recreational cannabis use. Furthermore, the proportion of daily users of each product differ (more daily tobacco versus cannabis use; Government of Canada, 2019; Statistics Canada, 2019) suggesting exposure to health warnings may not be as frequent for cannabis versus tobacco users. ...
Policy surrounding cannabis legalization is gaining popularity. Legalization must be prescriptive to protect public health. Current Canadian legislative frameworks do not include clear regulations for cannabis package labelling. Regulating cannabis package colors, descriptors, and other brand imagery, as well as using health warnings, are crucial to control cannabis consumption levels. Based on an assessment of the harms linked to cannabis use, an evaluation of existing cannabis and tobacco legislations with respect to packaging labelling, and an extraction of examples from the tobacco labelling literature, this commentary highlights the need for further cannabis legislation in Canada and provides recommendations for cannabis labelling policy.
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... This change begs questions about the population of users of the drug. Such questions are also important in the context of downplaying the effects of marijuana use and treating it as a drug which is safe (Popova et al., 2017, Okaneku et al., 2015 and has less dangerous social effects than alcohol (Rezkalla, Kloner, 2014;Simmons, Carey, 2002). ...
Alcohol and marijuana are the most commonly used psychoactive substances both in Europe and Poland. In the last four years the proportion of marijuana users in the adult population of Gdańsk has almost doubled: from 7.1% in 2015 to 14.1% in 2019. The surveys concerning the consumption of alcohol conducted every four years since 2007 indicate a significant fact: the proportion of people who drink is decreasing. However, this does not mean that they drink less or less often. A question elaborated in this article is whether marijuana users consume more or less alcohol than non-users. This article is based on the data collected in a questionnaire survey on alcohol and other psychoactive substance use conducted in Gdańsk in the autumn of 2019 on a representative sample of 1,004 adult residents of the city.
... Not much is known about how product regulations may shape or change absolute perceptions about cannabis, and to our knowledge, there are no studies that have compared perceptions of relative risk between smoked cannabis and tobacco, particularily among co-users residing in different cannabis policy environments. A study by Popova et al. found that yong adults in Colorado (the first US state to legalize recreational cannabis in 2012) perceive combustion-smoking (including cannabis smoking) as more harmful than non-combustible products (e.g., e-cigarettes, vaporizers and edibles), but there was no comparison between cigarettes and smoked cannabis (Popova et al., 2017). A qualitative study of young adults has suggested that co-users in Maryland (where recreational cannabis is decriminalized, and medical cannabis is legal) relate to their use of both substances in different ways, and may underestimate the harms of tobacco use in relation to their cannabis use, as well as underestimate the harms of cannabis use (Seaman et al., 2019). ...
Background
Although evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization.
Methods
Data are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England.
Results
Among this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent (<monthly) cannabis use. The highest proportion of co-users who smoked daily and used cannabis daily was in the US (34.8%), followed by Canada (30.6%), England (25.8%), and Australia (22.7%). More co-users in the US (78.3%) and Canada (73.6%) perceived smoked cannabis to be less harmful than cigarettes than in Australia (65.5%) and England (60.8%). The majority of co-users who used cannabis in the last 30 days had smoked it (92.3%), with those in England more likely to smoke cannabis (95.7%) compared to Canada (88.6%); there were no other differences between countries (US: 92.0%, Australia: 93.0%). Co-users in England (90.4%) and Australia (86.0%) were more likely to mix tobacco with cannabis than co-users in Canada (38.5%) and the US (22.3%).
Conclusion
Patterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia. Further attention as to how varying cannabis regulations may impact co-use patterns is warranted.
Cannabis use among youth and young adults (YYA) is rising and poses serious mental health risks, especially with the availability of high-potency products. Parents are often the first to observe the potential impacts of cannabis use and are essential in recognizing early warning signs, facilitating treatment, and supporting recovery. However, limited research has examined the perspectives of parents whose children experience severe mental health challenges following cannabis use. To explore parent perspectives, the research team conducted semi-structured interviews with a purposive sample of 13 parents who reported their children used cannabis and experienced mental health issues. Interviews were transcribed and dual coded. A deductive-inductive thematic analysis was used to generate themes. Four themes were identified including (1) cannabis use and mental health, (2) impact on parents and families, (3) treatment experiences, and (4) system recommendations. Parents described how their children’s cannabis use either worsened or appeared to trigger severe mental health crises, which increased emotional and financial burdens on their families. Many encountered health care providers who minimized cannabis-related risks, leading to inadequate support during treatment-seeking efforts. Parents also emphasized a lack of public health warnings and insufficient regulatory oversight, calling for better-informed clinicians and more robust public health messaging. These findings highlight an urgent need for family-supportive behavioral health interventions and regulatory reforms to address cannabis-related mental health issues among YYAs.
Background:
Despite limited scientific evidence, public perceptions of cannabis as health enhancing are significant. As food products, cannabis edibles (edibles), may also leverage food-related associations that convey health. Social media is a prominent and influential source of largely unregulated cannabis information and a potential place to correct misinformation. Given its potential to shape product appeal and perceptions of health benefits and risks, understanding the social media landscape around edibles and health is a priority.
Methods:
We conducted a quantitative content analysis of a random sample of #edibles Instagram posts (N = 702) published in January 2020. A structured coding instrument analyzed posts for: (1) non-food related health, medicine, and wellness content (2) food-related characteristics/associations suggesting edibles are healthy foods or appropriate for particular diets.
Results:
The majority of posts (61%) featured non-food related health, medicine, or wellness content. 35% of posts noted a general health or wellness issue or benefit, while 9% highlighted a medical condition, clinical diagnosis or attendant benefit; a wide range of wellness, health, and clinical issues were cited. Nearly half of all posts (45%) alluded to medicine or being medicated, while 22% referenced medical marijuana specifically. Connections to health were also made through food-related associations, with 13% of posts citing a dietary need or nutrient claim and 10% highlighting food-related characteristics that imply product healthfulness.
Conclusions:
Health-related content is widespread among #edibles Instagram posts. Communication approaches to counter unsubstantiated health claims and regulatory strategies limiting commercial promotion should be considered. Explicit connections between edibles and health and more implicit associations via hashtags and images warrant particular attention.
Aims
The aim of this study is to identify cannabis products according to their appeal among young adults and measure product sales trends.
Design, setting and participants
This was a retrospective comparative study using point‐of‐sale data from licensed recreational cannabis retailers that include buyer age with birth year entered by retailers, set in California, USA. Cannabis purchases by young adults (aged 21–24, GenZ) were compared with older adults (age 25+) over 4 years (2018–21).
Measurements
Sales for six cannabis product categories were analyzed using a commercial data set with imputations and a raw data set. Age‐appeal metrics were dollar and unit sales to young adults, and dollar and unit share ratios (young adults/older adults), where a share ratio of 100 denotes age‐appeal comparability. A product category was considered more young‐adult appealing than others if its mean on a metric was at least one standard deviation above the grand mean across all product categories.
Findings
Flower (cannabis plant material) and vapor pen appealed to young adults based on absolute dollar sales, dominating young‐adult spending compared with other cannabis products (37.24 and 31.83%, respectively). Vapor pen and concentrate appealed to young adults based on dollar share ratios of 152, meaning these products comprised a 52% greater share of young‐adult cannabis spending relative to older‐adult spending (31.83/20.97% and 10.47/6.88%, respectively). Less appealing to young adults were pre‐roll, edible/beverage and absorbable products (tincture/sublingual, capsule and topical). Flower showed the largest dollar sales growth (B = +1.55 million/month). Vapor pen tied for highest growth in the percent of product dollars from the largest package size (B = +0.85%/month) and showed the steepest price decline (B = −0.53 price per gram/month).
