German Teens Who Smoke and Vape Perceive Cannabis as Least Harmful and Most Intend to Use It
Among 8,521 German adolescents, dual users of cigarettes and e-cigarettes perceived cannabis as least harmful and had the highest intention to try it, while never-tobacco-users perceived the most risk and had the lowest intentions.
Quick Facts
What This Study Found
Among never-cannabis-users, dual cigarette/e-cigarette users perceived cannabis as least harmful and had the highest intention to use. Combustible-only users ranked next, followed by e-cigarette-only users. Never-tobacco-users perceived cannabis as most harmful and had the lowest use intentions. Lower risk perception was associated with higher intention to use cannabis.
Key Numbers
8,521 adolescents; mean age 14.0; 5.8% current cannabis use; 17.0% current tobacco/e-cigarette use; dual users had highest cannabis intentions; never-users had lowest.
How They Did This
Cross-sectional survey of 8,521 German adolescents (mean age 14.0, 50.6% female) collected autumn 2021-spring 2022. Linear regression models predicting risk perception and cannabis use intention by tobacco/e-cigarette use status among never-cannabis-users.
Why This Research Matters
Understanding the gateway pattern from tobacco products to cannabis helps target prevention. The risk perception gradient across tobacco use types suggests that interventions should address both substance-specific risk perceptions and broader substance use attitudes.
The Bigger Picture
The finding that e-cigarette-only users fell between dual users and never-users in cannabis risk perception suggests vaping alone modestly shifts attitudes toward cannabis, but combined with smoking, the effect is stronger.
What This Study Doesn't Tell Us
Cross-sectional design cannot establish whether tobacco use causes changes in cannabis risk perception. German-specific context with stricter cannabis laws at time of study. Self-reported data subject to social desirability bias.
Questions This Raises
- ?Does cannabis legalization in Germany (2024) change these risk perception patterns?
- ?Would targeted risk communication for tobacco-using teens reduce cannabis initiation?
Trust & Context
- Key Stat:
- Dual tobacco/vape users had highest cannabis use intentions
- Evidence Grade:
- Large school-based survey with clear gradient across tobacco use groups, limited by cross-sectional design.
- Study Age:
- 2025 publication with 2021-2022 data
- Original Title:
- Association of cigarette and e-cigarette use with cannabis-related risk perceptions and intentions.
- Published In:
- Journal of cannabis research, 7(1), 31 (2025)
- Authors:
- Kleine, Ronja, Isensee, Barbara, Nees, Frauke(14), Hanewinkel, Reiner
- Database ID:
- RTHC-06844
Evidence Hierarchy
Frequently Asked Questions
Are teens who vape more likely to try cannabis?
In this German study, e-cigarette users perceived cannabis as less risky and had higher intentions to use it than never-tobacco-users. But dual users (cigarettes plus e-cigarettes) had the highest cannabis intentions of all groups.
Does risk perception affect teen cannabis use?
Yes. Among German teens who had never used cannabis, perceiving it as less harmful was significantly associated with higher intention to use it. This suggests risk perception is a protective factor worth targeting in prevention programs.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06844APA
Kleine, Ronja; Isensee, Barbara; Nees, Frauke; Hanewinkel, Reiner. (2025). Association of cigarette and e-cigarette use with cannabis-related risk perceptions and intentions.. Journal of cannabis research, 7(1), 31. https://doi.org/10.1186/s42238-025-00288-6
MLA
Kleine, Ronja, et al. "Association of cigarette and e-cigarette use with cannabis-related risk perceptions and intentions.." Journal of cannabis research, 2025. https://doi.org/10.1186/s42238-025-00288-6
RethinkTHC
RethinkTHC Research Database. "Association of cigarette and e-cigarette use with cannabis-r..." RTHC-06844. Retrieved from https://rethinkthc.com/research/kleine-2025-association-of-cigarette-and
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.