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

In a new study at Columbia University Mailman School of Public Health, findings show that increased cigarette use is one possibility. While cigarette use has been declining for decades in the U.S., the study finds that adults who use cannabis daily do not perceive smoking a pack a day as being as harmful as those who do not use cannabis in the U.S. The findings are published in the journal Nicotine & Tobacco Research.

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

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

“Tobacco control has done a tremendous job in public education on the physical health risks associated with tobacco use, and cigarette smoking in particular, over the past several decades,” noted Goodwin. Her prior work shows that cigarette use, however, is much more common among those who use cannabis and that cannabis legalization may contribute to observed increases in cannabis use and cannabis-cigarette co-use among adults. “We wondered why that might be. Our findings suggest that diminished risk perception of pack a day cigarette use might be one contributing factor.”

At a recent Suffolk County Legislature Public Hearing on Introductory Resolution 1417 A Local law to Regulate the Packaging of Cannabis (Marijuana) Products to Dissuade its Appeal to Children, Goodwin discussed her work and, in particular, that of Canadian colleagues. The resolution, proposed by Legislator Kara Hahn, aims to ban cannabis packaging that appeals to children in Suffolk County, New York (NY01). Findings from Canada, which made cannabis legal federally show increases in adult cannabis use but as of the most recent study in 2022, no significant increases in cannabis use among adolescents. “Data from Canada suggests that plain packaging is one measure that can maximize the safe and effective rollout of cannabis legalization that ensures and protects the health, safety and well-being of all members of our community,” Goodwin said.

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