Conclusions
In California, USA, from 2018 to 2021, relative to older adults, young adults spent a greater share of their cannabis dollars on vapor pen and concentrate (products with high potency of delta‐9‐tetrahydrocannabinol).
Introduction
The tobacco endgame, policies aiming to end the commercial tobacco epidemic, requires sustained public support, including among youth. We assessed endgame support among California (USA) adolescents, including their reasons and associated participant and policy-specific factors.
Methods
Teens, Nicotine and Tobacco Project online surveys (n=4827) and focus groups were conducted in 2021 and 2022 among California residents aged 12–17 years. Cross-sectional survey participants were asked their agreement level with eight policy statements related to tobacco and/or cannabis sales restrictions, use in public places and use in multiunit housing. Ordered logistic regression modelled level of agreement according to respondent characteristics, behaviours and statement content. Qualitative data were collected through focus groups (n=51 participants), which were analysed to provide insight into support for different policies.
Results
Most survey participants agreed or strongly agreed with tobacco product sales restrictions (72%–75%, depending on the policy), bans on use in public spaces (76%–82%) and smoke-free (79%) and vape-free (74%) apartment buildings. Support was stronger among younger, female, Asian and tobacco non-using participants and for policies directed at ‘tobacco’ (vs ‘vapes’ or cannabis), at flavoured tobacco (compared with all tobacco), and when statements featured ‘should end’ (vs ‘not allowed’). Focus group participants who were supportive viewed policies as protecting children from harmful products, while those less supportive cited concerns about limiting adults’ freedoms and unintended consequences.
Conclusions
Most participants supported strong tobacco control policies. Public communication that promotes broader endgame benefits besides protecting youth and accelerates industry denormalisation may counter youth concerns and further bolster their support.
Marijuana use among U.S. college students is the highest since the mid-1980s. Because knowledge about marijuana and confidence in the knowledge are related to changing marijuana laws and marijuana-related messages ubiquitous in college students’ information environment, we examined their relationships with use. The Structural Equation Modeling method was used to analyze the relationships using survey responses from 249 college students in an adult-use marijuana legal state. Marijuana health knowledge was related to less use, and law knowledge was related to more use. Both relationships were mediated by perceived risk. Confidence in knowledge was related to more use directly as well as indirectly via lower peer disapproval and lower perceived risk. Among various marijuana message channels, peers were the most influential, contributing to lower health knowledge and higher confidence in knowledge.
OBJECTIVE: Non-tobacco blunt wraps (N-TBWs), which entered the marketplace in 2017, are being promoted as an alternative to traditional TBWs (e.g., cigarillos) for blunt smoking. The lack of studies on these novel products warrants an investigation. This study was the first to explore blunt smokers’ perceptions about N-TBWs and the extent of product marketing on Twitter.
METHODS: A corpus of tweets from Twitter, posted between January 2017 and November 2021, were identified by a Boolean search string (N = 149,343), where 48,695 tweets were classified as relevant by a machine learning algorithm. These relevant tweets were further screened and labeled as promotional or organic based on product URLs, usernames, keywords, or hashtags. Topic modeling using Dirichlet Allocation was then employed for identifying latent patterns of words among relevant tweets. The Social Networking Potential (SNP) score was employed for identifying influential accounts.
RESULTS: Most relevant tweets (89%) were organic, non-promotional expressions about N-TBWs. Account users who only posted non-promotional tweets had a significantly higher SNP than those who only posted promotional tweets. Yet, neither of the two groups of account users consisted of known celebrities. Topic modeling revealed three broad groups of topics (7 in total) denoting the attributes of hemp N-TBWs, interest in non-hemp N-TBWs, and product marketing.
CONCLUSIONS: The large proportion of organic tweets is indicative of the nascency of N-TBWs, which will need to be marketed more extensively if they are to replace cigar products used by blunt smokers.
Background: With more states legalizing recreational cannabis, examining cannabis retail and marketing is crucial, as it may influence consumers' perceptions and behaviors. Particularly understudied is online cannabis retail. Methods: In Spring 2022, coders collected and analyzed data regarding retailer characteristics, age verification, and marketing strategies (e.g., product availability, health-related content, promotions, website imagery) among 195 cannabis retail websites in five U.S. cities (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive analyses characterized the websites overall and across cities. Results: Overall, 80.5% verified age for website entry, and 92.8% offered online purchases (92.3% of retailers in Seattle, where prohibited). Of these, 82.9% required age verification for purchases, and 30.9% offered delivery. Almost all (>92%) offered flower/bud, concentrates, edibles, vaping devices, topicals, and tinctures. Health warnings were displayed on 38.3% of websites. Although all five states required health warnings regarding use during pregnancy, only 10.3% had these warnings. In addition, 59.0% posted some unsubstantiated health claims, most often indicating physical and mental health benefits (44.6%). Although Colorado, Washington, and Oregon prohibit health claims, 51.2-53.8% of these retailers posted them. Discounts, samples, or promotions were present on 90.8% of websites; 63.6% had subscription/membership programs. Subpopulations represented in website content included the following: 27.2% teens/young adults, 26.2% veterans, 7.2% sexual/gender minorities, and 5.6% racial/ethnic minorities. Imagery also targeted young people (e.g., 29.7% party/cool/popularity, 18.5% celebrity/influencer endorsement). Conclusions: Regulatory efforts are needed to better monitor promotional strategies and regulatory compliance (e.g., health claims, youth-oriented content, underage access) among online cannabis retailers.
Purpose:
As recreational cannabis is legalized, it is critical to know the impacts of legalization on youth cannabis use. Existing research generates conflicting results and does not shed light on channels of effects. This study investigates the impacts of legalization on youth cannabis initiation and overall cannabis use prevalence.
Methods:
We used Interrupted Time Series design and data from nationally-representative repeated cross-sectional Canadian surveys spanning 16 years. The primary outcomes were cannabis initiation rates and cannabis use prevalence among youths. The secondary outcomes were self-reported age of first cannabis use, ease of cannabis access, and perception of cannabis harm among youths.
Results:
After legalization, cannabis initiation rate among youths was 2.7 percentage points (95% confidence interval: 1.7-3.7; p < .01) or 69% higher, although there was no significant increase in the overall prevalence of cannabis use. Furthermore, there was a 4-month delay in the average age of first cannabis use among youths aged 17-18 years (95% confidence interval: 2.6-5.5 months; p < .01). The legalization was associated with greater perception of cannabis harm but also easier access to cannabis.
Discussion:
The impacts of legalization on youth cannabis use after 1 year are mixed. Although we observed an increase in cannabis initiation among youths who had never used cannabis, there was no change in the overall prevalence of cannabis use, implying a possible offsetting increase in cannabis cessation among existing users. To achieve legalization's goal of reducing youth cannabis use, policy measures are needed to curb youth cannabis access and initiation.
The outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) has been cause for concern to the medical community, particularly given that this novel illness has coincided with the COVID-19 pandemic, another cause of severe pulmonary illness. Though cannabis e-cigarettes tainted with vitamin E acetate were primarily associated with EVALI, acute lung injuries stemming from cannabis inhalation were reported in the literature prior to 2019, and it has been suggested that cannabis components or additives other than vitamin E acetate may be responsible. Despite these concerning issues, novel cannabis vaporizer ingredients continue to arise, such as Δ8-tetrahydrocannabinol, Δ10-tetrahydrocannabinol, hexahydrocannabinol, and cannabichromene. In order to address cannabis e-cigarette safety and vaping in an effective manner, we provide a comprehensive knowledge of the latest products, delivery modes, and ingredients. This perspective highlights the types of cannabis vaping modalities common to the United States cannabis market, with special attention to cartridge-type cannabis e-cigarette toxicology and their involvement in the EVALI outbreak, in particular, acute lung injurious responses. Novel ingredient chemistry, origins, and legal statuses are reviewed, as well as the toxicology of known cannabis e-cigarette aerosol components.
Abstarct
Background
Given changes in marijuana regulations, retail, and products and potential impact on use, we examined young-adult perceptions of different modes of use, the proportion using via different modes (e.g. smoking, vaping, ingesting), and associations with the use levels and stability of use over time.
Methods
We analyzed baseline and one-year follow-up survey data (Fall 2018–2019) among 3,006 young adults (ages 18–34) across six metropolitan areas (Atlanta, Boston, Minneapolis-St. Paul, Oklahoma City, San Diego, Seattle). Measures included marijuana use frequency and mode, sociodemographics, other substance use, and social influences.
Results
Participants’ rated the following modes of use as: least harmful/addictive: topicals, oral pills, joint/bowl; most socially acceptable: joint/bowl, edibles/beverages, vaporized; and most harmful/addictive and least acceptable: wrapped, vaped, or waterpipe/bong with tobacco. Baseline past-month use prevalence was 39.2% (n = 1,178). Most frequent use mode was smoking (joints/bowls/cigar papers; 54.0%), vaping (21.8%), via pipe/bong (15.1%), and ingesting (9.1%). Multinomial logistic regression indicated that participants in states with legalized marijuana retail were at greater odds for using via modes other than smoking; participants more frequently using were at greater odds for using via pipe/bong (vs. smoking) (ps < .001). Regarding most frequent mode across time, most consistent was pipe/bong (53.3%), followed by smoking (49.3%), vaping (44.5%), and ingesting (32.9%). Past-month abstinence at follow-up was most common among those originally ingesting (34.3% abstinent), followed by smoking (23.6%), vaping (18.8%), and pipe/bong (14.8%).
Conclusions
Ongoing surveillance is needed to understand marijuana use patterns over time across different user groups (particularly by mode) and to inform interventions promoting abstinence.
Background
Legalization of medical and recreational cannabis in US states has been accompanied by increases in availability, acceptability, and diversity in methods of cannabis use, as well as an increase in devices and methods for cannabis-tobacco co-use. Updated and specific survey measures of cannabis and cannabis-tobacco co-use are needed.
Methods
We employed a mixed-methods approach to identify sources of specification and measurement error in cannabis and cannabis-tobacco co-use measures. We surveyed and interviewed 36 young adult (age 18-29) cannabis and tobacco co-users in California (2017-2018), triangulated with document analysis of online cannabis websites and forums. We investigated how survey reports of cannabis use and cannabis-tobacco co-use compare to narrative descriptions provided during in-depth interviews. We identify key strategies for researchers collecting self-reported survey data to enhance accuracy and comprehensiveness of measures.
Findings
Potential sources of survey error included: broad variation in cannabinoid content and concentration, inconsistent interpretation of questions between participants and researchers (e.g. blunts were not considered co-use), and substantial variation in dosage within and between products. No evidence of survey recall bias or response editing was detected.
Conclusion
To enhance survey accuracy, we recommend surveys specify which cannabis delivery methods and forms are included and excluded in each measure, differentiate between cannabis products, and explicitly include or exclude CBD product use.
Objective:
In 2017, the US Food and Drug Administration (FDA) announced a proposed regulation to lower nicotine in cigarettes to minimally addictive levels to help smokers quit. We sought to explore effective message strategies communicating about nicotine reduction in cigarettes across the different key audiences that the regulation is most likely to influence.
Methods:
We designed four types of messages: efficacy messages, risk messages, a message about alternative sources of nicotine and a compensation message. Sixteen virtual focus groups were conducted in Atlanta and San Francisco in April–May 2020. Data were analysed in NVivo 12.0 using a thematic analysis approach.
Findings:
Exclusive smokers were receptive to both efficacy messages and risk messages. Dual users were the only group that was open to resorting to alternative sources of nicotine. Former smokers were critical of these messages as promoting the new kinds of cigarettes and potentially encouraging initiation and relapse of smoking. Non-smokers felt that efficacy messages downplayed the risks of smoking and did not scare people away from smoking. Presenting information that very low nicotine cigarettes (VLNCs) still contain harmful chemicals made smokers question continued smoking in the absence of nicotine and view VLNCs as harmful.
Conclusions:
Messages communicating about nicotine reduction in cigarettes might help to motivate smokers to quit and can correct the misperceptions that VLNCs are less harmful. The FDA should consider specific target audiences and use different messages that complement each other in communicating about this regulation.
Objectives
E-cigarette use is growing among New Zealand young people, yet their perceptions of the harms of e-cigarette use are unknown. This study aimed to determine domains and specific items for inquiry to inform the creation of a questionnaire assessing the perceptions of harms of e-cigarette use in this group.
Materials and Methods
An integrative literature review generated a preliminary list of survey items and domains. A Delphi study involving 6 expert academics was undertaken to verify and refine this list. The consensus was facilitated through online, structured communication.
Results
Previous data collection attempts included items assessing participants’ knowledge of e-cigarettes, their current e-cigarette and cigarette use, and how harmful they perceived e-cigarettes to be relative to cigarettes. The Delphi study refined the initial list of items while contributing additional considerations. A total of 54 items were organized into 7 domains: “E-cigarette Knowledge,” “Cigarette Use,” “E-cigarette Use,” “E-cigarette Relative Harm,” “E-cigarette Promotion,” “Acceptability (E-cigarettes and Cigarettes)”, and (“General Introduction”) items on participants’ identity characteristics (gender, age, ethnicity).
Conclusions
Each of the items will inform the design of a questionnaire assessing New Zealand young people’s perceptions of the harms of e-cigarette use. Development of these items will involve further literature reviewing, focus groups with end-users, and a pilot study.
Background: While cannabis is the most commonly used illicit substance, few studies have focused on the relationship between sociodemographic factors and preference for primary form or method of cannabis use.
Methods: The ‘Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory’ was used to collect information on the primary form and method of cannabis use in young adults ages 18 to 25 and adults 26 and older. Chi-square analysis was used to examine differences by age and sex (n = 852; n = 536 male).
Results: Young adults were more likely to report using bongs, vaporizers, and edibles, while older participants were more likely to report using blunts. Males were more likely to report marijuana, while females were more likely to report edibles as their primary form of cannabis use. Males were more likely to report using blunts, while females were more likely to report using joints and edibles.
Conclusions: Findings from this study suggest there are significant effects of age and sex on primary form and method of cannabis use. Future studies should examine how personality and environmental influences may affect preferences for forms and methods of cannabis use and how these affect long-term health outcomes.
