# Association of cigarette and e-cigarette use with cannabis-related risk perceptions and intentions

## TL;DR

Adolescents who use cigarettes or e-cigarettes are more likely to perceive cannabis as less harmful and intend to use it, suggesting a link between tobacco use and cannabis initiation.

## Contribution

The study identifies dual (e-)cigarette users as the highest-risk group for cannabis use initiation among German adolescents.

## Key findings

- Dual users of combustible and e-cigarettes perceived cannabis as least harmful and had the highest intention to use it.
- Never users of (e-)cigarettes perceived cannabis as most harmful and had the lowest intention to use it.
- Perceiving cannabis as harmful is a protective factor against cannabis use intentions in adolescents.

## Abstract

This study examines the associations of current use of combustible cigarettes or e-cigarettes with perceived risk of cannabis use and intention to use cannabis within the next year.

Data from 8,521 German adolescents were collected between autumn 2021 and spring 2022. Former but not current users of cannabis or (e-)cigarettes were excluded from analyses. Mean age was 14.0 years, and 50.6% of the sample were female. Current cannabis use was reported by 5.8%, current use of combustible and/or e-cigarettes by 17.0%. We conducted linear regression models predicting 1) risk perception by (e-)cigarette use, and 2) intention to use cannabis by (e-)cigarette use and risk perception, among never cannabis users.

Use of cannabis and (e-)cigarettes were strongly associated. Perceiving cannabis as less harmful was associated with a higher intention to use cannabis. Among never cannabis users, dual users of combustible and e-cigarettes perceived cannabis as least harmful and had the highest intention to use cannabis, followed by combustible cigarette-only users, and then e-cigarette-only users. Never combustible nor e-cigarette users perceived cannabis as most harmful and had the lowest intention to use cannabis.

Perception of cannabis as harmful might be a protective factor for intentions to use cannabis among German adolescents. Prevention programs should consider that adolescent combustible and e-cigarette users are a high-risk group for initiation of cannabis use.

The online version contains supplementary material available at 10.1186/s42238-025-00288-6.