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.
Youth prevention program designers, school health educators, tobacco cessation specialists
Dual tobacco/vape users had highest cannabis use intentions
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Large school-based survey with clear gradient across tobacco use groups, limited by cross-sectional design.
When this study was published
2025 publication with 2021-2022 data
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.
Questions still open
- Does cannabis legalization in Germany (2024) change these risk perception patterns?
- Would targeted risk communication for tobacco-using teens reduce cannabis initiation?
Common questions
Are teens who vape more likely to try cannabis?
Does risk perception affect teen cannabis use?
Read the original research
Association of cigarette and e-cigarette use with cannabis-related risk perceptions and intentions.
Journal of cannabis research, 7(1), 31
Citation
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
Explore the wider topic
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