In recent years, marijuana use on U.S. college campuses reached the highest point while the perceptions of risk and social disapproval registered the lowest since the early 1980s. However, little attention has been paid to the sources of the marijuana-related messages and their relationships with marijuana knowledge and confidence in knowledge, proximate protective/risk factors. To fill this gap, a convenience sample of students (N = 249) on a campus located in a U.S. recreational marijuana legal state were surveyed to identify their marijuana information sources and explore the relationships among the sources, confidence in marijuana knowledge, and objective knowledge. Peers/media were the most important sources and they were used more than other sources. Use of peers/media sources was related to lower health knowledge and higher confidence in knowledge. Although students named parents and education/science sources as important, these were less frequently used than siblings, the sources they named as the least important. This study advanced our understanding of the various sources of marijuana information used by U.S. college students and the relationships between the information sources and confidence in knowledge and objective knowledge, two emerging risk/protective factors in the era of marijuana deregulation.
Different patterns of cannabis use can be traced directly back to different interactions between 2 types of variables: pharmacological and environmental. As legal cannabis expands in the U.S. and around the world, state and national regulatory agencies are gaining control over these variables. Specifically, regulatory agencies are increasingly capable of altering (a) the pharmacological properties of cannabis products and (b) the way these products are distributed to the population. Consequently, cannabis regulatory agencies are in a unique position to use evidence from psychological science to alter cannabis consumption patterns in ways that mitigate potential harm to public health. However, most state-level legal cannabis regulatory systems in the U.S. are not yet evidence-based or public health-oriented. This applied review and commentary draws on evidence from the psychological science literature to help regulators better understand the types of behaviors they must address and guide empirically supported regulation of THC-laden cannabis, whether used putatively for medical or recreational reasons. This review is organized into 3 parts that correspond to the 3 primary agents within the cannabis regulation ecosystem: (a) the cannabis consumer, (b) the cannabis industry, and (c) the cannabis regulatory agency. Within this structure, the review addresses critical psychological variables that drive cannabis consumer and industry behaviors and discusses how regulatory agencies can use this information to protect public health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Actualmente, la población joven en nuestro país ha sufrido las consecuencias de la crisis económica en etapas distintas de su trayectoria vital. Para unos pudo suponer el abandono de estudios superiores, para otros la búsqueda infructuosa de su primer empleo, para otros la pérdida del empleo, o el retraso de la emancipación y formación de una familia. Estas situaciones pueden tener consecuencias relevantes en la salud mental, y en los hábitos de la población joven con potenciales efectos acumulativos que condicionarán su vida adulta. Conocer los efectos de la crisis y la austeridad en la salud (física, mental, hábitos y riesgos) de los jóvenes de 18 a 34 años es fundamental. Nuestro proyecto defiende además que estos efectos no tienen lugar en el vacío. Solo entendiendo mejor cómo interactúan en este colectivo los determinantes de la salud y el peso de factores como entorno, capital social, familia, escuela, trabajo, ocio y medios de comunicación podemos diseñar políticas correctivas, tanto universales como específicas, que tengan el doble objetivo de (i) mejorar la salud y los hábitos saludables de este los jóvenes, y (ii) corregir las desigualdades sociales ante la salud.
Background
Despite public awareness that tobacco secondhand smoke (SHS) is harmful, many people still assume that marijuana SHS is benign. Debates about whether smoke‐free laws should include marijuana are becoming increasingly widespread as marijuana is legalized and the cannabis industry grows. Lack of evidence for marijuana SHS causing acute cardiovascular harm is frequently mistaken for evidence that it is harmless, despite chemical and physical similarity between marijuana and tobacco smoke. We investigated whether brief exposure to marijuana SHS causes acute vascular endothelial dysfunction.
Methods and Results
We measured endothelial function as femoral artery flow‐mediated dilation (FMD) in rats before and after exposure to marijuana SHS at levels similar to real‐world tobacco SHS conditions. One minute of exposure to marijuana SHS impaired FMD to a comparable extent as impairment from equal concentrations of tobacco SHS, but recovery was considerably slower for marijuana. Exposure to marijuana SHS directly caused cannabinoid‐independent vasodilation that subsided within 25 minutes, whereas FMD remained impaired for at least 90 minutes. Impairment occurred even when marijuana lacked cannabinoids and rolling paper was omitted. Endothelium‐independent vasodilation by nitroglycerin administration was not impaired. FMD was not impaired by exposure to chamber air.
Conclusions
One minute of exposure to marijuana SHS substantially impairs endothelial function in rats for at least 90 minutes, considerably longer than comparable impairment by tobacco SHS. Impairment of FMD does not require cannabinoids, nicotine, or rolling paper smoke. Our findings in rats suggest that SHS can exert similar adverse cardiovascular effects regardless of whether it is from tobacco or marijuana.
Cannabis and tobacco are common drugs of abuse worldwide and are often used in combination through various routes of administration (ROAs). Here, we aimed to provide an overview of how cannabis and tobacco routes varied across countries and assess the impact of tobacco-based ROAs on motivation to use less cannabis, and less tobacco, in different models. A cross-sectional online survey (Global Drugs Survey 2014) was completed by 33,687 respondents (mean age = 27.9; % female = 25.9) who smoked cannabis at least once in the last 12 months. Most common ROA, frequency of cannabis/tobacco use, and questions about motivation to use less cannabis/tobacco were recorded. Tobacco-based ROA were used by 65.6% of respondents. These were most common in Europe (77.2–90.9%) and Australasia (20.7–51.6%) and uncommon in the Americas (4.4–16.0%). Vaporizer use was most common in Canada (13.2%) and the United States (11.2%). Using a non-tobacco ROA was associated with a 10.7% increase in odds for “desire to use less” tobacco (OR: 1.107, 95% CI: 1.003, 1.221), 80.6% increase in odds for “like help to use less tobacco” (OR: 1.806, 95% CI: 1.556, 2.095), and a 103.9% increase in the odds for “planning to seek help to use less tobacco” (OR: 2.039, 95% CI: 1.638, 2.539), in comparison to using a tobacco-based ROA. Associations between ROA and intentions to use less cannabis were inconsistent. Results support considerable global variation in cannabis and tobacco ROA. Tobacco routes are common, especially “joints with tobacco,” especially in Europe, but not in the Americas. Non-tobacco-based routes are associated with increased motivation to change tobacco use. Interventions addressing tobacco and cannabis need to accommodate this finding and encourage non-tobacco routes.
Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK.
Method Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance.
Findings MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.
Interpretation These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.
Objectives:
We sought to investigate adolescents' and adults' perceptions of an American Spirit advertisement with 'natural', 'organic' and 'additive-free' descriptors and related disclaimers.
Methods:
We conducted nine focus group discussions in the Southern USA, with 59 participants aged 13-64 years (30 male, 29 female), stratified by age, smoking status and susceptibility to smoking. We conducted thematic content analysis of the transcripts.
Results:
Many participants were sceptical or confused about the 'natural', 'organic' and 'additive-free' descriptors. Many participants viewed American Spirit cigarettes as being less, or possibly less harmful than other cigarettes, even though the ad contained disclaimers explicitly stating that these cigarettes are not safer. Some participants said that people tend to ignore disclaimers, a few expressed doubt that the disclaimers were fully true, and others did not notice the disclaimers. A few smokers said they smoke American Spirit cigarettes because they think they are not as bad for them as other cigarettes.
Conclusions:
Disclaimers intended to prevent consumers from attributing a health benefit to cigarettes labelled as 'natural', 'additive-free', or 'organic' may be insufficient. A ban on these descriptors may be a more appropriate remedy than disclaimers.
In recent years, electronic cigarettes (e-cigarettes) have generated considerable interest and debate on the implications for tobacco control and public health. Although the rapid growth of e-cigarettes is global, at present, little is known about awareness and use. This paper presents self-reported awareness, trial and current use of e-cigarettes in 10 countries surveyed between 2009 and 2013; for six of these countries, we present the first data on e-cigarettes from probability samples of adult smokers.
A cross-sectional analysis of probability samples of adult (≥ 18 years) current and former smokers participating in the International Tobacco Control (ITC) surveys from 10 countries. Surveys were administered either via phone, face-to-face interviews, or the web. Survey questions included sociodemographic and smoking-related variables, and questions about e-cigarette awareness, trial and current use.
There was considerable cross-country variation by year of data collection and for awareness of e-cigarettes (Netherlands (2013: 88%), Republic of Korea (2010: 79%), United States (2010: 73%), Australia (2013: 66%), Malaysia (2011: 62%), United Kingdom (2010: 54%), Canada (2010: 40%), Brazil (2013: 35%), Mexico (2012: 34%), and China (2009: 31%)), in self-reports of ever having tried e-cigarettes (Australia, (20%), Malaysia (19%), Netherlands (18%), United States (15%), Republic of Korea (11%), United Kingdom (10%), Mexico (4%), Canada (4%), Brazil (3%), and China (2%)), and in current use (Malaysia (14%), Republic of Korea (7%), Australia (7%), United States (6%), United Kingdom (4%), Netherlands (3%), Canada (1%), and China (0.05%)).
The cross-country variability in awareness, trial, and current use of e-cigarettes is likely due to a confluence of country-specific market factors, tobacco control policies and regulations (e.g., the legal status of e-cigarettes and nicotine), and the survey timing along the trajectory of e-cigarette awareness and trial/use in each country. These ITC results constitute an important snapshot of an early stage of what appears to be a rapid progression of global e-cigarette use.
As marijuana use becomes legal in some states, the dominant public opinion is that marijuana is a harmless source of mood alteration. Although the harms associated with marijuana use have not been well studied, enough information is available to cause concern.
Electronic cigarettes (e-cigarettes) are products that deliver a nicotine-containing aerosol (commonly called vapor) to users by heating a solution typically made up of propylene glycol or glycerol (glycerin), nicotine, and flavoring agents (Figure 1) invented in their current form by Chinese pharmacist Hon Lik in the early 2000s.1 The US patent application describes the e-cigarette device as “an electronic atomization cigarette that functions as substitutes [sic] for quitting smoking and cigarette substitutes” (patent No. 8,490,628 B2). By 2013, the major multinational tobacco companies had entered the e-cigarette market. E-cigarettes are marketed via television, the Internet, and print advertisements (that often feature celebrities)2 as healthier alternatives to tobacco smoking, as useful for quitting smoking and reducing cigarette consumption, and as a way to circumvent smoke-free laws by enabling users to “smoke anywhere.”3
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Recent reports show that fewer adolescents believe that regular cannabis use is harmful to health. Concomitantly, adolescents are initiating cannabis use at younger ages, and more adolescents are using cannabis on a daily basis. The purpose of the present study was to test the association between persistent cannabis use and neuropsychological decline and determine whether decline is concentrated among adolescent-onset cannabis users. Participants were members of the Dunedin Study, a prospective study of a birth cohort of 1,037 individuals followed from birth (1972/1973) to age 38 y. Cannabis use was ascertained in interviews at ages 18, 21, 26, 32, and 38 y. Neuropsychological testing was conducted at age 13 y, before initiation of cannabis use, and again at age 38 y, after a pattern of persistent cannabis use had developed. Persistent cannabis use was associated with neuropsychological decline broadly across domains of functioning, even after controlling for years of education. Informants also reported noticing more cognitive problems for persistent cannabis users. Impairment was concentrated among adolescent-onset cannabis users, with more persistent use associated with greater decline. Further, cessation of cannabis use did not fully restore neuropsychological functioning among adolescent-onset cannabis users. Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents.
In Australia, introduction of pictorial health warnings on cigarette packets was supported by a televised media campaign highlighting illnesses featured in two of the warning labels--gangrene and mouth cancer.
Two studies examined whether the warnings and the television advertisements complemented one another. Population telephone surveys of two cross-sections of adult smokers measured changes in top-of-mind awareness of smoking-related health effects from before (2005; n=587) to after the pack warnings were introduced (2006; n=583). A second study assessed cognitive and emotional responses and intentions to quit after smokers watched one of the campaign advertisements, comparing outcomes of those with and without prior pack warning exposure.
Between 2005 and 2006, the proportion of smokers aware that gangrene is caused by smoking increased by 11.2 percentage points (OR=23.47, p=0.000), and awareness of the link between smoking and mouth cancer increased by 6.6 percentage points (OR=2.00, p=0.006). In contrast, awareness of throat cancer decreased by 4.3 percentage points, and this illness was mentioned in the pack warnings but not the advertisements. In multivariate analyses, smokers who had prior exposure to the warnings were significantly more likely to report positive responses to the advertisements and stronger post-exposure quitting intentions.
Television advertisements and pictorial health warnings on cigarette packets may operate in a complementary manner to positively influence awareness of the health consequences of smoking and motivation to quit. Jurisdictions implementing pictorial warnings should consider the benefits of supportive mass media campaigns to increase the depth, meaning and personal relevance of the warnings.
Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK.
Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance.
MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.
These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.
Centre for Crime and Justice Studies (UK).
To describe the extent of the tobacco industry involvement in establishing international standards for tobacco and tobacco products and the industry influence on the International Organization for Standardization (ISO).
Analysis of tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement. Search words included "ISO", "CORESTA", "Barclay", "compensation and machine smoking", "tar and nicotine deliveries", and the name of key players, in different combinations.
It is clear that the tobacco industry, through the Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA), play a major role in determining the scientific evidence and suggesting the standards that are eventually adopted as international standards for tobacco and tobacco products in several areas, including the measurement of cigarette tar and nicotine yield.
ISO's tobacco and tobacco products standards are not adequate to guide tobacco products regulatory policies, and no health claims can be made based on ISO's tobacco products standards. There is an urgent need for tobacco control advocates and groups worldwide to be more involved with the work of the ISO, both directly and through their national standardisation organisations.
We report six cases of possible acute cardiovascular death in young adults, where very recent cannabis ingestion was documented by the presence of tetrahydrocannabinol (THC) in postmortem blood samples. A broad toxicological blood analysis could not reveal other drugs. Similar cases have been reported in the literature, but the toxicological analysis has been absent or limited to urine samples, which represent a much broader time window for cannabis intake. This paper presents six case reports, where cannabis alone was detected in blood. Further, an overview over previously published cases, clinical trials and possible patho-physiological mechanisms are presented.
Cognitive impairments are associated with long-term cannabis use, but the parameters of use that contribute to impairments and the nature and endurance of cognitive dysfunction remain uncertain.
To examine the effects of duration of cannabis use on specific areas of cognitive functioning among users seeking treatment for cannabis dependence.
Multisite retrospective cross-sectional neuropsychological study conducted in the United States (Seattle, Wash; Farmington, Conn; and Miami, Fla) between 1997 and 2000 among 102 near-daily cannabis users (51 long-term users: mean, 23.9 years of use; 51 shorter-term users: mean, 10.2 years of use) compared with 33 nonuser controls.
Measures from 9 standard neuropsychological tests that assessed attention, memory, and executive functioning, and were administered prior to entry to a treatment program and following a median 17-hour abstinence.
Long-term cannabis users performed significantly less well than shorter-term users and controls on tests of memory and attention. On the Rey Auditory Verbal Learning Test, long-term users recalled significantly fewer words than either shorter-term users (P =.001) or controls (P =.005); there was no difference between shorter-term users and controls. Long-term users showed impaired learning (P =.007), retention (P =.003), and retrieval (P =.002) compared with controls. Both user groups performed poorly on a time estimation task (P<.001 vs controls). Performance measures often correlated significantly with the duration of cannabis use, being worse with increasing years of use, but were unrelated to withdrawal symptoms and persisted after controlling for recent cannabis use and other drug use.
These results confirm that long-term heavy cannabis users show impairments in memory and attention that endure beyond the period of intoxication and worsen with increasing years of regular cannabis use.
To determine whether cannabis use in adolescence predisposes to higher rates of depression and anxiety in young adulthood.
Seven wave cohort study over six years.
44 schools in the Australian state of Victoria.
A statewide secondary school sample of 1601 students aged 14-15 followed for seven years.
Interview measure of depression and anxiety (revised clinical interview schedule) at wave 7.
Some 60% of participants had used cannabis by the age of 20; 7% were daily users at that point. Daily use in young women was associated with an over fivefold increase in the odds of reporting a state of depression and anxiety after adjustment for intercurrent use of other substances (odds ratio 5.6, 95% confidence interval 2.6 to 12). Weekly or more frequent cannabis use in teenagers predicted an approximately twofold increase in risk for later depression and anxiety (1.9, 1.1 to 3.3) after adjustment for potential baseline confounders. In contrast, depression and anxiety in teenagers predicted neither later weekly nor daily cannabis use.
Frequent cannabis use in teenage girls predicts later depression and anxiety, with daily users carrying the highest risk. Given recent increasing levels of cannabis use, measures to reduce frequent and heavy recreational use seem warranted.
Food labeling requirements specify the product information that is mandated by law and provide the criteria for furnishing additional information, including eligibility, form, placement, disclosures, and substantiation. Claims that promote the nutritional value, ingredient quality, and health-related benefits of food have increased significantly in recent years because of consumer interest and competitive pressure. This has resulted in more enforcement actions by regulatory agencies and public prosecutors, challenges raised through industry self-regulatory bodies, and a flood of class action lawsuits for false, misleading, or deceptive claims brought by private plaintiffs under state consumer protection laws. In many instances, litigation follows enforcement actions by regulatory agencies. Therefore, a legal review of a company’s labeling is critical and should have broader scope than in the past, taking into account both regulatory and litigation developments.
The Food and Drug Administration (FDA) is issuing this final rule to deem products meeting the statutory definition of "tobacco product,'' except accessories of the newly deemed tobacco products, to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). The Tobacco Control Act provides FDA authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products that the Agency by regulation deems to be subject to the law. With this final rule, FDA is extending the Agency's "tobacco product'' authorities in the FD&C Act to all other categories of products that meet the statutory definition of "tobacco product" in the FD&C Act, except accessories of such newly deemed tobacco products. This final rule also prohibits the sale of "covered tobacco products" to individuals under the age of 18 and requires the display of health warnings on cigarette tobacco, roll-your own tobacco, and covered tobacco product packages and in advertisements. FDA is taking this action to reduce the death and disease from tobacco products. In accordance with the Tobacco Control Act, we consider and intend the extension of our authorities over tobacco products and the various requirements and prohibitions established by this rule to be severable.
Heightened public interest in marijuana and marijuana-infused products for medicinal and recreational purposes led the nation’s state medical and osteopathic boards recently to issue recommendations about marijuana in patient care and a cautionary note advising actively licensed physicians to abstain from using marijuana while practicing medicine.¹ This is the first time that the dispensing or use of products derived from the Cannabis sativa plant have been highlighted in a policy recommendation of the Federation of State Medical Boards (FSMB), whose members include 70 state and territorial medical licensing boards of the United States. We examine the dilemma of physicians caught between increasingly permissive local statutes and prohibitive federal regulations and summarize 10 recommendations about marijuana for patient care from the agencies authorized by statute to protect the health and welfare of the public through the licensure and discipline of physicians and other health care professionals.
Commentary to: Considering marijuana legalization carefully: insights for other jurisdictions from analysis for Vermont
Policies legalizing marijuana for medical and recreational use have been increasing in the U.S. Considering the potential impact of these policies, important knowledge gaps exist, including information about the prevalence of various modes of marijuana use (e.g., smoked in joints, bowls, bongs; consumed in edibles or drinks) and about medical versus recreational use. Accordingly, this study assessed (1) prevalence and correlates of modes of current and ever marijuana use and (2) prevalence of medicinal and recreational marijuana use in U.S. adults.
Data came from Summer Styles (n=4,269), a nationally representative consumer panel survey of adults aged ≥18 years, collected in 2014. The survey asked about past 30-day (current) and ever mode of marijuana use and current reason for use (medicinal, recreational, both). Weighted prevalence estimates were computed and correlates were assessed in 2014 using logistic regression.
Overall, 7.2% of respondents reported current marijuana use; 34.5% reported ever use. Among current users, 10.5% reported medicinal-only use, 53.4% reported recreational-only use, and 36.1% reported both. Use of bowl or pipe (49.5%) and joint (49.2%) predominated among current marijuana users, with lesser use of bong, water pipe, or hookah (21.7%); blunts (20.3%); edibles/drinks (16.1%); and vaporizers (7.6%); 92.1% of the sample reported combusted-only marijuana use.
Combusted modes of marijuana use are most prevalent among U.S. adults, with a majority using marijuana for recreation. In light of changing policies and patterns of use, improved marijuana surveillance is critical for public health planning.
Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.
Introduction:
Flavored little cigar and cigarillo (LCC) smoking prevalence rate is increasing among young adults; little is known about their comprehension of its risks. To inform tobacco control regulatory policy and prevention methods, we explored young adult smokers’ risk perceptions of flavored LCC products and its use.
Methods:
Purposive samples (n = 90) of African American, Hispanic, and white young adults who self-identified as dual (smoked ≥ 1 LCC and cigarette in past 30 days) and cigarette-only (≥1 cigarette in past 30 days) smokers participated in 12 audiotaped focus groups and a semi-structured interview conducted in the Southeastern United States. Participants discussed their experiences smoking flavored LCCs and perceived health risks of smoking flavored LCCs. A brief survey was administered to characterize participants.
Results:
The participants had a mean age of 25.1 years (SD = 4.5), were majority male (53.1%), and were 60.0% African American, 29.5% white, and 17.5% Hispanic. Along with health risks and addiction, three major themes emerged as underlying contributors of risk perceptions: affect, participants’ smoking practices (amount smoked and inhalation), and beliefs about the components of LCCs (including flavoring and filters). Participants’ reported intention to smoke flavored LCCs with its tobacco or as blunts (filled with marijuana) also influenced perceptions. Flavored LCCs were viewed along a continuum of risks compared to cigarettes and blunt smoking.
Conclusions:
Our study revealed dimensions that were important for the formation of risk perceptions about flavored LCCs. A multidimensional conceptual model and a measure of risk perceptions that is inclusive of these dimensions should be developed and examined for LCC use patterns.
Although rates of adolescent cigarette use have remained constant or decreased, rates of marijuana and e-cigarette use are rising. Knowledge and perceptions of risks and benefits of tobacco products impact adolescents' decisions to use these products. However, little is known regarding adolescents' knowledge and perceptions of risks of e-cigarettes and marijuana nor how these perceptions are formed. This study uses qualitative techniques to assess and compare adolescents' perceptions of the risks and benefits of cigarettes, e-cigarettes, and marijuana.
Twenty-four adolescents (nine females and 15 males) from Northern California participated in six small-group discussions. Adolescents were asked what good or bad things might happen from using these products. To assess how perceptions and knowledge of risks and benefits were formed, participants were asked where and from whom they had learned about these products.
Adolescents described negative consequences of cigarette use but were much less sure regarding risks of marijuana and e-cigarette use. Conversely, they described few benefits of cigarettes but described a number of benefits of e-cigarette and marijuana use. Adolescents described learning about these products from the media, from family and friends, and from the school environment.
Adolescents have learned from multiple sources about risks of using cigarettes, but they receive much less and often incorrect information regarding marijuana and e-cigarettes, likely resulting in their positive and often ambivalent perceptions of marijuana and e-cigarettes.
Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
A major challenge in assessing the public health impact of legalising cannabis use in Colorado and Washington State is the absence of any experience with legal cannabis markets. The Netherlands created a de facto legalised cannabis market for recreational use, but policy analysts disagree about how it has affected rates of cannabis use. Some US states have created de facto legal supply of cannabis for medical use. So far this policy does not appear to have increased cannabis use or cannabis-related harm. Given experience with more liberal alcohol policies, the legalisation of recreational cannabis use is likely to increase use among current users. It is also likely that legalisation will increase the number of new users among young adults but it remains uncertain how many may be recruited, within what time frame, among which groups within the population, and how many of these new users will become regular users. This article is protected by copyright. All rights reserved.
© 2015 American Society for Clinical Pharmacology and Therapeutics.
Context Cognitive impairments are associated with long-term cannabis use, but
the parameters of use that contribute to impairments and the nature and endurance
of cognitive dysfunction remain uncertain.Objective To examine the effects of duration of cannabis use on specific areas
of cognitive functioning among users seeking treatment for cannabis dependence.Design, Setting, and Participants Multisite retrospective cross-sectional neuropsychological study conducted
in the United States (Seattle, Wash; Farmington, Conn; and Miami, Fla) between
1997 and 2000 among 102 near-daily cannabis users (51 long-term users: mean,
23.9 years of use; 51 shorter-term users: mean, 10.2 years of use) compared
with 33 nonuser controls.Main Outcome Measures Measures from 9 standard neuropsychological tests that assessed attention,
memory, and executive functioning, and were administered prior to entry to
a treatment program and following a median 17-hour abstinence.Results Long-term cannabis users performed significantly less well than shorter-term
users and controls on tests of memory and attention. On the Rey Auditory Verbal
Learning Test, long-term users recalled significantly fewer words than either
shorter-term users (P = .001) or controls (P = .005); there was no difference between shorter-term
users and controls. Long-term users showed impaired learning (P = .007), retention (P = .003), and retrieval
(P = .002) compared with controls. Both user groups
performed poorly on a time estimation task (P<.001
vs controls). Performance measures often correlated significantly with the
duration of cannabis use, being worse with increasing years of use, but were
unrelated to withdrawal symptoms and persisted after controlling for recent
cannabis use and other drug use.Conclusions These results confirm that long-term heavy cannabis users show impairments
in memory and attention that endure beyond the period of intoxication and
worsen with increasing years of regular cannabis use.
Background:
There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years.
Objectives:
This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions.
Methods:
In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products.
Results:
Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance: Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.
Marijuana is the most widely used illicit drug, with approximately 200 million users worldwide. Once illegal throughout the United States, cannabis is now legal for medicinal purposes in several states and for recreational use in 3 states. The current wave of decriminalization may lead to more widespread use, and it is important that cardiologists be made aware of the potential for marijuana-associated adverse cardiovascular effects that may begin to occur in the population at a greater frequency. In this report, the investigators focus on the known cardiovascular, cerebrovascular, and peripheral effects of marijuana inhalation. Temporal associations between marijuana use and serious adverse events, including myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis have been described. In conclusion, the potential for increased use of marijuana in the changing legal landscape suggests the need for the community to intensify research regarding the safety of marijuana use and for cardiologists to maintain an awareness of the potential for adverse effects.
The current study examined youth perceptions of appeal and harm of cigarette packaging with "natural" tobacco descriptors and references to filtration, as well as contraband tobacco in generic packaging.
In a between-group experiment, 7,647 youth were randomized to view a pair of cigarette packages and rate perceptions of appeal and relative risk.
The findings indicate that packages with "natural" descriptors were rated as significantly more appealing and less harmful. Packages with filter references were rated as significantly less harmful, whereas contraband cigarettes were rated as significantly less appealing than leading brands.
The findings suggest that cigarette packaging can enhance the appeal of cigarettes and may promote false beliefs about the reduced harm of brands. The lower appeal of contraband cigarettes suggests that other factors, such as reduced price and ease of access, likely account for contraband use among youth.
Cannabis (marijuana) smoke and tobacco smoke contain many of the same potent carcinogens, but a critical-yet unresolved-medical and public-health issue is whether cannabis smoking might facilitate the development of lung cancer. The current study aimed to assess the risk of lung cancer among young marijuana users.
A population-based cohort study examined men (n = 49,321) aged 18-20 years old assessed for cannabis use and other relevant variables during military conscription in Sweden in 1969-1970. Participants were tracked until 2009 for incident lung cancer outcomes in nationwide linked medical registries. Cox regression modeling assessed relationships between cannabis smoking, measured at conscription, and the hazard of subsequently receiving a lung cancer diagnosis.
At the baseline conscription assessment, 10.5 % (n = 5,156) reported lifetime use of marijuana and 1.7 % (n = 831) indicated lifetime use of more than 50 times, designated as "heavy" use. Cox regression analyses (n = 44,284) found that such "heavy" cannabis smoking was significantly associated with more than a twofold risk (hazard ratio 2.12, 95 % CI 1.08-4.14) of developing lung cancer over the 40-year follow-up period, even after statistical adjustment for baseline tobacco use, alcohol use, respiratory conditions, and socioeconomic status.
Our primary finding provides initial longitudinal evidence that cannabis use might elevate the risk of lung cancer. In light of the widespread use of marijuana, especially among adolescents and young adults, our study provides important data for informing the risk-benefit calculus of marijuana smoking in medical, public-health, and drug-policy settings.
Objective:
This study assessed the effects of pictorial health warning labels (HWLs) and a linked media campaign in Mexico.
Methods:
Cross-sectional data were collected from a population-based sample of 1756 adult smokers, aged 18-55 years, during the initial implementation of pictorial HWLs, which some smokers had seen on cigarette packages while others had seen only the text-based HWLs. Exposure to the campaign and pictorial HWLs was assessed with aided recall methods, and other questions addressed attention and cognitive impact of HWLs, knowledge related to HWL and campaign content, and quit-related thoughts and behaviours. Logistic and linear regression models were estimated to determine associations between key outcomes and intervention exposure.
Results:
In bivariate and multivariate adjusted models, recall of pictorial HWLs and of the campaign were positively associated with greater attention to and cognitive impact of HWLs, whereas only pictorial HWL exposure was associated with having refrained from smoking due to HWLs. Both recall of pictorial HWLs and of the campaign were independently associated with greater knowledge of secondhand smoke harms and toxic tobacco constituents. Smokers who recalled only the pictorial HWLs were more likely to try to quit than smokers who recalled neither the pictorial HWLs nor the campaign (17% vs 6%, p<0.001).
Conclusions:
Consistent with other studies, adult smokers' exposure to new pictorial HWLs in Mexico was associated with psychosocial and behavioural responses related to quit behaviour. Exposure to the complementary media campaign was associated with independent additive effects on campaign-related knowledge, and it enhanced psychosocial responses to pictorial HWLs.
Introduction and Aims. Perceived risks of cannabis use have rarely been researched in Australia. This paper reports on the beliefs about the adverse effects of cannabis use on health, social well-being, driving, mental health and changes in cannabis over time.
Design and Methods. Survey of 918 Australian adults was conducted as part of a quarterly omnibus self-report survey of an established panel.
Results. Respondents believed that cannabis use can cause health and social problems, can adversely affect a person's ability to drive a car, can be addictive, and can lead to use of other illicit drugs. They were uncertain as to whether cannabis can cause schizophrenia and depression, and whether cannabis had become more potent over time.
Implications. Prevention efforts should focus on educating the Australian people about the nature of cannabis-related harms.[Calabria B, Swift W, Slade T, Hall W, Copeland J. The perceived health risks of cannabis use in an Australian household survey. Drug Alcohol Rev 2012;31:809–812]
A growing literature has documented the substantial prevalence of and putative mechanisms underlying co-occurring (i.e. concurrent or simultaneous) cannabis and tobacco use. Greater understanding of the clinical correlates of co-occurring cannabis and tobacco use may suggest how intervention strategies may be refined to improve cessation outcomes and decrease the public health burden associated with cannabis and tobacco use.
A systematic review of the literature on clinical diagnoses, psychosocial problems and outcomes associated with co-occurring cannabis and tobacco use. Twenty-eight studies compared clinical correlates in co-occurring cannabis and tobacco users versus cannabis- or tobacco-only users. These included studies of treatment-seekers in clinical trials and non-treatment-seekers in cross-sectional or longitudinal epidemiological or non-population-based surveys.
Sixteen studies examined clinical diagnoses, four studies examined psychosocial problems and 11 studies examined cessation outcomes in co-occurring cannabis and tobacco users (several studies examined multiple clinical correlates). Relative to cannabis use only, co-occurring cannabis and tobacco use was associated with a greater likelihood of cannabis use disorders, more psychosocial problems and poorer cannabis cessation outcomes. Relative to tobacco use only, co-occurring use did not appear to be associated consistently with a greater likelihood of tobacco use disorders, more psychosocial problems or poorer tobacco cessation outcomes.
Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems and have poorer cessation outcomes than those who use cannabis but not tobacco. The converse does not appear to be the case.
Data from the Tucson epidemiological study of airways obstructive disease on smoking of non-tobacco cigarettes such as marijuana were analysed to determine the effect of such smoking on respiratory symptoms and pulmonary function. Among adults aged under 40, 14% had smoked non-tobacco cigarettes at some time and 9% were current users. The prevalence of respiratory symptoms was increased in smokers of non-tobacco cigarettes. After tobacco smoking had been controlled for men who smoked non-tobacco cigarettes showed significant decreases in expiratory flow rates at low lung volumes and in the ratio of the forced expiratory volume in one second to the vital capacity. This effect on pulmonary function in male non-tobacco cigarette smokers was greater than the effect of tobacco cigarette smoking. These data suggest that non-tobacco cigarette smoking may be an important risk factor in young adults with respiratory symptoms or evidence of airways obstruction.
Cannabis is the most widely used illicit drug in many developed societies. Its health and psychological effects are not well understood and remain the subject of much debate, with opinions on its risks polarised along the lines of proponents' views on what its legal status should be. An unfortunate consequence of this polarisation of opinion has been the absence of any consensus on what health information the medical profession should give to patients who are users or potential users of cannabis. There is conflicting evidence about many of the effects of cannabis use, so we summarise the evidence on the most probable adverse health and psychological consequences of acute and chronic use. This uncertainty, however, should not prevent medical practitioners from advising patients about the most likely ill-effects of their cannabis use. Here we make some suggestions about the advice doctors can give to patients who use, or are contemplating the use, of this drug.
Marijuana is one of the most widely used recreational substances in the world, considered by many consumers as a relatively safe drug with few significant side-effects. We report the case of a 21-year-old man who suffered an acute myocardial infarction following the use of marijuana, despite having no other identifiable risk factors for an acute cardiovascular event. We review the published medical literature regarding acute cardiovascular events following marijuana use and postulate a possible mechanism for this unusual pathological consequence of marijuana use.
A quota sample of 3272 people from the Australian population was surveyed by telephone about the health risks of marijuana use. Three-fifths of the sample (62%) believed that there were health problems caused by marijuana use and one in four (27%) were uncertain. The most commonly cited health effects were: lung cancer, mental problems, memory loss and respiratory disease. The health risks of marijuana use were perceived to increase with increasing frequency of use, and to be greater when the user was a teenager rather than an adult. The perceived health risks of marijuana increased with age, were higher among women than men, decreased with increasing education and frequency and quantity of alcohol and were substantially lower among those who had used marijuana, and those who knew someone who had used marijuana.
To examine how the US tobacco industry markets cigarettes as "natural" and American smokers' views of the "naturalness" (or unnaturalness) of cigarettes.
Internal tobacco industry documents, the Pollay 20th Century Tobacco Ad Collection, and newspaper sources were reviewed, themes and strategies were categorised, and the findings were summarised.
Cigarette advertisements have used the term "natural" since at least 1910, but it was not until the 1950s that "natural" referred to a core element of brand identity, used to describe specific product attributes (filter, menthol, tobacco leaf). The term "additive-free", introduced in the 1980s, is now commonly used to define natural cigarettes. Tobacco company market research, available from 1970 to 1998, consistently revealed that within focus group sessions, smokers initially had difficulty interpreting the term "natural" in relation to cigarettes; however, after discussion of cigarette ingredients, smokers viewed "natural" cigarettes as healthier. Tobacco companies regarded the implied health benefits of natural cigarettes as their key selling point, but hesitated to market them because doing so might raise doubts about the composition of their highly profitable "regular" brands.
Although our findings support the idea advanced by some tobacco control advocates that informing smokers of conventional cigarettes' chemical ingredients could promote cessation, they also suggest that such a measure could increase the ubiquity and popularity of "natural" cigarettes. A more effective approach may be to "denaturalise" smoking.
Marijuana legislation coming to Canada next spring
- Smithj
Smith J. Marijuana legislation coming to Canada next spring.
20 April 2016. Available at: https://www.thestar.com/news/
canada/2016/04/20/marijuana-legislation-coming-to-canadanext-spring.html (accessed 20 June 2016) (Archived at http://
www.webcitation.org/6qPYSNlv5 on 12 May 2017).
- Hall
US Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion
United States Department of Health and Human Services. The
Health Consequences of Smoking-50 Years of Progress: A Report
of the Surgeon General. Atlanta, GA: US Department of Health
and Human Services, Center for Disease Control and
Prevention, National Center for Chronic Disease Prevention
and Health Promotion, Office of Smoking and Health; 2014.
What are Reduced Risk Products (RRPs)
- Philip Morris International
Philip Morris International. What are Reduced Risk Products
(RRPs). 2016. Available at: https://www.pmiscience.com/
welcome/what-are-reduced-risk-products-rrps-ref-1 (accessed
20 June 2016) (Archived at http://www.webcitation.org/
6qPZIs2Td on 12 May 2017).
on organic production and labelling of organic products and repealing Regulation (EEC) No. 2092/91. Off J Eur Union
Council Regulation (EC) No. 834/2007 of 28 June 2007
on organic production and labelling of organic products
and repealing Regulation (EEC) No. 2092/91. Off J Eur
Union 2007.
Council Regulation (EC) No. 834
- J Off
- Eur